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Multibacillary nerve histology in clinically diagnosed borderline tuberculoid leprosy patients.  

Science.gov (United States)

The classification of leprosy into multibacillary (MB) and paucibacillary (PB) patients in almost all clinics is entirely dependent on clinical examination. In a study of 21 patients clinically classified as borderline tuberculoid (BT) and, therefore, belonging to the PB group, skin smears and skin and nerve biopsies were examined. Four patients did not have any histopathological evidence of leprosy. Skin smears showed that 1 patient was positive for acid-fast bacilli (AFB), 2 skin biopsies belonged to the borderline lepromatous (BL) category and showed AFB in their lesions, and AFB were present in 10 nerve biopsies classified as BL. It is possible that reported relapses among PB patients may be in those patients with demonstrable AFB in the lesions, including nerves. A careful follow-up study of this particular group of patients after PB multidrug therapy is suggested to resolve this question. PMID:8862266

Ebenezer, G J; Suneetha, S; Mohandas, R; Arunthathi, S

1996-09-01

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Clinical prognosis of patients with diagnosed chronic solvent intoxication  

Energy Technology Data Exchange (ETDEWEB)

The clinical symptoms and signs of 80 patients with chronic organic solvent intoxication were evaluated after 3-9 years (mean 5.8 years) of follow-up. Thirty-one of the patients had slight clinical neurological signs at the time of diagnosis while the rest of the patients had only neurophysiological or psychological disturbances. The most common subjective symptoms were headache, tiredness and memory disturbances. Of the clinical signs, disturbances occurred frequently in cerebellar functions, gait and station and fine motorics. In addition, psycho-organic alteration and neurasthenic signs were often found. After the follow-up clinical signs of impairment in the nervous system were present in 42 cases. At the group level, the subjective symptoms decreased during the follow-up but the objective clinical signs increased and worsened. Only the prognosis of disturbances in gait and station correlated with the duration and intensity of exposure. The present results emphasize the great difficulties arising in occupational neurology regarding chronic organic solvent intoxications. No clear-cut clinical picture exists and reliable estimation of prognosis in general cannot be made on the basis of the present knowledge.

Juntunen, J.; Antti-Poika, M.; Tola, S.; Partanen, T.

1982-05-01

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Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography.  

UK PubMed Central (United Kingdom)

Pneumonia is often diagnosed and treated empirically, but the accuracy of clinical assessment alone is largely unknown. We therefore set out to determine the diagnostic accuracy of clinical judgment based on signs and symptoms to detect radiographic pneumonia in patients presenting with acute cough in primary care.In 2810 patients consulting with acute cough in 12 European countries, general practitioners (GPs) recorded whether they considered pneumonia present ("yes" or "no") immediately after the history and physical examination. Chest radiography was performed within one week by local radiologists blind to other patient characteristics.140 patients had radiographic pneumonia (5%), of whom 41 (29%) had been diagnosed as such by the GP. GPs diagnosed pneumonia in 31 (1%) patients on clinical grounds who turned out not to have radiographic pneumonia (n=2670). In patients diagnosed with pneumonia by GPs on clinical grounds alone, 57% were subsequently diagnosed with radiographic pneumonia (positive predictive value, PPV). Negative predictive value (NPV), sensitivity and specificity of GPs' clinical judgment were 96%, 29% and 99% respectively. Patients with radiographic pneumonia, but who had not been diagnosed empirically by GPs, presented with less severe symptoms compared to patients with a clinical diagnosis of pneumonia (p<0.05).The predictive values of GPs' clinical judgment, particularly the high NPV's, are helpful in routine care. Nonetheless, the majority of diagnoses of radiographic pneumonias was not suspected on clinical grounds. There is a need to further support the detection of clinically relevant pneumonia in primary care.

Vugt SF; Verheij T; Jong PD; Butler C; Hood K; Coenen S; Goossens H; Little P; Broekhuizen B

2013-01-01

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Determinants of sexual dysfunction among clinically diagnosed diabetic patients  

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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.

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

2011-01-01

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

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Full Text Available 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 predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted ?-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 predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, ? = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, ? = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, ? = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, ? = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

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

2008-01-01

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

DEFF Research Database (Denmark)

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 predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical 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 predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, K = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, K = 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 affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters Udgivelsesdato: 2008

Jakobsen, K.D.; Hansen, T.

2008-01-01

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Coronary artery disease in patients clinically diagnosed with myocardial infarction in the medical intensive care unit.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study is to compare the clinical characteristics and outcomes of patients with and without coronary artery disease (CAD) confirmed by coronary angiography in critically ill patients clinically diagnosed with myocardial infarction. MATERIALS AND METHODS: This retrospective observational study involved 56 patients who were clinically diagnosed with myocardial infarction and subsequently underwent coronary angiography during their intensive care unit stay. RESULTS: Only 18 patients (32%) were finally confirmed to have CAD by coronary angiography. There were no significant differences in laboratory findings and clinical outcomes between patients with and without CAD. However, patients who developed shock (P = .009) and needed vasopressor support (P = .021) were less likely to be diagnosed with CAD. In addition, regional wall motion abnormality on echocardiography was more frequently observed in patients with CAD (P = .072). In a multiple logistic regression analysis, male sex (adjusted odds ratio [OR], 5.093; 95% confidence interval [CI], 1.177-22.037) and focal hypokinesia on echocardiography (adjusted OR, 5.134; 95% CI, 1.071-24.614) were independently associated with CAD. However, development of shock was inversely associated with CAD (adjusted OR, 0.107; 95% CI, 0.019-0.606). CONCLUSION: Coronary angiography in critically ill patients should only be performed in highly selected patients with predicting factors for CAD.

Ko Y; Park CM; Kim W; Jeong BH; Suh GY; Lim SY; Kwon OJ; Jeon K

2013-08-01

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Clinical correlates of apathy in patients recently diagnosed with Parkinson's disease: the ANIMO study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Little is known about apathy in the early stages of Parkinson's disease (PD). We determined the clinical correlates of apathy in a large representative sample of patients recently diagnosed with PD (ANIMO study). METHODS: PD patients, diagnosed within 2 years of inclusion, were recruited in 102 outpatient clinics situated in 82 populations throughout Spain. Apathy was quantified using the Lille Apathy Rating Scale (LARS). Clinical comparisons and correlations were performed using nonparametric tests. Regression analyses were used to test the association of clinical variables with apathy. RESULTS: We recruited 557 PD patients (60.3% men) with a mean age of 68.8 ± 9.7 years, and UPDRS motor score of 21.1 ± 10.8. Apathy only was diagnosed in 186 (33.4%), and apathy and depression in 215 patients (38.6%). Patients with higher comorbidity (OR = 1.10, 95% CI 1.01-1.20, p = 0.001), motor impairment (OR = 1.07, 95% CI 1.03-1.10, p < 0.0001), and lower education (OR = 2.16, 95% CI 1.21-3.85, p = 0.009) had higher odds of having apathy, in contrast to patients living in a rural environment (OR = 0.35, 95% CI 0.32-0.85, p = 0.01), and left predominant PD motor laterality (OR = 0.34, 95% CI 0.13-0.88, p = 0.01). LARS scores were significantly correlated with UPDRS motor scores (r(s) = 0.44, p < 0.001), predominantly with axial score (r(s) = 0.43, p < 0.001). CONCLUSIONS: In PD, apathy is a very common and disabling nonmotor symptom separable from depression. Patients living in a rural environment, with lower comorbidity and motor impairment, higher education background, and left predominant PD motor laterality are at lower risk of suffering from apathy.

Cubo E; Benito-León J; Coronell C; Armesto D

2012-01-01

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Predictors of survival in a series of clinically diagnosed progressive supranuclear palsy patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Investigations into prognostic factors in progressive supranuclear palsy have shown conflicting results. We performed a retrospective study in order to identify clinical predictors of survival in clinically diagnosed progressive supranuclear palsy patients referred to our centre. METHODS: Data on medical history, survival and five clinical disability milestones (inability to walk unassisted, unintelligible speech, severe dysphagia, dementia and institutionalization) were collected from outpatients' medical records and by a telephone interview to caregivers. Patients were subdivided into Richardson's syndrome and PSP-Parkinsonism according to symptoms during the first 2 years of disease. Survival was analyzed by the Kaplan-Meier method and Cox regression analysis. RESULTS: Forty-three consecutive patients were enrolled (86% Richardson's syndrome). Motor disturbances were the most frequent symptoms of onset. During the follow-up, 60.5% of patients died after a median survival of 7.1 years (2.2-18). Older age at onset (>63) (HR 2.8; 95% CI: 1.3-5.7; p = 0.007), early dysphagia (HR 2.3; 95% CI: 1-5.3; p = 0.05) and early cognitive deficits (HR 3.6; 95% CI: 1.6-8.2; p = 0.002) were predictors of shorter survival. Compared to PSP-Parkinsonism patients, Richardson's syndrome patients had shorter survival and higher mortality risk although not statistically significant (HR 3 95% CI: 0.9-9.9; p = 0.07). Seventy-seven percent of patients developed severe disability during follow-up: shorter time to the first clinical disability milestone predicted shorter survival (HR 7.8; 95% CI: 2.3-26; p = 0.0008). Conclusions: early dysphagia, cognitive impairment, older age at onset, and time to disability were predictors of shorter survival; Richardson's syndrome had a less favorable course than PSP-Parkinsonism. Clinical milestones should be considered as possible endpoints in future clinical trials.

Dell'aquila C; Zoccolella S; Cardinali V; de Mari M; Iliceto G; Tartaglione B; Lamberti P; Logroscino G

2013-08-01

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Clinical and demographical characteristics of patients diagnosed with conversion disorder in an emergency department  

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Full Text Available Objectives: Conversion reactions are the one of the common disorders in emergency departments (ED) in Turkey. Patients were diagnosed with conversion disorder according to their history and their physical and neurological examination by clinicians. Materials and Methods: Data was obtained by retrospective inspection of a state and university hospitals emergency records for one year. The age, sex, clinical and demographical characteristics and arrival time in the ED were investigated. Results: Total of 469 patients were diagnosed as conversion reaction at the two hospital’s ED in a year period. Sixty-one cases were male (13.0%) and 408 of the cases were female (87.0%). Mean age of the cases was 29.2±10.8. The number of conversion reactions was lower in spring (p=0.0001) and there was statistically significant increase in Sundays (p=0.0001). Religious holidays also had low rates of admission (0.4%, n=2). The figures peaked at 22:00-24:00. Conclusion: Emergency setting is where the clinician first encounter patients with conversion disorder. Patterns of presentations generally fluctuate depending on hours of the day and social events. Psychological side of these patients is often neglected and suggesting the patients to obtain psychiatric help will prevent further emergency admissions.

Mustafa SER?NKEN; Cem SENGÜL; Özgür KARCIOGLU; ?smail PAKSOY; Mehmet ZENC?R

2007-01-01

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Clinical characteristics of patients diagnosed with aortic dissection in the emergency department: a case series  

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Full Text Available Objectives: Aortic dissection (AD) is an emergency condition with high mortality rates. Classically, patients present with sudden onset of severe, ripping or tearing pain in the chest and back, although `atypical` presentations also exist. The objective of this study is to evaluate characteristics of the history and physicalexamination of patients diagnosed with aortic dissection in the emergency department (ED) and to highlight differences from signs and symptoms defined as `classical`. Materials and Methods: Computer records were quried for patients admitted to the ED and eventually diagnosed with AD in a fifty-four month period. Demographic variables, chief complaints, pain characteristics, risk factors for AD, vital signs, findings on examination, laboratory results including ECG, cardiac markers, chest X-ray, and computed tomography (CT) were obtained retrospectively from ED charts and recorded on data sheets. Stanford classification of the AD and how the diagnosis was established were also noted. Results: Forty seven cases (32 males (68,1%); 15 females (31.9%) mean age 66; range 25 to 87 years) were identified. Pain was described by 38 patients (80.9%). The most common presenting complaints were back pain (40,7%, n=19), chest pain (36,2%, n=17), abdominal pain (25,5%, n=12), syncope (19,1%, n=9), and shortness of breath (17%, n=8). Pulse deficit was recorded in 12 (25,5%), discrepancy in blood pressure readings between left and right arms in eight (17%, n=8), cardiac murmur in 40,4% (n=19), altered mental status in 14,9% (n=7) and neurologic deficit in 12,8% (n=6) patients. Tearing chest pain was recorded in only 8 patients (21,1%). Contrast-enhanced CT was the diagnostic modality in 42 (89,4%) cases and 31 patients (65%) had a widened mediastinnum recorded in ED the interpretation of the chest X-ray. Thirty-two (68,1%) patients were diagnosed to have AD with Stanford A classification, while the remaining 15 (31,9%) had Stanford B AD. Conclusion: Symptoms and signs of AD in the ED may be substantially different from what is `classically` expected. Only a minority of the patients reported sudden onset tearing pain in their chest and back. Pulse deficit, carotid or abdominal bruits, cardiac murmurs, blood pressure discrepancies are valuable albeit uncommon findings on examination. Further studies are required to define population-based clinical presentation of AD.

Murat YE??LARAS; Nesibe SÖNMEZ; Özgür KARCIO?LU; Hakan TOPAÇO?LU; Süveyda AKSAKALLI; Ba?ak BAYRAM

2006-01-01

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Assessment of Patients with Pulmonary Thromboembolism (PTE) Diagnosed in Our Clinic: 5 Years Experience  

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Full Text Available Objective: Pulmonary Thromboembolism is a life threatening disease. The aim of this study was to define PTE risk factors, clinical characteristics, severity, treatment modalities and responses (mortality, recurrence rates) and incidence of PTE in our hospital.Material and Method: We retrospectively analyzed data from 164 patients diagnosed as PTE in our clinic between 2000 to 2005. Results: The incidence of PTE was 20.3/100.000. 44.5% patients were male and 55.5% were female. There were no risk factors for PTE in 25.6% of the patients. Risk factors were; immobilization (29.9%), surgery (28.6%), malignancy (13.4%), heart failure (16.5%), cerebrovascular disease (15.2%), trauma (9.2%), previous VTE event (6.1%). Most of the embolies (70.7%) were localized in the pulmonary arteries of both lungs. One-sided embolies showed a preponderance in the right lung (60.5%). Sixteen point five percent of patients had massive PTE, 21.3% had submassive PTE and 62.2% had nonmassive PTE. The rate of use of unfractionated heparin for PTE treatment was 68.3%, low moleculer weight heparin 43.3%, warfarin 84.8%, and thrombolytic 9.8%. The mortality rate was 11% and recurrence rate was 14.6%. Conclusion: Frequent occurrence of PTE in immobile patients and in post operative patients in our study emphasizes the importance of preventive treatment modalities for PTE. Especially GIS malignities were found as risk factors for PTE. Because of the high frequency of idiopathic PTE, hereditary risk factors should be investigated. PTE are localized mostly in the pulmonary arteries of both lungs.

Abdullah ?im?ek; Özlem Türkkan; Kevser Melek; Füsun Öner Eyübo?lu

2010-01-01

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

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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.

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

2005-01-01

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Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. METHOD: We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. RESULTS: During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. CONCLUSIONS: Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation.

Hylwa SA; Foster AA; Bury JE; Davis MD; Pittelkow MR; Bostwick JM

2012-05-01

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Patients' and partners' illness perceptions in screen-detected versus clinically diagnosed type 2 diabetes: partners matter!  

UK PubMed Central (United Kingdom)

BACKGROUND: In type 2 diabetes, educational interventions that target differences between patients' and partners' illness perceptions have been advocated. OBJECTIVE: To investigate how the route to diagnosis of type 2 diabetes (through screening versus clinical symptoms) affects illness perceptions of patients and their partners. METHODS: In a cross-sectional study, we enrolled patients aged 40-75 years from general practices in the Netherlands with a new diagnosis of type 2 diabetes (?3 years), detected by either screening (n = 77) or clinical symptoms (n = 32). Patients and their partners each completed a postal Brief Illness Perception Questionnaire (Brief IPQ), and up-to-date clinical data were obtained from their GP. The Brief IPQ scores of the screening and clinical diagnosis groups were compared for both patients and partners, and multiple variable linear regression models with Brief IPQ scores as outcomes were developed. RESULTS: The route to diagnosis did not appear to have a strong influence on patients' illness perceptions but did influence illness perceptions of their partners. Partners of patients diagnosed through screening perceived greater consequences for their own life, had a stronger feeling that their patient-partners had control over their diabetes, were more concerned about their partners' diabetes, and believed that their patient-partners experienced more diabetes symptoms, compared with partners of patients who were diagnosed through clinical symptoms. CONCLUSIONS: The route to diagnosis of type 2 diabetes has a greater impact on the illness perceptions of partners than that of patients. Professionals in diabetes education and treatment should consider these differences in their approach to patient care.

Klein Woolthuis EP; de Grauw WJ; Cardol M; van Weel C; Metsemakers JF; Biermans MC

2013-08-01

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

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Full Text Available Abstract 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 diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure. Two senior cardiology fellows retrospectively determined the patient's heart failure status during their acute ED presentation. The Mann-Whitney u-test for two groups, the Kruskall-Wallis test for multiple groups, or Chi-square tests, were used as appropriate. Results There were 173 (39.4%) patients with a criterion standard diagnosis of decompensated heart failure. Among those with this criterion standard diagnosis of decompensated heart failure, discordant patients without an ED diagnosis of decompensated heart failure (n = 58) were more likely to have a history of COPD (p = 0.017), less likely to have a previous history of heart failure (p = 0.014), and less likely to have an elevated b-type natriuretic peptide (BNP) level (median 518 vs 764 pg/ml; p = 0.038) than those who were given a concordant ED diagnosis of decompensated heart failure. BNP levels were higher in those with a criterion standard diagnosis of decompensated heart failure than in those without a criterion standard diagnosis (median 657 vs 62.7 pg/ml). However, 34.6% of patients with decompensated heart failure had BNP levels in the normal ( Conclusion We found the ED diagnoses of decompensated heart failure to be discordant with the criterion standard in 14.3% of patients, the vast majority of which were due to a failure to diagnose heart failure when it was present. Patients with a previous history of COPD, without a previous history of heart failure and with lower BNP levels were more likely to have an ED misdiagnosis of non-decompensated heart failure. Readily available, accurate, objective ED tests are needed to improve the early diagnosis of decompensated heart failure in ED patients.

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

2006-01-01

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Clinical and radiological parameters of patients with lung thromboembolism, diagnosed by high probability ventilation / perfusion scintigraphies  

International Nuclear Information System (INIS)

Background: pulmonary embolism (PE) remains an elusive diagnosis, and still causes too many unexpected deaths. Because of this, noninvasive investigations are done when pulmonary embolism is suspected. Objective: to determine the clinical and x-rays findings in patients with diagnosis of pulmonary embolism by high probability ventilation/perfusion (V/Q) lung scan. Materials and methods: inpatient medical records of 91 patients with clinical suspected PE and high and low probability V/Q lung scan were analyzed (PIOPED criterion). Results: there were statistics correlation with four clinical findings: hemoptysis (p value=0,02, odds ratio=8,925), taquicardia (p value=0,02 odds ratio=3,5), chest pain (p value=0,01, odds ratio=1,87), and recent surgery (p value=0,02, odds ratio=2,762). The 70,7% chest x-rays were normal (p value

2002-01-01

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Clinical, biochemical, and immunological characteristics of newly diagnosed nonobese diabetic patients aged 18-45 years in China.  

UK PubMed Central (United Kingdom)

BACKGROUND: The purpose was to characterize the clinical, biochemical, and immunological features of newly diagnosed adult-onset nonobese diabetic patients in China. METHODS: Newly diagnosed diabetic patients aged 18-45 years with body mass index<23 kg/m(2) were included. Excluding one mitochondrial diabetes patient, there were 102 diabetic patients enrolled in this study. Clinical and biochemical data were collected and analyzed. Radioimmunoassay was used to detect islet autoantibodies. RESULTS: Among the 102 study participants, 68.6% had type 1 diabetes (T1DM), 20.6% had type 2 diabetes (T2DM), and 10.8% had latent autoimmune diabetes in adults (LADA). About 92% of the T1DM patients presented hyperglycemic symptoms. The corresponding number in T2DM and LADA patients was 13% and 38%, respectively (P<.01). C-peptide in T2DM patients (1.4±0.7 ng/ml) was significantly higher than that in T1DM (0.4±0.3 ng/ml) and LADA (0.4±0.2 ng/ml) patients (P<.01). The prevalence of glutamic acid decarboxylase antibody (GADA) (64.3%) in T1DM patients was higher than that of insulin autoantibody (17.1%) (P<.05). GADA and islet cell antibody (ICA) combination was positive in 75.7% of T1DM patients. CONCLUSION: T1DM patients accounted for majority of the study sample. In addition, the clinical symptoms of T1DM patients were more severe compared with T2DM patients. GADA is the most sensitive autoantibody marker for adult-onset T1DM and LADA. GADA and ICA are the best test combination for adult-onset autoimmune diabetes. Specific types of diabetes should be in mind when diabetes presents itself with special transmission mode or with other extrapancreatic manifestations.

Zhang S; Sun Q; Feng K; Fu Y; Wang O; Ping F; Li Y

2012-01-01

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Correlation between self-reported and clinically based diagnoses of bruxism in temporomandibular disorders patients.  

UK PubMed Central (United Kingdom)

The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self-reported questionnaire-based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One-hundred-fifty-nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism-related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of ? coefficient. The highest correlations were achieved for the sleep grinding referral item (? = 0·932) and for the awake clenching item (? = 0·811), whilst lower correlation values were found for the other items (? values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self-reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep-time activities.

Paesani DA; Lobbezoo F; Gelos C; Guarda-Nardini L; Ahlberg J; Manfredini D

2013-11-01

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Clinical characteristics and computed tomography findings in Arab patients diagnosed with pulmonary sarcoidosis  

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Full Text Available Background and Objective : Sarcoidosis is prevalent worldwide with significant heterogeneity across different ethnic groups. We aimed To describe the clinical characteristics and computed tomography findings among Arab patients with pulmonary sarcoidosis. Methods : A retrospective study of patient demographics, symptoms, co-morbid illness, sarcoidosis stage, treatment, pulmonary function and CT results. Results : Of 104 patients, most (77%) were 40 years of age or older at diagnosis, and females in this category (?40 years ) significantly outnumbered male patients (69/104 (66.3%) vs. 35/104 (33.7%), P=.003). The most common complaints were dyspnea (76%), cough (72.1%) and weight loss (32.7%). The majority of patients displayed impairment in lung function parameters at presentation. However, significant impairment in forced vital capacity, percentage predicted (FVC%) (Conclusion : At presentation, clinical manifestations of sarcoidosis among this sample of Arab patients were similar to reports from other nations. Further studies are needed to explore the effects of race and ethnicity on disease severity in the Middle East.

Alhamad Esam; Alanezi Mohammed; Idrees Majdy; Chaudhry Mohammad; AlShahrani Ali; Isnani Arthur; Shaikh Shaffi

2009-01-01

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

International Nuclear Information System (INIS)

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

2011-01-01

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[Clinical characteristics of patients diagnosed as high cardiac event probability by "Heart Risk View"].  

UK PubMed Central (United Kingdom)

"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 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.

Sakatani T; Ueoka A; Maruyama N; Shimoda Y; Kishita E; Tsubakimoto Y; Matsuo A; Inoue K; Fujita H; Kitamura M; Nishimura T

2011-11-01

23

[Clinical characteristics of patients diagnosed as high cardiac event probability by "Heart Risk View"].  

Science.gov (United States)

"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 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. PMID:22338909

Sakatani, Tomohiko; Ueoka, Akira; Maruyama, Naoki; Shimoda, Yoshiaki; Kishita, Eigo; Tsubakimoto, Yoshinori; Matsuo, Akiko; Inoue, Keiji; Fujita, Hiroshi; Kitamura, Makoto; Nishimura, Tsunehiko

2011-11-01

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

UK PubMed Central (United Kingdom)

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 parameters, drug susceptibility and treatment outcomes were compared between PTB patients with DM and those without DM. To control for age, the patients were stratified into two age groups (< 50 and ? 50 years) and their data were analysed. RESULTS: Of the 227 patients, 37 (16.3%) had DM, of which 26 (70.3%) had been diagnosed with DM prior to PTB diagnosis and 11 (29.7%) had developed DM at PTB diagnosis. After controlling for age, no significant differences were found between the two groups regarding mycobacterium burden, sputum-culture conversion rate, evidence of multidrug-resistant tuberculosis, frequency of adverse drug events from anti-TB medications, treatment outcomes and relapse rate. The presenting symptoms of anorexia (p = 0.050) and haemoptysis (p = 0.036) were observed significantly more frequently in PTB patients with DM, while the presenting symptom of cough was observed significantly more frequently in PTB patients without DM (p = 0.047). CONCLUSIONS: Plasma glucose levels should be monitored in all newly diagnosed PTB patients and a similar treatment regimen should be prescribed to PTB patients with DM and those without DM in high TB-burden countries.

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

2013-06-01

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

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

Hakan Gürkan; Sad?k Altan Özal; Haluk Esgin

2012-01-01

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Effect of meconium ileus on the clinical prognosis of patients with cystic fibrosis diagnosed at younger than 12 months  

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Full Text Available Aim: Meconium ileus (MI) is an early clue to the diagnosis of cystic fibrosis (CF) and it occurs in about 15-20% of CF patients. To determine the possible prognostic factors in patients with cystic fibrosis with and without MI.Material and Method: The sample consisted of 214 patients with CF diagnosed at younger than 12 months admitted to the pediatric pulmonology unit over a period of 18 years between January 1987 to December 2005. 22 patients presented with MI (MI group), 192 patients had non MI (nonMI group). Demographic, clinical, nutritional and laboratory data were obtained. Results: There were 11 female, 11 male patients in MI group, 85 female and 107 male patients in nonMI group. A statistically significant difference was not observed between the groups studied regarding the following variables: BMI, Staphylococcus aureus and Pseudomonas aeruginosa colonisations, mutation types, respiratory functions assesed by FEV1, lung findings. Pseudo-Bartter’s syndrome and progression to bronchiectasis were detected higher in nonMI group statistically. Conclusions: There is no prognostic difference between two groups when these patients are diagnosed early and followed-up by a multidisciplinary action and a collective treatment approach. The results of the present study suggest that meconium ileus is not an indication of a more severe phenotype of cystic fibrosis. (Turk Arch Ped 2010; 45: 105-10)

Sevgi Pekcan; Nural Kiper; Mehmet Köse; Ay?e Tana Aslan; Nazan Çobano?lu; Ebru Yalç?n; Deniz Do?ru; U?ur Özçelik

2010-01-01

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

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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.

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

2009-01-01

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Clinical and genetic predictors of weight gain in patients diagnosed with breast cancer.  

UK PubMed Central (United Kingdom)

Background:Post-diagnosis weight gain in breast cancer patients has been associated with increased cancer recurrence and mortality. Our study was designed to identify risk factors for this weight gain and create a predictive model to identify a high-risk population for targeted interventions.Methods:Chart review was conducted on 459 breast cancer patients from Northwestern Robert H. Lurie Cancer Centre to obtain weights and body mass indices (BMIs) over an 18-month period from diagnosis. We also recorded tumour characteristics, demographics, clinical factors, and treatment regimens. Blood samples were genotyped for 14 single-nucleotide polymorphisms (SNPs) in fat mass and obesity-associated protein (FTO) and adiponectin pathway genes (ADIPOQ and ADIPOR1).Results:In all, 56% of patients had >0.5?kg?m(-2) increase in BMI from diagnosis to 18 months, with average BMI and weight gain of 1.9?kg?m(-2) and 5.1?kg, respectively. Our best predictive model was a primarily SNP-based model incorporating all 14 FTO and adiponectin pathway SNPs studied, their epistatic interactions, and age and BMI at diagnosis, with area under receiver operating characteristic curve of 0.85 for 18-month weight gain.Conclusion:We created a powerful risk prediction model that can identify breast cancer patients at high risk for weight gain.

Reddy SM; Sadim M; Li J; Yi N; Agarwal S; Mantzoros CS; Kaklamani VG

2013-08-01

29

Comparison of PCR and clinical laboratory tests for diagnosing H. pylori infection in pediatric patients  

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Full Text Available Abstract Background Histology and/or culture are generally considered the gold standard for the detection of H. pylori infection. Especially in children, these tests may result in a false negative outcome because of patchy distribution of the organism in the stomach mucosa. We have developed a PCR assay utilizing nested primer pairs directed against a subunit of the H. pylori urease gene (ureA). As part of a prospective evaluation of diagnostic tests to aid in detecting H. pylori infection in children, the aim of this study was to compare our PCR and Western blot assays with results obtained from histologic examination of biopsy specimens, rapid urease tests, and an FDA approved serologic assay and published PCR results to determine if we could validate the assays for diagnostic use on our patient population. Results Gastric biopsy specimens obtained from 101 pediatric patients were evaluated for the presence of H. pylori using histologic techniques, rapid urease (CLOtest) test and the PCR assay. Serum samples from each patient were assayed using both ELISA and Western Blot for antibodies to H. pylori. A total of 32 patients tested were positive by at least one of the methods evaluated. Thirteen patients had positive histology, 13 had a positive CLOtest, and 17 patients had positive H. pylori PCR. Out of the 13 CLO positive patients, 12 were positive by histologic analysis and all 13 were positive by PCR. Results of serologic tests on the same population did not correlate well with other assays. Twenty-eight patients showed serologic evidence of H. pylori infection, of which 9 were both CLO and histology positive and 12 were positive by PCR. Of the seropositive patients, 26 were ELISA positive, 13 were positive by Western blot, and 11 by both serologic methods. Conclusions The results obtained suggest that our nested PCR assay has the specificity and sensitivity necessary for clinical application when compared to standard histologic examination and rapid urease test. In addition, we found the current commercially available approved ELISA method appears unable to accurately detect H. pylori in this population. The Western blot assay yielded better concordance with CLOtest and histology, but not as good as the nested PCR assay.

Vinette Kathleen MB; Gibney Kathleen M; Proujansky Roy; Fawcett Paul T

2004-01-01

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

International Nuclear Information System (INIS)

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

2006-01-01

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Phenotype-genotype analyses of clinically diagnosed Malaysian familial hypercholestrolemic patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Familial hypercholesterolemia and familial defective apo lipoprotein B are genetic disorders caused by defects in the low-density lipoprotein receptor gene and apo lipoprotein B 100 genes, respectively. The clinical phenotype of both diseases is characterized by increased plasma levels of total cholesterol and low density lipoprotein cholesterol, tendinous xanthomata, and premature coronary heart disease. OBJECTIVES: The aim of this study is to perform an association study between different gene sequence variants in low-density lipoprotein and apo lipoprotein B 100 genes to the clinical finding and lipid profile parameters of the study subjects. MATERIAL AND METHODS: A group of 164 familial hypercholesterolemic patients were recruited. The promoter region, exon 2-15 of the low density lipoprotein gene and parts of exon 26 and 29 of apo lipoprotein B 100 gene were screened by Denaturating Gradient High Performance Liquid Chromatography. RESULTS: For the apo lipoprotein B 100 gene, those with apo lipoprotein B 100 gene mutation have a significantly higher frequency of cardiovascular disease (P = 0.045), higher low density lipoprotein cholesterol and total cholesterol: high density lipoprotein cholesterol ratio than those without mutation (P = 0.03 and 0.02, respectively). For the low density lipoprotein gene defect those with frame shift mutation group showed the worst clinical presentation in terms of low density lipoprotein cholesterol level and cardiovascular frequency. CONCLUSIONS: There was a statistically significant association between mutations of low density lipoprotein gene and apo lipoprotein B 100 genes and history of cardiovascular disease, younger age of presentation, family history of hyperlipidemia, tendon xanthoma and low density lipoprotein cholesterol level.

Al-Khateeb A; Al-Talib H; Mohamed MS; Yusof Z; Zilfalil BA

2013-01-01

32

Predictors of mortality of patients newly diagnosed with clinical type 2 diabetes: a 5-year follow up study  

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Full Text Available Abstract Background At diabetes diagnosis major decisions about life-style changes and treatments are made based on characteristics measured shortly after diagnosis. The predictive value for mortality of these early characteristics is widely unknown. We examined the predictive value of patient characteristics measured shortly after diabetes diagnosis for 5-year all-cause and cardiovascular mortality with special reference to self-rated general health. Methods Data were from a population-based sample of 1,323 persons newly diagnosed with clinical diabetes and aged 40 years or over. Possible predictors of mortality were investigated in Cox regression models. Results Multivariately patients who rated their health less than excellent experienced increased all-cause and cardiovascular mortality. These end-points also increased with sedentary life-style, relatively young age at diagnosis and presence of cardiovascular disease (CVD) at diagnosis. Further predictors of all-cause mortality were male sex, low body mass index and cancer, while cardiovascular mortality increased with urinary albumin concentration. Conclusions We found that patients who rated their health as less than excellent had increased 5-year mortality, similar to that of patients with prevalent CVD, even when biochemical, clinical and life-style variables were controlled for. This finding could motivate doctors to discuss perceptions of health with newly diagnosed diabetic patients and be attentive to patients with suboptimal health ratings. Our findings also confirm that life-style changes and optimizing treatment are particularly relevant for relatively young and inactive patients and those who already have CVD or (micro)albuminuria at the time of diabetes diagnosis.

de Fine Olivarius Niels; Siersma Volkert; Nielsen Anni BS; Hansen Lars J; Rosenvinge Lotte; Mogensen Carl

2010-01-01

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[1H-MR spectroscopic imaging in patients with clinically diagnosed Alzheimer's disease  

UK PubMed Central (United Kingdom)

PURPOSE: To detect regional differences in accompanying metabolic changes, 1H-Magnetic Resonance Spectroscopic Imaging (MRSI) was performed in 16 patients with Alzheimer's disease (AD); the clinical diagnosis was based upon DSM-III-R and NINCDS-ADRDA guidelines. METHODS: In the hippocampal region metabolic maps of the local distribution of N-acetylaspartate (NAA), choline (Cho), creatine compounds (P(Cr)) and lactate were determined. Ratios of Cho/NAA, (P)Cr/NAA and Cho/(P)Cr calculated from selected hippocampal spectra were compared to those from healthy volunteers (n = 17). RESULTS: AD patients demonstrated an increase of Cho/NAA and (P)Cr/NAA ratios caused by increased choline compounds and decreased NAA. These alterations were observed in 11/12 cases in the hippocampal and in 7/12 in the temporo-occipital region. Hippocampal Cho/NAA ratios (0.56 +/- 0.19) were significantly elevated compared with controls (0.33 +/- 0.04; p < 0.0001). CONCLUSION: The observed elevation of choline compounds in the hippocampus supports the hypothesis that alterations in the cholinergic system play an important role in Alzheimer's disease. The observed reduction of NAA is due to neuronal degeneration.

Block W; Träber F; Kuhl CK; Fric M; Keller E; Lamerichs R; Rink H; Möller HJ; Schild HH

1995-09-01

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[Measurement of serum free light chains and its clinical significance in 20 newly diagnosed patients of multiple myeloma].  

Science.gov (United States)

The objective of this study was to explore the clinical significance of measuring serum free light chains (sFLC) and to compare with serum total light chains (free and binded) in multiple myeloma (MM). sFLC in 20 newly diagnosed MM patients and 20 cases of healthy people as control were measured by immuno-nephelometric assays; the serum light chains and kappa/lambda ratio were measured in all patients, while immunofixation electrophoresis (IFE) tests were carried out at the same time in 18 out of 20 patients. The results showed that the abnormality of serum free light chains and kappa/lambda ratio were found in all of the 20 newly diagnosed MM patients (p < 0.01). The measurement of sFLC showed higher sensitivity than the total serum chains (p < 0.01). It is concluded that the method testing sFLC by immuno-nephelometric assay combined with kappa/lambda ratio is valuable for MM diagnosis, and the measurement of sFLC can be used as one of indicators for MM diagnosis. PMID:18718070

Mao, Xiao-Bei; Chen, Xie-Qun; Zhai, Yong-Ping; Liang, Rong; Gao, Guang-Xun; Ma, Guo-Guang; Yu, Ya-Ping; Li, Feng

2008-08-01

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

UK PubMed Central (United Kingdom)

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 HbA1c on a number of clinical outcomes and all-cause mortality was assessed in Cox regression models. RESULTS: At diagnosis, 97 patients (8.5%) had an HbA1c level within normal range. Age (mean (SD)) at diagnosis was 64.5 (11.5) years. Both unadjusted and adjusted hazard ratios for the effect of HbA1c on mortality and other outcomes were not statistically significant. CONCLUSIONS: Patients who are diagnosed with type 2 diabetes mellitus by means of elevated fasting whole blood/plasma glucose but have HbA1c within reference range at diagnosis do not seem to have a relatively benign long-term clinical course. Therefore new diagnostic procedures should preferably be able to identify these individuals.

Veloso AG; Siersma V; Heldgaard PE; de Fine Olivarius N

2013-04-01

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Clinical characteristics and long-term outcome of patients with refractory sprue diagnosed at a single institution.  

UK PubMed Central (United Kingdom)

BACKGROUND: Refractory sprue (RS) is a rare and severe celiac-like enteropathy not responding to a strict gluten-free diet. Although prognosis is generally poor, little is known about the long-term outcome of patients. AIM: to report baseline characteristics and long-term outcome of a series of patients diagnosed and treated in a single institution. MATERIALS: We report a retrospective cohort of 25 consecutive patients (15 females; mean age 46 yr; range 28-71) diagnosed with RS based on the presence of a non-responsive celiac-like enteropathy. All patients were intensively treated with a gluten-free diet, steroids, nutritional support and immunosupression. RESULTS: Clinical and biological characteristics of patients suggest that, at least, 24 patients had clear evidences of celiac disease. HLA DQ2/DQ8 genes were present in all the 24 patients typed and autoimmune enteropathy was excluded in all. According to the genotyping, 12 patients had a polyclonal lymphocyte population (RS type I) and 13 exhibited monoclonal TCR-gamma gene rearrangements (RS type II). Sixteen patients had evidence of ulcerative jejunitis (UJ) (7 in RS type I and 9 in type II). Overall median follow-up time after diagnosis of RS was 29 mo/patient (range 7 to 204) (45 mo for type I and 24 mo for type II). Overall mortality was 48% (12 patients), 6 in each type. Eight patients with UJ (50%), 3 with lymphoma (two T-cell and one B-cell type) and 4 (44%) without ulcers died during follow-up. The causes of death were sepsis in the context of a progressive deterioration but without overt malignancies (n=5), vascular causes (n=3) and severe malnutrition (n=1). Three- and 5-yr survival rate after diagnosis of RS for the overall population was 60% and 56%. There was no differences between type I (67%, 58%) and type II RS patients (54% for both periods). Patients with UJ had lower but non-significant 3- and 5-yr survival rates (56% and 50%, respectively) compared with patients without ulcers (78% and 66%). Survivors had a favorable outcome. While 11 patients persists asymptomatic, two other cases still have mild diarrhea and one low body weight. CONCLUSIONS: We confirm that RS is a severe celiac disease-related disorder with very high mortality. Diagnosis of overt lymphoma (12%) in our long-term follow-up was not as frequent as was reported by other groups. A proportion of patients persist in good health for a long time irrespective of the nature of the IEL infiltration or the presence of UJ.

Mauriño E; Niveloni S; Cherñavsky AC; Sugai E; Vázquez H; Pedreira S; Periolo N; Mazure R; Smecuol E; Moreno ML; Litwin N; Nachman F; Kogan Z; Bai JC

2006-03-01

37

[Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroom-like appearance. It is an important cause of occipital epilepsy. AIM. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literature and the average cortical thickness of healthy subjects. PATIENTS AND METHODS: Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study; all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysis based on volumetric T1 sequences. RESULTS: Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainly parietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. CONCLUSIONS: We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected by ulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the ulegyria-affected area, although these data need to be replicated in a study with a greater number of patients.

Ladino LD; Arteaga A; Isaza SP; Delgado JA; Vélez JM; Castrillón G; Calvo V; Solarte RA; Balaguera P; Uribe CS

2012-05-01

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

International Nuclear Information System (INIS)

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

2008-01-01

39

Clinicians' information habits, patients' knowledge of diagnoses and etiological concepts in four different clinical samples.  

UK PubMed Central (United Kingdom)

A total of 230 psychiatric inpatients and their physicians in charge took part in semistandardized interviews. Patients suffering from schizophrenia received information less frequently and less comprehensively than other patients. The label of schizophrenia was often paraphrased or not communicated at all; patients knew their diagnosis less exactly than other subgroups. Asked to indicate the most important cause of their disorder, neurotics tended to name their living conditions (60%), and addicts preferred to blame themselves (73%). Only 26% of the patients with affective disorders or schizophrenia accepted the idea of their disorders as diseases in a medical sense, whereas the psychiatrists favored a biological concept in more than 90% of the cases. The findings stress the need to improve communication between patients and psychiatrists as regards information on illness and treatment.

Luderer HJ; Böcker FM

1993-10-01

40

EFNS task force on management of amyotrophic lateral sclerosis: guidelines for diagnosing and clinical care of patients and relatives.  

UK PubMed Central (United Kingdom)

Despite being one of the most devastating diseases known, there is little evidence for diagnosing and managing patients with amyotrophic lateral sclerosis (ALS). Although specific therapy is lacking, correct early diagnosis and introduction of symptomatic and specific therapy can have a profound influence on the care and quality of life of the patient and may increase survival time. This document addresses the optimal clinical approach to ALS. The final literature search was performed in the spring of 2005. Consensus recommendations are given graded according to the EFNS guidance regulations. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. People affected with possible ALS should be examined as soon as possible by an experienced neurologist. Early diagnosis should be pursued and a number of investigations should be performed with high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with vital capacity < 50%. Non-invasive positive pressure ventilation improves survival and quality of life but is underused. Maintaining the patients ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be fully discussed early with the patient and relatives respecting the patients social and cultural background.

Andersen PM; Borasio GD; Dengler R; Hardiman O; Kollewe K; Leigh PN; Pradat PF; Silani V; Tomik B

2005-12-01

 
 
 
 
41

[Evaluation of the clinical results in patients with symptomatic partial tears of the anterior cruciate ligament diagnosed arthroscopically].  

UK PubMed Central (United Kingdom)

PURPOSE OF THE STUDY: The study presents a retrospective evaluation of clinical data and arthroscopic findings in a group of our patients with symptomatic knee instability due to a partial tear of the anterior cruciate ligament (ACL). MATERIAL AND METHODS: The group included 31 patients diagnosed with symptomatic partial ACL tears, i.e. an isolated tear of the posterolateral (PL) or the anteromedial (AM) bundle. The patients' average age was 26.5 years. A side-to-side difference in ventral knee laxity was assessed using the anterior drawer test and the Lachman test under general anaesthesia before arthroscopy was commenced; rotational knee laxity was evaluated by the pivot shift test. An objective evaluation of side-to-side ventral laxity differences in both knees was performed on the GNRB® arthrometer with an applied pressure of 134 N and 250 N in the conscious patient. During arthroscopic examination, findings on the two ACL bundles were recorded. RESULTS: All 31 patients were diagnosed with symptomatic partial ACL tears, of them 22 had a PL bundle lesion and nine had an AM bundle tear. All patients with PL bundle lesions only reported problems in association with pivot sports, and all patients with AM bundle tears had problems regardless of any sports activities. In all patients with isolated AM bundle tears, the lesion was located close to its femoral attachment. In the patients with PL bundle tears, femoral location was found in 68% and tibial location in 32% of the patients. In the patients with partial PL bundle lesions, + and ++ results in the pivot shift test were recorded in 32% and 68% of the treated patients, respectively. The Lachman test showed + and ++ results in 71% and 9% of the patients, respectively. The anterior drawer test had negative results in 87% and positive + results in 13% of the patients. The side-to-side difference on the GNRB arthrometer ranged from 0.4 to 2.3 mm at a pressure of 134 N and from 1.2 to 4.2 mm at 250 N in the patients with isolated PL bundle lesions. In the patients with AM bundle lesions, the results were as follows: pivot shift test, 89% negative. 11% positive +; Lachman test, 56% negative, 44% positive +; anterior drawer test, 89% +, 11% ++; GNRB test, 2.2 to 4.4 mm at 134 N, and 4.3 to 7.1 at 250 N. DISCUSSION: The diagnosis of partial ACL lesions, i.e., isolated tears of the AM or the PL bundle, requires accurate knowledge of knee anatomy and its biomechanics. In accordance with other authors our results showed that an arthroscopic examination of both bundles of the ligament as well as knee laxity evaluation under general anaesthesia are most essential for making the definite diagnosis in partial ACL tears. They also confirmed that, in isolated AM bundle lesions, ventral laxity is present more often particularly at a higher degree of knee flexion while, in PL bundle lesions, rotational laxity is more frequent and ranges from 0 to 30 degrees of knee flexion. CONCLUSIONS: To make the definite diagnosis of partial ACL tears, patient medical history, clinical knee examination including instability type and degree assessment under general anaesthesia and, most importantly, arthroscopic findings on both ACL bundles are necessary.

Zeman P; Cibulková J; Nepraš P; Koudela K Jr; Mat?jka J

2013-01-01

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Biochemical, molecular, and clinical diagnoses of patients with cerebral creatine deficiency syndromes.  

Science.gov (United States)

Cerebral creatine deficiency syndromes (CCDS) are a group of inborn errors of creatine metabolism that involve AGAT and GAMT for creatine biosynthesis disorders and SLC6A8 for creatine transporter (CT1) deficiency. Deficiencies in the three enzymes can be distinguished by intermediate metabolite levels, and a definitive diagnosis relies on the presence of deleterious mutations in the causative genes. Mutations and unclassified variants were identified in 41 unrelated patients, and 22 of these mutations were novel. Correlation of sequencing and biochemical data reveals that using plasma guanidinoacetate (GAA) as a biomarker has 100% specificity for both AGAT and GAMT deficiencies, but AGAT deficiency has decreased sensitivity in this assay. Furthermore, the urine creatine:creatinine ratio is an effective screening test with 100% specificity in males suspected of having creatine transporter deficiency. This test has a high false-positive rate due to dietary factors or dilute urine samples and lacks sensitivity in females. We conclude that biochemical screening for plasma GAA and measuring of the urine creatine:creatinine ratio should be performed for suspected CCDS patients prior to sequencing. Also, based on the results of this study, we feel that sequencing should only be considered if a patient has abnormal biochemical results on repeat testing. PMID:23660394

Comeaux, Matthew S; Wang, Jing; Wang, Guoli; Kleppe, Soledad; Zhang, Victor Wei; Schmitt, Eric S; Craigen, William J; Renaud, Deborah; Sun, Qin; Wong, Lee-Jun

2013-04-17

43

Biochemical, molecular, and clinical diagnoses of patients with cerebral creatine deficiency syndromes.  

UK PubMed Central (United Kingdom)

Cerebral creatine deficiency syndromes (CCDS) are a group of inborn errors of creatine metabolism that involve AGAT and GAMT for creatine biosynthesis disorders and SLC6A8 for creatine transporter (CT1) deficiency. Deficiencies in the three enzymes can be distinguished by intermediate metabolite levels, and a definitive diagnosis relies on the presence of deleterious mutations in the causative genes. Mutations and unclassified variants were identified in 41 unrelated patients, and 22 of these mutations were novel. Correlation of sequencing and biochemical data reveals that using plasma guanidinoacetate (GAA) as a biomarker has 100% specificity for both AGAT and GAMT deficiencies, but AGAT deficiency has decreased sensitivity in this assay. Furthermore, the urine creatine:creatinine ratio is an effective screening test with 100% specificity in males suspected of having creatine transporter deficiency. This test has a high false-positive rate due to dietary factors or dilute urine samples and lacks sensitivity in females. We conclude that biochemical screening for plasma GAA and measuring of the urine creatine:creatinine ratio should be performed for suspected CCDS patients prior to sequencing. Also, based on the results of this study, we feel that sequencing should only be considered if a patient has abnormal biochemical results on repeat testing.

Comeaux MS; Wang J; Wang G; Kleppe S; Zhang VW; Schmitt ES; Craigen WJ; Renaud D; Sun Q; Wong LJ

2013-07-01

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

Directory of Open Access Journals (Sweden)

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)

Erinç SEV?NÇ; Cem ?ENGÜL; Burcu ÇAKALOZ; Hasan HERKEN

2010-01-01

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Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a U.S. sample.  

UK PubMed Central (United Kingdom)

PURPOSE: Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. METHODS: Participants (n = 181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. RESULTS: Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. CONCLUSIONS: The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

Ramsay CE; Stewart T; Compton MT

2012-05-01

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[Psychosomatic and psychosocial diagnoses at the Zurich University pediatric clinic. A retrospective study of ambulatory patients 1973 to 1982].  

Science.gov (United States)

This study analyses the number and distribution of children (n = 97,161) attending the medical out-patient service at the University Children's Hospital of Zurich with psychiatric diagnoses during the years 1973-1982. The average prevalence (one-year periods) of the patients with psychiatric diagnoses represents 17.8%, the incidence (ten-year period) represents 20.5%. In the group of patients with psychiatric diagnoses, the percentage of children having a psychosomatic diagnosis is 57.2%, the percentage of psychosocial diagnoses is 42.8% (29.9% developmental disturbance, 5.8% psychoreactive syndromes, 4.0% psychoorganic syndromes, 2.8% mental retardation, 0.3% psychosis). 58.7% of the patients with psychiatric diagnoses are boys, 41.3% girls; age-frequency demonstrates the following distribution: 1-4 years 22.6%, 5-7 years 19.3%, 8-10 years 19.5%, 11-13 years 18.5%, 14-16 years 14.5%, 17-20 years 5.6%. The data of this study document the importance of psychosomatic and psychosocial phenomena in childhood and adolescence. They have implications for the content of educational programs and research efforts. PMID:2437077

Wohnlich, H R; Stähli, R

1985-07-01

47

[Psychosomatic and psychosocial diagnoses at the Zurich University pediatric clinic. A retrospective study of ambulatory patients 1973 to 1982  

UK PubMed Central (United Kingdom)

This study analyses the number and distribution of children (n = 97,161) attending the medical out-patient service at the University Children's Hospital of Zurich with psychiatric diagnoses during the years 1973-1982. The average prevalence (one-year periods) of the patients with psychiatric diagnoses represents 17.8%, the incidence (ten-year period) represents 20.5%. In the group of patients with psychiatric diagnoses, the percentage of children having a psychosomatic diagnosis is 57.2%, the percentage of psychosocial diagnoses is 42.8% (29.9% developmental disturbance, 5.8% psychoreactive syndromes, 4.0% psychoorganic syndromes, 2.8% mental retardation, 0.3% psychosis). 58.7% of the patients with psychiatric diagnoses are boys, 41.3% girls; age-frequency demonstrates the following distribution: 1-4 years 22.6%, 5-7 years 19.3%, 8-10 years 19.5%, 11-13 years 18.5%, 14-16 years 14.5%, 17-20 years 5.6%. The data of this study document the importance of psychosomatic and psychosocial phenomena in childhood and adolescence. They have implications for the content of educational programs and research efforts.

Wohnlich HR; Stähli R

1985-07-01

48

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

Directory of Open Access Journals (Sweden)

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.

Lauth Bertrand; Levy Sigurður; Júlíusdóttir Guðlaug; Ferrari Pierre; Pétursson Hannes

2008-01-01

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Clinically and electrophysiologically diagnosed botulinum intoxication.  

Science.gov (United States)

In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings. PMID:23291807

Kotan, Dilcan; Aygul, Recep; Ceylan, Mustafa; Yilikoglu, Yalcin

2013-01-03

50

Clinically and electrophysiologically diagnosed botulinum intoxication.  

UK PubMed Central (United Kingdom)

In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

Kotan D; Aygul R; Ceylan M; Yilikoglu Y

2013-01-01

51

Activity of telithromycin and comparators against bacterial pathogens isolated from 1,336 patients with clinically diagnosed acute sinusitis  

Science.gov (United States)

Background Increasing antimicrobial resistance among the key pathogens responsible for community-acquired respiratory tract infections has the potential to limit the effectiveness of antibiotics available to treat these infections. Since there are regional differences in the susceptibility patterns observed and treatment is frequently empirical, the selection of antibiotic therapy may be challenging. PROTEKT, a global, longitudinal multicentre surveillance study, tracks the activity of telithromycin and comparator antibacterial agents against key respiratory tract pathogens. Methods In this analysis, we examine the prevalence of antibacterial resistance in 1,336 bacterial pathogens, isolated from adult and paediatric patients clinically diagnosed with acute bacterial sinusitis (ABS). Results and discussion In total, 58.0%, 66.1%, and 55.8% of S. pneumoniae isolates were susceptible to penicillin, cefuroxime, and clarithromycin respectively. Combined macrolide resistance and reduced susceptibility to penicillin was present in 200/640 (31.3 %) of S. pneumoniae isolates (128 isolates were resistant to penicillin [MIC >= 2 mg/L], 72 intermediate [MIC 0.12–1 mg/L]) while 99.5% and 95.5% of isolates were susceptible to telithromycin and amoxicillin-clavulanate, respectively. In total, 88.2%, 87.5%, 99.4%, 100%, and 100% of H. influenzae isolates were susceptible to ampicillin, clarithromycin, cefuroxime, telithromycin, and amoxicillin-clavulanate, respectively. In vitro, telithromycin demonstrated the highest activity against M. catarrhalis (MIC50 = 0.06 mg/L, MIC90 = 0.12 mg/L). Conclusion The high in vitro activity of against pathogens commonly isolated in ABS, together with a once daily dosing regimen and clinical efficacy with 5-day course of therapy, suggest that telithromycin may play a role in the empiric treatment of ABS.

Dohar, Joseph; Canton, Rafael; Cohen, Robert; Farrell, David John; Felmingham, David

2004-01-01

52

Activity of telithromycin and comparators against bacterial pathogens isolated from 1,336 patients with clinically diagnosed acute sinusitis  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Increasing antimicrobial resistance among the key pathogens responsible for community-acquired respiratory tract infections has the potential to limit the effectiveness of antibiotics available to treat these infections. Since there are regional differences in the susceptibility patterns observed and treatment is frequently empirical, the selection of antibiotic therapy may be challenging. PROTEKT, a global, longitudinal multicentre surveillance study, tracks the activity of telithromycin and comparator antibacterial agents against key respiratory tract pathogens. Methods In this analysis, we examine the prevalence of antibacterial resistance in 1,336 bacterial pathogens, isolated from adult and paediatric patients clinically diagnosed with acute bacterial sinusitis (ABS). Results and discussion In total, 58.0%, 66.1%, and 55.8% of S. pneumoniae isolates were susceptible to penicillin, cefuroxime, and clarithromycin respectively. Combined macrolide resistance and reduced susceptibility to penicillin was present in 200/640 (31.3 %) of S. pneumoniae isolates (128 isolates were resistant to penicillin [MIC >= 2 mg/L], 72 intermediate [MIC 0.12–1 mg/L]) while 99.5% and 95.5% of isolates were susceptible to telithromycin and amoxicillin-clavulanate, respectively. In total, 88.2%, 87.5%, 99.4%, 100%, and 100% of H. influenzae isolates were susceptible to ampicillin, clarithromycin, cefuroxime, telithromycin, and amoxicillin-clavulanate, respectively. In vitro, telithromycin demonstrated the highest activity against M. catarrhalis (MIC50 = 0.06 mg/L, MIC90 = 0.12 mg/L). Conclusion The high in vitro activity of against pathogens commonly isolated in ABS, together with a once daily dosing regimen and clinical efficacy with 5-day course of therapy, suggest that telithromycin may play a role in the empiric treatment of ABS.

Dohar Joseph; Cantón Rafael; Cohen Robert; Farrell David; Felmingham David

2004-01-01

53

Diversity of urinary symptoms in patients tentatively diagnosed with benign prostatic hyperplasia referred to a urologic clinic in Norway.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Lower urinary tract symptoms (LUTS) has become the preferred term used to classify the urinary symptoms of elderly men. This term places more emphasis on clinical appearance rather than being restricted to the functional pathophysiology. The objective of this study was to investigate this new concept in a group of patients who had been tentatively diagnosed with benign prostatic hyperplasia (BPH). The range of urinary symptoms, incontinence, sexual function and impact on daily living were registered. MATERIAL AND METHODS: Data from a group of 480 men awaiting urologic assessment were collected by questionnaire shortly after referral from their general practitioner between 1997 and 2000. The questionnaires used were the International Prostate Symptom Score (IPSS), the Symptom Problem Index, the International Continence Society-BPH, the Sandvik Incontinence Severity Index and the BPH-specific Interference with Activities. RESULTS: The mean age of the subjects was 67.0 years. As assessed by the IPSS, 15%, 54% and 31% of the men had mild, moderate and severe symptoms, respectively. Men who gave positive answers to questions regarding the frequency, amount and type of leakage were considered to have urinary incontinence (UI), which was found in 37% of cases. The majority of men had mild or moderate UI. Influence on daily living varied with the severity of symptoms. However, no significant differences in influence on daily living were found between groups with different degrees of severity of incontinence as all groups reported a relatively high impact. CONCLUSIONS: Our results show that UI is fairly common, very bothersome and socially embarrassing in male LUTS patients waiting for urologic evaluation. Although UI is not typically associated with BPH and is not regarded as a crucial component of LUTS, this study indicates that more emphasis should be placed on UI in the terminology of LUTS. UI may also act as an indicator of a need for healthcare.

Haltbakk J; Hanestad BR; Hunskaar S

2004-01-01

54

Schnitzler syndrome - an under diagnosed clinical entity.  

UK PubMed Central (United Kingdom)

Schnitzler syndrome is considered to be a rare disorder characterized by a monoclonal IgM protein and chronic urticaria that is associated with considerable morbidity. We hypothesized that the syndrome may be under recognized and patients may be deprived of highly effective therapy in the form of anakinra. We performed a retrospective search of the dysproteinemia database at Mayo Clinic as well as the medical records of all patients with chronic urticaria to determine the true incidence of the disease. We compared patients with the diagnosis of Schnitzler syndrome and those who met the criteria but in whom the syndrome was not recognized. Comparisons between groups were performed and survival curves determined. We identified 16 patients with diagnosed Schnitzler syndrome and an additional 46 patients who met diagnostic criteria. The monoclonal protein was IgM? in 94% of patients. Therapy with anakinra in 4 patients led to rapid and complete resolution of symptoms. The median overall survival for this syndrome is greater than 12.8 years. Progression to lymphoma was only observed in 8% of patients which is lower than what has previously been reported. Schnitzler syndrome may be present in up to 1.5% of patients with a monoclonal IgM in their serum and likely under-recognized as a clinical syndrome.

Jain T; Offord CP; Kyle R; Dingli D

2013-06-01

55

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

International Nuclear Information System (INIS)

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

56

Diagnosing patients with longstanding shoulder joint pain  

Science.gov (United States)

Methods: Eighty six patients with longstanding shoulder joint pain were "blindly" examined by two trained doctors using several clinical tests. In all patients an ultrasonographic examination was performed, and in 42 (49%) an arthroscopy. Results: Tests for impingement showed poor to moderate agreement. Tenderness of muscles, muscle weakness, and tests for labral lesion also showed poor agreement. Pain during muscle contraction showed moderate agreement. The agreement of clinical diagnoses was poor and the accuracy was low in comparison with arthroscopy. Ultrasonography was accurate in full thickness supraspinatus tendon tears, but inaccurate for partial tears and labral lesions. Conclusions: Most clinical tests showed poor agreement. Clinical and ultrasonographic diagnoses had low accuracy in comparison with arthroscopy.

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

2002-01-01

57

A review of the clinical outcomes for patients diagnosed with brainstem metastasis and treated with stereotactic radiosurgery.  

UK PubMed Central (United Kingdom)

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 suggests that higher prescribed marginal dose and the associated greater local control of brainstem lesions are associated with longer patient survival. Further research is necessary to better describe the most effective dose for individual brainstem lesions and to tailor optimum therapy to specific patient subgroups.

Lamm AF; Elaimy AL; Lamoreaux WT; Mackay AR; Fairbanks RK; Demakas JJ; Cooke BS; Lee CM

2013-01-01

58

Parasuicide and depression: a comparison of clinical and questionnaire diagnoses.  

UK PubMed Central (United Kingdom)

The frequency with which depressive disorder is diagnosed in parasuicide varies. It has been suggested that when observer bias is removed and a depression questionnaire employed, a greater number of young women who attempt suicide will be designated as depressed than would be expected on the basis of previous clinical reports. Our study compared clinical diagnoses made according to Feighner's research diagnostic criteria or DSM III with the categorisations obtained by the Levine-Pilowsky Depression questionnaire (LPD). Fifty-one patients, 34 female and 17 male, were studied, 31.4% having a primary Major Depressive Disorder and 23.5% secondary depression as clinical diagnoses. The LPD categorised 72.5% as depressed. Comparison of the clinical diagnoses with questionnaire data suggests that the LPD is overinclusive and not as specific as clinical diagnosis. Alcohol and substance abuse disorders accounted for almost one-third of the diagnoses and are therefore an important concomitant of parasuicide.

Reeves JC; Large RG; Honeyman M

1985-03-01

59

Short-term clinical importance of osseous injuries diagnosed at MR imaging in patients with anterior cruciate ligament tear.  

UK PubMed Central (United Kingdom)

PURPOSE: To determine the association between osseous injuries and short-term clinical outcome in patients with anterior cruciate ligament (ACL) tear. MATERIALS AND METHODS: The retrospective study was performed with institutional review board approval, and the requirement to obtain informed consent was waived. The study group consisted of 114 patients (57 male and 57 female patients with a mean age of 26.1 and 25.1 years, respectively) with ACL tear who underwent magnetic resonance (MR) imaging and ACL reconstruction surgery and who filled out International Knee Documentation Committee (IKDC) knee evaluation questionnaires before and 1 year after surgery. All MR images were independently reviewed by two radiologists to determine the presence of a cortical depression fracture on each surface of the knee joint. Bone marrow edema volume was quantified by using segmentation software. Correlation coefficients were used to determine the association between bone marrow edema volume and IKDC score. A multivariate analysis model was used to compare IKDC scores in patients without fracture, patients with a single fracture, and patients with multiple fractures. RESULTS: There was no significant association between total bone marrow edema volume and preoperative or postoperative IKDC score (P = .32 and P = .91, respectively). The mean preoperative and postoperative IKDC scores were 53.4 ± 18.6 and 93.0 ± 5.0, respectively, for patients without fracture, 54.8 ± 13.6 and 87.3 ± 10.8 for patients with a single fracture, and 53.1 ± 17.2 and 83.4 ± 12.7 for patients with multiple fractures. Patients with single and multiple fractures had similar (P = .91) preoperative IKDC scores but significantly lower (P < .001) postoperative IKDC scores compared to patients without fracture. CONCLUSION: Cortical depression fractures in patients with ACL tear are associated with decreased clinical outcome scores 1 year after ACL reconstruction surgery.

Kijowski R; Sanogo ML; Lee KS; Muñoz Del Río A; McGuine TA; Baer GS; Graf BK; De Smet AA

2012-08-01

60

A phase II clinical trial of topotecan and carboplatin in patients with newly diagnosed advanced epithelial ovarian cancer.  

Science.gov (United States)

A phase II clinical trial conducted to evaluate the efficacy and tolerability of topotecan and carboplatin as first-line therapy for women with advanced epithelial ovarian cancer was the objective of this study. Patients had histologically confirmed ovarian epithelial cancer with at least one measurable lesion. Patients received topotecan 1.5 mg/m(2) on days 1-3 and carboplatin at an area under the curve (AUC) of 5 on day 3 every 21 days for six cycles. All 42 patients enrolled were evaluable for response and toxicity. Median number of cycles delivered was six. Overall response rate was 71%, with 19 clinical complete responses (45%) and 11 clinical partial responses (26%). Median survival time was 47 months and 5-year survival was 42%. Myelosuppression was the predominant toxicity, with grade 3 or 4 neutropenia occurring in 100% of patients. However, this toxicity was transient and easily manageable; no patients experienced febrile neutropenia. The combination of topotecan and carboplatin is active in advanced epithelial ovarian cancer. Delay of therapy by 1 week or topotecan dose reduction to 1.25 mg/m(2) is the first-choice option to reduce topotecan toxicity without affecting the efficacy. Moreover, a chemotherapy regimen using weekly topotecan, which is currently being tested, should be considered. PMID:17362314

Vecchione, F; Fruscio, R; Dell'Anna, T; Garbi, A; Garcia Parra, R; Corso, S; Lissoni, A A

 
 
 
 
61

Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics.  

UK PubMed Central (United Kingdom)

BACKGROUND: Prompt identification and treatment of psoriatic arthritis (PsA) in patients with psoriasis is critical to reducing the risk of joint damage, disability, and comorbidities. OBJECTIVE: We sought to estimate PsA prevalence in patients with plaque psoriasis in 34 dermatology centers in 7 European and North American countries. METHODS: Consecutive patients were evaluated by dermatologists for plaque psoriasis and subsequently by rheumatologists for PsA. PsA prevalence was estimated primarily based on rheumatologists' assessment of medical history, physical examination, and laboratory tests. RESULTS: Of 949 patients evaluated, 285 (30%) had PsA (95% confidence interval 27-33) based on rheumatologists' assessment. PsA diagnosis changed in 1.2% of patients when diagnostic laboratory tests were added to medical history and physical examination. Of 285 patients given the diagnosis of PsA, 117 (41%) had not been previously given the diagnosis. LIMITATIONS: Bias may have been introduced by lack of standardized diagnostic criteria and unbalanced recruitment based on country populations. CONCLUSIONS: In this study, almost a third of patients with psoriasis seen in dermatology centers had PsA as determined by rheumatologists. More than a third of patients with PsA had not been previously given the diagnosis. Clinical evaluation alone is often sufficient basis for PsA diagnosis, but laboratory test results may be helpful in some patients.

Mease PJ; Gladman DD; Papp KA; Khraishi MM; Thaçi D; Behrens F; Northington R; Fuiman J; Bananis E; Boggs R; Alvarez D

2013-08-01

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

UK PubMed Central (United Kingdom)

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.

Patterson P; Cahn S; Sued O; Fink V; Figueroa M; Cesar C; Rojo M; Ben G; Vázquez M; Cahn P

2012-01-01

63

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

Directory of Open Access Journals (Sweden)

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.

P Patterson; S Cahn; O Sued; V Fink; M Figueroa; C Cesar; M Rojo; G Ben; M Vázquez; P Cahn

2012-01-01

64

Vascular outcomes in patients with screen-detected or clinically diagnosed type 2 diabetes: Diabscreen study follow-up.  

UK PubMed Central (United Kingdom)

PURPOSE: Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms. METHODS: In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206). Patients in both groups received the same guideline-concordant diabetes care. The main group outcome measure was a composite of death from cardiovascular disease (CVD), nonfatal myocardial infarction, and nonfatal stroke. RESULTS: Baseline vascular disease was more prevalent in the opportunistic targeted screening group, mainly ischemic heart disease (12.3% vs 3.9%, P = .001) and nephropathy (16.9% vs 7.1%, P = .002). After a mean follow-up of 7.7 years (SD = 2.4 years) and 7.1 years (SD = 2.7 years) for the opportunistic targeted screening and clinical diagnosis groups, respectively, composite primary event rates did not differ significantly between the 2 groups (9.5% vs 10.2%, P = .78; adjusted hazard ratio 0.67, 95% confidence interval, 0.36-1.25; P = .21). There were also no significant differences in the separate event rates of deaths from CVD, nonfatal myocardial infarction, and nonfatal strokes. CONCLUSIONS: Opportunistic targeted screening for type 2 diabetes detected patients with higher CVD morbidity at baseline when compared with clinical diagnosis but showed similar CVD mortality and major CVD morbidity after 7.7 years. Opportunistic targeted screening and guided care appears to improve vascular outcomes in type 2 diabetes in primary care.

Klein Woolthuis EP; de Grauw WJ; van Keeken SM; Akkermans RP; van de Lisdonk EH; Metsemakers JF; van Weel C

2013-01-01

65

Clinical and laboratory features of patients with rheumatoid arthritis diagnosed at rheumatology services in the Brazilian municipality of Cascavel, PR, Brazil.  

UK PubMed Central (United Kingdom)

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 Paraná, Brazil. PATIENTS AND METHODS: Data were collected between August 2010 and July 2011 in all health services of the municipality of Cascavel that provided health care in Rheumatology: a university-affiliated hospital, a public outpatient clinic and four private clinics. RESULTS: We identified 38 patients diagnosed with rheumatoid arthritis, resulting in an estimated incidence of 13.4 cases per 100,000 inhabitants/year. Thirty two patients were females, whose mean age was 47.6 years. The age group with the highest incidence was over 40 years. The mean time between first symptoms and diagnosis was 12.4 months. Rheumatoid factor was positive in 68.4% of the patients, and 18.4% already had radiological abnormalities at diagnosis. The pharmacological treatment of patients was also assessed and proved to be in accordance with those found in the literature. CONCLUSION: The incidence of rheumatoid arthritis obtained in the municipality of Cascavel was lower than those reported in international studies.

David JM; Mattei RA; Mauad JL; de Almeida LG; Nogueira MA; Menolli PV; Menolli RA

2013-02-01

66

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

International Nuclear Information System (INIS)

[en] 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)

2006-01-01

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Comparison of the performance of four different tools in diagnosing disease-associated anorexia and their relationship with nutritional, functional and clinical outcome measures in hospitalized patients.  

UK PubMed Central (United Kingdom)

BACKGROUND & AIMS: In hospitalized patients, lack of appetite, i.e., disease-associated anorexia, is the main factor determining insufficient food intake and weight loss, which in turn increase morbidity and mortality. Controversies exist on which tool should be preferred when diagnosing anorexia. Aim of the study was to evaluate in hospitalized medical patients, the performance of 4 different tools [i.e., self-assessment of appetite, FAACT-ESPEN score, visual analog scale (VAS), and the Anorexia Questionnaire (AQ)] in assessing disease-associated anorexia and predicting nutritional and clinical variables. MATERIALS AND METHODS: Hospitalized patients consecutively admitted to the Internal Medicine ward at our institution were considered. After informed consent was obtained, patients were asked to self-assess their appetite vs the previous month. The VAS, the FAACT-ESPEN score and the Anorexia Questionnaire were also submitted. Food intake immediately following the interview was recorded. Nutritional (i.e., body weight, height), functional (i.e., handgrip strength) and clinical variables (i.e., length of stay) were registered upon admission and before discharge. RESULTS: We studied 105 patients (74M:31F; 66.2 ± 16.3 yrs). The prevalence of anorexia as assessed by patients' self assessment, FAACT-ESPEN score, and the Anorexia Questionnaire was 23%, 10% and 48%, respectively. VAS did not show any correlation with food intake. Anorexic patients as identified by the self assessment of appetite showed reduced food intake and weaker handgrip strength than non-anorexic. The FAACT-ESPEN score correlated with body weight, food intake and handgrip strength, but was not related with length of stay. Anorexic patients as identified by the Anorexia Questionnaire showed reduced food intake, lower body weight, weaker handgrip strength and longer hospital stay than non-anorexic patients. DISCUSSION: The prevalence of anorexia significantly varies according to the diagnostic tool used. Except for VAS, all the tested tools identify patients with impaired nutritional and functional variables. However, only the Anorexia Questionnaire identifies patients with longer hospital stay. Our results suggest that in clinical practice, modification of appetite reflects different underlying mechanisms whose impacts on clinical outcome measures may differ. Therefore, an ideal anorexia assessment tool does not appear to exist, but it should be chosen according to the outcome measures to be assessed (i.e., Anorexia Questionnaire to predict length of stay).

Arezzo di Trifiletti A; Misino P; Giannantoni P; Giannantoni B; Cascino A; Fazi L; Rossi Fanelli F; Laviano A

2013-08-01

68

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

Science.gov (United States)

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

2013-01-01

69

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

Directory of Open Access Journals (Sweden)

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

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

2013-01-01

70

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

Directory of Open Access Journals (Sweden)

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

Hu Rong; Wu Yong; Jiang Xiaoying; Zhang Wenteng; Xu Le

2011-01-01

71

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

Directory of Open Access Journals (Sweden)

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

Barnestein-Fonseca Pilar; Leiva-Fernández José; Vidal-España Francisca; García-Ruiz Antonio; Prados-Torres Daniel; Leiva-Fernández Francisca

2011-01-01

72

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

UK PubMed Central (United Kingdom)

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

Barnestein-Fonseca P; Leiva-Fernández J; Vidal-España F; García-Ruiz A; Prados-Torres D; Leiva-Fernández F

2011-01-01

73

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

UK PubMed Central (United Kingdom)

BACKGROUND: The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies. METHODS: In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and 79 control subjects without diabetes were studied. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any of the carotid vessel segments. Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on Doppler ultrasound examination. The clinical features of carotid atherosclerotic lesions were analysed, and the risk factors associated with carotid atherosclerosis were evaluated using binary logistic regression in patients with diabetes. RESULTS: The prevalence of carotid atherosclerosis was significantly higher in the ketosis-onset diabetic group (30.80%) than in the control group (15.2%, p=0.020) after adjusting for age- and sex-related differences, but no significant difference was observed in comparison to the non-ketotic diabetic group (35.8%, p=0.487). The mean CIMT of the ketosis-onset diabetics (0.70±0.20 mm) was markedly higher than that of the control subjects (0.57±0.08 mm, p<0.001), but no significant difference was found compared with the non-ketotic type 2 diabetics (0.73±0.19 mm, p=0.582) after controlling for differences in age and sex. In both the ketosis-onset and the non-ketotic diabetes, the prevalence of carotid atherosclerosis was markedly increased with age (both p<0.001) after controlling for sex, but no sex difference was observed (p=0.479 and p=0.707, respectively) after controlling for age. In the ketosis-onset diabetics, the presence of carotid atherosclerosis was significantly associated with age, hypertension, low-density lipoprotein cholesterol and mean CIMT. CONCLUSIONS: The prevalence and risk of carotid atherosclerosis were significantly higher in the ketosis-onset diabetics than in the control subjects but similar to that in the non-ketotic type 2 diabetics. The characteristics of carotid atherosclerotic lesions in the ketosis-onset diabetics resembled those in the non-ketotic type 2 diabetics. Our findings support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes.

Li LX; Zhao CC; Ren Y; Tu YF; Lu JX; Wu X; Zhang WX; Zhu JA; Li MF; Yu LB; Bao YQ; Jia WP

2013-01-01

74

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

Directory of Open Access Journals (Sweden)

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.

Schnell Kerry; Weiss Carlos O; Lee Todd; Krishnan Jerry A; Leff Bruce; Wolff Jennifer L; Boyd Cynthia

2012-01-01

75

Bipolar symptoms in adult attention-deficit/hyperactivity disorder: a cross-sectional study of 510 clinically diagnosed patients and 417 population-based controls.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Bipolar spectrum disorders (BSD) have several symptoms and features in common with attention-deficit/hyperactivity disorder (ADHD). Here we explored the prevalence of BSD and the relationship between symptoms of BSD and ADHD in adult ADHD patients. METHOD: Norwegian adults diagnosed with DSM-IV ADHD during 1997 through 2007 (n = 510) and a random sample of 417 controls from the general population (aged 18-40 years) were recruited and responded to 85 questions rating symptoms of ADHD, lifetime symptoms of mood disorders, other comorbid conditions, and sociodemographic data. RESULTS: According to the Mood Disorder Questionnaire (MDQ), 50.6% of the ADHD patients screened positive for BSD, compared to 8.3% of the controls. In comparison, the prevalence of BSD according to DSM-IV in a subsample of interviewed patients (n = 50) was 32%. In the whole study sample (N = 927), an ADHD diagnosis was the strongest predictor for screening positive on the MDQ (OR = 5.0, P < .001), but the correlation between dimensional symptom levels of ADHD and of BSD was strongest in the control group (Pearson correlation r = 0.7, P < .001 vs r = 0.3, P < .001). Patients screening positive on the MDQ had significantly more drug problems, higher ADHD symptom scores, and lower educational and occupational levels. CONCLUSIONS: Our findings illustrate the close relationship between some symptoms of BSD and ADHD in adults. In clinical and research settings, patients screening positive for BSD should be assessed for a possible underlying or coexisting ADHD condition and vice versa.

Halmøy A; Halleland H; Dramsdahl M; Bergsholm P; Fasmer OB; Haavik J

2010-01-01

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Diagnósticos de enfermagem documentados para pacientes de clínica médica Diagnósticos de enfermería documentados para pacientes de clínica médica Documented nursing diagnoses for medical clinic patients  

Directory of Open Access Journals (Sweden)

Full Text Available Este artigo relata estudo descritivo, de análise de registros, dos diagnósticos de enfermagem documentados após três meses da implementação da classificação da NANDA-I no HU-USP e propõe resultados e intervenções para os três diagnósticos mais freqüentes. A amostra de conveniência, de 34% das internações no mês, constituiu-se de 30 prontuários de pacientes internados na Clínica Médica em agosto de 2004 (60% mulheres; idade média 60,9±23,1 anos; média de internação=5,8±2,7 dias). Os diagnósticos documentados nos prontuários, no primeiro dia de internação, foram manualmente transcritos e analisados segundo freqüências. Foram documentados 144 diagnósticos (31 categorias diagnósticas); com média de 4,8(± 4,0) diagnósticos por paciente (variação = 1 a 10) e os mais freqüentes foram: Dor aguda (66,7%), Integridade tissular prejudicada (63,3%), Desobstrução ineficaz de vias aéreas (43,3%), Risco para integridade da pele prejudicada (36,7%) e Integridade da pele prejudicada (33,3%). São apresentadas propostas de resultados e intervenções para os três mais freqüentes.Este artículo relata un estudio descriptivo, de analice de registros, de los diagnósticos de enfermería documentados tres meses después de la implementación de la clasificación de la NANDA-I en el HU-USP. La muestra de conveniencia (34% de las internaciones en el mes) constituyó de 30 prontuarios de pacientes internados en la Clínica Médica en agosto de 2004 (60% sexo femenino; edad promedio: 60,9±23,1 años; media de internación: 5,8±2,7 días). Los diagnósticos documentados en el primer día de hospitalización fueron manualmente transcritos y analizados según sus frecuencias. Fueron documentados 144 diagnósticos (31 categorías), media de 4,8± 4,0 por paciente (variación = 1-10) y los más frecuentes fueron: Dolor agudo (66,7%), Deterioro de la integridad tisular (63,3%), Limpieza inefectiva de las vías aéreas (43,3%), Riesgo de deterioro de la integridad cutánea (36,7%) y Deterioro de la integridad cutánea (33,3%). Son presentados los resultados e intervenciones para los 3 más frecuentes.This paper reports a descriptive study, based on nursing records, of nursing diagnoses documented three months after the implementation of the NANDA-I classification at the University of São Paulo's Hospital Universitário (HU-USP) and proposes outcomes and interventions for the 3 most frequent diagnoses. The convenience sample (34% of the month's admissions) consisted of 30 charts of patients admitted in the Medical Clinic in August of 2004 (60% female, average age 60.9±23.1 years, mean length of stay = 5.8±2.7 days). The diagnoses documented on the admission day were manually transcribed from the charts and analyzed according to their frequency. There were 144 diagnoses (31 categories), with an average of 4.8±4.0 diagnoses per patient (range = 1-10). The most frequent were: acute pain (66.7%), impaired tissue integrity (63.3%), ineffective airway clearance (43.3%), risk of impaired skin integrity (36.7%), and impaired skin integrity (33.3%). The proposed outcomes and interventions are presented.

Cassiana Mendes Bertoncello Fontes; Diná de Almeida Lopes Monteiro da Cruz

2007-01-01

77

Clinical manifestation and neuroimaging methods in diagnosing basal ganglia calcifications.  

Science.gov (United States)

The aim of this case study was to evaluate the clinical symptoms in patients with basal ganglia calciications and compare the neuroimaging methods used in conirming this state. The clinical status and performed transcranial sonography of basal ganglia structures in patients with brain calciications found by computed brain tomography was examined. In one of these patients DaTSCAN was performed. A large spectrum of different symptoms was found. Transcranial sonography of basal ganglia showed the hyperechogenicity of nucleus lenticularis in eight out of 10 patients. DaTSCAN, which was performed to one patient with parkinsonian signs and the hyperechogenicity of substantia nigra found by transcranial sonography, was normal. Transcranial sonography is a newly neuroimaging method which can contribute to diagnosing basal ganglia calciications in patients with different neurological signs. Computed tomography of brain remains the most adequate technique in visualising calciications. PMID:23348181

Stenc Bradvica, Ivanka; Jan?uljak, Davor; Butkovi?-Soldo, Silva; Mihaljevi?, Ivan; Vladeti?, Mirjana; Bradvica, Mario

2013-02-01

78

Clinical manifestation and neuroimaging methods in diagnosing basal ganglia calcifications.  

UK PubMed Central (United Kingdom)

The aim of this case study was to evaluate the clinical symptoms in patients with basal ganglia calciications and compare the neuroimaging methods used in conirming this state. The clinical status and performed transcranial sonography of basal ganglia structures in patients with brain calciications found by computed brain tomography was examined. In one of these patients DaTSCAN was performed. A large spectrum of different symptoms was found. Transcranial sonography of basal ganglia showed the hyperechogenicity of nucleus lenticularis in eight out of 10 patients. DaTSCAN, which was performed to one patient with parkinsonian signs and the hyperechogenicity of substantia nigra found by transcranial sonography, was normal. Transcranial sonography is a newly neuroimaging method which can contribute to diagnosing basal ganglia calciications in patients with different neurological signs. Computed tomography of brain remains the most adequate technique in visualising calciications.

Stenc Bradvica I; Jan?uljak D; Butkovi?-Soldo S; Mihaljevi? I; Vladeti? M; Bradvica M

2013-02-01

79

Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain.  

UK PubMed Central (United Kingdom)

OBJECT: A spinal epidural abscess (SEA) is rare but potentially devastating if not diagnosed early. Unfortunately, diagnostic delays and associated neurological deficits are common. The objectives of this analysis were to explore the use of a novel clinical decision guideline to screen patients who present to the emergency department (ED) with spine pain for SEA and to determine the diagnostic test characteristics of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level in patients at risk for SEA. METHODS: This was a prospective, cohort analysis comparing the incidence of diagnostic delays and presence of motor deficits at the time of diagnosis before and after implementation of a novel decision guideline using risk factor assessment followed by ESR and CRP testing prior to definitive imaging. A delay was defined as either multiple ED visits or admission to a nonsurgical service without a diagnosis of SEA. A 9-month substudy was performed in all patients who presented to the ED with spine pain so that the diagnostic test characteristics of the ESR and CRP level could be defined. RESULTS: A total of 55 patients with an SEA in the 9-year control period and 31 patients with an SEA in the 5-year study period were identified. Diagnostic delays were observed in 46 (83.6%) of 55 patients before guideline implementation versus 3 (9.7%) of 31 after guideline implementation (p < 0.001). Motor deficits were present at the time of diagnosis in 45 (81.8%) of 55 patients before guideline implementation versus 6 (19.4%) of 31 after guideline implementation (p < 0.001). The sensitivity and specificity of ESR in patients with an SEA risk factor were 100% and 67%, respectively. The receiver operating characteristic curve analysis revealed better test characteristics for ESR (area under curve 0.96) than for CRP (area under curve 0.81). CONCLUSIONS: A treatment guideline incorporating risk factor assessment followed by ESR and CRP testing was highly sensitive and moderately specific in identifying ED patients with SEA. A decrease in diagnostic delays and a lower incidence of motor deficits at the time of diagnosis was observed.

Davis DP; Salazar A; Chan TC; Vilke GM

2011-06-01

80

Phase II clinical study of boron neutron capture therapy combined with X-ray radiotherapy/temozolomide in patients with newly diagnosed glioblastoma multiforme—Study design and current status report  

International Nuclear Information System (INIS)

Recently, we reported our clinical experiences of boron neutron capture therapy (BNCT) for the newly diagnosed glioblastoma. The major differences of our protocol from the other past studies were simultaneous use of both sodium borocapate and boronophenylalanine, and combination with fractionated X-ray irradiation. These results showed the efficacy of combination therapy with external beam X-ray irradiation and BNCT. For our future study, we planned the multi-centric phase II clinical study for newly diagnosed glioblastoma patients in Japan (OSAKA-TRIBRAIN0902, NCT00974987).

2011-01-01

 
 
 
 
81

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  

Directory of Open Access Journals (Sweden)

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.

Juan Francisco Gálvez Flórez; David Andrés Rincón Salazar

2008-01-01

82

Development and validation of a clinical guideline for diagnosing blepharospasm.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To design and validate a clinical diagnostic guideline for aiding physicians in confirming or refuting suspected blepharospasm. METHODS: The guideline was developed and validated in a 3-step procedure: 1) identification of clinical items related to the phenomenology of blepharospasm, 2) assessment of the relevance of each item to the diagnosis of blepharospasm, and 3) evaluation of the reliability and diagnostic sensitivity/specificity of the selected clinical items. RESULTS: Of 19 clinical items initially identified, 7 were admitted by content validity analysis to further assessment. Both neurologists and ophthalmologists achieved satisfactory interobserver agreement for all 7 items, including "involuntary eyelid narrowing/closure due to orbicularis oculi spasms," "bilateral spasms," "synchronous spasms," "stereotyped spasm pattern," "sensory trick," "inability to voluntarily suppress the spasms," and "blink count at rest." Each selected item yielded unsatisfactory accuracy in discriminating patients with blepharospasm from healthy subjects and patients with other eyelid disturbances. Combining the selected items, however, improved diagnostic sensitivity/specificity. The best combination, yielding 93% sensitivity and 90% specificity, was an algorithm starting with the item "stereotyped, bilateral, and synchronous orbicularis oculi spasms inducing eyelid narrowing/closure" and followed by recognition of "sensory trick" or, alternatively, "increased blinking." CONCLUSION: This study provides an accurate and valid clinical guideline for diagnosing blepharospasm. Use of this guideline would make it easier for providers to recognize dystonia in clinical and research settings.

Defazio G; Hallett M; Jinnah HA; Berardelli A

2013-07-01

83

Baseline Demographic, Clinical and Laboratory Parameters Related with 24 Hour Urinary Sodium Excretion in Newly Diagnosed Patients with Type 2 Diabetes  

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Full Text Available OBJECTIVE: Hypertension is very frequently observed in patients with Type 2 diabetes. Increased salt intake has been shown to be related with elevated blood pressure. However, factors related with 24 hour urinary sodium (Na) excretion as a measure of Na intake is not specifically addressed in patients with newly diagnosed Type 2 diabetic patients.MATERIAL and METHODS: All patients underwent history taking, physical examination, blood pressure measurement, electocardiography, biochemical analysis, spot urine analysis, 24-hour urine collection to measure 24-hour urinary albumin, protein, sodium excretion and creatinine clearance.RESULTS: In total, 114 patients were enrolled. Spearman correlation analysis revealed that 24-hour urinary Na excretion was correlated with body mass index (BMI) ( rho: 0.265, p: 0.004). blood urea nitrogen (rho: -0.210, p: 0.025) creatinine clearance (rho: 0.313, p: 0.001), albumin (rho: 0.320, p: 0.001), hemoglobin (rho: 0.242, p: 0.013) and triglyceride (rho: 0.261, p: 0.008). Linear regression of independent factors revealed that BMI (B: 0.013, CI: 0.004-0.022, P: 0.004), presence of smoking (B: 0.132, CI: 0.02-0.243, P: 0.021), creatinine clearance (B: 0.002, CI: 0.001-0.004, P: 0.012), and triglyceride levels (B: 0.017, CI: 0.009-0.056, P: 0.003) were related with logarithmically converted 24-hour Na excretion.CONCLUSION: We demonstrated that BMI, creatinine clearance and serum triglyceride levels were independently associated with 24-hour urinary Na excretion in newly diagnosed Type 2 diabetic patients.

Af?ar, Bar??; K?rkpantur, Alper

2013-01-01

84

One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed. AIM: Assessing sociodemographic and clinical characteristics of young men (defined as ? 40 years) seeking first medical help for new onset ED as their primary sexual disorder. METHODS: Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). MAIN OUTCOME MEASURE: Descriptive statistics tested sociodemographic and clinical differences between ED patients ? 40 years and >40 years. RESULTS: New onset ED as the primary disorder was found in 114 (26%) men ? 40 years (mean [standard deviation [SD

Capogrosso P; Colicchia M; Ventimiglia E; Castagna G; Clementi MC; Suardi N; Castiglione F; Briganti A; Cantiello F; Damiano R; Montorsi F; Salonia A

2013-07-01

85

Clinical Study Pathologic Findings in MRI-Guided Needle Core Biopsies of the Breast in Patients with Newly Diagnosed Breast Cancer  

International Nuclear Information System (INIS)

The role of MRI in the management of breast carcinoma is rapidly evolving from its initial use for specific indications only to a more widespread use on all women with newly diagnosed early stage breast cancer. However, there are many concerns that such widespread use is premature since detailed correlation of MRI findings with the underlying histopathology of the breast lesions is still evolving and clear evidence for improvements in management and overall prognosis of breast cancer patients evaluated by breast MRI after their initial cancer diagnosis is lacking. In this paper, we would like to bring attention to a benign lesion that is frequently present on MRI-guided breast biopsies performed on suspicious MRI findings in the affected breast of patients with a new diagnosis of breast carcinoma

2011-01-01

86

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

UK PubMed Central (United Kingdom)

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' area 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?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.

de Waroux OL; Hughes G; Maguire H; Crook PD

2013-07-01

87

Exercise recommendations in patients with newly diagnosed fibromyalgia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate exercise recommendations in patients newly diagnosed with fibromyalgia. DESIGN: A retrospective chart review. SETTING: A public university rheumatology clinic. PATIENTS: Patients newly diagnosed with fibromyalgia (N = 122). MAIN OUTCOME MEASUREMENTS: Frequency and type of exercise recommendations. RESULTS: The mean (standard deviation) age of these patients with fibromyalgia was 45 ± 12 years; 91% were women. Exercise was recommended as part of the documented treatment plan in 47% of these patients (57/122); only 3 patients had a documented contraindication for exercise. Aquatic exercise was most frequently recommended (56% [32/57]), followed by combined aquatic-aerobic exercise (26% [15/57]), and, infrequently, aerobic exercise only (5% [3/57]); only 7% of these patients (4/57) were referred for physical therapy. The primary method of communication was verbal discussion (94% [54/57]). CONCLUSIONS: Although there is well-documented evidence that exercise is beneficial for patients with fibromyalgia, we found that less than half of patients with newly diagnosed fibromyalgia in our study were provided recommendations to initiate an exercise program as part of their treatment plan. Further investigation of these findings are warranted, including evaluation of other university and community rheumatology practices as well as that of other physicians caring for patients with fibromyalgia. However, our findings indicate that there appears to be an opportunity to provide more specific and practical education regarding the implementation of an exercise regimen for patients with newly diagnosed fibromyalgia. Physiatrists may be particularly well suited to manage the exercise component of patients with fibromyalgia because of their specialized training in exercise prescription.

Wilson B; Spencer H; Kortebein P

2012-04-01

88

A patient with MRSA infection to prosthesis of femoral head diagnosed non-invasively using bi-digital O-ring test: a clinical case report.  

Science.gov (United States)

Prosthesis of femoral head is a common surgical procedure, but the diagnosis of infection associated with the prosthesis remains difficult. We diagnosed non-invasively methicillin resistant Staphylococcus aureus (MRSA) infection of prosthesis of femoral head with Bi-Digital O-Ring Test (BDORT). BDORT uses the resonance phenomenon between 2 identical substances, and electromagnetic field principle. The method can non-invasively detect viral & bacterial infection. Accuracy of the BDORT findings was confirmed through bacterial culture & sensitivity test to antibiotics. Patient was successfully treated with operation of evulsion of the prosthesis of femoral head and administration of antibiotics and Cilantro. The drug compatibility was tested with BDORT. BDORT was an effective technique for non-invasively detecting infection of prosthesis and selecting the most effective antibiotics. PMID:12934960

Asou, Tomnohiro; Hayashi, Takuo; Jitsuiki, Ikuko; Muneshige, Hiroshi; Kimura, Hiroaki; Nagatomi, Akiyoshi; Kaseguma, Emi

2003-01-01

89

A patient with MRSA infection to prosthesis of femoral head diagnosed non-invasively using bi-digital O-ring test: a clinical case report.  

UK PubMed Central (United Kingdom)

Prosthesis of femoral head is a common surgical procedure, but the diagnosis of infection associated with the prosthesis remains difficult. We diagnosed non-invasively methicillin resistant Staphylococcus aureus (MRSA) infection of prosthesis of femoral head with Bi-Digital O-Ring Test (BDORT). BDORT uses the resonance phenomenon between 2 identical substances, and electromagnetic field principle. The method can non-invasively detect viral & bacterial infection. Accuracy of the BDORT findings was confirmed through bacterial culture & sensitivity test to antibiotics. Patient was successfully treated with operation of evulsion of the prosthesis of femoral head and administration of antibiotics and Cilantro. The drug compatibility was tested with BDORT. BDORT was an effective technique for non-invasively detecting infection of prosthesis and selecting the most effective antibiotics.

Asou T; Hayashi T; Jitsuiki I; Muneshige H; Kimura H; Nagatomi A; Kaseguma E

2003-01-01

90

Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: Summary of a public health/clinical collaborative meeting.  

UK PubMed Central (United Kingdom)

Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions, which emerged from the meeting. It was recognized that wide-spread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidencebased genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships.

Bellcross CA; Bedrosian SR; Daniels E; Duquette D; Hampel H; Jasperson K; Joseph DA; Kaye C; Lubin I; Meyer LJ; Reyes M; Scheuner MT; Schully SD; Senter L; Stewart SL; St Pierre J; Westman J; Wise P; Yang VW; Khoury MJ

2011-10-01

91

Role of pelvic phased array magnetic resonance imaging in staging of prostate cancer specifically in patients diagnosed with clinically locally advanced tumours by digital rectal examination.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To assess the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) for the prediction of extracapsular extension (ECE) in patients with clinical T3 (cT3) prostate cancer (PCa) compared to digital rectal examination (DRE). MATERIALS AND METHODS: A retrospective review of data for patients treated by radical prostatectomy for cT3 PCa was performed. Patients who underwent MRI in the pre-operative work-up were included. The likelihoods of extracapsular extension (T3a) and seminal vesicle invasion (T3b) were scored on the basis of MR images. For data analysis, receiver operating characteristic (ROC) curves were generated. RESULTS: Overall, 70 consecutive patients were included. Mean age was 63.8 (range 45-75) years, and the mean PSA level was 11.3 (range 2.9-26) ng/ml. Pathological analysis of the prostatic specimens confirmed 81.4% (n = 57) had pT3 disease. According to MRI, 57 (81.4%) patients were predicted correctly to have T3 disease. The overstaging (actual pT2) by either DRE or MRI or both was 18.6, 7 or 7%, respectively. The sensitivity, specificity and positive (PPV) and negative predictive values (NPV) of MRI were 94.7, 69, 93 and 75%. The kappa index of concordance between pre-operative MRI stage and pathological stage was 0.68 (P < 0.00001). The performance of MRI for T3 staging was AUC 0.87 (95% CI, 0.77-0.97). CONCLUSIONS: Pre-prostatectomy MRI adds significant incremental value to the assessment of patients with cT3 disease. Its ability to accurately predict and characterize pathological T3 status and its superiority to standard clinical variables (e.g. DRE) confirm its usefulness in pre-operative work-up.

Xylinas E; Yates DR; Renard-Penna R; Seringe E; Bousquet JC; Comperat E; Bitker MO; Grenier P; Rouprêt M

2013-08-01

92

"Testing-only" visits: an assessment of missed diagnoses in clients attending sexually transmitted disease clinics.  

UK PubMed Central (United Kingdom)

BACKGROUND: At sexually transmitted disease (STD) clinics, advances in testing technology coupled with increasing demands and diminishing resources have promoted the use of testing-only visits (clinic visits with testing for STDs but no full examination) to meet increasing demands for STD services. OBJECTIVES: The aims of the present study were to estimate the prevalence of STD diagnoses that could become "missed diagnoses" if patients would use testing-only visits and to examine patient characteristics associated with these potential missed diagnoses. METHODS: We conducted a self-administered survey of STD-related symptoms and sexual risk behaviors in patients seeking routine clinical care at 3 STD clinics. Medical charts were abstracted to estimate the prevalence of viral STDs, trichomoniasis, and other diagnoses from standard clinical services that could become missed diagnoses. RESULTS: Of 2582 patients included, the median age was 24 years and 50% were women. In women, overall, 3.2% were diagnosed as having a viral STD; 9.6%, trichomoniasis; and 41.0%, vulvovaginal candidiasis or symptomatic bacterial vaginosis. The prevalence of these potential missed diagnoses varied by patient characteristics, but in women who reported no symptoms, the prevalence of trichomoniasis was still 6.3%. In men, 19.3% received a diagnosis of urethritis but tested negative for both gonorrhea and chlamydia; this prevalence varied from 15.7% in those who reported no symptoms to 32.6% in those who reported malodor. CONCLUSIONS: A high proportion of STD clients received diagnoses from standard care visits that would be missed by testing-only visits. When patients, even those asymptomatic, use testing-only visits, missed diagnoses of STDs or related genital tract conditions can be substantial. The potential disadvantages of testing-only visits should be weighed against the advantages of such visits.

Xu F; Stoner BP; Taylor SN; Mena L; Martin DH; Powell S; Markowitz LE

2013-01-01

93

Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

Nagarajan Sripriya; Pushpanjali K

2008-01-01

94

Patient specific modelling in diagnosing depression  

DEFF Research Database (Denmark)

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

Ottesen, Johnny T.

2013-01-01

95

A 2.84?Mb deletion at 21q22.11 in a patient clinically diagnosed with marden-walker syndrome.  

UK PubMed Central (United Kingdom)

We present a girl with the characteristic clinical picture associated with Marden-Walker syndrome (MWS; OMIM 248700), including mask-like face with blepharophimosis, joint contractures, intellectual disability, a multicystic dysplastic kidney and cerebral dysgenesis. The long-term follow-up allowed us to monitor the evolution of the phenotype in this patient, and among the main findings we highlight the following: demyelination of the pyramidal tract demonstrated by transcranial magnetic stimulation and the involvement of the levator muscles of angle of mouth in fixed facial expression with relative integrity of the rest of the facial expression muscles. A 244?k array comparative genomic hybridization (aCGH) was carried out and showed a de novo interstitial deletion of approximately 2.84?Mb affecting only the cytoband 21q22.11 (genome coordinates chr21:31,874,016-34,711,763). We selected 10 of the most recent published cases with either total or partial deletions of cytoband 21q22.11 that provided good characterization of the genomic size or the genes in the deleted regions. We observed that in nine of the 10 cases the deleted regions included the RUNX1 gene in 21q22.12, which is not affected in the current patient's deletion or in that of Patient 3 from Roberson et al. [2011]. After a comparison of shared deleted genes between cases, and correlation of their potential phenotypes, we concluded that the pattern of defects considered for a diagnosis of MWS may represent part of the phenotypic expression of a partial or total deletion of 21q22.11. © 2013 Wiley Periodicals, Inc.

Carrascosa-Romero MC; Suela J; Pardal-Fernández JM; Bermejo-Sánchez E; Vidal-Company A; Macdonald A; Tébar-Gil R; Martínez-Fernández ML; Martínez-Frías ML

2013-09-01

96

A 2.84?Mb deletion at 21q22.11 in a patient clinically diagnosed with marden-walker syndrome.  

Science.gov (United States)

We present a girl with the characteristic clinical picture associated with Marden-Walker syndrome (MWS; OMIM 248700), including mask-like face with blepharophimosis, joint contractures, intellectual disability, a multicystic dysplastic kidney and cerebral dysgenesis. The long-term follow-up allowed us to monitor the evolution of the phenotype in this patient, and among the main findings we highlight the following: demyelination of the pyramidal tract demonstrated by transcranial magnetic stimulation and the involvement of the levator muscles of angle of mouth in fixed facial expression with relative integrity of the rest of the facial expression muscles. A 244?k array comparative genomic hybridization (aCGH) was carried out and showed a de novo interstitial deletion of approximately 2.84?Mb affecting only the cytoband 21q22.11 (genome coordinates chr21:31,874,016-34,711,763). We selected 10 of the most recent published cases with either total or partial deletions of cytoband 21q22.11 that provided good characterization of the genomic size or the genes in the deleted regions. We observed that in nine of the 10 cases the deleted regions included the RUNX1 gene in 21q22.12, which is not affected in the current patient's deletion or in that of Patient 3 from Roberson et al. [2011]. After a comparison of shared deleted genes between cases, and correlation of their potential phenotypes, we concluded that the pattern of defects considered for a diagnosis of MWS may represent part of the phenotypic expression of a partial or total deletion of 21q22.11. © 2013 Wiley Periodicals, Inc. PMID:23894067

Carrascosa-Romero, María Carmen; Suela, Javier; Pardal-Fernández, José Manuel; Bermejo-Sánchez, Eva; Vidal-Company, Alberto; Macdonald, Alexandra; Tébar-Gil, Roque; Martínez-Fernández, María Luisa; Martínez-Frías, María Luisa

2013-07-25

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Characteristics of HIV Infected Patients with Biopsy Diagnosed Spongiotic Dermatitis  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose. Twenty-six HIV patients with biopsy diagnosed spongiotic dermatitis (SD) were studied to determine their demographic and clinical characteristics. The condition was also investigated to determine if it was linked to the immune reconstitution inflammatory syndrome (IRIS). Methods. All patients whose skin biopsies were diagnosed by a pathologist as SD were identified. Medical records were reviewed to extract demographic descriptors, viral loads and CD4+ counts at the time that SD occurred. In an attempt to determine if the condition could be linked to Immune Reconstitution Syndrome (IRIS), the time from nadir CD4+ count to the occurrence of SD was determined. Results. SD patients were found to be older than expected but were similar to other clinic patients with regard to race/ethnicity and gender. CD4+ counts, viral loads were not related to SD. SD did not seem to be related to IRIS because few cases occurred within the time frame associated with IRIS. SD frequently appeared on the limbs although the literature suggests a more frequent appearance on the trunk and buttocks. Discussion. HIV clinicians may expect to see SD on occasion and it may appear in unusual body sites and at any time during the course of the infection.

Gus W. Krucke; Benjamin L. Cooper; Deanna E. Grimes; Richard M. Grimes

2011-01-01

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Overall prognosis of patients with diagnosed chronic organic solvent intoxication  

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The prognosis of 87 patients (mean age 38.6 years) was examined who had been diagnosed 3-9 years earlier as having chronic organic solvent intoxication due to trichloroethylene, perchloroethylene, or a mixture of solvents. The methods comprised an interview, a clinical neurological examination, neurophysiological examinations (EEGs and electroneuromyographs), and a psychological examination. In order to assess the prognosis, the patient's condition at the time of diagnosis was evaluated from the hospital records, and the condition upon reexamination was compared to that at the time of diagnosis. At the time of diagnosis, 31 patients had objective clinical signs in the neurological examination, whereas the remaining 56 had only subjective symptoms and neurophysiological or psychological findings attributed to the slight solvent intoxication. Upon reexamination, 42 patients had clinical neurological signs. Based on the clinical overall evaluation, the condition of 21 patients had deteriorated during the follow-up period, the condition of 23 had improved, and that of 43 had remained unchanged. The prognoses of the results of the separate examinations correlated poorly with each other. No statistically significant correlation was found between the overall prognosis and age, sex, the duration and the level of exposure, the termination of exposure after diagnosis, the presence of other diseases, or the use of alcohol.

Antti-Poika, M.

1982-12-01

99

[Relationship between insight, violence and diagnoses in psychotic patients].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Lack of insight is a common clinical problem in psichiatric patients, but few times has been properly studied until recently. Patients with good insight tend to show a better treatment adherence with a better prognosis and swow less hostility. This study aims to investigate whether there is a relationship between the hostility degree and insight or not and to anlalyze if there are insight quantitative differences between the patients regarding their diagnoses. METHOD: 168 psychotic patients were studied (including 86 patients with schizophrenia and 43 with bipolar disorder). PANNS P7 (hostility) item and G14 (poor impulse control) were analized in order to assess patients' violence and G12 in order to assess insight. All these data was correlated. It was also analyzed the PANSS results of schizophrenic vs bipolar patients regarding insight and hostility separately looking for a more homogenic pull of patients. RESULTS: Patients with greater hostility showed a worse impulse control and poorer insight than the rest. Schizophrenic patients showed a greater hostility and lower insight than bipolar patients. DISCUSSION: Lack of insight may lead to a greater hostility and worse impulse control. Therapeutic interventions adressed to improve insight could indirectly lower hostility and gain a better impulse control for psychotic patients.

Lera Calatayud G; Herrero Sebastián N; Aguilar García-Iturrospe E; González Piqueras JC; Sanjuán Arias J; Leal Cercós C

2012-01-01

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

Scientific Electronic Library Online (English)

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

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

2011-12-01

 
 
 
 
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Factuality levels of diagnoses in Swedish clinical text.  

UK PubMed Central (United Kingdom)

Different levels of knowledge certainty, or factuality levels, are expressed in clinical health record documentation. This information is currently not fully exploited, as the subtleties expressed in natural language cannot easily be machine analyzed. Extracting relevant information from knowledge-intensive resources such as electronic health records can be used for improving health care in general by e.g. building automated information access systems. We present an annotation model of six factuality levels linked to diagnoses in Swedish clinical assessments from an emergency ward. Our main findings are that overall agreement is fairly high (0.7/0.58 F-measure, 0.73/0.6 Cohen's ?, Intra/Inter). These distinctions are important for knowledge models, since only approx. 50% of the diagnoses are affirmed with certainty. Moreover, our results indicate that there are patterns inherent in the diagnosis expressions themselves conveying factuality levels, showing that certainty is not only dependent on context cues.

Velupillai S; Dalianis H; Kvist M

2011-01-01

102

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

Scientific Electronic Library Online (English)

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

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

2011-12-01

103

New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951.  

UK PubMed Central (United Kingdom)

BACKGROUND: The prognosis of patients with anaplastic oligodendrogliomas (AOD) and oligoastrocytomas (AOA) is variable. Biomarkers might be helpful to identify more homogeneous disease subtypes and improve therapeutic index. The aim of this study is to develop new clinical, pathological and molecular prognostic models for locally diagnosed anaplastic gliomas with oligodendroglial features (AOD or AOA). METHODS: Data from 368 patients with AOD or AOA recruited in The European Organisation for Research and Treatment of Cancer (EORTC) trial 26951 on adjuvant PCV (Procarbazine, CCNU, Vincristine) chemotherapy in anaplastic oligodendroglial tumours were used to develop multifactor models to predict progression free survival (PFS) and overall survival (OS). Different models were compared by their percentage of explained variation (PEV). Prognostic calculators were derived from these new models. RESULTS: Treatment (for PFS only), younger age, confirmed absence of residual tumour on imaging, frontal location, good World Health Organisation (WHO) performance status, absence of endothelial abnormalities and/or necrosis, 1p/19q codeletion and Isocitrate dehydrogenase 1 (IDH1) mutation were independent factors that predicted better PFS and OS. CONCLUSIONS: We identified important prognostic factors for AOD and AOA and showed that molecular markers added a major contribution to clinical and pathological factors in explaining PFS and OS. With a positive predictive value of 92% for PFS and 94% for OS, our models allow physicians to precisely identify high risk patients and aid in making therapeutic decisions.

Gorlia T; Delattre JY; Brandes AA; Kros JM; Taphoorn MJ; Kouwenhoven MC; Bernsen HJ; Frénay M; Tijssen CC; Lacombe D; van den Bent MJ

2013-07-01

104

Agreement on diagnoses of mental health problems between an online clinical assignment and a routine clinical assignment.  

UK PubMed Central (United Kingdom)

We examined the agreement between diagnoses assigned based on the Development and Well Being Assessment (DAWBA) information collected online, and ordinary day-to-day diagnostic assignment by Child and Adolescent Mental Health Service (CAMHS) clinicians. Diagnoses were compared for 286 patients. Raw agreement for diagnostic categories was 74-90%, resulting in kappa values of 0.41-0.49. Multinomial regression models for 'emotional diagnosis' and 'hyperkinetic/conduct diagnosis' were significant (P < 0.001). Age, gender and number of informants significantly contributed to the explanation of agreement and disagreement. Agreement on mental health diagnoses may be sufficient to replace routine clinical assignment of diagnoses with an online clinical assignment, thereby saving time and resources.

Brøndbo PH; Mathiassen B; Martinussen M; Handegård BH; Kvernmo S

2013-02-01

105

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

Scientific Electronic Library Online (English)

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

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

2008-01-01

106

Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia.  

UK PubMed Central (United Kingdom)

Duration of survival from time of first evaluation was studied in 61 patients with clinically diagnosed Alzheimer's disease (senile dementia of the Alzheimer type [SDAT]) and 34 patients with clinically diagnosed multi-infarct dementia (MID). Duration of survival did not differ significantly between MID and SDAT. However, since MID patients were younger at onset, MID patients had a lower life quotient than SDAT patients. Race, sex, and age at onset were not predictive of survival in SDAT. History of hypertension, elevated systolic blood pressure, lower scores on tests of Block Designs, and Logico-Grammatical Comprehension predicted shorter survival in SDAT. Age at onset and race were not predictive of survival in MID. Male sex, lower educational attainment, as well as low scores on tests of Logico-Grammatical Comprehension, Digit Span, Naming, Verbal Fluency, and receptive vocabulary, predicted shorter survival in MID.

Hier DB; Warach JD; Gorelick PB; Thomas J

1989-11-01

107

Childhood tuberculosis in household contacts of newly diagnosed TB patients.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Childhood tuberculosis (TB), although estimated to account for a major proportion of the global TB disease burden, has a lower public health priority. Reliable research and surveillance data on childhood TB is limited in most regions of the world. This study was conducted to assess the burden of childhood TB among the household contacts of new TB patients in Karachi, Pakistan. METHODS: A retrospective analysis of children (<15 years) who were household contacts of new adult TB patients presenting to Marie Adelaide Leprosy Center (MALC) clinics in Karachi during the period of 2008 to 2010 was conducted. RESULTS: Of the household children contacts (n = 6613) screened, 317 were suspected and 121(1.8%) diagnosed with TB. These included 89 (73.6%) with pulmonary and 32 (26.4%) with extra-pulmonary disease. Smear positivity rate in pulmonary cases was 32.6%. Mean age of children diagnosed with TB was 11.7 (± 2.8) years. Within the child-contacts screened, disease was found to be significantly higher among females (2.3%) in comparison to males (1.2%) (p-value <0.01). The commonest relationship of source cases to diagnosed children was the mother (n = 51, 42.1%). The source case was a female for 66.1% (n = 76) of the children. CONCLUSION: A smear positivity rate of 32.6% amongst pulmonary cases suggests their potential to spread disease and emphasizes a need to review the contribution of children in transmission of TB within communities. Greater vulnerability of the female child and considerable role of mother in disease transmission highlights a need to increase focus on females in TB control programs in Pakistan.

Batra S; Ayaz A; Murtaza A; Ahmad S; Hasan R; Pfau R

2012-01-01

108

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

Directory of Open Access Journals (Sweden)

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

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

2008-01-01

109

The Value of Laboratory Tests in Diagnosing Secondary Osteoporosis at a Fracture and Osteoporosis Outpatient Clinic  

Science.gov (United States)

Background: As more and more patients meeting the criteria for osteoporosis are referred to a fracture and osteoporosis outpatient clinic (FO clinic), the laboratory costs to screen for secondary osteoporosis also increases. This study was conducted to determine the value of screening on underlying diseases at an FO clinic by obtaining a standard set of laboratory tests. Methods: We included all 541 patients ?50 years with a fracture referred to our FO clinic, during the period January 2005 to January 2007. The bone mineral density (BMD) was measured by dual energy x-ray absorptiometry and expressed as a T score. A standard set of laboratory tests was obtained to screen on underlying diseases. Results: Laboratory results were as often abnormal in patients with a normal BMD compared to patients with a low BMD. Underlying diseases were infrequently diagnosed. However, the prevalence of secondary osteoporosis in men was quite high, up to 18.2%. The costs to diagnose 1 patient with an underlying disease did vary between €92 and €972 depending on the group of patients described. Conclusion: Screening all patients, referred to an FO clinic, for underlying diseases by obtaining a standard set of laboratory tests is probably not useful since laboratory tests are as often abnormal in patients with a normal BMD compared to patients with a low BMD. Moreover, the prevalence of secondary osteoporosis is low, while laboratory costs are substantial.

de Klerk, Gijs; Hegeman, J. Han; van der Velde, Detlef; van der Palen, Job; van Bergeijk, Leo; Duis, Henk J. ten

2013-01-01

110

Clinical application of multislice CT angiogram in diagnosing celiac artery aneurysm  

International Nuclear Information System (INIS)

Objective: To investigate the clinical application of multislice CT angiogram (MSCTA) in diagnosing celiac artery aneurysm. Methods: MSCTA of 13 patients with celiac artery aneurysm was analyzed retrospectively. Abdominal MSCTA with volume rendering (VR), multiplanar reconstruction (MPR) and maximum intensity projection (MIP) was performed on all patients. Results: The location, shape, extent, wall of the 13 aneurysms and their relationship to the adjacent vessels were clearly and accurately shown by VR, MIP and MPR. Conclusion: With high sensitivity and specificity, MSCTA is the investigation of choice for diagnosing celiac artery aneurysm. (authors)

2011-01-01

111

Fatal cerebral malaria diagnosed after death in a French patient.  

Science.gov (United States)

We report on the case of a French citizen who was found dead in his home, 4 days after returning from Cameroon. The patient died of imported malaria, as revealed by the postmortem investigations. Few such cases have been reported throughout the world. This article reviews deaths due to malaria diagnosed at the time of autopsy in France between 1995 and 2005. We conclude that the nonspecific symptoms of malaria can lead to a misdiagnosis and the need for a forensic expert to intervene at the scene of death, which usually occurs in the home. We will remind forensic pathologists of the clinical, biologic, and forensic aspects of this infectious disease. In particular, the uses of microbiologic analyses, the QBC malaria test and the Core malaria Pan/Pv/pf test as well as brain tissue histology will be reviewed. PMID:20508488

Alunni-Perret, Veronique; Vandenbos, Fanny; Kechkekian, Aurore; Marty, Pierre; Legros, Fabrice; Michiels, Jean François; Cardot-Leccia, Nathalie; Fortineau, Nicolas; Durant, Jacques; Quatrehomme, Gérald

2010-09-01

112

Fatal cerebral malaria diagnosed after death in a French patient.  

UK PubMed Central (United Kingdom)

We report on the case of a French citizen who was found dead in his home, 4 days after returning from Cameroon. The patient died of imported malaria, as revealed by the postmortem investigations. Few such cases have been reported throughout the world. This article reviews deaths due to malaria diagnosed at the time of autopsy in France between 1995 and 2005. We conclude that the nonspecific symptoms of malaria can lead to a misdiagnosis and the need for a forensic expert to intervene at the scene of death, which usually occurs in the home. We will remind forensic pathologists of the clinical, biologic, and forensic aspects of this infectious disease. In particular, the uses of microbiologic analyses, the QBC malaria test and the Core malaria Pan/Pv/pf test as well as brain tissue histology will be reviewed.

Alunni-Perret V; Vandenbos F; Kechkekian A; Marty P; Legros F; Michiels JF; Cardot-Leccia N; Fortineau N; Durant J; Quatrehomme G

2010-09-01

113

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese INTRODUÇÃO: Estudos epidemiológicos brasileiros sobre artrite reumatoide são bastante escassos, e os dados existentes hoje são majoritariamente de literatura internacional. OBJETIVOS: Determinar a incidência e algumas características clínicas e laboratoriais de pacientes com artrite reumatoide em Cascavel, PR, Brasil. PACIENTES E MÉTODOS: Os dados foram coletados entre agosto de 2010 e julho de 2011 em todos os serviços de saúde do município que possuíam aten (more) dimento na especialidade de reumatologia: um hospital universitário, o Centro Regional de Especialidades do Consórcio Intermunicipal de Saúde do Oeste do Paraná (CRE-CISOP) e quatro clínicas privadas da cidade. RESULTADOS: Foram identificados 38 pacientes com diagnóstico de artrite reumatoide, resultando em uma incidência estimada de 13,4 casos/100.000 habitantes/ano. Trinta e dois pacientes eram do gênero feminino, com média de idade de 47,6 anos. A faixa etária com maior incidência foi > 40 anos. O tempo médio entre os primeiros sintomas e o diagnóstico foi de 12,4 meses. O fator reumatoide foi positivo em 68,4% dos casos, e 18,4% já apresentavam alterações radiológicas no momento do diagnóstico. O tratamento farmacológico dos pacientes também foi avaliado e mostrou estar de acordo com o encontrado na literatura. CONCLUSÃO: A incidência de artrite reumatoide obtida em Cascavel está abaixo das incidências observadas em estudos internacionais. Abstract in english INTRODUCTION: Brazilian epidemiological studies on rheumatoid arthritis are scarce, thus all data currently available originate from the international literature. OBJECTIVES: To determine the incidence and some clinical and laboratory characteristics of patients with rheumatoid arthritis in the municipality of Cascavel, state of Paraná, Brazil. PATIENTS AND METHODS: Data were collected between August 2010 and July 2011 in all health services of the municipality of Cascav (more) el 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.

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

2013-02-01

114

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

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

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

2013-01-01

115

The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan.  

UK PubMed Central (United Kingdom)

BACKGROUND: No prior twin study has explored the heritability of clinically diagnosed attention deficit hyperactivity disorder (ADHD). Such studies are needed to resolve conflicting results regarding the importance of genetic effects for ADHD in adults. We aimed to estimate the relative contribution of genetic and environmental influences for clinically diagnosed ADHD across the lifespan with a specific focus on ADHD in adults. METHOD: Information on zygosity and sex was obtained from 59514 twins born between 1959 and 2001 included in the nationwide population-based Swedish Twin Registry. Clinical data for ADHD diagnoses (i.e. stimulant or non-stimulant medication for ADHD) were obtained from the Swedish Prescribed Drug Register (PDR) and from the National Patient Register (i.e. ICD-10 diagnosis of ADHD). Twin methods were applied to clinical data of ADHD diagnoses using structural equation modeling with monozygotic (MZ) and dizygotic (DZ) twins. RESULTS: The best-fitting model revealed a high heritability of ADHD [0.88, 95% confidence interval (CI) 0.83-0.92] for the entire sample. However, shared environmental effects were non-significant and of minimal importance. The heritability of ADHD in adults was also substantial (0.72, 95% CI 0.56-0.84). CONCLUSIONS: This study shows that the heritability of clinically diagnosed ADHD is high across the lifespan. Our finding of high heritability for clinically diagnosed ADHD in adults indicates that the previous reports of low heritability are best explained by rater effects, and that gene-identification studies of ADHD in adults need to consider pervasiveness (e.g. multiple raters) and developmentally (e.g. childhood-onset criteria) informative data.

Larsson H; Chang Z; D'Onofrio BM; Lichtenstein P

2013-10-01

116

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

International Nuclear Information System (INIS)

[en] 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

2010-01-01

117

Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent condition with underexplored risk factors. OBJECTIVES: We sought to determine CRS incidence and evaluate associations with a range of premorbid medical conditions for chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) using real-world clinical practice data. METHODS: Electronic health records data from 446,480 Geisinger Clinic primary care patients were used for a retrospective longitudinal cohort study for data from 2001-2010. By using logistic regression, newly diagnosed CRS cases between 2007 and 2009 were compared with frequency-matched control subjects on premorbid factors in the immediate (0-6 months), intermediate (7-24 months), and entire observed timeframes before diagnosis. RESULTS: The average incidence of CRS was 83 ± 13 CRSwNP cases per 100,000 person-years and 1048 ± 78 CRSsNP cases per 100,000 person-years. Between 2007 and 2009, 595 patients with incident CRSwNP and 7523 patients with incident CRSsNP were identified and compared with 8118 control subjects. Compared with control subjects and patients with CRSsNP, patients with CRSwNP were older and more likely to be male. Before diagnosis, patients with CRS had a higher prevalence of acute rhinosinusitis, allergic rhinitis, chronic rhinitis, asthma, gastroesophageal reflux disease, adenotonsillitis, sleep apnea, anxiety, and headaches (all P < .001). Patients with CRSsNP had a higher premorbid prevalence of infections of the upper and lower airway, skin/soft tissue, and urinary tract (all P < .001). In the immediate and intermediate timeframes analyzed, patients with CRS had more outpatient encounters and antibiotic prescriptions (P < .001), but guideline-recommended diagnostic testing was performed in a minority of cases. CONCLUSIONS: Patients who are given a diagnosis of CRS have a higher premorbid prevalence of anxiety, headaches, gastroesophageal reflux disease, sleep apnea, and infections of the respiratory system and some nonrespiratory sites, which results in higher antibiotic, corticosteroid, and health care use. The use of guideline-recommended diagnostic testing for confirmation of CRS remains poor.

Tan BK; Chandra RK; Pollak J; Kato A; Conley DB; Peters AT; Grammer LC; Avila PC; Kern RC; Stewart WF; Schleimer RP; Schwartz BS

2013-05-01

118

Clinical features and differential diagnoses in laryngeal mucoepidermoid carcinoma.  

UK PubMed Central (United Kingdom)

Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. However, it is a rare entity in larynx. Laryngeal cases are frequently misdiagnosed with other malignancies and they are under-reported. So, recognizing the clinical and histological features of this tumor is essential. Laryngeal mucoepidermoid carcinoma can arise in supraglottis, glottis and subglottis. Generally, it presents as a submucosal mass; therefore, progressive symptoms without any identifiable lesion in laryngoscopy must be well considered. The prognosis is somehow dependent on the histological features. In high-grade tumors, recurrence is more common and radical surgery with radiotherapy is recommended. In this paper, we provide a thorough literature review on mucoepidermoid carcinoma in the larynx. The most important distinguishing features of mucoepidermoid carcinoma and its two major differential diagnoses (squamous cell carcinoma and adenosquamous carcinoma) are clearly stated and pitfalls in true diagnosis of this tumor are discussed.

Mokhtari S; Mokhtari S

2012-01-01

119

Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination  

International Nuclear Information System (INIS)

Purpose: Image-guided biopsy occasionally fails to diagnose small lung lesions, which are highly suggestive of primary lung cancer. The aim of the present study was to evaluate the outcome of stereotactic body radiotherapy (SBRT) for small lung lesions that were clinically diagnosed as primary lung cancer without pathologic confirmation. Methods and Materials: A total of 115 patients were treated with SBRT in 12 institutions. Tumor size ranged from 5 to 45 mm in diameter, with a median of 20 mm. Results: The 3-year and 5-year overall survival rates for patients with a tumor size ?20 mm in diameter (n = 58) were both 89.8%, compared with 60.7% and 53.1% for patients with tumors >20 mm (n = 57) (p 20 mm. Among the patients with a tumor size ?20 mm, Grade 2 pulmonary complications were observed in 2 (3.4%), but no Grade 3 to 5 toxicity was observed. In patients with a tumor size >20 mm, Grades 2, 3, and 5 toxicity were observed in 5 patients (8.8%), 3 patients (5.3%), and 1 patient (1.8%), respectively. Conclusion: In patients with a tumor ?20 mm in diameter, SBRT was reasonably safe in this retrospective study. The clinical implications of the high local control rate depend on the accuracy of clinical/radiologic diagnosis for small lung lesions and are to be carefully evaluated in a prospective study.

2009-11-01

120

Role of Platelet Parameters in Diagnosing Various Clinical Conditions  

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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

Amar R. Shah; Sanjay N. Chaudhari; Menka H. Shah

2013-01-01

 
 
 
 
121

[Characterization of nursing diagnoses of patients in a cardiology unit].  

UK PubMed Central (United Kingdom)

This retrospective, descriptive-exploratory study aimed to formulate the most frequent nursing diagnoses (ND) among inpatients with ischemic heart disease and its association with sociodemographic and clinical data. Data collection was carried out by an instrument based on defining characteristics and risk factors (Taxonomy II, North American Nursing Diagnosis Association International) and submitted to descriptive and inferential analyses to test the association between ND and demographic and clinical data. Seventy-seven ND were formulated, and 18 ND were above 75 percentile. From those ND, 15 were associated to at least one sociodemographic or clinical variable as gender, age, marital status, professional activity and associated clinical condition.

Nunciaroni AT; Gallani MC; Agondi Rde F; Rodrigues RC; Castro LT

2012-03-01

122

The cost of diagnosing Type 2 diabetes mellitus by clinical opportunistic screening in general practice.  

UK PubMed Central (United Kingdom)

AIMS: Type 2 diabetes is associated with serious complications and shortens life. Its prevalence is increasing rapidly worldwide and no cure is available. One logical response is to diagnose the condition as early as possible. Clinical opportunistic screening is one mechanism for making the diagnosis before symptoms are reported. This paper reports the cost of using this technique in UK general practice. METHODS: In one UK general practice, the electronic medical records were searched to determine the number of blood glucose and oral glucose tolerance tests undertaken for non-pregnant adults without known diabetes over three consecutive years. The laboratory, staff and administrative costs associated with these screening tests were calculated. The records of all patients newly diagnosed with Type 2 diabetes during the same period were reviewed to identify diagnoses made by clinical opportunistic screening. Total costs were divided by the number of diagnoses to determine a cost per diagnosis detected by opportunistic screening. RESULTS: During the study period, 5720 screening tests were conducted for 2763 patients. Over the 3 years, 86 patients were diagnosed with Type 2 diabetes, 54 (63%) via screening (yield 2.0%; number needed to screen 51.2). The screening costs totalled £ 20,372. The average cost per new screen-detected diagnosis was £ 377. CONCLUSIONS: Almost two-thirds of new cases of Type 2 diabetes can be detected before symptoms are reported, at reasonable cost by opportunistic screening in general practice, without the use of extra resources. As an affordable alternative to population screening, clinical opportunistic screening merits further consideration.

Pereira Gray DJ; Evans PH; Wright C; Langley P

2012-07-01

123

Can we clinically diagnose dementia with Lewy bodies yet?  

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Full Text Available Abstract Dementia with Lewy Bodies (DLB) was initially identified and confirmed primarily by pathology, but is soon to be incorporated into the Diagnostic and Statistical Manual criteria as a clinical disease entity. Despite these advances over more than 20 years, current data suggest that the sensitivity of accurate clinical diagnosis of DLB is still very low, although there is mounting evidence that supportive features may increase diagnostic accuracy. Although DLB remains easy to identify pathologically with different cellular pathologies differentiating it from other dementia syndromes, pathological identification using only Lewy body pathology has been shown to be inaccurate due to overlap with patients without dementia symptoms. A number of studies now suggest that a combination of cellular pathologies, which include ?-synuclein and ?-amyloid deposition as well as dopamine denervation, assist with differentiating this dementia syndrome from others. The clinical and pathological overlap with the tauopathy of Alzheimer’s disease still remains to be clarified. To determine more robust and independent clinicopathological correlates from Alzheimer’s disease, longitudinal prospective studies, using specific clinical batteries on dementia patients reaching the proposed criteria for DLB, with post-mortem assessment of the multiple pathologies associated with dementia, are required. Identifying genetic causes for DLB is another approach to investigate the pathogenesis of DLB. However this approach has been hindered to date by difficulties with identifying DLB clinically. The use of novel techniques is likely to advance knowledge on the pathogenesis of DLB and assist with redefining clinical and pathologic diagnostic criteria. To achieve the goal of more accurate clinical diagnosis of DLB, breakthroughs are necessary on the pathogenesis of DLB.

Huang Yue; Halliday Glenda

2013-01-01

124

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 (more) 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. Abstract in english 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 hi (more) gh 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.

Espinosa Brito, Alfredo D; Figueiras Ramos, Benigno; Rivero Berovides, Juan D; del Sol Padrón, Luis G; Santos Peña, Moisés A; Rocha Quintana, Maikel

2010-06-01

125

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

Directory of Open Access Journals (Sweden)

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.

Alfredo D Espinosa Brito; Benigno Figueiras Ramos; Juan D Rivero Berovides; Luis G del Sol Padrón; Moisés A Santos Peña; Maikel Rocha Quintana

2010-01-01

126

A knowledge-based clinical toxicology consultant for diagnosing multiple exposures.  

UK PubMed Central (United Kingdom)

OBJECTIVE: This paper presents continued research toward the development of a knowledge-based system for the diagnosis of human toxic exposures. In particular, this research focuses on the challenging task of diagnosing exposures to multiple toxins. Although only 10% of toxic exposures in the United States involve multiple toxins, multiple exposures account for more than half of all toxin-related fatalities. Using simple medical mathematics, we seek to produce a practical decision support system capable of supplying useful information to aid in the diagnosis of complex cases involving multiple unknown substances. METHODS: The system is automatically trained using data mining techniques to extract prior probabilities and likelihood ratios from a database managed by the Florida Poison Information Center (FPIC). When supplied with observed clinical effects, the system produces a ranked list of the most plausible toxic exposures. During testing, the system diagnosed toxins at three levels: identifying the substance, identifying the toxin's major and minor categories, and identifying the toxin's major category alone. To enable comparison between these three levels, accuracy was calculated as the percentage of exposures correctly identified in top 10% of trained diagnoses. RESULTS: System evaluation utilized a dataset of 8901 multiple exposure cases and 37,617 single exposure cases. Initial system testing using only multiple exposure cases yielded poor results, with diagnosis accuracies ranging from 18.5% to 50.1%. Further investigation revealed that the system's inability to diagnose multiple disorders resulted from insufficient data and that the clinical effects observed in multiple exposures are dominated by a single substance. Including single exposures when training, the system achieved accuracies as high as 83.5% when diagnosing the primary contributors in multiple exposure cases by substance, 86.9% when diagnosing by major and minor categories, and 79.9% when diagnosing by major category alone. CONCLUSIONS: Although the system failed to completely diagnose exposures to multiple toxins, the ability to identify the primary contributor in such cases may prove valuable in aiding medical personnel as they seek to diagnose and treat patients. As time passes and more cases are added to the FPIC database, we believe system accuracy will continue to improve, producing a viable decision support system for clinical toxicology.

Schipper JD; Dankel DD 2nd; Arroyo AA; Schauben JL

2013-05-01

127

Perfil clínico-epidemiológico dos pacientes diagnosticados com hanseníase em um centro de referência na região nordeste do Brasil Clinical and epidemiological profile of patients diagnosed with leprosy in a reference center in the notheast of Brazil  

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Full Text Available FUNDAMENTOS: A hanseníase permanece sério problema de saúde pública mundial. O conhecimento das características epidemiológicas da doença é importante ferramenta para o controle da endemia. OBJETIVO: Descrever as características clínicas e epidemiológicas dos pacientes diagnosticados com hanseníase no ano de 2004 em um centro de referência da Região Nordeste do Brasil. MÉTODO: Foram avaliados prontuários de pacientes que deram entrada no registro ativo do Centro de Dermatologia Dona Libânia, em Fortaleza, Ceará, no período de janeiro a dezembro de 2004. RESULTADOS: dos 967 casos que deram entrada nesse Centro naquele ano, 909 foram casos novos. Cerca de 7,7% eram pacientes entre zero e 14 anos de idade, e a distribuição por gênero foi de 483 (49,95%) homens e 484 (50,05%) mulheres. A maioria apresentava a forma clínica dimorfa (54,6%), sendo 82,2% dos pacientes provenientes de Fortaleza, CE. Foi realizada a avaliação do grau de incapacidades no diagnóstico em 94,2% dos pacientes, com 21,7% apresentando grau diferente de zero no diagnóstico. CONCLUSÃO: Com base nos resultados obtidos, constatou-se a presença de elevado percentual (7,7%) de casos detectados em menores de 15 anos, associado a baixo percentual (5,8%) de pacientes diagnosticados na forma indeterminada e elevado percentual (21,7%) de casos com incapacidade ao diagnóstico.BACKGROUND: Leprosy continues to represent a serious public health problem worldwide. Knowledge of epidemiological characteristics of the disease is an important tool for the endemy control. OBJECTIVES: To describe the clinical and epidemiological characteristics of patients diagnosed with leprosy during 2004, in a Reference Center in the Northeast of Brazil. METHODS: We analyzed the records referring to patients who entered de active register of the Center of Dermatology Dona Libânia, in Fortaleza, Ceará, from January to december 2004. RESULTS: Out of 967 cases that entered this Center in this year, 909 were new detected cases. About 7,7% were between zero e 14 years old, and distribution per gender was of 483(49,95%) men and 484(50,05%) women. Most of them presented the borderline clinical form (54,6%), and 82,2% resided in the city of Fortaleza/CE. Measurement of disabilities degree in diagnosis was made in 94,2% of the patients, and 21,7% of total showed a degree different from zero. CONCLUSION: Based in the results, we noted a high percentual (7,7%) of patients under fifteen years old, associated with low percentual of indeterminate forms and a high percentual of cases with disabilities at diagnosis. These factors are expressive enough to make the authorities consider the difficulties to reach the goal of eliminating leprosy by the end of 2005, and the necessity of new approaches and strategies to control leprosy endemy.

Cícero Cláudio Dias Gomes; Maria Araci de Andrade Pontes; Heitor de Sá Gonçalves; Gerson Oliveira Penna

2005-01-01

128

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  

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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.

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

2010-01-01

129

Predictive value of combined clinically diagnosed bruxism and occlusal features for TMJ pain.  

UK PubMed Central (United Kingdom)

Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

Manfredini D; Peretta R; Guarda-Nardini L; Ferronato G

2010-04-01

130

[Diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus].  

UK PubMed Central (United Kingdom)

PURPOSE: To report the prevalence of the diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus and to evaluate the association between the retinopathy and different clinical variables. METHOD: A prospective study including all the newly diagnosed patients with type II diabetes mellitus between January 2001-March 2002 in the evidence of the Diabetes Center from Cluj has been conducted. The fundus appearance, age, sex, incidence of arterial hypertension and the diabetes therapy (diet alone, oral drugs, insulin) have been evaluated. RESULTS: During January 2001-March 2002, 487 patients have been diagnosed with type II diabetes mellitus in Cluj county. Diabetic retinopathy has been identified in 70 of these patients (14.37%). Most of the newly diagnosed patients with type II diabetes mellitus belonged to the age interval: 40-65 years, with an average of 58-59 years. CONCLUSIONS: Among the 70 patients with diabetic retinopathy at the moment of type II diabetes diagnosis, the first place is occupied by the back-ground diabetic retinopathy. (11.70%), followed by the clinically significant macular edema (1.43%), proliferative diabetic retinopathy (1.02%) and preproliferative diabetic retinopathy (0.20%). Systolic and diastolic arterial hypertension has been associated with higher degrees of severity of the diabetic retinopathy.

T?lu S; Kaucsar E; Soreanu A

2002-01-01

131

Clinical study of retrocaval ureter diagnosed by CT scan  

International Nuclear Information System (INIS)

Although retrocaval ureter is relatively uncommon congenital anomaly, surgical intervention is often necessary to alleviate the clinical signs and symptoms of the patients. Vena cavography has been indispensable imaging modality for the definitive diagnosis of this anomaly. Recently, however, CT scan in addition to excretory urography (IVP) and retrograde pyelography(RP) has been utilized in many reported cases in the diagnosis of retrocaval ureter. We have experienced 3 cases of retrocaval ureter consecutively. In this paper we report these 3 cases of retrocaval ureter, in which CT scan enabled us to confirm the definitive diagnosis. We also report another case of pelviureteric stenosis that was taken for retrocaval ureter by CT scan. Causes of the misdiagnosis is discussed. In conclusion CT scan is useful diagnostic modality in the diagnosis of retrocaval ureter and this lesser invasive technique might lessen the need for vena cavography. (author).

1987-01-01

132

Clinical outcomes of long-acting risperidone in recent versus long-term diagnosed Belgian schizophrenic patients: results from electronic Schizophrenia Treatment Adherence Registry (e-STAR) and Trial for the Initiation and Maintenance Of REmission in Schizophrenia with risperidone (TIMORES).  

UK PubMed Central (United Kingdom)

AIM: Potential differences in psychiatric clinical outcomes and hospitalization rates before and after the initiation of long-acting risperidone among recently and long-term diagnosed schizophrenia patients were studied. METHODS: Data from two observational studies (Trial for the Initiation and Maintenance Of REmission in Schizophrenia with risperidone (TIMORES) and electronic Schizophrenia Treatment Adherence Registry (e-STAR)) were categorized by the recency of their diagnose and compared in several post hoc analyses. Clinical Global Impression of illness Severity (CGI-S) and Global Assessment of Functioning (GAF) scores, as well as symptoms of clinical deterioration (including hospitalization data) at baseline, 12-month (for TIMORES and e-STAR) and 24-month (for e-STAR) follow-up were analysed. Other outcome measures included discontinuation rate, employment status and remission attainment. RESULTS: Statistically significantly differences between recent and long-term diagnosed schizophrenic patients at 12- and 24-month follow-up were found for CGI-S (between P?patient groups were found for measures of clinical deterioration, employment status and full symptomatic remission rates at 1 year. Although no consistent difference was found between recent and long-term patient groups for hospitalization parameters, the difference in length of full hospitalization days was statistically significantly different (P?patient groups at both 12- and 24-month endpoints: the mean change from baseline was significantly greater for e-STAR 'Early' at 12 months, but greater for e-STAR 'Late' at 24 months. CONCLUSIONS: The findings of the post hoc analyses support the significance of pharmacological interventions, such as long-acting risperidone, in addressing discontinuity issues, especially in recently diagnosed patients.

Dubois V; Peuskens J; Geerts P; Detraux J

2013-01-01

133

Practical algorithm for diagnosing patients with recurrent wheals or angioedema.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chronic urticaria is a common disorder characterized by recurrent wheals, angioedema, or both. Several differential diagnoses need to be considered in patients presenting with wheals and/or angioedema. These include rare diseases such as autoinflammatory syndromes and urticarial vasculitis in patients with recurrent wheals and bradykinin-mediated angioedema in patients with recurrent swellings. AIM AND RESULT: In order to not miss these conditions, we have developed a symptom-based diagnostic algorithm for the management of patients with wheals and/or angioedema. DISCUSSION AND CONCLUSION: By asking the right questions and performing a limited diagnostic workup as suggested here, this algorithm may help to establish the right diagnosis and treat patients early and more effectively.

Maurer M; Magerl M; Metz M; Siebenhaar F; Weller K; Krause K

2013-06-01

134

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

UK PubMed Central (United Kingdom)

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.

Trivedi P; Roy PS; Roy-Choudhury S; Narayan S

2013-05-01

135

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

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Full Text Available PURPOSE: Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS: From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS: Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of 20 ng/mL) and Gleason score (> 7) were independently predictive of positive bone scan, while clinical stage was not. CONCLUSION: Staging bone scans can be omitted in patients with a PSA level of = 20 ng/mL, and Gleason score < 8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.

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

2010-01-01

136

Personality Traits in Patients with Diagnoses of Panic Disorder  

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Full Text Available AbstractObjectives: The present study was conducted to investigate the personality traits which may have a negative impact on patients’ performance, health, and occurrence of panic disorder as well as its process and prognosis. Method: 51 subjects diagnosed with panic disorder were compared with 51 normal subjects through NEO Personality Inventory- Revised (NEO PI-R). Findings: The findings indicated that subjects suffering from panic disorder were more susceptible  to experiences of anxiety, depression, aggression, guilt-feeling, and stress. They were less extraverted, but as capable of controlling their impulses as normal subjects they prefer to have a stable life, and are not interested in experiencing adventures. Results: The study demonstrated that the personality traits of the subjects diagnosed with panic disorder more likely correlates with those of the Cluster C of personality disorders. 

H. Haghshenas; M. Mousavi Nasab; R. Farnam

2002-01-01

137

[Comparison of clinical performance of troponin T and troponin I in diagnosing acute myocardial infarction].  

UK PubMed Central (United Kingdom)

In this article we investigate clinical specificity and sensitivity of cardiac troponin T and cardiac troponin I tests in the patients who were admitted to the hospital with suspected acute coronary syndrome. We investigated 87 patients: the clinical investigation was performed, electrocardiogram was recorded and concentrations of cardiac troponin T and troponin I were estimated. According to the recommendations of the manufacturers of troponin T and troponin I tests, threshold diagnostic troponin T concentration for myocardial infarction was considered > or =0.1 ng/ml and troponin I > or =1.0 ng/ml. Troponin T concentration was analyzed in 60 patients; the sensitivity of troponin T test in diagnosing acute myocardial infarction was 85%, and the specificity was 87.2%. Troponin I test was performed in 46 patients; the sensitivity of the test was 76% and the specificity was 76.2%. In case when both troponin T and I tests were performed, the sensitivity of troponin T was 100% and specificity was 78% and of troponin I - respectively 86% and 78%. According to the receiver operator characteristic analysis there was no significant difference between the general accuracy of troponin T and troponin I in distinguishing patients with and without acute myocardial infarction. According to the results of receiver operator characteristic analysis, the biggest clinical sensitivity and specificity were achieved when threshold myocardial infraction diagnostic concentration of troponin T was considered >0.04 ng/ml and of troponin I >0.69 ng/ml.

Karciauskaite D; Grybauskiene R; Statkeviciene A; Auskalniene R

2004-01-01

138

Rapid determination of natural steroidal hormones in saliva for the clinical diagnoses  

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Full Text Available Abstract Background Saliva samples are easily collectable and non-invasive, and the monitoring of natural steroidal hormones, such as estrone (E1), 17?-estradiol (E2), estriol (E3), progesterone (P), and testosterone (T), in saliva has attracted much attention due to its numerous potential clinical and health-related applications. Because E1, E2, E3, P and T are useful indicators in numerous clinical and health-related diagnoses, there is a need for simultaneous determination. Results A gas chromatography-mass spectrometric assay was developed for rapid simultaneous determination of E1, E2, E3, P and T in saliva for clinical diagnoses. Extraction was achieved with a liquid extraction using 3.0 mL of pentane. The extract was dried and silylated with N-methyl-N-(trimethylsilyl) trifluoroacetamide/NH4I (100:2) under a catalysis of 1.5% dithioerythritol for 10 min at 90°C. The accuracy of the analytes was in the range of 96% to 112% at concentrations of 0.05 and 0.10 ?g/L (5.0 and 10.0 ?g/L for E3), respectively, with relative standard deviations of less than 11%. The lowest quantification limits were from 0.002 to 0.6 ?g/L for 1.0 mL of saliva. Conclusion Natural steroidal hormones were detected in the concentration ranges of nd to 0.2 ?g/L in human saliva. The salivary testosterone values in the patients with prostatic carcinoma were significantly lower than in normal males. The method may useful in numerous clinical and health-related diagnoses.

Oh Jin-Aa; Shin Ho-Sang

2012-01-01

139

[Subclinical and established kidney disease in recently diagnosed hypertensive patients].  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVE: To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. PATIENTS AND METHODS: Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. RESULTS: Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. CONCLUSIONS: Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease.

Gómez-Marcos MA; Martínez-Salgado C; Grandes G; Recio-Rodríguez JI; Castaño Sánchez Y; Rodríguez Sánchez E; García-Ortiz L

2010-03-01

140

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010.  

UK PubMed Central (United Kingdom)

UNLABELLED: What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. OBJECTIVES: • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. PATIENTS AND METHODS: • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. RESULTS: • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ? 6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 89.8% had localized, 6.4% locally advanced and 3.8% metastatic disease. CONCLUSIONS: • This study on PCa incidence in Spain, a western country with intensive opportunistic PSA screening, shows that PCa is a high incidence tumour, diagnosed close to 70 years, usually asymptomatic. • Almost 40% of cases have low risk disease with a risk of over-diagnosis and over-treatment. • Around 55% of patients with intermediate or high risk disease are candidates for active therapy which may result in a reduction of cancer-specific mortality.

Cózar JM; Miñana B; Gómez-Veiga F; Rodríguez-Antolín A; Villavicencio H; Cantalapiedra A; Pedrosa E

2012-12-01

 
 
 
 
141

Efficacy assessment of the implemented strategies to improve loss to follow-up in recently diagnosed HIV patients  

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Full Text Available Purpose of the study: The aim of the present study is to evaluate the strategies performed to decrease the loss to follow up in recently diagnosed HIV patients. Method: We reviewed the clinical charts of the recently diagnosed adult (>18 y/o) HIV patients who presented for the first time in our HIV clinic between 1/Jan/2009 and 30/Nov/2010. Among the patients who were newly diagnosed with HIV infection, we identified those who attended our clinic only once. Since January 2009, we implemented new strategies: those patients who were diagnosed with HIV infection were assigned an early appointment with an attending; those patients who did not attend the appointment were called to reassign another appointment; clinic hours were increased, another attending joined the team and the matters the patients had to deal with were reduced. The results obtained with regard to loss to follow up in these patients were compared with previous results, before January 2009, to assess the effectiveness of these measures. Summary of the results: 247 patients attended the clinic for the first time, 43 (17.4%) of them attended the clinic only once. Comparing with the 45-month period before the implementation of these strategies in which 256 patients attend the clinic and 135 (52.7%) attended the clinic only once, loss to follow up was improved (P=0.0000 [OR 0.19, 95% CI 0.12–0.29]). No statistically significant differences were found between both groups regarding age, gender, nationality, employment status, presence of family/partner at home or access to health insurance. Conclusions: Although the small sample size, the implemented measures decreased the lost to follow up in our clinic. This study emphasises the need to continue reinforcing engagement with clinical care in the newly diagnosed HIV patients.

V Fridman; N Bello; M Lasala

2012-01-01

142

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

Science.gov (United States)

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…

Treloar, Amanda Jane Commons; Lewis, Andrew J.

2009-01-01

143

Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, south-western Nigeria.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January1998 - December 2007). METHODS: A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed. RESULTS: Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer's disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used. CONCLUSION: Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria.

Amoo G; Akinyemi RO; Onofa LU; Akinyemi JO; Baiyewu O; Ogunlesi AO; Ogunniyi A

2011-11-01

144

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

International Nuclear Information System (INIS)

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.

2008-01-01

145

Predictive factors for breast cancer in patients diagnosed atypical ductal hyperplasia at core needle biopsy  

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Full Text Available Abstract Background Percutaneous core needle biopsy (CNB) is considered to be the standard technique for histological diagnosis of breast lesions. But, it is less reliable for diagnosing atypical ductal hyperplasia (ADH). The purpose of the present study was to predict, based on clinical and radiological findings, which cases of ADH diagnosed by CNB would be more likely to be associated with a more advanced lesion on subsequent surgical excision. Methods Between February 2002 and December 2007, consecutive ultrasound-guided CNBs were performed on suspicious breast lesions at Seoul St. Mary's Hospital. A total of 69 CNBs led to a diagnosis of ADH, and 45 patients underwent follow-up surgical excision. We reviewed the medical records and analyses retrospectively. Results Sixty-nine patients were diagnosed with ADH at CNB. Of these patients, 45 underwent surgical excision and 10 (22.2%) were subsequently diagnosed with a malignancy (ductal carcinoma in situ, n = 8; invasive cancer, n = 2). Univariate analysis revealed age (? 50-years) at the time of core needle biopsy (p = 0.006), size (> 10 mm) on imaging (p = 0.033), and combined mass with microcalcification on sonography (p = 0.029) to be associated with underestimation. When those three factors were included in multivariate analysis, only age (p = 0.035, HR 6.201, 95% CI 1.135-33.891) was an independent predictor of malignancy. Conclusion Age (? 50) at the time of biopsy is an independent predictive factor for breast cancer at surgical excision in patients with diagnosed ADH at CNB. For patients diagnosed with ADH at CNB, only complete surgical excision is the suitable treatment option, because we could not find any combination of factors that can safely predict the absence of DCIS or invasive cancer in a case of ADH.

Chae Byung; Lee Ahwon; Song Byung; Jung Sang

2009-01-01

146

[Case clinically diagnosed as depressive state after being stung by a lumpfish (Inimicus japonicus)].  

Science.gov (United States)

We experienced and report a case where the patient was clinically diagnosed as depressive state which developed after being stung by a lumpfish-a kind of Japanese stonefish (Inimicus japonicus). Stonefish venom causes various symptoms ranging from local swelling with pain to general disturbances such as respiratory and heart failure with marked hypotension, cardiac perturbation, and neurologic damage including general seizure and coma. In the current case, the patient complained of local swelling with pain in the early stage, but subsequently he developed depressive state, and finally he began to have suicidal idea. When a patient is encountered who expresses severe depressive symptoms with suicidal idea, we hope that the patient can be examined by a psychiatrist, since the patient may have a serious accident or commit suicide during the process of the disease. On the other hand, it is easy to miss such depressive patients in cases where the depressive state appears after the appearance of toxic symptoms, and this is especially true in cases where the patient seems to be recovering naturally. In conclusion, we hope that medical institutions cooperate in analyzing the pathology of this toxicosis, since each institution rarely encounters such depressive patients. PMID:17133982

Takeda, Tadashi

2006-10-01

147

[Case clinically diagnosed as depressive state after being stung by a lumpfish (Inimicus japonicus)].  

UK PubMed Central (United Kingdom)

We experienced and report a case where the patient was clinically diagnosed as depressive state which developed after being stung by a lumpfish-a kind of Japanese stonefish (Inimicus japonicus). Stonefish venom causes various symptoms ranging from local swelling with pain to general disturbances such as respiratory and heart failure with marked hypotension, cardiac perturbation, and neurologic damage including general seizure and coma. In the current case, the patient complained of local swelling with pain in the early stage, but subsequently he developed depressive state, and finally he began to have suicidal idea. When a patient is encountered who expresses severe depressive symptoms with suicidal idea, we hope that the patient can be examined by a psychiatrist, since the patient may have a serious accident or commit suicide during the process of the disease. On the other hand, it is easy to miss such depressive patients in cases where the depressive state appears after the appearance of toxic symptoms, and this is especially true in cases where the patient seems to be recovering naturally. In conclusion, we hope that medical institutions cooperate in analyzing the pathology of this toxicosis, since each institution rarely encounters such depressive patients.

Takeda T

2006-10-01

148

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

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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.

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

2006-01-01

149

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

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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.

Chandler Clare IR; Jones Caroline; Boniface Gloria; Juma Kaseem; Reyburn Hugh; Whitty Christopher JM

2008-01-01

150

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

International Nuclear Information System (INIS)

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

2010-01-01

151

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

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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

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

2010-12-15

152

[Infantile myasthenia gravis: report of a case diagnosed clinically  

UK PubMed Central (United Kingdom)

A rare case of infantile myasthenia gravis (congenital type) is reported. The child was 16 months old at the time of the diagnosis, although she presented signs suggestive of the disease since two months earlier. The diagnosis was based solely upon clinical criteria, including immediate response to a therapeutic test with Neostigmine, followed by excellent response to treatment with Mestinon. A review of the different types of myasthenia gravis in infancy is made, with emphasis on the clinical criteria for differential diagnosis of these cases.

Lopes JR; Fontenele FA

1985-09-01

153

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

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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 56–71) years. Median disease duration was 108 (60–168) 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.

Brand Caroline; Lowe Adrian; Hall Stephen

2008-01-01

154

Clinical Features and Differential Diagnoses in Laryngeal Mucoepidermoid Carcinoma  

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Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. However, it is a rare entity in larynx. Laryngeal cases are frequently misdiagnosed with other malignancies and they are under-reported. So, recognizing the clinical and histological features of this tumor is essential. ...

Mokhtari, Sepideh; Mokhtari, Saeedeh

155

[Clinical criteria to diagnose dengue in its early stages].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Clinical differentiation of dengue from other diseases with similar symptoms is difficult. The case definition of the World Health Organization (WHO) has high sensitivity but its specificity is very low. OBJECTIVE: A diagnostic scale was formulated for early clinical diagnosis of dengue that provided greater accuracy than that of the WHO definition. MATERIALS AND METHODS: A cohort of 251 adults (> 12 years of age) with unspecific acute febrile syndrome was selected from clinics located in Bucaramanga, Colombia. They consisted of 125 cases of dengue (serologically and/or virologically confirmed) and 126 with other febrile diseases. Clinical manifestations encountered during the first four days of dengue disease were determined, along with the diverse diagnostic combinations that were presented. RESULTS: : The scale consisted of the following criteria: presence of rash, positive tourniquet test, absence of nasal discharge, arthralgias, absence of diarrhea (1 point for each finding), leukocyte count < 4,000/mm3 (3 points) and platelet count < 180.000/mm3 (2 points). In a receiver-operating-characteristic curve, the predictive area of 81.0% was significantly superior to the one produced with WHO criteria, (70.0%, p < 0.001). Febrile syndrome with at least a 3 point score obtained the following values: sensitivity = 95.2%; specificity = 27.8%; positive predictive value = 56.7%; negative predicative value = 85.4%. With a 6-point score, sensitivity = 70.4%; specificity = 78.6%; positive predictive value = 76.5%; negative predicative value = 72.8%. With at least 8 points: sensitivity = 42.4%; specificity = 96%; positive predictive value = 91.4%; negative predictive value = 62.7%. With 9 or 10 points, specificity and positive predictive value were of 100%. CONCLUSION: The described scale proved useful for early clinical diagnosis of dengue, but requires validation for its application in endemic areas.

Díaz FA; Martínez RA; Villar LA

2006-03-01

156

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in english PURPOSE: Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS: From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were d (more) ivided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS: Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of

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

2010-12-01

157

Characterization of newly diagnosed HIV-infected patients who are lost to follow up  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose of the study: We previously identified that a great amount of newly diagnosed HIV-infected patients were lost to follow up after the diagnosis. The aim of the present study is to describe the characteristics of the newly diagnosed HIV-infected patients who are lost to follow up. Methods: We reviewed the clinical charts of the adult (>18 y/o) patients who attended for the first time our HIV clinic between 1/Jan/2005 and 31/Dec/2010. Among the patients who were newly diagnosed with HIV infection, we identified those who consulted the clinic only once. We considered patients were lost to follow up if they never came back within 12 months. We compared age, gender, nationality, education level and socioeconomic characteristics between those patients who were lost to follow and those who continue HIV care. We considered the first visit the one in which the patient was informed about his/her HIV seropositive condition. Summary of results: We included 504 patients, 179 (35.5%) never came back after the first visit. Patients who were lost to follow up (A) were younger (mean age 33.8 vs. 39.07 y/o) than those who continue follow up (B). We identified 11/179 patients older than 50 years in A and 52/325 in B; P = 0.001 (OR 0.34, 95% CI 0.16–0.70). In A 136/179 were male and 232/325 in B. 142/179 were Argentinian in A and 289/325 in B; P = 0.003 (OR 0.48, 95% CI 0.28–0.81). In A 61/179 lived alone and 39/325 in B; P = 0.000 (OR 3.79, 95% CI 0.64–1.37). 41/179 had health insurance in A and 162/325 in B; P = 0.003 (OR 0.30, 95% CI 0.28-0.81). A university or tertiary degree was reached in 33/179 in A and 110/325 in B; P = 0.000 (OR 0.44, 95% CI 0.28–0.70). Conclusions: We must continue reinforcing need for consistent clinical care in the newly diagnosed HIV patients, especially those who are younger, foreigners and socially excluded.

V Fridman; N Bello; M Lasala

2012-01-01

158

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

DEFF Research Database (Denmark)

Valid and up-to-date data on cancer diagnoses are needed for clinical quality monitoring and epidemiological research. The Danish National Registry of Patients (DNRP) is continuously updated, recording all Danish hospital contacts including cancer diagnoses. The Danish Cancer Registry (DCR) is updated once a year and includes quality control of diagnoses. We compared the quality of urological cancer diagnoses in the DNRP with the DCR to assess whether data in an administrative hospital registry are valid compared with data from a well-established cancer registry. We identified 60 434 incident urological cancer cases in the DNRP and/or the DCR from 2001 to 2009. Completeness and the positive predictive value (PPV) of urological cancer registration in the DNRP were estimated using the DCR as the reference standard. To examine the impact of potential misclassification, we computed mortality estimates for urological cancer patients in each registry. Because DCR registration procedures changed in 2004, the periods2001-2003 and 2004-2009 were analyzed separately. In 2004-2009, the overall completeness and PPV of urological cancer registration in the DNRP were 94.9% (95% confidence interval: 94.7-95.2%) and 86.6% (95% confidence interval: 86.3-86.9%), respectively, compared with diagnoses recorded in the DCR. Completeness and PPV of cancer registration in the DNRP varied between cancer subgroups. In 2001-2003, both completeness and PPV in the DNRP were slightly lower compared with 2004-2009. Mortality estimates in patients registered in the DNRP and the DCR varied slightly. The DNRP could be a valuable source of data for clinical quality monitoring and epidemiological research for some urological cancers, especially when current data are essential.

Gammelager, Henrik; Christiansen, Christian Fynbo

2012-01-01

159

The clinical study of diagnosing export obstruction with simulative dejecta  

International Nuclear Information System (INIS)

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

2007-01-01

160

DSMM XI study: dose definition for intravenous cyclophosphamide in combination with bortezomib/dexamethasone for remission induction in patients with newly diagnosed myeloma  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract A clinical trial was initiated to evaluate the recommended dose of cyclophosphamide in combination with bortezomib and dexamethasone as induction treatment before stem cell transplantation for younger patients with newly diagnosed multiple myeloma (MM). Thirty patients were treated ...

 
 
 
 
161

Early Maladaptive Schemas among patients diagnosed with bipolar disorder.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bipolar disorder is associated with a variety of cognitive features that seem to play a role in affective symptoms. Schema theory may serve as a unifying theory that would explain many of these features. This study is an exploratory investigation of schema theory's Early Maladaptive Schemas (EMSs) among individuals diagnosed with bipolar disorder. METHODS: A sample of 74 participants with bipolar disorder and 99 mixed clinical controls (46 with unipolar depression and 53 with anxiety disorders) completed the Young Schema Questionnaire and comparison measures. Associations were investigated using univariate and multivariate analyses. Mean scores were compared with previously established benchmarks. RESULTS: Participants with bipolar disorder demonstrate elevated scores on most EMSs, many at an intermediate position between nonclinical and mixed clinical control groups. When controlling for depression, participants with bipolar disorder exceed those with unipolar depression on Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity. Bipolar group membership is predicted by high scores on Approval-Seeking/Recognition-Seeking and low scores on Emotional Inhibition and Abandonment. LIMITATIONS: Women were overrepresented. Axis II traits were not assessed, nor were manic symptoms in the mixed clinical sample. CONCLUSIONS: Bipolar disorder is associated with a general activation of the EMSs. Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity seem to be particularly high, while Emotional Inhibition and Abandonment seem to be typically low. These EMS are highly consistent with characteristics of the bipolar spectrum. By demonstrating the activation of the EMSs, this study suggests that the EMS component of schema theory may be applied to bipolar disorder. Future research should explore how EMSs might interact with life events to trigger affective symptoms and, ultimately, the applicability of schema therapy to bipolar disorder.

Hawke LD; Provencher MD

2012-02-01

162

Antihypertensive medication prescription patterns and time trends for newly-diagnosed uncomplicated hypertension patients in Taiwan  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Knowledge of existing prescription patterns in the treatment of newly-diagnosed hypertension can provide useful information for improving clinical practice in this field. The aims of this study are to determine the prescription patterns and time trends for antihypertensive medication in newly-diagnosed cases of uncomplicated hypertension in Taiwan and to compare these with current clinical guidelines. Methods A total of 6,536 newly-diagnosed patients with uncomplicated hypertension, aged ?30 years, were identified from the representative 200,000-person sample in the computerized reimbursement database of the National Health Insurance in Taiwan. These patients were followed from 1998 to 2004 with all diagnoses, prescription data and medication charges being retrieved for subsequent analysis. Results Prescription patterns varied by age, gender and clinical facilities, with mono-therapies being found to be dominant in the first year, albeit declining over time. Calcium channel blockers and beta-blockers were the most frequently prescribed antihypertensive drugs, either alone or in combinations. Although least expensive, the prescription rates of diuretics were low, at 8.3% for mono-therapies and 19.9% overall. The prescription rate for angiotensin receptor blockers (ARBs) was elevated considerably over time. After controlling for other related factors by multiple logistic regression analysis, ARBs were found to be prescribed mainly by medical centers or regional hospitals. Conclusion These findings indicate the existence of a gap between current clinical practice and the desired goal of cost-effectiveness in antihypertensive treatment in Taiwan, which should be corrected.

Liu Pang-Hsiang; Wang Jung-Der

2008-01-01

163

Effects of data transformation methods on classification of patients diagnosed with myocardial infarction.  

UK PubMed Central (United Kingdom)

Large datasets may contain redundant data. Variable selection methods that select most relevant variables in the data set, fail to consider the interaction between the variables. Data transformation methods are used to transfer the original data to a new dimension and capture the most significant information within the data set. The data set used in this study was based on 45 clinical variables collected from 697 patients diagnosed as either having myocardial infarction (MI) or not. Principal component analysis (PCA) and independent component analysis (ICA) were applied prior to classification of patients to MI or Non-MI groups using support vector machines (SVM).

Mehrabi S; Mohammadi I; Kunjan K; Kharrazi H

2013-01-01

164

Neurological diagnoses in the emergency room: differences between younger and older patients.  

UK PubMed Central (United Kingdom)

UNLABELLED: Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, ?50 years old and >50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the ?50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.

Lange MC; Braatz VL; Tomiyoshi C; Nóvak FM; Fernandes AF; Zamproni LN; Piovesan EJ; Nóvak EM; Teive HA; Werneck LC

2011-04-01

165

Changes in Motivation for Treatment in Precontemplating Dually Diagnosed Patients Receiving Assertive Community Treatment.  

UK PubMed Central (United Kingdom)

In a population of dually diagnosed patients receiving assertive community treatment we used the theoretical framework of the transtheoretical model to establish (a) the proportions and characteristics of patients who were not motivated for treatment for psychiatric symptoms and substance use, (b) the proportion of patients who moved towards behavioral change after about 1 year, and examine how this change was related with clinical outcome; and (c) the sequence of change processes. Chi square tests and T tests were used to compare the patient characteristics and outcomes of patients who remained in precontemplation with those who progressed. During follow-up, 47 % of the patients came out of the precontemplation phase for treatment of psychiatric symptoms and 38 % for substance use behavior. Those who remained in precontemplation benefited less from treatment. Of those who did move forward, most appeared to become motivated for psychiatric treatment before becoming motivated to reduce substance use.

Kortrijk HE; Mulder CL; van Vliet D; van Leeuwen C; Jochems E; Staring AB

2013-01-01

166

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

Directory of Open Access Journals (Sweden)

Full Text Available Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram (EEG) is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities in brain death diagnosis. In this retrospective study, we used 153 EEGs from medical records of 89 brain death patients in organ procurement unit of the Iranian Tissue Bank admitted during 2002-2008. We extracted and analyzed information including EEGs, which were examined by a neurologist for waves, artifacts and EEG abnormalities. The mean age of the patients was 27.2 ± 12.7 years. The most common cause of brain death was multiple traumas due to accident (65%). The most prevalent artifact was electrical transformer. 125 EEGs (82%) were isoelectric (ECS) and seven EEGs (5%) were depictive of some cerebral activity which upon repeat EEGs, they showed ECS patterns too. There was no relationship between cause of brain death and cerebral activity in EEGs of the patients. In this study, we could confirm ECS patterns in all brain death patients whose status had earlier been diagnosed clinically. Considering the results of this study, it seems sensible to perform EEG as a final confirmatory test as an assurance to the patients' families.

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

2012-01-01

167

Fiberoptic bronchoscopy findings in patients diagnosed with lung cancer.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compile fiberoptic bronchoscopy findings in patients diagnosed with lung cancer and to correlate those with histopathological findings. METHODS: This was a retrospective study involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Sector of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. RESULTS: Endobronchial mass (64%) and mucosal infiltration (35%) were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%), adenocarcinoma, in 42 (21%) small cell carcinoma, in 24 (12%), and large cell carcinoma, in 2 (1%). More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78) was most commonly visualized as an endobronchial mass (in 74%), mucosal infiltration (in 36%), luminal narrowing (in 10%), or external compression (in 6%). CONCLUSIONS: Our results show that the endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.

Rabahi MF; Ferreira AA; Reciputti BP; Matos Tde O; Pinto SA

2012-07-01

168

Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage of the general population avoids gluten ingestion. However, the real existence of this condition is debated and specific markers are lacking. Our aim was thus to demonstrate the existence of WS and define its clinical, serologic, and histological markers. METHODS: We reviewed the clinical charts of all subjects with an irritable bowel syndrome (IBS)-like presentation who had been diagnosed with WS using a double-blind placebo-controlled (DBPC) challenge in the years 2001-2011. One hundred celiac disease (CD) patients and fifty IBS patients served as controls. RESULTS: Two hundred and seventy-six patients with WS, as diagnosed by DBPC challenge, were included. Two groups showing distinct clinical characteristics were identified: WS alone (group 1) and WS associated with multiple food hypersensitivity (group 2). As a whole group, the WS patients showed a higher frequency of anemia, weight loss, self-reported wheat intolerance, coexistent atopy, and food allergy in infancy than the IBS controls. There was also a higher frequency of positive serum assays for IgG/IgA anti-gliadin and cytometric basophil activation in "in vitro" assay. The main histology characteristic of WS patients was eosinophil infiltration of the duodenal and colon mucosa. Patients with WS alone were characterized by clinical features very similar to those found in CD patients. Patients with multiple food sensitivity were characterized by clinical features similar to those found in allergic patients. CONCLUSIONS: Our data confirm the existence of non-celiac WS as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with WS: one with characteristics more similar to CD and the other with characteristics pointing to food allergy.

Carroccio A; Mansueto P; Iacono G; Soresi M; D'Alcamo A; Cavataio F; Brusca I; Florena AM; Ambrosiano G; Seidita A; Pirrone G; Rini GB

2012-12-01

169

Severity Profiles in Patients Diagnosed of Benign Prostatic Hyperplasia in Spain.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To analyse the severity profiles and progression criteria in patients diagnosed of benign prostatic hyperplasia (BPH) in urology clinics in Spain. MATERIAL AND METHODS: A multicentre observational epidemiological study conducted in Spain between May-November 2008. A representative sample of 392 urologist gathered socio-demographic, clinical and patient-centered data from three consecutive patients with new diagnostic of BPH in urology clinics. RESULTS: A total of 1.115 patients were evaluated. Mean age was 65.7 years old. Mean time from the onset of symptoms to diagnostic was18,8 months. Mean IPSS score was 17.2. 63 patients (5,7%) had mild symptoms; 670 (60,1%) had moderate symptoms with a mean IPSS score of 14.6 and 382 (34.3%) had severe symptoms with a mean IPSS score of 23.7. Mean PSA was 2.6ng/ml and ultrasound measured prostatic volume was 49.2cc. A total of 713 (63,9%) patients met progression criteria (PSA >1.5ng/ml and volume>30cc). Symptoms severity was directly correlated with age, prostatic volume, PSA, presence of progression criteria and time from the onset of symptoms and inversely correlated with urine flow rate (P<.001). Progression criteria was directly correlated with age, symptoms severity and inversely with urine flow rate (P<.01). CONCLUSIONS: More than 90% of patients diagnosed of BPH in urology clinics in Spain had moderate to severe symptoms. Two thirds met progression criteria that correlate with age and severity of symptoms.

Miñana B; Rodríguez-Antolín A; Prieto M; Pedrosa E

2013-07-01

170

Difficult diagnoses in an austere environment: a clinical vignette ?the presentation, diagnosis, and management of ichthyosis.  

Science.gov (United States)

Lamellar ichthyosis (LI) is a rare inherited skin disorder of cornification, with an incidence of approximately 1 in 200,000 births. It is one of three types of autosomal recessive congenital ichthyosis (ARCI), a collective term for the spectrum of nonsyndromic ichthyoses caused by a number of well-described genetic mutations. We describe the case of LI diagnosed in a 10-day-old child of a Somali refugee at a free clinic in downtown Djibouti. Initial concern was for staphylococcal infection versus congenital disease. With the use of digital photographs, consultation with experts accessed through the Army Teledermatology Consultation Service supported a diagnosis of ARCI. Providing care to patients in austere environments can present numerous medical challenges. A provider cannot be expected to be able to diagnose and treat every disease and disorder alone, especially if there is a language barrier. Telemedicine can help close the gap in knowledge, particularly when presented with a challenging case. With a novel presentation, simply taking a photograph and e-mailing a consultant can quickly augment one?s medical acumen, ensuring appropriate diagnosis and treatment. PMID:23526325

Pickard-Gabriel, C J; Rudinsky, Sherri

2013-01-01

171

Difficult diagnoses in an austere environment: a clinical vignette ?the presentation, diagnosis, and management of ichthyosis.  

UK PubMed Central (United Kingdom)

Lamellar ichthyosis (LI) is a rare inherited skin disorder of cornification, with an incidence of approximately 1 in 200,000 births. It is one of three types of autosomal recessive congenital ichthyosis (ARCI), a collective term for the spectrum of nonsyndromic ichthyoses caused by a number of well-described genetic mutations. We describe the case of LI diagnosed in a 10-day-old child of a Somali refugee at a free clinic in downtown Djibouti. Initial concern was for staphylococcal infection versus congenital disease. With the use of digital photographs, consultation with experts accessed through the Army Teledermatology Consultation Service supported a diagnosis of ARCI. Providing care to patients in austere environments can present numerous medical challenges. A provider cannot be expected to be able to diagnose and treat every disease and disorder alone, especially if there is a language barrier. Telemedicine can help close the gap in knowledge, particularly when presented with a challenging case. With a novel presentation, simply taking a photograph and e-mailing a consultant can quickly augment one?s medical acumen, ensuring appropriate diagnosis and treatment.

Pickard-Gabriel CJ; Rudinsky S

2013-01-01

172

Postoperative ischemic changes following resection of newly diagnosed and recurrent gliomas and their clinical relevance.  

UK PubMed Central (United Kingdom)

OBJECT: The aim of surgical treatment of glioma is the complete resection of tumor tissue with preservation of neurological function. Inclusion of diffusion-weighted imaging (DWI) in the postoperative MRI protocol could improve the delineation of ischemia-associated postoperative neurological deficits. The present study aims to assess the incidence of infarctions following resection of newly diagnosed gliomas in comparison with recurrent gliomas and the influence on neurological function. METHODS: Patients who underwent glioma resection for newly diagnosed or recurrent gliomas had early postoperative MRI, including DWI and apparent diffusion coefficient (ADC) maps. Postoperative areas of restricted diffusion were classified as arterial territorial infarctions, terminal branch infarctions, or venous infarctions. Tumor entity, location, and neurological function were recorded. RESULTS: New postoperative ischemic lesions were identified in 26 (31%) of 84 patients with newly diagnosed gliomas and 20 (80%) of 25 patients with recurrent gliomas (p < 0.01). New permanent and transient neurological deficits were more frequent in patients with recurrent gliomas than in patients with newly diagnosed tumors. Patients with neurological deficits had a significantly higher rate of ischemic lesions. CONCLUSIONS: Postoperative infarctions occur frequently in patients with newly diagnosed and recurrent gliomas and do have an impact on postoperative neurological function. In this patient cohort there was a higher risk for ischemic lesions and for deterioration of neurological function after resection of recurrent tumors. Radiogenic and postoperative tissue changes could contribute to the higher risk of an ischemic infarction in patients with recurrent tumors.

Gempt J; Förschler A; Buchmann N; Pape H; Ryang YM; Krieg SM; Zimmer C; Meyer B; Ringel F

2013-04-01

173

?v?3 Integrin and Fibroblast growth factor receptor 1 (FGFR1): Prognostic factors in a phase I-II clinical trial associating continuous administration of Tipifarnib with radiotherapy for patients with newly diagnosed glioblastoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Based on our previous results showing the involvement of the farnesylated form of RhoB in glioblastoma radioresistance, we designed a phase II trial associating the farnesyltransferase inhibitor Tipifarnib with radiotherapy in patients with glioblastoma and studied the prognostic values of the proteins which we have previously shown control this pathway. PATIENTS AND METHODS: Patients were treated with 200mg Tipifarnib (recommended dose (RD)) given continuously during radiotherapy. Twenty-seven patients were included in the phase II whose primary end-point was time to progression (TTP). Overall survival (OS) and biomarker analysis were secondary end-points. Expressions of ?v?3, ?v?5 integrins, FAK, ILK, fibroblast growth factor 2 (FGF2) and fibroblast growth factor receptor 1 (FGFR1) were studied by immuno-histochemistry in the tumour of the nine patients treated at the RD during the previously performed phase I and on those of the phase II patients. We evaluated the correlation of the expressions of these proteins with the clinical outcome. RESULTS: For the phase II patients median TTP was 23.1weeks (95%CI=[15.4; 28.2]) while the median OS was 80.3weeks (95%CI=[57.8; 102.7]). In the pooled phase I and II population, median OS was 60.4w (95%CI=[47.3; 97.6]) while median TTP was 18.1w (95%CI=[16.9; 25.6]). FGFR1 over-expression (HR=4.65; 95%CI=[1.02; 21.21], p=0.047) was correlated with shorter TTP while FGFR1 (HR=4.1 (95% CI=[1.09-15.4]; p=0.036)) and ?v?3 (HR=10.38 (95%CI=[2.70; 39.87], p=0.001)) over-expressions were associated with reduced OS. CONCLUSION: Association of 200mg Tipifarnib with radiotherapy shows promising OS but no increase in TTP compared to historical data. FGFR1 and ?v?3 integrin are independent bad prognostic factors of OS and TTP.

Ducassou A; Uro-Coste E; Verrelle P; Filleron T; Benouaich-Amiel A; Lubrano V; Sol JC; Delisle MB; Favre G; Ken S; Laprie A; De Porre P; Toulas C; Poublanc M; Cohen-Jonathan Moyal E

2013-04-01

174

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

Directory of Open Access Journals (Sweden)

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.

Angela Sciacqua; Nadia Grillo; Michele Quero; Giorgio Sesti; Francesco Perticone

2012-01-01

175

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

Scientific Electronic Library Online (English)

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

Andrade Pineda, RE; Marcano Lozada, MJ

2003-07-01

176

Attrition from HIV testing to antiretroviral therapy initiation among patients newly diagnosed with HIV in Haiti.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We report rates and risk factors for attrition in the first cohort of patients followed through all stages from HIV testing to antiretroviral therapy (ART) initiation. DESIGN: Cohort study of all patients diagnosed with HIV between January and June 2009. METHODS: We calculated the proportion of patients who completed CD4 cell counts and initiated ART or remained in pre-ART care during 2 years of follow-up and assessed predictors of attrition. RESULTS: Of 1427 patients newly diagnosed with HIV, 680 (48%) either initiated ART or were retained in pre-ART care for the subsequent 2 years. One thousand eighty-three patients (76%) received a CD4 cell count, and 973 (90%) returned for result; 297 (31%) had CD4 cell count <200 cells per microliter, and of these, 256 (86%) initiated ART. Among 429 patients with CD4 >350 cells per microliter, 215 (50%) started ART or were retained in pre-ART care. Active tuberculosis was associated with not only lower odds of attrition before CD4 cell count [odds ratio (OR): 0.08; 95% confidence interval (CI): 0.03 to 0.25] but also higher odds of attrition before ART initiation (OR: 2.46; 95% CI: 1.29 to 4.71). Lower annual income (?US $125) was associated with higher odds of attrition before CD4 cell count (OR: 1.65; 95% CI: 1.25 to 2.19) and before ART initiation among those with CD4 cell count >350 cells per microliter (OR: 1.74; 95% CI: 1.20 to 2.52). After tracking patients through a national database, the retention rate increased to only 57%. CONCLUSIONS: Fewer than half of patients newly diagnosed with HIV initiate ART or remain in pre-ART care for 2 years in a clinic providing comprehensive services. Additional efforts to improve retention in pre-ART are critically needed.

Noel E; Esperance M; McLaughlin M; Bertrand R; Devieux J; Severe P; Decome D; Marcelin A; Nicotera J; Delcher C; Griswold M; Meredith G; Pape JW; Koenig SP

2013-03-01

177

Predictive value of pediatric thrombosis diagnoses in the Danish National Patient Registry  

Directory of Open Access Journals (Sweden)

Full Text Available Ruta Tuckuviene1, Soeren Risom Kristensen1, Jon Helgestad2, Anette Luther Christensen1, Soeren Paaske Johnsen31Department of Clinical Biochemistry, Center for Cardiovascular Research, 2Department of Pediatrics, 3Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, DenmarkAbstract: Data on the validity of pediatric thrombosis diagnoses are missing. We aimed to examine the predictive value of a diagnosis of venous and arterial thrombosis using the Danish National Patient Registry (DNPR). We identified all first-time diagnoses among children and adolescents (aged 0–18 years) between 1994 and 2006 in DNPR. In total, 1138 potential cases of thrombosis were identified; the medical records were retrieved for 1112 (97.7%) and the positive predictive value (PPV) computed. Overall, the diagnosis of thrombosis was verified in 598 of the 1112 cases, corresponding to a PPV of 53.7% (95% confidence interval [CI]: 50.8–56.7). Diagnoses from wards had the PPV of 62.5% (95% CI: 59.4–65.6). The predictive value of a thrombosis diagnosis from wards was age-dependent, with a higher PPV (77.4%, 95% CI: 68.7–84.7) in neonates (<28 days) and adolescents (15–18 years) (68.2%; 95% CI: 63.2–72.5)) than in children (28 days–14 years) (51.2%; (95% CI: 46.0–56.4)). The PPV of a thrombosis diagnosis was improved by restricting the analysis to diagnoses from wards, primary diagnoses, and admissions with a length of stay of three or more days. The results indicate that an interpretation of nonvalidated hospital discharge data for pediatric thrombosis in a registry like DNPR should be made with caution.Keywords: pediatric thrombosis, discharge diagnosis, registry, positive predictive value

Ruta Tuckuviene; Soeren Risom Kristensen; Jon Helgestad; et al

2010-01-01

178

Evaluation of efficacy, safety, and cognitive profile of amisulpride per se and its comparison with olanzapine in newly diagnosed schizophrenic patients in an 8-week, double-blind, single-centre, prospective clinical trial.  

UK PubMed Central (United Kingdom)

Background. Impaired cognitive functions in schizophrenia are the major deciding factors in response to treatment. Conventional antipsychotics have minimal impact on cognitive dysfunctions and are associated with adverse effects. Atypical antipsychotics have shown promise in treatment of cognitive and negative symptoms of schizophrenia. Efforts are underway to find out the best drug amongst atypical antipsychotics. Objective. To compare efficacy, safety, and cognitive profile of amisulpride and olanzapine in the treatment of acute psychotic exacerbations of schizophrenia. Method. A prospective, randomized, double-blind, single-center, 8-week clinical trial we used. Subjects and Treatments. Seventy four patients were treated for two months with either amisulpride (400-800?mg/d) or olanzapine (10-20?mg/d). Statistics. Mann Whitney U test we used for independent samples with P < 0.05 taken as significant. Results. Brief psychiatric rating scale (BPRS) was used as a primary measure of efficacy. Other measures of efficacy and safety were also evaluated. Both amisulpride and olanzapine groups showed equivalent improvement in psychotic symptoms on BPRS scale. Less than five percent of patients suffered adverse effects only to withdraw from the study. Olanzapine group showed statistically significant (P < 0.05) weight gain compared with amisulpride group. Amisulpride group showed significant improvement (P < 0.05) in various cognitive parameters as compared to olanzapine group.

Pawar GR; Phadnis P; Paliwal A

2012-01-01

179

Controversies in the treatment of elderly patients with newly diagnosed glioblastoma.  

UK PubMed Central (United Kingdom)

Approximately half of all patients with glioblastoma are older than 65 years and nearly one-quarter are older than 70 years, with a rising incidence of this disease in the elderly population. The life expectancy of elderly patients with glioblastoma is significantly shorter than in younger patients. Potential explanations for this abbreviated survival include differences in tumor biology, reduced use of therapies, enhanced toxicity of treatment, or diminished efficacy of available therapies with increasing age. The current standard treatment of newly diagnosed, protocol-eligible, nonelderly patients with glioblastoma is based on the randomized prospective EORTC/NCIC study that included patients aged 18 to 70 years with a performance status of ECOG 0 to 2. Limited single-institution retrospective series suggest that clinically fit elderly patients may benefit from a similar treatment regimen. However, no randomized trial has been performed in the elderly population using this regimen. Available prospective randomized clinical trials in the elderly population with glioblastoma have shown that radiotherapy is superior to supportive care only, that single-modality hypofractionated radiotherapy (reduced dose and shorter treatment schedule) is an alternative to single-modality standard fractionated radiotherapy, and that single-agent temozolomide is equivalent to radiotherapy alone. This article summarizes published data of current patterns of care in elderly patients and reviews published evidence as it pertains to the benefit of different treatment modalities in elderly patients with glioblastoma. Notwithstanding the previously mentioned randomized trials, the optimal treatment of elderly patients with glioblastoma remains controversial.

Holdhoff M; Chamberlain MC

2013-09-01

180

Patients with colorectal and renal cell carcinoma diagnoses appear to be at risk for additional malignancies.  

UK PubMed Central (United Kingdom)

UNLABELLED: Patients with colorectal cancer (CRC) and renal cell carcinoma (RCC) may be at risk for additional primary malignancies. A review of 101 patients with these concurrent diagnoses was performed. Forty-two percent of patients had 1 or more additional malignancies; none appeared to be associated with Lynch syndrome (LS). This suggests the need for careful follow-up in these patients and further study. BACKGROUND: Small studies have demonstrated that patients who have both colorectal and renal cell carcinoma may be at increased risk for the development of additional malignancies. A possible genetic basis has been suggested. Our study describes the clinicopathologic features of these patients and clarifies the relationship of this cohort with Lynch syndrome (LS). METHODS: Patients with primary CRC and RCC treated at our institution were identified. Medical records were reviewed for demographic and clinical information. Immunohistochemical staining for mismatch repair (MMR) proteins was performed on tumor tissue when possible. RESULTS: During the study period, 24,642 patients were treated for CRC and 7,366 were treated for RCC at our institution. One hundred seventy-nine patients had both diagnoses, with 101 patients eligible for inclusion in our cohort. Tumors were typically early stage. The 2 cancers presented as synchronous lesions in 42% of patients. Thirty-two patients had 1 additional primary malignancy, 7 patients had 2 additional primary malignancies, and 3 patients had 3 additional primary malignancies. No patient had a family history that met the Amsterdam II criteria (AC) for LS, but 50% had family members with 1 malignancy. One of 10 colorectal tumors analyzed for the absence of MMR protein expression demonstrated the absence of MSH6, but the corresponding RCC demonstrated intact expression of all 4 MMR proteins. CONCLUSION: It is rare for patients to be diagnosed with both CRC and RCC. The clinicopathologic features of this cohort and the results of immunohistochemical analysis performed on a sample of these patients do not suggest LS. However, the high rate of additional carcinomas suggests a need for careful follow-up. Multicenter longitudinal studies are warranted to further understand the natural history and possible genetic basis for this entity.

Steinhagen E; Moore HG; Lee-Kong SA; Shia J; Eaton A; Markowitz AJ; Russo P; Guillem JG

2013-03-01

 
 
 
 
181

Neuropsychiatric symptoms, quality of sleep and quality of life in patients diagnosed with nasal septal deviation.  

UK PubMed Central (United Kingdom)

OBJECTIVES: This study aims to evaluate the psychiatric symptoms, quality of sleep, quality of life and the predictive factors affecting quality of sleep in patients diagnosed with nasal septal deviation (NSD). PATIENTS AND METHODS: Forty male patients (mean age 22.3±1.4 years; range 21 to 26 years) who admitted to the otorhinolaryngology (ORL) clinic of the A?r? Military Hospital and diagnosed with NSD as a result of a through ORL examination between February 2009 and April 2009 and 36 healthy volunteer (mean age 21.7±1.0 years; range 21 to 25 years) controls, were included in this study. Pre- and postoperative evaluations were performed using the Quality of Life Scale (Short Form-36/SF-36), the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List Revised (SCL-90-R). RESULTS: All patients and controls completed pre- and postoperative evaluations. No complications occurred. There was a statistically significant difference between the groups in the quality of sleep measures, in the SCL-90-R subscales of somatization, obsession, interpersonal sensitivity, depression, anxiety, phobic anxiety, hostility, paranoid thought, and psychoticism, additional scales and in physical health dimension of SF-36 Quality of Life Scale. CONCLUSION: Psychiatric symptoms are more common in patients with nasal septal deviation when compared to healthy controls. The impairments in nasal breathing in patients with NSD may cause a decline in the physical dimension of quality of life and a marked impairment in sleep quality.

Fidan T; Fidan V; Ak M; Sütbeyaz Y

2011-11-01

182

A previously diagnosed mitochondrial neurogastrointestinal encephalomyopathy patient presenting with perforated ileal diverticulitis.  

Science.gov (United States)

Mitochondrial neurogastrointestinal encephalomyopathy is an autosomal recessive multisystem disorder characterized clinically by severe gastrointestinal dysmotility; cachexia; ptosis, opthalmoparesis or both; peripheral neuropathy; leukoencephalopathy and mitochondrial abnormalities in muscle. Gastrointestinal dysmotility causes intestinal pseudo-obstruction and small intestinal diverticula. In this case report, we present a previously diagnosed 32-year-old female mitochondrial neurogastrointestinal encephalomyopathy syndrome patient who was hospitalized and operated due to ileal diverticulitis perforation and died due to postoperative respiratory complications, and we discuss the characteristic manifestations of the disease. PMID:16547854

Aksoy, Fikret; Demirel, Gökhan; Bilgiç, Tayfun; Güngör, Ibrahim Gürhan; Ozçelik, Alp

2005-12-01

183

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

Directory of Open Access Journals (Sweden)

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.

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

2008-01-01

184

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

UK PubMed Central (United Kingdom)

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

Folkema AM; Holman RC; McQuiston JH; Cheek JE

2012-01-01

185

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

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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).

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

1984-08-01

186

Early detection of hospitalized patients with previously diagnosed obstructive sleep apnea using computer decision support alerts.  

UK PubMed Central (United Kingdom)

Obstructive sleep apnea (OSA) is a worldwide problem affecting 2-14% of the general population and most patients remain undiagnosed. OSA patients are at elevated risk for hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, stroke and death during hospitalization. Clinical screening questionnaires are used to identify hospitalized patients with OSA; especially before surgery. However, current screening questionnaires miss a significant number of patients and require more definitive testing before specific therapy can be started. Moreover, many patients are admitted to the hospital with a previous diagnosis of OSA that is not reported. Thus, many patients with OSA do not receive appropriate therapy during hospitalization due to the lack of information from previous inpatient and outpatient encounters. Large enterprise data warehouses provide the ability to monitor patient encounters over wide geographical areas. This study found that previously diagnosed OSA is highly prevalent and undertreated in hospitalized patients and the use of early computer alerts by respiratory therapists resulted in significantly more OSA patients receiving appropriate medical care (P < 0.002) which resulted in significantly fewer experiencing hypoxemia (P < 0.006). The impact was greater for non-surgery patients compared to surgery patients.

Evans RS; Flint VB; Cloward TV; Beninati W; Lloyd JF; Megwalu K; Simpson KJ; Alsharit AM; Balls SB; Farney RJ

2013-01-01

187

Discriminant validity of the Inventory to Diagnose Depression between patients with major depression and pure anxiety disorders.  

UK PubMed Central (United Kingdom)

We examined the discriminant validity of the Inventory to Diagnose Depression (IDD), a self-report instrument designed to diagnose major depressive disorder as defined in DSM-III-R. Forty patients with major depression (MD), 20 patients with anxiety disorders, who had not had a lifetime history of depression (ADs), and 40 control subjects completed the IDD. The IDD results were compared in the three contrasting groups (MD vs. AD+control subjects, MD vs. AD, and MD vs. control subjects). The concordance between the IDD and clinical diagnoses, using a structured interview, was significantly high in the three groups (k = 0.81, 0.66, 0.90, respectively). The IDD total score in the MD group was the highest among the three groups and was distinguished from the AD group or control group (P < 0.001, F = 139.9, d.f. = 2,97). However, the IDD occasionally diagnosed subjects with AD as having MD.

Uehara T; Sato T; Sakado K; Kameda K

1997-06-01

188

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

Scientific Electronic Library Online (English)

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

Valdés Ramos, Eduardo; Bencosme Rodríguez, Niurka

2009-12-01

189

Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anterior cutaneous nerve entrapment syndrome (ACNES) is hardly considered in the differential diagnosis of chronic abdominal pain. Some even doubt the existence of such a syndrome and attribute reported successful treatment results to a placebo effect. The objective was to clarify the role of local anaesthetic injection in diagnosing ACNES. The hypothesis was that pain attenuation following lidocaine injection would be greater than that after saline injection. METHODS: Patients aged over 18 years with suspected ACNES were randomized to receive an injection of 10 ml 1 per cent lidocaine or saline into the point of maximal abdominal wall pain just beneath the anterior fascia of the rectus abdominis muscle. Pain was recorded using a visual analogue scale (VAS; 1-100 mm) and a verbal rating scale (VRS; 0, no pain; 4, severe pain) during physical examination just before and 15-20 min after injection. A reduction of at least 50 per cent on the VAS and/or 2 points on the VRS was considered a successful response. RESULTS: Between August 2008 and December 2010, 48 patients were randomized equally (7 men and 41 women, median age 47 years). Four patients in the saline group reported a successful response compared with 13 in the lidocaine group (P = 0·007). CONCLUSION: Entrapped branches of intercostal nerves may contribute to the clinical picture in some patients with chronic abdominal pain. Pain reduction following local infiltration in these patients was based on an anaesthetic mechanism and not on a placebo or a mechanical (volume) effect. Registration number: NTR2016 (Nederlands Trial Register; http://www.trialregister.nl).

Boelens OB; Scheltinga MR; Houterman S; Roumen RM

2013-01-01

190

Critical review of factors predicting health-related quality of life in newly diagnosed coronary artery disease patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Newly diagnosed coronary heart disease patients can experience significant negative changes in their health-related quality of life (HRQoL). No existing literature review was found related to factors predicting HRQoL in newly diagnosed coronary heart disease patients. PURPOSE: The aim of this study was to identify factors predicting HRQoL in newly diagnosed coronary heart disease patients. REVIEW METHODS: We searched studies published between 1997 and 2009 with combinations of key words including factors, predictor, health-related quality of life, quality of life, first diagnosed coronary heart disease patients, and coronary heart disease patients. Data sources were ProQuest, ScienceDirect, CINAHL, PsychINFO, PubMed, and Scopus. Seventeen studies were identified that primarily examined HRQoL from 6 weeks to 12 months after diagnosis. CONCLUSIONS: Factors predicting HRQoL in newly diagnosed coronary heart disease patients can be divided into 3 groups: sociodemographic, clinical, and psychosocial. Characteristics in each category most strongly predictive of HRQoL in newly diagnosed coronary heart disease patients were: Sociodemographic positive predictors were baseline HRQoL, education level, and marital status; sociodemographic negative predictors included number of cardiovascular risks and female gender. Age was an inverse predictor. Clinical negative predictors included angina, physical functioning, and fatigue. Psychosocial positive predictors included social support and a sense of coherence, whereas depression, anxiety and depression, overall psychosocial characteristics or mood disturbance, anxiety, and hostility were negative predictors. CLINICAL IMPLICATIONS: This review identifies predictors of HRQoL and shows the importance of assessing factors that predict HRQoL at baseline and throughout the trajectory of this chronic illness because the concept of HRQoL changes over time but the predictors remain constant.

Pragodpol P; Ryan C

2013-05-01

191

The utility of magnetic resonance imaging (MRI) in diagnosing hemosiderosis of long term hemodialysis patients  

International Nuclear Information System (INIS)

The utility of magnetic resonance imaging (MRI) in diagnosing hemosiderosis (H) was evaluated in patients on long-term hemodialysis. The study subjects were 19 patients with serum ferritin (Ft) ?300 ?g/l, and 4 patients, with Ft

1992-01-01

192

Implants placed simultaneously with particulated bone graft in patients diagnosed with recessive dystrophic epidermolysis bullosa.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe the rehabilitation with implants placed simultaneously with particulated bone graft in 4 patients diagnosed with recessive dystrophic epidermolysis bullosa. MATERIALS AND METHODS: A retrospective study was conducted of 4 patients diagnosed with recessive dystrophic epidermolysis bullosa and treated with dental implants and simultaneous particulate bone graft from January 2005 to December 2009. All patients had marked oral involvement, with devastating alterations in the soft and hard tissues and were rehabilitated with a fixed prosthesis. RESULTS: Eighteen implants showed dehiscence or fenestration and were placed simultaneously with particulated bone grafts to cover exposed threads: 14 received autologous bone and 4 tricalcium betaphosphate. In 16, the bone graft was covered with resorbable collagen membranes and in 2 with a nonresorbable titanium-reinforced membrane. Of the 18 implants, 8 were placed in the maxilla combining drills and osteotomes and 10 in the mandible with the conventional drilling procedure. All implants survived after a minimum follow-up of 12 months (range 12 to 48). CONCLUSIONS: The results of this small-sample clinical study suggest that endosseous implants can be placed simultaneously with particulated bone graft, providing support for a fixed prosthesis in patients with recessive dystrophic epidermolysis bullosa and considerably improving these patients' quality of life.

Peñarrocha-Oltra D; Aloy-Prósper A; Ata-Ali J; Peñarrocha-Diago M; Peñarrocha-Diago M

2012-01-01

193

Metabolic syndrome and exaggerated blood pressure response to exercise in newly diagnosed hypertensive patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Running evidence supports a prognostic value of an exaggerated blood pressure response to exercise (EBPR). The impact of the metabolic syndrome (MS) on EBPR in hypertensive patients has not been investigated. DESIGN: A cross-sectional study in the setting of an outpatient hypertension clinic. METHODS: In total, 325 non-diabetic patients with newly diagnosed hypertension were divided into two groups based on the presence (n?=?95) or absence (n?=?230) of the MS as defined with NCEP-ATP III criteria. All subjects underwent ambulatory blood pressure monitoring, echocardiography and exercise treadmill testing. RESULTS: Hypertensive patients with MS exhibited higher prevalence of EBPR (by 17%, p?=?0.002) and peak exercise systolic BP (by 10.4?mmHg, p?=?0.001) irrespectively of confounders. Metabolic equivalents were higher in hypertensives with MS (by 0.6?ml/kg/min, p?=?0.048), but the difference lost significance after adjusting for confounders, including body mass index. Logistic regression analysis identified the MS as an independent predictor of an EBPR (p?=?0.016). Hypertensive patients with MS had a 2.3-fold risk of exhibiting EBPR compared to those without MS. However, individual components of MS altogether as well as each one separately failed to predict EBPR. CONCLUSIONS: Presence of MS in newly diagnosed hypertensive patients is associated with increased peak exercise BP and a higher frequency of EBPR over and above its separate elements.

Tsioufis C; Kasiakogias A; Tsiachris D; Kordalis A; Thomopoulos C; Giakoumis M; Bounas P; Pittaras A; Michaelides A; Stefanadis C

2012-06-01

194

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

Directory of Open Access Journals (Sweden)

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

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

2003-01-01

195

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

Scientific Electronic Library Online (English)

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

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

2003-10-01

196

Referral and Final Diagnoses of Patients Assessed in an Academic Vertigo Center  

Science.gov (United States)

Objective: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient. Materials and methods: Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65?years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses. Results: Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.

Geser, Rebekka; Straumann, Dominik

2012-01-01

197

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

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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.

Niwinska, Anna, E-mail: alphaonetau@poczta.onet.pl [Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Murawska, Magdalena [Department of Biostatistics, Erasmus University Medical Center, Rotterdam (Netherlands)

2012-04-01

198

Clients, problems, and diagnoses in a military community mental health clinic: a 20-month study.  

UK PubMed Central (United Kingdom)

A descriptive epidemiologic study was performed using intake data from an Army community mental health clinic. This clinic was on a U.S. Army non-training post; data were collected over a 20-month period. Two diagnoses, occupational problem and phase of life or other life circumstance problem, were utilized by clinicians in 51% of all cases. Axis I diagnoses were found in 21% of the cases and medication was prescribed in 7%. Women were over-represented relative to men. We concluded that the patterns of diagnoses reflected the demand characteristics of the military environment. One implication of this study is that psychiatric care must be examined in the context of the community and not just as an administrative or economic system.

McCarroll JE; Orman DT; Lundy AC

1993-11-01

199

Characteristics of patients diagnosed with schizoaffective disorder compared with schizophrenia and bipolar disorder.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Information on basic demographic and clinical characteristics of schizoaffective disorder is sparse and subject to sampling bias and low diagnostic reliability. In the present study we aimed to: (i) estimate the demographic and clinical descriptors in schizoaffective disorder patients and (ii) compare the findings with those with schizophrenia and bipolar disorder. METHODS: To minimize sampling bias and low reliability, we systematically reviewed studies that simultaneously compared schizoaffective, schizophrenia, and bipolar disorder patients. We estimated demographic, clinical, and psychometric characteristics based on weighted pooling, and compared disorders by meta-analysis. We also estimated whether schizoaffective disorder is closer to schizophrenia or to bipolar disorder. RESULTS: We identified 50 studies that included 18312 patients. Most characteristics of the 2684 schizoaffective disorder patients fell between those of 4814 diagnosed with bipolar disorder and 10814 with schizophrenia. However, the schizoaffective group had the highest proportion of women (52%), had the youngest age at illness onset (23.3 ± 3.8 years), and had the highest standardized ratings of psychosis and depression. Differences in pooled parameters between schizoaffective versus schizophrenia and versus bipolar disorder subjects were similar. Values for patients with schizoaffective disorders mostly were intermediate between schizophrenia and bipolar disorder. However, the majority of studies showed schizoaffective patients to be more like schizophrenia than bipolar disorder patients in seven out of nine demographic and clinical categories as well as in five out of eight psychometric measures. These results remained similar when we restricted the analyses to studies with psychotic bipolar disorder patients only or to studies using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IIIR and DSM-IV only. CONCLUSIONS: The present study provided estimates of important characteristics of schizoaffective disorder - as balanced as possible in summarizing the findings from observational studies as unbiased as possible. The results did not support the hypothesis that schizoaffective disorder is primarily an affective disorder. The stronger resemblance of schizoaffective disorder to schizophrenia than to bipolar disorder needs further investigation.

Pagel T; Baldessarini RJ; Franklin J; Baethge C

2013-05-01

200

A Multidimensional Analysis of Body Image Concerns Among Newly Diagnosed Patients with Oral Cavity Cancer  

Science.gov (United States)

Background Body image is a critical psychosocial issue for patients facing treatment for oral cancer yet there is limited research conducted in this area. This study utilizes a multidimensional approach to body image assessment and evaluates relationships between body image, demographic, health, and psychosocial variables. Methods Newly diagnosed patients with oral cancer completed self-report questionnaires and a structured clinical interview. Results Most participants identified current and/or future body image concerns primarily related to impending surgery. Adequate psychometric properties were demonstrated on a range of body image measures. Depression was the strongest and most consistent predictor of body image outcomes. Conclusions Preliminary evidence supports the importance of evaluating body image concerns in oral cancer patients prior to surgical intervention. Our findings have implications for developing validated body image tools and can be used to guide psychosocial interventions targeting body image disturbance.

Fingeret, Michelle Cororve; Vidrine, Damon J.; Reece, Gregory P.; Gillenwater, Ann M.; Gritz, Ellen R.

2009-01-01

 
 
 
 
201

Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography  

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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.

Kim, Yong Kyun [Dept. of Diagnostic Radiology, Koeralife Daejeon Healthcare Center, Daejeon (Korea, Republic of)

2008-06-15

202

Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the clinical effectiveness and cost-effectiveness of transthoracic echocardiography (TTE) in all patients who are newly diagnosed with atrial fibrillation (AF). DESIGN: Narrative synthesis reviews were conducted on the prognostic and diagnostic accuracy of TTE for, and prevalence of, pathologies in patients with AF. Databases were searched from inception. MEDLINE searches were conducted from March to August 2010, and reference lists of articles checked. There were 44 diagnostic accuracy studies, five prognostic studies, and 16 prevalence studies accepted into the review. Given the complexity of the many pathologies identified by TTE, the variety of potential changes to clinical management, and paucity of data, the model focused on changes to oral anticoagulation (OAC). The mathematical model assessed the cost-effectiveness of TTE for patients with AF who were not routinely given OAC, assuming, if left atrial abnormality was detected, that the higher risk of stroke warranted OAC; this meant that patients with a CHADS2 (cardiac failure, hypertension, age, diabetes, stroke doubled) score of 0 [dabigatran etexilate (Pradaxa(®), Boehringer Ingelheim)/rivaroxaban (Xarelto(®), Bayer Schering)] or 0/1 (warfarin) were included. A simplified approach evaluated the additional quality-adjusted life-years (QALYs) required in order for TTE to be perceived as cost-effective at a threshold of £20,000 per QALY. SETTING: Transthoracic echocardiography is usually performed in cardiology clinics but may be used in primary or non-specialist secondary care. PARTICIPANTS: Patients with newly diagnosed AF. INTERVENTION: Transthoracic echocardiography. MAIN OUTCOME MEASURES: Prognosis, diagnostic sensitivity or specificity of TTE, prevalence of pathologies in patients with AF, cost-effectiveness and QALYs. RESULTS: Prognostic studies indicated that TTE-diagnosed left ventricular dysfunction, increased left atrial diameter and valvular abnormality were significantly associated with an increased risk of stroke, mortality or thromboembolism. There was a high prevalence (around 25-30%) of ischaemic heart disease, valvular heart disease and heart failure in patients with AF. Diagnostic accuracy of TTE was high, with most pathologies having specificity of ? 0.8 and sensitivity of ? 0.6. The mathematical model predicted that when the CHADS2 tool is used the addition of TTE in identifying patients with left atrial abnormality appears to be cost-effective for informing some OAC decisions. In the simplified approach a threshold of 0.0033 was required for a TTE to be cost-effective. CONCLUSIONS: When CHADS2 was used, the addition of TTE in identifying patients with left atrial abnormality was cost-effective for informing some OAC decisions. A simple analysis indicates that the number of QALYs required for TTE to be cost-effective is small, and that if benefits beyond those associated with a reduction in stroke are believed probable then TTE is likely to be cost-effective in all scenarios. Our findings suggest that further research would be useful, following up newly diagnosed patients with AF who have undergone TTE, to study treatments given as a result of TTE diagnoses and subsequent cardiovascular events. This could identify additional benefits of routine testing, beyond stroke prevention. Studies assessing the proportion of people with a CHADS2 score of 0 or 1 that have left atrial abnormality would provide better estimates of the cost-effectiveness of TTE, and allow more accurate estimates of the sensitivity and specificity of TTE for identifying left atrial abnormality in AF to be obtained. STUDY REGISTRATION: PROSPERO CRD42011001354. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Simpson E; Stevenson M; Scope A; Poku E; Minton J; Evans P

2013-08-01

203

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

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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; howeve...

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

204

The Heterogeneity of Early Parkinson's Disease: A Cluster Analysis on Newly Diagnosed Untreated Patients  

Science.gov (United States)

Background The variability in the clinical phenotype of Parkinson’s disease seems to suggest the existence of several subtypes of the disease. To test this hypothesis we performed a cluster analysis using data assessing both motor and non-motor symptoms in a large cohort of newly diagnosed untreated PD patients. Methods We collected data on demographic, motor, and the whole complex of non-motor symptoms from 100 consecutive newly diagnosed untreated outpatients. Statistical cluster analysis allowed the identification of different subgroups, which have been subsequently explored. Results The data driven approach identified four distinct groups of patients, we have labeled: 1) Benign Pure Motor; 2) Benign mixed Motor-Non-Motor; 3) Non-Motor Dominant; and 4) Motor Dominant. Conclusion Our results confirmed the existence of different subgroups of early PD patients. Cluster analysis revealed the presence of distinct subtypes of patients profiled according to the relevance of both motor and non-motor symptoms. Identification of such subtypes may have important implications for generating pathogenetic hypotheses and therapeutic strategies.

Amboni, Marianna; Picillo, Marina; Moccia, Marcello; Longo, Katia; Santangelo, Gabriella; De Rosa, Anna; Allocca, Roberto; Giordano, Flavio; Orefice, Giuseppe; De Michele, Giuseppe; Santoro, Lucio; Pellecchia, Maria Teresa; Barone, Paolo

2013-01-01

205

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

Directory of Open Access Journals (Sweden)

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

Chanda Pascalina; Castillo-Riquelme Marianela; Masiye Felix

2009-01-01

206

The frequency and correlates of anxiety in patients with first-time diagnosed mild dementia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anxiety in persons with dementia has received little attention despite its severe consequences. In this observational cross-sectional study, we investigated the frequency of anxiety and associations between anxiety and socio-demographic and clinical variables in an outpatient sample with first-time diagnosed mild dementia. METHODS: The study sample (n = 169) comprised participants recruited from clinics in geriatric medicine and old age psychiatry for a longitudinal dementia study. Symptoms of anxiety were rated by a caregiver on the Neuropsychiatric Inventory (NPI) and by the patient on the anxiety tension item on the Montgomery and Åsberg Depression Rating Scale. Measures of caregiver stress, dementia-related impairment (Clinical Dementia Rating (CDR) scale), and cognitive functioning were also included. RESULTS: According to caregiver reports, 19.5% had clinically significant anxiety and an additional 22.5% had subclinical anxiety. Half of the patients reported experiencing anxiety from time to time. Patients with Lewy-body dementia reported anxiety more often compared to patients with Alzheimer's disease. Anxiety was associated with depression, higher caregiver stress, and more dementia-related impairment, but not with cognitive test performance. Caregiver stress and higher CDR score increased the odds for anxiety significantly, even when controlling for depression. CONCLUSION: Anxiety is common in patients with mild dementia, and seems to be associated not so much with cognitive test performance than with caregiver distress and the patient's ability to function in daily life. Anxiety should be taken into account when assessing dementia, as well as screened for when examining patients with known dementia.

Hynninen MJ; Breitve MH; Rongve A; Aarsland D; Nordhus IH

2012-11-01

207

Comparative Survival in Patients With Postresection Recurrent Versus Newly Diagnosed Non-Small-Cell Lung Cancer Treated With Radiotherapy  

International Nuclear Information System (INIS)

Purpose: To compare the survival of postresection recurrent vs. newly diagnosed non-small-cell lung cancer (NSCLC) patients treated with radiotherapy or chemoradiotherapy. Methods and Materials: The study population consisted of 661 consecutive patients with NSCLC registered in the radiation oncology databases at two medical centers in the United States between 1992 and 2004. Of the 661 patients, 54 had postresection recurrent NSCLC and 607 had newly diagnosed NSCLC. Kaplan-Meier and Cox regression models were used for the survival analyses. Results: The distribution of relevant clinical factors between these two groups was similar. The median survival time and 5-year overall survival rates were 19.8 months (95% confidence interval [CI], 13.9-25.7) and 14.8% (95% confidence interval, 5.4-24.2%) vs. 12.2 months (95% CI, 10.8-13.6) and 11.0% (95% CI, 8.5-13.5%) for recurrent vs. newly diagnosed patients, respectively (p = .037). For Stage I-III patients, no significant difference was observed in the 5-year overall survival (p = .297) or progression-free survival (p = .935) between recurrent and newly diagnosed patients. For the 46 patients with Stage I-III recurrent disease, multivariate analysis showed that chemotherapy was a significant prognostic factor for 5-year progression-free survival (hazard ratio, 0.45; 95% CI, 0.224-0.914; p = .027). Conclusion: Our institutional data have shown that patients with postresection recurrent NSCLC achieved survival comparable to that of newly diagnosed NSCLC patients when they were both treated with radiotherapy or chemoradiotherapy. These findings suggest that patients with postresection recurrent NSCLC should be treated as aggressively as those with newly diagnosed disease.

2010-03-15

208

Effects of glaucoma medications on the cardiorespiratory and intraocular pressure status of newly diagnosed glaucoma patients  

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AIMS—To evaluate the short term cardiovascular, respiratory, and intraocular pressure (IOP) effects of four glaucoma medications in newly diagnosed glaucoma patients.?METHODS—141 newly diagnosed glaucoma patients were recruited and underwent a full ocular, cardiovascular, and respiratory examination...

Waldock, A; Snape, J; Graham, C

209

Comparing ICD9-encoded diagnoses and NLP-processed discharge summaries for clinical trials pre-screening: a case study.  

UK PubMed Central (United Kingdom)

The prevalence of electronic medical record (EMR) systems has made mass-screening for clinical trials viable through secondary uses of clinical data, which often exist in both structured and free text formats. The tradeoffs of using information in either data format for clinical trials screening are understudied. This paper compares the results of clinical trial eligibility queries over ICD9-encoded diagnoses and NLP-processed textual discharge summaries. The strengths and weaknesses of both data sources are summarized along the following dimensions: information completeness, expressiveness, code granularity, and accuracy of temporal information. We conclude that NLP-processed patient reports supplement important information for eligibility screening and should be used in combination with structured data.

Li L; Chase HS; Patel CO; Friedman C; Weng C

2008-01-01

210

Comparing ICD9-encoded diagnoses and NLP-processed discharge summaries for clinical trials pre-screening: a case study.  

Science.gov (United States)

The prevalence of electronic medical record (EMR) systems has made mass-screening for clinical trials viable through secondary uses of clinical data, which often exist in both structured and free text formats. The tradeoffs of using information in either data format for clinical trials screening are understudied. This paper compares the results of clinical trial eligibility queries over ICD9-encoded diagnoses and NLP-processed textual discharge summaries. The strengths and weaknesses of both data sources are summarized along the following dimensions: information completeness, expressiveness, code granularity, and accuracy of temporal information. We conclude that NLP-processed patient reports supplement important information for eligibility screening and should be used in combination with structured data. PMID:18999285

Li, Li; Chase, Herbert S; Patel, Chintan O; Friedman, Carol; Weng, Chunhua

2008-11-06

211

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

Directory of Open Access Journals (Sweden)

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.

Staii Anca; Mirocha Sarah; Todorova-Koteva Kristina; Glinberg Simone; Jaume Juan C

2010-01-01

212

Inflammatory myopathies--a review of newly diagnosed patients (2004-2008) in the Counties Manukau region.  

UK PubMed Central (United Kingdom)

AIMS: To estimate incidence, review clinical characteristics and management of newly diagnosed patients with idiopathic inflammatory myositis in Counties Manukau and to compare the findings with other reported series in New Zealand and overseas. METHODS: A case note study of computer generated data of patients having a diagnosis of inflammatory myopathy from January 2004 to December 2008 were included in this retrospective review. RESULTS: Twelve patients were newly diagnosed in the 5-year period. Polymyositis (PM) was diagnosed in 58%, dermatomyositis (DM) in 33% and inclusion body myositis (IBM) in 8%. Amyopathic dermatomyositis (ADM) and malignancy associated dermatomyositis were diagnosed in one patient each. There was slight preponderance of men in dermatomyositis and women in polymyositis. Muscle biopsy was performed in 75% and electromyography was reported in 58%. High-dose prednisone was administered to 83%, and 50 % required other immunosuppressives, such as methotrexate (33%) and azathioprine (16%). Overall therapeutic response was good (75%) with 2 deaths (17%), one each in dermatomyositis and polymyositis. Regular follow-up was maintained in 92 %. Nasopharyngeal carcinoma was diagnosed in a patient with polymositis during follow up. CONCLUSIONS: Idiopathic inflammatory myositis is a challenging group of heterogenous disorders. This study highlights the need to review current criteria to include subcategories, such as amyopathic dermatomyositis, and the importance of long term surveillance to detect occult malignancy.

Gupta R; Gow PJ

2013-03-01

213

Leiomyomas and massive digestive hemorrhages: Case reports of patients diagnosed in 2004  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings), and at the same time a definite therapeutic procedure. Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.

Golubovi? Gradimir; ?eleketi? Dušica; Kiurski Milosav; Tomaševi? Ratko; Stankovi? Dragana; Pavlovi? Aleksandar

2007-01-01

214

Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients wi...

Nolla Solé, Joan Miquel; Gómez Vaquero, Carmen; Fiter, Jordi; Roig Vilaseca, Daniel; Mateo Soria, Lourdes; Rozadilla Sacanell, Antoni

215

EPIDEMIOLOGICAL STUDY REGARDING FAMILY AGGREGATION IN PATIENTS DIAGNOSED WITH COLORECTAL CANCER  

Directory of Open Access Journals (Sweden)

Full Text Available Colorectal cancer (CRC) is the second leading cause of cancer death both in the USA and Europe. Approximately 20% of all CRC cases occur in patients with family aggregation, but they do not respect a hereditary transmission model. The aim of this study was to establish the incidence of the disease and the clinical evolution aspects of CRC in patients with family history of colorectal neoplasm. Methods: We have studied the medical records and the histopathological findings of 460 patients diagnosed with CRC at the Institute of Gastroenterology and Hepatology, Iasi, during the period November 2007-December 2009. The patients were grouped as follows: the first group – patients with family history of CRC (n=56); the 2nd group – patients with no family history (n=318); the 3rd group – patients with familial history of neoplasia, others than CRC (n=86). Data on gender, age, provenience environment, tumor location, anatomical-pathological aspects, stage and synchronous lesions have been evaluated. Results: CRC family aggregation was found at 12.2% of the total cases of CRC, 85.7% of these patients had first-degree relatives. CRC was more frequent in males, predominantly from the urban area, regardless to the precence or the absence of the familial history of CRC. The highest incidence of CRC in patients with familial history was in the 6th decade versus the patients with no family history, where the disease appears two decades later. The location of CRC prevails in the rectum and the sigmoid colon, especially in patients with no family history. In patients with familial history of CRC one-third of cases are located in the proximal colon, most of them being in advanced stages. Conclusions: Family history of CRC is corelated to an increased risk of the disease, and therefore, screening programs of the relatives of patients with CRC is a necessary.

Maria Maxim; Anca Trifan

2011-01-01

216

Asperger Syndrome: a frequent comorbidity in first diagnosed adult ADHD patients?  

UK PubMed Central (United Kingdom)

BACKGROUND: Because adult ADHD is often accompanied by psychiatric comorbidities, the diagnostic process should include a thorough investigation for comorbid disorders. Asperger-Syndrome is rarely reported in adult ADHD and commonly little attention is paid to this possible comorbidity. SUBJECTS AND METHODS: We investigated 53 adult ADHD-patients which visited our out patient clinic for first ADHD-diagnosis (17 females, 36 males; range of age: 18-56 years) for the frequency of a comorbid Asperger-Syndrome. Diagnosis of this autism-spectrum disorder was confirmed by applying the appropriate DSM-IV-criteria. Additionally we tested the power of the two screening-instruments "Autism-spectrum quotient" (AQ) and "Empathy quotient" (EQ) by Baron-Cohen for screening Asperger-Syndrome in adult ADHD. RESULTS: Eight ADHD-patients were diagnosed with a comorbid Asperger-Syndrome (15.1%). The difference in AQ- and EQ-scores between pure ADHD-patients and comorbid patients was analysed, showing significantly higher scores in AQ and significant lower scores in EQ in comorbid patients. CONCLUSIONS: Results show that the frequency of Asperger-Syndrome seems to be substantially increased in adult ADHD (versus the prevalence of 0.06% in the general population), indicating that investigators of adult ADHD should also be attentive to autism-spectrum disorders. Especially the AQ seems to be a potential screening instrument for Asperger-Syndrome in adult ADHD-patients.

Roy M; Ohlmeier MD; Osterhagen L; Prox-Vagedes V; Dillo W

2013-06-01

217

Changes in quality of life among newly diagnosed breast cancer patients in Taiwan.  

UK PubMed Central (United Kingdom)

AIM: To examine changes in quality of life among patients with breast cancer and factors related to it, during the first three months after diagnosis. BACKGROUND: Numerous studies have examined quality of life among cancer survivors or among patients with cancer after aggressive treatment; such research has demonstrated that quality of life in the third month after surgery can significantly predict quality of life in the long run. In contrast, changes in quality of life causes among patients during the acute treatment phase have not been well studied. DESIGN: Prospective longitudinal study. METHODS: Newly diagnosed patients with breast cancer were recruited during 2008-2009. Sixty-one cases completed the four data collections on the day before operation and one, two and three months after surgery. Data were collected using the Functional Living Index-Cancer, Symptom Distress Scale, the Self-Efficacy Scale and a 0-10 Anxiety Numeric Rating Scale. Generalized Estimating Equations were applied for data analysis. RESULTS: There were significant changes in quality of life over the three months following surgery, and the worst quality of life was observed in the first month after surgery. Less advanced stages of cancer, lower anxiety, less symptom distress and higher perceived self-efficacy in the preoperative interview could significantly predict which patients experienced more positive quality of life trends. Fatigue, limited shoulder function and perceived poor appearance were the most significant factors predicting changes of quality of life. CONCLUSION: Preoperative physical and psychological factors, as well as sense of self-efficacy for managing the cancer, are important factors for predicting changes in patients' quality of life. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should be alert to factors contributing to changes of quality of life among patients receiving chemotherapy. Interventions based on these results should be developed and their effectiveness tested for their impact on breast cancer patients' quality of life. Clinical interventions based on these results should be developed to improve breast cancer patients' quality of life.

Cheng SY; Lai YH; Chen SC; Shun SC; Liao YM; Tu SH; Chen CS; Hsiang CY; Chen CM

2012-01-01

218

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

UK PubMed Central (United Kingdom)

UNLABELLED: 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.

Sørgaard KW; Rezvy G; Bugdanov A; Sørlie T; Bratlid T

2013-01-01

219

Nomogram prediction for overall survival of patients diagnosed with cervical cancer.  

UK PubMed Central (United Kingdom)

BACKGROUND: Nomograms are predictive tools that are widely used for estimating cancer prognosis. The aim of this study was to develop a nomogram for the prediction of overall survival (OS) in patients diagnosed with cervical cancer. METHODS: Cervical cancer databases of two large institutions were analysed. Overall survival was defined as the clinical endpoint and OS probabilities were estimated using the Kaplan-Meier method. Based on the results of survival analyses and previous studies, relevant covariates were identified, a nomogram was constructed and validated using bootstrap cross-validation. Discrimination of the nomogram was quantified with the concordance probability. RESULTS: In total, 528 consecutive patients with invasive cervical cancer, who had all nomogram variables available, were identified. Mean 5-year OS rates for patients with International Federation of Gynecologists and Obstetricians (FIGO) stage IA, IB, II, III, and IV were 99.0%, 88.6%, 65.8%, 58.7%, and 41.5%, respectively. Seventy-six cancer-related deaths were observed during the follow-up period. FIGO stage, tumour size, age, histologic subtype, lymph node ratio, and parametrial involvement were selected as nomogram covariates. The prognostic performance of the model exceeded that of FIGO stage alone and the model's estimated optimism-corrected concordance probability was 0.723, indicating accurate prediction of OS. We present the prediction model as nomogram and provide a web-based risk calculator (http://www.ccc.ac.at/gcu). CONCLUSION: Based on six easily available parameters, a novel statistical model to predict OS of patients diagnosed with cervical cancer was constructed and validated. The model was implemented in a nomogram and provides accurate prediction of individual patients' prognosis useful for patient counselling and deciding on follow-up strategies.

Polterauer S; Grimm C; Hofstetter G; Concin N; Natter C; Sturdza A; Pötter R; Marth C; Reinthaller A; Heinze G

2012-09-01

220

Oral rehabilitation of a 12-year-old patient diagnosed with a central giant cell granuloma using a fibula graft and an implant-supported prosthesis: a clinical report.  

Science.gov (United States)

This clinical report describes the oral rehabilitation of a 12-year-old boy with a central giant cell granuloma of the mandible. He underwent en bloc resection of a central giant cell granuloma, free vascularized fibula reconstruction, implant placement, and prosthesis fabrication. The multidisciplinary approach successfully restored function and esthetics. Considerations regarding the extensive surgical and prosthetic rehabilitation of a young adult with remaining growth are discussed. PMID:18395534

Lee, Heeje; Ercoli, Carlo; Fantuzzo, Joseph J; Girotto, John A; Coniglio, John U; Palermo, Matthew

2008-04-01

 
 
 
 
221

Intensive Chemotherapy and Immunotherapy in Patients With Newly Diagnosed Primary CNS Lymphoma: CALGB 50202 (Alliance 50202).  

UK PubMed Central (United Kingdom)

PURPOSE: Concerns regarding neurocognitive toxicity of whole-brain radiotherapy (WBRT) have motivated development of alternative, dose-intensive chemotherapeutic strategies as consolidation in primary CNS lymphoma (PCNSL). We performed a multicenter study of high-dose consolidation, without WBRT, in PCNSL. Objectives were to determine: one, rate of complete response (CR) after remission induction therapy with methotrexate, temozolomide, and rituximab (MT-R); two, feasibility of a two-step approach using high-dose consolidation with etoposide plus cytarabine (EA); three, progression-free survival (PFS); and four, correlation between clinical and molecular prognostic factors and outcome. PATIENTS AND METHODS: Forty-four patients with newly diagnosed PCNSL were treated with induction MT-R, and patients who achieved CR received EA consolidation. We performed a prospective analysis of molecular prognostic biomarkers in PCNSL in the setting of a clinical trial. RESULTS: The rate of CR to MT-R was 66%. The overall 2-year PFS was 0.57, with median follow-up of 4.9 years. The 2-year time to progression was 0.59, and for patients who completed consolidation, it was 0.77. Patients age > 60 years did as well as younger patients, and the most significant clinical prognostic variable was treatment delay. High BCL6 expression correlated with shorter survival. CONCLUSION: CALGB 50202 demonstrates for the first time to our knowledge that dose-intensive consolidation for PCNSL is feasible in the multicenter setting and yields rates of PFS and OS at least comparable to those of regimens involving WBRT. On the basis of these encouraging results, an intergroup study has been activated comparing EA consolidation with myeloablative chemotherapy in this randomized trial in PCNSL, in which neither arm involves WBRT.

Rubenstein JL; Hsi ED; Johnson JL; Jung SH; Nakashima MO; Grant B; Cheson BD; Kaplan LD

2013-09-01

222

[Clinical prediction rule for diagnosing deep vein thrombosis in primary care].  

UK PubMed Central (United Kingdom)

Patients with suspected deep vein thrombosis (DVT) are often managed on an outpatient basis by primary care physicians. International guidelines recommend anticoagulant treatment for patients with suspected DVT when diagnostic testing is delayed or when clinical probability is high. Our goal was to build a clinical prediction rule specifically for easy use in primary care to help decide about starting anticoagulant therapy while awaiting ultrasound examination. Between January and December 2006, 276 patients with clinically suspected DVT were included in this study by 189 general practitioners from Brittany, France. All patients underwent a standardized clinical assessment and were then referred for ultrasonography. The diagnosis of DVT was confirmed in 103 (37%) patients. The final clinical prediction rule comprises four risk factors for DVT (personal history of venous thromboembolism +1, immobilization in previous month +1, estrogen contraceptive +2, active malignancy +3), one clinical sign (swelling of the calf +1), and the presence of an alternative diagnosis more likely than that of DVT (-3). The proportion of confirmed DVT was 26% in patients classified as at low risk, with a score less than 2 points, and 63% in patients classified at high risk, that is, with a score of 2 points or more. This clinical prediction rule is based on simple history and clinical factors that are routinely collected by GPs from patients with suspected DVT. It could help to decide about the immediate prescription of anticoagulation pending ultrasound. This rule should be externally validated before its use in clinical practice can be recommended.

Gagne P; Simon L; Le Pape F; Bressollette L; Mottier D; Le Gal G

2009-04-01

223

[Clinical prediction rule for diagnosing deep vein thrombosis in primary care].  

Science.gov (United States)

Patients with suspected deep vein thrombosis (DVT) are often managed on an outpatient basis by primary care physicians. International guidelines recommend anticoagulant treatment for patients with suspected DVT when diagnostic testing is delayed or when clinical probability is high. Our goal was to build a clinical prediction rule specifically for easy use in primary care to help decide about starting anticoagulant therapy while awaiting ultrasound examination. Between January and December 2006, 276 patients with clinically suspected DVT were included in this study by 189 general practitioners from Brittany, France. All patients underwent a standardized clinical assessment and were then referred for ultrasonography. The diagnosis of DVT was confirmed in 103 (37%) patients. The final clinical prediction rule comprises four risk factors for DVT (personal history of venous thromboembolism +1, immobilization in previous month +1, estrogen contraceptive +2, active malignancy +3), one clinical sign (swelling of the calf +1), and the presence of an alternative diagnosis more likely than that of DVT (-3). The proportion of confirmed DVT was 26% in patients classified as at low risk, with a score less than 2 points, and 63% in patients classified at high risk, that is, with a score of 2 points or more. This clinical prediction rule is based on simple history and clinical factors that are routinely collected by GPs from patients with suspected DVT. It could help to decide about the immediate prescription of anticoagulation pending ultrasound. This rule should be externally validated before its use in clinical practice can be recommended. PMID:19062245

Gagne, Pierre; Simon, Luc; Le Pape, Florence; Bressollette, Luc; Mottier, Dominique; Le Gal, Grégoire

2008-12-04

224

Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients.  

Science.gov (United States)

Two hundred eighty-eight eating disorder patients were administered the DSM-III-R Structured Clinical Interview (SCID) and the DSM-IV SCID for axis I and II. Concordance between DSM-III-R and DSM-IV was excellent for the axis I affective and anxiety disorders, bulimia nervosa, and substance abuse/dependence. It was also excellent for axis II paranoid, schizoid, borderline, and antisocial personality disorders. Agreement between the two nosological systems was lower for alcohol abuse/dependence with a kappa of.63. Kappas were also poor for the following personality disorders: schizotypal (.44), histrionic (.29), dependent (.54), obsessive-compulsive (.62) and not otherwise specified (.63). There was a substantial difference in the diagnosis of anorexia nervosa between DSM-III-R and DSM-IV. Fourteen patients were diagnosed with anorexia nervosa, binge/purge type, using DSM-IV criteria, while only six received the diagnoses of anorexia nervosa and bulimia nervosa using DSM-III-R criteria. Kappa was.49 and the percent agreement was 79%. While there are considerable areas of overlap in DSM-IV and DSM-III-R, there are also areas of substantial differences. Clinicians and researchers must be very cautious when attempting to compare data from the different nosologies. PMID:11704934

Sunday, S R; Peterson, C B; Andreyka, K; Crow, S J; Mitchell, J E; Halmi, K A

225

Genetical analysis of all Danish patients diagnosed with chronic granulomatous disease  

DEFF Research Database (Denmark)

Chronic granulomatous disease (CGD) is a rare inherited disorder of the innate immune system caused by a defect in NADPH oxidase, leaving the granulocytes unable to kill invading microorganisms. CGD is caused by mutation in one of the five components gp91phox, p22phox, p47phox, p67phox and p40phox, encoded by the X-linked CYBB gene and the autosomal CYBA, NCF1, NCF2 and NCF4 genes respectively. We have collected samples from all Danish patients with known CGD followed in the clinic or newly diagnosed during a 5-year period, a cohort of 27 patients, and characterized them genetically. The cohort includes 10 male patients with X-linked CGD and one female with extremely lyonized expression of a defective CYBB allele. Six patients had mutation in CYBA. Seven of 10 patients with a defect in NCF1 were homozygous for the common GT deletion, one was compound heterozygous for the GT deletion and a splice-site mutation, and two patients were homozygous for a nonsense mutation in exon 7. Three novel mutations were detected, a deletion of exon 6 in CYBA, a duplication of exon 8-13 in CYBB and a splice site mutation in intron 7 of NCF1.

Jakobsen, M A; Katzenstein, Terese Lea

2012-01-01

226

Genetical analysis of all Danish patients diagnosed with chronic granulomatous disease.  

UK PubMed Central (United Kingdom)

Chronic granulomatous disease (CGD) is a rare inherited disorder of the innate immune system caused by a defect in NADPH oxidase, leaving the granulocytes unable to kill invading microorganisms. CGD is caused by mutation in one of the five components gp91phox, p22phox, p47phox, p67phox and p40phox, encoded by the X-linked CYBB gene and the autosomal CYBA, NCF1, NCF2 and NCF4 genes respectively. We have collected samples from all Danish patients with known CGD followed in the clinic or newly diagnosed during a 5-year period, a cohort of 27 patients, and characterized them genetically. The cohort includes 10 male patients with X-linked CGD and one female with extremely lyonized expression of a defective CYBB allele. Six patients had mutation in CYBA. Seven of 10 patients with a defect in NCF1 were homozygous for the common GT deletion, one was compound heterozygous for the GT deletion and a splice-site mutation, and two patients were homozygous for a nonsense mutation in exon 7. Three novel mutations were detected, a deletion of exon 6 in CYBA, a duplication of exon 8-13 in CYBB and a splice site mutation in intron 7 of NCF1.

Jakobsen MA; Katzenstein TL; Valerius NH; Roos D; Fisker N; Mogensen TH; Jensen PØ; Barington T

2012-11-01

227

Nomogram to predict the probability of relapse in patients diagnosed with borderline ovarian tumors.  

UK PubMed Central (United Kingdom)

OBJECTIVE: This study aimed to develop a nomogram predicting the probability of relapse in individual patients who have surgery for borderline ovarian tumors (BOTs). METHODS: This retrospective study included 801 patients with BOT diagnosed between 1985 and 2008 at 6 gynecologic cancer centers. We analyzed covariates that were associated with the risk of developing a recurrence by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The 5 most significant or clinically important variables associated with an increased risk of recurrence were included in the nomogram. The nomogram was internally validated. RESULTS: Fifty-one patients developed a recurrence after a median observation period of 57 months. Age at diagnosis, the International Federation of Gynecology and Obstetrics stage, cell type, preoperative serum CA125, and type of surgery (radical vs fertility-sparing) were associated with an increased risk of recurrence and were used in the nomogram. Bootstrap-corrected concordance index was 0.67 and showed good calibration. CONCLUSIONS: Five factors that are commonly available to clinicians treating patients with BOT were used in the development of a nomogram to predict the risk of recurrence. The nomogram will be useful to counsel patients about risk-reduction strategies to minimize the risk of recurrence or to inform patients about a very low risk of recurrence making intensive follow-up unwarranted.

Obermair A; Tang A; Kondalsamy-Chennakesavan S; Ngan H; Zusterzeel P; Quinn M; Carter J; Leung Y; Janda M

2013-02-01

228

Ocular toxoplasmosis: clinical characteristics in pediatric patients.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe the clinical features of Ocular Toxoplasmosis in pediatric patients. METHODS: A retrospective, non-comparative series of cases was studied. We reviewed the clinical records of patients 16 year old or younger diagnosed with Ocular Toxoplasmosis. RESULTS: Forty patients (56 eyes) were included. The mean age was 9.5 yrs old. Twenty were female. Unilateral involvement was noticed in 60% of patients. The most common symptoms were strabismus (32.1%) and reduced VA in (23.2%). An inactive retinal scar was observed in most cases (71.4%). Panuveitis was found in 8 eyes (14.2%), and posterior uveitis in 7 eyes of 7 patients (12.5%); one eye presented neuroretinitis. The most frequent location of retinochoroidal lesions was the posterior pole (72.7%). CONCLUSIONS: In children, ocular toxoplasmosis is most commonly diagnosed during the inactive stage. When inflammation is present, it can be severe and frequently associated with other complications such vasculitis and papillitis.

Garza-Leon M; Garcia LA

2012-04-01

229

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

Scientific Electronic Library Online (English)

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

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

2013-09-01

230

A phase II clinical trial of poly-ICLC with radiation for adult patients with newly diagnosed supratentorial glioblastoma: a North American Brain Tumor Consortium (NABTC01-05).  

UK PubMed Central (United Kingdom)

PURPOSE: This phase II study was designed to determine the overall survival time of adults with supratentorial glioblastoma treated with the immune modulator, polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC), in combination with and following radiation therapy (RT). METHODS AND MATERIALS: This was an open-label, single arm phase II study. Patients were treated with RT in combination with poly-ICLC followed by poly-ICLC as a single agent. Poly-ICLC was initiated 7-28 days after the surgical procedure that established the diagnosis; radiotherapy began within 7 days of the first dose of poly-ICLC and within 35 days of surgical diagnosis. Treatment with poly-ICLC continued following the completion of RT to a maximum of 1 year or until tumor progression. RESULTS: 31 patients were enrolled in this study. One patient did not have a Glioblastoma mutiforme and was deemed ineligible. For the 30 eligible patients, time to progression was known for 27 patients and 3 were censored. The estimated 6-month progression-free survival was 30% and the estimated 1-year progression-free survival was 5%. Median time to progression was as 18 weeks. The 1-year survival was 69% and the median survival was 65 weeks. CONCLUSIONS: The combined therapy was relatively well-tolerated. This study suggests a survival advantage compared to historical studies using RT without chemotherapy but no survival advantage compared to RT with adjuvant nitrosourea or non-temozolomide chemotherapy. Our results suggest that poly-ICLC has activity against glioblastoma and may be worth further study in combination with agents such as temozolomide.

Butowski N; Chang SM; Junck L; DeAngelis LM; Abrey L; Fink K; Cloughesy T; Lamborn KR; Salazar AM; Prados MD

2009-01-01

231

CPAP adherence in patients with newly diagnosed obstructive sleep apnea prior to elective surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: Obstructive sleep apnea (OSA) is prevalent in the surgical population, and it has been suggested that preoperative patients should be screened and treated for OSA. However, it remains unclear whether patients diagnosed with OSA in the preoperative period adhere to prescribed CPAP therapy. OBJECTIVE: Our aim was to objectively quantify CPAP adherence, investigate predictors of poor CPAP adherence, and to establish an optimal CPAP setting in a cohort of presurgical patients diagnosed with OSA as part of the preoperative work-up. METHODS: In a retrospective observational study, we collected data on all adult presurgical patients seen by the Anesthesia Perioperative Medicine Clinic (APMC) who screened positive for OSA on the STOP-Bang questionnaire and underwent an in-laboratory diagnostic polysomnogram (PSG) before surgery. CPAP was offered to patients with moderate or severe OSA. Objective CPAP adherence was recorded during the perioperative period. Factors associated with reduced CPAP adherence were delineated. Patient characteristics were compared between those with STOP-Bang scores of 3-4 and those with higher scores (STOP-Bang score ? 5). RESULTS: During a 2-year period, 431 patients were referred and 211 patients completed a PSG. CPAP therapy was required in 65% of patients, and the optimal level was 9 ± 2 cm H(2)O. Objective CPAP adherence was available in 75% of patients who received CPAP therapy; median adherence was 2.5 h per night, without any significant difference between the STOP-Bang subgroups. African American race, male gender, and depressive symptomatology were independent predictors of reduced CPAP adherence. Severe OSA was significantly more prevalent in patients with a STOP-Bang score ? 5 than those whose score was 3-4 (55.1% versus 34.4%, p = 0.005). However, optimum CPAP pressure levels and adherence to therapy did not differ between the 2 STOP-Bang groups. CONCLUSIONS: Adherence to prescribed CPAP therapy during the perioperative period was extremely low. African American race, male gender, and depressive symptoms were independently associated with reduced CPAP usage. Further research is needed to identify and overcome barriers to CPAP acceptance and adherence in the perioperative setting.

Guralnick AS; Pant M; Minhaj M; Sweitzer BJ; Mokhlesi B

2012-10-01

232

Examining the relevance of the physician's clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The aim of this study was to examine the relevance of clinical assessment in diagnosing appendicitis in the current medical environment, in which routine use of computed tomography (CT) has become the norm. METHODS: A retrospective review was conducted, analyzing patient demographics, Alvarado clinical assessment scoring, and radiologic and pathologic results. RESULTS: A total of 664 patients were identified. Higher Alvarado scores were significantly associated with pathologically confirmed appendicitis (low, 87%; moderate, 92%; high, 96%; P = .05). As clinical assessment scores increased, use of CT decreased significantly (low, 97%; moderate, 85%; high, 79%; P = .01). The negative appendectomy rate for patients with clinical assessments consistent with appendicitis was 4%, compared with 3% associated with CT. Regardless of assessment scores, 82% of the cohort underwent CT. From a random sample of 100 charts, 87% of initial emergency department plans stratified disposition on the basis of the results of CT. CONCLUSIONS: Although physical examination remains crucial, CT has become the primary modality dictating care of patients with presumed appendicitis.

Nelson DW; Causey MW; Porta CR; McVay DP; Carnes AM; Johnson EK; Steele SR

2013-04-01

233

Perception of health and understanding of cardiovascular risk among patients with recently diagnosed diabetes and/or metabolic syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Cardiovascular (CV) disease mortality is increased in diabetes mellitus (DM) and metabolic syndrome (MS), conditions which share CV risk factors. AIM: The purpose of this study was to assess understanding of CV risk by patients with DM and/or MS diagnosed less than 1 year before and seen in primary care. Perception by these patients of their health state is also analysed. DESIGN: A multicentre, observational study in subjects diagnosed with DM diagnosed less than 1 year before and/or with MS, in whom agreement between CV risk perceived by patients and assessed by physicians was analysed. METHODS: Medical registry data and a survey of health status and perceived risk by patients and physicians. Agreement of patient perception of CV risk with perception of the physician in charge and with the CV risk established with clinical registry data was assessed. Self-perceived health status was also studied. RESULTS: A total of 150 physicians recruited 681 patients (71.5% with DM and 28.5% with MS) aged 60.8 ± 10.8 years (55.8% males). Good or excellent health were reported by 41.3% and 0.9%, respectively. Inability to give an estimate of CV risk was found in 39.8%. Agreement between the CV risks perceived by patients and evaluated by chart was poor: kappa index 0.145 (95% CI 0.101-0.189), p < 0.001. Agreement between CV risk perceived by patients and clinical data in the medical registry was weak: kappa index 0.165 (95% CI 0.117-0.213), p < 0.001. CONCLUSIONS: Patients with recently diagnosed DM and/or with MS have a poor awareness of their CV risk and 42.2% of them think that they have good or excellent health.

Martell-Claros N; Aranda P; González-Albarrán O; Dalfó-Baqué A; Domínguez-Sardiña M; de la Cruz JJ; Campo C; de Álvaro C

2013-02-01

234

Stereotactic body radiotherapy (SBRT) for non- pathologically diagnosed lung cancer patients  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Medically inoperable patients with primary or recurrent lung cancer are increasingly being diagnosed clinically without pathologic confirmation especially for patients with comorbidities that preclude biopsy. The objective of this study is to report the outcomes of medically inoperable patients with unbiopsied primary or recurrent lung carcinoma with SBRT. Methods: From 2008-2011, 22 patients with non-pathologically diagnosed primary or recurrent lung cancer were treated with SBRT. All patients had diagnostic imaging clinically consistent with primary or recurrent lung malignancy. Fifteen patients had primary lung cancer and 7 had recurrent disease previously treated with surgery or fractionated radiotherapy. Median SBRT dose was 50 Gy (Range 40-55 Gy) in a median of 5 fractions (Range 4-10 fractions). Median BED was 100 Gy (Range 72-151.2 Gy). Results: Median follow up is 15.3 months (Range 6.6-33.0 months). Primary tumors had a median longest dimension on the original CT of 1.6cm, which enlarged to 2.0cm (P<0.001) on serial CT and decreased to 1.3cm (P=0.003) after SBRT. Recurrent tumors had a median longest dimension of 1.6cm, which increased to 2.7cm (P=0.33) on repeat CT and subsequently stabilized at 2.7cm after SBRT. On FDG-PET scan, median standard uptake value (SUV) for the entire population is 5.4 before SBRT which decreased to 2.3 (P<0.001) after treatment. For the entire population, absolute local control was 90.9%. Kaplan-Meier curves estimates at 2 years show regional control 100%, distant control 75%, cancer specific survival 92%, and overall survival 75%. There were no grade 3/4 acute or chronic treatment-related toxicities. Conclusions: In medically inoperable patients, a diagnosis of lung cancer can be provisionally made radiographically without pathologic confirmation. Local control can be achieved with minimal toxicity with the use of SBRT.

Matthew M Harkenrider; Matthew H Bertke; Neal E Dunlap; Anthony E Dragun

2012-01-01

235

CACNA1E variants affect beta cell function in patients with newly diagnosed type 2 diabetes. the Verona newly diagnosed type 2 diabetes study (VNDS) 3.  

UK PubMed Central (United Kingdom)

BACKGROUND: Genetic variability of the major subunit (CACNA1E) of the voltage-dependent Ca(2+) channel Ca(V)2.3 is associated to risk of type 2 diabetes, insulin resistance and impaired insulin secretion in nondiabetic subjects. The aim of the study was to test whether CACNA1E common variability affects beta cell function and/or insulin sensitivity in patients with newly diagnosed type 2 diabetes. METHODOLOGY/PRINCIPAL FINDINGS: In 595 GAD-negative, drug naïve patients (mean ± SD; age: 58.5 ± 10.2 yrs; BMI: 29.9 ± 5 kg/m(2), HbA1c: 7.0±1.3) with newly diagnosed type 2 diabetes we: 1. genotyped 10 tag SNPs in CACNA1E region reportedly covering ?93% of CACNA1E common variability: rs558994, rs679931, rs2184945, rs10797728, rs3905011, rs12071300, rs175338, rs3753737, rs2253388 and rs4652679; 2. assessed clinical phenotypes, insulin sensitivity by the euglycemic insulin clamp and beta cell function by state-of-art modelling of glucose/C-peptide curves during OGTT. Five CACNA1E tag SNPs (rs10797728, rs175338, rs2184945, rs3905011 and rs4652679) were associated with specific aspects of beta cell function (p<0.05-0.01). Both major alleles of rs2184945 and rs3905011 were each (p<0.01 and p<0.005, respectively) associated to reduced proportional control with a demonstrable additive effect (p<0.005). In contrast, only the major allele of rs2253388 was related weakly to more severe insulin resistance (p<0.05). CONCLUSIONS/SIGNIFICANCE: In patients with newly diagnosed type 2 diabetes CACNA1E common variability is strongly associated to beta cell function. Genotyping CACNA1E might be of help to infer the beta cell functional phenotype and to select a personalized treatment.

Trombetta M; Bonetti S; Boselli M; Turrini F; Malerba G; Trabetti E; Pignatti P; Bonora E; Bonadonna RC

2012-01-01

236

Variants of GCKR affect both ?-cell and kidney function in patients with newly diagnosed type 2 diabetes: the Verona newly diagnosed type 2 diabetes study 2.  

UK PubMed Central (United Kingdom)

OBJECTIVE: In genome-wide association studies, performed mostly in nondiabetic individuals, genetic variability of glucokinase regulatory protein (GCKR) affects type 2 diabetes-related phenotypes, kidney function, and risk of chronic kidney disease (CKD). We tested whether GCKR variability affects type 2 diabetes or kidney-related phenotypes in newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS: In 509 GAD-negative patients with newly diagnosed type 2 diabetes, we 1) genotyped six single nucleotide polymorphisms in GCKR genomic region: rs6717980, rs1049817, rs6547626, rs780094, rs2384628, and rs8731; 2) assessed clinical phenotypes, insulin sensitivity by the euglycemic insulin clamp, and ?-cell function by state-of-the-art modeling of glucose/C-peptide curves during an oral glucose tolerance test; and 3) estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease formula. RESULTS: The major alleles of rs6717980 and rs2384628 were associated with reduced ?-cell function (P < 0.05), with mutual additive effects of each variant (P < 0.01). The minor alleles of rs1049817 and rs6547626 and the major allele of rs780094 were associated with reduced eGFR according to a recessive model (P < 0.03), but with no mutual additive effects of the variants. Additional associations were found between rs780094 and 2-h plasma glucose (P < 0.05) and rs8731 and insulin sensitivity (P < 0.05) and triglycerides (P < 0.05). CONCLUSIONS: Our findings are compatible with the idea that GCKR variability may play a pathogenetic role in both type 2 diabetes and CKD. Genotyping GCKR in patients with newly diagnosed type 2 diabetes might help in identifying patients at high risk for metabolic derangements or CKD.

Bonetti S; Trombetta M; Boselli ML; Turrini F; Malerba G; Trabetti E; Pignatti PF; Bonora E; Bonadonna RC

2011-05-01

237

Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography.  

UK PubMed Central (United Kingdom)

BACKGROUND: Paravalvular abscess is a complication of endocarditis that may lead to persistent infection, conduction abnormalities, fistula formation, worsening congestive heart failure, and death. METHODS: Between 1991 and 2001, paravalvular abscess was identified on transesophageal echocardiography in 24 patients who subsequently underwent surgical treatment. Echocardiographic findings were reviewed for location of abscess, presence of a valvular prosthesis, valvular function, and presence of vegetations. Information gathered included the time interval between transesophageal echocardiography diagnosis and operation, inhospital mortality, and microbiologic data. RESULTS: Of 24 patients, 9 died, for a mortality of 38%. Of the patients who died, the average survival after operation was 43 days, with a range of 1 to 238 days. Of the 14 patients with significant valvular or paravalvular regurgitation, 8 died (57%). However, of the 10 patients with mild or no regurgitation, only 1 died (10%). This difference was statistically significant (P =.02). CONCLUSION: Patients without preserved valve function (those with moderate or severe regurgitation) have a significantly worse outcome (57% mortality) than do those with normal valvular function (10% mortality).

Cosmi JE; Tunick PA; Kronzon I

2004-07-01

238

Diagnosing and managing spinal injury in patients with ankylosing spondylitis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Individuals with ankylosing spondylitis are at an increased risk of vertebral fractures. These are often unstable, leading to primary and secondary neurological injury and conferring high levels of morbidity and mortality. Fractures in these patients can occur after minimal trauma and are easily missed, with potentially disastrous consequences. OBJECTIVES: To educate health professionals who may be involved in the initial assessment and management of ankylosing spondylitis patients with possible spinal injuries, despite not being spinal specialists. CASE REPORTS: We present three cases from our own hospital, which illustrate the pitfalls associated with traumatic spinal injury in ankylosing spondylitis. Case 1 shows why delayed presentation of spinal injury is common, as well as demonstrating the need for multiple imaging modalities in some patients. Case 2 is an example of primary neurological injury in this patient group, and case 3 highlights the risk of secondary neurological injury, as well as the effect of multiple comorbidities on patient outcomes. CONCLUSIONS: It is important that staff in the Emergency Department have an understanding of the extreme caution that is needed in the management of possible spinal injuries in patients with or suspected of having ankylosing spondylitis.

Waldman SK; Brown C; Lopez de Heredia L; Hughes RJ

2013-04-01

239

Direct medical care costs associated with patients diagnosed with chronic HCV.  

UK PubMed Central (United Kingdom)

BACKGROUND: HCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial. OBJECTIVES: This study aimed to estimate the direct medical care costs of chronic HCV infection. PATIENTS AND METHODS: For this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$). RESULTS: Average direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs. CONCLUSIONS: According to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).

Ashtari S; Vahedi M; Pourhoseingholi MA; Karkhane M; Kimiia Z; Pourhoseingholi A; Safaee A; Moghimi-Dehkordi B; Zali MR; Alavian SM

2013-05-01

240

Do STD clinics correctly diagnose STDs? An assessment of STD management in Hefei, China.  

UK PubMed Central (United Kingdom)

The main purposes of the study were to assess the accuracy of laboratory testing and the diagnosis by physicians in sexually transmitted disease (STD) clinics in Hefei, China. Among 347 men complaining of urethral discharge or dysuria, 240 tested positive at the National Centre for either Neisseria gonorrhoeae or Chlamydia trachomatis, 310 tested positive according to the clinic laboratories, and 347 were diagnosed by the physicians. For chlamydia, the sensitivity and positive predictive value (PPV) of the clinic laboratories were 55% and 26%, and for the diagnosis by the physicians were 61% and 24%. Laboratory testing and the diagnosis by the physicians had low power to detect mixed infection. The PPVs for the diagnosis by the physicians were 50% for syphilis and 43% for herpes simplex virus (HSV), indicating that both syphilis and HSV were over-diagnosed. Over half of those previously infected had not received education to prevent reinfection. Thus, the quality of clinic laboratory testing was not high and physicians often misdiagnosed STDs.

Liu H; Detels R; Yin Y; Li X; Visscher B

2003-10-01

 
 
 
 
241

Conditional probability of survival in patients with newly diagnosed glioblastoma.  

UK PubMed Central (United Kingdom)

PURPOSE: The disease outcome for patients with cancer is typically described in terms of estimated survival from diagnosis. Conditional probability offers more relevant information regarding survival for patients once they have survived for some time. We report conditional survival probabilities on the basis of 498 patients with glioblastoma multiforme receiving radiation and chemotherapy. For 1-year survivors, we evaluated variables that may inform subsequent survival. Motivated by the trend in data, we also evaluated the assumption of constant hazard. PATIENTS AND METHODS: Patients enrolled onto seven phase II protocols between 1975 and 2007 were included. Conditional survival probabilities and 95% CIs were calculated. The Cox proportional hazards model was used to evaluate prognostic values of age, Karnofsky performance score (KPS), and prior progression 1-year post diagnosis. To assess the constant hazard assumption, we used a likelihood-ratio test to compare the Weibull and exponential distributions. RESULTS: The probabilities of surviving an additional year given survival to 1, 2, 3, and 4 years were 35%, 49%, 69%, and 93%, respectively. For patients who survived for 1 year, lower KPS and progression were significantly predictive of shorter survival (both P < .001), but age was not (hazard ratio, 1.22 for a 10-year increase; P = .25). The Weibull distribution fits the data significantly better than exponential (P = .02), suggesting nonconstant hazard. CONCLUSION: Conditional probabilities provide encouraging information regarding life expectancy to survivors of glioblastoma multiforme. Our data also showed that the constant hazard assumption may be violated in modern brain tumor trials. For single-arm trials, we advise using individual patient data from historical data sets for efficacy comparisons.

Polley MY; Lamborn KR; Chang SM; Butowski N; Clarke JL; Prados M

2011-11-01

242

Screening for bipolar disorder with the Mood Disorders Questionnaire in patients diagnosed as major depressive disorder - the experience in China.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bipolar disorder (BD) is often misdiagnosed as a major depressive disorder (MDD). This study aimed to test the usefulness of the screening tool, the Mood Disorders Questionnaire (MDQ), to identify BD patients misdiagnosed as MDD in Chinese clinical settings. METHODS: A total of 1487 patients treated for MDD were consecutively examined in 13 mental health centers in China. The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The MDQ was completed by patients to identify symptoms characteristic of BD. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI). RESULTS: Three hundred-nine of the 1487 patients (20.8%) satisfied DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. The optimal cut-off point on the MDQ to differentiate BD from MDD was 3, while cut-off points of 5 and 3 differentiated BD-I and BD-II from MDD, respectively. The maximum sensitivity was 0.31, 0.45 and 0.22 for differentiating BD, BD-I and BD-II from MDD, respectively. CONCLUSIONS: The optimal cutoff points of the MDQ for screening BD in Chinese patients originally diagnosed as MDD were considerably lower than those in earlier studies. The routine clinical use of the MDQ as a screening scale for BD in Chinese patients treated for MDD does not seem to be justified.

Hu C; Xiang YT; Wang G; Ungvari GS; Dickerson FB; Kilbourne AM; Lai KY; Si TM; Fang YR; Lu Z; Yang HC; Hu J; Chen ZY; Huang Y; Sun J; Wang XP; Li HC; Zhang JB; Chiu HF

2012-12-01

243

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

International Nuclear Information System (INIS)

[en] 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

2009-01-01

244

[Splenic focal lesion in oncologic patients diagnosed by ultrasound  

UK PubMed Central (United Kingdom)

Focal lesion of the spleen are infrequent, they appear in 2-4% of patients with malignancies, in our experience we found metastases in nineteen oncologic patients (0.54%) this fact modified the staging prognosis and therapeutic. All the cases were correlated with laparoscopy, fine needle biopsy guided by ultrasound, and or laparotomy. It is emphasized tha the spleen's size was normal in 47.4%. The usual appearance was multiple focal lesions in 89.5% and the sonography pattern of the lesion was variable: Hypoechoic in 63.2% hyperechoic an mixed in 15.8% respectively and cystic in 5.3%. We conclude that ultrasound is an excellent non invasive method to detect focal lesions of the spleen in oncologic patient, where is necessary to know the histology of this lesions, fine needle guided biopsies, can be done safely.

Isern AM; Fernández C; Salamanca M; Monserat R; Merola L; Balabu M; Fuentes D; Sánchez MJ; Gori H; Salazar J

1993-01-01

245

[Acceptance of own disease by patients with diagnosed glaucoma].  

UK PubMed Central (United Kingdom)

UNLABELLED: The notion of glaucoma comprises a number of diseases which are all characterized by optic nerve damage. It was estimated that nearly 70 million people all over the world suffer from glaucoma and 10% of them have lost their sight because of glaucomatous optic nerve atrophy. The aim of this paper is to determine the acceptance level of the condition by patients with primary glaucoma as well as to study the relations between the acceptance level and the parameters influencing it directly or indirectly. MATERIAL AND METHODS: The study included 50 patients (40 women and 10 men) aged between 20 and 90 with recognized primary open-angle glaucoma. A questionnaire and a standardized Acceptance of Illness Scale (AIS) were used to evaluate the study material. The observed differences and relation levels were subjected to statistical analysis with the use of the Student's t test as well as the chi2 test, and the statistical significance level was established at p < 0.05. RESULTS: Within the studied group, people between the ages of 61 and 70 (38%), with secondary education (48%), were the most numerous. The most frequent therapeutic method was local treatment (application of eye drops). Prescribed medication was taken on a regular basis by 86% of patients, lack of regularity was declared by 14% of them. The 26% of patients realize their duties less accurately than before and 12% of them declared the need of frequent breaks in their work. The analysis showed a statistically significant relation (p = 0.0005) between the acceptance level of the condition and refraining from various forms of activity. The low acceptance of patients' illness determined the increase of they resignation from all forms of physical activity. CONCLUSIONS: The consecutive degrees of disease acceptance (low, medium, high) are comprised in glaucoma patients in the same proportion, i.e. each degree comprises around 30% of patients the most serious problems accepting the illness. This means that the tolerance of the disease is observed in 1/3 of patients with glaucoma. The most serious problems in disease acceptance were determined in elderly people and those with elementary or vocational education.

Karna-Matyjaszek U; Sierzantowicz R; Mariak Z

2010-01-01

246

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

UK PubMed Central (United Kingdom)

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 was 65.2 years. Urinary glucose concentration (UGC) was determined quantitatively in a freshly voided morning urine specimen. RESULTS: The over-all prevalence of peripheral vascular disease (PVD) was 16.5%. Bivariately, high values of UGC were associated with low prevalence of PVD (p<0.001, chi2-test). The predictive value of PVD--together with HbA1c, glomerular filtration rate (GFR) and 10 other possible predictors--was confirmed in a logistic regression analysis with glycosuria (Y/N) as outcome variable (p=0.0004). CONCLUSION: Surprisingly, type 2 diabetic patients with PVD tend not to have glycosuria as compared to patients without PVD. PVD may be indicative of generalized atherosclerotic lesions in the major vessels, including the renal arteries. This could lead to a lowering of GFR and thereby of the amount of glucose filtered. Assuming no, or only a minor direct effect of PVD on tubular function, this would lead to an increased renal threshold for glucose in patients with PVD.

de Fine Olivarius N; Holstein-Rathlou NH; Siersma V; Witt K; Vestbo E; Andreasen AH; Mogensen CE

2004-06-01

247

Cache valley virus in a patient diagnosed with aseptic meningitis.  

UK PubMed Central (United Kingdom)

Cache Valley virus was initially isolated from mosquitoes and had been linked to central nervous system-associated diseases. A case of Cache Valley virus infection is described. The virus was cultured from a patient's cerebrospinal fluid and identified with real-time reverse transcription-PCR and sequencing, which also yielded the complete viral coding sequences.

Nguyen NL; Zhao G; Hull R; Shelly MA; Wong SJ; Wu G; St George K; Wang D; Menegus MA

2013-06-01

248

Pharmacological therapy in patients diagnosed with Peyronie's disease.  

Science.gov (United States)

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. PMID:22802890

Halal, A A; Geavlete, P; Ceban, E

2012-06-18

249

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

Directory of Open Access Journals (Sweden)

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

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

2011-01-01

250

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

Scientific Electronic Library Online (English)

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

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

2011-04-01

251

Clinical aspects of pneumocystis pneumonia in patients with lung cancer  

International Nuclear Information System (INIS)

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)

2009-01-01

252

Acute myeloid leukemia in patients previously diagnosed with breast cancer: experience of the GIMEMA group.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate in a multicenter retrospective study, the clinical and laboratory characteristics and the outcome of patients with acute myeloid leukemia (sAML) previously diagnosed with breast cancer (BC) among an adult acute leukemia population. PATIENTS AND METHODS: Between June 1992 and July 1996, 3934 new cases of adults with acute leukemia were recorded in GIMEMA Archive of Adult Acute Leukemia (2964 AML, 901 ALL, 69 acute leukemia expressing both myeloid and lymphoid surface markers). RESULTS: Two hundred patients (5.1%) presented with a history of previous malignancy (21 of them were affected by ALL and 179 by AML). Among sAML, 37 patients (29%) had a previous breast cancer. They consisted of 36 females and 1 male, median age 56 years, range 34-87. The median latency between the 2 malignancies was 54 months (range 5-379). Twenty-seven patients received chemo- and/or radiotherapy for breast cancer (7 only chemotherapy, 6 only radiotherapy, and 14 combined treatment). All patients were surgically treated but in 10 patients surgical debridement was the sole therapy for breast cancer. The drugs most frequently employed were alkylating agents (18 patients), topoisomerase II inhibitors (9 patients), antimetabolites (20 patients) (CMF, CEF and MMM combinations). At onset of sAML the median WBC count was 7.7 x 10(9)/l (0.8-153) and the median platelet count was 33.5 x 10(9)/l (3-305). Considering morphological features, FAB subtypes were 4 M0, 5 M1, 11 M2, 5 M3, 8 M4, 3 M5, and 1 M6. Cytogenetic study was performed on 28 patients and 12 of them presented abnormalities. It is noteworthy that chromosome 5 or 7 abnormalities (typically observed in those patients treated with alkylating agents) were present only in three cases. Thirty-four patients received chemotherapy for sAML, and twenty-five of them achieved a CR (74%), with a median duration of twenty-eight weeks (5-280+). The overall survival was 8 months (1-80+). DISCUSSION: The high number of sAML we observed in patients with a previous breast cancer, may be due to the fact that this malignancy is the most frequent neoplasm in women and by the high probability of cure with a consequent long disease-free survival. Our results suggest that the risk of sAML after recovery from breast cancer is increasing due to the rise in the number of patients cured from breast cancer, and in the future could be a relevant problem for haematologists.

Pagano L; Pulsoni A; Mele L; Tosti ME; Cerri R; Visani G; Melillo L; Candoni A; Clavio M; Nosari A; Petti MC; Martino B; Mele A; Levis A; Allione B; Almici C; Equitani F; Leone G; Mandelli F

2001-02-01

253

Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of the study was to assess the impact of systematic use of the DSM-IV-TR cultural formulation on diagnoses of psychotic disorders among patients of ethnic minority and immigrant backgrounds referred to a cultural consultation service (CCS) in Canada. METHODS: The study entailed a review of medical records and case conference transcripts of 323 patients seen in a ten-year period at the CCS to determine factors associated with change in the diagnosis of psychotic disorders by the CCS. Logistic regression analysis was used to identify variables associated with changes in diagnosis. RESULTS: A total of 34 (49%) of the 70 cases with an intake (referral) diagnosis of a psychotic disorder were rediagnosed as nonpsychotic disorders, whereas only 12 (5%) of the 253 cases with an intake diagnosis of a nonpsychotic disorder were rediagnosed as a psychotic disorder (p<.001). Major depression, posttraumatic stress disorder (PTSD), adjustment disorder, and bipolar affective disorder were the common disorders diagnosed with use of the cultural formulation. Rediagnosis of a psychotic disorder as a nonpsychotic disorder was significantly associated with being a recent arrival in Canada (odds ratio [OR]=6.05, 95% confidence interval [CI]=1.56-23.46, p=.009), being nonblack (OR=3.72, CI=1.03-13.41, p=.045), and being referred to the CCS by nonmedical routes (such as social work or occupational therapy) (OR=3.23, CI=1.03-10.13, p=.044). CONCLUSIONS: Misdiagnosis of psychotic disorders occurred with patients of all ethnocultural backgrounds. PTSD and adjustment disorder were misidentified as psychosis among immigrants and refugees from South Asia. Studies are needed that compare clinical outcomes of use of cultural consultation with outcomes from use of other cultural competence models.

Adeponle AB; Thombs BD; Groleau D; Jarvis E; Kirmayer LJ

2012-02-01

254

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

UK PubMed Central (United Kingdom)

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.

Pineda-Alvarez DE; Dubourg C; David V; Roessler E; Muenke M

2010-02-01

255

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

Science.gov (United States)

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

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

2010-02-15

256

Skin Cancer Surveillance and Malignancies of the Skin in a Community-Dwelling Cohort of Patients With Newly Diagnosed Chronic Lymphocytic Leukemia.  

UK PubMed Central (United Kingdom)

PURPOSE: Assess compliance with skin cancer screening guidelines in a community-dwelling cohort of patients with newly diagnosed chronic lymphocytic leukemia (CLL) and evaluate the clinical utility of such screening. METHODS: We identified patients diagnosed at Mayo Clinic with CLL between January 1, 2004, and June 1, 2012, who resided within 30 miles of Mayo Clinic. We evaluated adherence to skin cancer screening and identified the prevalence of skin malignancies during follow-up. Medical records were reviewed to document skin cancer screening and diagnosis of a skin malignancy. RESULTS: Collectively, 113 individuals who met criteria were diagnosed with CLL during the study interval. Forty-one patients (36%) had a whole body skin examination by either a dermatologist or primary care provider documented within 6 months of diagnosis; of these; nine (8% of overall cohort; 22% of examined patients) had a skin malignancy identified. Fifteen additional skin malignancies were diagnosed during follow-up. There were a total of 24 skin malignancies (21% of cohort) diagnosed, including basal cell carcinoma (n = 10), squamous cell carcinoma (n = 11), sebaceous carcinomas (n = 2), and melanoma (n = 1). CONCLUSION: We documented a low compliance with guidelines to screen for skin malignancy in a community-dwelling cohort of patients with newly diagnosed CLL. Standardized and systems-based approaches are likely to increase compliance with skin cancer screening guidelines in patients with CLL.

Mansfield AS; Rabe KG; Slager SL; Schwager SM; Call TG; Brewer JD; Shanafelt TD

2013-08-01

257

Uso do propranolol de ação prolongada em 40 pacientes com tremor essencial e virgens de tratamento: um ensaio clínico não controlado/ Clinical response to long action propranolol in 40 patients diagnosed with essential tremor with no previous treatment: an open, non-controlled study  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O tremor essencial (TE) é o distúrbio do movimento mais frequente. Entre os tratamentos de primeira escolha está o uso de beta-bloqueadores. O objetivo deste trabalho é relatar os resultados do uso de propranolol de ação prolongada (PAP) em 40 pacientes com TE e virgens de tratamentos anteriores. MÉTODO: 40 pacientes com TE foram submetidos a um protocolo de avaliação pré-estabelecido em que constavam escalas de classificação para o tremor e escalas de avalia? (more) ?ão da severidade do tremor. Todos os pacientes foram submetidos a avaliação inicial e após 1 mês de tratamento. RESULTADOS: com relação ao tipo de tremor, 36 pacientes (90% do total) tinham o tipo 2; os tipos 3 e 4 ocorreram em dois pacientes cada (10% do total). Houve história familiar de tremor em 25 casos (62,5%). A média de idade dos pacientes foi 43,1 anos e a média de idade de início dos sintomas foi 27,4 anos. Dos 40 indivíduos avaliados, 33 ou 82,5% apresentaram algum grau de melhora com PAP; em 52,5 % a melhora foi considerada ótima ou boa. CONCLUSÃO: o PAP mostrou ser uma medicação adequada para o tratamento do TE nesta amostra de 40 pacientes avaliados. Abstract in english Essential tremor (ET) is the most common movement disorder and betablockers are still consideres the first line of treatment. The aim of our study is to report the clinical response to long action propranolol (LAP) of 40 patients diagnosed with essential tremor with no previous treatment. METHOD: 40 patients with ET were evaluated with rating scales for severity of tremor and clinical classification of ET. All patients were evaluated at least twice, at enlrollment and one (more) month after starting treatment. RESULTS: thirty-six patients (90%) had type 2 ET and types 3 and 4 ocurred in two patients each (10%). Familiar history was positive in 25 patients (62.5%). Mean age at first evaluation was 43.1 years and mean age at onset was 27.4 years. Of all patients, 33 (82.5%) had some degree of benefit and in 52,5 % this benefit was either good or excelent. CONCLUSION: LAP seems to be a good treatment option for ET in our series of 40 patients.

Troiano, André R.; Teive, Hélio A.G.; Fabiani, Giórgio B.; Zavala, Jorge A.A.; Sá, Daniel S.; Germiniani, Francisco M.B.; Camargo, Carlos Henrique F.; Werneck, Lineu C.

2004-03-01

258

Uso do propranolol de ação prolongada em 40 pacientes com tremor essencial e virgens de tratamento: um ensaio clínico não controlado Clinical response to long action propranolol in 40 patients diagnosed with essential tremor with no previous treatment: an open, non-controlled study  

Directory of Open Access Journals (Sweden)

Full Text Available O tremor essencial (TE) é o distúrbio do movimento mais frequente. Entre os tratamentos de primeira escolha está o uso de beta-bloqueadores. O objetivo deste trabalho é relatar os resultados do uso de propranolol de ação prolongada (PAP) em 40 pacientes com TE e virgens de tratamentos anteriores. MÉTODO: 40 pacientes com TE foram submetidos a um protocolo de avaliação pré-estabelecido em que constavam escalas de classificação para o tremor e escalas de avaliação da severidade do tremor. Todos os pacientes foram submetidos a avaliação inicial e após 1 mês de tratamento. RESULTADOS: com relação ao tipo de tremor, 36 pacientes (90% do total) tinham o tipo 2; os tipos 3 e 4 ocorreram em dois pacientes cada (10% do total). Houve história familiar de tremor em 25 casos (62,5%). A média de idade dos pacientes foi 43,1 anos e a média de idade de início dos sintomas foi 27,4 anos. Dos 40 indivíduos avaliados, 33 ou 82,5% apresentaram algum grau de melhora com PAP; em 52,5 % a melhora foi considerada ótima ou boa. CONCLUSÃO: o PAP mostrou ser uma medicação adequada para o tratamento do TE nesta amostra de 40 pacientes avaliados.Essential tremor (ET) is the most common movement disorder and betablockers are still consideres the first line of treatment. The aim of our study is to report the clinical response to long action propranolol (LAP) of 40 patients diagnosed with essential tremor with no previous treatment. METHOD: 40 patients with ET were evaluated with rating scales for severity of tremor and clinical classification of ET. All patients were evaluated at least twice, at enlrollment and one month after starting treatment. RESULTS: thirty-six patients (90%) had type 2 ET and types 3 and 4 ocurred in two patients each (10%). Familiar history was positive in 25 patients (62.5%). Mean age at first evaluation was 43.1 years and mean age at onset was 27.4 years. Of all patients, 33 (82.5%) had some degree of benefit and in 52,5 % this benefit was either good or excelent. CONCLUSION: LAP seems to be a good treatment option for ET in our series of 40 patients.

André R. Troiano; Hélio A.G. Teive; Giórgio B. Fabiani; Jorge A.A. Zavala; Daniel S. Sá; Francisco M.B. Germiniani; Carlos Henrique F. Camargo; Lineu C. Werneck

2004-01-01

259

Diagnoses and clinical outcomes associated with surgically amputated feline digits submitted to multiple veterinary diagnostic laboratories.  

Science.gov (United States)

Amputation is commonly performed in an attempt to both treat and diagnose conditions affecting the digits of cats. The records of multiple veterinary diagnostic laboratories were searched to identify submissions of amputated digits from cats. Eighty-five separate submissions were reviewed for diagnosis, age, sex, limb of origin, and digits affected; and the original submitting clinics were surveyed to determine clinical outcome. The Kaplan-Meier product-limit method was used to determine the disease-free interval and survival time. Neoplastic disease was identified in 63 of 85 submissions, with exclusively inflammatory lesions composing the other 22 cases. In 60 (95.2%) of the neoplastic cases, a malignant tumor was identified. Squamous cell carcinoma was the most commonly identified malignant tumor (n = 15; 23.8%) and was associated with a median survival time of 73 days. Other diagnoses included fibrosarcoma (n = 14; 22.2%); adenocarcinoma, likely metastases of a primary pulmonary neoplasm (n = 13; 20.6%); osteosarcoma (n = 5; 7.9%); mast cell tumor (n = 4; 6.3%); hemangiosarcoma (n = 5; 7.9%); malignant fibrous histiocytoma (n = 2; 3.2%); giant cell tumor of bone (n = 2; 3.2%); and hemangioma (n = 2; 3.2%). Giant cell tumor of bone has not been previously described in the digits of cats. Various neoplasms can occur in the digits of cats, and submission of the amputated digit for histopathologic diagnosis is essential to determine the histogenesis and predict the clinical outcome. PMID:17491078

Wobeser, B K; Kidney, B A; Powers, B E; Withrow, S J; Mayer, M N; Spinato, M T; Allen, A L

2007-05-01

260

Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets  

Science.gov (United States)

Object Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2–4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ± 42.6g (range 16.5–177.9g) and 3620 ± 2166 rad/sec2 (range 183–7589 rad/sec2), respectively. Conclusions Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a “concussion spectrum” may be needed in future research efforts, as well as in the clinical diagnostic arena.

Duhaime, Ann-Christine; Beckwith, Jonathan G.; Maerlender, Arthur C.; McAllister, Thomas W.; Crisco, Joseph J.; Duma, Stefan M.; Brolinson, P. Gunnar; Rowson, Steven; Flashman, Laura A.; Chu, Jeffrey J.; Greenwald, Richard M.

2013-01-01

 
 
 
 
261

Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Objective To estimate the mortality rate of patients newly diagnosed with chronic atrial fibrillation (AF) and compare it with the one in the general population. To evaluate the role of co-morbidity and other factors on the risk of dying among AF patients. Methods We used the General Practice Research Database in the UK to perform a retrospective cohort study. We followed a cohort of chronic AF patiens (N = 1,035) and an age and sex matched cohort of 5,000 subjects sampled from the general population. We used all deceased AF patients as cases (n = 234) and the remaining AF patients as controls to perform a nested case-control analysis. We estimated mortality risk associated with AF using Cox regression. We computed mortality relative risks using logistic regression among AF patients. Results During a mean follow-up of two years, 393 patients died in the general population cohort and 234 in the AF cohort. Adjusted relative risk of death in the cohort of AF was 2.5 (95%CI 2.1 – 3.0) compared to the general population. Among AF patients, mortality risk increased remarkably with advancing age. Smokers carried a relative risk of dying close to threefold. Ischaemic heart disease was the strongest clinical predictor of mortality with a RR of 3.0 (95% CI; 2.1–4.1). Current use of calcium channel blockers, warfarin and aspirin was associated with a decreased risk of mortality. Conclusions Chronic AF is an important determinant of increased mortality. Major risk factors for mortality in the AF cohort were age, smoking and cardiovascular co-morbidity, in particular ischaemic heart disease.

Ruigómez Ana; Johansson Saga; Wallander Mari-Ann; García Rodríguez Luis

2002-01-01

262

Clinical value of CT scan in diagnosing nasal malignant lymphoma (a report of 11 cases)  

International Nuclear Information System (INIS)

Objective: To investigate the value of CT in diagnosing nasal malignant lymphoma. Methods: CT findings of 11 patients with nasal malignant lymphoma proved pathologically were reviewed retrospectively. Results: The lesions pathologically diagnosed were all NHL and 9 cases were peripheral T-cell lymphoma. CT scan showed: (1) Lesions arose mainly from nasal vestibule or anterior part of nasal cavity, consisting of hyperplasia type 2 cases, infiltration type 3 cases, and hyperplasia-infiltration (mixed) type 6 cases. (2) Density of mass of hyperplasia type was relatively homogeneous, presenting as isodensity or slight hyper-density, while infiltration and mixed type appeared inhomogeneous. (3) Slight bony erosion was found in 8 cases, characterized by 'mouse nibbled' or cribriform bony absorption. (4) Adjacent structures were usually involved, and lesions might be polycentric. (5) Lesions often shrank or disappeared after radiotherapy. Conclusion: CT findings of nasal malignant lymphoma are relatively characteristic. It can clearly demonstrate the extent of lesion

2000-01-01

263

Acute porphyrias: clinical spectrum of hodpitalized patients  

International Nuclear Information System (INIS)

[en] 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)

2007-01-01

264

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

UK PubMed Central (United Kingdom)

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

Venkatramani R; Ji L; Lasky J; Haley K; Judkins A; Zhou S; Sposto R; Olshefski R; Garvin J; Tekautz T; Kennedy G; Rassekh SR; Moore T; Gardner S; Allen J; Shore R; Moertel C; Atlas M; Dhall G; Finlay J

2013-06-01

265

Depression or depressiveness in patients diagnosed with Anorexia Nervosa and Bulimia Nervosa - pilot research.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The target of this work is to consider if depressive symptoms intercurrent with patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) form a depression complex or whether they are physiological depression accompanying adolescence. We wished to observe the perception of these patients,of their functioning, both social and within their families and also looking for common point in the issues mentioned above trying to locate them within the course of the basic illness. SUBJECTS AND METHODS: We studied 19 patients suffering from eating disorders, and aged between 12 and 24 years old. 15 of them suffered from the restrictive form of AN and 4 suffered from BN. The control group consisted of 30 healthy girls in the same age interval. In the study authors used the Beck Depression Inventory (BDI) and the Quebec Quality of Life Questionnaire. RESULTS: Comparison of a number of points acquired in the survey using Beck Depression Scale revealed statistic significance at the level p<0.001 which points to a more frequent occurrence of depression symptoms among persons with eating disorders comparing to control group. The survey using the Questionnaire for Social Quality showed no statistically significant differences between study and control groups (p>0.05). The authors observed a statistically significant increased frequency of suicidal thoughts in the study group compared to the controls. CONCLUSIONS: To diagnose depression, depressive symptoms presented by the patients must give the image of depression at the clinical level. The result of the Beck's scale needs to be confronted with the clinical picture. Depression in adolescence requires differentiation from depressiveness.

Dêbska E; Janas A; Bañczyk W; Janas-Kozik M

2011-09-01

266

Overt diabetes mellitus among newly diagnosed Ugandan tuberculosis patients: a cross sectional study.  

UK PubMed Central (United Kingdom)

BACKGROUND: There is a documented increase of diabetes mellitus in Sub Saharan Africa, a region where tuberculosis is highly endemic. Currently, diabetes mellitus is one of the recognised risk factors of tuberculosis. No study has reported the magnitude of diabetes mellitus among tuberculosis patients in Uganda, one of the countries with a high burden of tuberculosis. METHODS: This was a cross-sectional study conducted among 260 consenting adult patients with a confirmed diagnosis of tuberculosis admitted on the pulmonology wards of Mulago national referral and teaching hospital in Kampala, Uganda to determine the prevalence of diabetes mellitus and associated clinical factors. Laboratory findings as well as the socio-demographic and clinical data collected using a validated questionnaire was obtained. Point of care random blood sugar (RBS) testing was performed on all the patients prior to initiation of anti tuberculosis treatment. Diabetes mellitus was diagnosed if the RBS level was ? 200mg/dl in the presence of the classical symptoms of diabetes mellitus. RESULTS: The prevalence of diabetes mellitus among the admitted patients with tuberculosis was 8.5%. Only 5 (1.9%) patients with TB had a known diagnosis of diabetes mellitus at enrolment. Majority of the study participants with TB-DM co-infection had type 2 diabetes mellitus (n=20, 90.9%).At bivariate analysis, raised mean ALT concentrations of ?80 U/L were associated with DM (OR-6.1, 95% CI 1.4-26.36, p=0.032) and paradoxically, HIV co-infection was protective of DM (OR-0.32, 95% CI 0.13-0.79, P=0.016). The relationship between DM and HIV as well as that with ALT remained statistically significant at multivariate analysis (HIV: OR- 0.17 95%CI 0.06-0.51, p=0.002 and ALT: OR-11.42 95%CI 2.15-60.59, p=0.004). CONCLUSION: This study demonstrates that diabetes mellitus is common among hospitalized tuberculosis patients in Uganda. The significant clinical predictors associated with diabetes mellitus among tuberculosis patients were HIV co-infection and raised mean serum alanine transaminase concentrations.

Kibirige D; Ssekitoleko R; Mutebi E; Worodria W

2013-01-01

267

An exploratory study of cognitive load in diagnosing patient conditions.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether the ways in which information is presented to physicians will improve their ability to respond in a timely and accurate manner to acute care needs. The forms of the presentation compared traditional textual, chart and graph representations with equivalent symbolic language representations. To test this objective, our investigation involved two studies of interpreting patient conditions using two forms of information representation. The first assessed the level of cognitive effort (the outcome variable is known as cognitive load), and the second assessed the time and accuracy outcome variables. PARTICIPANTS: Our investigation consisted of two studies, the first study involved 3rd and 4th year medical students, and the second study involved three board certified physicians who worked in an intensive care unit of a metropolitan hospital. DESIGN: The first study utilized an all-within-subject design with repeated measures, where pretests were utilized as control covariate for prior learning and individual differences. The second study utilized a random sampling of records analyzed by two physicians and qualitatively evaluated by board-certified intensivists. RESULTS: The first study indicated that the cognitive load to interpret the symbolic representation was less than those presented in the more traditional textual, chart and graphic form. The second study suggests that experienced physicians may react in a more timely fashion with at least the same accuracy when the symbolic language was used than with traditional charts and graphs. CONCLUSIONS: The ways in which information is presented to physicians may affect the quality of acute care, such as in intensive, critical and emergency care units. When information can be presented in symbolic form, it may be cognitively processed more efficiently than when it is presented in the usual textual and chart form, potentially lowering errors in diagnosis and increasing the responsiveness to patient conditions.

Workman M; Lesser MF; Kim J

2007-06-01

268

Analysis of Prognostic Factors in NSCLC Patients with Brain Metastases ?Diagnosed by Constrast-enhanced MRI After Whole Brain Radiotherapy  

Directory of Open Access Journals (Sweden)

Full Text Available Background and objective Brain metastases are a common complication of lung cancer, occurring in 20%-40% of patients. The aim of this study is to explore prognostic factors in non-small cell lung cancer (NSCLC) in patients with brain metastases diagnosed by constrast-enhanced MRI after whole brain radiotherapy. Methods TA retrospective review of clinical data from 241 NSCLC patients with brain metastases received whole brain radiotherapy from April 2007 to October 2008 was performed. A number of potential factors that might affect prognosis after irradiation were evaluated. The significance of prognostic variables in the survival resulted from univariate analysis by Kaplan-Meier combining with Log-rank test, and the multivariate analysis was obtained by Cox regression model. Results Median follow-up time for the survivors was 19.1 months. For all patients, the median survival time (MST) was 8.7 months. By univariate analysis, female patients with KPS>70, no symptom when diagnosed with brain metastases, tumor controlled in the chest, and received more than 3 cycles of chemotherapy and combined target therapy were the important factors for overall survival. By multivariate analysis, female, tumors controlled in the chest, and combined target therapy were independent prognostic factors for NSCLC patients with brain metastases. Tumor controlled in the chest was the most important independent prognostic factor. Conclusion Gender, local tumor controlled, and combined target therapy significantly influenced NSCLC brain metastases diagnosed by constrast-enchanced MRI survival after whole brain radiotherapy.

Hui LIU; Qiongya WU; Xiaomei GONG; Xiaodong HE; Hongyu WU; Zhaoying SHENG; Dao’an ZHOU

2011-01-01

269

Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: a pilot study.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Rheumatic heart disease (RHD) continues to cause gross distortions of the heart and the associated complications of heart failure and thromboembolic phenomena in this age of numerous high-efficacy drugs and therapeutic interventions. Due to the lack of contemporary local data, there is no national strategy for the control and eradication of the disease in Uganda. This study aimed to describe the presenting clinical features of newly diagnosed patients with RHD, with particular reference to the frequency of serious complications (atrial fibrillation, systemic embolism, heart failure and pulmonary hypertension) in the study group. METHODS: One hundred and thirty consecutive patients who satisfied the inclusion criteria were recruited over a period of eight months from June 2011 to January 2012 at the Mulago Hospital, Uganda. Data on demographic characteristics, disease severity and presence of complications were collected by means of a standardised questionnaire. RESULTS: Seventy-one per cent of the patients were female with a median age of 33 years. The peak age of the study group was 20 to 39 years, with the commonest presenting symptoms being palpitations, fatigue, chest pain and dyspnoea. The majority of the patients presented with moderate-to-severe valvular disease. Pure mitral regurgitation was the commonest valvular disease (40.2%), followed by mitral regurgitation plus aortic regurgitation (29%). Mitral regurgitation plus aortic regurgitation plus mitral stenosis was found in 11% of patients. There was only one case involving the tricuspid valve. The pulmonary valves were not affected in all patients; 45.9% of patients presented in severe heart failure in NYHA class III/IV, 53.3% had pulmonary hypertension, 13.9% had atrial fibrillation and 8.2% had infective endocarditis. All patients presented with dilated atria (> 49 mm). CONCLUSION: A significant proportion of RHD patients present to hospital with severe disease associated with severe complications of advanced heart failure, pulmonary hypertension, infective endocarditis and atrial fibrillation. There is a need to improve awareness of the disease among the population, and clinical suspicion in primary health workers, so that early referral to specialist management can be done before severe damage to the heart ensues.

Zhang W; Mondo C; Okello E; Musoke C; Kakande B; Nyakoojo W; Kayima J; Freers J

2013-03-01

270

HIV-1 subtype distribution and its demographic determinants in newly diagnosed patients in Europe suggest highly compartmentalized epidemics  

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Full Text Available Abstract Background Understanding HIV-1 subtype distribution and epidemiology can assist preventive measures and clinical decisions. Sequence variation may affect antiviral drug resistance development, disease progression, evolutionary rates and transmission routes. Results We investigated the subtype distribution of HIV-1 in Europe and Israel in a representative sample of patients diagnosed between 2002 and 2005 and related it to the demographic data available. 2793 PRO-RT sequences were subtyped either with the REGA Subtyping tool or by a manual procedure that included phylogenetic tree and recombination analysis. The most prevalent subtypes/CRFs in our dataset were subtype B (66.1%), followed by sub-subtype A1 (6.9%), subtype C (6.8%) and CRF02_AG (4.7%). Substantial differences in the proportion of new diagnoses with distinct subtypes were found between European countries: the lowest proportion of subtype B was found in Israel (27.9%) and Portugal (39.2%), while the highest was observed in Poland (96.2%) and Slovenia (93.6%). Other subtypes were significantly more diagnosed in immigrant populations. Subtype B was significantly more diagnosed in men than in women and in MSM > IDUs > heterosexuals. Furthermore, the subtype distribution according to continent of origin of the patients suggests they acquired their infection there or in Europe from compatriots. Conclusions The association of subtype with demographic parameters suggests highly compartmentalized epidemics, determined by social and behavioural characteristics of the patients.

Abecasis Ana B; Wensing Annemarie MJ; Paraskevis Dimitris; Vercauteren Jurgen; Theys Kristof; Van de Vijver David AMC; Albert Jan; Asjö Birgitta; Balotta Claudia; Beshkov Danail; Camacho Ricardo J; Clotet Bonaventura; De Gascun Cillian; Griskevicius Algis; Grossman Zehava; Hamouda Osamah; Horban Andrzej; Kolupajeva Tatjana; Korn Klaus; Kostrikis Leon G; Kücherer Claudia; Liitsola Kirsi; Linka Marek; Nielsen Claus; Otelea Dan; Paredes Roger; Poljak Mario; Puchhammer-Stöckl Elisabeth; Schmit Jean-Claude; Sönnerborg Anders; Stanekova Danika; Stanojevic Maja; Struck Daniel; Boucher Charles AB; Vandamme Anne-Mieke

2013-01-01

271

HIV-1 subtype distribution and its demographic determinants in newly diagnosed patients in Europe suggest highly compartmentalized epidemics.  

UK PubMed Central (United Kingdom)

BACKGROUND: Understanding HIV-1 subtype distribution and epidemiology can assist preventive measures and clinical decisions. Sequence variation may affect antiviral drug resistance development, disease progression, evolutionary rates and transmission routes. RESULTS: We investigated the subtype distribution of HIV-1 in Europe and Israel in a representative sample of patients diagnosed between 2002 and 2005 and related it to the demographic data available. 2793 PRO-RT sequences were subtyped either with the REGA Subtyping tool or by a manual procedure that included phylogenetic tree and recombination analysis. The most prevalent subtypes/CRFs in our dataset were subtype B (66.1%), followed by sub-subtype A1 (6.9%), subtype C (6.8%) and CRF02_AG (4.7%). Substantial differences in the proportion of new diagnoses with distinct subtypes were found between European countries: the lowest proportion of subtype B was found in Israel (27.9%) and Portugal (39.2%), while the highest was observed in Poland (96.2%) and Slovenia (93.6%). Other subtypes were significantly more diagnosed in immigrant populations. Subtype B was significantly more diagnosed in men than in women and in MSM > IDUs > heterosexuals. Furthermore, the subtype distribution according to continent of origin of the patients suggests they acquired their infection there or in Europe from compatriots. CONCLUSIONS: The association of subtype with demographic parameters suggests highly compartmentalized epidemics, determined by social and behavioural characteristics of the patients.

Abecasis AB; Wensing AM; Paraskevis D; Vercauteren J; Theys K; Van de Vijver DA; Albert J; Asjö B; Balotta C; Beshkov D; Camacho RJ; Clotet B; De Gascun C; Griskevicius A; Grossman Z; Hamouda O; Horban A; Kolupajeva T; Korn K; Kostrikis LG; Kücherer C; Liitsola K; Linka M; Nielsen C; Otelea D; Paredes R; Poljak M; Puchhammer-Stöckl E; Schmit JC; Sönnerborg A; Stanekova D; Stanojevic M; Struck D; Boucher CA; Vandamme AM

2013-01-01

272

Long-Time Survival in A Patient with Turcot Syndrome Diagnosed in The Fifth Decade: Case Report  

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Full Text Available Turcot syndrome is a rare inherited disorder characterized by the association of colon and central nervous system neuroepithelial tumors. Here, we present a patient with Turcot Syndrome having glioblastoma together with colon adenocarcinoma. The patient, 47 year-old male, was referred to our department for cranial radiotherapy after gross-total resection of primary brain tumor in October 2003. During clinical follow-up in October 2004 a right colon mass was determined and right hemicolectomy was performed. Six courses of adjuvant chemotherapy were applied after resection. The patient is still under follow-up without any recurrences or metastasis. He has also first-degree relatives with colon cancer in his family's history. It has been declared that patients with Turcot Syndrome who have high-grade glial tumor, survive longer than other brain tumor patients. With some certain exceptions, all these patients were young. There are few patients who were diagnosed of glioblastoma at the fifth decade and had long survival period. Present case is elderly diagnosed with Turcot syndrome and has long survival for glioblastoma, therefore, it is a rare clinical manifestation of Turcot Syndrome.

Deniz MEYDAN; Bilge GÜRSEL; Nilgün ÖZBEK; Eylem ODABA?I; Levent YILDIZ; Güzin DEMIRA?

2011-01-01

273

Managing the patient with newly diagnosed Parkinson disease.  

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The treatment of early Parkinson disease (PD) is generally symptomatic, although therapy that also offers neuroprotection in early-stage PD would be welcomed. Levodopa remains the most effective agent for relief of PD symptoms, but chronic levodopa therapy is associated with motor fluctuations and dyskinesias, and clinicians may therefore opt to postpone its use. Alternatives to levodopa in early PD include monoamine oxidase (MAO)-B inhibitors, amantadine, and dopamine agonists. MAO-B inhibitors have only mild symptomatic effects. Amantadine is associated with improvement in functional disability and, in a subset of PD patients, a robust symptomatic improvement. Dopamine agonists improve symptoms and may have a neuroprotective effect. Partial dopamine agonists, adenosine A(2A)-receptor antagonists, and safinamide are symptomatic therapies that are under investigation. Neuro protective strategies under study include enhancement of mitochondrial function, antiinflammatory mechanisms, calcium channel blockade, and uric acid elevation. Deep brain stimulation may slow cognitive and motor decline when used in early PD. Stem cell therapy and gene therapy are still under investigation. PMID:22761267

Singer, Carlos

2012-07-01

274

Managing the patient with newly diagnosed Parkinson disease.  

UK PubMed Central (United Kingdom)

The treatment of early Parkinson disease (PD) is generally symptomatic, although therapy that also offers neuroprotection in early-stage PD would be welcomed. Levodopa remains the most effective agent for relief of PD symptoms, but chronic levodopa therapy is associated with motor fluctuations and dyskinesias, and clinicians may therefore opt to postpone its use. Alternatives to levodopa in early PD include monoamine oxidase (MAO)-B inhibitors, amantadine, and dopamine agonists. MAO-B inhibitors have only mild symptomatic effects. Amantadine is associated with improvement in functional disability and, in a subset of PD patients, a robust symptomatic improvement. Dopamine agonists improve symptoms and may have a neuroprotective effect. Partial dopamine agonists, adenosine A(2A)-receptor antagonists, and safinamide are symptomatic therapies that are under investigation. Neuro protective strategies under study include enhancement of mitochondrial function, antiinflammatory mechanisms, calcium channel blockade, and uric acid elevation. Deep brain stimulation may slow cognitive and motor decline when used in early PD. Stem cell therapy and gene therapy are still under investigation.

Singer C

2012-07-01

275

Cecal volvulus: a rare cause of bowel obstruction in a pediatric patient diagnosed pre-operatively by conventional imaging studies  

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Cecal volvulus is an acute surgical condition that is extremely rare in children, with a mortality rate of up to 40%. The clinical symptoms are often non-specific, and pediatric patients frequently have neurological deficits with associated communication difficulties, making the clinical diagnosis extremely challenging. Conventional radiographic imaging studies play a key role in the prospective diagnosis in children. We report a rare case of cecal volvulus in a 12-year-old boy who was diagnosed pre-operatively by abdominal radiographs and a contrast enema. (orig.)

Vo, Nghia J.; O' Hara, Sara M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati (United States); Alonso, Maria H. [Cincinnati Children' s Hospital Medical Center, Division of Pediatric and Thoracic Surgery, Cincinnati, Ohio (United States)

2005-11-01

276

Diagnosing pubovisceral avulsions: a systematic review of the clinical relevance of a prevalent anatomical defect.  

UK PubMed Central (United Kingdom)

The aims of this systematic literature review were to assess whether the detection of pubovisceral avulsions using magnetic resonance (MR) imaging or perineal ultrasonography was clinically relevant in women with pelvic floor dysfunction and to evaluate the relation with anatomy, symptoms, and recurrence after surgery. We performed a systematic literature review using three bibliographical databases (PubMed, Embase, and CINAHL) as data sources. Clinical studies were included in which pubovisceral avulsions were studied in relation to pelvic organ prolapse (POP) stage, pelvic floor symptoms, and/or recurrence of POP after surgery. Ultimately, 21 studies met the inclusion criteria. POP stage and recurrence of POP after surgery were strongly associated with pubovisceral avulsions. Contradictory results were found regarding the relation between pubovisceral avulsions and urinary symptoms and symptoms of anorectal dysfunction. Pubovisceral avulsions, as diagnosed by MR imaging or perineal ultrasonography, are associated with higher stages of POP and recurrence of POP after surgery.

Lammers K; Fütterer JJ; Prokop M; Vierhout ME; Kluivers KB

2012-12-01

277

Psychotropic prescription patterns among patients diagnosed with depressive disorder based on claims database in Japan.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVE: Clinical guidelines recommend monotherapy with antidepressants for the treatment of major depression. This study examined prescription patterns with regard to both duration and type of treatment used among patients with newly diagnosed non-psychotic major depression based on a claims database from health insurance societies between 2008 and 2011 in Japan. METHODS: A retrospective cohort (N = 600,000) followed up for 4 years was used to identify patients (age ?18 years) with newly diagnosed non-psychotic major depression. The prescription patterns and polypharmacy were examined. Four different types of pharmaceutical drugs were defined as possible psychotropic agents for major depression: (1) first- and/or second-generation antidepressants; (2) benzodiazepines; (3) sulpiride; and (4) antipsychotics. The data were analyzed by an intent-to-treat approach at months 0, 1, 3, 6, and 12 from the date of diagnosis. RESULTS: A total of 7,338 patients (3,684 males and 3,654 females, mean age 36.8 ± 10.9 years) with newly diagnosed non-psychotic major depression were identified. The median duration of treatment was 122 days. The proportion of patients in the cohort prescribed at least one type of defined psychotropic agents was 75.6 % (month 0), 47.3 % (month 1), 36.0 % (month 3), 26.8 % (month 6), and 17.4 % (month 12). The proportion of patients in the cohort prescribed at least one first- and/or second-generation antidepressant was 50.2 % (month 0), 34.9 % (month 1), 27.5 % (month 3), 20.3 % (month 6), and 12.5 % (month 12). The proportion of patients receiving at least one benzodiazepine was 58.0 % (month 0), 36.7 % (month 1), 27.1 % (month 3), 20.0 % (month 6), and 12.0 % (month 12). The proportion of patients receiving an antidepressant as monotherapy was only 12.0 % (month 0), 7.8 % (month 1), 6.5 % (month 3), 4.8 % (month 6), and 2.9 % (month 12), whereas the proportion of patients treated with a benzodiazepine alone was 13.5 % (month 0), 6.9 % (month 1), 4.6 % (month 3), 3.5 % (month 6), and 2.7 % (month 12). Various combinations of polypharmacy were observed. The most common was a combination of at least one antidepressant and benzodiazepine, which was prescribed to 36.7 % (month 0), 25.8 % (month 1), 19.9 % (month 3), 14.9 % (month 6), and 9.2 % (month 12) of the cohort. CONCLUSIONS: Based on analysis of prescription patterns and type of treatment used for treating non-psychotic major depression, a majority of patients were not treated according to the recommended guidelines in Japan. Various patterns of prescription and use of polypharmacy were observed over time. The median duration of treatment was shorter than the recommendation (6 months) in the guidelines.

Onishi Y; Hinotsu S; Furukawa TA; Kawakami K

2013-08-01

278

The Canadian guidelines and the interdisciplinary clinical capacity of Canada to diagnose fetal alcohol spectrum disorder.  

UK PubMed Central (United Kingdom)

BACKGROUND: In 2005, the CMAJ published the Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. The intent of this publication was to encourage a more consistent interdisciplinary team approach and diagnostic procedure for FASD diagnoses. That same year, the Canada Northwest FASD Research Network (CanFASD Northwest) determined the locations and capacity for interdisciplinary FASD diagnosis across Canada. Six years later, we wondered how successfully these Guidelines had been in bringing consistency to FASD clinical work. METHOD: All clinical programs in Canada that routinely performed FASD evaluations were identified through membership in either our Network Action Team on FASD Diagnosis, professional meetings, organizational memberships, websites, programs lists available from Provincial or Federal offices or by word of mouth. Surveys were sent to all of the programs identified. RESULTS: A total of 55 clinics had been identified in seven provinces and one territory in 2005 that did FASD multidisciplinary diagnostics. In 2011 only 44 clinics were identified in six provinces and one territory using the same methodology. Survey responses were completed by 89% of these 44 clinics identified in 2011. The Guidelines were well known to all programs and actively referred to by most. Only 46% of respondents had a full staff of professionals on site for diagnosis, however 90% did use the team approach in determining final FASD diagnosis, while 79% used the team to help in developing a treatment plan. Among the clinics reporting, 74% of them used the new diagnostic schema proposed in the Guidelines and another 12% report using both the Guidelines and another system for diagnosis. INTERPRETATION: The Guidelines have become well known to the medical community. They have contributed to increased consistency in approach and in diagnosis. The variations in clinical ability to fully staff themselves, and the 20% decline in clinic numbers suggest important funding gaps. Many provinces and territories still have no local interdisciplinary programs for FASD diagnosis, and the need across Canada is still many times greater than what is currently available.

Clarren SK; Lutke J; Sherbuck M

2011-01-01

279

Relations between nursing data collection, diagnoses and prescriptions for adult patients at an intensive care unit.  

Science.gov (United States)

This descriptive, retrospective study aimed to analyze the relation between nursing data collection, diagnoses and prescriptions for 26 adult patients who were hospitalized at the intense care unit of a large teaching hospital for at least 24 hours. Through the analysis of medical records, 135 diagnoses and 421 nursing prescriptions were established, and 24 different diagnosis categories and 20 different items for prescriptions were identified. The most frequent diagnosis risk was that for infection, present in the medical records of 22 (84.60%) patients, with 175 prescriptions (42%) related to this diagnosis. The data the nurses collected were sufficient to establish the nursing diagnoses, and the majority of prescriptions (87.9%) were related to the diagnoses. PMID:18833451

de Carvalho, Emilia Campos; Martins, Fernanda Titareli Merizio; Dalri, Maria Célia Barcellos; Canini, Silvia Rita Marin da Silva; Laus, Ana Maria; Bachion, Maria Marcia; Rossi, Lidia Aparecida

280

Expert nursing diagnoses. The link between nursing care plans and patient classification systems.  

UK PubMed Central (United Kingdom)

The two main tools used by the nurse in organizing and managing patient care are nursing care plans and the patient classification system. The author presents an overview of a novel approach that links these two tools through the use of expert nursing diagnoses and then applies the development and use of expert nursing diagnoses to the psychiatric setting. The author also describes the methodology used to develop the related patient classification, clarifies the validation procedure, gives examples of the final product, and considers the application and potential value of the total approach.

Karshmer JF

1991-01-01

 
 
 
 
281

Expert nursing diagnoses. The link between nursing care plans and patient classification systems.  

Science.gov (United States)

The two main tools used by the nurse in organizing and managing patient care are nursing care plans and the patient classification system. The author presents an overview of a novel approach that links these two tools through the use of expert nursing diagnoses and then applies the development and use of expert nursing diagnoses to the psychiatric setting. The author also describes the methodology used to develop the related patient classification, clarifies the validation procedure, gives examples of the final product, and considers the application and potential value of the total approach. PMID:1987340

Karshmer, J F

1991-01-01

282

Validation of spontaneous abortion diagnoses in the Danish National Registry of Patients  

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Full Text Available Sarah Rytter Lohse1, Dóra Körmendiné Farkas1, Nicolai Lohse1, Sven Olaf Skouby2, Finn Erland Nielsen3, Timothy L Lash1, Vera Ehrenstein11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Obstetrics and Gynecology, 3Department of Cardiology, Herlev University Hospital, Herlev, DenmarkPurpose: The purpose of this study is to validate the diagnosis of spontaneous abortion (SA) recorded in the Danish National Registry of Patients (DNRP).Methods: We randomly selected patients registered in the DNRP with a diagnosis of SA between 1980 and 2008 from hospitals in the county of North Jutland and searched for their discharge records in hospital files. We estimated positive predictive value (PPV) of the DNRP diagnosis and stratified the analysis by period (1980–1994 versus 1995–2008), hospital type (regional versus local), and International Classification of Diseases revisions (ICD-8 versus ICD-10).Results: We could identify hospital files of 117/174 (67%) sampled registration records. Of those, the diagnosis was confirmed in 114 patients, yielding a PPV of 97.4% (95% confidence interval = 92.7%–99.5%). The PPV did not markedly vary by period, hospital type, or ICD revision. Among the three patients with available data who did not fulfill the criteria for SA, one had an induced abortion and two had threatened abortion but did not miscarry.Conclusion: Registration of SA in the DNRP accurately reflects the diagnoses recorded in medical charts. The DNRP is a suitable source of data on SAs for epidemiologic research.Keywords: spontaneous abortion, validation, diagnosis, Danish National Registry of Patients, positive predictive value

Sarah Rytter Lohse; Dóra Körmendiné Farkas; Nicolai Lohse; et al

2010-01-01

283

Concordance between Clinical and Histopathological Diagnoses at Komfo Anokye Teaching Hospital Oral and Maxillofacial Unit  

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Full Text Available Background: Accurate diagnosis of orofacial tumours is important as this determines the treatment options as well as the eventual treatment outcome. Agreement between clinical and histopathological diagnosis becomes important in this regard. Aims: The aim was to determine the level of agreement between clinical and histopathology diagnosis of orofacial lesions. Method: This is a retrospective study of all histopathology reports seen at KATH maxillofacial unit. Thedata collected included, clinical diagnosis and histological diagnosis. Results: A total of 567 histopathology reports were evaluated. The percentage of agreement between clinical and histopathological diagnosis was 62.8%. Conclusion: The agreement between clinical and histopathological diagnosis was high. However clinicians cannot rely on only the clinical diagnosis in managing patients.

Alexander Acheampong Oti; Peter Donkor; Solomon Obiri-Yeboah; Michael Yelibora

2013-01-01

284

[Cytogenetic study of 4 patients diagnosed with splenic B-cell lymphoma with villous circulating cells  

UK PubMed Central (United Kingdom)

We present the cytogenetic study of 4 patients diagnosed of splenic B-cell lymphoma with villous lymphocytes. In such patients, it is noteworthy the chromosomal abnormality, del(7)(q32), found in two cases (in one as a sole chromosomal abnormality).

Solé F; Woessner S; Florensa L; Besses C; Palacín A; Martí M; Sans-Sabrafén J

1993-08-01

285

Glaucoma subtypes in Ethiopian clinic patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Until population-based data become available in Ethiopia, hospital-based studies may reflect the distribution of the subtypes of glaucoma in certain parts of the country. PURPOSE: The main aim of this study was to determine the subtypes of glaucoma in Jimma University Hospital, Ethiopia. METHODS: A facility-based cross-sectional study was conducted in Jimma University Hospital from April 1, 2007 to March 30, 2008. The study population consisted of 335 consecutive new and follow-up patients with glaucoma diagnosed based on strict objective criteria. RESULTS: The mean (SD) age of the study patients was 57.0 (12.7) years (range, 8 to 90 y). The male to female ratio was 2.7:1. The 2 most common subtypes of glaucoma found were exfoliation glaucoma (35.2%) and primary open angle glaucoma (32.8%). Primary angle closure glaucoma was diagnosed in 18.5% of patients. CONCLUSIONS: The finding of exfoliation glaucoma as the most common subtype of glaucoma in the present clinic-based study is interesting. Such observation has never been reported from anywhere in Africa. We recommend community-based surveys to define the real distribution of the glaucoma subtypes in Ethiopia.

Tenkir A; Solomon B; Deribew A

2013-02-01

286

FENO measurement and sputum analysis for diagnosing asthma in clinical practice.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine the diagnostic accuracy of fractional exhaled nitric oxide (FENO) measurement in pneumologists routine diagnostic work-up; and to determine the impact of the inflammatory pattern on diagnostic accuracy. METHODS: Prospective diagnostic study in 393 patients attending a private practice of pneumologists with complaints suspicious of obstructive airway disease (OAD). Index test was FENO measurement. Reference standard was the Tiffeneau ratio (FEV(1)/VC) or airway resistance as assessed by whole body plethysmography, with additional bronchoprovocation or bronchodilator testing. Morning sputum was analysed with smear slides which were prepared and stained by Giemsa. RESULTS: 154 patients were diagnosed as having asthma (145 diagnoses based on bronchial provocation, 9 based on bronchodilator results), 5 had COPD. For the whole group, asthma could be ruled in at FENO > 71 ppb (PPV 80%; 95% CI 63-90%) and ruled out at FENO ? 9 ppb (NPV 82%; 95% CI 67-91%) (area under the curve (AUC) = 0.656; 95% CI 0.600-0.712; p < 0.001). 128 patients delivered sputum. FENO was 44.3 ppb (sd 48.9) in patients with predominant eosinophilic inflammation, 18.5 ppb with neutrophilic inflammation, and 23.1 ppb in others (p = 0.003). Diagnostic accuracy of FENO increased when patients with neutrophilic inflammation were omitted from analysis (AUC = 0.745; 95% CI 0.651-0.838; p < 0.001). Then asthma could be ruled in at FENO > 31 ppb (PPV 82%; 95% CI 63-92%) and ruled out at FENO ? 12 ppb (NPV 81%; 95% CI 62-91%). CONCLUSIONS: FENO measurement can be useful as an additional diagnostic tool in pneumologists' practice. The diagnostic value of FENO could be improved when inflammatory patterns are taken into account.

Schneider A; Schwarzbach J; Faderl B; Welker L; Karsch-Völk M; Jörres RA

2013-02-01

287

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

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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.

Evrim Aktepe; Kadir Demirci; Ali Metehan Çal??kan; Yonca Sönmez

2010-01-01

288

Autologous tumor lysate-pulsed dendritic cell immunotherapy for pediatric patients with newly diagnosed or recurrent high-grade gliomas.  

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Immunotherapy has the potential to improve clinical outcomes with little toxicity for pediatric patients with brain tumors. We conducted a pilot feasibility study of tumor lysate-pulsed dendritic cell (DC) vaccination in pediatric patients (1 to 18 years old) with newly diagnosed or recurrent high-grade glioma (HGG). A total of nine DC vaccine doses, each containing 1 × 10(6) cells per dose were administered to three out of the seven originally enrolled patients. Toxicities were limited to mild side-effects, except in one case of elevated alkaline phosphatase, which resolved without clinical consequences. Two patients with primary lesions amongst the three vaccinated were alive at the time of writing, both without evidence of disease. Pre- and post-vaccination tumor samples from a patient with an anaplastic oligoastrocytoma that recurred failed to demonstrate immune cell infiltration by immunohistochemistry. Peripheral cytokine levels were evaluated in one patient following DC vaccination and demonstrated some changes in relation to vaccination. DC vaccine is tolerable and feasible with some limitations for pediatric patients with HGG. Dendritic cell based immunotherapy may provide some clinical benefit in pediatric patients with glioma, especially for patients with minimal residual disease, but further investigation of this modality is required. PMID:23645755

Lasky, Joseph L; Panosyan, Eduard H; Plant, Ashley; Davidson, Tom; Yong, William H; Prins, Robert M; Liau, Linda M; Moore, Theodore B

2013-05-01

289

Autologous tumor lysate-pulsed dendritic cell immunotherapy for pediatric patients with newly diagnosed or recurrent high-grade gliomas.  

UK PubMed Central (United Kingdom)

Immunotherapy has the potential to improve clinical outcomes with little toxicity for pediatric patients with brain tumors. We conducted a pilot feasibility study of tumor lysate-pulsed dendritic cell (DC) vaccination in pediatric patients (1 to 18 years old) with newly diagnosed or recurrent high-grade glioma (HGG). A total of nine DC vaccine doses, each containing 1 × 10(6) cells per dose were administered to three out of the seven originally enrolled patients. Toxicities were limited to mild side-effects, except in one case of elevated alkaline phosphatase, which resolved without clinical consequences. Two patients with primary lesions amongst the three vaccinated were alive at the time of writing, both without evidence of disease. Pre- and post-vaccination tumor samples from a patient with an anaplastic oligoastrocytoma that recurred failed to demonstrate immune cell infiltration by immunohistochemistry. Peripheral cytokine levels were evaluated in one patient following DC vaccination and demonstrated some changes in relation to vaccination. DC vaccine is tolerable and feasible with some limitations for pediatric patients with HGG. Dendritic cell based immunotherapy may provide some clinical benefit in pediatric patients with glioma, especially for patients with minimal residual disease, but further investigation of this modality is required.

Lasky JL 3rd; Panosyan EH; Plant A; Davidson T; Yong WH; Prins RM; Liau LM; Moore TB

2013-05-01

290

Comparison of Clinical Diagnoses, NIMH-DISC-IV Diagnoses and SCL-90-R Ratings in an Adolescent Psychiatric Inpatient Unit: A Brief Report  

Science.gov (United States)

Introduction To compare results of clinical diagnosis, NIMH DISC-IV diagnoses and the Global Severity Index of the Symptom Check List- Revised (SCL-90-R) in an adolescent inpatient population. Method NIMH DISC-IV and SCL-90-R were administered to consecutive admissions to the inpatient adolescent unit of a teaching hospital as a regular admission procedure. Results There was better agreement between clinical diagnosis and the NIMH-DISC-IV diagnosis as compared to previous studies for NIMH DISC-IV. The presence of an NIMH DISC-IV diagnosis was associated with elevated SCL-90-R scores. Conclusion Structured diagnostic interviews and Self rated symptom scales are useful adjuncts in clinical diagnostics, enhancing valuable clinical expertise.

Roberts, Nasreen; Parker, Kevin C.H.; Dagnone, Marla

2005-01-01

291

A randomized trial of dyadic peer support intervention for newly diagnosed breast cancer patients in Korea.  

UK PubMed Central (United Kingdom)

BACKGROUND: At the time of diagnosis, patients with cancer are highly exposed to the risk of psychological morbidity. The effects of psychosocial intervention for newly diagnosed cancer patients have not been extensively studied. OBJECTIVE: The objective of this study was to test the effects of a dyadic peer support intervention on self-efficacy, anxiety, depression, and mental adjustment among newly diagnosed breast cancer patients in Korea. METHODS: This study used a randomized controlled trial design. One hundred twenty-nine patients were recruited within 1 month of diagnosis with breast cancer in the National Cancer Center in Korea. The study participants were randomly assigned to either experimental (n = 64) or control (n = 65) group. The experimental group underwent dyadic peer support intervention during the 6 weeks after surgery. The control group received the usual care. RESULTS: There was a significant difference in changes in self-efficacy for self-management of breast cancer between the experimental and control groups; however, no significant changes were observed in anxiety, depression, and mental adjustment between the 2 groups. CONCLUSIONS: A 6-week dyadic peer support intervention was feasible and effective for increasing self-efficacy for self-management among newly diagnosed breast cancer patients in Korea. However, this intervention did not improve other psychological outcomes. IMPLICATIONS FOR PRACTICE: Oncology nurses are optimally positioned to promote adjustment in patients with cancer. Trained peer support partners, supervised by skilled nurses, may be useful in improving self-efficacy of patients newly diagnosed with breast cancer.

Lee R; Lee KS; Oh EG; Kim SH

2013-05-01

292

Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: An assessment of clinical potential  

International Nuclear Information System (INIS)

The purpose of this analysis was to assess the potential of BNCT, with L-boronophenylalanine (L-BPA), as first line radiotherapy for glioblastoma multiforme (GBM). The survival of patients with newly diagnosed GBM from a phase II BNCT study was compared with those from the two arms of a phase III study with conventional radiotherapy (RT) vs. RT plus concomitant and adjuvant medication with temozolomide (TMZ). A small subgroup, for which the methylation status of the O6-methylguanine–DNA methyltransferase (MGMT) DNA-repair gene was known, was also considered. The results indicated that the use of BNCT with BPA should be explored in a stratified randomized phase II trial in which patients with the unmethylated MGMT DNA-repair gene are offered BNCT vs. RT plus TMZ.

2011-01-01

293

Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: An assessment of clinical potential  

Energy Technology Data Exchange (ETDEWEB)

The purpose of this analysis was to assess the potential of BNCT, with L-boronophenylalanine (L-BPA), as first line radiotherapy for glioblastoma multiforme (GBM). The survival of patients with newly diagnosed GBM from a phase II BNCT study was compared with those from the two arms of a phase III study with conventional radiotherapy (RT) vs. RT plus concomitant and adjuvant medication with temozolomide (TMZ). A small subgroup, for which the methylation status of the O{sup 6}-methylguanine-DNA methyltransferase (MGMT) DNA-repair gene was known, was also considered. The results indicated that the use of BNCT with BPA should be explored in a stratified randomized phase II trial in which patients with the unmethylated MGMT DNA-repair gene are offered BNCT vs. RT plus TMZ.

Hopewell, J.W., E-mail: john.hopewell@gtc.ox.ac.uk [Green Templeton College and Particle Therapy Cancer Research Institute, University of Oxford, Oxford (United Kingdom); Gorlia, T. [Data Center, EORTC, Brussels (Belgium); Pellettieri, L. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Neurosurgery, Goeteborg University, Goeteborg (Sweden); Giusti, V. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Mechanical, Nuclear and Production Engineering, University of Pisa, Pisa (Italy); H-Stenstam, B. [Nykoeping Hospital, County of Sormland (Sweden); Skoeld, K. [Hammercap Medical AB, Stockholm (Sweden)

2011-12-15

294

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

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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.

Hallas Peter; Ellingsen Trond

2006-01-01

295

Distribution of diagnoses in a population of patients with temporomandibular disorders.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The objective of this study was to describe the frequency of TMD diagnoses in a patient population for comparison with the available literature. METHODS: Five hundred twenty consecutive patients seeking TMD treatment underwent a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) assessment. The prevalence and age distribution of the different RDC/TMD axis I and II diagnoses were described. RESULTS: Muscle disorders, disk displacements, and other joint disorders were diagnosed respectively in 56.4%, 42.0%, and 57.5% of patients. Sixty percent of patients had depression symptoms, 76.6% had somatization, and 21.8% presented high levels of pain-related impairment. Disk displacements were more frequently diagnosed in the younger-aged, other joint disorders in the older-aged, and muscle disorders in the middle-aged subjects (ANOVA for mean age comparison, F = 3.355; P = .002). CONCLUSIONS: These distribution frequencies of TMD diagnoses provide insight into the epidemiology of this disease.

Manfredini D; Arveda N; Guarda-Nardini L; Segù M; Collesano V

2012-11-01

296

Accuracy of diagnoses in patients with spinal cord injury referred to hospital rehabilitation departments.  

UK PubMed Central (United Kingdom)

BACKGROUND: Establishing a comprehensive diagnosis, together with the implementation of evidence-based therapeutic methods, is a prerequisite for effective and safe rehabilitation. The purpose of the study was to evaluate the accuracy of referral diagnoses and identify the risk factors for diagnostic neglect in persons after spinal injury with neurological consequences (SINC) referred to rehabilitation departments in hospitals. MATERIAL AND METHODS: Referral diagnoses were compared with tentative diagnoses established on admission in 350 randomly chosen patients with SINC admitted to a rehabilitation department between 1998 and 2011. The patients were divided into Group A of those admitted in 1998-2004 and Group B of those admitted in 2006-11 (175 subjects each). The patterns of and risk factors for inaccurate and deficient referral diagnoses (IDRD) were analyzed. RESULTS: The rate of IDRD was 38.3% in Group A and 35.4% in Group B. The number of diagnoses where additional data were added after verification on admission was 111 in Group A and 129 in Group B. The most common deficiencies in referral diagnoses consisted in the failure to identify symptomatic urinary tract infections (49), heterotopic ossification (39), and pressure sores (32). The IDRD rate was significantly (p>0.05) higher in patients referred from hospitals, surgical departments, those with thoracic spine lesions, complete neurological deficits, and those with at least two co-morbidities or concomitant injuries. Median time between SINC and admission for rehabilitation was longer in subjects with accurate referral diagnoses (180 days) compared with the IDRD group (54 days). Age, gender and cause of SINC did not correlate with IDRD. CONCLUSIONS: Risk factors for IDRD in SINC patients include complete neurological deficit, short time elapsing from SINC, referral from a hospital, referral from a surgical department, thoracic spinal lesion, and multiple co-morbidities.

Tederko P; Krasuski M; Dobies B

2012-03-01

297

Childhood onset diagnoses in a case series of teens at clinical high risk for psychosis.  

UK PubMed Central (United Kingdom)

UNLABELLED: REASONS: Schizophrenia is typically an adult neurodevelopmental disorder that has its antecedents in childhood and adolescence. Little is known about disorders "usually first diagnosed in infancy, childhood and adolescence" (e.g., childhood-onset disorders) in "prodromal" teens at heightened clinical risk for psychotic disorder. MAIN FINDINGS: Childhood-onset disorders were prevalent in putatively prodromal teens, including anxiety and disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), and, surprisingly, elimination disorders. These may reflect developmental antecedents in psychotic disorders such as schizophrenia. KEY DATA AND STATISTICS: A case series of 9 teens (ages 13-17) identified as prodromal to psychosis were evaluated with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Childhood-onset diagnoses commonly endorsed (threshold or subthreshold) included ADHD (5/9), oppositional defiant disorder (5/9), enuresis or encopresis (4/9), conduct disorder (2/9), separation anxiety (3/9), and transient tic disorder (2/9). Enuresis was identified in 3 of the 4 older teens (ages 15-17). MAJOR CONCLUSIONS: An understanding of the childhood-onset disorders that occur in teens at risk for psychotic illnesses, such as schizophrenia, can shed light on the pathophysiology of schizophrenia and potentially inform early identification and intervention.

Mazzoni P; Kimhy D; Khan S; Posner K; Maayan L; Eilenberg M; Messinger J; Kestenbaum C; Corcoran C

2009-12-01

298

Clinical utility of histological examination of gastric ulcer margin to diagnose Helicobacter pylori infection.  

UK PubMed Central (United Kingdom)

BACKGROUND: To investigate the effectiveness of histological examination of ulcer margins (HEUM) in detecting Helicobacter pylori (H. pylori) infection in patients with non-bleeding gastric ulcers (GUs). METHODS: A retrospective study included 284 patients with GU undergoing concomitant HEUM and rapid urease test (RUT) to detect H. pylori infection between January 2005 and December 2006. The slides were reviewed by an experienced pathologist (revised HEUM) in the 52 patients with inconsistent results on the initial HEUM and RUT. H. pylori infection was defined as a postive RUT and/or revised HEUM. Detection rates of H. pylori infection for HEUM and RUT were calculated accordingly. In patients with H. pylori infection, several parameters including ulcer characteristics and pathological findings were compared between patients with negative and positive (revised) HEUM. RESULTS: A total of 164 (57.7%) patients had positive results of H. pylori infection. The overall detection rates of H. pylori infection on the initial HEUM, revised HEUM and RUT were 78.0% (128/164), 89.0% (146/164), and 94.5% (155/164), respectively. For antrum ulcers, the respective detection rates were 81.0% (85/105), 92.4% (97/105), and 93.3% (98/105), for angulus ulcers, 78.6% (22/28), 85.7% (24/28), and 100% (28/28), and for proximal stomach ulcers, 61.9% (13/21), 81.0% (17/21), and 90.4% (19/21). In patients with H. pylori infection, gastric malignancy was more frequently observed in patients with false negative than true positive HEUMs. CONCLUSIONS: HEUM might be not sensitive enough for diagnosing H. pylori in patients with GU. It was especially insensitive when the ulcers were in the proximal stomach, the ulcers were malignant, or the slides were interpreted by pathologists in a rotating manner.

Lee MS; Yeh CJ; Chen HY; Tsou YK; Lin CH; Lien JM

2012-05-01

299

Clinical Utility of Histological Examination of Gastric Ulcer Margin to Diagnose Helicobacter Pylori Infection  

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Full Text Available Background: To investigate the effectiveness of histological examination of ulcer margins (HEUM) in detecting Helicobacter pylori (H. pylori) infection in patients with non-bleeding gastric ulcers (GUs). Methods: A retrospective study included 284 patients with GU undergoing concomitant HEUM and rapid urease test (RUT) to detect H. pylori infection between January 2005 and December 2006. The slides were reviewed by an experienced pathologist (revised HEUM) in the 52 patients with inconsistent results on the initial HEUM and RUT. H. pylori infection was defined as a postive RUT and/or revised HEUM. Detection rates of H. pylori infection for HEUM and RUT were calculated accordingly. In patients with H. pylori infection, several parameters including ulcer characteristics and pathological findings were compared between patients with negative and positive (revised) HEUM.Results: A total of 164 (57.7%) patients had positive results of H. pylori infection. The overall detection rates of H. pylori infection on the initial HEUM, revised HEUM and RUT were 78.0% (128/164), 89.0% (146/164), and 94.5% (155/164), respectively. For antrum ulcers, the respective detection rates were 81.0% (85/105), 92.4% (97/105), and 93.3% (98/105), for angulus ulcers, 78.6% (22/28), 85.7% (24/28), and 100% (28/28), and for proximal stomach ulcers, 61.9% (13/21), 81.0% (17/21), and 90.4% (19/21). In patients with H. pylori infection, gastric malignancy was more frequently observed in patients with false negative than true positive HEUMs.Conclusions: HEUM might be not sensitive enough for diagnosing H. pylori in patients with GU. It was especially insensitive when the ulcers were in the proximal stomach, the ulcers were malignant, or the slides were interpreted by pathologists in a rotating manner.

Mu-Shien Lee; Chi-Ju Yeh; Hsing-Yu Chen; Yung-Kuan Tsou; Cheng-Hui Lin; Jau-Min Lien

2012-01-01

300

[The clinical characteristics of 5 patients with inherited hypertrophic cardiomyopathy].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore the clinical characteristics of patients with inherited hypertrophic cardiomyopathy. METHODS: The clinical characteristics, electrocardiogram, serum chemistry and diagnostic methods were retrospectively investigated in 5 patients with inherited hypertrophic cardiomyopathy. RESULTS: The electrocardiograms of all patients were abnormal, with prominent left ventricular voltage and ST-T changes. One male patient with clinicopathological features of early onset, muscle weakness, ventricular preexcitation, elevations of two serum proteins and intracytoplasmic vacuoles containing autophagic material and glycogen in biceps brachial muscle cells was diagnosed Danon's disease. Mitochondrial cardiomyopathy was diagnosed in one male patient with early onset, short PR interval and biopsy findings of ragged-red fibers in biceps brachial muscle. Three patients were diagnosed as Fabry's disease with clinical characteristics including pain and acroparesthesias, angiokeratoma and decrease of alpha-galactosidase A activity. CONCLUSION: Some of the rare inherited hypertrophic cardiomyopathy might easily be clinically misdiagnosed as hypertrophic cardiomyopathy, systemic and careful case history inquiring and specific relevant examinations would help to make the right diagnosis in these patients.

He JQ; Han ZH; Ren XJ; Gao YC; Zhang XL; Jiang TY

2009-04-01

 
 
 
 
301

Clinical characteristics and natural history of antenatally diagnosed fetal uropathy. An analysis of 55 cases.  

UK PubMed Central (United Kingdom)

The clinical characteristics and natural history of 55 cases with antenatally diagnosed fetal uropathy were investigated. Percutaneous aspiration of the fetal pelvic or vesical urine was performed to decompress progressive unilateral hydronephrosis in 2 cases and to evaluate renal function in another 2 cases of bilateral hydronephrosis. As the postnatal diagnosis, upper urinary tract dilatation (hydronephrosis or hydronephroureter, 33 cases) and renal dysplasia (15 cases) made up 87% of all cases. A combination of hydronephrosis in one kidney and renal dysplasia in the other was also found in another 2 cases. Among 35 cases with upper urinary tract dilatation, 27 cases demonstrated pelviureteric junction stenosis and surgical intervention was necessary in 15 cases. In 17 cases with renal dysplasia, spontaneous regression was observed in only 3 cases and surgical intervention by means of percutaneous nephrostomy and nephrectomy was performed in 4 and 6 cases, respectively.

Kubota M; Suita S; Shono T; Satoh S; Nakano H

1996-07-01

302

Clinical characteristics and natural history of antenatally diagnosed fetal uropathy. An analysis of 55 cases.  

Science.gov (United States)

The clinical characteristics and natural history of 55 cases with antenatally diagnosed fetal uropathy were investigated. Percutaneous aspiration of the fetal pelvic or vesical urine was performed to decompress progressive unilateral hydronephrosis in 2 cases and to evaluate renal function in another 2 cases of bilateral hydronephrosis. As the postnatal diagnosis, upper urinary tract dilatation (hydronephrosis or hydronephroureter, 33 cases) and renal dysplasia (15 cases) made up 87% of all cases. A combination of hydronephrosis in one kidney and renal dysplasia in the other was also found in another 2 cases. Among 35 cases with upper urinary tract dilatation, 27 cases demonstrated pelviureteric junction stenosis and surgical intervention was necessary in 15 cases. In 17 cases with renal dysplasia, spontaneous regression was observed in only 3 cases and surgical intervention by means of percutaneous nephrostomy and nephrectomy was performed in 4 and 6 cases, respectively. PMID:8823609

Kubota, M; Suita, S; Shono, T; Satoh, S; Nakano, H

303

How to diagnose the 22q11.2 deletion syndrome in patients with schizophrenia: a case report.  

UK PubMed Central (United Kingdom)

The 22q11.2 deletion syndrome is caused by a microdeletion of chromosome 22. One third of all patients with 22q11.2 deletion develop schizophrenia-like symptoms. In general, the prevalence of 22q11.2 deletion in patients with schizophrenia is 1%--2%. The 22q11.2 deletion is one of the major known genetic risk factors for schizophrenia. However, clinical differences in the phenotypes between patients with schizophrenia who are 22q11.2 deletion carriers and those who are not are still unknown. Therefore, it may be difficult to diagnose 22q11.2 deletion in patients with schizophrenia on the basis of clinical symptoms. To date, only two Japanese patients with the deletion have been identified through microdeletion studies of patients with schizophrenia in the Japanese population. Herein, we report the case study of a 48-year-old Japanese woman with 22q11.2 deletion who had a 30-year history of schizophrenia. Based on craniofacial anomalies, unpredictable agitation, hypocalcemia, and brain imaging finding, we suspected the 22q11.2 deletion in clinical populations and diagnosed the deletion using fluorescence in situ hybridization analysis. To find common phenotypes in Japanese patients with the deletion who have schizophrenia-like symptoms, we compared phenotypes among three Japanese cases. The common phenotypes were an absence of congenital cardiovascular anomalies and the presence of current findings of low intellectual ability, agitation, and hypocalcemia. We propose that hypocalcemia and agitation in patients with schizophrenia may derive from the 22q11.2 deletion, particularly when these phenotypes are coupled with schizophrenia-like symptoms.

Ohi K; Hashimoto R; Yamamori H; Yasuda Y; Fujimoto M; Nakatani N; Kamino K; Takeda M

2013-09-01

304

Lúpus eritematoso sistêmico (LES): perfil clínico-laboratorial dos pacientes do Hospital Universitário Onofre Lopes (UFRN-Natal/Brasil) e índice de dano nos pacientes com diagnóstico recente Systemic lupus erythematosus (SLE): clinical and laboratory profile of patients followed at the Onofre Lopes University Hospital (UFRN - Natal/Brazil) and early organ damage in patients with recently diagnosed disease  

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Full Text Available OBJETIVO: Determinar a freqüência das manifestações clínicas e laboratoriais de pacientes com lúpus eritematoso sistêmico (LES) e identificar os danos precoces nos pacientes com diagnóstico recente. MÉTODOS: Avaliação retrospectiva de 164 pacientes com LES do ambulatório de Reumatologia do Hospital Universitário Onofre Lopes - UFRN, de abril de 2003 a dezembro de 2004. As manifestações clínicas e laboratoriais avaliadas referem-se aos critérios de classificação do Colégio Americano de Reumatologia. A avaliação do índice de dano, através do SLICC/ACR DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) foi realizada em 32 pacientes que tinham entre dois e três anos de diagnóstico. RESULTADOS: As manifestações clínicas mais freqüentes foram as cutâneas (90,2%), em especial a fotossensibilidade. As demais manifestações clínicas e laboratoriais foram semelhantes às descritas na literatura. Dano orgânico precoce foi identificado em nove pacientes com doença recente (28,1%) e, novamente, o acometimento cutâneo foi o mais freqüente (12,5%). CONCLUSÃO: Tanto as manifestações clínicas quanto os danos orgânicos precoces mais comuns foram relacionados à pele. Portanto, faz-se necessário o incentivo à fotoproteção em nossa região, que tem alta influência dos raios ultravioleta.OBJECTIVE: to analyse clinical and laboratory features of patients with systemic lupus erythematosus (SLE), and to describe the early damage outcome of SLE patients in recent onset disease. METHODS: a retrospective study of 164 SLE patients followed at The Onofre Lopes University Hospital - Universidade Federal do Rio Grande do Norte (ufrn), from April, 2003 to December, 2004. The clinical and laboratory data were analyzed according to American College of Rheumatology criteria for sle. Thirty two patients between two and three years of disease were evaluated concerning the irreversible damage using slicc/acr di (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). RESULTS: the most frequent clinical manifestations were cutaneous (90.2%), specially photosensitivity. The other clinical and laboratory features were similar to the literature. Early organ damage was present in nine patients (28.1%) with recent onset disease and the cutaneous involvement (12.5%) was the most frequent too. CONCLUSION: This study suggests that high exposure to ultraviolet light rays could influence clinical manifestations and early damage in sle patients.

Elaine Lira Medeiros Bezerra; Maria José Pereira Vilar; Olívia de Fátima Costa Barbosa; Sílvia Queiroz Santos; Milena de Araújo Castro; Marília Cavalcanti da Trindade; Emilia Inoue Sato

2005-01-01

305

Assessing the level of breast cancer awareness among recently diagnosed patients in Ain Shams University Hospital.  

UK PubMed Central (United Kingdom)

Breast cancer is the leading female malignancy among Egyptian women. The majority of Egyptian breast cancer patients present at late stages of the disease with a large tumor size compared to Western countries. Low breast cancer awareness, social and cultural factors were suggested to play crucial role in late presentation of breast cancer among Egyptians. The aim of our present study is to establish a questionnaire-based survey that can assess levels of breast cancer awareness among Egyptians. Patients enrolled were interviewed and answered 60 questions related to knowledge, symptoms, risk factors, prevention and management options of breast cancer. We evaluated our interactions with breast cancer patients and defined the level of awareness gained from education and culture of Egyptian women. Our results described that Egyptian breast cancer patients lack knowledge about their illness and condition. The lowest levels of awareness were related to age, education and culture. We concluded that breast cancer public awareness and women education programs covering factors identified in our study is warranted among Egyptian population. Overview OBJECTIVE: To assess breast cancer awareness among recently diagnosed breast cancer Egyptian patients. SUBJECTS AND METHODS: Among 289 interviewed breast cancer patients we enrolled 45 patients who fulfilled the study inclusion criteria. Participants were asked to answer a validated 60-item questionnaire that inquires about socio-demographic characteristics, knowledge of breast cancer symptoms, risk factors, symptoms, prevention, general management and willingness to participate in awareness campaigns. The average of interview time was about 45 min, depending on patient's age and education level. RESULTS: The mean age of included patients was 48.2 ± 10.19 years. Geographical distribution revealed that 66.7% patients were from Cairo and the rest were from other governorates, including Aswan, Sharqia, Mansora, Qena, Kalyobia, Elminya and Sohag. Among interviewed patients 85% were non-working housewives, 42.2% of them were illiterate. Questions about knowledge of breast cancer revealed that 53.33% of patients knew an acquaintance with breast cancer; however, they spent a median time of 3 months to seek medical advice after recognizing the first symptom with a delay range between a month and 72 months. We found that 73% of the participants presented to a physician with the same first recognized symptom and 75.6% didn't think of cancer then as a possible diagnosis. Total breast cancer knowledge scores had an average of 13.3 (out of 35 knowledge points), with 93% of the patients recognizing "painless breast mass" as a breast cancer symptom and 44% only recognized the concept of breast self examination. Interestingly, 61.4% identified breastfeeding as a risk factor for breast cancer, 60% did not recognize mammography as an early detection method, and 57.7% agreed that clinical breast examination (CBE) is important for early detection. Regarding management, 75% said breast cancer was potentially curable and 60% said medical care could be helpful regardless the age of presentation. CONCLUSION: Egyptian breast cancer patients knew little about their condition. Less awareness was related to age and education level. Low knowledge of risk factors, early detection and management of breast cancer should be addressed by designing patient education programs, where less educated patients are supported by health care professionals to participate in the management of breast cancer. Moreover, we found that 67% and 97% of enrolled breast cancer patients were willing as well to participate in spreading awareness among their community and among their own families, respectively.

El-Shinawi M; Youssef A; Alsara M; Aly MK; Mostafa M; Yehia A; Hurlbert M; El-Tawab RA; Mohamed MM

2013-09-01

306

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

International Nuclear Information System (INIS)

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 ?2-test. We compared the results with DSA and operation results. Results: The statistical analysis of the diagnostic results by the three experienced neuroradiologists had no statistical difference (P > 0.05). All of the 17 patients showed clearly the abnormality of spinal cord vessels and the range of lesions by CT spinal angiography. Among them, one patient was diagnosed as arteriovenous fistulas (AVF) by MRI and CT spinal angiography, which was verified by surgical operation. DSA of the same patient, however, did not visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT spinal angiography could only show AVM not AVF. The type differentiations of all the other 16 patients were consistent with DSA results. For 13 cases with positive CT spinal angiography results, DSA displayed 20 feeding vessels, among which 16 vessels were displayed correctly by CT spinal angiography, four could not be visualized, and two turned out to be false-positive. Fistulas were not displayed in six cases by CT spinal angiography. Draining veins were displayed clearly in all cases, which agreed with DSA results. Four cases who took CE-MRA obtained the same type diagnosis as that from CT spinal angiography. Feeding arteries were not displayed in CE-MRA of one case, but could be clearly visualized in other three cases, and the results agreed with CTA and DSA results. Fistulas could be seen in two cases. Draining veins and the disease range could be displayed distinctly by 3D CE-MRA. Conclusion: CT spinal angiography is quite valuable for diagnosing vascular malformation of spinal cord. It can be a screening exam before DSA, and has a guiding effect on DSA, reducing the amount of time required for DSA.

1100-01-00

307

A phase 1 trial of ABT-510 concurrent with standard chemoradiation for patients with newly diagnosed glioblastoma.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the maximum tolerated dose of ABT-510, a thrombospondin-1 mimetic drug with antiangiogenic properties, when used concurrently with temozolomide and radiotherapy in patients with newly diagnosed glioblastoma. DESIGN: Phase 1 dose-escalation clinical trial. SETTING: Comprehensive Cancer Center, University of Alabama at Birmingham. Patients A total of 23 patients with newly diagnosed, histologically verified glioblastoma enrolled between April 2005 and January 2007. INTERVENTIONS: Four cohorts of 3 patients each received subcutaneous ABT-510 injection at doses of 20, 50, 100, or 200 mg/d. The maximum cohort was expanded to 14 patients to obtain additional safety and gene expression data. The treatment plan included 10 weeks of induction phase (temozolomide and radiotherapy with ABT-510 for 6 weeks plus ABT-510 monotherapy for 4 weeks) followed by a maintenance phase of ABT-510 and monthly temozolomide. MAIN OUTCOME MEASURES: Patients were monitored with brain magnetic resonance imaging and laboratory testing for dose-limiting toxicities, defined as grades 3 or 4 nonhematological toxicities and grade 4 hematological toxicities. Therapy was discontinued if 14 maintenance cycles were completed, disease progression occurred, or if the patient requested withdrawal. Disease progression, survival statistics, and gene expression arrays were analyzed. RESULTS: There were no grade 3 or 4 dose-limiting toxicity events that appeared related to ABT-510 for the dose range of 20 to 200 mg/d. A maximum tolerated dose was not defined. Most adverse events were mild, and injection-site reactions. The median time to tumor progression was 45.9 weeks, and the median overall survival time was 64.4 weeks. Gene expression analysis using TaqMan low-density arrays identified angiogenic genes that were differentially expressed in the brains of controls compared with patients with newly diagnosed glioblastoma, and identified FGF-1 and TIE-1 as being downregulated in patients who had better clinical outcomes. CONCLUSIONS: ABT-510, at subcutaneous doses up to 200 mg/d, is tolerated well with concurrent temozolomide and radiotherapy in patients with newly diagnosed glioblastoma, and low-density arrays provide a useful method of exploring gene expression profiles.

Nabors LB; Fiveash JB; Markert JM; Kekan MS; Gillespie GY; Huang Z; Johnson MJ; Meleth S; Kuo H; Gladson CL; Fathallah-Shaykh HM

2010-03-01

308

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

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Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram (EEG) is performed in all patients for the d...

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

309

Patient Safety in Clinical Trials  

Science.gov (United States)

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

310

Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda.  

UK PubMed Central (United Kingdom)

BACKGROUND: Complications of rheumatic heart disease are associated with severe morbidity and mortality in developing countries where the disease prevalence remains high. Due to lack of screening services, many patients present late, with severe valve disease. In Uganda, the disease and its complications are still not well studied. OBJECTIVE: To profile and describe cardiovascular complications in newly diagnosed rheumatic heart disease patients attending the Mulago National Referral Hospital in Uganda. METHODS: This was a cross-sectional study where consecutive, newly diagnosed rheumatic heart disease patients were assessed and followed up for complications, such as heart failure, pulmonary hypertension, atrial fibrillation, recurrence of acute rheumatic fever, and stroke. RESULTS: A total of 309 (115 males and 196 females) definite rheumatic heart disease patients aged 15-60 years were enrolled in the study and analysed. Complications occurred in 49% (152/309) of the newly diagnosed rheumatic heart disease cases, with heart failure (46.9%) the most common complication, followed by pulmonary arterial hypertension (32.7%), atrial fibrillation (13.9%), recurrence of acute rheumatic fever (11.4%), infective endocarditis (4.5%) and stroke (1.3%). Atrial fibrillation and acute rheumatic fever were the most common complications associated with heart failure. CONCLUSION: In this study we found that about 50% of newly diagnosed rheumatic heart disease patients in Uganda presented with complications. Heart failure and pulmonary arterial hypertension were the most commonly observed complications.

Okello E; Wanzhu Z; Musoke C; Twalib A; Kakande B; Lwabi P; Wilson NB; Mondo CK; Odoi-Adome R; Freers J

2013-04-01

311

The comparative effects of valsartan and amlodipine on vascular microinflammation in newly diagnosed hypertensive patients.  

UK PubMed Central (United Kingdom)

Pentraxin 3 (PTX3) is a new candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors. We aimed to investigate the effects of valsartan and amlodipine on the PTX3 and C-reactive protein (CRP) levels in patients with essential hypertension. Patients with a newly diagnosed essential hypertension were admitted to our internal medicine outpatient clinic. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5-10 mg/day) as group A (n = 22; mean age ± standard deviation [SD]: 52 ± 11 year) and angiotensine II receptor blocker (valsartan, 80-320 mg/day) as group B (n = 28; mean age ± SD: 50 ± 14 year). Endothelial dysfunction and systemic inflammation were evaluated with PTX3 and CRP. There was a significant decrease in the level of PTX3 after treatment in two groups (P < .05). Although there was a significant decrease in the level of CRP after treatment in amlodipine group, there was no significant decrease in the levels of PTX3 and CRP after treatment in two groups. There were no significant differences in the systolic and diastolic blood pressure reduction between the two treatment groups. In the treatment of hypertension, prior knowledge of the level of plasma PTX3 could be important in antihypertensive drug choice. C-reactive protein and PTX3 are the markers that have role in vascular inflammation and are found associated with the prognosis of cardiovascular outcomes in many trials. In our study, PTX and CRP levels were decreased when compared to baseline levels.

Unlu M; Karaman M; Ay SA; Balta S; Cakar M; Demirkol S; Celik T; Arslan E; Demirbas S; Turker T; Yaman H; Bulucu F; Sa?lam K

2013-01-01

312

Observational prospective cohort study of patients with newly-diagnosed ocular sebaceous carcinoma.  

UK PubMed Central (United Kingdom)

PURPOSE: To investigate the epidemiology and clinicopathological management for ocular sebaceous carcinoma (OSC) in the UK. METHODS: Observational prospective cohort study of patients with newly-diagnosed OSC. The British Ophthalmological Surveillance Unit captured incident cases of OSC between 2008 and 2010. Incident and 6-month follow-up questionnaires from reporting ophthalmologists captured OSC demographic and clinical data. RESULTS: Data were available on 51 patients with unilateral OSC (response rate 85%). The UK estimated annual incidence was 0.41 cases per million population (95% CI 0.31 to 0.54). Median age was 70 years (SD 14, range 28-98) with 57% women. OSC location was upper lid (54%), lower lid (20%), multicentric (14%) and caruncle (12%). Most common misdiagnoses included chalazion (42%), basal cell carcinoma (30%) and blepharoconjunctivitis (16%), with median delay in diagnosis of 10 months (SD 9, range 0.5-36). Specialist ophthalmic pathologists performed diagnostics in 62%, with pagetoid/intraepithelial spread present in 39%. Misdiagnosis of chalazion (p=0.019) and pagetoid tumour spread (p=0.016) was associated with a significant diagnostic delay (one-way ANOVA/R(2)). Primary surgical management involved excision with reconstruction (49%), primary exenteration (10%) and Mohs surgery (8%). There were three deaths (out of 51) during the study period; one patient died of OSC-related disease and the other two due to other causes. CONCLUSIONS: This population-based prospective study confirms OSC as a rare cancer in the UK. Masquerade syndromes result in significant diagnostic delays and increase the risk of pagetoid tumour spread. There is considerable UK variation in pathological and surgical management, and ocular reconstruction and radical surgery is often required for OSC due to delayed presentation.

Muqit MM; Foot B; Walters SJ; Mudhar HS; Roberts F; Rennie IG

2013-01-01

313

Clinical Analysis of 10 AIDS Patients with Malignant Lymphoma  

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Full Text Available Objective This work summarizes the clinical features and treatment of 10 AIDS patients with malignant lymphoma. Methods A total of 10 AIDS patients with malignant lymphoma seen in Beijing Ditan Hospital since 2009 were enrolled. Clinical Manifestations, pathological examinations, immunity levels, Epstein-Barr virus antibody examinations, complications, treatments, and outcomes were retrospectively analyzed. Results The main clinical manifestations of these patients included intermittent fever in 2 cases, neck masses and fever in 3 cases, auxiliary lymph node enlargement in 2 cases, and abdominal pain and bloating with fever in 3 cases. Up to 7 patients were pathologically diagnosed with diffuse large B cell lymphoma (DLBCL), and 3 patients were pathologically diagnosed with Burkitt’s lymphoma. Up to 8 patients had CD4 cell counts below 200/?L, and 2 patients had a level of more than 200/?L. Up to 7 patients were negative for EBV-IgM antibodies and 3 patients were not examined. Six patients underwent different chemotherapy and their prognoses were different. One patient with Burkitt’s lymphoma alternatively took CODOXM and IVAC for 3 turns after VP chemotherapy; 1 patient with liver metastasis took R-CHOP 5 times, then changed therapy regimen to R-MINE and MINE. One patient with adrenal DLBCL took CHOP 6 times. Three patients with DLBCL took CHOP 1 or 2 times. Four patients gave up treatment. Various infections and side effects occurred, including bone marrow suppression, gastrointestinal bleeding, and renal dysfunction during chemotherapy. Six patients took HAART, and 4 did not. Six patients died, whereas 3 patients got improved; and 1 patient was discharged. Conclusions AIDS patients with malignant lymphoma had various clinical manifestations, were immunocompromised, and had multiple metastases when they were admitted; they were already in the interim or late stage of lymphoma. Chemotherapy was not effective, and additional complications occurred. HAART failed to improve patient prognosis, and the overall prognosis was poor.

Gui-ju Gao; Di Yang; Ke-ke Lin; Jiang Xiao; Xin Li; Hong-yuan Liang; Hong Liu; Ning Han; Hong-xin Zhao

2012-01-01

314

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

Directory of Open Access Journals (Sweden)

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.

Kar Rakhee; Dutta Shyamali; Tyagi Seema

2008-01-01

315

Reliability of clinical judgements of insight in patients with psychoses.  

UK PubMed Central (United Kingdom)

We evaluated the reliability of scaled and binary clinical judgements of insight. Twelve clinicians rated 30 DVD interview recordings of patients diagnosed with a psychotic disorder. Scaled ratings produced an ICC of 0.62. Reliability of categorical (binary) ratings was 0.37 (k). While ordinal ratings are more reliable than binary ratings, reliability across both methods is too low for important decision-making. Clinical judgements of insight are impaired by a lack of standardised diagnostic criteria.

Galloghly DP; Dear GE; Jablensky A

2013-08-01

316

Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease. RESEARCH DESIGN AND METHODS: Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone. RESULTS: Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median +/- SE, 26 +/- 4.8 months). In five patients, glycemic control deteriorated after 9-36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients. CONCLUSIONS: These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.

Ilkova H; Glaser B; Tunçkale A; Bagriaçik N; Cerasi E

1997-09-01

317

Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up.  

UK PubMed Central (United Kingdom)

BACKGROUND: Clinical management of papillary breast lesions (PBLs) remains controversial. The objective of this study was to identify pathologic and radiologic predictors of malignancy from a large cohort of PBLs diagnosed on core-needle biopsy (CNB). STUDY DESIGN: Retrospective review of the institutional pathology database identified all PBLs diagnosed from 2001 to 2009 and surgically excised within 6 months of diagnosis. PBLs were divided into intraductal papilloma (IDP) and IDP associated with atypical ductal or lobular hyperplasia (ADH/ALH). Surgical pathology of all lesions was reviewed and upgrade was defined as a change to a lesion of greater clinical significance, including ALH, ADH, lobular, or ductal carcinoma in situ (LCIS or DCIS), and invasive ducal carcinoma (IDC). RESULTS: We identified 276 patients (mean age 56 years; range 23 to 88 years) with PBLs on CNB. Seventy-nine patients (28.6%) upgraded to a lesion of greater clinical significance. Of the 234 (84.7%) had IDP only, 42 (17.9%) upgraded to ADH, and 21 (8.9%) to DCIS or IDC. Of the 42 (15.3%) patients with associated ADH or ALH on CNB, 16 (38.0%) upgraded to DCIS or IDC. The majority of patients (n = 173, 62.6%) had no breast symptoms. All patients had an abnormal mammogram and/or ultrasound that prompted the CNB. Among all clinical and radiographic variables analyzed, older age alone was predictive of upgrade. CONCLUSIONS: Frequent upgrade to a high-risk lesion or cancer is observed with IDPs diagnosed on CNB without adequate identifiable clinical and radiographic risk factors. Surgical excision should be performed for all IDPs to delineate subsequent clinical management.

Rizzo M; Linebarger J; Lowe MC; Pan L; Gabram SG; Vasquez L; Cohen MA; Mosunjac M

2012-03-01