WorldWideScience
 
 
1

New clinical score to diagnose nonalcoholic steatohepatitis in obese patients  

Directory of Open Access Journals (Sweden)

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

Pulzi Fernanda BU

2011-02-01

2

Determinants of sexual dysfunction among clinically diagnosed diabetic patients  

Science.gov (United States)

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

2011-01-01

3

Determinants of sexual dysfunction among clinically diagnosed diabetic patients  

Directory of Open Access Journals (Sweden)

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.

Sarpong Charity

2011-05-01

4

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: English Abstract in english 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 investig [...] ated. 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.

2008-09-01

5

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, Klaus Damgaard; Hansen, Thomas Folkmann

2008-01-01

6

Determinants of sexual dysfunction among clinically diagnosed diabetic patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 diab...

Sarpong Charity; Alidu Huseini; Kba, Owiredu William; Gyasi-Sarpong Christian K

2011-01-01

7

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

Directory of Open Access Journals (Sweden)

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

Jin-You Wang

2014-05-01

8

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

Science.gov (United States)

A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all patients with a clinical diagnosis of meningitis, irrespective of their immune status should be investigated for cryptococcal infection. PMID:14652440

Prasad, K N; Agarwal, J; Nag, V L; Verma, A K; Dixit, A K; Ayyagari, A

2003-09-01

9

Who is referred to neurology clinics?--the diagnoses made in 3781 new patients.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE: Information on the nature and relative frequency of diagnoses made in referrals to neurology outpatient clinics is an important guide to priorities in services, teaching and research. Previous studies of this topic have been limited by being of only single centres or lacking in detail. We aimed to describe the neurological diagnoses made in a large series of referrals to neurology outpatient clinics. METHOD: Newly referred outpatients attending neurology clinics in all the NHS neur...

Stone, J.; Carson, A.; Duncan, R.; Roberts, R.; Warlow, C.; Hibberd, C.; Coleman, R.; Cull, R.; Murray, G.; Pelosi, A.; Cavanagh, J.; Matthews, K.; Goldbeck, R.; Smyth, R.; Walker, J.

2010-01-01

10

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

Directory of Open Access Journals (Sweden)

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.

Tropp Hans

2005-06-01

11

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

Scientific Electronic Library Online (English)

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

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

12

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

Scientific Electronic Library Online (English)

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

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

2014-04-01

13

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1995-09-01

14

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

Directory of Open Access Journals (Sweden)

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.

Eckert Daniel C

2006-11-01

15

[Clinical recommendations for diagnosing, treatment and monitoring patients with non-small cell lung cancer].  

Science.gov (United States)

In Croatia, lung cancer is the most common malignant disease among male population and the third common among female population where 85% of patients have non-small cell lung cancer. Due to significance of this disease it is necessary to define and implement standardized approach for diagnostic and treatment algorithm as well to patients monitoring. Several multidisciplinary sessions were organized in achieving this goal. The sessions' results are given in the form of the Clinical guidelines. PMID:22329290

Samarzija, Miroslav; Gugi?, Damir; Radi?, Jasna; Vrdoljak, Eduard; Jakopovi?, Marko; Boban, Marijo; Lovasi?, Ingrid Belac; Chalfe, Nabil; Plestina, Sanja; Slobodnjak, Zoran; Jezek, Silvana Smojver; Jonji?, Nives; Kukuljan, Melita

2011-01-01

16

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 < 0,001). Conclusion: the clinical and x-rays findings in patients with diagnosis of PE by high probability V/Q lung scan were: hemoptysis, taquicardia, chest pain, recent surgery and normal chest x-ray. This is important because would help to choose the patients in whom the V/Q lung scan will have the maximal performance (Au)

17

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)

18

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

Directory of Open Access Journals (Sweden)

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

2010-05-01

19

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

DEFF Research Database (Denmark)

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

Vach, Werner; HØilund-Carlsen, Poul Flemming

2011-01-01

20

Clinical profile of patients diagnosed with leptospirosis after a typhoon: a multicenter study.  

Science.gov (United States)

This study described the clinical features and complications of leptospirosis among patients seen at nine tertiary hospitals from September 28 to November 30, 2009 after a heavy rainfall typhoon. The clinical findings of the confirmed cases were compared with the previous clinical studies on seasonal leptospirosis in the Philippines. Risk factors for complicated disease were also identified. Confirmed cases were based on any of the following: positive leptospiral cultures of blood or urine, single high leptospira microscopic agglutination test (MAT) titer of 1:1,600, a fourfold rise in MAT, and/or seroconversion. Of 670 patients with possible leptospirosis, 591 were probable by the WHO criteria, 259 (44%) were confirmed. Diagnosis was confirmed by MAT 176 (68%), by culture 57 (22%), and by MAT and culture 26 (10%). The mean age of the confirmed cases was 38.9 years (SD 14.3). The majority were males (82%) and had a history of wading in floodwaters (98%). The majority of the patients presented with nonspecific signs, with fever as the most common (98.5%). Other findings were myalgia (78.1%), malaise (74.9%), conjunctival suffusion (59.3%), oliguria (56.6%), diarrhea (39%), and jaundice (38%). Most of the patients presented with a moderate-to-severe form of leptospirosis (83%). Complications identified were renal failure (82%), pulmonary hemorrhage (8%), meningitis (5%), and myocarditis (4%). Mortality rate was 5%, mostly due to pulmonary hemorrhage. This study emphasizes the importance of public awareness and high index of suspicion among clinicians of leptospirosis during the monsoon months when flooding is common. Early recognition and detection of the disease should decrease morbidity and mortality. PMID:24450239

Mendoza, Myrna T; Roxas, Evalyn A; Ginete, Joanne Kathleene; Alejandria, Marissa M; Roman, Arthur Dessi E; Leyritana, Katerina T; Penamora, Mary Ann D; Pineda, Cristina C

2013-11-01

 
 
 
 
21

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Marin-avellan, L. E.; Mcgauley, G. A.; Campbell, C. D.; Fonagy, P.

2014-01-01

22

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

Directory of Open Access Journals (Sweden)

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.

Proujansky Roy

2004-01-01

23

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

Science.gov (United States)

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

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

2014-08-01

24

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

International Nuclear Information System (INIS)

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

25

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

DEFF Research Database (Denmark)

Chronic exposure to glucocorticoids (GCs) has many side effects including glucose intolerance and diabetes and may accelerate the occurrence of cardiovascular disease and increase mortality. We studied the 14-year clinical development of diabetes in patients diagnosed with diabetes during GC treatment. A population-based sample of 1369 people newly diagnosed with clinical type 2 diabetes underwent a clinical examination at diagnosis, and surviving patients were followed up 6 and 14 years later. Patients receiving oral GC treatment at diagnosis were compared with the other patients. Of 1369 patients, 35 (2.6%) were treated with oral GCs at diabetes diagnosis. At that point, patients on GC therapy were older (69.9 versus 65.3 years, p = 0.007, sex-adjusted) and tended to have lower BMI (26.1 versus 29.1 kg/m(2) , p = 0.023), also 6 years after diagnosis (24.8 versus 28.4, p = 0.011), than patients not being treated with GCs. In a univariate Cox regression model, GC treatment at diagnosis increased all-cause mortality with a hazard ratio (95% confidence interval) of 2.01 (1.39-2.89, p = 0.0002, n = 1369), while this decreased to 1.41 (0.98-2.04, p = 0.065, n = 1369) when adjusted for age and sex and to 1.39 (0.92-2.11, p = 0.12, n = 1086) when risk factors, complications and cancer were added to the model. Apart from differences in age and overweight, patients in this relatively small sample of those diagnosed with clinical type 2 diabetes during GC treatment were comparable at diagnosis and during 14 years of follow-up with those not treated with GCs, including with regard to the adjusted mortality rate

Olivarius, Niels de Fine; Siersma, Volkert Dirk

2011-01-01

26

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

DEFF Research Database (Denmark)

? Chronic exposure to glucocorticoids (GCs) has many side effects including glucose intolerance and diabetes and may accelerate the occurrence of cardiovascular disease and increase mortality. We studied the 14-year clinical development of diabetes in patients diagnosed with diabetes during GC treatment. A population-based sample of 1369 people newly diagnosed with clinical type 2 diabetes underwent a clinical examination at diagnosis, and surviving patients were followed up 6 and 14?years later. Patients receiving oral GC treatment at diagnosis were compared with the other patients. Of 1369 patients, 35 (2.6%) were treated with oral GCs at diabetes diagnosis. At that point, patients on GC therapy were older (69.9 versus 65.3?years, p?=?0.007, sex-adjusted) and tended to have lower BMI (26.1 versus 29.1?kg/m(2) , p?=?0.023), also 6?years after diagnosis (24.8 versus 28.4, p?=?0.011), than patients not being treated with GCs. In a univariate Cox regression model, GC treatment at diagnosis increased all-cause mortality with a hazard ratio (95% confidence interval) of 2.01 (1.39-2.89, p?=?0.0002, n?=?1369), while this decreased to 1.41 (0.98-2.04, p?=?0.065, n?=?1369) when adjusted for age and sex and to 1.39 (0.92-2.11, p?=?0.12, n?=?1086) when risk factors, complications and cancer were added to the model. Apart from differences in age and overweight, patients in this relatively small sample of those diagnosed with clinical type 2 diabetes during GC treatment were comparable at diagnosis and during 14?years of follow-up with those not treated with GCs, including with regard to the adjusted mortality rate.

Olivarius, Niels de Fine; Siersma, Volkert

2010-01-01

27

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

International Nuclear Information System (INIS)

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

28

Clinical Use of Skull Tap Vestibular Evoked Myogenic Potentials for the Diagnoses of the Cerebellopontine Angle Tumor Patients  

Science.gov (United States)

Objective. To document our experiences using a new skull tapping induced Vestibular Evoked Myogenic Potentials (tap VEMPs) technique combined with standard Auditory Vestibular Evoked Myogenic Potentials (AC VEMPs) for advanced clinical assessment of cerebellopontine angle tumor (CPAT) patients. Design and Study Sample. Three patients were selected in order to highlight observations shown in a larger patient population and to show the variability of the findings. Both tap VEMPs and AC VEMPs were acquired from the sternocleidomastoid muscle (SCM) with EMG-based biofeedback and monitoring. Results. The usefulness of VEMPs was demonstrated, indicating the presence of a tumor and contributing additional information as to the involved nerve bundles in two out of the three cases. Conclusion. Due to the sensory organ dependency and related innervations differences, acquiring both AC VEMPs and tap VEMPs is likely to increase the probability of diagnosing CPATs and provide more information on the involved vestibular nerve bundles. This study demonstrates the feasibility of the possible expansion and combination of tap VEMPs and AC VEMPs techniques into a clinical diagnostic battery for advanced assessment of CPAT patients and its contribution as a guideline for the use of tap VEMPs in general. PMID:24804198

Yavuz, Erdem; Lachowska, Magdalena; Pierchala, Katarzyna; Morawski, Krzysztof; Niemczyk, Kazimierz; Delgado, Rafael E.

2014-01-01

29

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 ADDw0.62 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)

30

The predictive value of transcranial sonography in clinically diagnosed patients with early stage Parkinson's disease: Comparison with DAT PET scans.  

Science.gov (United States)

Early and correct diagnosis of Parkinson's disease (PD) is critical for patient counseling and therapeutic management. The diagnostic accuracy of transcranial sonography of substantia nigra (SN-TCS) for early stage PD patients remains controversial. Dopamine transporter (DAT) imaging is sensitive to detect presynaptic dopamine neuronal dysfunction, and has been studied as a diagnostic tool for degenerative Parkinsonism. To investigate the predictive value of SN-TCS for the DAT PET scans in clinically diagnosed early stage PD patients, we performed the SN-TCS and DAT Positron Emission Computed Tomography (PET) imaging examinations on 53 patients. Using the DAT PET results as clinical gold standard, the sensitivity and specificity of TCS was 68.75% and 40% respectively. The positive predictive value (PPV) of an abnormal TCS for an abnormal PET scan was 91.67%. However, the negative predictive value (NPV) for a normal PET scan was only 11.76%. The false negative rate was 31.25%. In 35 patients, the result of the SN-TCD was in accordance with the result of the DAT PET scan (Kappa=0.042, P>0.05). The consistency between SN-TCS and PET scans was poor. We conclude that SN-TCS would not be used as a diagnostic tool for early stage PD patients. Negative result of TCS could not exclude the diagnosis of PD. Further tests like DAT-PET is needed for validation. On the other hand, positive SN-TCS will reduce the added diagnostic value of a presynaptic neuronimaging scan. PMID:25218716

Liu, Ping; Li, Xin; Li, Fang-Fei; Ou-Yang, Qiao-Hong; Zhang, Hong-Xia; Feng, Tao

2014-10-17

31

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Jongmans, Mcj; Ravenswaaij-arts, Cma; Pitteloud, N.; Ogata, T.; Sato, N.; Claahsen-van Grinten, Hl; Donk, K.; Seminara, S.; Bergman, Jeh; Brunner, Hg; Crowley, Wf; Hoefsloot, Lh

2009-01-01

32

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

Sevi?nc?, Erinc?; S?engu?l, Cem; C?akaloz, Burcu; Herken, Hasan

2010-01-01

33

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

2010-06-01

34

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

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

35

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.

Cohen Robert

2004-08-01

36

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

Directory of Open Access Journals (Sweden)

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

Manuel Menéndez-González

2014-04-01

37

Morphologic features of the recipient heart in patients having cardiac transplantation and analysis of the congruence or incongruence between the clinical and morphologic diagnoses.  

Science.gov (United States)

Cardiac transplantation (CT) has been one of the great medical advances of the last nearly 50 years. We studied the explanted hearts of 314 patients having CT at Baylor University Medical Center Dallas from 1993 to 2012, and compared the morphologic diagnoses to the clinical diagnoses before CT. Among the 314 patients the morphologic and clinical diagnoses were congruent in 272 (87%) and incongruent in 42 (13%). Most of the incongruity occurred among the 166 patients with non-ischemic cardiomyopathy (non-IC) (36/166 [22%]), and of that group the major incongruity occurred among the patients with hypertrophic cardiomyopathy (7/17 [41%]), non-compaction left ventricular cardiomyopathy (NCLVC) (3/3 [100%]), mononuclear myocarditis (3/3 [100%]), arrhythmogenic right ventricular cardiomyopathy (ARVC) (4/4 [100%]), and cardiac sarcoidosis (8/8 [100%]). The phrase "non-IC" is a general term that includes several subsets of cardiac diseases and simply means "insignificant narrowing of 1 or more of the epicardial coronary arteries," but it does not specify the specific cause of the heart failure leading to CT. A number of cardiac illustrations are provided to demonstrate the morphologic variability occurring among the patients with IC and non-IC. PMID:25181314

Roberts, William C; Roberts, Carey Camille; Ko, Jong Mi; Filardo, Giovanni; Capehart, John Edward; Hall, Shelley Anne

2014-07-01

38

Reliability of clinical temporomandibular disorder diagnoses.  

Science.gov (United States)

Temporomandibular disorders (TMD) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD. The Research Diagnostic Criteria for TMD (RDC/TMD) is the most widely used TMD diagnostic system for conducting clinical research. It has been translated into 18 languages and is used by a consortium of 45 RDC/TMD-based international researchers. While reliability of RDC/TMD signs and symptoms of TMD has been amply reported, the reliability of RDC/TMD diagnoses has not. The aim of the study was to determine the reliability of clinical TMD diagnoses using standardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data came from reliability assessment trials conducted at 10 international clinical centers, involving 30 clinical examiners assessing 230 subjects. Intraclass correlation coefficients (ICC) were calculated to characterize the reliability. The reliability of the diagnoses was fair to good. Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60, respectively. Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction. RDC/TMD diagnoses of disc displacement without reduction, osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC's, but percent agreement was always >95%. The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non-pain diagnoses (ICC=0.72) and for detecting any diagnosis versus no diagnosis (ICC=0.78). In clinical decision-making and research, arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment. The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses, supporting its use in clinical research and decision making. PMID:16154702

John, Mike T; Dworkin, Samuel F; Mancl, Lloyd A

2005-11-01

39

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.

V Fink

2012-11-01

40

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

Directory of Open Access Journals (Sweden)

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

Maruyama Koichi

2010-03-01

 
 
 
 
41

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

Energy Technology Data Exchange (ETDEWEB)

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

Neumann, C.H.

1986-10-01

42

Bortezomib Improves Survival of Newly Diagnosed Patients with Multiple Myeloma  

Science.gov (United States)

The targeted drug bortezomib, when added to standard therapy (melphalan and prednisone), improves survival of patients with newly diagnosed multiple myeloma, according to the May 1, 2010, issue of the Journal of Clinical Oncology.

43

Differential diagnoses to MS : experiences from an optic neuritis clinic  

DEFF Research Database (Denmark)

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

Horwitz, Henrik; Friis, Tina

2014-01-01

44

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

Directory of Open Access Journals (Sweden)

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

Mustafa Yakut

2012-06-01

45

Early anti-TNF treatment in pediatric Crohn's disease. Predictors of clinical outcome in a population-based cohort of newly diagnosed patients.  

Science.gov (United States)

Abstract Objective. Pediatric Crohn's disease (CD) is often debilitating, with upper gastrointestinal (GI) involvement and complications over time. Treatment with tumor necrosis factor (TNF) blockers can induce and maintain remission. We wanted to evaluate the outcome of patients medically treated for CD to investigate whether clinical, endoscopic and biochemical factors at diagnosis are associated with the early initiation of treatment with the TNF blocker infliximab. Materials and methods. Patients aged <18 years, diagnosed with CD were characterized according to the Porto criteria, with endoscopy, magnetic resonance imaging and biochemical tests before individual treatment. They were followed prospectively until a prescheduled examination within 2 years. Results. Thirty-six pediatric patients were included, 18 (50%) received infliximab. Infliximab-treated patients had shorter disease duration, more upper GI involvement (p = 0.03) and higher median C-reactive protein (CRP) (28 vs. 7.5 mg/l, p = 0.02), erythrocyte sedimentation rate (ESR) (32 vs. 18 mm/h, p = 0.01) and fecal calprotectin (1506 vs. 501 mg/kg, p = 0.01) levels. Infliximab treatment was well tolerated, and 15/18 of patients achieved clinical remission. At follow-up, 11/17 in the infliximab group and 8/13 in the non-infliximab group achieved ileocolonic mucosal healing. A majority in the infliximab group had a marked reduction of CD-specific upper GI lesions but persistence of unspecific upper GI inflammation at follow-up. Conclusion. High levels of inflammatory markers and upper GI lesions were associated with initiation of infliximab treatment. A substantial proportion of patients still had unspecific lesions in the upper GI tract regardless of treatment. Future studies must clarify the prognostic role of persistent upper GI-involvement despite mucosal healing in the ileocolon. PMID:25310799

Olbjørn, Christine; Nakstad, Britt; Småstuen, Milada C; Thiis-Evensen, Espen; Vatn, Morten H; Perminow, Gøri

2014-12-01

46

Significance of dietary folate intake, homocysteine levels and MTHFR 677 C>T genotyping in South African patients diagnosed with depression: test development for clinical application.  

Science.gov (United States)

Low folate intake in the presence of the functional MTHFR 677 C > T (rs1801133) polymorphism is an important cause of elevated homocysteine levels previously implicated in major depressive disorder (MDD) and many other chronic diseases. In this study the clinical relevance and inter-relationship of these aspects were evaluated in 86 South African patients diagnosed with MDD and 97 population-matched controls participating in a chronic diseases screening program. A questionnaire-based clinical and nutrition assessment was performed, homocysteine levels determined, and all study participants genotyped for MTHFR 677 C > T (rs1801133) using allele-specific TaqMan technology. The folate score was found to be significantly lower in the patient group compared to controls (p?=?0.003) and correlated with increased body mass index (BMI), particularly in females with MDD (p?=?0.009). BMI was significantly higher in the MDD patients compared with controls after adjustment for age and sex (p?=?0.015), but this association was no longer significant after further adjustment for the level of folate intake in the diet. In MDD patients but not controls, the minor T-allele of MTHFR 677 C > T was associated with increased BMI (p?=?0.032), which in turn correlated significantly with increased homocysteine levels. The significant association between BMI and homocysteine levels was observed in both the MDD patient (p?=?0.049) and control (p?=?0.018) study groups. The significantly higher homocysteine levels observed in MDD patients compared to controls after adjustment for age and sex (p?=?0.030), therefore appears to be mediated by the effects of MTHFR 677 C > T and low folate intake on BMI. Detection of the low-penetrance MTHFR 677 C > T mutation reinforces the importance of folate intake above the recommended daily dose to prevent or restore dysfunction of the methylation pathway. PMID:24532086

Delport, Darnielle; Schoeman, Renata; van der Merwe, Nicole; van der Merwe, Lize; Fisher, Leslie R; Geiger, Dieter; Kotze, Maritha J

2014-06-01

47

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

Directory of Open Access Journals (Sweden)

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

Barberan Jose

2012-11-01

48

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

2012-07-01

49

Prevalence and clinical characteristics of lower limb atherosclerotic lesions in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study  

Science.gov (United States)

Background The clinical features of atherosclerotic lesions in ketosis-onset diabetes are largely absent. We aimed to compare the characteristics of lower limb atherosclerotic lesions among type 1, ketosis-onset and non-ketotic type 2 diabetes. Methods A cross-sectional study was performed in newly diagnosed Chinese patients with diabetes, including 53 type 1 diabetics with positive islet-associated autoantibodies, 208 ketosis-onset diabetics without islet-associated autoantibodies, and 215 non-ketotic type 2 diabetics. Sixty-two subjects without diabetes were used as control. Femoral intima-media thickness (FIMT), lower limb atherosclerotic plaque and stenosis were evaluated and compared among the four groups based on ultrasonography. The risk factors associated with lower limb atherosclerotic plaque were evaluated via binary logistic regression in patients with diabetes. Results After adjusting for age and sex, the prevalence of lower limb plaque in the patients with ketosis-onset diabetes (47.6%) was significantly higher than in the control subjects (25.8%, p?=?0.013), and showed a higher trend compared with the patients with type 1 diabetes (39.6%, p?=?0.072), but no difference was observed in comparison to the patients with non-ketotic type 2 diabetes (62.3%, p?=?0.859). The mean FIMT in the ketosis-onset diabetics (0.73?±?0.17 mm) was markedly greater than that in the control subjects (0.69?±?0.13 mm, p?=?0.045) after controlling for age and sex, but no significant differences were found between the ketosis-onset diabetics and the type 1 diabetics (0.71?±?0.16 mm, p?=?0.373), and the non-ketotic type 2 diabetics (0.80?±?0.22 mm, p?=?0.280), respectively. Age and FIMT were independent risk factors for the presence of lower limb plaque in both the ketosis-onset and non-ketotic type 2 diabetic patients, while sex and age in the type 1 diabetic patients. Conclusions The prevalence and risk of lower limb atherosclerotic plaque in the ketosis-onset diabetes were remarkably higher than in the control subjects without diabetes. The features and risk factors of lower limb atherosclerotic lesions in the ketosis-onset diabetes resembled those in the non-ketotic type 2 diabetes, but different from those in the type 1 diabetes. Our findings provide further evidences to support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes rather than idiopathic type 1 diabetes. PMID:24926320

2014-01-01

50

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

Directory of Open Access Journals (Sweden)

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

Valdimarsdottir Heiddis B

2011-01-01

51

Clinical significance of combined determination of serum relevant inflammatory factors (TNF-?m, hs-CRP) and HbAlc contents in patients with newly diagnosed DM2  

International Nuclear Information System (INIS)

Objective: To study the inter-relationship between the serum contents of TNF-?, hs-CRP and HbAlc in patients with newly diagnosed DM2. Methods: Serum TNF-?, hs-CRP (with RIA), glucose (with biochemistry) and HbAlc (with micro column cbromatograpy) contents were examlued in 50 patients with newly diagnosed DM2 before any treatment and 50 controls. Results: The serum contents of TNF-?, hs-CRP and HbAlc in patients with newly diagnosed DM2 were significantly higher than those in controls (P<0.001). Serum TNF-?, hs-CRP, HbAlc and glucose contents were mutually positively correlated (P<0.05). Conclusion: Serum TNF-?, hs-CRP and HbAlc contents were all significantly increased in patients with new]y diagnosed DM2, indicating participation of imflammatory factors in the development of diabetes. Combined determination of these parameters would be helpful for monitoring the progression of disease and outcome prediction. (authors)

52

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  

Energy Technology Data Exchange (ETDEWEB)

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).

Kawabata, Shinji, E-mail: neu046@poh.osaka-med.ac.jp [Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka 569-8686 (Japan); Miyatake, Shin-Ichi; Hiramatsu, Ryo; Hirota, Yuki; Miyata, Shiro; Takekita, Yoko; Kuroiwa, Toshihiko [Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka 569-8686 (Japan); Kirihata, Mitsunori [Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8931 (Japan); Sakurai, Yoshinori; Maruhashi, Akira; Ono, Koji [Kyoto University Research Reactor Institute, 2 Asashiro-Nishi, Kumatori-cho, Sennan-gun, Osaka 590-0494 (Japan)

2011-12-15

53

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  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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. Abstract in english 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 Biomed [...] ical 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.

54

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

2008-09-01

55

Smoking Habits Among Patients Diagnosed with Oral Lichen Planus  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Oral lichen planus (OLP is one of the most common dermatologic diseases that manifests in the oral cavity. The purpose of this study was to evaluate the association between smoking habits and the clinical subtypes of OLP. Methods Oral findings and smoking data from 187 charts of OLP patients from an oral medicine clinic was reviewed and compared to data from 76 matched control patients. Results and Discussion Ninety-three patients were diagnosed with reticular OLP, 55 with atrophic and 39 with erosive forms of the disease. Symptomatic OLP occurred in 63.6% of patients. Fewer cases of reticular OLP were symptomatic than erosive OLP (p

Gorsky Meir

2004-06-01

56

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

DEFF Research Database (Denmark)

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

Toogood, Andrew; Brabant, Georg

2012-01-01

57

Schnitzler syndrome: an under-diagnosed clinical entity  

Science.gov (United States)

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 over 12.8 years. Progression to lymphoma was only observed in 8% of patients; this is lower than previous reports. 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. PMID:23812931

Jain, Tania; Offord, Chetan P.; Kyle, Robert A.; Dingli, David

2013-01-01

58

[Nursing diagnoses for diabetic patients using insulin].  

Science.gov (United States)

This is a descriptive study with a qualitative approach that has as objective to identify the nursing diagnoses of diabetic patients using insulin, having as inquiry method the study of multiple cases. The data were obtained by the researcher by means of physical examination and the technique of interview directed in the instrument based on the Orem's Self-Care Theory. After data collection, the diagnostic indentification was proceeded from the nominated nursing diagnoses of NANDA Taxonomy II, using Risner's reasoning diagnostic process. The identified nursing diagnoses with a higher frequency than 50% were six: impaired skin integrity (100%), risk for infection (100%), behavior of health search (57,2%), disturbed sleep (57,2%), chronic pain (57,2%) and risk for peripheral neurovascular dysfunction (57,2%). The application of the nursing process based in Orem and the importance of the identified diagnostic for clients nursing care were evidenced. PMID:19142391

Becker, Tânia Alves Canata; Teixeira, Carla Regina de Souza; Zanetti, Maria Lúcia

2008-01-01

59

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

Scientific Electronic Library Online (English)

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

Juan Francisco, Gálvez Flórez; David Andrés, Rincón Salazar.

2009-03-01

60

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

Directory of Open Access Journals (Sweden)

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

Juan Francisco Gálvez Flórez

2009-03-01

 
 
 
 
61

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

Scientific Electronic Library Online (English)

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

Juan Francisco, Gálvez Flórez; David Andrés, Rincón Salazar.

62

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Wevers, M. R.; Ausems, M. G. E. M.; Verhoef, S.; Bleiker, E. M. A.; Hahn, D. E. E.; Hogervorst, F. B. L.; Luijt, R. B.; Valdimarsdottir, H. B.; Hillegersberg, R.; Rotgers, E. J. T.; Aaronson, N. K.

2011-01-01

63

Different Pathophysiological Phenotypes among Newly Diagnosed Type 2 Diabetes Patients  

DEFF Research Database (Denmark)

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

Stidsen, Jacob

64

Payer costs of patients diagnosed with epilepsy.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

PURPOSE: To identify the annual cost to a third-party payer of inpatient and outpatient services and prescription drugs for patients diagnosed with epilepsy or convulsions. METHODS: Retrospective study using administrative and claims data from a private insurer in the Northeast United States with >1.8 million covered lives. Health plan members were included if they had a claim for epilepsy or convulsions and a claim for an antiepileptic drug (AED) between January 1992 and December 1996. Annua...

Griffiths, R.

1999-01-01

65

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

66

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

Science.gov (United States)

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 widespread 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 evidence-based 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. PMID:22237445

Bedrosian, Sara R.; Daniels, Elvan; Duquette, Debra; Hampel, Heather; Jasperson, Kory; Joseph, Djenaba A.; Kaye, Celia; Lubin, Ira; Meyer, Laurence J.; Reyes, Michele; Scheuner, Maren T.; Schully, Sheri D.; Senter, Leigha; Stewart, Sherri L.; Pierre, Jeanette St.; Westman, Judith; Wise, Paul; Yang, Vincent W.; Khoury, Muin J.

2013-01-01

67

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

International Nuclear Information System (INIS)

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

68

Intramedullary disorders diagnosed by MRI. Clinical course in 23 cases  

Energy Technology Data Exchange (ETDEWEB)

We report the clinical course of 23 cases with intramedullary disorders diagnosed by MRI. Spinal vascular disease was the most common, and occurred in 11 cases, intramedullary tumor occurred in 6, and multiple sclerosis, myelitis, spinal edema each in 2. The characteristic MRI findings of the intramedullary disorders were spinal cord swelling on T1 weighted image and changes in the intensity on the T2 weighted image. Surgical treatment was performed in 5 of the 11 with spinal vascular disease and in 6 with an intra-medullary tumor. One patient with AV malformation underwent embolization of the spinal artery. The other 11 received conservative treatment. The period of follow-up ranged from 6 months to 9 years after onset. Complete recovery from symptoms was achieved in only 2 patients, some recovery was achieved in 8, no change in 10, and deterioration occurred in 3. In conclusion, it has become easy to diagnose intramedullary disorders by utilizing MRI. However, an accurate qualitative diagnosis is difficult except for spinal vascular disease. Complete recovery from the symptoms of intramedullary disorders remains difficult to achieve by available treatments. (author)

Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Hirohashi, Akiyuki; Sato, Kimiaki [Kurume Univ., Fukuoka (Japan). School of Medicine

1996-09-01

69

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

Science.gov (United States)

Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia. PMID:24364199

Matkovi?, Visnja; Haller, Herman; Vrdoljak, Eduard; Corusi?, Ante; Jelavi?, Tihana Boraska; Strini?, Tomislav; Karnjus-Begonja, Ruzica; Barisic, Dubravko; Tomi?, Snjezana; Kukura, Vlastimir; Ban, Marija; Ranka, Stern Padovan; Matic, Mate; Skalec, Suzana Lide; Topolovec, Zlatko; Mrcela, Milanka; Zekan, Josko; Fröbe, Ana; Hajredini, Adem; Babic, Damir; Mamula, Ozren; Brnci?-Fischer, Alemka; Vojnovi?, Zeljko; Sundov, Dinka

2013-01-01

70

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

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

2011-12-01

71

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

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

72

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

Science.gov (United States)

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

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

2009-01-01

73

Clinical spectrum of pulmonary hamartoma diagnosed by surgical resection  

International Nuclear Information System (INIS)

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

74

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

DEFF Research Database (Denmark)

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

Svensson, Elisabeth; Mor, Anil

2014-01-01

75

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

DEFF Research Database (Denmark)

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

Toogood, Andy; Brabant, Georg

2011-01-01

76

Imaging findings in patients with-right lower quadrant pain: alternative diagnoses to appendicitis.  

Science.gov (United States)

Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed. PMID:9294554

Jain, K A; Quam, J P; Ablin, D S; Gerscovich, E O; Shelton, D K

1997-01-01

77

Intravenous urography for diagnosing synchronous upper-tract tumours in patients with newly diagnosed bladder carcinoma can be restricted to patients with high-risk superficial disease  

International Nuclear Information System (INIS)

Aim: To determine the incidence of synchronous upper-tract transitional cell carcinomas (TCCs) in patients with newly diagnosed bladder cancer and to evaluate the need for performing intravenous urography (IVU) in these patients. Materials and Methods: Imaging data on 330 consecutive patients who were diagnosed with TCC of the bladder over a 2-year period were retrospectively reviewed. Only 233 out of the 330 patients had IVU at presentation. The IVU results were recorded as normal, abnormal, or equivocal. The follow-up radiological or urological investigations in the patients who had an equivocal IVU were reviewed. Clinical follow-up data on all 330 patients were also recorded. Results: Only 233 out of the 330 patients had an IVU at presentation. Four of these (1.7%) patients were found to have synchronous upper-tract tumours. Twenty-two patients were reported to have equivocal findings on IVU. Nine of these patients had follow-up imaging [computed tomography (CT) = 5, IVU = 4], which were reported as normal. Retrograde urography was performed in two patients, which was normal. The remaining 11 patients did not have any evaluation of the upper tracts despite the equivocal findings on IVU, but routine clinical follow-up did not reveal any significant disease. Three patients with high-risk superficial disease developed upper-tract tumours that were detected on follow-up. Conclusion: IVU for diagnosing synchronous upper-tract tumours in patients with newly diagnosed blamours in patients with newly diagnosed bladder carcinoma can be restricted to patients with high-risk superficial disease

78

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

International Nuclear Information System (INIS)

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

79

Incidence of Captopril–Induced Cough in Newly Diagnosed Hypertensive Patients: Incidence in an Outpatient Medical Clinic Population in Iran in 2011-2012  

Directory of Open Access Journals (Sweden)

Results: The overall incidence of captopril-induced cough was 15.5%, with a significant difference between females and males and obviously a higher rate in females (P=0.017. In addition, cough was significantly more common in females than males in 36- to 45-year-old group (46.42% vs. 24.71%. The incidence of cough after treatment with captopril decreased by increasing age of patients and this reduction in both male and female patients was statistically significant (P

Javad Azimivaghar

2014-08-01

80

The Spanish Diagnostic Interview Schedule. Reliability and comparison with clinical diagnoses.  

Science.gov (United States)

The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was translated into Spanish. The reliability of the Spanish instrument, its equivalence to the English version, and its agreement with clinical diagnoses were examined in a study of 90 bilingual (English-and Spanish-speaking) and 61 monolingual (Spanish-speaking only) patients from a community mental health center. The study design involved two independent DIS administrations and one independent clinical evaluation of each subject. PMID:6639288

Burnam, M A; Karno, M; Hough, R L; Escobar, J I; Forsythe, A B

1983-11-01

 
 
 
 
81

Intravenous urography for diagnosing synchronous upper-tract tumours in patients with newly diagnosed bladder carcinoma can be restricted to patients with high-risk superficial disease  

Energy Technology Data Exchange (ETDEWEB)

Aim: To determine the incidence of synchronous upper-tract transitional cell carcinomas (TCCs) in patients with newly diagnosed bladder cancer and to evaluate the need for performing intravenous urography (IVU) in these patients. Materials and Methods: Imaging data on 330 consecutive patients who were diagnosed with TCC of the bladder over a 2-year period were retrospectively reviewed. Only 233 out of the 330 patients had IVU at presentation. The IVU results were recorded as normal, abnormal, or equivocal. The follow-up radiological or urological investigations in the patients who had an equivocal IVU were reviewed. Clinical follow-up data on all 330 patients were also recorded. Results: Only 233 out of the 330 patients had an IVU at presentation. Four of these (1.7%) patients were found to have synchronous upper-tract tumours. Twenty-two patients were reported to have equivocal findings on IVU. Nine of these patients had follow-up imaging [computed tomography (CT) = 5, IVU = 4], which were reported as normal. Retrograde urography was performed in two patients, which was normal. The remaining 11 patients did not have any evaluation of the upper tracts despite the equivocal findings on IVU, but routine clinical follow-up did not reveal any significant disease. Three patients with high-risk superficial disease developed upper-tract tumours that were detected on follow-up. Conclusion: IVU for diagnosing synchronous upper-tract tumours in patients with newly diagnosed bladder carcinoma can be restricted to patients with high-risk superficial disease.

Bajaj, A. [Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester (United Kingdom); Sokhi, H. [Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester (United Kingdom); Rajesh, A. [Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester (United Kingdom)]. E-mail: arajesh27@hotmail.com

2007-09-15

82

Core criteria for diagnosing borderline patients.  

Science.gov (United States)

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

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

1986-01-01

83

Correlation between clinical and histopathologic diagnoses of potentially malignant oral lesions  

Directory of Open Access Journals (Sweden)

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

Bokor-Brati? Marija

2004-01-01

84

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

Science.gov (United States)

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

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

2014-01-01

85

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

Directory of Open Access Journals (Sweden)

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

Stone S Noell

2005-03-01

86

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background The advent of prostate specific antigen (PSA) testing in the United States of America (USA) has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers. Methods...

Noell, Stone S.; Hoffman Richard M; Espey David; Potosky Arnold L

2005-01-01

87

Imaging and clinical follow-up of newborns diagnosed with pyelectasia  

International Nuclear Information System (INIS)

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

88

Discrepancy between clinical and pathological diagnoses of CBD and PSP.  

Science.gov (United States)

Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are often clinically confused with each other. Moreover, the discrepancy between clinical and pathological diagnoses of CBD and PSP are still controversial. We report here two atypical cases of PSP and CBD. A 73-year old woman was admitted with right hand rigidity, limb kinetic apraxia and cortical sensory loss. Brain atrophy, hypoperfusion and hypometabolism predominantly in the left frontoparietal lobes indicated CBD clinically. Pathological studies revealed neuronal loss and spongy change without ballooned neurons (BN) in the cerebral cortex. Modified Gallyas-Braak (G-B) staining revealed neurofibrillary tangles (NFTs) and tufted astrocytes, indicating pathological diagnosis of PSP. A 75-year-old man admitted with vertical gaze palsy, neck dystonia, parkinsonism and dementia. Atrophy of the frontal lobes and tegmentum of the midbrain and symmetrical frontal hypoperfusion in SPECT indicated PSP. However, neuronal loss and BN in the frontal lobes and clusters of astrocytic plaques indicated CBD pathologically. The G-B staining was useful for differentiating between CBD and PSP, but our atypical cases bring up a new issue about differential diagnosis of CBD and PSP. PMID:15754090

Mizuno, Toshiki; Shiga, Kensuke; Nakata, Yuriko; Nagura, Junko; Nakase, Taizen; Ueda, Yoshihiro; Takanashi, Yoshiaki; Urasaki, Kohji; Oyamada, Yumiko; Fushiki, Shinji; Nishikawa, Junji; Yasuhara, Masahiro; Nakajima, Kenji; Nakagawa, Masanori

2005-06-01

89

Associated diagnoses (comorbidity) in patients with borderline personality disorder.  

Science.gov (United States)

The authors administered the Diagnostic Interview Schedule to 21 patients with borderline personality disorder. The patients met criteria for various other DSM-III diagnoses, meeting exclusion criteria in some cases, and not in other cases. Frequency distribution of each diagnosis and the diagnoses of each individual patient, are presented. Affective disorder was the most common diagnosis (85%). Of these, 62% had primary major depression, and 23% had secondary depression. Other diagnoses include bipolar disorder, dysthymia, panic, agoraphobia, alcohol and Drug abuse, somatization disorder, and many others. The authors conclude that while borderline disorder may be a sub-affective disorder, a specific diagnostic profile for this disorder that accounts for the presence of other Axis I and Axis II syndromes has yet to be delineated. PMID:2326383

Prasad, R B; Val, E R; Lahmeyer, H W; Gaviria, M; Rodgers, P; Weiler, M; Altman, E

1990-03-01

90

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

Directory of Open Access Journals (Sweden)

Full Text Available Aska Drljevic,1 Michael Borre,2 Morten Høyer,3 Vera Ehrenstein,4 Mary Nguyen-Nielsen4 1Department of Pharmacology, 2Department of Urology, 3Department of Oncology, 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Background and aim: It is well established that cancer patients have an increased risk of venous thromboembolism (VTE. However, no previous study has examined the quality of VTE diagnoses related to cancer patients in the Danish National Registry of Patients (DNRP. To support future studies on cancer and risk of VTE, this study aimed to estimate the positive predictive value (PPV of VTE diagnoses among prostate cancer (PC patients registered in the DNRP. Materials and methods: We conducted a validation study using data from hospitals within the Central Denmark Region, which covers a population of 1.3 million people. Using the DNRP, we identified a total of 120 PC patients registered with VTE within the period 1995–2012. We also identified a random sample of 120 PC patients with no VTE registration within the same period. Therefore, a total of 240 patients were selected for medical chart review. We compared data from the DNRP to data collected from medical record review (ie, reference standard. We then computed PPV, sensitivity, and specificity with corresponding 95% confidence intervals (CIs using the Jeffreys method. Results: The final study sample included 232 PC patients, of which 115 were registered with VTE and 117 had no registration of VTE in the DNRP. We found the overall PPV of VTE diagnoses in the DNRP to be 86.1% (95% CI 78.9%–91.5%. Sensitivity was 98.0% (95% CI 93.8%–99.6%, and specificity was 87.8% (95% CI 81.4%–92.6%. We also found the PPV of incident PC diagnoses in the DNRP to be 98.3% (95% CI 96.1%–99.4%. Conclusion: For PC patients, the registration of VTE diagnoses in the DNRP is associated with a high PPV. We provide evidence that data from the DNRP are valid for studies on risk of VTE among cancer patients. Keywords: positive predictive value, prostatic neoplasms, validation study, venous thromboembolism

Drljevic A

2014-10-01

91

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  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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. Abstract in english 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 d [...] uring 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.

92

Concordância entre os diagnósticos clínico e histopatológico de lesões bucais diagnosticadas em Clínica Universitária / Agreement between clinical and histopathological diagnoses of oral lesions diagnosed in clinic university  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: O diagnóstico da grande variedade de lesões que ocorrem na cavidade bucal é fundamental para a prática odontológica. Na clínica, é comum o cirurgião-dentista se deparar com lesões bucais de diagnóstico duvidoso. Nessas situações, o clínico deve pensar na indicação da realização da bióps [...] ia como parte complementar - ou até mesmo conclusiva - do diagnóstico final dessas lesões bucais. A avaliação da concordância entre os diagnósticos clínico e histopatológico de lesões bucais permite analisar a acuidade e a capacidade do profissional ou acadêmico de Odontologia em realizar o diagnóstico clínico correto. OBJETIVO: O presente estudo objetivou avaliar a concordância entre os diagnósticos clínico e histopatológico de lesões bucais, diagnosticadas em clínica odontológica universitária. MÉTODO: Trata-se de um estudo analítico, de caráter retrospectivo, realizado com pacientes biopsiados e que tiveram laudos histopatológicos emitidos entre fevereiro de 2010 e julho de 2012. O programa estatístico SPSS 17.0 for Windows foi utilizado para análise dos dados. Foram conduzidas análises descritivas dos dados. A concordância entre os diagnósticos também foi medida pela estatística Kappa. RESULTADO: Obteve-se uma amostra de 125 pacientes. A média de idade foi de 48,64 anos, sendo a maioria do sexo feminino (58,4%). Os diagnósticos histopatológicos mais prevalentes foram os processos proliferativos não neoplásicos (36,6%). A concordância entre os diagnósticos clínico e histopatológico ocorreu na maioria dos pacientes (87,8%). O valor de Kappa para a concordância entre os diagnósticos foi de 0,75. CONCLUSÃO: A concordância entre os diagnósticos ocorreu na maioria dos pacientes investigados, tendo sido apresentado valor correspondente a uma concordância substancial. Abstract in english BACKGROUND: The diagnosis of wide variety of lesions occurring in the oral cavity is critical to the practice of dentistry. It is common for dentists to find oral lesions of doubtful diagnosis. In these situations, the dentist should consider the indication of biopsy as a complement or even conclus [...] ive final diagnosis of these oral lesions. The evaluation of the agreement between the clinical and histopathological diagnosis of oral lesions allows the accuracy and ability analysis of the professional or his/her dentistry academic level to perform clinical diagnosis correctly OBJECTIVE: This study aimed to evaluate the correlation between clinical and histopathological diagnosis of oral lesions diagnosed in a university dental clinic. METHOD: This is an analytical, retrospective study conducted with patients biopsied and who had pathologic reports issued between February 2010 and July 2012. The SPSS 17.0 for Windows was used for data analysis. We conducted descriptive analyzes of the data. The concordance between the diagnoses was also measured using kappa statistics. RESULT: It was obtained through a sample of 125 patients. The average age was 48.64 years, with a majority of women (58.4%). The histopathological diagnoses were the most prevalent non-neoplastic proliferative processes (36.6%). The concordance between the clinical and histopathological diagnosis occurred in most patients (87.8 %). The kappa value for the agreement between diagnoses was 0.75 CONCLUSION: The concordance between the diagnoses occurred in most patients investigated presented corresponding to substantial agreement.

João Gabriel Silva, Souza; Luiza Anjos, Soares; Geane, Moreira.

2014-01-01

93

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

Scientific Electronic Library Online (English)

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

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

94

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

Directory of Open Access Journals (Sweden)

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

2010-02-01

95

Evaluation of Patients With Brain Tumors According to International NANDA Nursing Diagnoses: Care Suggestions  

Directory of Open Access Journals (Sweden)

Full Text Available Aim: This research is designed to be cross-sectional with the purpose of identifying post operative early and late nursing diagnoses of the patients with brain tumor. Nurses' knowledge about the possible post-operative nursing diagnoses and directing the care accordingly ensure prevention of some possible post-operative complications.Methods: The research was carried out with the patients hospitalized at Brain Surgery intensive care unit and clinic in Ege University School of Medicine between January 2009 and April 2009. In the research, post-operative early and late nursing diagnoses of the patients were evaluated through NANDA nursing diagnosis terminology which is widely used internationally.Results: It was found out that 68.1% of the patients were diagnosed with neuroepithelial tumor according to WHO central nervous system classification, and 47.7% were semi-dependent and 43.2% were independent following the first 24 hours and hospitalized in the clinic for 11.89 days in average and in the intensive-care unit for 11.0 days in average. 25 different diagnoses and 123 nursing diagnoses in total were identified for the 44 patients evaluated in the research. Analyses of the nursing diagnoses and diagnose days revealed 9.8% constipation (0.-6. days, 8.9% nausea (0.-4.days, 8.1% insufficient liquid volume (0. - 4. days, 7.7% acute pain (0.- 4. days, 6.5% hyperthermia (0. – 4. days, 5.7 % insufficient respiration (0. -11. days, 4.0% excessive liquid volume (3. – 7. days, 4.0% impairment in sensory perception (0. -11. days, 4.0 % impairment in urinary excretion ( 0. – 5. days, 4.0 % confusion (4. – 11. days and risk of infection (3. – 6. days diagnosis.Conclusion: Hyperthermia, excessive liquid volume, constipation, nausea which could lead to increased intracranial pressure that is supposed to be prevented for the patients in neurosurgical units were diagnosed especially in the post-operative early period (0. -3. days and Confusion and impairment in sensory perception were diagnosed in the post-operative late period.

Turkan OZBAYIR

2010-06-01

96

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

Directory of Open Access Journals (Sweden)

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

2010-12-01

97

Estudio epidemiológico y clínico de los pacientes diagnosticados de tuberculosis en el área noroeste de Madrid / Clinical and epidemiological study of patients diagnosed with tuberculosis in the northwest area of Madrid  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Estimar la incidencia y las características epidemiológicas y clínicas de los pacientes diagnosticado de Tuberculosis en un hospital comarcal de área noroeste de Madrid, para determinar si existe un aumento de la incidencia debido a la inmigración. Material y métodos: Se revisaron los caso [...] s de tuberculosis desde Enero de 1996 a Junio del 2001, buscados a través del laboratorio de anatomía patológica y microbiología, recogiendo de las historias clínicas datos demográficos, clínicos y diagnósticos de la enfermedad. Resultados: Se registraron un total de 66 tuberculosis (10 de ellos en inmigrantes) con una incidencia del 13/100.000 habitantes en el 1996, descendiendo hasta una incidencia del 7/100.000 en el 2000. La mediana de la edad es de 34 años con una incidencia del doble en varones (31/100.000 habitantes) respecto a las mujeres (17/100.000). El factor de riesgo predominante es el alcoholismo con 11 casos (16.7%). Las pruebas diagnosticas más empleadas fueron la radiografía de tórax realizada en 61/66 (92%) y fue positiva en 57 (93,4%), BAAR 59 (89%) siendo positiva 34 (57,6%), cultivo de esputo 47 (71%) dando positiva 32 (68%) y el Mantoux 28 (42%) siendo positiva 20 (71.4%). La localización de la enfermedad es principalmente pleuro-pulmonar 50 casos (75%). No se tipificaron prácticamente mycobacterias atípicas (5 casos). Hubo una buena respuesta al tratamiento siendo tratados con tres fármacos (isoniacida, rifampicina y piracinamida) el 88% de los pacientes con un tiempo de duración de 6,8 meses (DE: 2,8). Conclusión: La incidencia de tuberculosis en el área noroeste de Madrid es inferior al resto de la Comunidad de Madrid, descendió en el 1997 y se ha mantenido en el 9/100.000 hasta el 2000 pese al aumento de la inmigración. Abstract in english Objective: Estimate the incidence and the epidemiological and clinical characteristics of patients diagnosed with tuberculosis in a county hospital located in the north western area of the Autonomous Region of Madrid, to determine if there has been an increase due to immigration. Material and method [...] s: Tuberculosis cases from January, 1996 to June, 2001 were analysed, researched through the Microbiology and Pathologic Anatomy Laboratory, fetching information such as demographics, clinical studies and disease diagnostics from the different medical histories. Results: A total of 66 tuberculosis cases were registered, ten of them among immigrants, with an incidence of 13/100.000 inhabitants in 1996, decreasing to a 7/100.000 incidence in 2000. The age average is 34 with double the incidence in males (31/100.000) than females (17/100.000). The main risk factor is alcoholism with 11 cases (16.7%). The most commonly used diagnostic tests were the thorax radiography (61/66, 92%) with 57 (93.4%) positive identifications, culture of esputo (47/66, 71%) with 32 (68%) positive ids, and the Mantoux test (28, 42%) with 20 (71.4%) positive ids. The location of the illness is mainly pleuro-pulmonar in 50 cases (75%). There were almost no atypical mycobacterium found (5 cases). Overall, response to treatment with 3 drugs (isoniacide, rifampicine, piracinamide) was good in 88% of patients, with the average treatment lasting 6.8 months (ED: 2.8). Conclusion: The incidence of tuberculosis in the north western area of Autonomous Community of Madrid is below that of the rest of our Community. It dipped in 1997 and has been stable around 9/100.000 inhabitants until 2000, even with the effect of immigration.

M. C., Vieira Pascual; C., Bischofberger; C., Pérez de Oteyza.

98

Should physicians fake diagnoses to help their patients?  

Science.gov (United States)

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

Helgesson, G; Lynöe, N

2008-03-01

99

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

Scientific Electronic Library Online (English)

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

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

100

[Corynebacterium pseudodiphtheriticum pneumonia in a patient diagnosed with HIV infection].  

Science.gov (United States)

Corynebacterium pseudodiphteriticum is a diphteromorphic bacterium, previously described as pathogenic in very few cases. We present the case of a patient diagnosed of infection by the human immunodeficiency virus (HIV), who developed pneumonia probably caused by Corynebacterium pseudodiphtheriticum and who had a good response to the initial empirical therapy with cephotaxime. We reviewed the literature on patients with diagnosis of HIV infection, acquired immunodeficiency syndrome (AIDS) and AIDS-related complex and we found just one case of this corynebacterium acting as pathogenic and causing a pulmonary abscess. PMID:8136430

Roig, P; López, M M; Arriero, J M; Cuadrado, J M; Martín, C

1993-10-01

 
 
 
 
101

Bone Disease in Newly Diagnosed Lupus Nephritis Patients  

Science.gov (United States)

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

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

2014-01-01

102

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

103

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

Directory of Open Access Journals (Sweden)

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

2012-03-01

104

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

Directory of Open Access Journals (Sweden)

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.

Lee Ahwon

2009-10-01

105

The genotoxicity and cytotoxicity among patients diagnosed with organophosphate poisoning.  

Science.gov (United States)

The genotoxicity and cytotoxicity were investigated in 40 patients (20 females aged 21.57 +/- 1.42 and 20 males aged 29.35 +/- 3.59) diagnosed at the Emergency Department with organophosphate poisoning. Chromosome aberrations (CAs), sister chromatid exchanges (SCEs), micronucleus (MN), mitotic index (MI), replication index (RI) and nuclear division index (NDI) were evaluated in peripheral bloods of patients. The blood samples were collected from the patients on admission to the emergency department before treatment and after treatment before being discharged from the intensive care unit. The CA, MI and NDI values were increased before the discharge when compared to the levels measured on admission. However, there are no differences in mean SCE, frequency of MN and RI (Tab. 2, Ref. 42). PMID:19750985

Satar, Salim; Kayraldiz, Ahmet; Rencuzogullari, Eyyup; Karakoc, Emre; Sebe, Ahmet; Avci, Akkan; Yesilagac, Hasan; Topaktas, Mehmet

2009-01-01

106

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

Energy Technology Data Exchange (ETDEWEB)

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

107

Functional disability high among newly diagnosed older breast cancer patients  

Science.gov (United States)

Many older women with newly diagnosed breast cancer have difficulty accomplishing daily tasks, and African-Americans seem to be disproportionately affected. Those are the findings of a new study published early online in CANCER by researchers from the Case Western Reserve University School of Medicine and University Hospitals Case Medical Center in Cleveland (home of the Case Comprehensive Cancer Center), a peer-reviewed journal of the American Cancer Society. The study's results suggest that many breast cancer patients could benefit from receiving therapy to improve their physical function.

108

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

Directory of Open Access Journals (Sweden)

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

LI Xiao-hong

2013-07-01

109

A comparison of arthrography to clinical diagnostics for diagnosing meniscal lesions  

International Nuclear Information System (INIS)

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

110

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

Science.gov (United States)

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

Karnjus-Begonja, Ruzica; Vrdoljak, Eduard; Corusi?, Ante; Haller, Herman; Jelavic, Tihana Boraska; Matkovi?, Visnja; Strini?, Tomislav; Barisi?, Dubravko; Tomic, Snjezana; Kukura, Vlastimir; Ban, Marija; Padovan, Ranka Stern; Skalec, Suzana Lide; Belaj, Nenad; Puljiz, Mario; Ferari, Ani Mihaljevi?; Hajredini, Adem; Babic, Damir; Mahovli?, Vesna; Pajtler, Marija

2013-01-01

111

Boron neutron capture therapy (BNCT) for newly-diagnosed glioblastoma: Comparison of clinical results obtained with BNCT and conventional treatment.  

Science.gov (United States)

The purpose of this study was to evaluate the clinical outcome of boron neutron capture therapy (BNCT) and conventional treatment in patients with newly diagnosed glioblastoma. Since 1998 we treated 23 newly-diagosed GBM patients with BNCT without any additional chemotherapy. Their median survival time was 19.5 months; the 2-, 3-, and 5-year survival rates were 31.8%, 22.7%, and 9.1%, respectively. The clinical results of BNCT in patients with GBM are similar to those of recent conventional treatments based on radiotherapy with concomitant and adjuvant temozolomide. J. Med. Invest. 61: 254-263, August, 2014. PMID:25264042

Kageji, Teruyoshi; Nagahiro, Shinji; Mizobuchi, Yoshifumi; Matsuzaki, Kazuhito; Nakagawa, Yoshinobu; Kumada, Hiroaki

2014-01-01

112

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

Directory of Open Access Journals (Sweden)

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

2008-01-01

113

Ultrasonographic and clinical appearance of hemorrhagic ovarian cyst diagnosed by transvaginal scan.  

Science.gov (United States)

We examined clinical and sonographic findings in 112 patients diagnosed as having hemorrhagic ovarian cyst (HOC) who had clinical and transvaginal sonographic follow up. The patients were classified into group A (n=40) with signs and symptoms of acute abdomen and group B (n=72) with no symptoms or mild abdominal pain, and their ultrasonographic and clinical findings were compared. Significant differences were found in mean age, white blood cell (WBC) count, greatest diameter of the mass, shortest diameter of the mass, and size of cross section of the mass. The internal echograms of HOCs were grouped into 4 types: (1) hyperechoic and hypoechoic solid type; (2) reticular or sponge-like type; (3) mixture type of solid and cystic components; and (4) cystic types. In all image types, septum-like or thread-like echoes were seen. Transvaginal sonography (TVS) of type 1, type 2, and type 3 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. HOCs were found more frequently in nulliparous patients (n=79, 70.5%) than in multiparous (n=33, 29.5%). There were many luteal phase (n=86, 76.8%) in comparison with follicular phase (n=13, 11.6%). Thirteen cases were detected during early gestation (n=13, 11.6%). In group A, severe pain reduced or disappeared within 3 h in 37/40 (92.5%) of the patients. Blood flow inside the masses was analyzed in 14 patients by the color Doppler method and showed no significant change. Taken together, this study elucidated the ultrasonographic and clinical characteristics of HOCs, which provide useful information to differentiate HOCs from organic masses and help to avoid unnecessary laparotomy. PMID:12928726

Nemoto, Yoshihiro; Ishihara, Kaisuke; Sekiya, Takao; Konishi, Hideki; Araki, Tutomu

2003-06-01

114

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

115

[Consensus on nursing diagnoses, interventions and outcomes for home care of patients with heart failure].  

Science.gov (United States)

This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice. PMID:23596917

Azzolin, Karina; de Souza, Emiliane Nogueira; Ruschel, Karen Brasil; Mussi, Cláudia Motta; de Lucena, Amália Fátima; Rabelo, Eneida Rejane

2012-12-01

116

Decreased plasma granulysin and increased interferon-gamma concentrations in patients with newly diagnosed and relapsed tuberculosis.  

Science.gov (United States)

Granulysin and interferon-gamma (IFN-?) have broad antimicrobial activity which controls Mycobacterium tuberculosis (M. tuberculosis) infection. Circulating granulysin and IFN-? concentrations were measured and correlated with clinical disease in Thai patients with newly diagnosed, relapsed and chronic tuberculosis (TB). Compared to controls, patients with newly diagnosed, relapsed and chronic TB had lower circulating granulysin concentrations, these differences being significant only in newly diagnosed and relapsed TB (P H37Ra) enhanced production of granulysin by PBMCs. In vitro, stimulation of PBMCs of newly diagnosed TB patients with PPD produced greater amounts of IFN-? than did controls, while those stimulated with H37Ra did not. The results demonstrate that patients with active pulmonary TB have low circulating granulysin but high IFN-? concentrations, suggesting possible roles in host defense against M. tuberculosis for these agents. PMID:21545511

Pitabut, Nada; Mahasirimongkol, Surakameth; Yanai, Hideki; Ridruechai, Chutharut; Sakurada, Shinsaku; Dhepakson, Panadda; Kantipong, Pacharee; Piyaworawong, Surachai; Moolphate, Saiyud; Hansudewechakul, Chamnarn; Yamada, Norio; Keicho, Naoto; Okada, Masaji; Khusmith, Srisin

2011-08-01

117

Heart Failure as First Sign of Development of Cardiac Metastases in a Patient with Diagnosis of Papillary Thyroid Carcinoma on Treatment with Tyrosine-Kinase Inhibitors: Differential Diagnoses and Clinical Management  

Science.gov (United States)

Background Cardiac metastases from papillary thyroid carcinoma are very uncommon. Their incidence is rising due to improvements in survival and diagnosis; nevertheless, our patient is the fourth case reported up to date. There are no clinical trials available in this scenario. Therefore, treatment choice is made based on clinical experience and case reports; notably, the largest case report series was prior to the approval for using tyrosine-kinase inhibitors in thyroid cancer. Patient A 73-year-old lady had dedifferentiated papillary thyroid cancer with ongoing sorafenib. After 9 months on this treatment, she presented with dyspnea and heart failure. Differential diagnosis included infection, progression of disease and cardiotoxicity. After a comprehensive assessment (echocardiography, computed tomography, PET, magnetic resonance), we found progression of lung disease, and the appearance of heart metastases. Results After recovering from the basal status, she started on second-line treatment with sunitinib, which was well-tolerated. She achieved stable disease with a decrease in tumor marker levels. Conclusions We should include cardiac metastases in the differential diagnosis of heart failure in cancer patients. Magnetic resonance imaging is the gold standard for assessment. Sorafenib is the mainstay of the first-line therapy in metastatic thyroid cancer, achieving long-term disease control with good tolerance. Sunitinib could be a safe second-line treatment option (not cardiotoxicity related) with promising results. Therefore, our report presents a sequence of treatment with tyrosine-kinase inhibitors in metastatic thyroid carcinoma with an encouraging outcome, which deserves further investigation.

Bruixola, Gema; Segura, Angel; Caballero, Javier; Andres, Ana; Reche, Encarnacion; Escoin, Corina; Diaz-Beveridge, Roberto

2014-01-01

118

Caracterización clinicoepidemiológica de pacientes con tuberculosis diagnosticada en el Hospital Provincial "Celia Sánchez Manduley" / Clinical and epidemiological characterization of patients with tuberculosis diagnosed in "Celia Sánchez Manduley" Provincial Hospital  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se realizó un estudio descriptivo, retrospectivo y longitudinal de 63 pacientes con tuberculosis, atendidos en el Hospital Clinicoquirúrgico Docente Universitario "Celia Sánchez Manduley" de Manzanillo, provincia de Granma, desde el 2009 hasta el 2011, con vistas a caracterizarles según factores cli [...] nicoepidemiológicos de interés. Entre las variables analizadas figuraron: edad, sexo, procedencia, factores de riesgo, formas clínicas de la tuberculosis, tipo de tuberculosis extrapulmonares y categoría de casos. En la casuística predominaron el sexo masculino, los grupos etarios de 45-65 años, procedentes en su mayoría de zonas rurales; la ingestión de alcohol como factor de riesgo asociado y las formas pulmonares con baciloscopia positiva como las formas clínicas más frecuentes. La mayoría de los casos notificados fueron nuevos Abstract in english A descriptive, retrospective and longitudinal study of 63 patients with tuberculosis, assisted in "Celia Sánchez Manduley" Teaching Clinical-Surgical University Hospital, Manzanillo, Granma province was carried out from the 2009 to 2011, aimed at characterizing them according to interesting clinical [...] and epidemiological factors. Among the analyzed variables there were: age, sex, origin, risk factors, clinical forms of tuberculosis, type of extrapulmonary tuberculosis and cases category. Male sex, the age groups 45-65, most of them coming from rural areas; alcohol consumption as associated risk factor and the pulmonary forms with positive bacilloscopy as the most frequent clinical forms prevailed in the case material. Most of the confirmed cases were new

Sahily, Quintero Salcedo; Aracelis, Reyes Castillo; Gladys Leidis, Blanco Zambrano; Haidee, Marrero Rodríguez; Jesús Ángel, Quintero García.

2014-06-01

119

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

Science.gov (United States)

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

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

2014-01-01

120

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

2008-06-01

 
 
 
 
121

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

Scientific Electronic Library Online (English)

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

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

122

[Nursing diagnoses for clients hospitalized in an infectious disease clinic].  

Science.gov (United States)

The aim of this exploratory descriptive study was to create nursing diagnosis statements for hospitalized clients based on the Database of Special Nursing Language Terms of the Infectious Diseases Clinic of a teaching hospital and on the ICNP®. Further, we aimed to validate the diagnosis statements with the participation of clinical nurses and nursing teachers who worked at the clinic. Eighty-eight nursing diagnosis statements were constructed. However, only those that achieved a correlation index (CI) ? 0.80, as determined by the experts participating in the study, were validated, resulting in seventy diagnosis statements. The study results showed that the aims were achieved, and the statements will facilitate communication processes among nursing professionals. Furthermore, they will ensure that care is guided by methodological principles, thus providing client care with greater resolvability power. PMID:23743914

de Andrade, Lidiane Lima; da Nóbrega, Maria Miriam Lima; Freire, Maria Eliane Moreira; Nóbrega, Renata Valeria

2013-04-01

123

Examination of Contingency Payments to Dually-Diagnosed Patients in a Multi-faceted Behavioral Treatment  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Contingency management (CM) may be a promising component of treatment to help dually-diagnosed patients reduce their substance use. However, most prior studies examining CM with these patients have not examined the relationships among patient variables and contingency rewards received. This study examined whether characteristics of dually-diagnosed patients were related to CM payments received in a multi-faceted program. Fifty-nine dually-diagnosed patients participated in a multimodal behavi...

Kinnaman, Joanna Strong; Slade, Eric; Bennett, Melanie E.; Bellack, Alan S.

2007-01-01

124

Clinical Use of Capillary PCR To Diagnose Mycoplasma Pneumonia  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In the present study, serologic data were compared with data obtained by capillary PCR to establish the efficacy of capillary PCR for the determination of Mycoplasma infection in samples obtained from throat swabs, bronchoalveolar lavage fluids (BALF), and sputum of patients with Mycoplasma pneumonia. We performed PCR analysis for Mycoplasma DNA on a total of 325 samples from 197 patients with community-acquired pneumonia and in whom Mycoplasma pneumonia was suspected. There were 68 PCR-posit...

Honda, Junichi; Yano, Takafumi; Kusaba, Mikako; Yonemitsu, Junko; Kitajima, Hiromoto; Masuoka, Megumi; Hamada, Kaori; Oizumi, Kotaro

2000-01-01

125

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

Science.gov (United States)

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

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

2014-01-01

126

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

2012-08-01

127

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

DEFF Research Database (Denmark)

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

Drljevic, Aska; Borre, Michael

2014-01-01

128

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

Science.gov (United States)

Background and aim It is well established that cancer patients have an increased risk of venous thromboembolism (VTE). However, no previous study has examined the quality of VTE diagnoses related to cancer patients in the Danish National Registry of Patients (DNRP). To support future studies on cancer and risk of VTE, this study aimed to estimate the positive predictive value (PPV) of VTE diagnoses among prostate cancer (PC) patients registered in the DNRP. Materials and methods We conducted a validation study using data from hospitals within the Central Denmark Region, which covers a population of 1.3 million people. Using the DNRP, we identified a total of 120 PC patients registered with VTE within the period 1995–2012. We also identified a random sample of 120 PC patients with no VTE registration within the same period. Therefore, a total of 240 patients were selected for medical chart review. We compared data from the DNRP to data collected from medical record review (ie, reference standard). We then computed PPV, sensitivity, and specificity with corresponding 95% confidence intervals (CIs) using the Jeffreys method. Results The final study sample included 232 PC patients, of which 115 were registered with VTE and 117 had no registration of VTE in the DNRP. We found the overall PPV of VTE diagnoses in the DNRP to be 86.1% (95% CI 78.9%–91.5%). Sensitivity was 98.0% (95% CI 93.8%–99.6%), and specificity was 87.8% (95% CI 81.4%–92.6%). We also found the PPV of incident PC diagnoses in the DNRP to be 98.3% (95% CI 96.1%–99.4%). Conclusion For PC patients, the registration of VTE diagnoses in the DNRP is associated with a high PPV. We provide evidence that data from the DNRP are valid for studies on risk of VTE among cancer patients. PMID:25328419

Drljevic, Aska; Borre, Michael; H?yer, Morten; Ehrenstein, Vera; Nguyen-Nielsen, Mary

2014-01-01

129

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

DEFF Research Database (Denmark)

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

Sodemann, M

2009-01-01

130

Biopsy diagnoses of clinically atypical pigmented lesions of the head and neck in adults.  

Science.gov (United States)

A subset of facial melanoma in situ has histological features that overlap with those of "dysplastic" nevi. The authors evaluated this important diagnostic pitfall by assessing the frequency of melanoma as the final diagnosis in skin biopsies submitted over a 1-year period with a clinical impression of "atypical" or dysplastic nevus from the head or neck of adults. A total of 1998 biopsies met inclusion criteria. Final diagnoses included both melanocytic and nonmelanocytic processes. Clear trends were noted based on the age of the patient with benign nevi encompassing nearly 70% of specimens in patients aged 21-29 years and <10% in patients aged 70 years and above. The incidence of atypical nevi decreased with age (16% in 21-29 years, 3% in age 70+ years). Nineteen of the 180 (10%) atypical nevi in our series were located on the face (7, cheek; 6, forehead; 3, jawline; and 3, temple), a location not traditionally associated with atypical nevi. Facial atypical nevi were found in all age groups. Malignant melanoma accounted for 1.8% of all specimens increasing from 0% in the patients aged 21-29 years to 5% in patients aged 70 years and above. Caution is warranted when evaluating skin biopsies from sun-damaged skin of the head or neck of an older adult submitted with a clinical diagnosis of atypical nevus. However, the authors' findings suggest that atypical nevi with histological features of dysplastic nevi occur on the head and neck of adults, including elderly adults. The incidence of such lesions decreases with age as the incidence of melanoma increases, and careful clinicopathologic correlation is vital. PMID:25247672

Udovenko, Olga; Griffin, John R; Elston, Dirk M

2014-10-01

131

Correlates of Depression among Patients Diagnosed with Chronic Illnesses in Saudi Arabia  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Depression contributes to an increased medical morbidity and mortality among patients with chronic medical illnesses. The purpose of this study was to investigate correlates of depression among patients diagnosed with chronic illnesses in Saudi Arabia. Methods: A cross sectional survey using 412 patients diagnosed with chronic illnesses has been used to collected data in regards to depressive symptoms, psychological distress, coping, and life satisfaction. Results: 25.2% of the patients reported that they had moderate to severe depressive symptoms, and about 13.8% of them had mild level of depression. Psychological distress and life satisfaction were significant correlates with depressive symptoms (r = 0.33, 0.54, p < 0.001, while coping strategies is not. The results also showed that there is a significant and negative correlation between patients’ age and depression score (r = 0.17, p ? 0.001. Regarding gender differences, the analysis showed that there was no significant difference between male and female patients in their depressive symptoms (t = ?0.69, p = 0.488. Conclusion: implication for clinical practice and research discussed.

Ahmad E. Aboshaiqah

2014-08-01

132

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

Science.gov (United States)

As a significant number of patients diagnosed with transient ischemic attack (TIA) at emergency department are at risk to develop TIA or cerebral vascular accident (CVA), several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. We aimed to evaluate the role of ABCD2 scoring which includes age, blood pressure, clinical symptoms, diabetes mellitus, and duration of symptoms in predicting short term outcome of the patients presenting with TIA. One hundred consecutive patients visited between 2009 and 2010 in Hazrat Rasoul Akram Hospital and diagnosed with TIA were enrolled and their ABCD2 scores were registered. The incidence of death, CVA, or TIA during the first week after the attack was recorded. Eleven patients suffered new TIA/CVA after 1 week. Sensitivity and specificity of ABCD2 score for predicting CVA/TIA at cut-off point of 4 were 72.7% and 52.8%, respectively. At the same cut-off point for ABCD2, positive and negative predictive values were 16% and 94 %, respectively. Our results show that although patients with ABCD2 score greater than 4 were more likely to develop recurrent TIA/CVA in short term, those with lesser score still harbour a considerable risk for TIA/CVA. Though ABCD2 as an easily applicable tool is very helpful in management of TIA patients at emergency department, but it should not be the only measure to rely on in our decision making. PMID:24338191

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

2013-01-01

133

The value of second-opinion pathology diagnoses on prostate biopsies from patients referred for management of prostate cancer  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Gleason score (GS) (sum of primary plus secondary grades) is used to predict patients' clinical outcome and to customize treatment strategies for prostate cancer (PC). However, due in part to pathologist misreading, there is significant discrepancy of GS between needle-core biopsies (NCB) and radical prostatectomy specimens. We assessed the requirement for re-evaluating NCB diagnosed by outside pathologists in patients referred to our institution for management of PC. In 100 patients, we revi...

Barqawi, Al B.; Turcanu, Ruslan; Gamito, Eduard J.; Lucia, Scott M.; O Donnell, Colin I.; Crawford, E. David; La Rosa, David D.; La Rosa, Francisco G.

2011-01-01

134

Study of Selenium Concentration in Patients with Newly Diagnosed Non-Hodgkin`s Lymphoma  

Directory of Open Access Journals (Sweden)

Full Text Available This study was designed to examine selenium concentrations in patients with newly diagnosed Non-Hodgkin`s Lymphoma (NHL and the possible association between the levels of this trace element with clinical features of the disease. Also, to test the hypothesis that selenium concentration at presentation would predict for response to treatment. This study was carried out on fifty-patients with newly diagnosed NHL and 25 control subjects, blood samples were taken for measurement of selenium by spectrometry. In comparison to the control subjects the serum selenium level was significantly lower with NHL with a mean of 0.033 (SD, 0.1 vs 0.81 (SD, 0.05, p<0.001. The mean serum selenium was significantly lower in patients with poorer performance status (p = 0.03 and in patients with advanced stage (p = 0.02, but there was no significant relation to the aggressiveness of the disease. Serum albumin was the only parameter that showed a significant positive correlation with serum selenium. There was a trend for serum selenium level to be higher in patients who achieved CR, but the difference was not statistically significant (p = 0.1. Selenium may play a role in the pathogenesis and prognosis of patients with NHL. In this study; the level of selenium was found inversely associated with the clinical stage of the disease and the performance status and may predict for the response to treatment in aggressive lymphoma. The possible utility of measuring serum selenium in NHL deserves further evaluation in clinical trials.

Maha I. Esmaeel

2008-01-01

135

Sociodemographic profile of breast cancer patients diagnosed by FNAC.  

Science.gov (United States)

The study included 431 patients who underwent breast FNAC over a period of five years between 2003 and 2008. The required clinical details were obtained from the requisition forms. The Information about the level of education and occupation were collected by interviewing the subjects. The number of cases of breast carcinoma was significant constituting 14.84% (n = 64). The study showed that the peak age for breast carcinoma was between 41 and 50 years. This correlates with the national figure where most of the cases observed belonged to the reproductive age group. Most of the females were married (93.75%) and were multiparous (92.18%). Maximum number of patients had only received primary education. There was not much difference in the number regarding whether they lived in urban or rural areas. Middle and lower socioeconomic class contributed the bulk of the cases and it were the housewives who were in majority (85.93%). PMID:24765692

Rizvi, Ghazala; Pandey, Harishankar; Roy, Shilpa Basu; Pant, Hema; Jha, Amitesh Kumar; Maitra, Sanjay

2013-05-01

136

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

International Nuclear Information System (INIS)

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.

137

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

Eduardo, Valdés Ramos; Niurka, Bencosme Rodríguez.

138

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  

Directory of Open Access Journals (Sweden)

Full Text Available Se realizó un estudio descriptivo transversal con 300 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre octubre de 2007 y mayo de 2008, con el objetivo de conocer la frecuencia de hipertensión arterial y su relación con 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 la piel, hábitos tóxicos, edad al comienzo de la diabetes, estado nutricional, circunferencia de la cintura, tensión arterial y complicaciones crónicas de la diabetes. Se encontró hipertensión arterial en 210 pacientes (70 %; de ellos, 57 (27,1 % presentaron hipertensión sistólica aislada, 39 (18,5 % hipertensión diastólica, y 114 (54,4 % hipertensión sistodiastólica. La hipertensión arterial se presentó desde el inicio de la diabetes en el 62,9 %. El 76,1 % de los pacientes hipertensos tenían sobrepeso u obesidad (P=0,0557. Resultó significativa la asociación entre la hipertensión arterial y la cardiopatía isquémica (p= 0,0117. En relación con el ictus y la insuficiencia arterial periférica, aunque la mayoría de los casos eran hipertensos, no llegó a ser estadísticamente significativo (p= 0,8261, p= 0,8600. El 71,1 % de los pacientes con retinopatía diabética y el 75 % con nefropatía diabética eran hipertensos (p= 0,8261, p= 0,8600. Se concluye que la hipertensión arterial tiene una elevada incidencia en los pacientes con diabetes mellitas tipo 2, porque está presente en un porcentaje importante desde el diagnóstico de la diabetes y se asocia significativamente a la presencia de cardiopatía isquémica.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 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.

Eduardo Valdés Ramos

2009-12-01

139

[Patients at the memory clinic with choreatic movements].  

Science.gov (United States)

In this case-report we present two patients who were referred to the memory clinic. In both cases there is doubt about the earlier diagnosis. During the physical examination choreatic movements were observed. After repeating diagnostic tests, both patients were diagnosed with Huntington's disease. The dementia with this disease is often preceded by psychiatric symptoms, which makes it quite difficult to diagnose, especially in an early stage of the disease. That is why it is essential that, in case of even the slightest doubt or confronted with new insights, geriatricians should see patients again in the memory clinic and repeat nosologic diagnosis. PMID:21400960

Klompe, L A; Eerenberg, J G; Verschoor, C J

2011-02-01

140

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

Directory of Open Access Journals (Sweden)

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

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

2008-05-01

 
 
 
 
141

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

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

142

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

2003-10-01

143

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

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

2003-10-01

144

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background The heterogeneity of conditions underlying respiratory distress, whether classified clinically as acute lung injury (ALI) or the more severe acute respiratory distress syndrome (ARDS), has hampered efforts to identify and more successfully treat these patients. Examination of postmortem lungs among cases clinically diagnosed as ARDS identified a cohort that showed a consistent morphology at the light and electron microscope levels, and featured pathognomon...

Fan Kang; Nagle William A

2002-01-01

145

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

International Nuclear Information System (INIS)

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

146

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

International Nuclear Information System (INIS)

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

147

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.

Johansson Sven-Erik

2008-06-01

148

Chromosome 1 abnormalities in elderly patients with newly diagnosed multiple myeloma treated with novel therapies.  

Science.gov (United States)

Multiple myeloma is a plasma cell disorder characterized by malignant plasma cell infiltration in the bone marrow, serum and/or urine monoclonal protein and organ damage. The aim of this study was to investigate the impact of chromosome 1 abnormalities in a group of elderly patients (>65 years) with newly diagnosed multiple myeloma enrolled in the GIMEMA-MM-03-05 trial and treated with bortezomib, melphalan and prednisone or bortezomib, melphalan, prednisone and thalidomide followed by bortezomib and thalidomide maintenance. We also evaluated the link between chromosome 1 abnormalities and other clinical, genetic and immunophenotypic features by a multivariate logistic regression model. Interphase fluorescence in situ hybridization on immunomagnetically purified plasma cells and bone marrow multiparameter flow cytometry were employed. A multivariate Cox model showed that chromosome 1 abnormalities, age >75 years and a CD19(+)/CD117(-) immunophenotype of bone marrow plasma cells were independent risk factors for overall survival in elderly patients with newly diagnosed multiple myeloma. Moreover, a detrimental effect of thalidomide, even when administered in association with bortezomib, was observed in patients with abnormal chromosome 1 as well as in those with 17p deletion, while the benefit of adding thalidomide to the bortezomib-melphalan-prednisone regimen was noted in patients carrying an aggressive CD19(+)/CD117(-) bone marrow plasma cell immunophenotype. This trial was registered at www.clinicaltri-als.gov as #NCT01063179. PMID:25015938

Caltagirone, Simona; Ruggeri, Marina; Aschero, Simona; Gilestro, Milena; Oddolo, Daniela; Gay, Francesca; Bringhen, Sara; Musolino, Caterina; Baldini, Luca; Musto, Pellegrino; Petrucci, Maria T; Gaidano, Gianluca; Passera, Roberto; Bruno, Benedetto; Palumbo, Antonio; Boccadoro, Mario; Omedè, Paola

2014-10-01

149

Oncological patterns of care and outcomes for 265 elderly patients with newly diagnosed glioblastoma in France.  

Science.gov (United States)

The incidence of glioblastoma (GBM) has increased in patients aged 70 years or older, and will continue to grow. Elderly GBM patients have been excluded from most clinical trials; furthermore, optimal care management as well as benefit/risk ratio of GBM treatments are still being debated. This study describes oncological patterns of care, prognostic factors, and survival for patients ? 70 years in France. We identified patients over 70 with newly diagnosed and histologically confirmed GBM on data previously published by the French Brain Tumor DataBase. We included 265 patients. Neurological deficits and mental status disorders were the most frequent symptoms. The surgery consisted of resection (RS n?=?95) or biopsy (B n?=?170); 98 patients did not have subsequent oncological treatment. After surgery, first-line treatment consisted of radiotherapy (RT n?=?76), chemotherapy (CT n?=?52), and concomitant radiochemotherapy (CRC n?=?39). The median age at diagnosis was 76, 74, and 73 years, respectively, for the untreated, B?+?RT and/or CT, RS?±?RT and/or CT groups. Median survival (in days, 95 % CI) with these main strategies, when analyzed according to surgical groups, was: B-CT n?=?41, 199[155-280]; B-CRC n?=?21, 318[166-480]; B-RT n?=?37, 149[130-214]; RS-CT n?=?11, 245[211-na]; RS-CRC n?=?18, 372[349-593]; RS-RT n?=?39, 269[218-343]. This population study for elderly GBM patients is one of the most important in Europe, and could be considered as a historical cohort to compare future treatments. Moreover, we can hypothesize that elderly patients (versus patients <70 years) are undertreated. Karnofsky performance status seems to be the most relevant clinical predictive factor, and RS and CRC have a positive impact on survival for elderly GBM patients in the general population, at least when feasible. PMID:24526367

Zouaoui, Sonia; Darlix, Amélie; Fabbro-Peray, Pascale; Mathieu-Daudé, Hélène; Rigau, Valérie; Fabbro, Michel; Bessaoud, Faiza; Taillandier, Luc; Ducray, François; Bauchet, Fabienne; Wager, Michel; Faillot, Thierry; Capelle, Laurent; Loiseau, Hugues; Kerr, Christine; Menei, Philippe; Duffau, Hugues; Figarella-Branger, Dominique; Chinot, Olivier; Trétarre, Brigitte; Bauchet, Luc

2014-07-01

150

Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography  

Energy Technology Data Exchange (ETDEWEB)

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

151

Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography  

International Nuclear Information System (INIS)

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.

152

Novel NLRP12 mutations associated with intestinal amyloidosis in a patient diagnosed with common variable immunodeficiency.  

Science.gov (United States)

Heterozygous mutations in the NLRP12 gene have been found in patients with systemic auto-inflammatory diseases. However, the NLRP12-associated periodic fever syndromes show a wide clinical spectrum, including patients without classical diagnostic symptoms. Here, we report on a 20-year-old female patient diagnosed with common variable immunodeficiency (CVID), who developed intestinal amyloidosis and carried novel compound heterozygous mutations in NLRP12, identified by whole exome and transcriptome sequencing. CVID is a primary immunodeficiency characterized by low serum immunoglobulins, recurrent bacterial infections and development of malignancy, but it also presents with a magnitude of autoimmune features. Because of the unspecific heterogeneous clinical features of the disease, a delay in diagnosis is common. Secondary, inflammatory (AA type) amyloidosis has infrequently been observed in CVID patients. Based on our case observation and a critical review of the literature, we suggest that NLRP12 mutations might account for a small fraction of CVID patients with severe auto-inflammatory complications. PMID:25064839

Borte, Stephan; Celiksoy, Mehmet Halil; Menzel, Volker; Ozkaya, Ozan; Ozen, Fatma Zeynep; Hammarström, Lennart; Yildiran, Alisan

2014-10-01

153

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

Science.gov (United States)

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is an inflammatory CNS disorder characterized by 1) subacute onset of cerebellar and brainstem symptoms, 2) peripontine contrast-enhancing perivascular lesions with a "salt-and-pepper" appearance on MRI, and 3) angiocentric, predominantly T-lymphocytic infiltration as revealed by brain biopsy. Inflammatory diseases including neuroinfections, CNS lymphoma and neurosarcoidosis must be excluded. Since CLIPPERS was described in 2010, many patients might have been misdiagnosed in the past. We therefore searched medical records from a large tertiary neurological center, the Department of Neurology at Rigshospitalet, Copenhagen University Hospital, for patients discharged between 1999 and 2013 with a diagnosis of "sarcoidosis with other localization", "other acute disseminating demyelination", "other demyelinating disease in the CNS" or "encephalitis, myelitis or encephalomyelitis". Of 206 identified patients, 24 had been examined by brain biopsy and were included for further evaluation. Following clinical, neuroradiological and neuropathological review, 3 patients (12.5%) were reclassified as having CLIPPERS. Median long-term follow-up was 75 months. The present results suggest that clinical re-evaluation of patients previously diagnosed with unspecified inflammatory demyelinating CNS disease or atypical neurosarcoidosis may increase the detection rate of CLIPPERS. Further, potentially severe neurological deficits and progressive parenchymal atrophy on MRI may suggest neurodegenerative features, which emphasizes the need for early immunomodulatory treatment. PMID:24954086

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

2014-08-15

154

Acute porphyrias: clinical spectrum of hodpitalized patients  

International Nuclear Information System (INIS)

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

155

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

2010-12-01

156

DINAMICS OF CYTOKINES PATTERN IN PATIENTS WITH PRESUMPTIVE AND DIAGNOSED AUTOIMMUNE DISORDERS  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of the study was to determine the dynamic of cytokinic pattern in patients with suspicion or diagnosed with autoimmune illnesses in different stages, and the potential of these biological assays as possible indicators in the diagnosis and the monitoring of these illnesses. The 41 patients were selected at the District Emergency Hospital and the Municipal Hospital of Ploiesti. Bioethics requirements were followed upon for patients selected for the study. The patients’ ages varied from 21 to over 81 years old. The assay of IL -1?, IL -2, IL- 4, IL-6, IL -10, IL- 12, TNF-? was performed using the immunoenzymatic method ELISA (Enzyme-Linked ImmunoSorbent Assay. Low seric concentration of C3 and Ig A have been associated with elevated seric levels of CRP, fibrinogen, CIC, IL- 1?, IL-4 and IL-6 for the majority of patients used in the study. Very high seric levels of IL- 1? were registered in cirrhosis and hepatitis, diabetes, mushroom intoxications, CVA and hemorrhage. Patients intoxicated with mushrooms and patients with rheumatism, who also had aan underlying disese, suvh osteoporosis and obesity, presented higher values of IL- 1?, IL-2, IL-4, IL-6, and IL-10. However, the determined titres for cytokines can be used in the diagnosis of some autoimmune disorders and in the monitoring of treatments, only in correlation with clinical and paraclinical complementary data.

Claudia Vlad

2012-03-01

157

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Aberg-Wistedt Anna; Furhoff Anna-Karin; Wernering Estera; Stromberg Ranja

2008-01-01

158

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

LENUS (Irish Health Repository)

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

Ridgway, P F

2009-11-01

159

[Myasthenia gravis. Clinical evaluation of 153 patients].  

Science.gov (United States)

We have retrospectively analysed the records of patients diagnosed as having myasthenia gravis and followed up in our department from February 1973 to March 1995. The main clinical findings were ptosis, diplopia, dysphagia, dysphonia or dysarthria, mastigatory impairment, dyspnea, asthenia, weakness of the cervical muscles and of the extremities, as well as findings of the physical and neurological examination. Based on the information collected, the patients were classified clinically according the modified Osserman-Gerkins scale, but considering the non-dynamic aspects of that scale, we used the modified functional scale of Niakan and classified the patients clinically as follows: remission, controlled, stable, partially controlled, poorly controlled, no response. We collected 153 patients, 104 (68.0%) females and 49 (32.0%) males producing a female/male ratio of 2.2:1. The duration of the disease varied from seven days to 27 years, mean 6.26 years (+/- 5.44). Age at the first symptoms varied between 24 hours to 80 years, mean of 32.13 years (+/- 19.48). We had 30 patients ranging from 0 to 15 years of age, 91 patients were observed between 15 and 50 years and 32 patients after the age of 50 years. Above the age of 60 years, the disease aflicts males more than females with a ratio of 1.5:1. The acquired autoimmune form with generalized weakness was the most frequent presentation. However, ocular muscle weakness with ptosis and diplopia were the most common clinical presentation in our series. PMID:10450354

Cunha, F M; Scola, R H; Werneck, L C

1999-06-01

160

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

2009-04-01

 
 
 
 
161

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

Science.gov (United States)

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. PMID:22924696

Jakobsen, M A; Katzenstein, T L; Valerius, N H; Roos, D; Fisker, N; Mogensen, T H; Jensen, P Ø; Barington, T

2012-11-01

162

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

163

Comparison of diabetes patients with "demyelinating" diabetic sensorimotor polyneuropathy to those diagnosed with CIDP  

Science.gov (United States)

Background We have previously identified a subset of diabetic sensorimotor polyneuropathy (DSP) patients with probable demyelination related to poor glycemic control. We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury in diabetes patients with “demyelinating” DSP (D-DSP) differed from those diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) (CIDP + diabetes mellitus [DM]). Methods D-DSP (56) and CIDP + DM (67) subjects underwent clinical examination and nerve conduction studies (NCS), and were compared using analysis of variance, contingency tables, and Kruskal–Wallis analyses. Results Of the 123 subjects with a mean age of 60.5 ± 15.6 years and mean hemoglobin A1c (HbA1c) of 8.2 ± 2.2%, 54% had CIDP + DM and 46% had D-DSP. CIDP + DM subjects were older (P = 0.0003), had shorter duration of diabetes (P = 0.005), and more severe neuropathy as indicated by Toronto Clinical Neuropathy Score (TCNS) (P = 0.003), deep tendon reflexes (P = 0.02), and vibration perception thresholds (VPT) (P = 0.01, P = 0.02). The mean HbA1c value for D-DSP subjects (8.9 ± 2.3%) was higher than in CIDP + DM subjects (7.7 ± 2.0%, P = 0.02). Conclusions The clinical phenotype and electrophysiological profile of CIDP + DM patients is marked by more severe neuropathy and better glycemic control than in patients with D-DSP. These findings indicate that these two conditions – despite similarities in their electrophysiological pattern of demyelination – likely differ in etiology. PMID:24363969

Dunnigan, Samantha K; Ebadi, Hamid; Breiner, Ari; Katzberg, Hans D; Lovblom, Leif E; Perkins, Bruce A; Bril, Vera

2013-01-01

164

Cortical hemosiderin is associated with seizures in patients with newly diagnosed malignant brain tumors.  

Science.gov (United States)

Hemorrhage is common in brain tumors. Due to characteristic magnetic field changes induced by hemosiderin it can be detected using susceptibility weighted MRI (SWI). Its relevance to clinical syndromes is unclear. Here we investigated the patterns of intra-tumoral SWI positivity (SWI(pos)) as a surrogate for hemosiderin with regard to the prevalence of epilepsy. We report on 105 patients with newly diagnosed supra-tentorial gliomas and brain metastasis. The following parameters were recorded from pre-operative MRI: (1) SWI(pos) defined as dot-like or fine linear signal changes; (2) allocation of SWI(pos) to tumor compartments (contrast enhancement, central hypointensity, non-enhancing area outside contrast-enhancement); (3) allocation of SWI(pos) to include the cortex, or SWI(pos) in subcortical tumor parts only; (4) tumor size on T2 weighted and gadolinium-enhanced T1 images. 80 tumors (76 %) showed SWI(pos) (4/14 diffuse astrocytoma WHO II, 5/9 anaplastic astrocytoma WHO III, 41/46 glioblastoma WHO IV, 30/36 metastasis). The presence of SWI(pos) depended on tumor size but not on patient's age, medication with antiplatelet drugs or anticoagulation. Seizures occurred in 60 % of patients. Cortical SWI(pos) significantly correlated with seizures in brain metastasis (p = 0.044), and as a trend in glioblastoma (p = 0.062). Cortical SWI(pos) may confer a risk for seizures in patients with newly diagnosed brain metastasis and glioblastoma. Whether development of cortical SWI(pos) induced by treatment or by the natural course of tumors also leads to the new onset of seizures has to be addressed in longitudinal studies in larger patient cohorts. PMID:24045969

Roelcke, Ulrich; Boxheimer, Larissa; Fathi, Ali Reza; Schwyzer, Lucia; Ortega, Marcos; Berberat, Jatta; Remonda, Luca

2013-12-01

165

Exercise and Cancer Treatment Symptoms in 408 Newly Diagnosed Older Cancer Patients.  

Science.gov (United States)

While the benefits of exercise for managing cancer-and treatment-related side effects has been shown among various populations of cancer survivors, a relative dearth of information exists among older cancer patients. OBJECTIVES: To determine the prevalence of exercise participation during and after primary cancer treatment in older (?65 years) and the oldest (?80 years) cancer patients and to examine the relationships between exercise, symptoms, and self-rated health (SRH). MATERIALS AND METHODS: 408 newly diagnosed older cancer patients (mean age=73, range=65-92) scheduled to receive chemotherapy and/or radiation therapy reported symptoms and SRH prior to, during, and 6 months after treatment, and exercise participation during and following treatment. RESULTS: Forty-six percent of older and 41% of the oldest patients reported exercising during treatment. Sixty percent of older and 68% of the oldest patients reported exercising in the 6 months thereafter. Older patients who exercised during treatment reported less shortness of breath and better SRH during treatment, and better SRH following treatment. The oldest patients who exercised during treatment reported less memory loss and better SRH during treatment and less fatigue and better SRH following treatment. The oldest patients who exercised following treatment reported less fatigue, skin problems, and total symptom burden following treatment. CONCLUSION: These data suggest a willingness of older cancer patients to attempt exercise during and after treatment. Exercise during these times is associated with less severe symptoms; further clinical research examining the efficacy of formal exercise interventions to reduce symptoms and improve SRH in older cancer patients is needed. PMID:22712028

Sprod, Lisa K; Mohile, Supriya G; Demark-Wahnefried, Wendy; Janelsins, Michelle C; Peppone, Luke J; Morrow, Gary R; Lord, Raymond; Gross, Howard; Mustian, Karen M

2012-04-01

166

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 SciELO Chile | Language: Spanish 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 radiol [...] ógicos y endoscópicos y de los estudios funcionales en pacientes con los diferentes tipos de hernia hiatal. Método: Se evaluaron 115 pacientes, todos con diagnóstico radiológico de hernia hiatal mayor a 5 cm, realizando estudios endoscópicos, histológicos y manometría esofágica, junto a pHmetría de 24 h. Resultados: La edad fue similar en los 4 tipos de hernia hiatal. Síntomas de reflujo gastroesofágico se presentaron con gran frecuencia en hernias tipo I y III, mientras que síntomas mecánicos se manifestaron en hernias tipo IV. El estudio manométrico mostró un esfínter hipotensivo junto con reflujo ácido patológico en casi 90% de las hernias tipo I y IIII. Conclusión: El estudio más útil para el diagnóstico de hernia hiatal es el radiológico. La endoscopia es necesaria para comprobar el daño de la mucosa esofágica. Los estudios funcionales muestran una alta prevalencia de reflujo ácido patológico en hernias hiatales tipo I y II. Abstract in english Background: The finding of a hiatal hernia is usual during upper gastrointestinal endoscopies. However the correlation of symptoms, manometric and radiological findings with the endoscopy report is far from clear. Aim: To assess radiological findings, 24 pH measurements, esophageal manometry and sym [...] ptoms among patients in whom a hiatal hernia was found during an upper gastrointestinal endoscopy. Material and Methods: One hundred fifteen patients aged 23 to 82 years (77 women), with an endoscopic diagnosis of a hiatal hernia of more than 5 cm were studied. An esophageal manometry and 24 hour pH determination were carried out. Results: Hiatal hernias type I, II, II and IV were found in 50, 12, 38 and 15 patients of similar age, respectively. Gastroesophageal reflux symptoms were more common among patients with hernias type I and III. Mechanical symptoms such as retrosternal pain were more common in type IV hernias. Manometry showed a hypotensive sphincter in 100 and 78% of patients with hernias type I and III, respectively. An abnormal 24 hour pH measurement was found in 95 and 85% of patients with hernias type I and III, respectively. Conclusions: Functional studies show a high frequency of pathological acid reflux among patients with hiatal hernias type I and III.

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

2013-09-01

167

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.

Anthony E Dragun

2012-06-01

168

Patterns of hospital use by patients with diagnoses related to HIV infection.  

Science.gov (United States)

The authors analyzed the use of hospitals by patients with a diagnosis of human immunodeficiency virus (HIV) infection, using data from the National Hospital Discharge Survey. In the period 1984-90, the rates of both discharges and days of care for HIV-infected patients rose dramatically. For 1988-90, black males had the highest HIV-related discharge rate, followed by white males and black females, whose rates were similar. The discharge rate for patients with HIV-related diagnoses increased more in the Northeast than in the three other regions of the country. By 1990 the rate for the Northeast was nearly triple the rate for other major regions. More than half of female and black patients with HIV-related diagnoses were hospitalized in the Northeast. Private insurance was the principal expected source of payment for the care of half of the HIV-infected patients discharged in 1985, but for only a third in 1990. Medicaid covered 40 percent of the patients with HIV-related diagnoses discharged in 1990. Larger proportions of female than male patients and of black patients than white patients were covered by Medicaid. Acquired immunodeficiency syndrome was the diagnosis coded for most patients with an HIV-related diagnosis, but in larger proportions for patients who were male or white patients. Nonspecific HIV diagnoses were coded for larger proportions of female and black patients. HIV-infected patients had an average of 3.6 diagnoses in addition to their HIV diagnosis. Nearly a fourth of the additional diagnoses were for other infectious diseases, such as pneumocystosis or candidiasis. Anemia, pneumonia, and drug use and dependence also were frequent diagnoses. PMID:8416116

Kozak, L J; McCarthy, E; Moien, M

1993-01-01

169

The relationship between HIV testing and CD4 counts at HIV diagnosis among newly diagnosed HIV-1 patients in Japan.  

Science.gov (United States)

The aim of this study was to investigate the factors relating to CD4 level at HIV diagnosis and HIV testing behaviour. Participants were newly diagnosed patients (n = 654) in Japan from 2000 to 2005. Around 75% of participants were diagnosed at hospital and clinics. Mean CD4 counts at diagnosis through voluntary HIV testing, screening tests and testing due to concomitant sexually transmitted infection (STI) were 368, 336 and 316 cells/?L, respectively. In contrast, the mean CD4 count where testing was due to the presence of HIV-related clinical symptoms was 151 cells/?L (P policy that promotes HIV testing in medical settings and among STI patients is needed to facilitate earlier HIV diagnosis in Japan. PMID:22581950

Takano, M; Okada, M; Oka, S; Wagatsuma, Y

2012-04-01

170

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2014-08-15

171

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

2004-03-01

172

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 SciELO Brazil | Language: Portuguese 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. MÉ [...] TODO: 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. 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 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.

173

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

Science.gov (United States)

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

Apakama, Okwuchi; Appleton, Richard

2006-06-01

174

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2002-01-01

175

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.

176

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

Science.gov (United States)

Introduction Tuberculosis (TB) is a disease which affects people worldwide, but there is knowledge lacking about patients’ experiences in low-prevalence and high-income countries. Aim To provide a theoretical framework for the process of being diagnosed with tuberculosis in a Danish setting. Method A grounded theory design with field studies and qualitative interviews, following the recommendations from Glaser and Strauss. Result A process of being publicly diagnosed was identified, which developed during the patient's trajectory from being on the way to becoming a patient, becoming a patient with TB, and finally being in medical treatment. Before being diagnosed with TB, patients were weighing between biding their time and deciding to undergo an examination. Social pressure and feelings of social responsibility tended to affect the decision. Having undergone the examination(s), the patients were publicly diagnosed. Being publicly diagnosed meant changing social interactions and fighting to regain control. Conclusion Findings offer new insight and an empirically derived basis for developing interventions aimed at reducing the burden of being diagnosed with tuberculosis and increasing the wellbeing of the patients. PMID:24766675

Konradsen, Hanne; Lillebaek, Troels; Wilcke, Torgny; Lomborg, Kirsten

2014-01-01

177

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

DEFF Research Database (Denmark)

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

Konradsen, Hanne; Lillebaek, Troels

2014-01-01

178

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

International Nuclear Information System (INIS)

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

179

Expected long-term survival of patients diagnosed with multiple myeloma in 2006–2010  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The findings of this Decision Making and Problem Solving article suggest that patients diagnosed with multiple myeloma in 2006–2010 are expected to have much higher long-term survival perspectives than suggested by previously available survival statistics.

Brenner, Hermann; Gondos, Adam; Pulte, Dianne

2009-01-01

180

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

Science.gov (United States)

Patients with congenital heart disease corrected in early childhood may later in life present with cardiac symptoms caused by other associated congenital anomalies that were initially not diagnosed. Nowadays, several noninvasive imaging modalities are available for the visualisation of cardiac anatomy in great detail. We describe two patients with an unroofed coronary sinus, a rare congenital anomaly which could be diagnosed using a combination of modalities including echocardiography, cardiac CT and cardiac MRI. PMID:24590769

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

2014-05-01

 
 
 
 
181

CDC Confirms First Patient Diagnosed with Ebola in United States  

Science.gov (United States)

... to discuss how they should respond to an Ebola case just one week prior to the patient's admission. "Because of that, we were well prepared to deal with this crisis," he said, describing the facility as a "large ...

182

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

Science.gov (United States)

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

Korten, Volkan; Gokengin, Deniz; Fincanci, Muzaffer; Yildirmak, Taner; Uzun Kes, Nuray; Tasdelen Fisgin, Nuriye; Inan, Dilara; Eraksoy, Haluk; Akalin, Halis; Kaptan, Figen

2014-01-01

183

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

International Nuclear Information System (INIS)

atistically significant (p=0.035). Conclusion: PCR, with all its limitations, is potentially a useful diagnostic test in patients with presumptively diagnosed tuberculous pericardial effusion. A PCR positive patient responds better to therapy as compared to PCR negative patient. (author)

184

A 30-year Evaluation of the Agreement between Clinical and Histopathological Diagnoses of Peripheral Epithelial and Mesenchymal Lesions in Mashhad Dental School: 1976-2006  

Directory of Open Access Journals (Sweden)

Full Text Available Statement of Problems: Sufficient knowledge, experience and careful examination usually lead to appropriate clinical diagnosis. However, lesions with similar clinical features present a diagnostic challenge. Therefore, a confirmatory histopathological examination can be helpful to reach the final diagnosis. Purpose: The present study was conducted to evaluate the agreement between clinical and histopathological diagnoses of oral epithelial and mesenchymal lesions in a period of 30-years (1976-2006 at Mashhad Dental School.Materials and Methods: The percentage of concurrence and discrepancy between clinical and histopathological diagnoses of 625 epithelial and 2480 mesenchymal lesions was compared. Clinical data including the patient’s gender and age and the lesion’s location were also evaluated in cases with discrepancy. Data were analyzed using Mann-Whitney, T-Test, Chi-Square, Likehood Ratio, Fisher’s Exact and Kappa tests.Results: An overall agreement between clinical and histopathological diagnoses was seen in 71/4% of epithelial lesion cases, with maximum parity in squamous cell carcinoma and papilloma. In 57/1% of the mesenchymal cases, the diagnosis was in total agreement. Denture hyperplasia, epulis fissuratum, and pregnancy tumor showed the highest concurrence, respectively.Conclusion: Although histopathological examination leads to final diagnosis, in some cases proper strategies and more attention to clinical features of the lesion are necessary to minimize the discrepancy, especially for those with non-specific clinical presentation.

Salehinejad J.

2011-10-01

185

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

2011-09-01

186

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patientsclinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their...

Silva Machado Luciana, E.; de Macedo Nery Marianita; de Góis Nery Cláudio; Leles Cláudio

2012-01-01

187

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

2012-06-12

188

Pharmacological therapy in patients diagnosed with Peyronie's disease  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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.

Halal, Aa; Geavlete, P.; Ceban, E.

2012-01-01

189

Newly diagnosed diabetes mellitus patients presenting with proliferative diabetic retinopathy as an initial sign  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To investigate the clinical features of newly diagnosed diabetes mellitus (NDM patients showing proliferative diabetic retinopathy (PDR as an initial sign.METHODS: As a retrospective case series, the medical records of a total of four hundred and thirty-two patients who underwent a vitrectomy due to PDR were reviewed to find the subjects. Of 432 patients, six cases of NDM patients showing PDR as an initial sign were included and analyzed with their systemic and ocular features. Main outcome measures:the systemic features and ocular features [preoperative and postoperative best corrected visual acuity (BCVA, intraoperative findings].RESULTS: The mean onset age of visual symptoms was 36.3 years old. The mean serum insulin and C-peptide titer was below the normal range. The mean fasting plasma glucose was 178mg/dL and the mean postprandial 2h plasma glucose was 306mg/dL. The mean HbA1c at diagnosis was 11.02%. In all cases, an acute progressive fibrovascular proliferation was observed. Intraoperative retinal tears were found in three cases of six. The mean preoperative BCVA was +0.67±0.58 logMAR and the mean BCVA at postoperative 6 months was +0.20±0.30 logMAR.CONCLUSION: All patients were considered to have latent autoimmune diabetes in adults (LADA. A rapid deterioration of kidney function as well as poor diabetic control status at diagnosis was observed in all six cases. The ocular features of the patients showed acute progressive fibrovascular proliferation and relatively favorable postoperative visual acuity.

Hoon Park

2014-02-01

190

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Lee Ahwon; Chae Byung; Song Byung; Jung Sang

2009-01-01

191

Diagnosing erectile dysfunction could save your patient's life  

Science.gov (United States)

Erectile dysfunction and coronary artery disease are increasingly recognized as different clinical manifestations of the same process. Because the smaller vessels of the penis may be affected by plaque burden much earlier than the larger coronary, internal carotid, and femoral arteries, men may present with symptoms of erectile dysfunction long before signs of cardiovascular disease manifest. This presents an opportunity for the urologist to not only treat the sexual dysfunction and uncover occult coronary disease, but also to screen for cardiac risk, as even men with mild arteriogenic erectile dysfunction may be at risk for cardiovascular disease.

Brock, Gerald

2014-01-01

192

Clinical Analysis of 45 Patients with Malignant Pleural Mesothelioma  

Directory of Open Access Journals (Sweden)

Full Text Available Background and objective Malignant pleural mesothelioma (MPM is a rare tumor with increasing incidence, and its early diagnoses and early treatments are difficult. The aim of the current study is to investigate the clinical features, diagnoses, and treatments of MPM, and provide reference for clinical use. Methods A total of 45 MPM patients admitted in the Chinese PLA General Hospital from January 1997 to December 2010 and their clinical records were analyzed retrospectively. Results The major clinical symptoms of the patients included: chest pain (53.33%, chest distress (48.89% and cough (37.78%. The CT manifestations of MPM included: pleural thickening (71.11%, pleural effusion (60% and lung shadow (40%. The pleural fluid was exudative. The number of nucleated cells in the fluid increased, most of which were mononuclear cells. Moreover, the lactic acid dehydrogenase (LDH levels in the culture medium significantly increased. The most common clinical stage of MPM patients was either stage of III or IV. Thoracoscopy was one of the main diagnosis methods, and epithelium cell type was the main pathologic type. In addition, MPM was easily misdiagnosed as tuberculous pleurisy. Patients with an early stage of MPM were mainly cured through surgery, whereas chemotherapy was applied for the patients with advance stage. The disease control rate of the patients with epithelial type was higher than that of the patients with fibrosarcoma type. Conclusion The rate of MPM misdiagnosis is high because most of the patients have untypical clinical symptoms. However, CT scan can provide an important basis for the diagnosis of MPM. The accurate diagnoses were based on pathological examinations and immunohistochemistry. The methods of treatment include chemotherapy, surgical operation, radiotherapy and supportive treatment. However, these treatments are still insufficient and require further studies.

Jie CHEN

2012-02-01

193

Aetiology analysis of 35 patients firstly diagnosed with oculomotor palsy  

Directory of Open Access Journals (Sweden)

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

Yi-Min Pu

2013-08-01

194

National Guidelines Not Always Followed When Diagnosing Smear-Negative Pulmonary Tuberculosis in Patients with HIV in Botswana  

Science.gov (United States)

Background Diagnosis of smear negative pulmonary tuberculosis (SNPTB) is challenging, especially in patients with HIV. The Botswana National Tuberculosis Program (BNTP) guidelines give guidance in diagnosing and treating SNPTB. Patients with chronic cough should be screened for TB by 3 sputum smear investigations. If negative, a chest x-ray (CXR) should be performed. If negative for TB, antimicrobial treatment for other infections should be started. We investigated the clinicians’ use of the guidelines in clinical practice. Methods Data regarding the medical history (coughing period), requested and conducted investigations concerning tuberculosis diagnosis (sputum smear or culture or CXR) or alternative diagnoses (sputum microscopy or blood or sputum culture for diagnosis of other organisms), in SNPTB HIV-positive patients (outpatients and admitted patients) from 2006–2009 in a district hospital in Botswana were extracted from all available hospital medical records. Additionally, a survey was done in all doctors diagnosing SNPTB in this hospital using a self-administered questionnaire with questions regarding the application of the BNTP guidelines in practice. Descriptive analyses of collected data were performed to test the compliance to the guidelines. Results Data from medical records showed that in 47.0% (132/281) of patients, TB treatment was started without microbiological results from sputum smears. Other methods to rule out or confirm PTB were used in 2.1% (6/281); and 99.6% (280/281) of SNPTB patients had received a CXR. The survey in 7 clinicians found that all always used CXR, and all clinicians requested three sputum results only sometimes. Six out of 7 clinicians started antibiotics before starting TB treatment. Reasons clinicians gave for difficulties in following the guidelines included inability of patients to produce sputum; and laboratory delays in releasing sputum results. Conclusion Between 2006 and 2009 a high proportion of SNPTB diagnoses in a district hospital in Botswana were not supported by laboratory investigation. PMID:24551128

Tafuma, Taurayi A.; Burnett, Rosemary J.; Huis in 't Veld, Diana

2014-01-01

195

Clinical classification of tetanus patients  

Directory of Open Access Journals (Sweden)

Full Text Available The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05, most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000 whereas no such trend was observed for the categories of better prognosis (grades I and II. This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.

D.B. Miranda-Filho

2006-10-01

196

Clinical Evaluation of a Type III Secretion System Real-Time PCR Assay for Diagnosing Melioidosis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A Burkholderia pseudomallei type III secretion system real-time PCR assay was evaluated on clinical specimens in a region where melioidosis is endemic. The PCR was positive in 30/33 (91%) patients with culture-confirmed melioidosis. All six patients with melioidosis septic shock were blood PCR positive, suggesting potential for rapid diagnosis and commencement of appropriate therapy.

Meumann, Ella M.; Novak, Ryan T.; Gal, Daniel; Kaestli, Mirjam E.; Mayo, Mark; Hanson, Joshua P.; Spencer, Emma; Glass, Mindy B.; Gee, Jay E.; Wilkins, Patricia P.; Currie, Bart J.

2006-01-01

197

Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion.  

Science.gov (United States)

Head trauma and concussion in football players have recently received considerable media attention. Postmortem evidence suggests that accrual of damage to the brain may occur with repeated blows to the head, even when the individual blows fail to produce clinical symptoms. There is an urgent need for improved detection and characterization of head trauma to reduce future injury risk and promote development of new therapies. In this study we examined neurological performance and health in the presence of head collision events in high school football players, using longitudinal measures of collision events (the HIT(™) System), neurocognitive testing (ImPACT(™)), and functional magnetic resonance imaging MRI (fMRI). Longitudinal assessment (including baseline) was conducted in 11 young men (ages 15-19 years) participating on the varsity and junior varsity football teams at a single high school. We expected and observed subjects in two previously described categories: (1) no clinically-diagnosed concussion and no changes in neurological behavior, and (2) clinically-diagnosed concussion with changes in neurological behavior. Additionally, we observed players in a previously undiscovered third category, who exhibited no clinically-observed symptoms associated with concussion, but who demonstrated measurable neurocognitive (primarily visual working memory) and neurophysiological (altered activation in the dorsolateral prefrontal cortex [DLPFC]) impairments. This new category was associated with significantly higher numbers of head collision events to the top-front of the head, directly above the DLPFC. The discovery of this new category suggests that more players are suffering neurological injury than are currently being detected using traditional concussion-assessment tools. These individuals are unlikely to undergo clinical evaluation, and thus may continue to participate in football-related activities, even when changes in brain physiology (and potential brain damage) are present, which will increase the risk of future neurological injury. PMID:20883154

Talavage, Thomas M; Nauman, Eric A; Breedlove, Evan L; Yoruk, Umit; Dye, Anne E; Morigaki, Katherine E; Feuer, Henry; Leverenz, Larry J

2014-02-15

198

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

Scientific Electronic Library Online (English)

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

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

2014-01-01

199

Managing the patient with newly diagnosed Parkinson disease.  

Science.gov (United States)

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

200

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

DEFF Research Database (Denmark)

Patienter med symptomer, der ikke umiddelbart passer med en kendt medicinsk diagnose, er hyppige i almen praksis. Praktiserende læger blev i denne undersøgelse bedt om at sætte en diagnosekode på disse patienter, og der viste sig at være en meget stor variation i valget med op til 31 forskellige diagnoser på samme patient. Samtidig angiver lægerne dog ofte, at disse patienter fejler flere ting samtidigt. Der fandtes i undersøgelsen ingen forskel mellem de nordiske lande. Undersøgelsen blev lavet ved at lade praktiserende læger se videooptagelser af 9 patienter fra praksis og efterfølgende udfylde et elektronisk spørgeskema for hver af disse patienter. Videooptagelserne var lavet på baggrund af transkriberede cases fra en norsk praksis og indspillet med skuespillere. Undersøgelsen blev gennemført blandt 126 praktiserende læger i Norge, Danmark og Sverige i 2010. Hos patienter med medicinsk uforklarede symptomer bør man i højere grad være opmærksom på multimorbiditet, og en simpel diagnosetilgang vil være uhensigtsmæssig fx i forbindelse med sygemeldinger og sundhedspolitiske beslutninger.

Maeland, Silje; Werner, Erik L.

2012-01-01

 
 
 
 
201

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

Science.gov (United States)

Introduction Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Methods Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. Results The study included 693 patients (561 male, 132 female) from 24 sites. Reason for HIV testing was available in 640 patients (92%). The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7%) and sex among men who have sex with men (MSM) (22.6%). At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm3 (3–1433/mm3). Primary HIV infection was determined in 42/693 (6%) patients and 9/693 (% 1, 2) cases were considered “probable primary HIV infection.” The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2%) patients delayed their presentation for more than 3 months. The longest delay was 11 months. Conclusions The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions. PMID:25394100

Dokuzoguz, Basak; Korten, Volkan; Gokengin, Deniz; Fincanci, Muzaffer; Yildirmak, Taner; Nuray Kes, Uzun; Tasdelen Fisgin, Nuriye; Inan, Dilara; Eraksoy, Haluk; Akalin, Halis

2014-01-01

202

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

Directory of Open Access Journals (Sweden)

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.

Yonca Sönmez

2010-01-01

203

Incidence of Retinal Complications in a Cohort of Newly Diagnosed Diabetic Patients  

Science.gov (United States)

Purpose We aimed at estimating the incidence of diabetic retinopathy (DR) and maculopathy (DMP) among newly diagnosed type 1 (t1DM) and type 2 diabetic patients (t2DM) in the United Kingdom primary care system. The incidence of DMP among patients with DR was also estimated. Method We conducted a cohort study using The Health Improvement Network database. The cohort included 64,983 incident diabetic patients (97.3% were t2DM) aged 1–84 years diagnosed between 2000 and 2007. This cohort was followed from the date of diabetes diagnosis until recording of DR or DMP in two separate follow-ups. Follow-up was censored at 85 years of age, death, or end of 2008. An additional follow-up was conducted from DR to DMP diagnosis using similar censoring reasons. DR and DMP cumulative incidences were calculated as well as incidence rates (IR; cases per 1,000 person-years) per calendar period (2000–2001 and 2006–2007). Results Follow-up for DR: 9 years after diabetes diagnosis, 28% of t2DM and 24% of t1DM patients had developed DR (7,899 incident DR cases). During the first 2 years with diabetes, the IR was almost 2 times higher in patients diagnosed with diabetes in 2006–2007 (47.7) than among those diagnosed in 2000–2001 (24.5). Follow-up for DMP: 9 years after diabetes diagnosis, 3.6% of t2DM and 4.4% of t2DM patients had developed DMP (912 incident DMP cases). During the first 2 years with diabetes, the IR was three times higher in patients diagnosed with diabetes in 2006–2007 (5.8) than among those diagnosed in 2000–2001 (1.8). Macular oedema occurred in 0.8% of patients. Conclusions In a cohort of incident diabetes, 28% of patients developed retinopathy and 4% maculopathy within the first 9 years. The 2-year IRs of DR and DMP were higher in patients diagnosed with diabetes during the period 2006–2007 than in those diagnosed during the 2000–2001 period. PMID:24963628

Martin-Merino, Elisa; Fortuny, Joan; Rivero-Ferrer, Elena; Garcia-Rodriguez, Luis Alberto

2014-01-01

204

Prevalence of parenterally transmitted hepatitis viruses in clinically diagnosed cases of hepatitis  

Directory of Open Access Journals (Sweden)

Full Text Available Hepatitis B virus (HBV is the most important causative agent of blood borne hepatitis in humans. Hepatitis D Virus (HDV infection occurs either as a coinfection or superinfection in HBV carriers. Hepatitis C virus (HCV is the major cause of transfusion non-A, non-B hepatitis and continues to be a major cause of human liver disease throughout the world. The present study was conducted on 70 clinically diagnosed cases of viral hepatitis to study the prevalence of parenterally transmitted viral hepatitis. The serum samples were tested for HBsAg, HBeAg, IgM anti-HBc, anti-HBe, anti-HCV and anti-HDV using separate ELISA kits. Of the 70 serum samples tested, 28(40% were positive for HBsAg out of which 3 (4.28% were positive for HBeAg also. Five (7.1% of the HBsAg positive cases tested positive for IgM anti-HBc also. HBsAg alone was found in 17(24.28% cases. The prevalence of anti-HCV was 3 (4.28% in 70 cases. Thus early screening of clinically diagnosed cases of viral hepatitis is essential for establishing diagnosis and treatment to prevent long term sequelae.

Arora D

2005-01-01

205

Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome: A Case Report  

Science.gov (United States)

Objective The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain. Clinical features A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS. Interventions and outcomes The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index. Conclusion This patient with BJHS who had decreased disability and spine pain improved after a course of multimodal chiropractic care. PMID:24711783

Strunk, Richard G.; Pfefer, Mark T.; Dube, Derrick

2014-01-01

206

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

Directory of Open Access Journals (Sweden)

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

Marta Rorat

2013-06-01

207

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

Directory of Open Access Journals (Sweden)

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

Uehara T

2013-12-01

208

Lynch syndrome screening should be considered for all patients with newly diagnosed endometrial cancer.  

Science.gov (United States)

Lynch syndrome (LS) is an autosomal dominant inherited disorder caused by germline mutations in DNA mismatch repair (MMR) genes. Mutation carriers are at substantially increased risk of developing cancers of the colorectum and endometrium, among others. Given recent recommendations for universal, cost-effective screening of all patients with newly diagnosed colorectal cancer using MMR protein immunohistochemistry, we evaluated MMR protein expression in a series of endometrial cancers in the general population. A total of 605 consecutive cases of primary endometrial cancer at a single institution (1997 to 2013) were evaluated regardless of age, family history, or histologic features. Evaluation methods consisted of immunohistochemistry for the MMR proteins MLH1, MSH2, MSH6, and PMS2, followed by DNA methylation analysis for cases with MLH1/PMS2 deficiency. Germline mutation testing was performed on a subset of cases. Forty MMR-deficient, nonmethylated endometrial cancers were identified: 3 MLH1/PMS2 and 37 MSH6/MSH2 protein deficiencies. Only 25% occurred in women below 50 years of age (range, 39 to 88 y), 1 of which was in a risk-reducing hysterectomy specimen. Only 15% of patients had a prior history of carcinoma, including only 2 patients with prior colorectal carcinoma. Most (80%) of the endometrial cancers were purely endometrioid; there were 2 mixed endometrioid/mucinous, 1 mucinous, 1 serous, 2 clear cell, and 2 carcinosarcoma cases. When grading was applicable, 40% of the endometrial malignancies were FIGO grade 1, 34% grade 2, and 26% grade 3. Thirteen percent arose in the lower uterine segment, and 23% had tumor-infiltrating lymphocytes. Of the tumors with known germline testing, 41% with a LS-associated germline mutation were not associated with any of the traditional indicators that have been recommended for LS screening (ie, age 50 y or younger, personal/family cancer pedigree that meets Bethesda guideline criteria, presence of MMR-associated tumor morphology, or location in the lower uterine segment). These data suggest that a significant number of LS-associated endometrial carcinomas are missed using clinical, histologic, and locational screening parameters and provide support for universal screening of all newly diagnosed endometrial cancers. PMID:25229768

Mills, Anne M; Liou, Sofia; Ford, James M; Berek, Jonathan S; Pai, Reetesh K; Longacre, Teri A

2014-11-01

209

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

LENUS (Irish Health Repository)

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

Qasim, A

2012-02-01

210

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2001-06-01

211

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2012-01-01

212

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

Directory of Open Access Journals (Sweden)

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

RodolfoRey

2014-05-01

213

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

DEFF Research Database (Denmark)

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

Henriksen, Daniel Pilsgaard; Nielsen, Stig LØnberg

2014-01-01

214

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

215

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

DEFF Research Database (Denmark)

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

Roed, Casper; Engsig, Frederik Neess

2012-01-01

216

Clinical management of patients with hyperthyroidism  

International Nuclear Information System (INIS)

The clinical management of the hyperthyroid patient is controversial, because there is no perfect treatment. Factors that influence the choice of therapy include the patient's age, sex, and type of hyperthyroidism, as well as patient and physician preference

217

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

2008-04-01

218

Anti-neutrophil cell antibodies in newly diagnosed patients with type-1-diabetes.  

Science.gov (United States)

Both anti neutrophil cell antibodies and anti endothelial cell antibodies were found in 7 out of 30 newly-diagnosed type-1 diabetic patients. This confirms the abnormal activation of the immunological system in the early stage of type-1 diabetes mellitus. PMID:10482047

Parlapiano, C; Marangi, M; Campana, E; Giovanniello, T; Pantone, P; Suraci, C; Sanguigni, S

1999-01-01

219

ANESTHETIC MANAGEMENT OF PATIENT WITH PRE-DIAGNOSED ZELLWEGER SYNDROME DURING THE MAGNETIC RESONANCE IMAGING  

Directory of Open Access Journals (Sweden)

Full Text Available Zellweger Syndrome (ZS is rare peroxysome deficiency disorder and patients suffering from this syndrome display a range of disturbances including neurological, sceletal, hepatological and oculer abnormalities. Present abnormalities may cause serious complications in the anesthetic management. However anesthetic management of patients with ZS is not clarified enough. That is why we would like to share our experience by presenting our anesthetic approaches, towards a 11 months baby pre-diagnosed with ZS, during magnetic resonance imaging (MRI procedure.

Berrin I??k

2008-01-01

220

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

Science.gov (United States)

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

Sayan, Murat; Sargyn, Fatma; Inan, Dilara; Yyldyz Sevgi, Dilek; Kocagul Celikbas, Aysel; Yasar, Kadriye; Kaptan, Figen; Sayyn Kutlu, Selda; Tasdelen Fysgyn, Nuriye; Inci, Ayse; Ceran, Nurgul; Karao?lan, Ylkay; Cagatay, Atahan; Kemal Celen, Mustafa; Tekin Koruk, Suda; Ceylan, Bahadyr; Yyldyrmak, Taner; Akalyn, Halis; Korten, Volkan; Willke, Ayse

2014-01-01

 
 
 
 
221

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

DEFF Research Database (Denmark)

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

Nielsen, Jens Steen; Thomsen, Reimar W.

2013-01-01

222

Clinical and histopathological characteristics in patients with postmenopausal bleeding  

Directory of Open Access Journals (Sweden)

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

Mandi? Aljoša

2013-01-01

223

A phase II neoadjuvant trial of anastrozole, fulvestrant, and gefitinib in patients with newly diagnosed estrogen receptor positive breast cancer.  

Science.gov (United States)

Endocrine therapy in patients with breast cancer can be limited by the problem of resistance. Preclinical studies suggest that complete blockade of the estrogen receptor (ER) combined with inhibition of the epidermal growth factor receptor can overcome endocrine resistance. We tested this hypothesis in a phase II neoadjuvant trial of anastrozole and fulvestrant combined with gefitinib in postmenopausal women with newly diagnosed ER-positive breast cancer. After a baseline tumor core biopsy, patients were randomized to receive anastrozole and fulvestrant or anastrozole, fulvestrant, and gefitinib (AFG) for 3 weeks. After a second biopsy at 3 weeks, all patients received AFG for 4 months and surgery was done if the tumor was operable. The primary endpoint was best clinical response by RECIST criteria and secondary endpoints were toxicity and change in biomarkers. The study closed after 15 patients were enrolled because of slow accrual. Median patient age was 67 years and median clinical tumor size was 7 cm. Four patients had metastatic disease present. Three patients withdrew before response was assessed. In the remaining 12 patients, there were two complete clinical responses (17%), three partial responses (25%), five had stable disease (41%), and two (17%) had progressive disease. Most common adverse events were rash in four patients, diarrhea in four, joint symptoms in three, and abnormal liver function tests in three. There were no grade 4 toxicities and all toxicities were reversible. At 3 weeks, cell proliferation as measured by Ki-67 was significantly reduced in the AFG group (P value = 0.01), with a parallel reduction in the expression of the Cyclin D1 (P value = 0.02). RNA microarray data showed a corresponding decrease in the expression of cell cycle genes. These results suggest that AFG was an effective neoadjuvant therapy and consistently reduced proliferation in ER-positive tumors. PMID:21792626

Massarweh, Suleiman; Tham, Yee L; Huang, Jian; Sexton, Krystal; Weiss, Heidi; Tsimelzon, Anna; Beyer, Amanda; Rimawi, Mothaffar; Cai, Wei Yen; Hilsenbeck, Susan; Fuqua, Suzanne; Elledge, Richard

2011-10-01

224

THE CLINICAL SPECTRUM OF RESPIRATORY DISEASES IN PATIENTS WITH PRIMARY ANTIBODY DEFICIENCY  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Primary Humoral Immunodeficiencies (PHID) are currently increasingly being recognized. Patients with PHID frequently show respiratory complications.The objectives of the study is to determine the clinical spectrum of respiratory diseases in patients with PHID.We extracted data from the clinical files of patients with PHID, diagnosed according to WHO criteria. We encountered 125 patients (84 males), with the diagnosis of primary antibody deficiency including common-variable immunodeficiency (6...

Amiri Kordestani, L.; Gharagouzlou, M.; Uezaei, N.; Abolmaali, K.; Movahedi, M.; Puurpak, Z.; Farhondi, A.; Moein, M.; Aghamohammadi, A.; Habibi, Z.; Mahmoudi, M.

2000-01-01

225

First-line imatinib mesylate in patients with newly diagnosed accelerated phase-chronic myeloid leukemia.  

Science.gov (United States)

Imatinib mesylate is the sole BCR-ABL tyrosine kinase inhibitor approved as first-line treatment of accelerated-phase (AP) chronic myeloid leukemia (CML). Indication was based on the STI571 0109 study, in which imatinib favorably compared to historical treatments in patients failing prior therapies. The relevance of these results to currently newly diagnosed AP-CML patients remains unknown. We evaluated the benefit of imatinib in 42 newly diagnosed AP-CML patients. In all, 16 patients had hematological acceleration without chromosomal abnormalities in addition to the Philadelphia chromosome (ACAs; HEM-AP), 16 solely had ACAs (ACA-AP) and 10 had hematological acceleration plus ACAs (HEM-AP + ACA). Major cytogenetic responses were achieved in 93.7% of HEM-AP patients, 75% of patients with ACA-AP (P=NS) and 40% of patients with HEM-AP + ACA (P=0.0053). The 24-month failure-free survival rate was 87.5% in HEM-AP patients, 43.8% in ACA-AP patients and 15% in HEM-AP + ACA patients (P=0.022). The 24-month estimate of progression-free survival was 100% in HEM-AP patients, 92.8% in ACA-AP patients and 58.3% in HEM-AP + ACA patients (P=0.0052). In conclusion, frontline imatinib allows favorable outcomes in HEM-AP and ACA-AP patients but appears insufficient for patients with HEM-AP + ACA. Broader-target and/or more potent BCR-ABL tyrosine kinase inhibitors alone or in combination may be considered in this setting. PMID:22460758

Rea, D; Etienne, G; Nicolini, F; Cony-Makhoul, P; Johnson-Ansah, H; Legros, L; Huguet, F; Tulliez, M; Gardembas, M; Bouabdallah, K; Rousselot, P; Cayuela, J-M; Guilhot, F; Mahon, F-X

2012-10-01

226

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

DEFF Research Database (Denmark)

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

Danielsen, Solveig; Boa, Eric

2012-01-01

227

CT-guided transthoracic cutting needle lung biopsy: its clinical application in diagnosing diffuse lung diseases  

International Nuclear Information System (INIS)

Objective: To evaluate the clinical application and safety of CT-guided transthoracic cutting needle lung biopsy in diagnosing diffuse lung diseases. Methods: By using automatic biopsy gun (14 and 16 gauge), CT-guided transthoracic cutting needle lung biopsy was performed in 29 cases with diffuse lung diseases. The samples obtained were sent for pathological and immunohistochemical examination. The sampling successful rate, the diagnostic accuracy and the occurrence of complications were analyzed. Results: Technical success rate was 100%, and large size of sample enough for pathological and immunohistochemical examination was obtained in all 29 cases. Definite pathological diagnosis could be made in 25 cases, with the positive diagnostic rate of 82.8%. The main complications included pneumothorax and pulmonary hemorrhage. The symptoms in most cases were not severe and disappeared within one week after the treatment. Conclusion: For the diagnosis of diffuse lung diseases, CT-guided transthoracic cutting needle lung biopsy is a safe, easy, effective and reliable method with high successful rate, high diagnostic value and fewer complications, in these respects this technique is superior to transbronchial lung biopsy, open lung biopsy and video-assisted thoracoscopic lung biopsy. Therefore, this technique should be popularized in clinical practice. (authors)

228

Exome sequencing and directed clinical phenotyping diagnose cholesterol ester storage disease presenting as autosomal recessive hypercholesterolemia  

Science.gov (United States)

Objective Autosomal recessive hypercholesterolemia (ARH) is a rare inherited disorder characterized by extremely high total and low-density lipoprotein cholesterol levels that has been previously linked to mutations in LDLRAP1. We identified a family with ARH not explained by mutations in LDLRAP1 or other genes known to cause monogenic hypercholesterolemia. The aim of this study was to identify the molecular etiology of ARH in this family. Approach and Results We used exome sequencing to assess all protein coding regions of the genome in three family members and identified a homozygous exon 8 splice junction mutation (c.894G>A, also known as E8SJM) in LIPA that segregated with the diagnosis of hypercholesterolemia. Since homozygosity for mutations in LIPA is known to cause cholesterol ester storage disease (CESD), we performed directed follow-up phenotyping by non-invasively measuring hepatic cholesterol content. We observed abnormal hepatic accumulation of cholesterol in the homozygote individuals, supporting the diagnosis of CESD. Given previous suggestions of cardiovascular disease risk in heterozygous LIPA mutation carriers, we genotyped E8SJM in >27,000 individuals and found no association with plasma lipid levels or risk of myocardial infarction, confirming a true recessive mode of inheritance. Conclusions By integrating observations from Mendelian and population genetics along with directed clinical phenotyping, we diagnosed clinically unapparent CESD in the affected individuals from this kindred and addressed an outstanding question regarding risk of cardiovascular disease in LIPA E8SJM heterozygous carriers. PMID:24072694

Stitziel, Nathan O.; Fouchier, Sigrid W.; Sjouke, Barbara; Peloso, Gina M.; Moscoso, Alessa M.; Auer, Paul L.; Goel, Anuj; Gigante, Bruna; Barnes, Timothy A.; Melander, Olle; Orho-Melander, Marju; Duga, Stefano; Sivapalaratnam, Suthesh; Nikpay, Majid; Martinelli, Nicola; Girelli, Domenico; Jackson, Rebecca D.; Kooperberg, Charles; Lange, Leslie A.; Ardissino, Diego; McPherson, Ruth; Farrall, Martin; Watkins, Hugh; Reilly, Muredach P.; Rader, Daniel J.; de Faire, Ulf; Schunkert, Heribert; Erdmann, Jeanette; Samani, Nilesh J.; Charnas, Lawrence; Altshuler, David; Gabriel, Stacey; Kastelein, John J.P.; Defesche, Joep C.; Nederveen, Aart J.; Kathiresan, Sekar; Hovingh, G. Kees

2014-01-01

229

Clinical Profile of Leprosy Patients: A Prospective Study  

Science.gov (United States)

Introduction: Early diagnosis and early adequate drug treatment is very important aspect to reduce the load in cases of leprosy. So, correct labeling of paucibacillary and multibacillary cases is a prerequisite for the adequate treatment. Confirmation of diagnosis is an important indication for histopathological examination in doubtful cases. Objectives: The present study was carried out to know the clinical profile of leprosy patients, concordance between clinical and histopathological diagnosis in cases of leprosy, and to assess the therapeutic efficacy of antileprosy therapy. Study Design: Two hundred and fifty clinically diagnosed leprosy patients attending skin outdoor patient department (OPD) were included in the study. Slit skin smear was performed in all the cases. In that case concordance between clinical and histology can be determined only in 30 cases. All the patients were treated with MDT (multidrug therapy) as per WHO guideline. Results: A total of 250 patients attended the clinic with male to female ratio of 1.7:1. The highest incidence was noted in 17-40 years of age group. In the clinical disease spectrum, 40% patients were in the borderline spectrum followed by tuberculoid leprosy (TT) (29.2%), lepromatous leprosy (LL) (26.8%), and 3.9% of indeterminate leprosy (IL). A total of 18% of patients were of primary neuritic leprosy. A total of 8.3% patients had definite history of contact in the family or neighborhood. Clinicopathological correlation was noted in 60% of patients with maximum disparity (52.9%) in the borderline group of patients. A total of 52.8% were MB (Multibacillary) and 47.2% were PB (Paucibacillary) cases. Morphological index became negative after 6 months in all patients. Mean fall of bacteriological index after 6 months was 0.19, while after 1 year, it was 1.05. Conclusion: Timely diagnosis and adequate treatment of cases with MDT is most effective. Histopathological examination is must in doubtful cases of leprosy. PMID:24700934

Thakkar, Sejal; Patel, Sangita V

2014-01-01

230

The criteria for avoiding unnecessary computerized tomography and bone scan in staging patients with newly diagnosed prostate cancer. Retrospective study of patients at Matsusaka Chuo General Hospital  

International Nuclear Information System (INIS)

Staging for prostate cancer often includes computed tomography (CT) and bone scan in Japan. We examined the criteria of avoiding unnecessary CT and bone scan for the prostate cancer patients at Matsusaka Chuo General Hospital. Two hundred and eleven patients were newly diagnosed at our institution between 1998 September and 2004 April. We reviewed data from 208 patients who had a staging CT and bone scan. The data was analysed using Gleason score, clinical T-stage and serum prostatic specific antigen (PSA) level. CT detected lymphadenopathy in 19 patients (9.1%), Bone scan detected bone metastasis in 31 patients (14.9%). However there was no lymphadenopathy detected by CT in the patients with 20 ng/ml or less. In the analysis using PSA and Gleason score, there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and Gleason sum 7 or less. In the analysis using PSA and clinical local stage there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and localized lesion (cT1-2). In a new prostate cancer patient CT and bone scan can be avoidable by PSA level of 20 ng/ml or less and cT1-2 or less and Gleason sum 7 or less. (author)

231

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

Directory of Open Access Journals (Sweden)

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

e Silva Machado Luciana

2012-08-01

232

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

DEFF Research Database (Denmark)

BACKGROUND: Studies have shown that type 2 diabetic patients have higher all-cause mortality than people without diabetes, but it is less clear how diabetes affects mortality in elderly patients and to what degree mortality differs between diabetic men and women. The aim of the present study is to investigate the age- and sex-specific all-cause mortality pattern in patients with type 2 diabetes in comparison with the Danish background population. METHODS: Population-based cohort study of 1323 patients, diagnosed with clinical type 2 diabetes in 1989-92 and followed for 16 years. Median (interquartile range) age at diagnosis was 65.3 (55.8-73.6) years. The age- and sex-specific hazard rates were estimated for the cohort using the life table method and compared with the expected hazard rates calculated with Danish register data from the general population. RESULTS: In comparison with the general population, diabetic patients had a 1.5-2.5 fold higher risk of dying depending on age. The over-mortality was higherfor men than for women. It decreased with age in both sexes, and among patients over 80 years at diagnosis the difference between the observed and the expected survival was small. CONCLUSION: We found an excess mortality of type 2 diabetic patients compared with the background population in all age groups. The excess mortality was most pronounced in men and in young patients Udgivelsesdato: 2009

Hansen, Lars JØrgen; Olivarius, Niels de Fine

2009-01-01

233

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

International Nuclear Information System (INIS)

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

234

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2010-04-15

235

Patterns of hospital use by patients with diagnoses related to HIV infection.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The authors analyzed the use of hospitals by patients with a diagnosis of human immunodeficiency virus (HIV) infection, using data from the National Hospital Discharge Survey. In the period 1984-90, the rates of both discharges and days of care for HIV-infected patients rose dramatically. For 1988-90, black males had the highest HIV-related discharge rate, followed by white males and black females, whose rates were similar. The discharge rate for patients with HIV-related diagnoses increased ...

Kozak, L. J.; Mccarthy, E.; Moien, M.

1993-01-01

236

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

Science.gov (United States)

We evaluated the efficacy of using standard radiologic and histologic criteria to guide the follow-up of patients with lobular carcinoma in situ (LCIS), lobular neoplasia (LN), or atypical lobular hyperplasia (ALH). Patients with high-risk benign lesions diagnosed on biopsy were presented and reviewed in a multidisciplinary clinical management conference from 1 November 2003 through September 2011. Associations between patient characteristics and rates of upgrade were determined by univariate and multivariate logistic models, and times to diagnosis carcinoma were calculated. Of 853 cases reviewed, 124 (14.5%) were lobular neoplasms. In all, 104 patients were clinically and/or radiographically monitored. In 20 patients, who were found to have LN on core biopsy and were recommended to have immediate surgical excision, a more significant lesion was identified in 8 (40%) of the excised specimens. Factors associated with a more significant lesion on excisional biopsy included whether the lobular lesion had been targeted for biopsy and whether the extent of disease involved three or more terminal duct lobular units. Of the 104 patients radiographically and clinically monitored, the median follow-up time was 3.4 years with a range of 0.44-8.6 years. Five patients under surveillance were subsequently diagnosed with breast malignancy (three of the five at a site unrelated to the initial biopsy). Patients with incidental lobular lesions identified on percutaneous core needle biopsy have a small risk of upgrade and may not require an excisional biopsy. Clinical management of low-volume lobular lesions in a multidisciplinary setting is an efficacious alternative to surgical excision when radiologic and histologic characteristics are well-defined. PMID:24639339

Middleton, Lavinia P; Sneige, Nour; Coyne, Robin; Shen, Yu; Dong, Wenli; Dempsey, Peter; Bevers, Therese B

2014-06-01

237

Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients  

Directory of Open Access Journals (Sweden)

Full Text Available Highly active antiretroviral therapy (HAART has dramatically decreased opportunistic infections (OIs in human immunodeficiency virus (HIV-infected patients. However, gastrointestinal disease continues to account for a high proportion of presenting symptoms in these patients. Gastrointestinal symptoms in treated patients who respond to therapy are more likely to the result of drug-induced complications than OI. Endoscopic evaluation of the gastrointestinal tract remains a cornerstone of diagnosis, especially in patients with advanced immunodeficiency, who are at risk for OI. The peripheral blood CD4 lymphocyte count helps to predict the risk of an OI, with the highest risk seen in HIV-infected patients with low CD4 count (< 200 cells/mm3. This review provides an update of the role of endoscopy in diagnosing OI in the upper gastrointestinal tract in HIV-infected patients in the era of HAART.

Ana Luiza Werneck-Silva, Ivete Bedin Prado

2009-03-01

238

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

Directory of Open Access Journals (Sweden)

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

Anna Fritz

2008-04-01

239

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

Science.gov (United States)

Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART). The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function). Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications. PMID:18292845

Jakimiuk, Artur J; Fritz, Anna; Grzybowski, Wojciech; Walecka, Irena; Lewandowski, Piotr

2007-01-01

240

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database  

Science.gov (United States)

Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use. Please see later in the article for the Editors' Summary PMID:25333943

Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.

2014-01-01

 
 
 
 
241

Socio-demographic predictors of high support needs in newly diagnosed breast cancer patients.  

Science.gov (United States)

This study aimed to identify high support needs and their socio-demographic predictors to improve supportive care for newly diagnosed breast cancer patients. A cross-sectional study measured patients' needs and unsatisfied support needs by the supportive care needs survey (SCNS-34), administered after surgery, chemotherapy or radiotherapy. Socio-demographic, disease and treatment characteristics completed data collection. A total of 308 questionnaires were completed with a response rate of 88%. The most frequent support needs (73.3% of patients) related to information and the highest unsatisfied support needs to the management of emotions and daily life (36.3-39.6% of patients). Younger age predicted high and dissatisfied support needs (P < 0.05). Patients born outside Switzerland or with a lower level of education had more needs in daily living and psychological domains (P < 0.05). Being born outside Switzerland also predicted dissatisfaction with information provided. Being parent was a predictor of significant needs in the daily living domain after adjusting for disease and treatment characteristics (P= 0.01). Therefore, information, psychological and daily living support for newly diagnosed breast cancer patients should be strongly reinforced, particularly in patients being born outside Switzerland, those with children or being younger. For the latter, support in sexuality domain should also be emphasised. PMID:20477860

Griesser, A-C; Vlastos, G; Morel, L; Beaume, C; Sappino, A-P; Haller, G

2011-07-01

242

A comparison of clinical and radiographic caries diagnoses in posterior teeth of 12-year-old Lithuanian children.  

Science.gov (United States)

Bite-wing radiography has been recommended for use in adolescents as clinical examinations alone may lead to underestimation of carious lesions in approximal and occlusal surfaces. The aim of this study was to describe the relationship between clinical and radiographic caries diagnoses among 12-year-old Lithuanians using a new clinical scoring system which differentiates between cavitated and non-cavitated caries lesions. Eight hundred and seventy-two children were examined clinically and two standardized posterior bite-wing radiographs were taken of each participant. Bite-wing radiography contributed significantly to the total number of lesions diagnosed only at the dentin level in approximal surfaces. Clinical examination performed better than radiographic examination at the non-cavitated/enamel level, particularly on occlusal surfaces. Less than 2% of the clinically sound surfaces were diagnosed with dentin lesions/fillings radiographically. When using the cavitated level of clinical diagnosis, the frequency of 'hidden' caries lesions increased from 1.9 to 2.9% in approximal surfaces, and from 1.7 to 5. 2% in occlusal surfaces. The intra-examiner reliability data for the clinical and radiographic recordings supported the conclusion of an additional diagnostic value of bite-wings only for approximal surfaces. The findings demonstrate that the diagnostic yield of bite-wing radiography is higher for approximal than for occlusal surfaces. The efficacy of bite-wings depends on the refinement of the clinical caries diagnostic criteria. 'Hidden' caries does not seem to be a major problem when the clinical caries diagnostic criteria include non-cavitated diagnoses. PMID:10460957

Machiulskiene, V; Nyvad, B; Baelum, V

1999-01-01

243

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

DEFF Research Database (Denmark)

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

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

2011-01-01

244

Intensified chemo-immunotherapy with or without stem cell transplantation in newly diagnosed patients with peripheral T-cell lymphoma.  

Science.gov (United States)

Peripheral T-cell lymphomas (PTCLs) receiving conventional treatment have a poor clinical outcome. We conducted a phase II study to evaluate the feasibility and efficacy of chemo-immunotherapy in young (?60 years old, Clin A study) and elderly (>60 and < or =75 years old, Clin B study) patients with newly diagnosed PTCL. Clin A patients (n=61) received two courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone)-21 with alemtuzumab (AL, 30?mg) followed by two courses of high-dose chemotherapy. On the basis of donor availability, patients in response received allogeneic (allo) or autologous (auto) stem cell transplantation (SCT). Clin B patients (n=25) received six courses of CHOP-21 and AL (10?mg). Clin A responding patients were 38 of 61 (62%) and received alloSCT (n=23) or autoSCT (n=14); one complete remission (CR) patient was not transplanted. At a median follow-up of 40 months, the 4-year overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS) rates were 49, 44 and 65%, respectively. In Clin B study, the response rate was 72%. At a median follow-up of 48 months, the 4-year OS, PFS and DFS rates were 31, 26 and 44%, respectively. In conclusion, front-line alloSCT or autoSCT is effective in prolonging DFS in young patients; AL in elderly improved response with no survival benefit. PMID:24662801

Corradini, P; Vitolo, U; Rambaldi, A; Miceli, R; Patriarca, F; Gallamini, A; Olivieri, A; Benedetti, F; Todeschini, G; Rossi, G; Salvi, F; Bruno, B; Baldini, L; Ferreri, A; Patti, C; Tarella, C; Pileri, S; Dodero, A

2014-09-01

245

Pharmacokinetic of Arsenic Trioxide in Newly Diagnosed Acute Promyelocytic Leukemia Patients  

Directory of Open Access Journals (Sweden)

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

R. Hosseini

2008-01-01

246

Prevalence of SAP gene defects in male patients diagnosed with common variable immunodeficiency.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The molecular basis of common variable immunodeficiency (CVID) is undefined, and diagnosis requires exclusion of other diseases including X-linked lymphoproliferative disease (XLP). This rare disorder of immunedysregulation presents typically after Epstein-Barr virus infection and results from defects in the SAP (SLAM associated protein) gene. SAP mutations have been found in a few patients diagnosed previously as CVID, suggesting that XLP may mimic CVID, but no large-scale analysis of CVID p...

Eastwood, D.; Gilmour, Kc; Nistala, K.; Meaney, C.; Chapel, H.; Sherrell, Z.; Webster, Ad; Davies, Eg; Jones, A.; Gaspar, Hb

2004-01-01

247

Second and subsequent tumours among 1927 retinoblastoma patients diagnosed in Britain 1951-2004  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Retinoblastoma is an eye tumour of childhood that occurs in heritable and non-heritable forms. In the heritable form, there is a predisposition to the development of non-ocular subsequent primary tumours (SPTs). Methods: This study included 1927 retinoblastoma patients diagnosed in Britain from 1951 to 2004. Ascertainment was through the (UK) National Registry of Childhood Tumours; cases were followed-up for the occurrence of SPTs. Standardised incidence ratios (SIRs) were calcula...

Maccarthy, A.; Bayne, Am; Brownbill, Pa; Bunch, Kj; Diggens, Nl; Draper, Gj; Hawkins, Mm; Jenkinson, Hc; Kingston, Je; Stiller, Ca; Vincent, Tj; Murphy, Mfg

2013-01-01

248

Psychosocial predictors of suicidal ideation in patients diagnosed with chronic illnesses in jordan.  

Science.gov (United States)

Suicide ideation (SI) is considered a major psychiatric emergency in patients diagnosed with chronic illnesses. Suicide ideation is a multifaceted issue that involves bio- psychosocial and cultural factors that interfere with patients' abilities. The purpose of this study is to investigate the psychosocial predictors of SI among Jordanian patients with chronic illnesses. A cross-sectional design using self-administered questionnaires was used to collect data from 480 patients diagnosed with diabetes mellitus, cardiovascular diseases, and cancer. The mean score of suicide ideation was 4.07 (SD  =  1.7) and almost 20% (n  =  85) of the participants found to be suicidal, the majority were suffering from moderate to severe depressive symptoms and low levels of life satisfaction. Also, the analysis showed that the patients had a high level of optimism and moderate perception of social support from family, friends, and significant other. Type of illness has a significant relation to the 'seriousness' component of SI (p  =  0.023). Depression (?  =  0.345, prisk factor for 'thought' component of SI, and optimism (?  =  -0.008, p<0.05) a significant protective factor against the thought component of SI. Patients with chronic illnesses suffer serious psychological disturbances and are in need of psychological care, and periodic psychological screening to maintain their psychological wellbeing. PMID:25353299

Amer, Nuha Remon Yacoub; Hamdan-Mansour, Ayman M

2014-11-01

249

Treatment outcome of tuberculosis patients in a clinic of Bangalore.  

Science.gov (United States)

A total of 112 cases (New = 101, previously treated = 11) were diagnosed as suffering from tuberculosis (TB) at a private clinic in Bangalore city. The clinic identified TB suspects, established diagnosis of TB, administered direct observation of treatment (DOT), maintained treatment cards and undertook defaulter retrieval actions as and when required. The Revised National Tuberculosis Control Programme (RNTCP) provided support in terms of sputum microscopy supply of patient-wise drug boxes and registration of patients. Ninety six (95.1%) of new cases and 10 (90.9%) of previously treated cases had successful treatment outcome. Most patients completed treatment within the prescribed period. No TB deaths were reported during the period of treatment. PMID:25241566

Subramaniyam, S; Chadha, V K; Manuvel, C; Praseeja, P; Sharada, M A; Nagendra, N; Gupta, J

2014-07-01

250

Hematogenous and lymphatic tumor cell dissemination may be detected in patients diagnosed with ductal carcinoma in situ of the breast.  

Science.gov (United States)

Tumor cell dissemination in bone marrow (BM) and lymph nodes is considered an important step in systemic disease progression and is associated with poor prognosis. Only invasive cancers are assumed to shed isolated tumor cells (ITC) into the bloodstream and infiltrate lymph nodes. However, latest studies indicate that tumor cell dissemination may occur before stroma invasion, i.e., in ductal carcinoma in situ (DCIS). Therefore, the purpose of this study was to examine the incidence of ITC in bone marrow and sentinel lymph nodes (SN) in patients diagnosed with DCIS and its correlation with clinicopathological factors. 266 patients who were treated at the Department of Gynecology and Obstetrics (University Hospital Tuebingen, Germany) between 2003 and 2009 with DCIS were included into this study. BM aspirates were analyzed by immunocytochemistry (pancytokeratin antibody A45-B/B3) using ACIS system (Chromavision) according to the ISHAGE evaluation criteria. SN were analyzed in 221 of these patients by extensive step sectioning and hematoxylin-eosin staining. In 34 of 266 patients (13%), ITC in BM could be detected. There was no correlation found between tumor size, grading, histology, or Van Nuys Prognostic Index and tumor cell dissemination. In two cases, metastatic spread into lymph nodes was observed (pN1mi), whereas in one case, ITC in lymph nodes were detected; however, additional sectioning and immunohistochemical staining of the primary lesion in the cases with positive SN did not reveal invasive cancer. Interestingly, all the three patients were BM negative. Tumor cell dissemination may be detected in patients diagnosed with DCIS. Either these cells have started already to disseminate from preinvasive mammary lesions or from occult invasive tumors or represent the earliest step of microinvasion in a preinvasive lesion. The clinical relevance of these cells has to be further evaluated. PMID:21455667

Banys, Malgorzata; Gruber, Ines; Krawczyk, Natalia; Becker, Sven; Kurth, Ralph; Wallwiener, Diethelm; Jakubowska, Jolanta; Hoffmann, Jürgen; Rothmund, Ralf; Staebler, Annette; Fehm, Tanja

2012-02-01

251

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

Directory of Open Access Journals (Sweden)

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

Ad A. van Bodegraven

2013-09-01

252

Diagnoses and nursing interventions identified in patients with spinal cordy injury: literature systematic review  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: to describe nursing diagnoses identified in patients with spinal cord injury, the diagnosis rate in basic human needs (BHN theory of Wanda de Aguiar Horta to identify nursing interventions to be implemented to minimize and / or resolve the identified diagnoses. Methodology: this is a literature survey in the Virtual Health Library using four search strategies. We selected eight articles. To complement the research was used a dissertation on the subject and the bibliography of Horta. Results: we identified 16 nursing diagnoses, with a prevalence of 87.5% in physiological needs, followed by the psychosocial needs (12.5%. Have been identified diagnostics for the psycho-spiritual needs. Were listed by 26 nurses nursing interventions focused predominantly on the physiological needs (92.31%. Conclusion: it was possible to identify and classify diagnoses and nursing interventions aimed at NHB. It should be emphasized that nurses must have a focused look at all needs to be given assistance in a comprehensive and humane.

Flávia Lima Miranda, Sílvia Marquez Henriques, Camila Moreira Abrahão, Nayara Drumond Gonçalves, Meire Chucre Tannure

2010-05-01

253

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

Directory of Open Access Journals (Sweden)

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

Caldarella C

2013-06-01

254

Rescuing experience of myasthenia gravis crisis (with 38 patients of clinical analysis)  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Our research was designed to explore the more effective rescuing treatment by summarizing clinical features of the patients with myasthenia gravis crisis. During the course, we carried out a retrospective analysis about clinical data and the course of diagnose and treatment of 38 patients (65 cases) with myasthenia gravis crisis who were in hospital in recent 15 years. As a result, most patients with myasthenia gravis crisis relieved after po...

Guohua Zhang; Chengguo Zhang; Guanglun Zeng

2013-01-01

255

Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: To determine the frequency of hypothyroidism in a sample of hyperlipemic patients and evaluate clinical and laboratory factors indicative of thyropathy among them. METHODS: Fifty-one hyperlipemic patients, grouped according to an earlier or recent diagnosis of their thyroid function into euthyroid and hypothyroid, were evaluated with clinical and laboratory examinations of blood levels of free T4 and TSH (by radioimmunoassay. Patients were on average 46.8±11.7 years old, predominantly of the female sex (62.5%; 31% had a previous diagnosis of hypothyroidism and were under treatment with thyroxin. RESULTS: Fourteen three percent of patients analyzed had hypothyroidism, which had not been detected before. Differentiating attributes of the groups analyzed were: a predominance of females among the hypothyroid patients and a higher HDL serum concentration among those recently diagnosed. CONCLUSION: In the present study, new cases of hypothyroidism in hyperlipemic patients were a frequent occurrence, yet few clinical and laboratory data except tests evaluating free T4 and TSH in the blood indicated which patients had thyroid dysfunction.

Castro Ana Valéria Barros de

2001-01-01

256

Clinical and laboratory evaluation of hyperlipemic and hypothyroid patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVE: To determine the frequency of hypothyroidism in a sample of hyperlipemic patients and evaluate clinical and laboratory factors indicative of thyropathy among them. METHODS: Fifty-one hyperlipemic patients, grouped according to an earlier or recent diagnosis of their thyroid function into [...] euthyroid and hypothyroid, were evaluated with clinical and laboratory examinations of blood levels of free T4 and TSH (by radioimmunoassay). Patients were on average 46.8±11.7 years old, predominantly of the female sex (62.5%); 31% had a previous diagnosis of hypothyroidism and were under treatment with thyroxin. RESULTS: Fourteen three percent of patients analyzed had hypothyroidism, which had not been detected before. Differentiating attributes of the groups analyzed were: a predominance of females among the hypothyroid patients and a higher HDL serum concentration among those recently diagnosed. CONCLUSION: In the present study, new cases of hypothyroidism in hyperlipemic patients were a frequent occurrence, yet few clinical and laboratory data except tests evaluating free T4 and TSH in the blood indicated which patients had thyroid dysfunction.

Ana Valéria Barros de, Castro; Alexandra Procópio, Bononi; Flávio, Aragon; Carlos Roberto, Padovani; Célia Regina, Nogueira; Gláucia M. F. da Silva, Mazeto; Walkyria de Paula, Pimenta.

257

Clinical application of bone marrow scintigraphy in diagnosing some hematological diseases  

International Nuclear Information System (INIS)

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

258

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center.  

Science.gov (United States)

Object Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. Methods Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990-2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. Results Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2-77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24-34 months) and 9 months (95% CI 6-11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3-1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6-11 months). Conclusions The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy. PMID:25127097

Suki, Dima; Khoury Abdulla, Rami; Ding, Minming; Khatua, Soumen; Sawaya, Raymond

2014-10-01

259

Assessing the unmet supportive care needs of newly diagnosed patients with cancer.  

Science.gov (United States)

Adequate monitoring in cancer control needs to include measures of psychosocial outcomes so as to take account of the totality of the felt cancer experience. There is a need to know whether the experience of cancer is changing, as well as a need for tools to identify where supportive care interventions or services could be targeted to good effect. The aim of this study was to investigate the utility of using a telephone-administered survey to identify the unmet needs of cancer patients. Participants were identified from a statewide population-based cancer registry following an episode of hospitalized care in Victoria (Australia). Of the 506 eligible patients, 236 completed a telephone adaptation of the Supportive Care Needs Survey-Short Form (SCNS-SF31). Sampling from the cancer registry was shown to provide timely contact with patients. Results from the survey indicated that perceived needs for this newly diagnosed group of cancer patients were mostly in the area of information provision. Results also showed that some socio-demographic and disease-specific variables affected the level of perceived unmet needs. Overall, this study indicated that registry-based sampling was practical and the telephone adaptation of the SCNS-SF31 provided a reliable method to explore the unmet needs of newly diagnosed patients with cancer. PMID:19549286

Sutherland, G; Hill, D; Morand, M; Pruden, M; McLachlan, S-A

2009-11-01

260

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

Directory of Open Access Journals (Sweden)

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

Hummers-Pradier Eva

2011-06-01

 
 
 
 
261

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

Directory of Open Access Journals (Sweden)

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

Chen Xiu-jun

2011-12-01

262

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVES: The aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. METHODS: This study was based on the analysis of secondary data from the Brazilian AIDS Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. RESULTS: 544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5% at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis was very similar in both groups. CONCLUSION: The characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

Marise Oliveira Fonseca

2012-12-01

263

Alteraciones neuroftalmológicas en pacientes con hipertensión endocraneana idiopática Neuro-opththalmologic alterations in patients diagnosed with idiopathic endocranial hypertension  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Determinar el comportamiento de las alteraciones neuroftalmológicas en pacientes con hipertensión endocraneana idiopática. MÉTODOS: Estudio prospectivo en 80 pacientes con hipertensión endocraneana idiopática en el Instituto de Oftalmología "Ramón Pando Ferrer" durante el período 2006-2010, con énfasis en manifestaciones clínicas, examen físico y evaluación del disco por tomografía de coherencia óptica. RESULTADOS: La hipertensión endocraneana idiopática se presentó en el 61 % de mujeres entre 15 y 40 años. Las manifestaciones clínicas predominantes fueron cefalea, oscurecimientos visuales transitorios y diplopía. El examen físico mostró papiledema en todos los pacientes, afectación campimétrica en 87 % y alteraciones del contraste en 79 %, relacionados con el tiempo de evolución. La tomografía de coherencia óptica fue útil para diagnóstico y seguimiento de los casos estudiados. CONCLUSIONES: La hipertensión endocraneana idiopática produce daño funcional visual irreversible en pacientes diagnosticados tardíamente.OBJECTIVE: To determine the behavior of neuro-ophthalmologic alterations of this entity. METHODS: A prospective study was conducted in 80 patients diagnosed with idiopathic endocranial hypertension seen in the "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from 2006 to 2020 emphasizing the clinical manifestations, the physical examination and the assessment of disk by optical coherence tomography. RESULTS: The idiopathic endocranial hypertension was present in the 61 % of women aged between 15 and 40. The predominant clinical manifestations were headache, transient visual darkening and diplopia. The physical examination showed the presence of papilledema in all patients, campimetry affection in the 87 % and contrast alterations in the 79 % related to course time. The optical coherence tomography was useful for diagnosis and follow-up of the study cases. CONCLUSIONS: The idiopathic endocranial hypertension produces a visual functional damage irreversible in patients diagnosed in a late way.

Yannara Elina Columbié Garbey

2011-06-01

264

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

Science.gov (United States)

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

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

2014-08-01

265

[Myelodisplasic syndromes diagnosed in a geriatric hospital: morphological profile in 100 patients].  

Science.gov (United States)

Myelodysplastic syndrome (MDS) is particularly common in geriatric practice. As few data are available in very elderly patients, we conducted a 54-month retrospective study in patients over 70 years with MDS diagnosed at Hôpital Charles Foix. Patients with cobalamine, folate or iron deficiency were excluded. Regarding biological and morphologic approaches, MDS patients were classified according to the FAB criteria. We then tempted to reclassify the patients according to the WHO criteria. The Bournemouth scoring system was used as a prognostic tool. During the study period, 100 patients were included, 29 males and 71 females, median age 86 +/- 7 years (70-103). At the time of bone marrow sampling, a peripheral blood cytopenia was documented in 64 patients, a bicytopenia in 27 patients and a pancytopenia in 9 patients. Isolated anaemia (Hb 100 fL) was observed in 21 % of the cases. According to the FAB criteria, the 100 patients were classified as follows: refractory anaemia (RA): 79%; RA with ringed sideroblasts (RARS): 8%; RA with excess of blasts (RAEB): 8%; RAEB in transformation: 1%; chronic myelomonocytic leukaemia: 4%. According to the WHO classification, the patients were reclassified as follows: RA (unilineage) (with or without ringed sideroblasts): 10%; refractory cytopenia with multilineage dysplasia with or without ringed sideroblasts (RCMD): 73%; RAEB: 7% (RAEB-1 6%, RAEB-21%); MDS/Myeloproliferative disorder: 4%; unclassified (hypocellularity): 5%; acute leukaemia: 1%. In order to estimate prognosis at the time of the bone marrow aspirate, we calculated the Bournemouth'score: 8 patients scored 0,57 scored 1,25 scored 2,8 scored 3 and 2 scored 4. In this geriatric population, 83% cases of MDS are RA or RCMD (with or without sideroblasts); MDS with excess of blasts are uncommon. Thus, elderly patients under study with MDS were diagnosed at an earlier stage of the disease than younger ones from series published in the literature. Due to frequent comorbidities, geriatric patients may be symptomatic for a slight decrease of haemoglobin level. Therefore, elderly patients are investigated as soon as they present with moderate anaemia that may explain the early MDS diagnosis. PMID:15047472

Dewulf, G; Gouin, I; Pautas, E; Gaussem, P; Chaïbi, P; Andreux, J-P; Siguret, V

2004-01-01

266

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

Directory of Open Access Journals (Sweden)

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

Tokunaga Mari

2010-06-01

267

Immunoglobulin light chain amyloidosis is diagnosed late in patients with preexisting plasma cell dyscrasias.  

Science.gov (United States)

AL amyloidosis (AL) is rare and frequently remains undiagnosed until organ function is compromised, even among patients with known pre-existing untreated plasma cell dyscrasias (PCD). We identified 168 patients with AL amyloidosis who had a prior untreated PCD. The earliest symptom or sign (s/s) was defined as the first symptom reported by the patient that could be attributed to organ dysfunction caused by AL. The interval from the time of development of s/s to the establishment of diagnosis of AL (Interval-SA) was calculated. PCD diagnosis preceded recorded onset of s/s in 75% (114/152) of patients, with a median interval-SA for this group of 10 months. PCD was diagnosed after s/s in 25% (38/152) of patients, with a median interval-SA of 20 months. Overall survival (OS) from diagnosis of AL was not different between the two groups. AL amyloidosis patients with an identified pre-existing PCD had less advanced cardiac disease at AL diagnosis when compared to a control group of AL patients without preidentified PCD. Long-term OS was not significantly superior among patients with a pre-identified PCD. In patients with "asymptomatic" PCD, symptoms and signs of AL amyloidosis should be solicited, since timely diagnosis is important in AL amyloidosis. Am. J. Hematol. 89:1051-1054, 2014. © 2014 Wiley Periodicals, Inc. PMID:25111004

Kourelis, Taxiarchis V; Kumar, Shaji K; Go, Ronald S; Kapoor, Prashant; Kyle, Robert A; Buadi, Francis K; Gertz, Morie A; Lacy, Martha Q; Hayman, Suzanne R; Leung, Nelson; Dingli, David; Lust, John A; Lin, Yi; Zeldenrust, Stephen R; Rajkumar, S Vincent; Dispenzieri, Angela

2014-11-01

268

Left atrial function predicts heart failure events in patients with newly diagnosed left ventricular systolic heart failure during short-term follow-up.  

Science.gov (United States)

We assessed the effect of left atrial (LA) function index, LA ejection fraction, LA kinetic energy, and maximal LA volume on 6 months clinical outcome in patients with newly diagnosed systolic heart failure (HF). During a 36-month period, 179 consecutive patients (17% female, mean age 63 ± 14 years) were enrolled. During the follow-up, 46 patients had an event (32% event rate; 15 were fatal). Those with an adverse event were older, had lower creatinine clearance, advanced New York Heart Association stage, higher prevalence of ischemic HF, and lower values for right ventricle systolic wave in the tissue Doppler imaging evaluation, compared with those without an event. Multivariate analysis revealed that LA function and ischemic etiology of HF were the most significant prognostic indicators after index hospitalization. This study reveals the important role of LA function for the short-term prognosis of patients with newly diagnosed systolic HF in sinus rhythm. PMID:24165115

Chrysohoou, Christina; Kotroyiannis, Iason; Antoniou, Christos-Constadinos; Brili, Stella; Vaina, Sophia; Latsios, George; Tousoulis, Dimitris; Pitsavos, Christos; Stefanadis, Christodoulos

2014-10-01

269

[Leishmania (Viannia) braziliensis Vianna, 1911 in French Guiana. Clinical, therapeutic and epidemiological considerations in the ninth human diagnosed case].  

Science.gov (United States)

The authors report the ninth case of cutaneous Leishmaniasis without mucosal involvement due to Leishmania (Viannia) braziliensis (isoenzymatic profile related to zymodeme MON-44) diagnosed in a legionnaire who recently arrived in French Guiana. The skin lesion as a single ulcerated nodule of the dorsum of the left ringfinger was cured after two courses of four intramuscular injections of pentamidine isothionate (total posology of pentamidine-base: 16.6 mg/kg). The transmission occurred during nocturnal trekking in forest and swamps just behind the coastal belt at Degrad Saramaka (7 km South of Kourou). In French Guiana, the good level of medical care and the early treatment of the majority of the cases of Leishmaniasis may explain the rarity of mucosal lesions. Since the clinical aspect of the lesion is not sufficient to prejudge the identity of the causative species, it is necessary to perform cultivation of Leishmania for iso-enzymatic identification. The adaptation of pentamidine doses and long term follow up of patients infected by L. (V.) braziliensis could be defined more precisely. PMID:9264733

Raccurt, C P; Pradinaud, R; Couppie, P; Moreau, B; Pratlong, F; Dedet, J P; Cotellon, P; Juminer, B; Sainte-Marie, D

1996-01-01

270

Serum thrombin activatable fibrinolysis inhibitor levels in patients with newly diagnosed multiple myeloma.  

Science.gov (United States)

Multiple myeloma has been associated with the development of thromboembolic events. Thrombin activatable fibrinolysis inhibitor (TAFI) is a carboxypeptidase B-like proenzyme, which potently inhibits fibrinolysis. The purpose of the present study was to assess the TAFI levels in patients with newly diagnosed multiple myeloma. Twenty-seven newly diagnosed multiple myeloma patients (16 women and 11 men) and 27 age-matched healthy individuals (14 women and 13 men) were included in the study. Serum TAFI levels were significantly increased in patients with multiple myeloma (46 ± 13. 3 vs. 36. 6 ± 9.7 ?g/ml) compared with healthy individuals. Serum TAFI levels were negatively correlated with serum albumin (CC: -0.453, P < 0.05) and hemoglobin levels (CC: -0.392, P < 0.05) and positively correlated with the ?-2 microglobulin levels (CC: 0.524, P < 0.05). In this study, we observed significantly elevated TAFI levels in patients with multiple myeloma and higher serum TAFI levels were suggested to be associated with higher disease stage. With these results, a possible role of elevated TAFI levels in thromboembolic manifestations in the course of multiple myeloma can be suggested. PMID:21297448

Balcik, Ozlem S; Albayrak, Murat; Uyar, Mehtap E; Dagdas, Simten; Yokus, Osman; Ceran, Funda; Cipil, Handan; Kosar, Ali; Ozet, Gulsum

2011-06-01

271

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

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Asthma and obesity are among diseases that cause several problems and impair quality of life.  The concurrence of these diseases, changes in the respiratory physiology, changes associated with obesity and limited activity associated with asthma may cause an interaction between the two conditions. Materials and Methods: We studied the epidemiologic characteristics of all recently diagnosed cases of asthma with no previous treatment who visited the Respiratory Diseases Clinic of the Ghaem Hospital from 2004 to 2007, their Body Mass Indexes (BMI were calculated and then spirometry was performed in all cases. Results: We studied 232 cases with the mean age of 38.96±12.94 years and the mean BMI of 27.05±4.92. Cough and exertional dyspnea were the most common clinical symptoms. In spirometric evaluations, the mean maximum mid-expiratory flow (MMEF increased with weight, which was not, however, insignificant. FVC in obese patients was significantly less than in normal weight cases. A significant correlation was not also seen between BMI and FEV1 (r=-0.023, P=0.729. Conclusion: Except for FVC which had a significant correlation with BMI, other studied indices yielded no significant results, which calls for more extensive studies with larger populations. Considering the fact that mild asthma is less common in obese patients, better weight control in asthmatic patients can promote their quality of life and make asthma management more effective.

Davood Attaran

2011-06-01

272

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

Directory of Open Access Journals (Sweden)

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

A Miranda

2012-11-01

273

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

LENUS (Irish Health Repository)

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

Kellett, John

2009-01-01

274

Visfatin and adiponectin as novel markers for evaluation of metabolic disturbance in recently diagnosed rheumatoid arthritis patients.  

Science.gov (United States)

The aim is to assess metabolic disturbance in early rheumatoid arthritis patients and its relation to the clinical characteristics of patients. Forty recently diagnosed untreated rheumatoid arthritis (RA) patients with disease duration less than 1 year (group I) along with age- and sex-matched forty healthy volunteers who served as controls (group II) were studied. Disease activity score was used to assess disease activity. Blood pressure, BMI, glucose, insulin and complete lipid profile, visfatin, and adiponectin were measured. Insulin resistance (IR) was estimated by the homeostasis model assessment for insulin resistance (HOMA-IR). Beta-cell function was estimated by the homeostasis model assessment (HOMA-B). Also, rheumatoid factor, anticyclic citrullinated peptide antibodies were measured. Group I had significantly higher fasting insulin, HOMA-(IR, B), visfatin, lipid profile (except HDL), and lower adiponectin versus group II (p = 0.000). There were significant positive correlations between visfatin and the following biochemical parameters: insulin, HOMA-IR, HOMA-B, cholesterol, triglycerides, LDL-C (p = 0.05, 0.029, 0.005, 0.001, 0.002, 0.045, respectively). Also, the disease activity score was positively correlated with visfatin (p = 0.003). Meanwhile, there were significant negative correlations between adiponectin and the following biochemical parameters: insulin, HOMA-IR, HOMA-B, cholesterol, triglycerides, LDL-C, visfatin (p = 0.031, 0.023, 0.001, 0.000, 0.000, 0.016, 0.000, respectively). Also, the disease activity score was negatively correlated with adiponectin (p = 0.001). The findings of the present study showed that recently diagnosed untreated RA patients are characterized by a severe metabolic disturbance state that is driven primarily by disease activity. PMID:23471745

El-Hini, Sahar Hossam; Mohamed, Faten Ismail; Hassan, Amel Ali; Ali, Fatma; Mahmoud, Amel; Ibraheem, Hanaa M

2013-09-01

275

Genetical and Clinical Survey of Maple Syrup Urine Disease Patients  

Directory of Open Access Journals (Sweden)

Full Text Available A 54-day old male infant was referred to the hospital because of weakness, lethargy, poor feeding, general hypotonia, nystagmus, pollakisuria and seizures. Blood gas analysis revealed metabolic acidosis. PT and PTT was disturbed. Brain sonography showed possible hemorrhagy in basal ganglia. The patient died in respiratory distress. Urine chromatography showed broad leucine, isoleucine and valine bands. Maple syrup urine disease was diagnosed. We review in brief genetical, biochemical and clinical aspects of maple syrup urine disease and its different types.

MT Haghi Ashtiani

2000-06-01

276

Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-na?ve Japanese patients with early-diagnosed Crohn's disease  

Science.gov (United States)

Background Early induction with biologics can reduce complications in patients with Crohn’s disease (CD) and improve their quality of life. The safety of biologics, however, is uncertain. Granulocyte and monocyte adsorptive apheresis (GMAA) is a natural biologic therapy that selectively removes granulocytes and monocytes/macrophages and has few severe adverse effects. The effects of GMAA on patients with early-diagnosed CD are unclear. We investigated the effects of GMAA combined with thiopurines on patients with early-diagnosed CD. Methods Twenty-two corticosteroid- and biologic-naïve patients with active early-diagnosed CD were treated with intensive GMAA (twice per week) combined with thiopurines administration. Active early-diagnosed CD was defined as follows: (i) within 2years after diagnosis of CD, (ii) with no history of both surgical treatment and endoscopic dilation therapy, and (iii) Crohn’s Disease Activity Index (CDAI) was higher than 200. We investigated the ratios of clinical remission defined as CDAI was less than or equal to 150 at 2, 4, 6 and 52weeks and mucosal healing defined as a Simplified Endoscopic Activity Score for Crohn’s Disease (SES-CD) as 0 at 6 and 52weeks. Adverse events were recorded at each visit. Results The ratios of clinical remission at 2, 4, and 6 weeks were 6 of 22 (27.2%), 12 of 22 (54.5%), and 17 of 22 (77.2%), respectively. At 52 weeks, 18 of 21 patients (81.8%) were in clinical remission. The ratios of mucosal healing at 6 and 52 weeks were 5 of 22 (22.7%) and 11 of 22 (50%), respectively. The difference in the mucosal healing ratio was significant between 6 and 52 weeks (p?=?0.044). No serious adverse effects were observed during this study. Conclusions Combination therapy with intensive GMAA and thiopurines administration rapidly induced high remission in patients with active early-diagnosed CD without serious adverse effect. Mucosal healing was observed in 50.0% of enrolled patients. This combination therapy might be a rational option for patients with early-diagnosed CD. PMID:25015328

2014-01-01

277

Population-based consultation patterns in patients with shoulder pain diagnoses  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background To assess the annual consultation prevalence and new onset consultation rate for doctor-diagnosed shoulder pain conditions. Methods We identified all residents in the southernmost county in Sweden who received a shoulder pain diagnosis during 2006 (ICD-10 code M75. In subjects who did not consult due to such disorders during 2004 and 2005, we estimated the new onset consultation rate. The distribution of specific shoulder conditions and the length of the period of repeated consultation were calculated. Results Annual consultation prevalence was 103/10 000 women and 98/10 000 men. New onset consultation rate was 80/10 000 women (peak in age 50–59 at 129/10 000 and 74/10 000 men (peak in age 60–69 at 116/10 000. About one fifth of both genders continued to consult more than three months after initial presentation, but only a few percent beyond two years. Rotator cuff - and impingement syndromes were the most frequent diagnoses. Conclusion The annual consultation prevalence for shoulder pain conditions (1% was similar in women and men, and about two thirds of patients consulted a doctor only once. Impingement and rotator cuff syndromes were the most frequent diagnoses.

Tekavec Eva

2012-11-01

278

Long-term test-retest reliability of personality disorder diagnoses in opiate dependent patients.  

Science.gov (United States)

This investigation reports the two year test-retest reliability of DSM-III-R personality disorder (PD) diagnoses in a sample of 219 patients with opiate dependence admitted to methadone treatment. Different MA/PhD interviewers at each assessment used a semistructured diagnostic interview for PD, the Structured Interview for DSM-III-R Personality Disorders (SIDP-R), to make their diagnoses. The reliability of any PD diagnosis versus no PD was fair (kappa = .51). The reliability for any specific PD (weighted kappa = .31) was poor. Antisocial (kappa = .45) and sadistic (kappa = .42), were the only specific PDs for which at least fair reliability was achieved. At the cluster level, only Cluster B had fair reliability (kappa = .47). The intraclass correlation coefficients between number of criteria for the specific PDs at the two evaluation points were consistently higher (range .22 to .62.) than were the corresponding kappas for categorical diagnoses. In that the base rates for most of the PDs were low and agreement for the specific PDs typically exceeded 90%. Increasing the base rate by lowering the diagnostic threshold, or examining more severe cases by raising the diagnostic threshold, did not consistently effect reliability. Reasons for the low kappa coefficients and the implications for PD research are discussed. PMID:9891287

Cacciola, J S; Rutherford, M J; Alterman, A I; McKay, J R; Mulvaney, F D

1998-01-01

279

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

DEFF Research Database (Denmark)

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

Ciet, Pierluigi; Wielopolski, Piotr

2014-01-01

280

Newly diagnosed adult AML and MPAL patients frequently show clonal residual hematopoiesis.  

Science.gov (United States)

Adult acute myeloid leukemia (AML) is a highly heterogeneous stem cell malignancy characterized by the clonal expansion of immature myeloid precursors. AML may emerge de novo, following other hematopoietic malignancies or after cytotoxic therapy for other disorders. Here, we investigated the clonal vs reactive nature of residual maturing bone marrow cells in 59 newly diagnosed adult AML and mixed phenotype acute leukemia (MPAL) patients as assessed by interphase fluorescence in situ hybridization analysis of AML and myelodysplastic syndrome-associated cytogenetic alterations and/or the pattern of chromosome X inactivation, in females. In addition, we investigated the potential association between the degree of molecular/genetic involvement of hematopoiesis and coexistence of altered immunophenotypes by flow cytometry. Our results indicate that residual maturing neutrophils, monocytes and nucleated red cell precursors from the great majority of newly diagnosed AML and MPAL cases show a clonal pattern of involvement of residual maturing hematopoietic cells, in association with a greater number of altered immunophenotypes. These findings are consistent with the replacement of normal/reactive hematopoiesis by clonal myelopoiesis and/or erythropoiesis in most newly diagnosed AML and MPAL cases, supporting the notion that in most adults presenting with de novo AML, accumulation of blast cells could occur over a pre-existing clonal hematopoiesis. PMID:23579575

Fernandez, C; Santos-Silva, M C; López, A; Matarraz, S; Jara-Acevedo, M; Ciudad, J; Gutierrez, M L; Sánchez, M L; Salvador-Osuna, C; Berruezo, M J; Díaz-Arias, J Á; Palomo-Hernández, A M; Colado, E; González, N; Gallardo, D; Asensio, A; García-Sánchez, R; Saldaña, R; Cerveró, C; Carboné-Bañeres, A; Gutierrez, O; Orfao, A

2013-11-01

 
 
 
 
281

Incidentally diagnosed giant invasive sacral schwannoma. Its clinical features and surgical management without stability.  

Science.gov (United States)

Schwannomas are benign encapsulated tumors of Schwan cells that grow slowly along the peripheral myelin nerve fibers. Sacral spinal schwannomas are very rare, and the incidence of sacral schwannoma ranges from 1-5% of all spinal schwannomas, and only around 50 cases are reported in the literature. There are 3 defined types of sacral schwannomas. These are retroperitoneal or presacral, intra osseous, and spinal schwannomas. Patients commonly present with complaints of pain and paresthesia due to the spinal schwannoma extending to extra spinal tissues. Direct x-ray, CT, MRI, and scintigraphy are used for preoperative diagnosis and treatment planning. Local recurrence and transformation to malignancy is very rare. For this reason, the frequently preferred treatments are subtotal removal of the mass or simple enucleation. In our article, we discuss the clinical features and the surgical treatment we performed without the need for stabilization in an incidentally determined giant invasive schwannoma case. PMID:24983285

Togral, Guray; Arikan, Murat; Hasturk, Askin E; Gungor, Safak

2014-07-01

282

C9ORF72 repeat expansions and other FTD gene mutations in a clinical AD patient series from Mayo Clinic  

Science.gov (United States)

Alzheimer disease (AD) and frontotemporal dementia (FTD) are two frequent forms of primary neurodegenerative dementias with overlapping clinical symptoms. Pathogenic mutations of the amyloid precursor protein (APP) and presenilins 1 and 2 (PSEN1, PSEN2) genes have been linked to familial early-onset forms of AD; however, more recently mutations in the common FTD genes encoding the microtubule associated protein tau (MAPT), progranulin (GRN) and C9ORF72, have also been reported in clinically diagnosed AD patients. To access the contribution of mutations in a well-characterized series of patients, we systematically performed genetic analyses of these EOAD and FTD genes in a novel cohort of 227 unrelated probands clinically diagnosed as probable AD which were ascertained at Mayo Clinic Florida between 1997 and 2011. All patients showed first symptoms of dementia before 70 years. We identified 9 different pathogenic mutations in the EOAD genes in a total of 11 patients explaining 4.8% of the patient population. Two mutations were novel: PSEN1 p.Pro218Leu and PSEN2 p.Phe183Ser. Importantly, mutations were also identified in all FTD genes: one patient carried a MAPT p.R406W mutation, one patient carried the p.Arg198Glyfs19X loss-of-function mutation in GRN and two patients were found to carry expanded GGGGCC repeats in the non-coding region of C9ORF72. Together the FTD genes explained the disease in 1.8% of our probable AD population. The identification of mutations in all major FTD genes in this novel cohort of clinically diagnosed AD patients underlines the challenges associated with the differential diagnosis of AD and FTD resulting from overlapping symptomatology and has important implications for molecular diagnostic testing and genetic counseling of clinically diagnosed AD patients. Our findings suggest that in clinically diagnosed AD patients, genetic analyses should include not only the well-established EOAD genes APP, PSEN1 and PSEN2 but also genes that are usually associated with FTD. Finally, the overall low frequency of mutation carriers observed in our study (6.6%) suggests the involvement of other as yet unknown genetic factors associated with AD. PMID:23383383

Wojtas, Aleksandra; Heggeli, Kristin A; Finch, NiCole; Baker, Matt; DeJesus-Hernandez, Mariely; Younkin, Steven G; Dickson, Dennis W; Graff-Radford, Neill R; Rademakers, Rosa

2012-01-01

283

[A case of clinically diagnosed corticobasal degeneration with unilateral cortical reflex myoclonus showing so-called giant SEP].  

Science.gov (United States)

We report a 66-year-old woman clinically diagnosed as having a corticobasal degeneration (CBD), who showed electrophysiologically cortical reflex myoclonus. She developed a clumsiness and action myoclonus on the right extremities, and aphasia. The extrapyramidal signs such as dystonia and rigidity were also noted on the right side. Sequential MR images showed a progressive brain atrophy in the left frontoparietal area, where a blood perfusion was reduced on single photon emission computed tomography (SPECT). The median nerve stimulation on the affected right side, but not left side, elicited an enhanced long-loop reflex. The onset latency of the long-loop reflex (43.8msec) was similar to that of the reported cases of CBD (Thompson et al, 1994); but, significantly shorter than that reported in the patients with typical cortical reflex myoclonus. The right median nerve stimulation also elicited so-called giant somatosensory evoked potentials (SEPs). On the basis of the scalp topography of the giant SEPs, we found the high amplitude central P22-N30 components to reflect a radial dipole. We also recorded the myoclonus-related cortical spike by jerk-locked back averaging. Both the giant SEP and myoclonus-related cortical spike were recorded only on the left scalp. We therefore suggest that these two cortical activities are similar in terms of wave form, scalp topography and time relationship to either the long-loop reflex or myoclonus and may be located in the precentral area. This is the first report of a patient with CBD presenting both the giant SEP and myoclonus-related cortical spike. PMID:10548907

Tanosaki, M; Okushima, T; Ozaki, I; Baba, M; Matsunaga, M

1999-07-01

284

Nursing diagnoses for the immediate postoperative period of patients submitted to liver transplantation  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: The objective of this study was to identify the nursingdiagnoses in the immediate postoperative period of patientssubmitted to liver transplantation. Methods: Retrospective studycarried out by examination of the digitalized medical charts ofpatients submitted to liver transplantation from July 1st toDecember 31st, 2002. Results: Twenty-three patients had undergoneliver transplantation in the period determined for the study. Threehundredand eleven nursing diagnoses classified in 27 categorieswere found. Conclusion: Incidence of 100% of the following diagnosiswas observed: bathing/hygiene self-care deficit, impaired tissueintegrity, impaired bed mobility, risk for aspiration, risk for infection,risk for impaired skin integrity, and risk for falls.

Tatiane Ramos Canero

2004-06-01

285

Celiac disease and diabetes mellitus diagnosed in a pediatric patient with Hirschsprung disease.  

Science.gov (United States)

Hirschsprung disease is a disorder of neural crest migration characterized by intestinal aganglionosis along a variable segment of the gastrointestinal tract. It is a complex disorder associated with several syndromes. Celiac disease is an autoimmune enteropathy characterized by dietary intolerance to gluten proteins and can be associated with autoimmune conditions such as diabetes mellitus. Celiac disease can mimic Hirschsprung disease when presenting with constipation and abdominal distention. We present the case of celiac disease diagnosed in a patient with Hirschsprung disease who subsequently developed type one diabetes mellitus. PMID:22475248

Menchise, Alexandra Nicole; Condino, Adria A; Levitt, Marc A; Hebra, Andre; Wilsey, Michael J

2013-02-01

286

Few differences in cytokines between patients newly diagnosed with type 1 diabetes and their healthy siblings  

DEFF Research Database (Denmark)

The cause of the worldwide increase in type 1 diabetes (T1D) is largely unknown. T cells are thought to play a role in disease progression. In contemporary research over the last decade, age- and gender-specific serum levels as well as changes of Th1 and Th2-related cytokines are not well described. From a population-based register of children diagnosed from 1997 to 2005 this study explores eight different cytokines at time of diagnosis. Only TGF-? and IL-18 showed higher levels in patients compared to siblings in an adjusted model (p

Svensson, Jannet; Eising, Stefanie

2012-01-01

287

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

International Nuclear Information System (INIS)

Purpose: To report toxicity and overall survival (OS) in patients with newly diagnosed glioblastoma multiforme (GBM) treated with hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ). Methods and Materials: Patients with newly diagnosed GBM after biopsy or resection and with adequate performance status and organ or bone marrow function were eligible for this study. Patients received postoperative hypo-IMRT to the surgical cavity and residual tumor seen on T1-weighted brain MRI with a 5-mm margin to a total dose of 60 Gy in 10 fractions (6 Gy/fraction) and to the T2 abnormality on T2-weighted MRI with 5-mm margin to 30 Gy in 10 fractions (3 Gy/fraction). Concurrent TMZ was given at 75 mg/m2/day for 28 consecutive days. Adjuvant TMZ was given at 150 to 200 mg/m2/day for 5 days every 28 days. Toxicities were defined using Common Terminology Criteria for Adverse Events version 3.0. Results: Twenty-four patients were treated, consisting of 14 men, 10 women; a median age of 60.5 years old (range, 27–77 years); and a median Karnofsky performance score of 80 (range, 60–90). All patients received hypo-IMRT and concurrent TMZ according to protocol, except for 2 patients who received only 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 6.5 (range, 0–14).With a median follow-up of 14.8 months (range, 2.7–34.2 months) for all patients and a minimum follow-up of 20.6 months for living patients, no instances of grade 3 or higher nonhematologic toxicity were observed. The median OS was 16.6 months (range, 4.1–35.9 months). Six patients underwent repeated surgery for suspected tumor recurrence; necrosis was found in 50% to 100% of the resected specimens. Conclusion: In selected GBM patients, 60 Gy hypo-IMRT delivered in 6-Gy fractions over 2 weeks with concurrent and adjuvant TMZ is safe. OS in this small cohort of patients was comparable to that treated with current standard of care therapy.

288

Nilotinib as frontline therapy for patients with newly diagnosed Ph+ chronic myeloid leukemia in chronic phase: results from the Japanese subgroup of ENESTnd.  

Science.gov (United States)

Recent results from the phase 3 ENESTnd (Evaluating Nilotinib Efficacy and Safety in Clinical Trials-Newly Diagnosed Patients) study have demonstrated superiority of nilotinib over imatinib for the treatment of newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia in the chronic phase (CML-CP). Here, we report results from the Japanese subset of patients in ENESTnd, and assess whether results in this subpopulation are consistent with the overall study population. Seventy-nine Japanese patients with CML-CP were randomized to receive nilotinib 300 mg twice daily (BID) (n = 30), nilotinib 400 mg BID (n = 24) or imatinib 400 mg once daily (QD) (n = 25). Major molecular response rates at 12 months, the primary endpoint, were at least twice as high for nilotinib 300 mg BID (57%) and nilotinib 400 mg BID (50%) compared with imatinib 400 mg QD (24%). No patient on nilotinib progressed, while one patient progressed on imatinib. Both drugs were generally well tolerated and discontinuations due to adverse events were comparable among treatment arms. The results in the subpopulation of Japanese patients from ENESTnd closely mirror the results of the overall population, and support the use of nilotinib at 300 mg BID in Japanese patients with newly diagnosed CML-CP. PMID:21523338

Nakamae, Hirohisa; Shibayama, Hirohiko; Kurokawa, Mineo; Fukuda, Tetsuya; Nakaseko, Chiaki; Kanda, Yoshinobu; Nagai, Tadashi; Ohnishi, Kazunori; Maeda, Yasuhiro; Matsuda, Akira; Amagasaki, Taro; Yanada, Masamitsu

2011-05-01

289

Clinical presentation of patients with symptomatic anterior hip impingement.  

Science.gov (United States)

Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97 degrees and 9 degrees, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder. PMID:19130160

Clohisy, John C; Knaus, Evan R; Hunt, Devyani M; Lesher, John M; Harris-Hayes, Marcie; Prather, Heidi

2009-03-01

290

[Nursing diagnoses  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The history and the evolution of nursing diagnoses in the USA are briefly presented, together with the main controversies and objections against their widespread introduction and use in Europe. Though the creation of a nursing diagnoses taxonomy might be a very exacting but culturally stimulating task, one of the main problems to overcome is the identification of a theoretical framework. Clinical and theoretical research is needed to validate in our culture the process of formulation and the ...

Di Giulio, Paola

1992-01-01

291

Accuracy of EUS for estimating the depth of tumor invasion and for diagnosing lymph node metastasis and recurrence in patients with m3 and sm esophageal carcinomas  

International Nuclear Information System (INIS)

Esophagus-preserving therapy has been increasingly used to treat esophageal cancer invading the m3 and sm, thereby avoiding radical surgery. However, many problems remain to be solved, including the diagnosis of lymph node metastasis and recurrence and the assessment of long-term outcomes. We studied 132 patients who had esophageal cancer with m3 and sm invasion. Clinical course after esophagus-preserving therapy, and the accuracy and roles of endoscopic ultrasonography (EUS) for diagnosing the depth of tumor invasion, lymph node metastasis, and recurrence were assessed. EUS can be used to examine the cervical, thoracic, and abdominal regions, without being affected by heat beats. Therefore, EUS can more clearly depict lymph nodes than CT or US. The accuracy of EUS was 86.4% for estimating the depth of tumor invasion and 82% for diagnosing lymph node metastasis. All cases of nodal recurrence were diagnosed by EUS. Among patients who received chemoradiotherapy, enlarged lymph nodes often appeared around 3 years after treatment, and recurrence was diagnosed slightly later than that in patients who underwent endoscopic mucosal resection. Endoscopic ultrasound-guided fine-needle aspiration biopsy was sometimes performed to determine the treatment policy. Patients who receive chemoradiotherapy should undergo regular long-term follow-up by CT, US, and EUS. EUS is essential for the earlier detection of recurrence. (author)

292

Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Childhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire. Methods In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104 born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191 was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158 and controls (n = 171 completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions. Results Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort. Conclusion A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community.

Trell Erik

2005-04-01

293

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

Science.gov (United States)

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

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

2013-08-06

294

Survival benefit from boron neutron capture therapy for the newly diagnosed glioblastoma patients  

International Nuclear Information System (INIS)

Objective: Since 2002-2007, we applied boron neutron capture therapy (BNCT) to >50 cases of malignant gliomas (MGs) with epithermal neutron irradiations. Recently, we showed the early radiographical improvement of malignant glioma patients by our modified BNCT, with simultaneous use of BPA (borono-phenylalanine) and BSH (sodium borocaptate). In this time, we focused on the survival benefit from BNCT for the newly diagnosed glioblastoma patients. Methods: BNCT group including 21 newly histological confirmed glioblastoma patients treated with surgical removal followed by BNCT in Osaka Medical College during 2002-2006 period. Ten patients were treated with BNCT only, and in the other 11 patients, 20-30 Gy fractionated external beam X-ray irradiation therapy (XRT) was performed after BNCT. No chemotherapy was administered until tumor progression was observed. Results: Treatments were well tolerated. Any kind of acute systemic or local severe toxicity were not demonstrated. Mean over all survival of the patients treated by BNCT was 20.7 and the median was 15.6 months with 2-years survival of 25%. Stratification by RPA criteria showed 6, 6, 8 and 1 patients, respectively, in classes III-VI. Three patients out of six in class III and one out of eight in class V are alive at the end point of this study. All the patients in classes IV and VI died. Median survival time for the BNCT group compared to the RTOG database was as follows: 20.6 months vs. 17.9 months for class III; 166 months vs. 17.9 months for class III; 16.9 months vs. 11.1 months for class IV; 13.2 months vs. 8.9 months for class V. Conclusion: The RTOG RPA prognostic criteria were helpful in establishing which class of glioma patients could potentially benefit from BNCT. BNCT showed a survival benefit in all of the RPA classes of the RTOG database not only for the good prognosis group.

295

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

Directory of Open Access Journals (Sweden)

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

Gulbun YUKSEL

2007-03-01

296

Alteraciones neuroftalmológicas en pacientes con hipertensión endocraneana idiopática / Neuro-opththalmologic alterations in patients diagnosed with idiopathic endocranial hypertension  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish OBJETIVO: Determinar el comportamiento de las alteraciones neuroftalmológicas en pacientes con hipertensión endocraneana idiopática. MÉTODOS: Estudio prospectivo en 80 pacientes con hipertensión endocraneana idiopática en el Instituto de Oftalmología "Ramón Pando Ferrer" durante el período 2006-2010 [...] , con énfasis en manifestaciones clínicas, examen físico y evaluación del disco por tomografía de coherencia óptica. RESULTADOS: La hipertensión endocraneana idiopática se presentó en el 61 % de mujeres entre 15 y 40 años. Las manifestaciones clínicas predominantes fueron cefalea, oscurecimientos visuales transitorios y diplopía. El examen físico mostró papiledema en todos los pacientes, afectación campimétrica en 87 % y alteraciones del contraste en 79 %, relacionados con el tiempo de evolución. La tomografía de coherencia óptica fue útil para diagnóstico y seguimiento de los casos estudiados. CONCLUSIONES: La hipertensión endocraneana idiopática produce daño funcional visual irreversible en pacientes diagnosticados tardíamente. Abstract in english OBJECTIVE: To determine the behavior of neuro-ophthalmologic alterations of this entity. METHODS: A prospective study was conducted in 80 patients diagnosed with idiopathic endocranial hypertension seen in the "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from 2006 to 2020 emphasizing the cl [...] inical manifestations, the physical examination and the assessment of disk by optical coherence tomography. RESULTS: The idiopathic endocranial hypertension was present in the 61 % of women aged between 15 and 40. The predominant clinical manifestations were headache, transient visual darkening and diplopia. The physical examination showed the presence of papilledema in all patients, campimetry affection in the 87 % and contrast alterations in the 79 % related to course time. The optical coherence tomography was useful for diagnosis and follow-up of the study cases. CONCLUSIONS: The idiopathic endocranial hypertension produces a visual functional damage irreversible in patients diagnosed in a late way.

Yannara Elina, Columbié Garbey; Mayttee, Herrera Padrón; Yaimara, Hernández Silva; Odelaisys, Hernández Echavarría; Léster, Pola Alvarado; Rosaralis, Santiesteban Freixas.

2011-06-01

297

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

Directory of Open Access Journals (Sweden)

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

Milisavljevi? Nemanja

2013-01-01

298

Distinguishing SWEDDs Patients with Asymmetric Resting Tremor from Parkinson's Disease: A Clinical and Electrophysiological Study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Approximately 10% of patients diagnosed clinically with early Parkinson's disease (PD) have normal dopaminergic functional imaging (Scans Without Evidence of Dopaminergic Deficit [SWEDDs]). An important subgroup of SWEDDs are those with asymmetric rest tremor resembling parkinsonian tremor. Clinical and pathophysiological features which could help to distinguish SWEDDs from PD have not been explored. We therefore studied clinical details including non-motor symptoms in 25 tremulous SWEDDs pat...

Schwingenschuh, P.; Ruge, D.; Edwards, M. J.; Terranova, C.; Katschnig, P.; Carrillo, F.; Silveira-moriyama, L.; Schneider, S. A.; Kagi, G.; Palomar, F. J.; Talelli, P.; Dickson, J.; Lees, A. J.; Quinn, N.; Mir, P.

2010-01-01

299

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

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

2010-01-01

300

Demographic and Clinical Outcomes of the Patients with Shoulder Pain  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose: Localized shoulder pain is one of the most important pathologies of musculoskeletal system. A prevalence study has revealed that it is the third most common pathology among the locomotor system diseases. The aim of this study was to evaluate the statistical results of the demographic and clinical information regarding patients, who applied to our clinic with shoulder pain. Methods: Information of 68 patients with shoulder pain, who were registered in the first 6 months of 2011 to our Physical medicine and rehabilitation Clinique were examined. Patients' demographic data and information regarding their complaints were obtained (e.g. duration, diagnosis, treatment, and so on. and statistical analyses were performed on these findings. Results: Totally findings of 42 patients were obtained. The majority of patients were female, who were housewives. A large proportion of complaints were chronic with multiple diagnoses. Almost all patients received combined treatments. Conclusion: Even though our findings are in accordance with the literature, the low sampling size was a significant limitation. [Cukurova Med J 2013; 38(2.000: 170-173

Bayram Kelle

2013-04-01

 
 
 
 
301

ANALYSIS OF THE LEVEL OF PROGESTERONE IN PATIENTS WITH NEWLY DIAGNOSED RESPIRATORY SARCOIDOSIS  

Directory of Open Access Journals (Sweden)

Full Text Available Sarcoidosis is a multi-system disease of unknown causes development. Aim: study of the level of progesterone blood of patients with sarcoidosis, depending on their gender. Materials and methods: a defined level of progesterone blood serum in 71 patients with newly diagnosed with sarcoidosis aged 20 to 65 years. Results: comparing indices of progesterone 31st men with respiratory sarcoidosis and the control group was discovered a higher level of progesterone among patients. Depending on the indications to the treatment with glucocorticoids were also found statistically significant differences. The analysis of progesterone blood in patients with sarcoidosis in the reproductive age is statistically significant difference between the level of progesterone in women, which the recommended therapy with glucocorticosteroids, and who is not. The first group he significantly lower than in the second group, as well as reduced as compared with a control group of healthy women. When studying the level of progesterone in the patients in the period of menopause, which is not recommended by hormone therapy, indicators are statistically significantly higher in comparison with the control group, consisting of healthy postmenopausal women age (p<0.05. Conclusion: the necessity of detailed studying of the state of sexual hormones to treat sarcoidosis and the background of the different regimens.DOI: http://dx.doi.org/10.12731/2218-7405-2014-2-4

????? ???????????? ???????????

2014-03-01

302

Treatment of newly diagnosed myeloma in patients not eligible for transplantation.  

Science.gov (United States)

Melphalan plus prednisone (MP) has long been considered the gold-standard treatment for elderly patients with newly diagnosed myeloma, and it still forms the backbone for combinations based on novel agents. MP plus thalidomide (MPT), bortezomib (VMP), or lenalidomide (MPR), as induction plus maintenance, have proved to be superior to MP and are currently the treatment of choice for this population. Low-dose dexamethasone in combination with thalidomide and cyclophosphamide (CTDa) or with lenalidomide can be an alternative option for these patients. The benefit of these novel agents in terms of prolonged survival is accompanied by increases in treatment-related adverse events, however, which may be particularly pronounced in older individuals. In managing these patients, efficacy and toxicity should be balanced, and thus prophylactic measures to avoid adverse effects are mandatory. Moreover, reduced-intensity regimens are recommended for fragile or very elderly patients. Finally, the wide array of new treatment options will facilitate individualized treatment approaches, based on characteristics of the disease, patient comorbidities, and personal and social circumstances. PMID:21347656

Mateos, M Victoria; San-Miguel, Jesús

2011-06-01

303

Electrophysiological assessment of visual function in newly-diagnosed IDDM patients.  

Science.gov (United States)

Electrophysiological tests (electroretinogram, oscillatory potentials, visual evoked potentials, in the basal condition and after photostress) reveal an abnormal function of the visual system in insulin-dependent diabetic (IDDM) patients. The aim of our work was to assess whether electrophysiological abnormalities in visual function exist in newly-diagnosed diabetic patients free of any fluorangiographic signs of retinopathy. Ten control subjects (age 28.7 +/- 2.44 years) and then IDDM patients (age 25.2 +/- 6.78 years; disease duration 5.3 +/- 3.5 months) in stable metabolic control (HbA1C 7.5 +/- 1.1%) were evaluated. Flash-electroretinograms and oscillatory potentials were similar in both groups. Visual evoked potentials (VEP) recorded under basal conditions showed that P100 latency was significantly increased in the diabetic patients compared to control subjects (p VEP after photostress was equivalent in diabetic patients and control subjects. The impaired basal VEPs suggest an early involvement of the nervous conduction in the optic nerve. However, the preserved flash-electroretinogram and the normal recovery time after photostress indicate that a short disease duration does not induce physiopathological changes in the outer retinal layers or in the macular function. PMID:7556982

Uccioli, L; Parisi, V; Monticone, G; Parisi, L; Durola, L; Pernini, C; Neuschuler, R; Bucci, M G; Menzinger, G

1995-07-01

304

Prevalence of Lynch Syndrome among Patients with Newly Diagnosed Endometrial Cancers  

Science.gov (United States)

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

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

2013-01-01

305

Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure.  

Science.gov (United States)

Patients with acute myeloid leukemia (AML) may present with early complications from sepsis or leukemic infiltration. Benefits from early in-intensive care unit (ICU) hematological management was evaluated in 42 adults with newly diagnosed AML with hematological risk of early death (age 46 years, French-American-British [FAB] M4/5 58%, leukocytes 103 × 10(9)/L) first admitted to the ICU without immediate life support (early-ICU). Controls were 42 patients primarily admitted to hematology wards, matched for age, leukocytes and FAB subtype. Twenty (47.6%) control patients were subsequently admitted to the ICU (late-ICU). Late-ICU patients presented with increased respiratory and cardiac rates, decreased oxygen saturation (SpO(2)) and blood pressure, at hospital admission. Late-ICU admission resulted in increased use of mechanical ventilation (60% vs. 33%) and vasopressors (60% vs. 16%), longer ICU stay (9 [6-25] vs. 5 [2-9] days) and decreased ICU survival (65% vs. 79%). Direct admission to the ICU of patients with high-risk AML with physiological disturbances but no organ dysfunction is associated with improved outcomes. PMID:22233111

Lengliné, Etienne; Raffoux, Emmanuel; Lemiale, Virginie; Darmon, Michael; Canet, Emmanuel; Boissel, Nicolas; Schlemmer, Benoît; Dombret, Hervé; Azoulay, Elie

2012-07-01

306

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVES: The aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS) at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. METHODS: This study was based on the analysis of secondary data from the Brazilian AIDS [...] Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. RESULTS: 544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5%) at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM) was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis) was very similar in both groups. CONCLUSION: The characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

Marise Oliveira, Fonseca; Unaí, Tupinambás; Artur Iuri Alves de, Sousa; Kathy, Baisley; Dirceu Bartolomeu, Greco; Laura, Rodrigues.

307

Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma.  

Science.gov (United States)

Reliable data on large cohorts of patients with glioblastoma are needed because such studies differ importantly from trials that have a strong bias toward the recruitment of younger patients with a higher performance status. We analyzed the outcome of 676 patients with histologically confirmed newly diagnosed glioblastoma who were treated consecutively at a single institution over a 7-year period (1997-2003) with follow-up to April 30, 2006. Survival probabilities were 57% at 1 year, 16% at 2 years, and 7% at 3 years. Progression-free survival was 15% at 1 year. Prolongation of survival was significantly associated with surgery in patients with a good performance status, whatever the patient's age, with an adjusted hazard ratio of 0.55 (p < 0.001) or a 45% relative decrease in the risk of death. Radiotherapy and chemotherapy improved survival, with adjusted hazard ratios of 0.61 (p = 0.001) and 0.89 (p = 0.04), respectively, regardless of age, performance status, or residual tumor volume. Recurrence occurred in 99% of patients throughout the follow-up. Reoperation was performed in one-fourth of these patients but was not effective, whether performed within 9 months (hazard ratio, 0.86; p = 0.256) or after 9 months (hazard ratio, 0.98; p = 0.860) of initial surgery, whereas second-line chemotherapy with procarbazine, lomustine, and vincristine (PCV) or with temozolomide improved survival (hazard ratio, 0.77; p = 0.008). Surgery followed by radiotherapy and chemotherapy should be considered in all patients with glioblastoma, and these treatments should not be withheld because of increasing age alone. The benefit of second surgery at recurrence is uncertain, and new trials are needed to assess its effectiveness. Chemotherapy with PCV or temozolomide seems to be a reasonable option at tumor recurrence. PMID:17993634

Filippini, Graziella; Falcone, Chiara; Boiardi, Amerigo; Broggi, Giovanni; Bruzzone, Maria G; Caldiroli, Dario; Farina, Rita; Farinotti, Mariangela; Fariselli, Laura; Finocchiaro, Gaetano; Giombini, Sergio; Pollo, Bianca; Savoiardo, Mario; Solero, Carlo L; Valsecchi, Maria G

2008-02-01

308

Daily intake of antioxidants in relation to survival among adult patients diagnosed with malignant glioma  

Directory of Open Access Journals (Sweden)

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

Il'yasova Dora

2010-05-01

309

Endocan-a novel inflammatory indicator in newly diagnosed patients with hypertension: a pilot study.  

Science.gov (United States)

Endothelial dysfunction is regarded as the initial lesion in the development of atherosclerosis. Endocan, previously called endothelial cell-specific molecule 1 (ESM-1), is a new candidate immunoinflammatory marker that may be associated with cardiometabolic risk factors. Therefore, we assessed serum levels of endocan in newly diagnosed patients with untreated essential hypertension (HT). A total of 18 patients with HT and 23 normotensive control participants were included in the study. Serum endocan levels, carotid intima-media thickness (cIMT), and high-sensitivity C-reactive protein (hsCRP) were measured. Serum endocan levels were significantly higher in the HT group (P < .001). In patients with HT, serum endocan levels correlated positively with cIMT and hsCRP (r = .551, P < .001 and r = .644, P < .001, respectively). Our findings suggest that circulating endocan levels represent a new marker in patients with essential HT. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders. PMID:24402320

Balta, Sevket; Mikhailidis, Dimitri P; Demirkol, Sait; Ozturk, Cengiz; Kurtoglu, Ertugrul; Demir, Mustafa; Celik, Turgay; Turker, Turker; Iyisoy, Atila

2014-10-01

310

Serum Selenium, Zinc, and Copper in Early Diagnosed Patients with Pemphigus Vulgaris  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Pemphigus vulgaris is a life threatening, blistering skin disease.It is an autoimmune abnormality.Due to involvement of oral cavity and pharynx,patients are at risk of nutrients deficiency.The aim of this study was to evaluate the status of selenium, copper, and zinc in these patients.Methods:In a case-control study, 43 newly diagnosed pemphigus vulgaris patients were compared with 58 healthy people from 2009 to 2010. The severity of the disease was estimated according to Harman's scores.Serum selenium was measured with atomic absorption but serum zinc and copper concentrations were determined spectrophotometrically. Data were compared with independent t test. Correlations were evaluated by Pearson correlation test.Results: Both groups were the same based on sex, age, and weight and body mass index.The mean duration of disease was 5.6 month. The oral and skin severities were 1.79 and 2.3 respectively, based on Harman's scores. Serum selenium of pemphigus patients was significantly less than that of healthy people (P<0.001.Serum copper was negatively correlated with duration of disease in males (P=0.02, r=-0.5.Conclusions: Pemphigus vulgaris negatively affects on serum selenium, copper and zinc.It seems that serum selenium, copper and zinc decrease as the disease lasts longer.

M Zarei

2012-04-01

311

Sialocintigraphy versus ultrasonography of the salivary glands in patients first diagnosed with Sjögren's syndrome.  

Science.gov (United States)

Sjögren's syndrome (SjS) is an autoimmune disease characterized by distraction of particularly salivary and lacrimal glands. The aim of the present study was to compare salivary gland scintigraphy (SGS) and salivary gland ultrasonography (SUS) in identifying salivary gland function in patients first diagnosed with SjS. We recruited 20 such patients with SjS (5 male, 15 female, aged from 35 to 65 y, mean age 52, standard deviation: +/-5 y. All patients were submitted to SUS and SGS longitudinal and transverse images. Before the scintiscan, patients fasted for 6 h. Technetium-99m pertechnetate ((99m)Tc-PT) 110 MBq was injected intravenously (i.v.) and simultaneous multi-frames dynamic acquisition was performed for 30 min. In two patients who had discordant results between SUS and US, labial biopsy was performed. Dynamic acquisition curves for 30 sec for the parotid and the submandibular glands were generated. For each gland we have calculated: (a) the maximum uptake (MU): the ratio between the mean counts in the gland at 20 min and the background activity and (b) the outflow efficiency (OE): the ratio between the minimum counts after lemon juice stimulation at 30 min and the counts at 20 min. The results showed abnormal scintiscans with low MU and high OE in one or more of the glands, in 17/20 patients. These results were confirmed by SUS in 15 cases and in two cases labial biopsy confirmed the diagnosis made by SGS while SUS was negative. In the remaining 3/20 cases of SjS both tests, SUS and SGS, showed normal results. Discrepancies between SGS findings and labial biopsy as found in two of our cases have been reported by others and may be due among other causes to early lymphocytic infiltration in SjS. Normal findings of SGS have also been reported. In conclusion, in cases first diagnosed with SjS, the function of the parotid and the submandibular glands was better identified by the SGS as compared to SUS. Although SGS is a more complex and expensive examination, it should be preferred to SUS as more sensitive and indicating the stage of SjS. PMID:16894414

Decuzzi, Marco; Tatulli, Francesca; Giampaolo, Maria; Tesse, Riccardina; Gasparre, Marianna; Pepe, Giovanna; Decuzzi, Paolo; Asteriadis, Ioannis

2006-01-01

312

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

DEFF Research Database (Denmark)

BACKGROUND: Hospital-based discharge registries are used increasingly for longitudinal epidemiological studies of HIV. We examined completeness of registration of HIV infections and of chronic hepatitis B (HBV) and hepatitis C (HCV) coinfections in the Danish National Hospital Registry (DNHR) covering all Danish hospitals. METHODS: The Danish HIV Cohort Study (DHCS) encompasses all HIV-infected patients treated in Danish HIV clinics since 1 January 1995. All 2,033 Danish patients in DHCS diagnosed with HIV-1 during the 10-year period from 1 January 1995 to 31 December 2004 were included in the current analysis. We used the DHCS as a reference to examine the completeness of HIV and of HBV and HCV coinfections recorded in DNHR. Cox regression analysis was used to estimate hazard ratios of time to diagnosis of HIV in DNHR compared to DHCS. RESULTS: Of the 2,033 HIV patients in DHCS, a total of 2,006 (99%) were registered with HIV in DNHR. Of these, 1,888 (93%) were registered in DNHR within one year of their first positive HIV test. A CD4 or = 100,000 copies/ml and being diagnosed after 1 January 2000, were associated with earlier registration in DNHR, both in crude and adjusted analyses. Thirty (23%) HIV patients registered with chronic HBV (n = 129) in DHCS and 126 (48%) of HIV patients with HCV (n = 264) in DHCS were registered with these diagnoses in the DNHR. Further 17 and 8 patients were registered with HBV and HCV respectively in DNHR, but not in DHCS. The positive predictive values of being registered with HBV and HCV in DHCS were thereby estimated to 0.88 and 0.97 and in DNHR to 0.32 and 0.54. CONCLUSION: The study demonstrates that secondary data from national hospital databases may be reliable for identification of patients diagnosed with HIV infection. However, the predictive value of co-morbidity data may be low Udgivelsesdato: 2008

Obel, N.; Reinholdt, H.

2008-01-01

313

Malnutrition and clinical outcome in urological patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2011-01-01

314

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

Directory of Open Access Journals (Sweden)

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

Lim MY

2014-05-01

315

Demographic and clinical profile of myelopathy patients.  

Science.gov (United States)

This descriptive type of cross sectional study was aimed to identify the demographic profile, clinical presentations of myelopathy and to find out the etiological factors associated with myelopathy. Total 65 patients having clinical features of myelopathy, admitted in Neurology and Medicine ward of Mymensingh Medical College Hospital from February 2009 to December 2010 were purposively studied. Patients underwent a detailed clinical evaluation followed by laboratory investigations and neuro-imaging studies. Out of 65 cases, 80.0% were male and 20.0% were female with mean age 39.15 ± 16.8 years. Highest number of cases (41.6%) was farmers. Most of the cases (72.3%) hailed from rural area. Mean duration of illness was 7.74 ± 15.8 months. 41.54% patients presented with paraplegia/paraparesis and 58.46% with quadriparesis/quadriplegia. 63.1% patients had sensory disturbance. It is observed that 58.5% had urinary sphincter disturbance and 21.5% had bowel sphincter disturbance. Among the causes of myelopathy found in this study, 29.23% patients had spondylotic myelopathy and 24.62% had transverse myelitis (ATM). In 12.31% patients the cause of myelopathy could not be identified. Myelopathy is more common in males and most of the patients are farmers. Spondylotic and Transverse myelopathy is the main etiology of compressive and non-compressive myelopathy respectively. PMID:22561764

Uddin, M J; Rahman, K M; Bhattacharjee, M; Dey, S K; Alam, M N; Barman, K K; Mondal, G D

2012-04-01

316

Clinical tomographic correlations of 220 patients with neurocisticercosis, Bahia, Brazil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english Neurocysticercosis (NCC) is a common parasitic disease in our region, presenting diversity of neurological symptoms and signs. The present study has as primary objective an evaluation of the NCC's clinical and epidemiological profile within Bahia State, by means of a prospective study of 220 patient [...] s diagnosed from March 1988 to March 1999, with a follow-up of six months. Exams, such as Computed Cranial Tomography Scan (CT), Cerebral Spine Fluid (CSF) and Electroencephalogram (EEG), were accomplished in three distinct moments of these patients' evolution: at starting or diagnostic point (zero time), at after-intervention period (one month after treatment), and at control period (six months after treatment).

Antônio de Souza, Andrade-Filho; Luiz Frederico da Silva, Figuerôa; Victor Mascarenhas, Andrade-Souza.

2007-02-01

317

[Fusariosis diagnosed in the laboratory of an UH in Tunisia: epidemiological, clinical and mycological study].  

Science.gov (United States)

The genus Fusarium, initially known for its important agro-economic impact, is more and more often implicated in human pathology. In fact, multiples allergic, toxic and infectious manifestations are more reported in immunocompetent and immunocompromised hosts. The objective of our study was to analyse the epidemiological, mycological and clinical features of fusariosis reported in our CHU. Eighty-seven cases of Fusarium infections were collected: 34 cases of onychomycosis (39%), 26 cases of intertrigos (30%), 25 cases of keratomycosis (29%), one case of atypical invasive fusariosis due to Fusarium oxysporum species complex (FOSC) and one case of localized gingivolabial fusariosis due to Fusarium solani species complex (FSSC) in a patient with leukemia in phase of deep bone marrow aplasia, whose outcome was favorable after exiting of aplasia period and a treatment by amphotericine B. The case of pseudotumoral cutaneous fusariosis to F. oxysporum complicated with osteolysis and septic arthritis occurred in a pregnant woman without any immune deficit. The evolution was fatal in spite of prescription of multiple systemic antifungals. Concerning keratomycosis, Fusarium was the first agent responsible for these infections (43%). The corneal traumatism was found in 37.5% of cases and FSSC was the most isolated (72%). For superficial dermatomycosis, Fusarium was the third agent of onychomycosis in molds (25%). The most isolated species were FSSC (68%) and FOSC (20%). The intertrigo frequency was 0.07% and they were mostly caused by FSSC (84%) and FOSC (16%). Fusarium is an important cause of mold infections in our region. So, the species identification is useful because some species are resistant to the most common systemic antifungal agents. PMID:23725904

Néji, S; Trabelsi, H; Cheikhrouhou, F; Sellami, H; Guidara, R; Trigui, A; Feki, J; Boudaya, S; Turki, H; Makni, F; Ayadi, A

2013-06-01

318

Loop-mediated isothermal amplification method for diagnosing Pneumocystis pneumonia in HIV-uninfected immunocompromised patients with pulmonary infiltrates.  

Science.gov (United States)

Loop-mediated isothermal ampli?cation (LAMP) is becoming an established nucleic acid ampli?cation method offering rapid, accurate, and cost-effective diagnosis of infectious diseases. We retrospectively evaluated 78 consecutive HIV-uninfected patients who underwent LAMP method for diagnosing Pneumocystis pneumonia (PCP). Diagnosis of PCP was made by the detection of Pneumocystis jirovecii (P. jirovecii) with positive LAMP or conventional staining (CS) (Grocott methenamine silver staining or Diff-Quick™) on the basis of compatible clinical symptoms and radiologic findings. Additionally, we reviewed HIV-uninfected immunocompromised patients who underwent subcontract PCR as a historical control. LAMP was positive in 10 (90.9%) of 11 positive-CS patients. Among 13 negative-CS patients with positive LAMP, 11 (84.6%) had PCP, and the remaining 2 were categorized as having P. jirovecii colonization. LDH levels in negative-CS PCP were higher than in positive-CS PCP (p = 0.026). (1 ? 3)-?-D-glucan levels in negative-CS PCP were lower than in positive-CS PCP (p = 0.011). The interval from symptom onset to diagnosis as PCP in LAMP group (3.45 ± 1.77 days; n = 22) was shorter than in subcontract PCR group (6.90 ± 2.28 days; n = 10; p < 0.001). As for patients without PCP, duration of unnecessary PCP treatment in LAMP group (2; 2-3 days; n = 10) was shorter than in subcontract PCR group (7; 7-12.25 days; n = 6; p = 0.003). LAMP showed higher sensitivity (95.4%) and positive predictive value (91.3%) than subcontract PCR did. Pneumocystis LAMP method is a sensitive and cost-effective diagnostic method and is easy to administer in general hospitals. In-house LAMP method would realize early diagnosis of PCP, resulting in improving PCP prognosis and reducing unnecessary PCP-specific treatment. PMID:25187511

Nakashima, Kei; Aoshima, Masahiro; Ohkuni, Yoshihiro; Hoshino, Eri; Hashimoto, Kohei; Otsuka, Yoshihito

2014-12-01

319

Diffuse Large B-Cell Lymphoma (Richter Syndrome) in Patients with Chronic Lymphocytic Leukaemia: A Cohort Study of Newly Diagnosed Patients  

Science.gov (United States)

Summary Nearly all information about patients with chronic lymphocytic leukaemia (CLL) who develop diffuse large B-cell lymphoma (Richter syndrome [RS]) is derived from retrospective case series or patients treated on clinical trials. We used the Mayo Clinic CLL Database to identify patients with newly diagnosed CLL (1/2000–7/2011). Individuals who developed biopsy-proven RS during follow-up were identified. After median follow-up of 4 years, 37/1641 (2.3%) CLL patients developed RS. The rate of RS was approximately 0.5%/year. Risk of RS was associated with advanced Rai stage at diagnosis (p<0.001), high-risk FISH (p<0.0001), unmutated IGHV (p=0.003), and expression of ZAP-70 (p=0.02) and CD38 (p=0.001). The rate of RS doubled in patients treated for CLL (1%/year). Stereotyped B-cell receptors (odds-ratio=4.2; p=0.01) but not VH4–39 was associated with increased risk of RS. Treatment with combination of purine analogues and alkylating agents increased the risk of RS 3-fold (odds-ratio= 3.26, p=0.0003). Median survival after RS diagnosis was 2.1 years. The RS prognosis score stratified patients into three risk groups with median survivals of 0.5 years, 2.1 years and not reached. Both underlying characteristics of the CLL clone and subsequent CLL therapy influence the risk of RS. Survival after RS remains poor and new therapies are needed. PMID:23841899

Parikh, Sameer A.; Rabe, Kari G.; Call, Timothy G.; Zent, Clive S.; Habermann, Thomas M.; Ding, Wei; Leis, Jose F.; Schwager, Susan M.; Hanson, Curtis A.; Macon, William R.; Kay, Neil E.; Slager, Susan L.; Shanafelt, Tait D.

2014-01-01

320

Diffuse large B-cell lymphoma (Richter syndrome) in patients with chronic lymphocytic leukaemia (CLL): a cohort study of newly diagnosed patients.  

Science.gov (United States)

Nearly all information about patients with chronic lymphocytic leukaemia (CLL) who develop diffuse large B-cell lymphoma [Richter syndrome (RS)] is derived from retrospective case series or patients treated on clinical trials. We used the Mayo Clinic CLL Database to identify patients with newly diagnosed CLL between January 2000 and July 2011. Individuals who developed biopsy-proven RS during follow-up were identified. After a median follow-up of 4 years, 37/1641 (2·3%) CLL patients developed RS. The rate of RS was approximately 0·5%/year. Risk of RS was associated with advanced Rai stage at diagnosis (P < 0·001), high-risk genetic abnormalitites on fluorescence in situ hybridization (P < 0·0001), unmutated IGHV (P = 0·003), and expression of ZAP70 (P = 0·02) and CD38 (P = 0·001). The rate of RS doubled in patients after treatment for CLL (1%/year). Stereotyped B-cell receptors (odds-ratio = 4·2; P = 0·01) but not IGHV4-39 family usage was associated with increased risk of RS. Treatment with combination of purine analogues and alkylating agents increased the risk of RS three-fold (odds-ratio = 3·26, P = 0·0003). Median survival after RS diagnosis was 2·1 years. The RS prognosis score stratified patients into three risk groups with median survivals of 0·5 years, 2·1 years and not reached. Both underlying characteristics of the CLL clone and subsequent CLL therapy influence the risk of RS. Survival after RS remains poor and new therapies are needed. PMID:23841899

Parikh, Sameer A; Rabe, Kari G; Call, Timothy G; Zent, Clive S; Habermann, Thomas M; Ding, Wei; Leis, Jose F; Schwager, Susan M; Hanson, Curtis A; Macon, William R; Kay, Neil E; Slager, Susan L; Shanafelt, Tait D

2013-09-01

 
 
 
 
321

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

Scientific Electronic Library Online (English)

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

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

2014-09-01

322

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

Scientific Electronic Library Online (English)

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

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

323

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

Directory of Open Access Journals (Sweden)

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

Seyyed Hamid Hashemi

2005-01-01

324

Nursing diagnoses for patients with hematological toxicity after antineoplastic chemotherapy based on the icnp®  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: to compose affirmative the nursing diagnosis, based on ICNP® Version 1.0, for patients with hematological toxicity after antineoplastic chemotherapy. Methodology: a descriptive exploratory study developed from identification of priorities in terms of ICNP®, for the construction of affirmative the nursing diagnosis for patients with haematological toxicity after antineoplastic chemotherapy, using the construction of affirmative criterion provided by International Council of Nurses and in accordance with ISO 18.104. Results: since the terms were constructed eleven affirmative the nursing diagnosis: Immunologic impairment process; Fever; Dyspnea; Impaired skin integrity; Fading; Inability to perform self-care in hospitalization or in domicile; Risk for infection; Risk for septic shock; Risk for hemorrhaging process; Risk for trauma; Risk for non adherence to treatment. Conclusion: conclude that the results of the study demonstrated the service to the proposed objective and it is expected that these diagnoses nursing care applied in patients with haematological toxicity after antineoplastic chemotherapy is possible to achieve an effective assistance to this clientele.

Marisaulina Wanderley Abrantes de Carvalho, Angela Amorim de Araújo, Maria Miriam Lima da Nóbrega

2009-10-01

325

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

International Nuclear Information System (INIS)

To evaluate the effect of short-term intensive insulin treatment on ?-cell function in newly diagnosed type 2 diabetes patients with apparently hyperglycemia, twenty-four newly diagnosed type 2 diabetes patients with FPG more than 12.0 mmol/L were treated by short-term transient intensive insulin in average 9.04-4.8 days. Their ?-cell function was assessed by oral glucose