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Sample records for patients clinically diagnosed

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

    Directory of Open Access Journals (Sweden)

    Pulzi Fernanda BU

    2011-02-01

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

  2. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

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    Sarpong Charity

    2011-05-01

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

  3. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Science.gov (United States)

    2011-01-01

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

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

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

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

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

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann

    2008-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were 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.

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

    Directory of Open Access Journals (Sweden)

    Klaus Damgaard Jakobsen

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted ?-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, ? = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, ? = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, ? = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, ? = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

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

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    Koray Karabekiro?lu

    2011-01-01

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

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

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    Wolfe Rory

    2006-06-01

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

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

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    Jin-You Wang

    2014-05-01

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

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

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    Tropp Hans

    2005-06-01

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

  12. Utility of complement fixation and microimmunofluorescence assays for detecting serologic responses in patients with clinically diagnosed psittacosis.

    OpenAIRE

    Wong, K. H.; Skelton, S. K.; Daugharty, H.

    1994-01-01

    The serodiagnosis of human psittacosis was considerably improved by a microimmunofluorescence (MIF) assay that uses selected strains of Chlamydia psittaci, C. pneumoniae, and C. trachomatis as antigens. The 78 patients examined in the study were clinically diagnosed as having psittacosis on the basis of compatible clinical symptoms following exposure to sick birds. The conventional complement fixation (CF) test identified 36 patients, or 46% (36 of 78) of the total, as positive. Antibody resp...

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

    Scientific Electronic Library Online (English)

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

    2014-04-01

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

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

    International Nuclear Information System (INIS)

    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

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

    Scientific Electronic Library Online (English)

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

    2015-04-01

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

  16. 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)

  17. 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)

  18. 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)

    Olivarius, Niels de Fine; Siersma, Volkert

    2010-01-01

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

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

    Science.gov (United States)

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

    2014-08-01

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

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

    OpenAIRE

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

    2008-01-01

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

  1. 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)

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

    OpenAIRE

    Jongmans, MCJ; van Ravenswaaij-Arts, CMA; Pitteloud, N.; Ogata, T; Sato, N.; Claahsen-van der Grinten, HL; van der Donk, K; Seminara, S; Bergman, JEH; Brunner, HG; Crowley, WF; Hoefsloot, LH

    2008-01-01

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

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

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    Manuel Menéndez-González

    2014-04-01

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

    Fuursted, K.; Arpi, M.

    2008-01-01

    We aimed to evaluate broad-range PCR and subsequent sequencing compared to conventional culture in the diagnosis of spinal infection. The method was a prospective study of all patients admitted to Aarhus University Hospital for surgery during a 12-months period with a clinically diagnosed infection of the spine. Samples from patients undergoing surgery for non-infectious causes (malignancy etc.) were included as control group. Specimens were submitted to conventional culture and molecular investigation with 16S rRNA gene amplification and sequence analysis. 38 patients were included in the study (clinically diagnosed spinal infections=18; non-infectious diseases=20). The specificity was excellent for both culture and PCR (95% and 100%, respectively). A true culture positive result was obtained in 50% of patients (9/18) and 61% was positive (11/18) by broad-range PCR. When combined, culture and PCR allowed for a microbiological diagnosis in 72% of patients (13/18). A positive culture was found only in patientstreated <= 7 d compared to <= 16 d for PCR. However, PCR and culture result were equally negatively affected by duration of treatment. The combination of culture and broad-range PCR substantially adds to the number of microbiological diagnoses obtained, and improves the clinician's opportunity to tailor therapy to individual patients Udgivelsesdato: 2008

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

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    Almind Gitte

    2011-02-01

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

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

    DEFF Research Database (Denmark)

    Mor, Anil; Svensson, Elisabeth

    2014-01-01

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

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

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    V Fink

    2012-11-01

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

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

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    Maruyama Koichi

    2010-03-01

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

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

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    Neumann, C.H.

    1986-10-01

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

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

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    Marti? Vesna

    2015-01-01

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

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

    DEFF Research Database (Denmark)

    Horwitz, Henrik; Friis, Tina

    2014-01-01

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

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

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    Zhang Wenteng

    2011-06-01

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

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

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    Li Lian-Xi

    2013-01-01

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

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

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    Mustafa Yakut

    2012-06-01

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

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

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2015-01-01

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

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

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    Barberan Jose

    2012-11-01

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

  18. Diagnosing Patients with Age-Related Hearing Loss and Tinnitus: Supporting GP Clinical Engagement through Innovation and Pathway Redesign in Audiology Services

    Science.gov (United States)

    Davis, Adrian; Smith, Pauline A.; Booth, Michelle; Martin, Margaret

    2012-01-01

    The public health challenge of hearing impairment is growing, as age is the major determinant of hearing loss. Almost one in four (22.6%) over 75-year olds reports moderate or severe worry because of hearing problems. There is a 40% comorbidity of tinnitus and balance disorders. Good outcomes depend on early presentation and appropriate referral. This paper describes how the NHS Improvement Programme in England used service improvement methodologies to identify referral pathways and tools which were most likely to make significant improvements in diagnosing hearing loss, effective referrals and better patient outcomes. An audiometric screening device was used in GP surgeries to enable thresholds for effective referrals to be measured in the surgery. Revised referral criteria, the use of this device, new “assess and fit” technology in the audiology clinic, and direct access pathways can transform audiology service delivery so that patient outcomes are measurably better. This, in turn, changes the experience of GPs, so they are more likely to refer patients who can benefit from treatment. At the end of 2011, 51?GP practices in one of the audiology pilot areas had bought HearCheck screeners, a substantial development from the 4 practices who first engaged with the pilot. PMID:22829836

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

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    SH Miri Ghaffarzadeh

    2012-05-01

    Full Text Available

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

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

     

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

     

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

     

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

     

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

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    Valdimarsdottir Heiddis B

    2011-01-01

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

  1. 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)

  2. Using specialized standardized patients to improve differential diagnoses.

    Science.gov (United States)

    Payne, Leslie Karns

    2015-06-11

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

  3. Emotional interplay and communication with patients diagnosed with schizophrenia

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    Fatouros Bergman, Helena

    2009-01-01

    Emotional interplay and communication with patients diagnosed with schizophrenia was studied in clinical interviews. Fifty-one video recorded interviews were conducted by two psychologists with nine patients. Qualitative and quantitative methods were used in three successive studies. Study I examined the communicative interplay on an overall level, including verbal and nonverbal means of communication. The interviewer’s willingness to explore and pursue the emotional content in the patient?...

  4. 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)

    Juan Francisco Gálvez Flórez

    2008-09-01

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

  5. 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)

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

    2008-09-01

    Full Text Available Introducción: La coexistencia de trastornos psiquiátricos con abuso/dependencia al tabaco, alcohol y sustancias ilícitas es un problema de salud pública en el mundo. Esto ha generado grandes retos diagnósticos en situaciones clínicas donde tienden a sobreponerse ambas condiciones psicopatológicas y [...] que oscurecen el panorama de intervención terapéutica. Objetivos: Fomentar e implementar un adecuado diagnóstico de la patología dual en Colombia, a fin de encaminar al paciente por el tratamiento correcto en su proceso de rehabilitación. Método: Se buscó la literatura biomédica en los servidores de Medline, OVID, Proquest, Scielo y EMBASE, cruzando la expresión del MeSH diagnóstico dual con trastornos relacionados con el consumo de sustancias, tabacco y epidemiología, delimitando los resultados a los estudios clínicos, revisiones sistemáticas o metanálisis publicados en español o inglés en los últimos 25 años en la población farmacodependiente adulta. Resultados: Se encontraron 209 estudios que cumplían con los criterios de inclusión, de los cuales, de acuerdo con su resumen, se seleccionaron los 100 más relevantes. Conclusiones: La implementación rigurosa de estas guías diagnósticas debe encaminar al especialista en contacto con la población farmacodependiente a realizar el diagnóstico dual de forma más frecuente y certera, para que los pacientes obtengan mejores resultados y beneficios a largo plazo. 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.

  6. Transient ischaemic attack clinic: an evaluation of diagnoses and clinical decision making.

    Science.gov (United States)

    Lee, Will; Frayne, Judith

    2015-04-01

    The diagnosis of transient ischaemic attack (TIA) is based largely on the patient's symptom recall and clinical judgement. This decision-making process is highly subjective and the inter-observer reliability of TIA diagnosis is at best moderate, even among neurologists. The aim of this study is to examine the presenting features and final diagnoses of referrals to a TIA clinic and to evaluate characteristics that favoured the diagnosis of TIA over other TIA "mimics". Consecutive new referrals to a tertiary metropolitan hospital TIA clinic over a 9month period were examined. Characteristics between TIA and non-TIA diagnoses were compared and analysed. Eighty-two patients were recruited. Eighteen (22%) were given a final diagnosis of TIA or stroke. Major alternative diagnoses included migraine (n=17, 21%), presyncope/syncope (n=13, 16%) and anxiety (n=7, 9%). Four (5%) patients had unclassifiable symptoms with no clear final diagnosis. Mean age was 67±a standard deviation of 17years and patients diagnosed with TIA/stroke were on average older than those with non-TIA diagnoses (77±10 versus 64±17years, p=0.003). A diagnosis of TIA/stroke was favoured in the presence of moderate to severe weakness (p=0.032), dysphasia (p=0.037) or dysarthria (p=0.005). Unclassifiable symptoms (for example, palpitations, confusion, headache) were reported in 27 patients (33%) and their presence favoured non-TIA diagnoses (p=0.0003). TIA constituted a minority of the referrals to our clinic. Accurate clinical diagnosis of TIA facilitates early stroke prevention and avoids unnecessary investigations and prescriptions. Attempts to improve diagnostic accuracy of TIA should target improving the education and awareness of frontline medical practitioners. PMID:25669115

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

    DEFF Research Database (Denmark)

    Toogood, Andrew; Brabant, Georg

    2012-01-01

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

  8. 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)

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

    2009-03-01

    Full Text Available Introducción: Los esfuerzos para avanzar en el tratamiento de patologías duales buscan integrar las intervenciones terapéuticas que permitan mejorar sus tasas de remisión y recuperación. A pesar de la contundente evidencia epidemiológica que asocia el consumo de sustancias con las patologías 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.

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

    DEFF Research Database (Denmark)

    Stidsen, Jacob

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

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

    Directory of Open Access Journals (Sweden)

    Shin Yong-jeen

    2011-06-01

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

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

    Science.gov (United States)

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

    2015-03-01

    We randomised 46 newly diagnosed patients with chronic myeloid leukaemia (median age 56) to receive dasatinib 100 mg QD or imatinib 400 mg QD and report outcome as an intention-to-treat analysis with 36 months follow-up. Early cytogenetic and molecular responses were superior in the dasatinib group, with a tendency that imatinib patients caught up with time. For instance, MR(3.0) was reached at 3 months in 36% vs. 8% (P = 0.02), at 12 months in 81% vs. 46% (P = 0.02) and at 18 months in 73% vs. 65% (n.s.) of the patients in the two groups. In contrast, MR(4.5) was consistently superior in the dasatinib group at all time points from 6 months onwards, reaching 61% vs. 21% (P dasatinib and imatinib arms, respectively, remained on assigned drug. Dasatinib dose was frequently reduced, but with maintained excellent effect. One imatinib patient progressed to blastic phase, but no CML-related deaths occurred. In conclusion, our data compare favourably with those of the dasatinib registration study, DASISION. The fast and deep molecular responses induced by dasatinib compared with imatinib may be exploited to increase the proportion of patients who can achieve a treatment-free remission after treatment discontinuation. PMID:25082346

  12. 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.)

  13. Anion gap, anion gap corrected for albumin, and base deficit fail to accurately diagnose clinically significant hyperlactatemia in critically ill patients.

    Science.gov (United States)

    Chawla, Lakhmir S; Jagasia, Dhiraj; Abell, Lynn M; Seneff, Michael G; Egan, Melinda; Danino, Natale; Nguyen, Aline; Ally, Mazer; Kimmel, Paul L; Junker, Christopher

    2008-01-01

    Anion gap, anion gap corrected for serum albumin, and base deficit are often used as surrogates for measuring serum lactate. None of these surrogates is postulated to predict hyperlactatemia in the critically ill. We prospectively collected data from September 2004 through August 2005 for 1381 consecutive admissions. Patients with renal disease, ketoacidosis, or toxic ingestion were excluded. Anion gap, anion gap corrected for albumin, and base deficit were calculated for all patients. We identified 286 patients who met our inclusion or exclusion criteria. The receiver-operating characteristic area under the curve for the prediction of hyperlactatemia for anion gap, anion gap corrected for albumin, and base deficit were 0.55, 0.57, and 0.64, respectively. Anion gap, anion gap corrected for albumin, and base deficit do not predict the presence or absence of clinically significant hyperlactatemia. Serum lactate should be measured in all critically ill adults in whom hypoperfusion is suspected. PMID:18431828

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

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf

    2015-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

  16. Patient specific modelling in diagnosing depression

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2015-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

  18. Dually diagnosed patients’ responses to substance use disorder treatment

    OpenAIRE

    Boden, M. Tyler; Moos, Rudolf

    2009-01-01

    Few studies have investigated whether dually diagnosed patients with co-occurring substance use and psychiatric disorders (DD) respond as well to substance use disorder (SUD) treatments as patients with SUD do. Here we assessed whether male veteran DD and SUD patients with alcohol dependence diagnoses differed in the process and outcomes of residential SUD treatment. The main findings showed that (a) DD patients did not perceive SUD programs as positively as patients with SUD did and had wors...

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

    DEFF Research Database (Denmark)

    Svensson, Elisabeth; Mor, Anil

    2015-01-01

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

  20. A Nationwide Survey of Lymphangioleiomyomatosis in Korea: Recent Increase in Newly Diagnosed Patients

    OpenAIRE

    Park, Hye Yun; Nam, Hae-seong; Chung, Man Pyo; Jeong, Sung Hwan; Kim, Yu Jin; Cha, Seung-ick; Kim, Young Whan; Park, Jong Sun; Uh, Soo-taek; Park, Choon-sik; Park, Moo Suk; Moon, Ji Ae; Jung, Kyung Soo; Jegal, Yang Jin; Kim, Dong Soon

    2010-01-01

    In 2007, the Korean Interstitial Lung Disease Society had collected clinical data of patients who have diagnosed as Lymphangioleiomyomatosis (LAM) since 1990 through nationwide survey, which showed that LAM patients had increased sharply after 2004. The present study was performed to show the clinical features of Korean patients with LAM, and to establish the reason for the recent increase in the diagnosis. All 63 patients were women and the mean age at diagnosis was 36 yr. The most common pr...

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

    Science.gov (United States)

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

    2014-10-27

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

  2. Calciphylaxis in a dialysis patient diagnosed by muscle biopsy.

    Science.gov (United States)

    Stavros, Kara; Motiwala, Rajeev; Zhou, Lan; Sejdiu, Fatmir; Shin, Susan

    2014-03-01

    Calciphylaxis is a rare condition seen mostly in patients with chronic renal disease and secondary hyperparathyroidism who develop painful skin lesions and myopathy secondary to extensive small vessel calcification, which leads to tissue ischemia. It is typically diagnosed by a biopsy of prominent skin lesions. Here, we report a 49-year-old man with end-stage renal disease on chronic peritoneal dialysis who presented with weakness, myalgias, and necrotic skin lesions. Multiple skin biopsies were nondiagnostic because of severe extensive necrosis, and the diagnosis of systemic calciphylaxis was eventually made by a muscle biopsy. This case demonstrates the significant muscle involvement in calciphylaxis and highlights the importance of maintaining a high clinical suspicion for patients with risk factors for calciphylaxis, even when skin biopsy does not confirm it. PMID:24534833

  3. 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)

  4. A Nationwide Survey of Lymphangioleiomyomatosis in Korea: Recent Increase in Newly Diagnosed Patients

    Science.gov (United States)

    Park, Hye Yun; Nam, Hae-Seong; Jeong, Sung Hwan; Kim, Yu Jin; Cha, Seung-Ick; Kim, Young Whan; Park, Jong Sun; Uh, Soo-Taek; Park, Choon-Sik; Park, Moo Suk; Moon, Ji Ae; Jung, Kyung Soo; Jegal, Yang Jin; Kim, Dong Soon; Song, Jin Woo; Yum, Ho-Kee; Park, Young Bum

    2010-01-01

    In 2007, the Korean Interstitial Lung Disease Society had collected clinical data of patients who have diagnosed as Lymphangioleiomyomatosis (LAM) since 1990 through nationwide survey, which showed that LAM patients had increased sharply after 2004. The present study was performed to show the clinical features of Korean patients with LAM, and to establish the reason for the recent increase in the diagnosis. All 63 patients were women and the mean age at diagnosis was 36 yr. The most common presenting symptom was dyspnea and 8 patients had tuberous sclerosis complex. The survival rate at 5 yr after diagnosis was 84%. Compared with patients diagnosed after 2004 (n=34), the patients diagnosed before 2004 (n=29) complained with dyspnea more (P=0.016) and had lower FEV1% predicted (P=0.003), and DLco% predicted (P=0.042). The higher proportion of patients diagnosed after 2004 showed the normal chest radiography, and they were detected by routine chest CT screening (P=0.016). This study showed that clinical features of Korean patients with LAM were not different from those reported elsewhere. It is concluded that the reason for the increase of newly diagnosed patients is the result of increase in detection of the early stage LAM by the widespread use of chest CT screening. PMID:20676330

  5. 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 (ri 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)

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

    DEFF Research Database (Denmark)

    Toogood, Andy; Brabant, Georg

    2011-01-01

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

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

    Science.gov (United States)

    2014-01-01

    Background In 2013 the World Health Organization deemed hypertension as a global crisis as it is the leading risk factor attributed to global mortality. Therefore, there is a great need for effective alternative treatment strategies to combat a condition that affects 40% of adults worldwide. Recently, the FlaxPAD Trial observed a significant reduction in systolic and diastolic blood pressure in hypertensive patients with peripheral arterial disease that consumed 30 g of milled flaxseed per day for one year. However, these patients were already on anti-hypertensive medication. Therefore, there is a need to assess if dietary flaxseed can effectively reduce blood pressure in the absence of peripheral arterial disease and anti-hypertensive medication in newly diagnosed hypertensive patients. Methods/Design The HYPERFlax Trial is a parallel, superiority, phase II/III, randomized, double-blinded, controlled clinical trial. St. Boniface Hospital and the Health Sciences Centre of Winnipeg, Canada, will recruit 100 participants newly diagnosed with stage 1 hypertension who have yet to be administered anti-hypertensive medication. Participants will be randomly allocated with a 1:1 ratio into a flaxseed or control group and provided food products to consume daily for six months. At baseline, two, four, and six months, participant assessments will include the primary outcome measure, averaged automated blood pressure, and secondary measures: 24-hour food recall, international physical activity questionnaire, anthropometrics, and blood and urine sampling for biochemical analysis. Plasma will be assessed for lipids, metabolomics profiling, and molecules that regulate vascular tone. Urine will be collected for metabolomics profiling. With an estimated dropout rate of 20%, the trial will have a power of 0.80 to detect differences between groups and across time, out of an effect size of 0.7 (SD) at an ? level of 0.05. Discussion This trial will determine if dietary flaxseed is efficacious over six months as an anti-hypertensive therapy in subjects newly diagnosed with hypertension. If flaxseed can effectively reduce blood pressure as a monotherapy, then flaxseed will provide individuals on a global basis with a cost-effective food-based strategy to control hypertension. Trial registration NCT01952340, Registered 24 September 2013. PMID:24938224

  8. Clinical application of multislice CT angiogram in diagnosing celiac artery aneurysm

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Soniza Vieira Alves-Leon

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Francisco Emilio PUSTIGLIONI

    1999-12-01

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

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

    Scientific Electronic Library Online (English)

    Francisco Emilio, PUSTIGLIONI; Giuseppe Alexandre, ROMITO.

    1999-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Bokor-Brati? Marija

    2004-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Alfredo D Espinosa Brito

    2010-06-01

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

  15. 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

    Directory of Open Access Journals (Sweden)

    Cícero Cláudio Dias Gomes

    2005-12-01

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

  16. Can we clinically diagnose dementia with Lewy bodies yet?

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    Huang Yue

    2013-02-01

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

  17. 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)

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

    2014-01-01

    Full Text Available 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.

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

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    V Fridman

    2012-11-01

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

  19. Cerebral Lesions Diagnosed by Fluid Attenuated Inversion Recovery (FLAIR Imaging in Epileptic Patients

    Directory of Open Access Journals (Sweden)

    2007-01-01

    Full Text Available The purpose of this study was to illustrate the spectrum of cerebral lesions diagnosed by Fluid Attenuated Inversion Recovery (FLAIR imaging in patients with epilepsy. A retrospective study was conducted on 104 patients with epilepsy who had undergone brain MRI with fluid attenuated inversion recovery sequence at the MRI center of Sheikholraiis clinic, Tabriz, Iran. Abnormalities scans were acquired in 66(63.5% patients. Space Occupying Tumors (SOT was detected in 25(24% patients, Vascular Malformations (VM in 17(16.35% patients, hippocampal sclerosis in 7(6.8% patients, Scars of Old Lesions (SOL in 7(6.8% patients, multiple sclerosis in 4(3.85% patients, malformations of cortical development in 2(1.9% patients and other in 4(3.85% patients. The most frequent lesions were Space Occupying Tumors (SOT, followed, in decreasing order by Vascular Malformations (VM and Hippocampal Sclerosis (HS. The most common tumors were low-grade gliomas.

  20. 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)

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

    2003-01-01

    Full Text Available 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.

  1. Should physicians fake diagnoses to help their patients?

    Science.gov (United States)

    Helgesson, G; Lynöe, N

    2008-03-01

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

  2. Low Prevalence of Transmitted Drug Resistance in Patients Newly Diagnosed with HIV-1 Infection in Sweden 2003-2010

    OpenAIRE

    Karlsson, Annika; Bjo?rkman, Per; Bratt, Goeran; Ekvall, Hakan; Gisslen, Magnus; Soennerborg, Anders; Mild, Mattias; Albert, Jan

    2012-01-01

    Transmitted drug resistance (TDR) is a clinical and epidemiological problem because it may contribute to failure of antiretroviral treatment. The prevalence of TDR varies geographically, and its prevalence in Sweden during the last decade has not been reported. Plasma samples from 1,463 patients newly diagnosed with HIV-1 infection between 2003 and 2010, representing 44% of all patients diagnosed in Sweden during this period, were analyzed using the WHO 2009 list of mutations for surveillance...

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

    Directory of Open Access Journals (Sweden)

    A. Bostak

    2006-11-01

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

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

    Science.gov (United States)

    Treloar, Amanda Jane Commons; Lewis, Andrew J.

    2009-01-01

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

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

    OpenAIRE

    Karthikeyan, P.; Nirmal Coumare, V.

    2010-01-01

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

  6. Survivin expression in patients with newly diagnosed nodal diffuse large B cell lymphoma (DLBCL)

    OpenAIRE

    Markovic, O.; Marisavljevic, D.; Cemerikic-Martinovic, V.; Martinovic, T.; B. Filipovic; Stanisavljevic, D.; Živkovi?, R.; Hajder, J.; Stanisavljevic, N.; Mihaljevic, B.

    2012-01-01

    Survivin is one of the inhibitors of apoptosis proteins (IAP) that might play an important role in the pathogenesis of diffuse large B cell lymphoma (DLBCL). The present study was designed to investigate the clinical and prognostic significance of survivin expression in nodal DLBCL. We analyzed lymph node biopsy specimens obtained from 56 patients with newly diagnosed nodal DLBCL, treated with immunochemotherapy (R-CHOP). The expression of survivin was analyzed using the standard immunohistoc...

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

    OpenAIRE

    Ajit S Shinto; Selvakumar, Job

    2010-01-01

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

  8. Patient-physician interaction and quality of life in recently diagnosed breast cancer patients.

    Science.gov (United States)

    Kwan, Marilyn L; Tam, Emily K; Ergas, Isaac J; Rehkopf, David H; Roh, Janise M; Lee, Marion M; Somkin, Carol P; Stewart, Anita L; Kushi, Lawrence H

    2013-06-01

    Few studies have explored how patient-physician interactions influence patients' quality of life (QOL). In a prospective cohort study of 1,855 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California Medical Care Program from 2006 to 2011, we examined associations between patient-physician interactions during cancer treatment and QOL, overall and by racial/ethnic group. Participants completed the interpersonal processes of care (IPC) survey at approximately 8 months post-diagnosis to assess specific domains of the patient-physician interaction during the months after cancer diagnosis. Domains included: compassion, elicited concerns, explained results, decided together, lack of clarity, discrimination due to race/ethnicity, and disrespectful office staff. The functional assessment of cancer therapy-breast cancer was completed concurrently to measure QOL. Linear regression models examined the association of IPC with QOL, first adjusting for patient covariates including age, race, clinical factors, and psychosocial measures and then for physician characteristics such as age, sex, race/ethnicity, and specialty. For all participants (n = 1,855), IPC scores suggesting greater lack of clarity, discrimination due to race/ethnicity, and disrespectful office staff in patient-physician interactions were associated with lower QOL (P< 0.01). IPC scores suggesting physicians demonstrating compassion, eliciting concerns, or explaining results were associated with higher QOL (P< 0.01). Among Whites (n = 1,306), only the associations with higher QOL remained. African Americans (n = 110) who reported higher scores on physician compassion and elicited concerns had higher QOL, whereas higher scores for disrespectful office staff had lower QOL. No associations were observed among Asians (n = 201) and Hispanics (n = 186). After further adjustment for physician factors, the associations among Whites remained, whereas those among African Americans disappeared. In the breast cancer treatment setting, characteristics of the patient-physician interaction as perceived by the patient are associated with QOL, yet were not specific to patient race/ethnicity. PMID:23715629

  9. Diagnosing erectile dysfunction could save your patient’s life

    OpenAIRE

    Brock, Gerald

    2014-01-01

    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 o...

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    LI Xiao-hong

    2013-07-01

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

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

    Science.gov (United States)

    Takeda, Tadashi

    2006-10-01

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

  13. Counseling the Patient with Potentially HPV-Related Newly Diagnosed Head and Neck Cancer

    Science.gov (United States)

    Finnigan, John P.; Sikora, Andrew G.

    2014-01-01

    The recent emergence of a clinically distinct subset of head and neck cancers (HNC) caused by infection with the human papillomavirus (HPV) necessitates critical reevaluation of the existing counseling paradigm for patients with newly diagnosed HNC. Herein we propose a structural framework for patient counseling in which HPV testing is incorporated and the impact of HPV-status is discussed in the context of multiple medical and psychosocial domains. We strive to maintain a balance between making recommendations based on the best available scientific evidence and acknowledgment of uncertainty for both patients and providers. We anticipate that both the standard-of-care diagnostic workup and treatment, and counseling guidelines for these patients will change rapidly in the years ahead, as data from ongoing and planned prospective clinical trials become available. PMID:24488548

  14. 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)

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

    DEFF Research Database (Denmark)

    Gammelager, Henrik; Christiansen, Christian Fynbo

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Brand Caroline

    2008-01-01

    Full Text Available Abstract Background Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. Methods A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score Results One hundred and twenty seven women participated. The median age was 62 (IQR 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.

  17. Hyperinsulinemia in newly diagnosed patients with multiple sclerosis.

    Science.gov (United States)

    Penesova, Adela; Vlcek, Miroslav; Imrich, Richard; Vernerova, Lucia; Marko, Andrea; Meskova, Milada; Grunnerova, Lucia; Turcani, Peter; Jezova, Daniela; Kollar, Branislav

    2015-08-01

    There are limited data regarding glucose metabolism dysregulation in multiple sclerosis (MS). Present study investigates glucose and insulin response during oral glucose tolerance test (oGTT) in MS patients. We examined 19 MS patients and 19 age, sex and body mass index (BMI) matched healthy controls. MS patients were newly diagnosed, untreated and with low Expanded Disability Status Scale (EDSS) score (1.1?±?0.7). Plasma glucose, lactate, insulin and GLP-1 during oGTT, and fasting adipokines, lipid and inflammatory parameters were analyzed. Insulin sensitivity indices (ISI) were calculated. MS patients had comparable fasting (5.2?±?0.3 vs. 5.0?±?0.4 mmol/l, p?=?0.05) and post-load glucose concentrations as controls. Insulin response to oral glucose load in MS was increased (p?=?0.022). Insulin sensitivity was lower in MS compared to controls [ISI(Matsuda) 6.95?±?3.44 vs. 10.60?±?4.81, p?=?0.011 and ISI(Cederholm) 49.9?±?15.3 vs. 61.3?±?16.3, p?=?0.032]. We did not find any difference in lactate, GLP-1, total, HDL and LDL cholesterol, triglycerides, interleukin 6, tumor necrosis factor, C-reactive protein, resistin, leptin, adiponectin levels between groups. We found decreased insulin sensitivity with postprandial hyperinsulinemia in MS patients, which seems not to be related to chronic inflammation or physical inactivity. The role of hyperinsulinemia in CNS function impairment should be further investigated. PMID:25809135

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

    DEFF Research Database (Denmark)

    Horsboel, Trine A; Nielsen, Claus V

    2014-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2015-02-01

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

  20. Multiple gaps in care common among newly diagnosed HIV patients.

    Science.gov (United States)

    Rana, Aadia I; Liu, Tao; Gillani, Fizza S; Reece, Rebecca; Kojic, Erna M; Zlotnick, Caron; Wilson, Ira B

    2015-01-01

    The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI, of 581 newly diagnosed HIV patients >18 entering into care from 2004 to 2010, and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for >6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had ?2 gaps, 84 (14.5%) had ?3 gaps, and 21 (3.6%) died; 77% of the gaps were followed by a re-linkage with care The KM curves estimate that one-quarter of patients (95% CI = 22-29%) would experience ?1 gap in care by Year 1; nearly one-half (CI = 45-54%) by Year 2; and 90% (CI = 93-96%) by Year 8. A prior gap was a strong predictor (HR = 2.36; CI = 2.16-2.58) of subsequent gaps; other predictors included age prevention of gaps as well as re-engaging those lost to follow-up. PMID:25634492

  1. 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)

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

    2014-06-01

    Full Text Available 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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2013-12-01

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

    Rodkjaer, L; Laursen, T

    2009-01-01

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

  6. The heritability of clinically diagnosed attention-deficit/hyperactivity disorder in children and adults

    OpenAIRE

    Larsson, Henrik; Chang, Zheng; D Onofrio, Brian; Lichtenstein, Paul

    2013-01-01

    Background: No prior twin study has explored the heritability of clinically diagnosed ADHD. Such studies are needed to resolve conflicting results regarding the importance of genetic effects for ADHD in adults. We aimed to estimate the relative contribution of genetic and environmental influences for clinically diagnosed ADHD across the life-span with a specific focus on ADHD in adults. Method: Information about zygosity and sex was obtained from 59,514 twins born between 1959 and 200...

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

    DEFF Research Database (Denmark)

    Drljevic, Aska; Borre, Michael

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ahmad E. Aboshaiqah

    2014-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ruta Tuckuviene

    2010-06-01

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

  10. Vaccine Therapy in Treating Patients With Newly Diagnosed Advanced Colon Polyps | Division of Cancer Prevention

    Science.gov (United States)

    This randomized phase II clinical trial studies how well MUC1 peptide-poly-ICLC adjuvant vaccine works in treating patients with newly diagnosed advanced colon polyps (adenomatous polyps). Adenomatous polyps are growths in the colon that may develop into colorectal cancer overtime. Vaccines made from peptides may help the body build an effective immune response to kill polyp cells. MUC1 peptide-poly-ICLC adjuvant vaccine may also prevent the recurrence of adenomatous polyps and may prevent the development of colorectal cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-04-01

    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.

  12. 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.

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

    Science.gov (United States)

    Taneja, Sangeeta; Jena, Amarnath; Zaidi, Syed. Mohd. Shuaib; Khurana, Anuj

    2012-01-01

    Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well. PMID:22623820

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

    Directory of Open Access Journals (Sweden)

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

    2008-05-01

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

  15. Clinical Features and Differential Diagnoses in Laryngeal Mucoepidermoid Carcinoma

    OpenAIRE

    Sepideh Mokhtari; Saeedeh Mokhtari

    2011-01-01

    Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. However, it is a rare entity in larynx. Laryngeal cases are frequently misdiagnosed with other malignancies and they are under-reported. So, recognizing the clinical and histological features of this tumor is essential. Laryngeal mucoepidermoid carcinoma can arise in supraglottis, glottis and subglottis. Generally, it presents as a submucosal mass; therefore, progressive symptoms without any identifiable lesion in...

  16. Routine use of punch biopsy to diagnose small fiber neuropathy in fibromyalgia patients.

    Science.gov (United States)

    Levine, Todd D; Saperstein, David S

    2015-03-01

    Fibromyalgia is a clinical syndrome that currently does not have any specific pathological finding to aid in diagnosis. Therefore, fibromyalgia is most likely a heterogeneous group of diseases with similar symptoms. Identifying and understanding the pathological basis of fibromyalgia will allow physicians to better categorize patients, increasing prospective treatment options, and improving potential therapeutic endeavors. Recent work has demonstrated that approximately 50% of patients diagnosed with fibromyalgia have damage to their small unmyelinated nerve fibers. A skin punch biopsy is a sensitive and specific diagnostic test for this damage as a reduction in nerve fiber density allows for the diagnosis of small fiber neuropathy. Small fiber neuropathy is a disease with symptoms similar to fibromyalgia, but it often has a definable etiology. Identifying small fiber neuropathy and its underlying cause in fibromyalgia patients provides them with a succinct diagnosis, increases treatment options, and facilitates more specific studies for future therapeutics. PMID:25535201

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

    Directory of Open Access Journals (Sweden)

    Francisca de Fátima Vasconcelos

    2007-09-01

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

  18. 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)

  19. HIV type 1 genetic diversity in newly diagnosed Cuban patients.

    Science.gov (United States)

    Machado, Liuber Y; Blanco, Madeline; Dubed, Marta; Díaz, Héctor M; Ruiz, Nancy M; Váldes, Neysi; Romay, Dania; Lobaina, Leonor I

    2012-08-01

    Knowledge of the genetic diversity of HIV-1 constitutes a fundamental premise in the epidemiological surveillance. In the present study, the HIV-1 genetic variability from 142 Cuban patients who were diagnosed with HIV-1 infection during 2009 and 2010 was determined. HIV-1 subtypes were determined by partial RT-PCR and sequencing of the HIV-1 pol gene. The phylogenetic analysis showed that 47 (33.1 %) samples were subtypes B and 95 (66.9 %) were non-B subtypes, where G, H, and C subtypes, as well as the recombinant forms CRF19_cpx, CRF18_cpx, and CRFs BG, were included. The circulation of CRF05_DF was detected for the first time in Cuba. The analyses of recombinants showed the presence of recombinant CRF18_cpx/CRF19_cpx. The study confirms the high genetic diversity of HIV-1 and the circulation of new genetic variants in the studied population, which indicates the importance of maintaining constant epidemiological surveillance in Cuba. PMID:22059433

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

    Scientific Electronic Library Online (English)

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

    2015-04-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

  3. 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)

    Eduardo Valdés Ramos

    2009-12-01

    Full Text Available Se realizó un estudio descriptivo transversal con 300 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre octubre de 2007 y mayo de 2008, con el objetivo de conocer la frecuencia de hipertensión arterial y su relación con 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.

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

    Directory of Open Access Journals (Sweden)

    Sørgaard Knut W

    2013-01-01

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

  5. Electronic Transfer of Clinical Nursing Minimum Data Set Facilitates Nursing Diagnoses Validation

    OpenAIRE

    Delaney, Connie W.; Mehmert, Peg

    1990-01-01

    Computerized information systems may offer the most efficient, cost effective approach for maximizing the use of the Nursing Minimum Data Set to meet the data access and comparability demands for validation of nursing diagnoses. This report addressed Phases I and II of a larger study testing the research utility of the NMDS. The utility of the NMDS for retrospective validation of four nursing diagnoses as well as electronic retrieval and transfer of the NMDS from a computerized clinical infor...

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

    OpenAIRE

    K. Peltzer

    2004-01-01

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

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

    DEFF Research Database (Denmark)

    JØrgensen, Terese Sara HØj; Torp-Pedersen, Christian

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Kerrn-Jespersen, B M; Lindelof, M

    2014-01-01

    Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is an inflammatory CNS disorder characterized by 1) subacute onset of cerebellar and brainstem symptoms, 2) peripontine contrast-enhancing perivascular lesions with a "salt-and-pepper" appearance on MRI, and 3) angiocentric, predominantly T-lymphocytic infiltration as revealed by brain biopsy. Inflammatory diseases including neuroinfections, CNS lymphoma and neurosarcoidosis must be excluded. Since CLIPPERS was described in 2010, many patients might have been misdiagnosed in the past. We therefore searched medical records from a large tertiary neurological center, the Department of Neurology at Rigshospitalet, Copenhagen University Hospital, for patients discharged between 1999 and 2013 with a diagnosis of "sarcoidosis with other localization", "other acute disseminating demyelination", "other demyelinating disease in the CNS" or "encephalitis, myelitis or encephalomyelitis". Of 206 identified patients, 24had 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.

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

    Science.gov (United States)

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

    2014-08-15

    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

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

    International Nuclear Information System (INIS)

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

  11. Diagnoses during follow-up of patients presenting with fatigue in primary care

    OpenAIRE

    Nijrolder, I.; Windt, D.; Vries, H.; Horst, H.

    2009-01-01

    BACKGROUND: Little is known about the distribution of diagnoses that account for fatigue in patients in primary care. We evaluated the diagnoses established within 1 year after presentation with fatigue in primary care that were possibly associated with the fatigue. METHODS: We conducted a rospective observational cohort study with 1-year follow-up. We included adult patients who resented with a new episode of fatigue between June 2004 and January 2006. We extracted data on diagnoses during t...

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

    Scientific Electronic Library Online (English)

    Francisca de Fátima, Vasconcelos; Thelma Leite de, Araújo; Thereza Maria Magalhães, Moreira; Marcos Venícios de Oliveira, Lopes.

    2007-09-01

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

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

    DEFF Research Database (Denmark)

    Poulsen, Hans Skovgaard; Urup, Thomas

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Staii Anca

    2010-12-01

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

  15. Contributions of T Lymphocyte Abnormalities to Therapeutic Outcomes in Newly Diagnosed Patients with Immune Thrombocytopenia

    Science.gov (United States)

    Yang, Guohua; Zhuang, Yun; Qian, Xifeng; Zhou, Xin; Xiao, Dajiang; Shen, Yunfeng

    2015-01-01

    T cell abnormalities have been reported to play an important role in pathogenesis of immune thrombocytopenia (ITP) besides specific autoantibodies towards platelet. The aim of this study was to explore the clinical importance of T lymphocyte subsets in adult patients with newly diagnosed ITP before and after first-line treatment. Elderly ITP patients were also studied and we tried to analyze the relationships between these items and therapeutic outcomes. The patients were treated with intravenous immunoglobulin (IVIG) plus corticosteroids and therapeutic responses were evaluated. As a result, compared with the controls, absolute lymphocyte counts in ITP patients decreased significantly before treatment. After treatment, lymphocyte counts restored to control level regardless of their treatment outcomes. In addition, we observed increased IgG and CD19+ cell expression and decreased CD4+/CD8+ cell ratio in both whole ITP group and elderly group before treatment. After treatment, the increased IgG and CD19+ cell expression could be reduced in both respond and non-respond group regardless of patient age, while CD4+/CD8+ cell ratio could not be corrected in non-respond ITP patients. In non-respond ITP patients, increased CD8+ cell expression was noticed and could not be corrected by first-line treatment. Furthermore, even lower NK cell expression was found in non-respond elderly patients after treatment when compared with that in controls. Our findings suggest that ITP patients usually had less numbers of peripheral lymphocytes and patients with higher levels of CD8+ cells or lower levels of CD4+/CD8+ cell ratio were less likely to respond to first-line treatment. Lower levels of NK cells made therapies in elderly ITP patients even more difficult. PMID:25978334

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

    DEFF Research Database (Denmark)

    Jakobsen, M A; Katzenstein, Terese Lea

    2012-01-01

    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.

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

    LENUS (Irish Health Repository)

    Ridgway, P F

    2009-11-01

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

  18. Annual Research Review: Progress in Using Brain Morphometry as a Clinical Tool for Diagnosing Psychiatric Disorders

    Science.gov (United States)

    Haubold, Alexander; Peterson, Bradley S.; Bansal, Ravi

    2012-01-01

    Brain morphometry in recent decades has increased our understanding of the neural bases of psychiatric disorders by localizing anatomical disturbances to specific nuclei and subnuclei of the brain. At least some of these disturbances precede the overt expression of clinical symptoms and possibly are endophenotypes that could be used to diagnose an…

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

    Directory of Open Access Journals (Sweden)

    Tog?nel Rodica

    2013-04-01

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

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

    OpenAIRE

    Aboshaiqah, Ahmad E.

    2014-01-01

    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 pa...

  1. Diagnostic Value of Electrocardiographic T Wave Inversion in Lead aVL in Diagnosing Coronary Artery Disease in Patients with Chronic Stable Angina

    OpenAIRE

    Farhan, Hatem L.; Hassan, Kowthar S.; Ali Al-Belushi; Mansour Sallam; Ibrahim Al-Zakwani

    2010-01-01

    Objectives: The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease (CAD) remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina.Methods: Electrocardiograms (ECGs) of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded (66 patients). The remaining 191 pati...

  2. Sexually transmitted diseases in clinic patients in Lagos.

    OpenAIRE

    Rotimi, V. O.; Somorin, A. O.

    1980-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-08-15

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

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

    DEFF Research Database (Denmark)

    Engelhardt, Monika; Terpos, Evangelos

    2014-01-01

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

  6. Clinical characteristics of patients with conjunctivochalasis

    Directory of Open Access Journals (Sweden)

    Balci O

    2014-08-01

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

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

    DEFF Research Database (Denmark)

    Konradsen, Hanne; Lillebaek, Troels

    2014-01-01

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

  8. Attitudes among healthcare providers and patients diagnosed with sickle cell disease.

    Science.gov (United States)

    O'Connor, Stefani; Hanes, Deborah; Lindsey, Amy; Weiss, Mary; Petty, Lorie; Overcash, Janine

    2014-12-01

    Sickle cell disease (SCD) is a chronic condition that affects thousands of people worldwide. The purpose of this study is to illustrate some of the challenges and perceptions of people diagnosed with SCD. The aims were to describe stressors, problematic symptoms, sources of support, and interactions with healthcare providers. This descriptive study, using mostly open-ended questions and conceptual analysis, included a sample of patients with SCD who were older than 18 years in ambulatory (57%) and inpatient (43%) clinics. Participants completed a 20-minute interview. Pain or SCD crisis were the chief reasons for hospitalization, and a wellness checkup was the chief reason people returned to an ambulatory clinic. Most (74%) were able to perform chores. Family was reported to cause the most stress in the home and also provide the most help. Pain is a pervasive aspect of life, limiting activities of daily living. Negative interactions with healthcare providers are common; therefore, advocacy is necessary for patients with SCD. PMID:25427701

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

    DEFF Research Database (Denmark)

    Glintborg, Dorte; Hass Rubin, Katrine

    2015-01-01

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

  10. 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)

    Salehinejad J.

    2011-10-01

    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.

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

    OpenAIRE

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

    2012-01-01

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

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

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

    Directory of Open Access Journals (Sweden)

    Ay?e Sonay Kurt

    2013-12-01

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

  13. Reliability of self-reported diagnoses in patients with neurologically unexplained symptoms

    OpenAIRE

    Schrag, A.; Brown, R.; Trimble, M.

    2004-01-01

    Background: Patients with neurologically unexplained symptoms (NUS) often have a previous history of other medically unexplained symptoms. A past history of such symptoms can help make a positive diagnosis of a somatoform or affective disorder, and enable appropriate management strategies. However, information on past medical diagnoses is primarily obtained from patient interviews and may be inaccurate, particularly in patients with NUS.

  14. Dually diagnosed patients' benefits of mutual-help groups and the role of social anxiety.

    Science.gov (United States)

    Timko, Christine; Cronkite, Ruth C; McKellar, John; Zemore, Sarah; Moos, Rudolf H

    2013-02-01

    There is debate about whether dually diagnosed patients benefit from mutual-help groups (MHGs), partly because social anxiety may make participation problematic. We examined dually diagnosed patients' participation in MHGs and outcomes at 6, 12, and 24 months post-treatment, and the extent to which social anxiety was associated with participation. We also examined whether MHG participation and social anxiety were related to outcomes, and whether social anxiety moderated associations between participation and outcomes. We found high rates of MHG participation. Among patients who attended at least one meeting, outcomes were positive. Social anxiety was not associated with levels of MHG participation, but more participation was associated with better outcomes. When social anxiety moderated associations between MHG participation and outcomes, patients with more social anxiety benefited more from participation. Treated dually diagnosed patients participate in, and benefit from, MHGs, and participation and benefits are comparable, or even strengthened, among more socially-anxious patients. PMID:22763197

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

    Directory of Open Access Journals (Sweden)

    Abecasis Ana B

    2013-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-06-12

    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

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

    Scientific Electronic Library Online (English)

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

    2014-01-01

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

  19. Clinical outcomes and satisfaction of patients of clinical nurse specialists in psychiatric-mental health nursing.

    Science.gov (United States)

    Baradell, J G

    1995-10-01

    Survey research was conducted to examine clinical outcomes and satisfaction of patients of psychiatric mental health clinical nurse specialists (CNSs). Patients who had terminated from outpatient psychotherapy with 6 CNSs in 1993 were mailed a questionnaire (N = 223). Follow-ups by mail yielded a response rate of 45% (n = 100). The questionnaires included the Profile of Mood States-Short Form ([POMS-SF]; McNair, Lorr, & Droppleman, 1992). Quality of Life Function ([QOL]; Lehman, 1991), and Patient Satisfaction Scale (Baradell, 1994). Paired difference t-tests were used to evaluate clinical outcomes. Percentages were used to report satisfaction, and Pearson correlations were used to examine the relationship between clinical outcomes and patient satisfaction. The mean age for respondents was 37 years; 82% were female. Diagnoses included depression (46%), adjustment disorders (34%), anxiety (10%), and other (10%). Patients reported significant improvement in all clinical symptoms: anxiety, depression, anger, confusion, fatigue and vigor. Patients reported significant improvement in all domains of QOL: family, social, and job. Patients reported a very high level of satisfaction with the care provided. The more clinical improvement the patients reported, the more satisfied they were with the care provided. If nurses are to be included in a reformed health care delivery system in the future, additional research is essential. PMID:7487165

  20. Clinical Features of Schwannomatosis: A Retrospective Analysis of 87 Patients

    Science.gov (United States)

    Merker, Vanessa L.; Esparza, Sonia; Smith, Miriam J.; Stemmer-Rachamimov, Anat

    2012-01-01

    Background. Schwannomatosis is a recently recognized form of neurofibromatosis characterized by multiple noncutaneous schwannomas, a histologically benign nerve sheath tumor. As more cases are identified, the reported phenotype continues to expand and evolve. We describe the spectrum of clinical findings in a cohort of patients meeting established criteria for schwannomatosis. Methods. We retrospectively reviewed the clinical records of patients seen at our institution from 1995–2011 who fulfilled either research or clinical criteria for schwannomatosis. Clinical, radiographic, and pathologic data were extracted with attention to age at onset, location of tumors, ophthalmologic evaluation, family history, and other stigmata of neurofibromatosis 1 (NF1) or NF2. Results. Eighty-seven patients met the criteria for the study. The most common presentation was pain unassociated with a mass (46%). Seventy-seven of 87 (89%) patients had peripheral schwannomas, 49 of 66 (74%) had spinal schwannomas, seven of 77 (9%) had nonvestibular intracranial schwannomas, and four of 77 (5%) had intracranial meningiomas. Three patients were initially diagnosed with a malignant peripheral nerve sheath tumor; however, following pathologic review, the diagnoses were revised in all three cases. Chronic pain was the most common symptom (68%) and usually persisted despite aggressive surgical and medical management. Other common diagnoses included headaches, depression, and anxiety. Conclusions. Peripheral and spinal schwannomas are common in schwannomatosis patients. Severe pain is difficult to treat in these patients and often associated with anxiety and depression. These findings support a proactive surveillance plan to identify tumors by magnetic resonance imaging scan in order to optimize surgical treatment and to treat associated pain, anxiety, and depression. PMID:22927469

  1. 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

  2. CENTRAL SLEEP APNEA IN A PATIENT WITH CLINICALLY ISOLATED SYNDROME

    OpenAIRE

    Hu?seyinog?lu, Nergiz; Ozben, Serkan

    2014-01-01

    Central sleep apnea (CSA) is characterized by the cessation of air flow without respiratory effort during sleep. Various neurological diseases have been shown associated with CSA. In this case, we report a 37-year-old male with who admitted to us for sleep respiratory disturbance and diagnosed as both clinically isolated syndrome (CIS) and CSA after our investigation. Although the neurological examination of the patient was normal and we detected brain lesions in magnetic resonance imaging (M...

  3. Clinical and molecular characteristics of two transaldolase-deficient patients

    OpenAIRE

    Tylki-Szymanska, Anna; Wamelink, Mirjam M.C.; Stradomska, Teresa J.; Salomons, Gajja S.; Taybert, Joanna; D?browska-Leonik, Nel; Rurarz, Ma?gorzata

    2014-01-01

    Transaldolase (TALDO) deficiency is a rare metabolic disease in the pentose phosphate pathway, which manifests as a severe, early-onset multisystem disease. The body fluids of affected patients contain increased polyol concentrations and seven-carbon chain carbohydrates. We report the molecular and clinical findings in two recently diagnosed transaldolase-deficient children, both presented at birth. During infancy, they presented thin skin with a network of visible vessels, spider telangiecta...

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

    Directory of Open Access Journals (Sweden)

    María Virginia Bürgesser

    2011-04-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Yonca Sönmez

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Uehara T

    2013-12-01

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

  8. High frequency of activated NKp46(+) natural killer cells in patients with new diagnosed of latent autoimmune diabetes in adults.

    Science.gov (United States)

    Wang, Ye; Yuan, Weijun; Guo, Hui; Jiang, Yanfang

    2015-06-01

    To determine the potential association of different subsets of NK cells with the development of latent autoimmune diabetes of adults (LADA) in patients. The frequency of different subsets of NK and NKT cells, including IFN-?(+) and CD107a(+) NK and NKT cells, in 27 patients with newly diagnosed LADA and 20 healthy controls (HC) were determined by flow cytometry. The concentrations of serum autoantibodies against GAD65 were measured by direct radioligand assay. The potential association of the frequency of NK cells with clinical measures was analyzed. In comparison with that in the HC, significantly higher frequency of peripheral blood NK and NKp46(+) NK cells, but lower frequency of KIR3DL1(+) NK cells were detected in patients with newly diagnosed LADA (p?patients than that in the HC (p?patients (R?=?-0.4877, p?=?0.0099). There was no significant difference in the frequency of spontaneous and inducible CD107a(+) between patients and controls. Our data indicate a higher frequency of activated NKp46(+) NK cells may be associated with the development of LADA in humans. PMID:25495606

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

    OpenAIRE

    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.

    2008-01-01

    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% ...

  10. Managing the patient with newly diagnosed Parkinson disease.

    Science.gov (United States)

    Singer, Carlos

    2012-07-01

    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

  11. Erythema nodosum: The clinical and demographic characteristics of 33 patients

    Directory of Open Access Journals (Sweden)

    Bilal Sula

    2015-03-01

    Full Text Available Objective: In this study our aim was to determine demographic and clinical features, etiological factors, laboratory findings and treatment regimens of patients who were diagnosed and treated with erythema nodosum. Methods: Thirty-three patients who were clinical and histopathological diagnosed as erythema nodosum in dermatology clinic of our university, dated between 2008 and 2014, were evaluated retrospectively. Results: The study population consisted of 29 (87.9% female and 4 (12.1% male, with a mean age of 40.57±13.98 years (range, 11-69 years. Most patients were found in the 30-39 age range. The most frequent localization of lesions was found in the lower extremities (54.5%. Infections (30.3% were the most common identified etiologic factors followed by drugs (12.1%, pregnancy (6.1%, Behcet’s disease (6.1% and sarcoidosis (3.1%. The mean duration of disease was 12.60 days. 72.7% of patients were admitted as the first episode. The mean hospitalization time was 8.93 days. Conclusion: The etiology of erythema nodosum varies from country to country. The most common etiological factor was found idiopathic (42.4% in our study. However, etiologic factors are similar in all studies, only showed differences in the rankings. No showed significant difference between clinical, laboratory, histopathological findings and treatment.

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

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    Marta Rorat

    2013-06-01

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

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

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

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

  14. Clinical and histopathological characteristics in patients with postmenopausal bleeding

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    Mandi? Aljoša

    2013-01-01

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

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

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    e Silva Machado Luciana

    2012-08-01

    Full Text Available Abstract Background Temporomandibular disorder (TMD patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling 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.

  16. Normal urinary albumin excretion in recently diagnosed type 1 diabetic patients

    DEFF Research Database (Denmark)

    Lind, B; Jensen, T

    1989-01-01

    The urinary excretion of albumin and retinol binding protein were measured in 51 recently diagnosed Type 1 diabetic patients and 48 control subjects, matched for age and sex. The diabetic patients, admitted consecutively to the Steno Memorial Hospital, were all studied 3 to 6 months after the onset of diabetes. Urinary albumin excretion (median and 95% confidence interval) was similar in the diabetic patients and normal control subjects (8 (6-11) vs 8 (6-11) mg 24-h-1, NS). Four diabetic patients had urinary albumin excretion in the microalbuminuric range of 30-300 mg 24-h-1. There was no significant difference between the two groups in urinary excretion of retinol binding protein. The distribution among the individuals of both urinary proteins was positively skewed and similar in the two groups. In conclusion, no significant differences in the urinary excretion of albumin and retinol binding protein were found between recently diagnosed Type 1 diabetic patients and normal subjects.

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

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Nielsen, Stig LØnberg

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess

    2012-01-01

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

  19. Etiological Spectrum of Clinically Diagnosed Japanese Encephalitis Cases Reported in Guizhou Province, China, in 2006 ?

    OpenAIRE

    Xufang, Ye; Huanyu, Wang; Shihong, Fu; Xiaoyan, Gao; Shuye, Zhao; Chunting, Liu; Minghua, Li; Yougang, Zhai; Guodong, Liang

    2010-01-01

    The proportion of laboratory-confirmed Japanese encephalitis (JE) virus (JEV) infections was compared to the number of JE cases reported on the basis of seasonality and the clinical symptoms of hospitalized patients in Guizhou Province, China, between April and November 2006. Of the 1,837 patients with reported JE, 1,382 patients in nine prefectures were investigated. JE was confirmed in 1,210 of 1,382 (87.6%) patients by a JEV-specific immunoglobulin M (IgM) antibody-capture enzyme-linked im...

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

    Directory of Open Access Journals (Sweden)

    Rafanelli M

    2014-02-01

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

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

    DEFF Research Database (Denmark)

    FlØyel, Tina; Brorsson, Caroline

    2014-01-01

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

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

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    RodolfoRey

    2014-05-01

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

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

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess

    2010-01-01

    The objective of the study was to determine the long-term mortality and the causes of death in patients diagnosed with pneumococcal meningitis. The authors performed a nationwide, population-based cohort study including all Danish patients diagnosed with pneumococcal meningitis from 1977 through 2006 and alive 1 year after diagnosis. Data were retrieved from medical databases in Denmark. The absolute and relative risks of all-cause and cause-specific death were analyzed by using Kaplan-Meier survival curves, Poisson regression analysis, Cox regression analysis, and cumulative incidence functions. The authors identified 2,131 pneumococcal meningitis patients and an age- and gender-matched, population-based cohort of 8,524 individuals. Compared with the background population, the pneumococcal meningitis patients had an increased long-term mortality varying from an 8-fold increased mortality in the age category 0-

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

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

    DEFF Research Database (Denmark)

    Nielsen, Jens Steen; Thomsen, Reimar W.

    2013-01-01

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

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

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    An?l Gülsel Bahal?

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    BORGES Aércio Sebastião

    1997-01-01

    Full Text Available Acquired immunodeficiency syndrome (AIDS is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7% autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition

  9. Low prevalence of transmitted drug resistance in patients newly diagnosed with HIV-1 infection in Sweden 2003-2010.

    Science.gov (United States)

    Karlsson, Annika; Björkman, Per; Bratt, Göran; Ekvall, Håkan; Gisslén, Magnus; Sönnerborg, Anders; Mild, Mattias; Albert, Jan

    2012-01-01

    Transmitted drug resistance (TDR) is a clinical and epidemiological problem because it may contribute to failure of antiretroviral treatment. The prevalence of TDR varies geographically, and its prevalence in Sweden during the last decade has not been reported. Plasma samples from 1,463 patients newly diagnosed with HIV-1 infection between 2003 and 2010, representing 44% of all patients diagnosed in Sweden during this period, were analyzed using the WHO 2009 list of mutations for surveillance of TDR. Maximum likelihood phylogenetic analyses were used to determine genetic subtype and to investigate the relatedness of the sequences. Eighty-two patients showed evidence of TDR, representing a prevalence of 5.6% (95% CI: 4.5%-6.9%) without any significant time trends or differences between patients infected in Sweden or abroad. Multivariable logistic regression showed that TDR was positively associated with men who have sex with men (MSM) and subtype B infection and negatively associated with CD4 cell counts. Among patients with TDR, 54 (68%) had single resistance mutations, whereas five patients had multi-drug resistant HIV-1. Phylogenetic analyses identified nine significantly supported clusters involving 29 of the patients with TDR, including 23 of 42 (55%) of the patients with TDR acquired in Sweden. One cluster contained 18 viruses with a M41L resistance mutation, which had spread among MSM in Stockholm over a period of at least 16 years (1994-2010). Another cluster, which contained the five multidrug resistant viruses, also involved MSM from Stockholm. The prevalence of TDR in Sweden 2003-2010 was lower than in many other European countries. TDR was concentrated among MSM, where clustering of TDR strains was observed, which highlights the need for continued and improved measures for targeted interventions. PMID:22448246

  10. Low Prevalence of Transmitted Drug Resistance in Patients Newly Diagnosed with HIV-1 Infection in Sweden 2003–2010

    Science.gov (United States)

    Karlsson, Annika; Björkman, Per; Bratt, Göran; Ekvall, Håkan; Gisslén, Magnus; Sönnerborg, Anders; Mild, Mattias; Albert, Jan

    2012-01-01

    Transmitted drug resistance (TDR) is a clinical and epidemiological problem because it may contribute to failure of antiretroviral treatment. The prevalence of TDR varies geographically, and its prevalence in Sweden during the last decade has not been reported. Plasma samples from 1,463 patients newly diagnosed with HIV-1 infection between 2003 and 2010, representing 44% of all patients diagnosed in Sweden during this period, were analyzed using the WHO 2009 list of mutations for surveillance of TDR. Maximum likelihood phylogenetic analyses were used to determine genetic subtype and to investigate the relatedness of the sequences. Eighty-two patients showed evidence of TDR, representing a prevalence of 5.6% (95% CI: 4.5%–6.9%) without any significant time trends or differences between patients infected in Sweden or abroad. Multivariable logistic regression showed that TDR was positively associated with men who have sex with men (MSM) and subtype B infection and negatively associated with CD4 cell counts. Among patients with TDR, 54 (68%) had single resistance mutations, whereas five patients had multi-drug resistant HIV-1. Phylogenetic analyses identified nine significantly supported clusters involving 29 of the patients with TDR, including 23 of 42 (55%) of the patients with TDR acquired in Sweden. One cluster contained 18 viruses with a M41L resistance mutation, which had spread among MSM in Stockholm over a period of at least 16 years (1994–2010). Another cluster, which contained the five multidrug resistant viruses, also involved MSM from Stockholm. The prevalence of TDR in Sweden 2003–2010 was lower than in many other European countries. TDR was concentrated among MSM, where clustering of TDR strains was observed, which highlights the need for continued and improved measures for targeted interventions. PMID:22448246

  11. Acute admissions to medical departments in Denmark : Diagnoses and patient characteristics

    DEFF Research Database (Denmark)

    Vest-Hansen, Betina; Riis, Anders Hammerich

    2014-01-01

    BACKGROUND: Despite extensive research on individual diseases, population-based knowledge about reasons for acute medical admissions remains limited. Our aim was to examine primary diagnoses, Charlson Comorbidity Index (CCI) score, age, and gender among patients admitted acutely to medical departments in Denmark. METHODS: In this population-based observational study, 264,265 acute medical patients admitted during 2010 were identified in the Danish National Registry of Patients (DNRP), covering all hospitals in Denmark. Reasons for acute admissions were assessed by primary diagnoses, grouped according to the International Classification of Diseases 10th edition. Additionally, the CCI score, age and gender were presented according to each diagnostic group. RESULTS: Two-thirds of the patients had one of the four following reasons for admission: cardiovascular diseases (19.3%), non-specific Z-diagnoses ("Factors influencing health status and contact with health services") (16.9%), infectious diseases (15.5%), and non-specific R-diagnoses ("Symptoms and abnormal findings, not elsewhere classified") (11.8%). In total, 45% of the patients had a CCI score of one or more and there was a considerable overlap between the patients' chronic diseases and the reason for admission. The median age of the study population was 64years (IQR 47-77years), ranging from 46years (IQR 27-66) for injury and poisoning to 74years (IQR 60-83) for hematological diseases. Gender representation varied considerably within the diagnostic groups, for example with male predominance in mental disorders (59.0%) and female predominance in diseases of the musculoskeletal system (57.8%). CONCLUSION: Our study identifies that acute medical patients often present with non-specific symptoms or complications related to their chronic diseases.

  12. Ask, Understand, Remember: A Brief Measure of Patient Communication Self-Efficacy Within Clinical Encounters

    OpenAIRE

    Clayman, Marla L.; Pandit, Anjali U.; Bergeron, Ashley R.; Cameron, Kenzie A.; Ross, Emily; Wolf, Michael S.

    2010-01-01

    Patients' ability to effectively communicate with their health care providers is an essential aspect of proper self-care, especially for those with chronic conditions. We wanted to develop and validate a brief reliable measure of patient communication self-efficacy within clinical encounters. Consecutively recruited patients (n = 330) with diagnosed hypertension from seven primary care clinics in Chicago, Illinois, Grand Rapids, Michigan, and Shreveport, Louisiana completed an in-person inter...

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

    DEFF Research Database (Denmark)

    Mor, Anil; Thomsen, Reimar W.

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

  14. Accuracy of FDG-PET within the clinical practice of the ACOSOG Z4031 trial to diagnose clinical stage I NSCLC

    Science.gov (United States)

    Grogan, Eric L.; Deppen, Stephen A.; Ballman, Karla V.; Andrade, Gabriela M.; Verdial, Francys C.; Aldrich, Melinda C.; Chen, Chiu L.; Decker, Paul A.; Harpole, David H.; Cerfolio, Rrobert J.; Keenan, Robert J.; Jones, David R.; D’Amico, Thomas A.; Shrager, Joseph B.; Meyers, Bryan F.; Putnam, Joe B.

    2014-01-01

    Background Fluoro-deoxyglucose positron emission tomography (FDG-PET) is recommended for diagnosis and staging of NSCLC. Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity and specificity of 96% and 78%, respectively but were performed in select centers introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national ACOSOG Z4031 trial. Methods 959 eligible patients with clinical stage I (cT1-2N0M0) known or suspected NSCLC were enrolled between 2004 and 2006 in the Z4031 trial and 682 had a baseline FDG-PET. Final diagnosis was determined by pathological examination. FDG-PET avidity was categorized into four levels based on radiologist description or reported maximum standard uptake value (SUV). FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined. Results Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% CI: 79–85) and specificity was 31% (95% CI: 23%–40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false positive scans, 69% were granulomas. False negative scans occurred in 101 patients with adenocarcinoma being the most frequent (64%) and eleven were ?10mm. The sensitivity varied from 68% to 91% (p=0.03) and the specificity ranged from 15% to 44% (p=0.72) across cities with > 25 participants. Conclusions In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared to published studies. PMID:24576597

  15. Accuracy of Femur Angles Estimated by IMUs During Clinical Procedures Used to Diagnose Femoroacetabular Impingement.

    Science.gov (United States)

    McGinnis, Ryan S; Cain, Stephen M; Tao, Sui; Whiteside, David; Goulet, Grant C; Gardner, Elizabeth C; Bedi, Asheesh; Perkins, Noel C

    2015-06-01

    We present a novel method for quantifying femoral orientation angles using a thigh-mounted inertial measurement unit (IMU). The IMU-derived femoral orientation angles reproduce gold-standard motion capture angles to within mean (standard deviation) differences of 0.1 (1.1) degrees on cadaveric specimens during clinical procedures used for the diagnosis of Femoroacetabular Impingement (FAI). The method, which assumes a stationary pelvis, is easy to use, inexpensive, and provides femur motion trajectory data in addition to range of motion measures. These advantages may accelerate the adoption of this technology to inform FAI diagnoses and assess treatment efficacy. To this end, we further investigate the accuracy of hip joint angles calculated using this methodology and assess the sensitivity of our estimates to skin motion artifact during these tasks. PMID:25608299

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

    Directory of Open Access Journals (Sweden)

    Luo Bai-ling

    2011-10-01

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

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

    Directory of Open Access Journals (Sweden)

    N. G. Osipov

    2014-12-01

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

  18. A CLINICAL STUDY OF SOMATISING PATIENTS ATTENDING PSYCHIATRIC OUTPATIENT CLINIC

    OpenAIRE

    Chadda, R.K.; Bhatia, M.S.

    1990-01-01

    Patients presenting with bodily symptoms without any demonstrable physical basis were studied. Somatisation was observed in more than 80% of the sample studied. A higher percentage of somatisers were found in females, age groups 35-44 and above 55, unmarried and illiterate groups. Housewives formed the largest group of somatisers amongst different occupations. Common diagnoses amongst somatisers were neurotic depression, hysterical neurosis, anxiety neurosis and endogenous depression.

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

    International Nuclear Information System (INIS)

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

  20. Comprehensive Literature Review: Recent Advances in Diagnosing and Managing Patients with Poorly Differentiated Thyroid Carcinoma

    OpenAIRE

    Jack Hannallah; Jessica Rose; Guerrero, Marlon A.

    2013-01-01

    Poorly differentiated thyroid carcinomas are a rare form of thyroid carcinomas; they display an intermediate behavior between well-differentiated and anaplastic thyroid carcinomas. PDTCs are more aggressive than the well-differentiated, but less aggressive than the undifferentiated or anaplastic, forms. No clinical features can accurately diagnose poorly differentiated thyroid carcinomas. Thus, the results of histocytology, immunohistochemistry, and molecular genetics tests aid in diagnosis. ...

  1. [Diagnostic strategy in patients with clinically suspected deep vein thrombosis

    DEFF Research Database (Denmark)

    Mantoni, Margit Yvonne; Kristensen, M.

    2008-01-01

    INTRODUCTION: The standard method for diagnosing deep vein thrombosis (DVT) involves determination of D-dimer and ultrasound scanning. In an attempt to reduce the number of ultrasound examinations we have supplemented this with a clinical probability estimate for DVT (DVT-score) over one year. MATERIALS AND METHODS: A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal fossa. If no DVT was revealed, the patient was contacted by telephone 7-10 days later, and was offered a repeat examination if symptoms persisted. RESULTS: Three patients with chronic DVT were excluded. Normal D-dimer and low or moderate DVT-score was found in 103 patients, none had DVT. Only five patients with normal D-dimer had high DVT-scores, none had DVT, so that the benefit from determining DVT-scores was modest. Ultrasound scanning revealed DVT in 85 out of 397 patients with elevated D-dimer. A repeat examination was performed in 91 patients with persisting symptoms, and disclosed DVT in two. CONCLUSION: We recommend that ambulatory patients with clinically suspected DVT have a D-dimer test. If D-dimer is elevated, compression ultrasound should be performed in the groin and the popliteal fossa Udgivelsesdato: 2008/3/31

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

    Roug, Anne S; Hansen, Marcus Celik

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric

    2012-01-01

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

  5. Accuracy of self-reported tobacco use in newly diagnosed cancer patients

    Science.gov (United States)

    Morales, Nelson A.; Romano, Michelle A.; Cummings, K. Michael; Marshall, James R.; Hyland, Andrew J.; Hutson, Alan

    2015-01-01

    Purpose Accurate identification of tobacco use is critical to implement evidence-based cessation treatments in cancer patients. The purpose of this study is to evaluate the accuracy of self-reported tobacco use in newly diagnosed cancer patients. Methods Tobacco use questionnaires and blood samples were collected from 233 newly diagnosed cancer patients (77 lung, 77 breast, and 79 prostate cancer). Blood was analyzed for cotinine levels using a commercially available enzyme-linked immunosorbent assay. Patients with cotinine measurements exceeding 10 ng/mL were categorized as current smokers. Smoking status based upon cotinine levels was contrasted with self-report in current smokers, recent quitters (1 or less year since quit), non-recent quitters (>1 year since quit), and never smokers. Multivariate analyses were used to identify potential predictors of discordance between self-reported and biochemically confirmed smoking. Results Cotinine confirmed 100 % accuracy in self-reporting of current and never smokers. Discordance in cotinine and smoking status was observed in 26 patients (15.0 %) reporting former tobacco use. Discordance in self-reported smoking was 12 times higher in recent (35.4 %) as compared with non-recent quitters (2.8 %). Combining disease site, pack-year history, and employment status predicted misrepresentation of tobacco use in 82.4 % of recent quitters. Conclusions Self-reported tobacco use may not accurately assess smoking status in newly diagnosed cancer patients. Patients who claim to have recently stopped smoking within the year prior to a cancer diagnosis and lung cancer patients may have a higher propensity to misrepresent tobacco use and may benefit from biochemical confirmation. PMID:23553611

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

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Jones, Rupert C M; Price, David

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Court JH

    2015-04-01

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

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

    Science.gov (United States)

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

    2015-06-01

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

  10. Predictors of Distant Brain Recurrence for Patients With Newly Diagnosed Brain Metastases Treated With Stereotactic Radiosurgery Alone

    International Nuclear Information System (INIS)

    Purpose: To ascertain predictors of distant brain failure (DBF) in patients treated initially with stereotactic radiosurgery alone for newly diagnosed brain metastases. We hypothesize that these factors may be used to group patients according to risk of DBF. Methods and Materials: We retrospectively analyzed 100 patients with newly diagnosed brain metastases treated from 2003 to 2005 at our Gamma Knife radiosurgery facility. The primary endpoint was DBF. Potential predictors included number of metastases, tumor volume, histologic characteristics, extracranial disease, and use of temozolomide. Results: One-year actuarial risk of DBF was 61% for all patients. Significant predictors of DBF included more than three metastases (hazard ratio, 3.30; p = 0.004), stable or poorly controlled extracranial disease (hazard ratio, 2.16; p = 0.04), and melanoma histologic characteristics (hazard ratio, 2.14; p = 0.02). These were confirmed in multivariate analysis. Those with three or fewer metastases, no extracranial disease, and nonmelanoma histologic characteristics (N = 18) had a median time to DBF of 89 weeks vs. 33 weeks for all others. One-year actuarial freedom from DBF for this group was 83% vs. 26% for all others. Conclusions: Independent significant predictors of DBF in our series included number of metastases (more than three), present or uncontrolled extracranial disease, and melanoma histologic characteristics. These factors were combined to identify a lower risk subgrre combined to identify a lower risk subgroup with significantly longer time to DBF. These patients may be candidates for initial localized treatment, reserving whole-brain radiation therapy for salvage. Patients in the higher risk group may be candidates for initial whole-brain radiation therapy or should be considered for clinical trials

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

    Science.gov (United States)

    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

    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

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

    OpenAIRE

    Brand Caroline; Lowe Adrian; Hall Stephen

    2008-01-01

    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 ...

  13. Diagnosing and treating Diamond Blackfan anaemia: results of an international clinical consensus conference

    OpenAIRE

    Vlachos, Adrianna; Ball, Sarah; Dahl, Niklas; Alter, Blanche P.; Sheth, Sujit; Ramenghi, Ugo; Meerpohl, Joerg; Karlsson, Stefan; Liu, Johnson M.; Leblanc, Thierry; Paley, Carole; Kang, Elizabeth M; Leder, Eva Judmann; Atsidaftos, Eva; Shimamura, Akiko

    2008-01-01

    Diamond Blackfan anaemia (DBA) is a rare, genetically and clinically heterogeneous, inherited red cell aplasia. Classical DBA affects about seven per million live births and presents during the first year of life. However, as mutated genes have been discovered in DBA, non-classical cases with less distinct phenotypes are being described in adults as well as children. In caring for these patients it is often difficult to have a clear understanding of the treatment options and their outcomes be...

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

    Directory of Open Access Journals (Sweden)

    Caldarella C

    2013-06-01

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

  15. Effectiveness of one dose of mumps vaccine against clinically diagnosed mumps in Guangzhou, China, 2006–2012

    OpenAIRE

    Fu, Chuanxi; Xu, Jianxiong; Cai, Yuanjun; He, Qing; Zhang, Chunhuan; Jian CHEN; Dong, Zhiqiang; Hu, Wensui; Wang, Hui; Zhu, Wei; Wang, Ming

    2013-01-01

    Although mumps-containing vaccines were introduced in China in 1990s, mumps continues to be a public health concern due to the lack of decline in reported mumps cases. To assess the mumps vaccine effectiveness (VE) in Guangzhou, China, we performed a 1:1 matched case-control study. Among children in Guangzhou aged 8 mo to 12 y during 2006 to 2012, we matched one healthy child to each child with clinically diagnosed mumps. Cases with clinically diagnosed mumps were identified from surveillance...

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

    International Nuclear Information System (INIS)

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

  17. A Case of Erosive Polyarthritis in a Patient Diagnosed With a Suspicion of Atypical Mycobacteria

    OpenAIRE

    Almoallim, Hani; Alharbi, Laila; Alshareef, Zainab; Wali, Ghassan

    2013-01-01

    In this report, we introduce a case of erosive polyarthritis in a 55-year-old female diagnosed with Mycobacterium abscessus pulmonary infection. Her arthritis has been worsened after use of DMARDs. The patient demonstrated a significant response to the antimicrobial regimen that was administered. We call special attention to the possibility of Mycobacterium abscessus being a cause of reactive polyarthritis, particularly if symptoms worsened after use of disease-modifying antirheumatic drugs (...

  18. Eltrombopag therapy in newly diagnosed steroid non-responsive ITP patients.

    Science.gov (United States)

    Tripathi, Anil Kumar; Shukla, Ayush; Mishra, Sanjay; Yadav, Yogendra Singh; Yadav, Deependra Kumar

    2014-04-01

    Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterised by isolated thrombocytopenia (peripheral blood platelet count anti-D, or splenectomy. Previous studies have shown decreased platelet production in some ITP patients, aside from the evidence of enhanced platelet destruction. Thrombopoietin receptor agonists (TPO-RA), such as eltrombopag have been shown to provide good response in steroid non-responsive chronic ITP patients. We have studied response to eltrombopag in 25 newly diagnosed steroid non-responsive ITP patients; 80 % patients showed response at the end of 1 month, and 76 % sustained response at the end of 3 months. The platelet count rose from a mean value of 17.5 ± 3.6-152.5 ± 107.9 × 10(9)/L at the end of 1 month. Our results suggest a possible role of eltrombopag in newly diagnosed steroid non-responsive ITP patients. However, our study is limited in that it is a single-centre study, with a small sample size, and lacks a long-term safety profile. Our findings highlight the potential value of a larger prospective study on the upfront use of TPO-RA in patients of ITP. PMID:24526570

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

    Science.gov (United States)

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

    2014-11-01

    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, p<0.001) was a significant risk 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

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

    Directory of Open Access Journals (Sweden)

    Chen Xiu-jun

    2011-12-01

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

  1. Intelligent Virtual Patients for Training Clinical Skills

    Directory of Open Access Journals (Sweden)

    Thomas D. Parsons

    2011-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Ogorenko V.V.

    2014-03-01

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

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

    Directory of Open Access Journals (Sweden)

    bilge burcak annagur

    2012-01-01

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

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

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    Ad A. van Bodegraven

    2013-09-01

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

  5. Clinical importance of Clostridium difficile finding in hospitalized patients

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    Koci? Branislava

    2008-01-01

    Full Text Available Introduction Clostridium difficile infections predominatelly occur among hospitalized patients. The aim of this study was to evaluate the importance of finding the isolate of Clostridium difficile cultured from the stool of hospitalized patients. Material and methods Material consisted of 100 patients with at least one liquid stool samples and control group with form stool. Every patient spent minimum 48h in hospital before the sampling. The material was immediately cultured on mediums for isolation of enteric pathogens, and on selective CCFA medium (Biomedics for Clostridium difficile in anaerobic condition. Diagnosis of Clostridium difficile toxin in stool samples was achieved by ELISA-RIDASCREEN Clostridium difficile Toxin A/B test (R-Biopharm. Results One-hundred forty one stool samples of patients in Clinical Center Nis were cultivated and examined for C. difficile. The bacteria was isolated in seven patients from the clinical group. In four (57.14% patients, the presence of C. difficile toxin in stool was established. The bacteria was diagnosed from the stool samples of five patients from the control group, but the toxin was not found in their stool samples. Discussion The results performed at the Institute for Public Health Nis are in accordance with previously published results that all patients with positive findings of Clostridium difficile toxin in stool samples were on antibiotic treatment longer than 14 days. By analyzing the patient's stay in hospital and duration of antibiotic treatment, we observed the statistically significant difference in findings between the patients with CDAD and the patients from the control group with positive bacteria. Conclusion The study confirms the importance of finding Clostridium difficile associated disease in four (4% hospitalized patients.

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

    DEFF Research Database (Denmark)

    Petersen, Lars J; Mortensen, Jesper C

    2015-01-01

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

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

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    Yannara Elina Columbié Garbey

    2011-06-01

    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.

  8. Etiological spectrum of clinically diagnosed Japanese encephalitis cases reported in Guizhou Province, China, in 2006.

    Science.gov (United States)

    Xufang, Ye; Huanyu, Wang; Shihong, Fu; Xiaoyan, Gao; Shuye, Zhao; Chunting, Liu; Minghua, Li; Yougang, Zhai; Guodong, Liang

    2010-04-01

    The proportion of laboratory-confirmed Japanese encephalitis (JE) virus (JEV) infections was compared to the number of JE cases reported on the basis of seasonality and the clinical symptoms of hospitalized patients in Guizhou Province, China, between April and November 2006. Of the 1,837 patients with reported JE, 1,382 patients in nine prefectures were investigated. JE was confirmed in 1,210 of 1,382 (87.6%) patients by a JEV-specific immunoglobulin M (IgM) antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA), heminested reverse transcriptase PCR, and virus isolation. Two strains of JEV belonging to genotype 1 were isolated. Other viral pathogens responsible for encephalitis, including echovirus, mumps virus, herpes simplex virus, and cytomegalovirus, were identified in 67 of 172 (38.9%) JE-negative cases. On the basis of the distribution of the laboratory-confirmed JE cases from different hospitals according to the Chinese administrative division, which included hospitals at the provincial, city, county, and township levels, county hospitals detected the highest number of JE cases (81.8%), whereas township hospitals detected the smallest number of JE cases (1.4%). Provincial and city hospitals had the highest and lowest rates of accuracy of providing a clinical diagnosis of JE, as confirmed by laboratory testing (91.8% and 76.7%, respectively). This study demonstrates that laboratory confirmation improves the accuracy of diagnosis of JE and that an enhanced laboratory capacity is critical for JE surveillance as well as the identification of other pathogens that cause encephalitic syndromes with clinical symptoms similar to those caused by JEV infection. PMID:20147638

  9. Etiological Spectrum of Clinically Diagnosed Japanese Encephalitis Cases Reported in Guizhou Province, China, in 2006 ?

    Science.gov (United States)

    Xufang, Ye; Huanyu, Wang; Shihong, Fu; Xiaoyan, Gao; Shuye, Zhao; Chunting, Liu; Minghua, Li; Yougang, Zhai; Guodong, Liang

    2010-01-01

    The proportion of laboratory-confirmed Japanese encephalitis (JE) virus (JEV) infections was compared to the number of JE cases reported on the basis of seasonality and the clinical symptoms of hospitalized patients in Guizhou Province, China, between April and November 2006. Of the 1,837 patients with reported JE, 1,382 patients in nine prefectures were investigated. JE was confirmed in 1,210 of 1,382 (87.6%) patients by a JEV-specific immunoglobulin M (IgM) antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA), heminested reverse transcriptase PCR, and virus isolation. Two strains of JEV belonging to genotype 1 were isolated. Other viral pathogens responsible for encephalitis, including echovirus, mumps virus, herpes simplex virus, and cytomegalovirus, were identified in 67 of 172 (38.9%) JE-negative cases. On the basis of the distribution of the laboratory-confirmed JE cases from different hospitals according to the Chinese administrative division, which included hospitals at the provincial, city, county, and township levels, county hospitals detected the highest number of JE cases (81.8%), whereas township hospitals detected the smallest number of JE cases (1.4%). Provincial and city hospitals had the highest and lowest rates of accuracy of providing a clinical diagnosis of JE, as confirmed by laboratory testing (91.8% and 76.7%, respectively). This study demonstrates that laboratory confirmation improves the accuracy of diagnosis of JE and that an enhanced laboratory capacity is critical for JE surveillance as well as the identification of other pathogens that cause encephalitic syndromes with clinical symptoms similar to those caused by JEV infection. PMID:20147638

  10. 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)

    A Miranda

    2012-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2011-06-01

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

  12. Heterogeneity of autoantibodies in 100 patients with autoimmune myositis: insights into clinical features and outcomes

    OpenAIRE

    Koenig, Martial; Fritzler, Marvin J.; Targoff, Ira N.; Troyanov, Yves; Sene?cal, Jean-luc

    2007-01-01

    The objective of this study was to determine the prevalence, mutual associations, clinical manifestations, and diagnoses associated with serum autoantibodies, as detected using recently available immunoassays, in patients with autoimmune myositis (AIM). Sera and clinical data were collected from 100 patients with AIM followed longitudinally. Sera were screened cross-sectionally for 21 autoantibodies by multiplex addressable laser bead immunoassay, line blot immunoassay, immunoprecipitation of...

  13. Clinical Picture Of Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy Patients From Indian Origin

    OpenAIRE

    DVN Maithili; Pranathi Rao Pamuru; Khalid Mohiuddin; Sushant Remersu; Narasimhan Calambur; Sai Satish Oruganti; Pratibha Nallari

    2009-01-01

    Objective: Among the inherited cardiomyopathies, Arrhythmogenic right ventricular dysplasia/cardiomyopathy is unique with a peculiar pathology of fibro-fatty replacement. Studies have been carried out all over the world and several groups have reported clinical heterogeneity in manifestation of ARVD/C related symptoms. Present study is an attempt to identify the clinical profile of ARVD/C patients from Asian Indian origin.Methods: 31 patients in the span of three years were diagnosed with ARV...

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

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    Visser Otto

    2010-06-01

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

  15. Evidence-based interventional pain medicine according to clinical diagnoses. 2. Cluster headache.

    Science.gov (United States)

    van Kleef, Maarten; Lataster, Arno; Narouze, Samer; Mekhail, Nagy; Geurts, José W; van Zundert, Jan

    2009-01-01

    Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month. Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation. In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study. PMID:19874534

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

    Science.gov (United States)

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

    2014-08-01

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

  17. Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

    Science.gov (United States)

    2014-01-01

    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

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

    Science.gov (United States)

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

    2015-08-01

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

  19. Characteristics of patients with sensory neuropathy diagnosed with abnormal small nerve fibres on skin biopsy

    OpenAIRE

    De Sousa, E A; Hays, A. P.; Chin, R L; Sander, H W; Brannagan, T H

    2006-01-01

    Clinical, laboratory and electrodiagnostic (EDX) characteristics of 62 patients with sensory neuropathy with abnormal skin biopsies were reviewed. Reduced epidermal nerve fibre density (ENFD) was seen in 71% and morphological changes with normal ENFD were seen in 29% of the patients. Patients with small fibre sensory neuropathy may have associated large fibre loss undetected by routine EDX. Identified associations included abnormal glucose metabolism, Lyme vaccination, monoclonal gammopathy, ...

  20. 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)

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

    2012-12-01

    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.

  1. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Umer Ahmed

    2015-02-01

    Full Text Available INTRODUCTION: The main aim of this study was to determine the frequency of Enterobius Vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. MATERIALS: This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. RESULTS: Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8% patients had Enterobius Vermicularis infections. Malignancy (n=2, 0.1% and infection with Ascaris (n=1, 0.1% was found very rarely among the patients.Eggs in lumen (n=22, 0.7%, mucinous cystadenoma (n=28, 1.0%, mucocele (n=11, 0.4%, lymphoma (n=9, 0.3%, obstruction in lumen (n=17, 0.6% and purulent exudate (n=37, 1.3% were also seldom seen in the histopathological reports. CONCLUSION: Enterobius Vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries.

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

    International Nuclear Information System (INIS)

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

  3. A prospective study of spine fractures diagnosed by total spine computed tomography in high energy trauma patients

    International Nuclear Information System (INIS)

    Since it is known to be impossible to identify spinal fractures in high-energy trauma patients the primary trauma evaluation, we have been performing total spine computed tomography (CT) in high-energy trauma cases. We investigated the spinal fractures that it was possible to detect by total spine CT in 179 cases and evaluated the usefulness of total spine CT prospectively. There were 54 (30.2%) spinal fractures among the 179 cases. Six (37.5%) of the 16 cervical spine fractures that were not detected on plain X-ray films were identified by total spine CT. Six (14.0%) of 43 thoracolumbar spine fractures were considered difficult to diagnose based on the clinical findings if total spine CT had not been performed. We therefore concluded that total spine CT is very useful and should be performed during the primary trauma evaluation in high-energy trauma cases. (author)

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

    LENUS (Irish Health Repository)

    Kellett, John

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Nishi, Osamu; Sako, Mamoru; Murata, Tamaki; Uchino, Hitomi (Kyouritsu Clinic, Osaka (Japan)); AkagaKi, Youji; Taniguchi, Toshio

    1992-10-01

    The utility of magnetic resonance imaging (MRI) in diagnosing hemosiderosis (H) was evaluated in patients on long-term hemodialysis. The study subjects were 19 patients with serum ferritin (Ft) [>=]300 [mu]g/l, and 4 patients, with Ft<300 [mu]g/l served as controls, for a total of 23 patients on long-term hemodialysis receiving MRI examination. As a result, the intensity of the liver was diffusely reduced on T2 images in all 19 patients with Ft[>=]300 [mu]g/l. The severity of hemosiderosis was divided into groups designated 0 to III according to the degree of siderosis as evaluated by MRI. In a patient of severity I, the T1 image was normal and the intensity was reduced only on the T2 image. In a patient of severity III, the intensity was reduced on both T1 and T2 images. On the other hand, both T1 and T2 images showed normal liver intensity in all 4 controls with Ft<300 [mu]g/l. Furthermore, the results of liver function tests including GOT and GPT were normal in all 23 patients. The MRI-assessed severity of H (0 to III) correlated positively with serum Ft and serum Fe. These results suggest that the T1 image is useful for evaluating the severity of H, the T2 image for early diagnosis and that MRI and Ft are useful for evaluating the therapeutic effects on hemosiderosis. (author).

  6. Duodenal cryptococcus infection in an AIDS patient: retrospective clinical analysis.

    Science.gov (United States)

    Li, Jiamin; Wang, Ningfang; Hong, Qunying; Bai, Chunxue; Hu, Bijie; Tan, Yunshan

    2015-03-01

    Cryptococcal infection primarily affects the lung or the central nervous system and rare cases have been reported involving the gastrointestinal tract. However, among patients with HIV/AIDS, the gastrointestinal involvement is increasing. According to the PubMed search results, there were seven cases reported involving duodenal cryptococcosis combined with AIDS in five reports. Here, we report the case of a patient found to have AIDS combined with duodenal, pulmonary, and subsequent neurological cryptococcal infection simultaneously. The duodenal cryptococcosis was diagnosed on the basis of PET/computed tomography, which showed intense captation of glucose metabolism in duodenum (maximum standardized uptake value 16.53); a positive serum cryptococcal latex agglutination test; and upper gastrointestinal endoscopy-guided duodenal biopsy that confirmed Cryptococcus neoformans yeast. The patient's HIV screen test was positive. Because of refusal of lumbar puncture and the difficulty of performing transbronchial lung biopsy, the pulmonary and neurological involvements were the only clinical diagnoses. This case indicates that when cryptococcosis exists in a rare location, AIDS should be considered and when cryptococcosis occurs in the HIV-infected patient, disseminated disease is more common. PMID:25629567

  7. Towards optimal clinical and epidemiological registration of haematological malignancies: Guidelines for recording progressions, transformations and multiple diagnoses.

    Science.gov (United States)

    Gavin, Anna; Rous, Brian; Marcos-Gragera, Rafael; Middleton, Richard; Steliarova-Foucher, Eva; Maynadie, Marc; Zanetti, Roberto; Visser, Otto

    2015-06-01

    Haematological malignancies (HM) represent over 6% of the total cancer incidence in Europe and affect all ages, ranging between 45% of all cancers in children and 7% in the elderly. Thirty per cent of childhood cancer deaths are due to HM, 8% in the elderly. Their registration presents specific challenges, mainly because HM may transform or progress in the course of the disease into other types of HM. In the context of cancer registration decisions have to be made about classifying subsequent notifications on the same patient as the same tumour (progression), a transformation or a new tumour registration. Allocation of incidence date and method of diagnosis must also be standardised. We developed European Network of Cancer Registries (ENCR) recommendations providing specific advice for cancer registries to use haematology and molecular laboratories as data sources, conserve the original date of incidence in case of change of diagnosis, make provision for recording both the original as well as transformed tumour and to apply precise rules for recording and counting multiple diagnoses. A reference table advising on codes which reflect a potential transformation or a new tumour is included. This work will help to improve comparability of data produced by population-based cancer registries, which are indispensable for aetiological research, health care planning and clinical research, an increasing important area with the application of targeted therapies. PMID:24630945

  8. Outcome of patients diagnosed with diffuse toxic goiter after one month of radioactive I-131 therapy

    International Nuclear Information System (INIS)

    Full text: A retrospective study to evaluate the clinical outcome of treatment of hyperthyroidism due to diffuse toxic goiter using a calculated dose of radioactive I-131 in 27 patients referred for therapy by using the serum thyroid hormone level (FT4) one month post-therapy. All patients were maintained on anti-thyroid medications and were asked to stop treatment 5 days prior to thyroid scan. The calculated dose of Radioactive I-131 for each patient was determined by taking the dimensions of each thyroid gland and the 24- hour uptake value. Following the therapy, thyroid status was monitored by getting the thyroid hormone (FT4) one month post-therapy. There was a higher increased rate of hyperthyroidism in females than in males. These patients were advised to continue their anti-thyroid medications. Thus, determining the clinical outcome on post-therapy is useful since patients still require anti-thyroid or thyroid hormone intake. (author)

  9. Laboratory confirmation of clinically diagnosed malaria in a cohort of HIV-infected mothers and their children in Malawi.

    Science.gov (United States)

    Giuliano, Marina; Galluzzo, Clementina Maria; Mancinelli, Sandro; Andreotti, Mauro; Jere, Haswel; Sagno, Jean-Baptiste; Maulidi, Martin; Erba, Fulvio; Amici, Roberta; Buonomo, Ersilia; Scarcella, Paola; Marazzi, Maria Cristina; Vella, Stefano; Palombi, Leonardo

    2015-06-01

    To avoid overdiagnosis, accuracy in the identification of true malaria cases is of critical importance. Samples (either whole blood, dried blood spots or plasma/serum) collected at the time of clinically diagnosed malaria episodes in a cohort of Malawian HIV-infected mothers and their children were retrospectively tested with the enzyme-linked immunosorbent assay (ELISA) for HRP-2 (histidine-rich protein 2) detection. There were 55 and 56 clinically diagnosed cases of malaria in mothers and children, respectively, with samples available for testing. Rates of laboratory-confirmed episodes were 20% (11 of 55) in mothers and 16.1% (9 of 56) in children. Hemoglobin was lower in children with confirmed malaria compared to those with clinical malaria diagnosis. The results of our study support the widespread use of rapid diagnostic tests. PMID:25797059

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2005-01-01

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

  12. Propionic acidemia: clinical course and outcome in 55 pediatric and adolescent patients

    OpenAIRE

    Grünert Sarah C; Müllerleile Stephanie; De Silva Linda; Barth Michael; Walter Melanie; Walter Kerstin; Meissner Thomas; Lindner Martin; Ensenauer Regina; Santer René; Bodamer Olaf A; Baumgartner Matthias R; Brunner-Krainz Michaela; Karall Daniela; Haase Claudia

    2013-01-01

    Abstract Background Propionic acidemia is an inherited disorder caused by deficiency of propionyl-CoA carboxylase. Although it is one of the most frequent organic acidurias, information on the outcome of affected individuals is still limited. Study design/methods Clinical and outcome data of 55 patients with propionic acidemia from 16 European metabolic centers were evaluated retrospectively. 35 patients were diagnosed by selective metabolic screening while 20 patients were identified by newb...

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

    Directory of Open Access Journals (Sweden)

    Faustino R Pérez-López

    2010-12-01

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

  14. The analysis of C9orf72 repeat expansions in a large series of clinically and pathologically diagnosed cases with atypical parkinsonism.

    Science.gov (United States)

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

    2015-02-01

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

  15. The analysis of C9orf72 repeat expansions in a large series of clinically and pathologically diagnosed cases with atypical parkinsonism?

    Science.gov (United States)

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

    2015-01-01

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

  16. Characteristics of patients with sensory neuropathy diagnosed with abnormal small nerve fibres on skin biopsy.

    Science.gov (United States)

    De Sousa, E A; Hays, A P; Chin, R L; Sander, H W; Brannagan, T H

    2006-08-01

    Clinical, laboratory and electrodiagnostic (EDX) characteristics of 62 patients with sensory neuropathy with abnormal skin biopsies were reviewed. Reduced epidermal nerve fibre density (ENFD) was seen in 71% and morphological changes with normal ENFD were seen in 29% of the patients. Patients with small fibre sensory neuropathy may have associated large fibre loss undetected by routine EDX. Identified associations included abnormal glucose metabolism, Lyme vaccination, monoclonal gammopathy, vitamin B12 deficiency, coeliac disease, and diseases of the connective tissue, inflammatory bowel and thyroid. Sensory neuropathy remained undetermined in 50% of the patients. PMID:16844956

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

    Science.gov (United States)

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

    2013-08-06

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

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

    DEFF Research Database (Denmark)

    Ciet, Pierluigi; Wielopolski, Piotr

    2014-01-01

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

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

    Science.gov (United States)

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

    2013-02-01

    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

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

    Scientific Electronic Library Online (English)

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

    2011-06-01

    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. 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.

  1. Long-term vocational adjustment of cancer patients diagnosed during adolescence.

    Science.gov (United States)

    Tebbi, C K; Bromberg, C; Piedmonte, M

    1989-01-01

    Long-term vocational achievements of 40 survivors of cancer diagnosed during adolescence were examined and compared with 40 healthy sex-matched and age-matched controls. Patients' ages at diagnosis ranged from 13 to 19 years (mean, 16.15). Study subjects had survived cancer for over 5 years and were on no cancer therapy. Assessment measures included the Rand General Well-Being Scale, the Rand Functional Limitations and Physical Abilities Batteries, and a semistructured interview. The relation of physical disability and limitations caused by cancer to patients' achievements also was evaluated. Although cancer patients, on the average, were more concerned about their health and reported lower general spirits than controls, no differences were found between control and study groups with regard to overall general well-being. More cancer patients than controls reported that their health limited their ability to engage in vigorous activities. A greater functional deficit was found among unemployed than employed cancer patients. Employers and co-workers often were aware of the patient's diagnosis (85% and 67%, respectively). Cancer patients reported disease-related discrimination in hiring (7.4%), induction into the military (66.7%), and obtaining health, life, and disability insurance (31.5%). There was no significant relationship between health status and employment. Nevertheless, cancer patients had a higher average income than controls. Sixty-four percent of patients believed that changes in certain physical features of the workplace were necessary to facilitate readjustment to the job. Despite the disabilities experienced by cancer patients and generally negative public attitudes, long-term survivors have a good outlook on life and are competitive members of the workplace and society. PMID:2910420

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

    Science.gov (United States)

    Foreman, David; Morton, Stephanie; Ford, Tamsin

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ayhan Sar?ta?

    2011-11-01

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

  4. Attempted suicide and self-injury in patients diagnosed with eating disorders.

    Science.gov (United States)

    Stein, Daniel; Lilenfeld, Lisa R R; Wildman, Prudence C; Marcus, Marsha D

    2004-01-01

    Eating disorders (ED) patients are at high risk for developing suicidal behavior. The aim of the present study was to investigate factors associated with suicidal behavior in ED patients. One hundred fifty patients at an outpatient ED clinic were included in the study. Data were gathered by retrospective chart analysis. We found that 48 patients (32%) had a history of parasuicide (i.e., suicide attempts, self-injury, or both). A significantly greater percentage of parasuicidal patients than nonparasuicidal patients had EDs with bingeing/pursing symptomatology, used more than one type of purging method, and had a lifetime history of a drug use disorder, impulse control problems, and bipolar disorder, as well as a more extensive outpatient and inpatient treatment history. The findings of this study support an increased tendency toward impulsivity among parasuicidal ED outpatients. PMID:15526255

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

    Directory of Open Access Journals (Sweden)

    Milisavljevi? Nemanja

    2013-01-01

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

  6. Transmitted HIV type 1 drug resistance in newly diagnosed Cuban patients.

    Science.gov (United States)

    Machado, Liuber Y; Dubed, Marta; Díaz, Héctor; Ruiz, Nancy; Romay, Dania; Váldes, Neysi; Blanco, Madeline; Silva, Eladio

    2013-02-01

    Knowledge of the associated mutations to transmitted drug resistance (TDR) in strains of human immunodeficiency virus type 1 (HIV-1) constitutes a fundamental premise in epidemiological surveillance. In this present study, TDR from 200 Cuban patients who were diagnosed with HIV-1 between 2009 and 2011 was analyzed. By partial reverse transcriptase polymerase chain reaction (RT-PCR) and sequencing of the HIV pol gene, an HIV subtype and transmitted resistance profile were determined. The prevalence of associated mutations to the TDR in the individuals studied was 21.5%. In the region of the reverse transcriptase, the most common mutations were K103N and M184V, while in the region of the protease they were L33F and M46L. The results of this study provide evidence of TDR in the Cuban seropositive population and suggest the necessity of making resistance assays before beginning antiretroviral therapy in HIV-1-infected patients in Cuba. PMID:22985307

  7. Intelligent Virtual Patients for Training Clinical Skills

    OpenAIRE

    Thomas D. Parsons; Patrick Kenny; Albert

    2011-01-01

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

  8. The 12 item w.h.o.d.a.s. As primary self report outcome measure in a correctional community treatment center for dually diagnosed patients.

    Science.gov (United States)

    Bastiaens, Leo; Galus, James; Goodlin, Michael

    2015-06-01

    The World Health Organization Disability Assessment Scale (WHODAS) is suggested as a measure of impairment in DSM-5. The measurement of impaired functioning is crucial in the rehabilitation of dually diagnosed, addiction and mental health, patients. This study is the first to look at the use of the 12 item self report WHODAS as the primary outcome in a community correctional treatment facility for dually diagnosed patients.100 (55 male; 73 white, 25 black, 2 hispanic) former inmates, age 36.1 ± 11.1, with psychiatric and addiction diagnoses were treated in an integrated program. The 12 item WHODAS was completed by the patients during the initial evaluation and repeated an average of 11.1 ± 2.7 weeks later. The Clinical Global Impression-Severity Scale (CGI) was completed at the same time by the psychiatrist, independently of the WHODAS. At initial assessment, the CGI showed moderate severity and the WHODAS showed severe disability. CGI and WHODAS were significantly correlated (R 0.48, p < 0.0001). After three months of treatment, both measures improved: CGI with 46 % and WHODAS with 49 %. The CGI showed mild severity and the WHODAS moderate disability. The change in CGI was correlated with the change in WHODAS (R 0.57, p < 0.0001). The WHODAS appears sensitive to clinical improvement related to shortterm treatment of a highly co-morbid dual diagnosis population. PMID:25262006

  9. Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

    Directory of Open Access Journals (Sweden)

    Yi Lu, Rui Gao, Zhuan Liao, Liang-Hao Hu, Zhao-Shen Li

    2009-03-01

    Full Text Available AIM: To review the literature on capsule endoscopy (CE for detecting esophageal varices using conventional esophagogastroduodenoscopy (EGD as the standard.METHODS: A strict literature search of studies comparing the yield of CE and EGD in patients diagnosed or suspected as having esophageal varices was conducted by both computer search and manual search. Data were extracted to estimate the pooled diagnostic sensitivity and specificity.RESULTS: There were seven studies appropriate for meta-analysis in our study, involving 446 patients. The pooled sensitivity and specificity of CE for detecting esophageal varices were 85.8% and 80.5%, respectively. In subgroup analysis, the pooled sensitivity and specificity were 82.7% and 54.8% in screened patients, and 87.3% and 84.7% in the screened/patients under surveillance, respectively.CONCLUSION: CE appears to have acceptable sensitivity and specificity in detecting esophageal varices. However, data are insufficient to determine the accurate diagnostic value of CE in the screen/surveillance of patients alone.

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

    Directory of Open Access Journals (Sweden)

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

    2014-03-01

    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

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

    Science.gov (United States)

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

    2013-01-01

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

  12. Treatment recommendations in patients diagnosed with high-risk cutaneous squamous cell carcinoma

    International Nuclear Information System (INIS)

    Non-melanoma cutaneous cancers occur at an epidemic rate in Australia. With an ageing population, more Australians will develop these cancers and at an increasing rate. In the majority of cases local treatment is highly curative. However, a subset of the population will be diagnosed with a high-risk cutaneous squamous cell carcinoma. These can be defined as patients at risk of having subclinical metastases to regional lymph nodes based on unfavourable primary lesion features (including inadequately excised and recurrent lesions), patients with metastatic squamous cell carcinoma to regional lymph nodes, and squamous cell carcinoma in immunosuppressed patients. The mortality and morbidity associated with high-risk cutaneous squamous cell carcinoma is usually as a consequence of uncontrolled metastatic nodal disease and, to a lesser extent, distant metastases. Radiotherapy has an essential role in treating these patients and in many cases the addition of adjuvant radiotherapy may be life saving. It is therefore important that all clinicians treating skin cancers have an understanding and awareness of the optimal approach to these patients. The aim of this article is to present treatment recommendations based on an overview of the current published literature. Copyright (2005) Blackwell Science Pty Ltd

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

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre

    2013-01-01

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

  14. When Patients Lack Capacity: The Roles That Patients with Terminal Diagnoses Would Choose for Their Physicians and Loved Ones in Making Medical Decisions

    OpenAIRE

    NOLAN, MARIE T.; Hughes, Mark; Narendra, Derek Paul; Sood, Johanna R.; Terry, Peter B.; Astrow, Alan B.; KUB, JOAN; Thompson, Richard E.; SULMASY, DANIEL P.

    2005-01-01

    Current approaches to end-of-life decision making are widely considered inadequate. We explored these complexities by examining how patients with terminal diagnoses would choose to involve their physicians and loved ones in making medical decisions, assuming they were able and unable to participate. Cross-sectional interviews of 130 patients recently diagnosed with fatal conditions were conducted. Patients were recruited from two academic medical centers using a modification of the Decision C...

  15. Diagnosing and treating Diamond Blackfan anaemia: results of an international clinical consensus conference.

    Science.gov (United States)

    Vlachos, Adrianna; Ball, Sarah; Dahl, Niklas; Alter, Blanche P; Sheth, Sujit; Ramenghi, Ugo; Meerpohl, Joerg; Karlsson, Stefan; Liu, Johnson M; Leblanc, Thierry; Paley, Carole; Kang, Elizabeth M; Leder, Eva Judmann; Atsidaftos, Eva; Shimamura, Akiko; Bessler, Monica; Glader, Bertil; Lipton, Jeffrey M

    2008-09-01

    Diamond Blackfan anaemia (DBA) is a rare, genetically and clinically heterogeneous, inherited red cell aplasia. Classical DBA affects about seven per million live births and presents during the first year of life. However, as mutated genes have been discovered in DBA, non-classical cases with less distinct phenotypes are being described in adults as well as children. In caring for these patients it is often difficult to have a clear understanding of the treatment options and their outcomes because of the lack of complete information on the natural history of the disease. The purpose of this document is to review the criteria for diagnosis, evaluate the available treatment options, including corticosteroid and transfusion therapies and stem cell transplantation, and propose a plan for optimizing patient care. Congenital anomalies, mode of inheritance, cancer predisposition, and pregnancy in DBA are also reviewed. Evidence-based conclusions will be made when possible; however, as in many rare diseases, the data are often anecdotal and the recommendations are based upon the best judgment of experienced clinicians. The recommendations regarding the diagnosis and management described in this report are the result of deliberations and discussions at an international consensus conference. PMID:18671700

  16. Idiopathic intracranial hypertension patients firstly visit the ophthalmologic clinical practice

    Directory of Open Access Journals (Sweden)

    Xin-Ling Wang

    2013-07-01

    Full Text Available AIM: To investigate the features of idiopathic intracranial hypertension(IIHin the patients firstly visit the ophthalmologic clinical practice.METHODS: Six patients with 12 eyes were enrolled in this study. The predisposition, symptom, visual acuity, ocularfundus, visual field, ocular aligment, cerebral magnetic resonance imaging(MRIand magnetic resonance venography(MRV, cerebro-spinal fluid(CSFsuppressor and biochemical analysis were recorded and analyzed. RESULTS: The predispositions included catching a cold, anxiety reaction and taking doxycycline orally. The symptom included paroxysmal darkness, blurred vision, diplopia, and headache. The visual acuity remained normal or decreased mildly. The papilledema could be found in the ocular fundus examination. Normal visual field or enlargement of physiology scotoma, paralysis of lateral rectus in ocular aligment, normal cerebral MRI and MRV, and normal CSF biochemical results were the feature of these patients except the increased CSF suppressor between 250 and 300mmH2O.CONCLUSION: The detailed examination of central nerve system is essential for patients firstly visit the ophthalmologic clinical practice withpapilledema and lateral rectus paralysis to diagnose or exclude the possibility of IIH.

  17. Patient and health system delay among new pulmonary tuberculosis patients diagnosed at medical college hospitals in Puducherry, India

    Directory of Open Access Journals (Sweden)

    Murugan Natesan

    2015-01-01

    Full Text Available Background: Early diagnosis of the disease and prompt initiation of treatment are essential for an effective tuberculosis (TB control program. The delay in the diagnosis and treatment may worsen the disease, increases the risk of death and enhances tuberculosis transmission in the community. This study was done to assess the extent of various delays and their determinants among TB patients. Methods: A cross-sectional study including retrospective medical record review and patient interviews was conducted during the year 2010 in and around union territory of Puducherry in India. A structured questionnaire used in the WHO multi-country study to estimate the diagnostic and treatment delay in TB was used to interview the patients. Average estimates and proportions were calculated for continuous and categorical variables respectively. Unadjusted odds ratios (OR were calculated. Level of significance was determined at 95% confidence level (P value <0.05 and all tests applied were two-sided. Results: A total of 138 new sputum smear positive TB patients were included in the study. The mean age of participants was 41.8 years +/- 17.3 years (range 15-87 years. Majority (67.4% of the patients were male and married (68.8%. Majority (86% of the patients were literate. The median patient delay, health system delay and total delay was 36 days, 28.5 days and 81 days respectively. The place of residence (OR = 0.39, 95% CI = 0.18-0.87 and family size (OR = 0.45, 95% CI = 0.21-0.97 were found as the determinants of various delays for TB patients. Conclusion: Patient and health care system delay for TB patients is long. There is need to improve the referral mechanism to ensure an early initiation of treatment for TB patients diagnosed a tertiary care hospitals. [Int J Res Med Sci 2015; 3(1.000: 188-193

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

    Directory of Open Access Journals (Sweden)

    Rajesh Nair

    2013-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Gülay Ta?demir

    2013-01-01

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

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

    OpenAIRE

    Ahmad Ghanizadeh3; Marzie Abotorabi-Zarchi; Mohammad Reza Mohammadi; Ali Firoozabadi

    2012-01-01

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

  1. Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice.

    Science.gov (United States)

    Filippi, A; Paolini, I; Innocenti, F; Mazzaglia, G; Battaggia, A; Brignoli, O

    2009-11-01

    Blood pressure (BP) control remains unsatisfactory worldwide. Better knowledge of BP management in clinical practice is needed to develop more effective improving strategies. Using a large Italian primary care database, we selected the subjects diagnosed with hypertension, and extracted the diagnosis of myocardial infarction, angina pectoris/coronary disease, stroke/transitory ischemic attack (TIA), heart failure, atrial fibrillation, peripheral arterial disease, diabetes mellitus, the serum total cholesterol, HDL cholesterol, triglycerides, creatinine, BP, electrocardiogram, weight, height and the prescription of cardiovascular (CV) drugs. Hypertension was recorded in 119.065 individuals (prevalence 19.3%), 19.134 (16%) had no ambulatory visit and 33.183 (27.8%) had no BP value recorded. Overall, 14.594 (21.9%) had at least one recorded diagnosis showing high CV risk. BP was controlled (mean of BP values <140/90 mm Hg) in 28.918 patients (16.690 women, 12 189 men and 40 gender not recorded), that is, 43.23% of the subjects with recorded BP. Among the non-controlled patients, 21.866 (57.8%) were non-high risk grade 1 (mean BP 142.5/84.5 mm Hg; s.d. 13.1/8.2) and 7.123 (18.8%) high-risk grade 1 hypertensives (mean BP 150/83 mm Hg; s.d. 6.2/7.2). Less than three drugs were prescribed in 29.919 (79.1%) of non-controlled patients. Low attendance rate, BP under-recording and suboptimal use of politherapy are major obstacles to hypertension control. Most uncontrolled individuals are low-CV risk, grade 1 hypertensive patients, for whom the personal benefit of adding another drug is modest. Aiming at the recommended BP target in uncontrolled grade 2-3 hypertensive/high-CV risk patients would probably require two additional drugs. PMID:19242492

  2. Detection of Borreliae in Archived Sera from Patients with Clinically Suspect Lyme Disease

    OpenAIRE

    Sin Hang Lee; Vigliotti, Jessica S; Vigliotti, Veronica S.; William Jones; David M. Shearer

    2014-01-01

    The diagnoses of Lyme disease based on clinical manifestations, serological findings and detection of infectious agents often contradict each other. We tested 52 blind-coded serum samples, including 20 pre-treatment and 12 post-treatment sera from clinically suspect Lyme disease patients, for the presence of residual Lyme disease infectious agents, using nested PCR amplification of a signature segment of the borrelial 16S ribosomal RNA gene for detection and direct DNA sequencing of the PCR ...

  3. Clinical Management of Filovirus-Infected Patients

    Directory of Open Access Journals (Sweden)

    Danielle V. Clark

    2012-09-01

    Full Text Available Filovirus infection presents many unique challenges to patient management. Currently no approved treatments are available, and the recommendations for supportive care are not evidence based. The austere clinical settings in which patients often present and the sporadic and at times explosive nature of filovirus outbreaks have effectively limited the information available to evaluate potential management strategies. This review will summarize the management approaches used in filovirus outbreaks and provide recommendations for collecting the information necessary for evaluating and potentially improving patient outcomes in the future.

  4. Managing suicidal patients in clinical practice

    OpenAIRE

    Angelo De Gioannis; Diego de Leo

    2012-01-01

    The clinical management of suicidal patients can be very challenging. This paper guides the reader through the basic steps in assessing a subject and deciding the type of treatment to provide. Characteristics of main psychiatric pathologies associated with suicidality are described, with attention to the peculiarities that specific associations may frequently entail.

  5. A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna.

    Science.gov (United States)

    Hippler, Kathrin; Klicpera, Christian

    2003-02-28

    To date, it is questionable whether the diagnostic criteria for Asperger syndrome (AS) as stated by ICD-10 or DSM-IV still reflect Asperger's original account of 'autistic psychopathy' (AP) from the 1940s. The present study examined 74 clinical case records of children with AP diagnosed by Hans Asperger and his team at the Viennese Children's Clinic and Asperger's private practice between 1950 and 1986. The characteristic features of the children are outlined, including reasons for referral, parental background, behavioural problems, cognitive functioning, communication and interests. Results show that the patients of Asperger described in our study represent a subgroup of children with very high intellectual functioning, specific circumscribed interests and talents but impaired social, communication and motor skills. Sixty-eight percent of the sample met ICD-10 criteria for AS, while 25% fulfilled the diagnostic criteria for autism. Implications for the diagnosis of AS are discussed. PMID:12639327

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

    International Nuclear Information System (INIS)

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

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

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    Lim MY

    2014-05-01

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

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

    OpenAIRE

    Amp Xf Hn, Monica K.; Ulla Persson Lundholm; Ing-Liss Bryngelsson; Agneta Anderzén-Carlsson; Elisabeth Westerdahl

    2013-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Kovács, Zsuzsanna; Szabó, Csaba; Fülöp, Emöke

    2013-01-01

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

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

    OpenAIRE

    Mehtap Evran; Murat Sert; Tamer Tetiker

    2009-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

    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. PMID:25992100

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

    Scientific Electronic Library Online (English)

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

    2014-09-01

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

  14. A case of disseminated histoplasmosis diagnosed after oral presentation in an old HIV-negative patient in Sweden.

    Science.gov (United States)

    Mota de Almeida, Fernando J; Kivijärvi, Kristina; Roos, Göran; Nylander, Karin

    2014-09-10

    Histoplasmosis is an endemic disease in various regions such as North America and South-East Asia but remains rare in Europe. Disseminated histoplasmosis is unusual in HIV-negative patients. Here, we describe a case of disseminated histoplasmosis in an HIV-negative patient diagnosed after oral presentation. PMID:25209185

  15. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

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    Mikhailova ?.V.

    2013-09-01

    Full Text Available Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49% with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46% patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.

  16. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

    OpenAIRE

    Abdel-Razeq, Hikmat N; Mansour, Asem H; Yousef M Ismael

    2011-01-01

    Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE) in asymptomatic cancer patients. The significance and clinical outcome of such inc...

  17. Elevated plasma levels of TL1A in newly diagnosed systemic lupus erythematosus patients.

    Science.gov (United States)

    Xu, Wang-Dong; Chen, Dao-Jun; Li, Rui; Ren, Chun-Xia; Ye, Dong-Qing

    2015-08-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease. Cytokine-mediated immunity plays an important role in the pathogenesis of SLE. TNF-like ligand 1A (TL1A) belongs to the TNF superfamily of cytokines and has been found to perform significantly in autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease. To date, no study has discussed the expression levels of TL1A in SLE. We found that plasma levels of TL1A were significantly higher in newly diagnosed SLE patients compared with controls. Correlation analysis showed that plasma levels of TL1A were positively associated with SLE disease activity index. These data indicated that TL1A may play a role in SLE and may reflect the disease activity for SLE. PMID:25929716

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

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    Mohamad Noordin Noorliza

    2010-01-01

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

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

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    Rajesh Kumar

    2014-01-01

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

  20. Risk of insomnia attributable to ?-blockers in elderly patients with newly diagnosed hypertension.

    Science.gov (United States)

    Chang, Chia-Hsien; Yang, Yea-Huei Kao; Lin, Swu-Jane; Su, Jyun-Jhong; Cheng, Ching-Lan; Lin, Li-Jen

    2013-01-01

    Use of ?-blockers may cause insomnia and central nervous system and/or psychological side effects, but data are limited on the relative risks of insomnia among ?-blockers. This retrospective cohort study used Taiwan's National Health Insurance claims database from 2003 to 2007, where 4,063 patients aged above 65 years with newly diagnosed hypertension and treated with ?-blockers were followed for 1 year. The primary endpoint was a new insomnia event within 30 days of treatment initiation. Adjusted odds ratios of insomnia were obtained by logistic regressions, controlling for baseline risk factors of insomnia. Using propranolol therapy as the reference, the adjusted odds ratio (95% confidence interval) for the insomnia risk was 0.47 (0.35-0.63) for non-propranolol users, 0.31 (0.19-0.50) for bisoprolol, and 0.46 (0.33-0.66) for atenolol. Compared to the patients using non-selective ?-blockers, the adjusted odds ratio was 0.48 (0.36-0.34) for those using selective ?(1)-blockers. Additionally, the adjusted odds ratio was 0.72 (0.53-0.96) for ?-blockers with low lipophilicity when compared to those with high lipophilicity. The use of bisoprolol and atenolol was associated with the lowest risk of insomnia in elderly patients, as compared to propranolol. ?-Blockers with high selectivity in ?(1)-receptors and/or low lipophilicity were associated with a lower risk of insomnia. PMID:22813717

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

    International Nuclear Information System (INIS)

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

  2. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

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    Doucet Jean

    2008-01-01

    Full Text Available Abstract Background There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP. Methods The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U, Infectious Diseases (ID, Internal Medicine (IM, Geriatrics (G – of two French university hospitals. Results The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3:1 ratio of community-acquired AP (CA-AP to nosocomial AP (N-AP was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP, with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen. For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p vs. 19%, p Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p Conclusion This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

  3. Clinical diagnosis of hyposalivation in hospitalized patients

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    Soraya de Azambuja Berti-Couto

    2012-04-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years. Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom, chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9% presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05. Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05. CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

  4. Clinical features of ocular manifestations of 93 AIDS patients in Urumqi

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    Gang Liu

    2014-10-01

    Full Text Available AIM: To investigate the clinical features of acquired immune deficiency syndrome(AIDSpatients associated ocular diseases in Urumqi and the relationship between ocular fundus manifestations and CD4+T cell count.METHODS: The fundus of 93 AIDS patients were examined by indirect ophthalmoscopy. The clinical symptoms and CD4+T cell count of those patients with fundus changes were analyzed.RESULTS: Thirteen patients were found having fundus changes which occurred in one eye of 4 patients and two eyes of 9 patients, respectively, and the total detection rate was 14.0%. Seven patients had vision changes, and the main clinical features of retinal lesion were cotton wool spot and hemorrhage of retina. Four patients were diagnosed as retinitis with cytomegalovirus(CMVinfection and 9 patients were diagnosed as HIV related retinopathy diseases. Seven patients among 37 patients with CD4+T cell count ?100cell/?L had fundus changes related AIDS, and the detection rate was 18.9%; while 6 patients among 56 patients with CD4+T cell count >100cell/?L had fundus changes related AIDS, and the detection rate was 10.7%. There was statistical difference between the two detection rates(PCONCLUSION: No specificity was found of those patients with the clinical manifestation of HIV-related retinopathy, and those patients are easy to be missed diagnosis. A number of AIDS patients have fundus changes without any vision changes. Therefore, it is very useful for AIDS patients to be carried out the routine fundus examination for the early diagnosis and treatment.

  5. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

    Directory of Open Access Journals (Sweden)

    Hikmat N Abdel-Razeq

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension, and sudden death.Keywords: pulmonary embolism, incidental, cancer, chemotherapy

  6. Cutting biopsy guided by stereotactic localizing wire:its clinical application in diagnosing nonpalpable breast mass with incredulous malignant calcifications on mammogram

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical application of cutting biopsy guided by stereotactic localizing wire in diagnosing non-palpable breast mass with incredulous malignant calcifications on mammogram. Methods: Cutting biopsy guided by stereotactic localizing wire was performed in 311 patients with non-palpable breast mass and incredulous malignant calcifications on mammogram. The clinical data were retrospectively analyzed. Corresponding surgery was carried out in each patient after the diagnosis was confirmed. Comparison between biopsy results and postoperative pathologic results was made. The predilection of the breast lesions for age and sites was analyzed. Results: Of the total 311 cases,benign lesions were confirmed in 268 and malignant lesions in 43 by biopsy examination. The operative pathological results were in accordance with the biopsy results. The lesions showed a predilection for patients aged 45-55 and the site of predilection was the lateral-upper quadrant of the breast. Conclusion: With the advantages of accurate localization, simple manipulation and reliable safety, cutting biopsy guided by stereotactic localizing wire is of great value in effectively detecting early-stage breast cancer, especially for patients who has non-palpable breast mass and incredulous malignant calcifications on mammogram. (authors)

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

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    Bushe C

    2015-01-01

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

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

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    Peter Agergaard

    2011-02-01

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

  9. Circulating plasma cells detected by flow cytometry as a predictor of survival in 302 patients with newly diagnosed multiple myeloma

    OpenAIRE

    Nowakowski, Grzegorz S.; Thomas E. Witzig; Dingli, David; Tracz, Michal J.; Gertz, Morie A.; Lacy, Martha Q; Lust, John A; Dispenzieri, Angela; Greipp, Philip R.; Kyle, Robert A.; Rajkumar, S Vincent

    2005-01-01

    We detected circulating plasma cells (PCs) by flow cytometry in 302 patients with newly diagnosed multiple myeloma (MM) by gating on CD38+CD45- cells. The number of circulating PCs per 50 000 mononuclear cells was reported. In 80 (27%) patients, no circulating PC were seen; 106 (35%) patients had 1 to 10 and 115 (38%) patients had more than 10 circulating PCs. Median overall survival for the 302 patients was 47 months. Patients with 10 or fewer circulating PCs had a median survival of 58.7 mo...

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Correlation of serum prostate specific antigen levels and Tc-99m mdp bone scintigraphy in newly diagnosed patients with prostrate cancer (abstract)

    International Nuclear Information System (INIS)

    The aim of the study was to evaluate the correlation between serum prostate specific antigen (PSA) level and bone scintigraphy in newly diagnosed untreated prostate cancer patients. The probability of a positive bone scan for metastases was analyzed for different threshold values of prostate specific antigen (PSA), acid phosphastase and alkaline phosphates. Fifty four newly diagnosed untreated prostate cancer patients (mean age, 67 years range, 41 to 94) were included in this study. In each case serum PSA, acid phosphatase and alkaline phosphatase measurements were performed followed by whole body Technetium-99m MDP bone scan. The positive predictive value of serum PSA level for bone metastases at the threshold of 10 ng/ml was 70% whereas the same threshold level of PSA gave a negative predictive value of 100%. We used receiver operating characteristics (ROC) analysis to examine the power of predictive value of each serum test, in predicting the results of the bone scan. We also applied regression analysis for the assessment of correlation between the levels of tumor markers and the extent of bone pathology. It was concluded that bone scintigraphy seems to be unnecessary in evaluation of newly diagnosed untreated prostate cancer in patients with no clinical signs of bone pathology and serum PSA levels of equal to or less than 10 ng/ml. (author)

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

    Science.gov (United States)

    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

    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

  13. Recovery of a patient from clinical rabies--California, 2011.

    Science.gov (United States)

    2012-02-01

    In May 2011, a girl aged 8 years from a rural county in California was brought to a local emergency department (ED) with a 1-week history of progressive sore throat, difficulty swallowing, and weakness. After she developed flaccid paralysis and encephalitis, rabies was diagnosed based on 1) detection of rabies virus-specific antibodies in serum and cerebrospinal fluid (CSF), 2) a compatible clinical syndrome in the patient, and 3) absence of a likely alternative diagnosis. The patient received advanced supportive care, including treatment with therapeutic coma. She was successfully extubated after 15 days and discharged from the hospital 37 days later to continue rehabilitation therapy as an outpatient. The public health investigation identified contact with free-roaming, unvaccinated cats at the patient's school as a possible source of infection. Several of these cats were collected from the school and remained healthy while under observation, but at least one was lost to follow-up. A total of 27 persons received rabies postexposure prophylaxis (PEP) for potential exposures to the patient's saliva. No further cases of rabies associated with this case have been identified. Rabies prevention efforts should highlight the importance of domestic animal vaccination, avoidance of wildlife and unvaccinated animals, and prompt PEP after an exposure. PMID:22298301

  14. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

    Directory of Open Access Journals (Sweden)

    Miho Takenoshita

    2010-10-01

    Full Text Available Miho Takenoshita1, Tomoko Sato1, Yuichi Kato1, Ayano Katagiri1, Tatsuya Yoshikawa1, Yusuke Sato2, Eisuke Matsushima3, Yoshiyuki Sasaki4, Akira Toyofuku11Psychosomatic Dentistry, 2Complete Denture Prosthodontics, 3Liaison Psychiatry and Palliative Medicine, 4Center for Education and Research in Oral Health Care, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanBackground: Burning mouth syndrome (BMS and atypical odontalgia (AO are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities.Objective: To analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities.Study design: Psychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision.Results: The proportion of F4 classification (neurotic, stress-related, and somatoform disorders in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders. However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses.Conclusion: Although BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ substantially.Keywords: glossodynia, stomatodynia, ICD-10, somatoform disorder

  15. Clinical evaluation of 625 lacunar syndrome patients

    OpenAIRE

    Ghandehari, Kavian

    2009-01-01

    Aim: Lacunar syndromes consist of a group of characteristic clinical presentations that are usually compatible with a small deep infarct. Validation of these syndromes could help neurologists predict the prognosis and type of cerebrovascular disease. Materials and Methods: Consecutive stroke patients on 2 Iranian stroke registries compiled between 2001 and 2007 were enrolled in this prospective validation study. Lacunar syndromes were defined as pure motor, pure sensory, mixed sensory motor...

  16. Clinical usefulness of diffusion-weighted magnetic resonance imaging in patients with ischemic cerebrovascular disease

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Takashi; Sugimoto, Koichi; Sato, Naoaki; Matsuda, Wakoto; Hattori, Atsuhiko [Kobari General Hospital, Noda, Chiba (Japan); Yanaka, Kiyoyuki; Matsumura, Akira; Nose, Tadao

    2000-02-01

    Diffusion-weighted magnetic resonance imaging was performed to determine the detectability of ischemic changes in patients with ischemic cerebrovascular disease. We retrospectively reviewed 103 patients with symptoms suggestive of ischemic cerebrovascular disease. All patients underwent computed tomography, routine magnetic resonance imaging, and diffusion-weighted imaging. Of 103 patients, 18 were imaged within 3 hours after onset, 57 were imaged between 3 and 24 hours, and 29 were imaged between 24 and 144 hours. Eighty-eight patients were diagnosed as ischemic cerebrovascular disease. Magnetic resonance imaging was performed at a 1.0 Tesla clinical machine using single-shot spin-echo/echo-planar imaging sequence. In each case, three sets of diffusion-weighted magnetic resonance imaging (DWI) with motion-probing gradient pulses in the x, y, and z directions were taken. The detectability of ischemic changes of each imaging modality was compared. DWI detected ischemic changes in 83 of 88 cases with clinical diagnoses of cerebral ischemia (sensitivity; 94.3%). In contrast, DWI showed negative findings in 15 of the 15 patients with diagnoses other than cerebral ischemia (selectivity; 100.0%). DWI detected ischemic changes in 16 out of 18 patients (88.6%) within 3 hours after the onset. In contrast, T2-weighted image did not detect any ischemic changes in the same period. These results suggest that DWI is considered to be highly useful for the early diagnosis of cerebral ischemia. (author)

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

    Directory of Open Access Journals (Sweden)

    Sugayama Sofia Mizuho Miura

    2003-01-01

    Full Text Available OBJECTIVE: To evaluate the cardiovascular findings and clinical follow-up of patients with Williams-Beuren syndrome. METHODS: We studied 20 patients (11 males, mean age at diagnosis: 5.9 years old, assessed for cardiovascular abnormalities with electrocardiography and Doppler echocardiography. Fluorescence in situ hybridization (FISH was used to confirm the diagnosis of the syndrome. RESULTS: Elastin gene locus microdeletion was detected in 17 patients (85% (positive FISH, and in 3 patients deletion was not detected (negative FISH. Sixteen patients with a positive FISH (94% had congenital cardiovascular disease (mean age at diagnosis: 2,3 years old. We observed isolated (2/16 supravalvular aortic stenosis and supravalvular aortic stenosis associated (11/16 with pulmonary artery stenosis (4/11; mitral valve prolapse (3/11; bicuspid aortic valve (3/11; aortic coarctation (2/11, thickened pulmonary valve (2/11; pulmonary valvular stenosis (1/11; supravalvular pulmonary stenosis (1/11; valvular aortic stenosis (1/11; fixed subaortic stenosis (1/11; pulmonary artery stenosis (2/16 associated with pulmonary valvar stenosis (1/2 and with mitral valve prolapse (1/2; and isolated mitral valve prolapse (1/16. Four patients with severe supravalvular aortic stenosis underwent surgery (mean age: 5.7 years old, and 2 patients had normal pressure gradients (mean follow-up: 8.4 years. CONCLUSION: A detailed cardiac evaluation must be performed in all patients with Williams-Beuren syndrome due to the high frequency of cardiovascular abnormalities.

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

    Scientific Electronic Library Online (English)

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

    2003-11-01

    Full Text Available OBJECTIVE: To evaluate the cardiovascular findings and clinical follow-up of patients with Williams-Beuren syndrome. METHODS: We studied 20 patients (11 males, mean age at diagnosis: 5.9 years old), assessed for cardiovascular abnormalities with electrocardiography and Doppler echocardiography. Fluo [...] rescence in situ hybridization (FISH) was used to confirm the diagnosis of the syndrome. RESULTS: Elastin gene locus microdeletion was detected in 17 patients (85%) (positive FISH), and in 3 patients deletion was not detected (negative FISH). Sixteen patients with a positive FISH (94%) had congenital cardiovascular disease (mean age at diagnosis: 2,3 years old). We observed isolated (2/16) supravalvular aortic stenosis and supravalvular aortic stenosis associated (11/16) with pulmonary artery stenosis (4/11); mitral valve prolapse (3/11); bicuspid aortic valve (3/11); aortic coarctation (2/11), thickened pulmonary valve (2/11); pulmonary valvular stenosis (1/11); supravalvular pulmonary stenosis (1/11); valvular aortic stenosis (1/11); fixed subaortic stenosis (1/11); pulmonary artery stenosis (2/16) associated with pulmonary valvar stenosis (1/2) and with mitral valve prolapse (1/2); and isolated mitral valve prolapse (1/16). Four patients with severe supravalvular aortic stenosis underwent surgery (mean age: 5.7 years old), and 2 patients had normal pressure gradients (mean follow-up: 8.4 years). CONCLUSION: A detailed cardiac evaluation must be performed in all patients with Williams-Beuren syndrome due to the high frequency of cardiovascular abnormalities.

  19. Diagnosing chronic rhinosinusitis : comparing questionnaire-based and clinical-based diagnosis

    DEFF Research Database (Denmark)

    Lange, B; Thilsing, T

    2013-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the correlation between questionnaire-based and clinical-based CRS.

  20. Clinical value of 67Ga-citrate scintigraphy in diagnosing Hodgkin's lymphomas and bronchogenic carcinomas

    International Nuclear Information System (INIS)

    Using 67Ga-citrate scintigraphy was performed in 363 patients. Out of these 246 patients had Hodgkin's lymphomas 95 of which had been examined before therapy was started. 117 of the patients examined had bronchogenic carcinoma. The scintigraphy revealed an active focus in 85% of patients with Hodgkin's lymphomas and in 88% of patients with bronchogenic carcinoma. The results obtained confirmed the diagnostic value of the method. Differences in the efficiency of the method are pointed out, depending on the localization of the disorder and on the uptake capacity of some non-tumorous processes. (author)

  1. A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer

    Directory of Open Access Journals (Sweden)

    Julia Hannum Rose

    2008-03-01

    Full Text Available Julia Hannum Rose1,2,3, Rosanne Radziewicz4, Karen F Bowman5, Elizabeth E O’Toole11Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2Louis Stokes Cleveland VAMC-GRECC, Cleveland, OH, USA; 3Center for Health Care Research and Policy, Case at MetroHealth Medical Center, Cleveland, OH, USA; 4Department of Nursing, MetroHealth Medical Center, Cleveland, OH, USA; 5Department of Sociology, Case Western Reserve University, Cleveland, OH, USAAbstract: As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997, health information processing style (Miller 1995; Miller et al 2001 and non-directive client-centered therapy (Rogers 1951, 1967, have guided the development of a coping and communication support (CCS intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients’ quality of care and quality of life over time.Keywords: aging, psycho-oncology interventions, advanced cancer, supportive care

  2. Clinical service desires of medical cannabis patients

    Directory of Open Access Journals (Sweden)

    Janichek Jennifer L

    2012-03-01

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

  3. Assessment of the decreased productivity of patients with diabetes type 2 in the Clinical Endocrynological Center Sofia, Bulgaria

    OpenAIRE

    Plaveev O,; Dimitrova Z; Ovcharova N; Petkova V; Stefanova M; Ivanova S.

    2006-01-01

    This study aims to assess the influence of type 2 diabetes on the patients’ productivity and quality of life. The WHO’s methodology – HLQ (Health and Labor Questionnaire) is applied. Subjects were 38 patients with type 2 diabetes, diagnosed and treated at the Clinical center on endocrinology at the MU-Specialized hospital center for active treatment-Sofia. Control consisted of 100 patients without diabetes. The results from the study proofs the fact that the patients with type 2 diabete...

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-15

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

  7. Epidemiology and Survival Analysis of Jordanian Female Breast Cancer Patients Diagnosed from 1997 to 2002

    Directory of Open Access Journals (Sweden)

    Ghazi Sharkas

    2011-04-01

    Full Text Available Background: Breast cancer is the most common cancer among Jordanian women, yet survival data are scarce. This study aims to assess the observed five-year survival rate of breast cancer in Jordan from 1997 to 2002 and to determine factors that may influence survival. Methods: Data were obtained from the Jordan Cancer Registry (JCR, which is a population-based registry. From 1997-2002, 2121 patients diagnosed with breast cancer were registered in JCR. Relevant data were collected from JCR files, hospital medical records and histopathology reports. Patient's status, whether alive or dead, wasascertained from the Department of Civil Status using patients’ national numbers (ID. Statistical analysis was carried out using SPSS (version 10. Survival probabilities by age, morphology, grade, stage and other relevant variables were obtained with the Kaplan Meier method. Results: The overall five-year survival for breast cancer in Jordan, regardless of the stage or grade was 64.2%, meanwhile it was 58% in the group aged less than 30 years. The best survival was in the age group 40-49 years (69.3%. The survival for adenocarcinoma was 57.4% and for medullary carcinoma, it was 82%. The survival rate approximated 73.8% for well-differentiated, 55.6% for anaplastic, and 58% for poorly differentiated cancers. The five-year survival rate was 82.7% for stage I, 72.2% for stage II, 58.7% for stage III, and 34.6% for stage IV cancers.Conclusion: According to univariate analysis, stage, grade, age and laterality of breast cancer significantly influenced cancer survival. Cox regression analysis revealed that stage, grade and age factors correlated with prognosis, while laterality showed no significant effect on survival. Results demonstrated that overall survival was relatively poor. We hypothesized that this was due to low levels of awareness and lack of screening programs.

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

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, B; Jensen, T

    1990-01-01

    Renal function was studied in 18 patients with Type 1 diabetes mellitus. All were participating in the Canadian-European randomized placebo-controlled cyclosporin trial in newly diagnosed Type 1 diabetic patients, nine being randomized to placebo, and nine to cyclosporin A. During treatment for 12 to 18 months, cyclosporin A caused significant reductions in the glomerular filtration rate (before drug withdrawal, cyclosporin 97 +/- 18 vs placebo 125 +/- 16 ml min-1 1.73-m-2, p less than 0.05), renal plasma flow (454 +/- 83 vs 536 +/- 70 ml min-1 1.73-m-2, p less than 0.05), and lithium clearance (17 +/- 3 vs 28 +/- 5 ml min-1 1.73-m-2, p less than 0.05). The fractional proximal reabsorption was increased (0.82 +/- 0.03 vs 0.78 +/- 0.03, p less than 0.05), and the fractional distal sodium reabsorption reduced (0.88 +/- 0.03 vs 0.94 +/- 0.02, p less than 0.05). These results are in accordance with the hypothesis that the nephrotoxic effect of cyclosporin A results from a preferential constriction of afferent glomerular vessels. One year after withdrawal of the drug, all variables were similar in the two groups, except for blood glucose control which was worse in the cyclosporin A treated group. When corrected for differences in blood glucose control it appeared that in three out of nine patients glomerular filtration rate had not completely returned to the reference range of the placebo group. We conclude that the nephrotoxic side-effects of cyclosporin A treatment for 1 year are reversible. There are, however, signs of minor and perhaps chronic renal injury.

  9. Demographic and clinical characteristics of parapsoriasis patients

    Directory of Open Access Journals (Sweden)

    Nafiseh Esmaeili

    2012-12-01

    Full Text Available Background an Aim: parapsoriasis is a rare chronic idiopathic dermatosis which commonly manifests with round or oval scaling and itching erythematosus plaques on trunk and extremities. Considering the size of the lesions, parapsoriasis is divided into two groups: small plaque and large plaque. Study of demographic characteristics of this disease may help to identify the high risk groups who are more susceptible to cutaneous lymphoma with high mortality as well as proper allocation of health service resources.Methods: In this retrospective cross-sectional study, affected parapsoriasis patients whom were referred to Razi Hospital in Tehran between April 2003 to March 2009 were studied. Three hundred and twenty patients were investigated for variables: age, sex, place of residence, location of the lesions and clinical subgroups according to the histopathology reports.Results: 53.4% of patients were female. The disease was most commonly observed in age group of 20 to 50 years and the mean age of the patients was 43.3 years. Eighty-five percent of the patients were inhabitant of Tehran province. 88.1% of patients had large plaque lesions and 11.9% had small plaque lesions. The most common sites of lesions were on the trunk (53.4% followed by the extremities (38.7%.Conclusion: Based on these findings, it was determined that parapsoriasis most commonly affects middle-aged women. Involvement of trunks and extremities were most commonly observed. Large plaque type was the most common type. 

  10. Scoring System for Mortality in Patients Diagnosed with and Treated Surgically for Differentiated Thyroid Carcinoma with a 20-Year Follow-Up

    Science.gov (United States)

    López-Bru, David; Palazón-Bru, Antonio; Folgado-de la Rosa, David Manuel; Gil-Guillén, Vicente Francisco

    2015-01-01

    Background Differentiated thyroid carcinoma (DTC) is associated with an increased mortality. Few studies have constructed predictive models of all-cause mortality with a high discriminating power for patients with this disease that would enable us to determine which patients are more likely to die. Objective To construct a predictive model of all-cause mortality at 5, 10, 15 and 20 years for patients diagnosed with and treated surgically for DTC for use as a mobile application. Design We undertook a retrospective cohort study using data from 1984 to 2013. Setting All patients diagnosed with and treated surgically for DTC at a general university hospital covering a population of around 200,000 inhabitants in Spain. Participants The study involved 201 patients diagnosed with and treated surgically for DTC (174, papillary; 27, follicular). Exposures Age, gender, town, family history, type of surgery, type of cancer, histological subtype, microcarcinoma, multicentricity, TNM staging system, diagnostic stage, permanent post-operative complications, local and regional tumor persistence, distant metastasis, and radioiodine therapy. Main outcome measure All-cause mortality. Methods A Cox multivariate regression model was constructed to determine which variables at diagnosis were associated with mortality. Using the model a risk table was constructed based on the sum of all points to estimate the likelihood of death. This was then incorporated into a mobile application. Results The mean follow-up was 8.8±6.7 years. All-cause mortality was 12.9% (95% confidence interval [CI]: 8.3–17.6%). Predictive variables: older age, local tumor persistence and distant metastasis. The area under the ROC curve was 0.81 (95% CI: 0.72–0.91, p<0.001). Conclusion This study provides a practical clinical tool giving a simple and rapid indication (via a mobile application) of which patients with DTC are at risk of dying in 5, 10, 15 or 20 years. Nonetheless, caution should be exercised until validation studies have corroborated our results. PMID:26115328

  11. The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient : a prospective magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid; Torfing, Trine

    2012-01-01

    In 1954, Norell described the 'fat pad sign' for the first time. This refers to the radiological visualization of the elbow fatty tissue. This is a prospective study with the aim of clarifying the relation between the presence of a positive fat pad sign on the lateral radiograph and the type of injury verified on MRI. From January to December 2010, 31 children were diagnosed primarily with a positive fat pad sign. An above-the-elbow cast was applied and all patients were referred for an MRI within a few days. All patients were recommended a clinical follow-up and informed about the MRI results. After revision, five patients were found to have a negative fat pad sign and were excluded. This resulted in a total of 26 patients, 10 men and 16 women, mean age 10±2.62 years. The time between the injury and the initial radiological examination was 0.8±0.27 days and the MRI was obtained on an average of 6.6±3.84 days. A total of 12 patients had an injury of the left side and 14 of the right side. The MRI showed a posterior positive sign in all except five cases and six occult fractures, which accounts for 23%. Nineteen patients (73%) had a bone bruise. All patients except one had a normal range of movement with no pain on the last clinical examination after 2-3 weeks. The presence of a positive fad pad sign is not synonymous with occult fractures. Finding occult fractures on MRI does not alter the final treatment of these patients. On the basis of this study and review of other similar studies, pediatric patients who presented with elbow effusion verified on conventional radiographs could be treated with a cast for 2-3 weeks and extra clinical or radiological controls did not seem to be indicated. Level of evidence: Level III, development of diagnostic criteria on the basis of consecutive patients.

  12. Clinical use of lactate monitoring in critically ill patients

    OpenAIRE

    Bakker, J.; Nijsten, M. W. N.; Jansen, T.C.

    2013-01-01

    Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Althou...

  13. Clinical analysis of pulmonary cryptococcosis in non-HIV patients in south China

    Science.gov (United States)

    Xie, Xiaona; Xu, Botao; Yu, Chang; Chen, Mayun; Yao, Dan; Xu, Xiaomei; Cai, Xueding; Ding, Cheng; Wang, Liangxing; Huang, Xiaoying

    2015-01-01

    Aims: The aim of this study was to investigate the clinical characteristics of pulmonary cryptococcosis occurring in non-HIV patients, and to develop early diagnosis of pulmonary cryptococcosis in immunocompetent cases as well. Methods: We retrospectively reviewed the clinical data of 41 non-HIV infected patients with pulmonary cryptococcosis who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2006 to April 2014. Results: The study included a total of 41 patients (23 males and 18 females) with mean age of 47 years. 12.19% of patients had a history of direct exposure to pigeon droppings; 31.70% of the patients’ working or living environments were potentially contaminated by fungal spores. Almost one-third of the patients involved into the study were asymptomatic. The most common clinical manifestations were cough, expectoration and hemoptysis. The most common radiological manifestation was single node or mass in lung, which was described as untypical. Of all cases, 11 patients were diagnosed by CT-guided percutaneous cutting needle biopsy (PCNB), 5 patients were diagnosed by operation, and Crytococcus spore was found in 7 patients’ cerebrospinal fluid. 8 patients’ blood Cryptococcus Neoformans capsular polysaccharide antigens latex agglutination tests were positive. 36 patients received antifungal therapy. 5 patients underwent surgical resection. During 6 to 24 months follow-up, 40 cases showed total recovery and 1 cases showed improvement. Conclusions: Pulmonary cryptococcosis in non-HIV subjects might be related to fungus-contaminated environmental exposure. The great variations and protean manifestations of its clinical features often lead to misdiagnosis. Recognition and invasive examination of non-HIV infected patients’ pulmonary cryptococcosis in the early stage may help with improvement of its diagnosis and prognosis.

  14. Clinical presentation in patients with systemic sclerosis

    International Nuclear Information System (INIS)

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

  15. A single-institution analysis of the utility of pre-induction ejection fraction measurement in patients newly diagnosed with acute myeloid leukemia.

    Science.gov (United States)

    Bryant, Adam; Sheppard, Dawn; Sabloff, Mitchell; Delbaere, Michelle; Maze, Ronnen; Allan, David; Atkins, Harold; Bence-Bruckler, Isabelle; Faught, Carolyn; Huebsch, Lothar; Tay, Jason; Zanke, Brent; Bredeson, Chris

    2015-01-01

    Anthracyclines, a standard component of induction therapy for acute myeloid leukemia (AML) are known to be cardiotoxic. Existing evidence supporting routine baseline pre-induction cardiac function testing is limited. We conducted a retrospective analysis of 119 consecutive patients diagnosed with AML at our center from 2009 to 2012. In the 76 patients for whom induction chemotherapy was planned, baseline ejection fraction measurements were rarely abnormal (four cases), and in none of these abnormal cases did the result change management decisions. Awaiting LVEF evaluation results led to a delay in chemotherapy administration by a mean of approximately 2 days at significant additional costs to the healthcare system. Routine baseline ejection fraction measurement should be abandoned as it does not change management, results in treatment delay and unnecessary healthcare expenditures. More selective baseline testing, preferentially in patients in whom there is a clinical reason of cardiac disease, should be pursued. PMID:24913512

  16. Efficacy and safety of decitabine in combination with G-CSF, low-dose cytarabine and aclarubicin in newly diagnosed elderly patients with acute myeloid leukemia

    Science.gov (United States)

    Zhu, Yu; Zhou, Jianfeng; Xu, Yanli; Li, Yan; Yu, Kang; Pan, Ling; Wang, Jianmin; Ding, Jiahua; Gu, Jian; Zhou, Shanhua; Shi, Jinning; Hong, Ming; Xu, Ji; Pan, Liangqin; Duan, Limin; Zhang, Run; Zhang, Sujiang; Zhu, Huayuan; Lu, Hua; Liu, Peng; Qiu, Hongxia; Wu, Hanxin; Qian, Sixuan

    2015-01-01

    Purpose This prospective phase II, open label, study was designed to assess the efficacy and safety of D-CAG induction treatment for elderly patients with newly diagnosed AML. Experimental Design All patients in this study were treated with decitabine of 15 mg/m2 for 5 days and G-CSF for priming, in combination with cytarabine of 10-mg/m2 q12h for 7 days and aclarubicin of 10 mg/day for 4 days (D-CAG). Results Among 85 evaluable patients, overall response rate (ORR) and complete remission (CR) were 82.4% and 64.7%, respectively, after 1 cycle of therapy. The ORR in patients aged <70 years was 83.0% and 81.6% in patients aged ?70 years. There was a significantly longer median overall survival (OS) in patients with response (16 months) than in those without response (7 months, p< 0.0001). The OS for patients aged ?70 years and 60-69 years was 10 months and 12 months, respectively (p=0.4994). The two-year OS probability was 19.2% and the twenty-month survival rate was 33.8%. Induction mortality of D-CAG treated elderly patients with AML is 4.4%. Conclusion D-CAG regimen was well tolerated and showed a promising clinic efficacy in elderly patients with AML (?70 years). PMID:25749041

  17. Phase II Evaluation of Gefitinib in Patients With Newly Diagnosed Grade 4 Astrocytoma: Mayo/North Central Cancer Treatment Group Study N0074

    International Nuclear Information System (INIS)

    Purpose: Amplification of the epidermal growth factor receptor (EGFR) gene represents one of the most frequent gene alterations in glioblastoma (GBM). In the current study, we evaluated gefitinib, a potent EGFR inhibitor, in the treatment of adults with newly diagnosed GBM. Methods and Materials: Ninety-eight patients (96 evaluable) were accrued between May 18, 2001, and August 2, 2002. All were newly diagnosed GBM patients who were clinically and radiographically stable/improved after radiation treatment (enrollment within 5 weeks of radiation completion). No prior chemotherapy was permitted. EGFR amplification/mutation, as assessed by fluorescence in situ hybridization and immunohistochemistry, was not required for treatment with gefitinib but was studied when tissues were available. Gefitinib was administered at 500 mg each day; for patients receiving dexamethasone or enzyme-inducing (CYP3A4) agents, dose was escalated to a maximum of 1,000 mg QD. Treatment cycles were repeated at 4-week intervals with brain magnetic resonance imaging at 8-week intervals. Results: Overall survival (OS; calculated from time of initial surgery) at 1 year (primary end point) with gefitinib was 54.2%, which was not statistically different compared with that of historical control population (48.9%, data from three previous Phase III North Central Cancer Treatment Group studies of newly diagnosed GBM patients). Progression-free survival (PFS) at 1 year post-RT (16.7%) was also not signif1 year post-RT (16.7%) was also not significantly different to that of historical controls (30.3%). Clinical outcome was not affected by EGFR status (amplification or vIII mutation). Fatigue (41%), rash (62%), and loose stools (58%) constituted the most frequent adverse events, the majority of these being limited to Grade 1/2. Of note, the occurrence of drug-related adverse effects, such as loose stools was associated with improved OS. Conclusions: In our evaluation of nearly 100 patients with newly diagnosed GBM, treatment with adjuvant gefitinib post-radiation was not associated with significant improvement in OS or PFS. However, patients who experienced gefitinib-associated adverse effects (rash/diarrhea) did demonstrate improved OS.

  18. How Is Atherosclerosis Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Atherosclerosis Diagnosed? Your doctor will diagnose atherosclerosis based on ... Rate This Content: NEXT >> Featured Video What is atherosclerosis? 10/14/2014 August 4, 2014 Atherosclerosis Clinical ...

  19. Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study.

    OpenAIRE

    Russo Federico; Righi Roberto; Minervini Lina; Margari Francesco; Casacchia Massimo; Boncompagni Giancarlo; Boccalon Roberto M; Ballerini Andrea; Salteri Andrea; Frediani Sonia; De Rossi Andrea; Scatigna Marco

    2007-01-01

    Abstract Background Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients ...

  20. Effect of Initiating a Multidisciplinary Care Clinic on Access and Time to Treatment in Patients With Pancreatic Adenocarcinoma

    Science.gov (United States)

    Gardner, Timothy B.; Barth, Richard J.; Zaki, Bassem I.; Boulay, Brian R.; McGowan, Margit M.; Sutton, John E.; Ripple, Gregory H.; Colacchio, Thomas A.; Smith, Kerrington D.; Byock, Ira R.; Call, Marsha; Suriawinata, Arief A.; Tsapakos, Michael J.; Mills, Jeannine B.; Srivastava, Amitabh; Stannard, Maureen; Lisovsky, Mikhail; Gordon, Stuart R.; Pipas, J. Marc

    2010-01-01

    Purpose: Neoadjuvant therapy for pancreatic adenocarcinoma requires referral to multiple specialists before initiating therapy. We evaluated the effect of establishing a multidisciplinary clinic (MDC) for patients with newly diagnosed pancreatic adenocarcinoma on treatment access and time to therapy. Methods: Patients with newly diagnosed pancreatic adenocarcinoma diagnosed and treated at our center were included. Two patient groups were defined: preclinic represented those patients diagnosed before 2008 and MDC represented those patients diagnosed since 2009 who were treated in the newly created MDC and were initially candidates for neoadjuvant therapy. The primary outcomes were days from diagnosis to first treatment (initiation of chemotherapy or external beam radiation), days to completion of all required consultations, and number of visits needed before initiation of therapy. Results: Ninety-seven patients were diagnosed and treated at our medical center from 2003 to 2008; 22 were treated in 2009 after the implementation of the MDC. Compared with the preclinic group, patients treated in the MDC had shorter times from biopsy to treatment (7.7 days v 29.5 days, P < .001), shorter time to completion of all required pretreatment consultations (7.1 days v 13.9 days, P < .001), and fewer visits to complete all consultations (1.1 v 4.3, P < .001). Thirty-three percent of patients seen in the MDC enrolled onto clinical research trials. Conclusion: In patients with pancreatic adenocarcinoma undergoing neoadjuvant therapy, the establishment of a multidisciplinary pancreas tumor clinic led to improved patient access to consultations and shorter time to initial treatment. PMID:21358957

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-08-06

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

  3. Risk of cancer in patients with medically diagnosed hay fever or allergic rhinitis.

    Science.gov (United States)

    Hemminki, Kari; Försti, Asta; Fallah, Mahdi; Sundquist, Jan; Sundquist, Kristina; Ji, Jianguang

    2014-11-15

    Data on allergic conditions as risk or protective factors for cancer are controversial probably because most studies have used self-reported data on mixed groups of allergies in a case-control setting. We define cancer risks in medically diagnosed hay fever/allergic rhinitis patients in a nationwide cohort study. A total of 138,723 hay fever/allergic rhinitis patients were identified from three Swedish health care databases and standardized incidence ratios (SIRs) were calculated for subsequent cancers identified from the Swedish Cancer Registry. Overall cancer risk was not changed (SIR 1.03). For individual cancers, the highest SIR was observed for nasal cancer (SIR 2.63), followed by testicular (1.46) and endocrine tumors (1.42), and kidney (1.31), prostate (1.18) and breast (1.11) cancers. The results were consistent in the three sources of data and all SIRs were above unity, albeit mainly not statistically significant. The SIRs for nervous system tumors were above unity and of borderline significance. SIRs were decreased for esophageal (0.50), liver (0.62) and lung (0.78) cancers, and the three sources of data agreed in the direction of the effect. The increased risks for testicular, renal, prostate and endocrine cancers may be explained by immunological mechanisms. Excess risk for these cancer accounts for a significant population attributable fraction. Nervous system cancers showed a borderline increase and none of the histological types were significantly decreased, providing strong evidence against the published case-control studies, which have reported protective effects. The reasons for the reduced risks for esophageal, liver and lung cancer remain to be explained. PMID:24692097

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

    International Nuclear Information System (INIS)

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

  5. Referral and final diagnoses of patients assessed in an academic vertigo center

    Directory of Open Access Journals (Sweden)

    RebekkaGeser

    2012-11-01

    CONCLUSION: Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.

  6. The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): First Psychometric Evaluation in a Dutch Sample of Clinically Referred Youths.

    Science.gov (United States)

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

    2015-06-01

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

  7. Auto-Antibodies and Their Association with Clinical Findings in Women Diagnosed with Microscopic Colitis

    OpenAIRE

    Roth, Bodil; Gustafsson, Rita; Ohlsson, Bodil

    2013-01-01

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

  8. Clinical significance of ANCA in 98 patients.

    Science.gov (United States)

    Geffriaud-Ricouard, C; Noël, L H; Chauveau, D; Houhou, S; Grünfeld, J P; Lesavre, P

    1993-01-01

    Clinical and histological data leading to precise diagnosis were retrospectively obtained in 98 patients with antineutrophil cytoplasmic antibodies (ANCA) detected by indirect immunofluorescence (IIF). Specificity was determined by myeloperoxidase (MPO) and proteinase 3 (PR3) specific ELISA in all and a comparative study based on ANCA specificity was performed. Vasculitis was present in all cases. PR3-ANCA occurred predominantly in males (25/38) with WG (19/38). MPO-ANCA occurred predominantly in older women and were often associated with various autoimmune disorders. There was a high prevalence of lung hemorrhage (18/45) and mPA (26/45) in this group. Patients with negative MPO and PR3 specific ELISA despite positive IIF (n = 15) were almost exclusively WG (13/15) and were characterized by a high prevalence of hepatic and digestive manifestations. Renal and patient survival at the 75th percentile was 15 months with MPO-ANCA and 16 months with PR3, and was similar for patients with WG and mPA. With immunosuppressive treatment, ANCA disappeared in 66% of cases and this disappearance was always associated with absence of disease activity. PMID:7905232

  9. Real-time PCR for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding: comparison with other classical diagnostic methods.

    Science.gov (United States)

    Saez, Jesús; Belda, Sofía; Santibáñez, Miguel; Rodríguez, Juan Carlos; Sola-Vera, Javier; Galiana, Antonio; Ruiz-García, Montserrat; Brotons, Alicia; López-Girona, Elena; Girona, Eva; Sillero, Carlos; Royo, Gloria

    2012-10-01

    The aim of this study was to determine the diagnostic usefulness of quantification of the H. pylori genome in detection of infection in patients with upper gastrointestinal bleeding (UGB). A total of 158 consecutive patients with digestive disorders, 80 of whom had clinical presentation of UGB, were studied. The number of microorganisms was quantified using a real-time PCR system which amplifies the urease gene with an internal control for eliminating the false negatives. A biopsy sample from the antrum and corpus of each patient was processed. The rapid urease test, culture, histological study, stool antigen test, and breath test were done. The gold standard was a positive culture or positive results in at least two of the other techniques. When a positive result was defined as any number of microorganisms/human cell, the sensitivity of real-time PCR was greater in bleeding patients, especially in the gastric corpus: 68.4% (95% confidence interval [CI], 52.3 to 84.5%) in non-UGB patients versus 91.5% (95% CI, 79.6 to 97.6%) in UGB patients. When a positive result was defined as a number of microorganisms/human cell above the optimal value that maximizes the Youden index (>3.56 microorganisms/human cell in the antrum and >2.69 in the corpus), the sensitivity and specificity in UGB patients were over 80% in both antrum and corpus. Our findings suggest that some bleeding patients with infection caused by H. pylori may not be correctly diagnosed by classical methods, and such patients could benefit from the improved diagnosis provided by real-time PCR. However, the clinical significance of a small number of microorganisms in patients with negative results in classical tests should be evaluated. PMID:22837325

  10. Full Mouth Rehabilitation of an Ectodermal Dysplasia Patient with Implant-Supported Prostheses: A Clinical Report

    OpenAIRE

    Rahab Ghoveizi; Hakimeh Siadat; Sakineh Nikzad; Ghasem Ommati Shabestari; Yadolah Soleimani Shayesteh

    2013-01-01

    Full mouth rehabilitation in patients with ectodermal dysplasia (ED) is difficult to manage, especially because the afflicted individuals are quite young when they are evaluated for treatment; therefore, esthetics is an important concern. This clinical report describes the rehabilitation of a 19-year-old girl diagnosed with ectodermal dysplasia. Eleven implants were placed in the maxilla and mandible along with bone grafting to the upper jaw and both arches were constructed by metal-ceramic i...

  11. Clinical Applications of Circulating Tumor Cells in Lung Cancer Patients by CellSearch System

    OpenAIRE

    AnnaTruini

    2014-01-01

    Circulating tumor cells (CTCs) are cells spread from the primary tumor into the bloodstream that might represent an important biomarker in lung cancer. The prognosis of patients diagnosed with lung cancer is generally poor mainly due to late diagnosis. Recent evidences have reported that tumor aggressiveness is associated with the presence of CTCs in the blood stream; therefore, several studies have focused their attention on CTC isolation, characterization, and clinical significance. So far,...

  12. The clinical spectrum of lichen sclerosus in male patients - a retrospective study.

    Science.gov (United States)

    Kantere, Despina; Löwhagen, Gun-Britt; Alvengren, Gunilla; Månesköld, Anna; Gillstedt, Martin; Tunbäck, Petra

    2014-09-01

    Lichen sclerosus (LS) is a chronic dermatosis mainly localised to the anogenital area. The aim of this study was to investigate the clinical features of LS in adult men. A retrospective analysis of records from 771 patients diagnosed with LS was made and a questionnaire was sent to all patients. The results showed that the clinical spectrum was wide. Itch, tenderness and pain were frequently reported and more than half of the patients reported that LS had a negative impact on their sexual health. Phimosis was common and almost 1/3 of the patients were circumcised before or during the study period. Eight cases (1%) of penile squamous cell carcinoma were recorded. This emphasises the need for follow-up of male patients with LS. PMID:24549239

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

    DEFF Research Database (Denmark)

    Thomsen, Reimar W.; Mor, Anil

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

  14. X-ray and CT signs of connective tissue dysplasia in patients with primarily diagnosed infiltrative pulmonary tuberculosis

    International Nuclear Information System (INIS)

    The x-ray signs of connective tissue systemic dysplasia (CTSD) in patients with primarily diagnosed pulmonary tuberculosis was investigated. Fifty-four patients (28 med and 26 women aged 18-70) with primarily diagnosed infiltrative pulmonary tuberculosis underwent x-ray study. In patients with infiltration pulmonary tuberculosis CTSD in the lungs manifests by their diminishing, deformity of the lung pattern, high position of the diaphragm cupola, mediastinum shift to the side of the pathology, which is better seen on CT. The degree of CTSD x-ray signs in the lungs depends on the number of phenotypical signs that is the degree of the disease manifestation. CT allows more accurate determining of the signs of connective tissue dysplasia in which tuberculosis develops

  15. The Practical Uses of Ultrasound in a Clinical Setting to Diagnose Thrombosis of the Ulnar Artery

    OpenAIRE

    Serafine, Matthew S.; Peterson, Charles S.

    2013-01-01

    A 43-year-old professional skateboarder presented to the sports medicine clinic with complaints of left wrist pain to the ulnar aspect. Two weeks prior to presentation, his wrist became suddenly painful with no specific trauma. He reported a history of falls over the years while skateboarding but none directly correlated to his onset of wrist pain. Radiographic results were negative for wrist or hand fracture. Physical examination yielded tenderness and mild swelling to the ulnar aspect of th...

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

    OpenAIRE

    Martin-dunlap, Tonya M.; Wachtel, Mitchell S.; Margenthaler, Julie A.

    2013-01-01

    The present study sought to determine the survival outcomes for women diagnosed with breast and endometrial cancer. Using SEER data, a population-based cohort study of women diagnosed with breast and endometrial cancer was conducted. Kaplan-Meier survival curves were created for disease-specific survival rates. A total of 2,027 women diagnosed with breast and endometrial cancer were identified. Of these, 1,296 (63.9%) developed breast cancer first and 731 (36.1%) developed endometrial cancer ...

  17. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients.

    Science.gov (United States)

    Spencer, C A

    1988-12-01

    In either an ambulatory or a hospitalized patient setting, a normal serum sensitive thyrotropin (TSH) value is strongly suggestive of euthyroidism if the patient has intact hypothalamic-pituitary function and is not receiving drugs known to suppress pituitary TSH secretion. In stable ambulatory patients, an abnormal sensitive TSH value is strongly suggestive of clinical or subclinical thyroid hormone excess or deficiency, which can be confirmed by a free thyroxine (T4) index (FT4I) and evaluation for antimicrosomal antibody (AMA) as a marker of autoimmune thyroid disease. In a hospitalized patient, an abnormality in sensitive TSH or FT4I does not necessarily indicate a thyroid problem but may merely reflect a nonthyroidal illness or glucocorticoid or dopamine treatment. A thyrotropin releasing hormone (TRH) test may be needed to diagnose hyperthyroidism in a hospitalized patient with a basal sensitive TSH level of less than 0.1 microU/ml because a detectable TRH response contraindicates hyperthyroidism whereas hyperthyroid patients with nonthyroidal illness have the expected absent response. In a hospitalized patient, hypothyroidism must be diagnosed on the basis of both a high TSH level and a low FT4I because an isolated high TSH value may merely reflect the recovery phase of a nonthyroidal illness. No clinical urgency exists for establishing a diagnosis of subclinical hypothyroidism in a hospitalized patient; definitive determination of thyroid status can be deferred until recovery and discharge. PMID:3143866

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

    Directory of Open Access Journals (Sweden)

    A Carlo Altamura

    2008-03-01

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

  19. Breast cancer patients with lobular cancer more commonly have a father than a mother diagnosed with cancer

    Directory of Open Access Journals (Sweden)

    Ellberg Carolina

    2011-11-01

    Full Text Available Abstract Background The association between lobular breast cancer and family history is not clear. The aim of the study was to possibly identifying new hereditary patterns predisposing for cancer in the different histopathologic subtypes of breast cancer, with focus on patients with lobular breast cancer and cancer in their first degree relatives. Methods In 1676 consecutive breast cancer patients detailed family history of cancer was related to histopathologic subtype of breast cancer. Results Patients with lobular breast cancer were found to be significantly positively associated with having a father diagnosed with cancer, OR 2.17 (95% confidence interval (CI 1.37-3.46. The finding persisted after excluding breast cancer in the family. Ductal breast cancer was associated with having a mother diagnosed with cancer. There was a significant association between lobular breast cancer and having a father with prostate cancer, OR 2.4 (CI 1.1-5.3. The occurrence of having a father with prostate cancer for lobular breast cancer patients was higher in the younger patient group, OR 2.9 (CI 1.1-7.8, and was still high but lost statistical significance in the older patient group, OR 1.9 (CI 0.5-7.4. The association between lobular breast cancer and a father remained significant after excluding fathers with prostate cancer, OR 1.94 (CI 1.20-3.14. Other commonly occurring tumor types in the father included sarcoma and leukemia. Conclusion We propose that lobular breast cancer is associated with having a father diagnosed with cancer, most commonly prostate carcinoma. Since the association remained after excluding family history of breast cancer, the association seems independent of classical breast cancer heredity. The association with a father diagnosed with cancer also remained after removing prostate cancer, indicating an independence from prostate cancer as well. The reason for this association is genetically unclear, but could involve sex-specific imprinting.

  20. Pacientes con Giardia lamblia diagnosticada por frotis duodenal / Patients with Giardia lamblia diagnosed through duodenal smear

    Scientific Electronic Library Online (English)

    Hidelisa, Herrero Aguirre; Jesús, Fernández Duharte; Suleidy, Vega Sam; José Antonio, Candel Herrero.

    1636-16-01

    Full Text Available Se efectuó un estudio descriptivo y transversal de 105 pacientes mayores de 15 años con infección por Giardia lamblia, diagnosticada por frotis duodenal mediante endoscopia en el Servicio de Gastroenterología del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturn [...] ino Lora Torres" de Santiago de Cuba, desde enero hasta diciembre del 2012, con vistas a caracterizarles. Entre las variables analizadas figuraron: edad, sexo, síntomas digestivos referidos, positividad del frotis e imagen endoscópica. Se utilizó el porcentaje como medida de resumen. Predominaron el sexo femenino (58,0 %), el grupo etario de 29-39 años (38,0 %), la epigastralgia como síntoma principal (66,6 %) y las imágenes endoscópicas grados I y II como las más frecuentes (68,4 y 41,3 %, respectivamente). El índice de positividad a la giardiasis fue relevante Abstract in english A descriptive and cross sectional study of 105 patients older than 15 years with infection by Giardia lamblia, diagnosed through duodenal smear by means of endoscopy was carried out in the Gastroenterology Service of the Specialties Polyclinic from "Saturnino Lora Torres" Teaching Provincial Clinica [...] l Surgical Hospital in Santiago de Cuba, from January to December, 2012, with the objective of characterizing them. Among the analyzed variables there were: age, sex, referred digestive symptoms, positivity of the smear and endoscopic image. The percentage was used as summary measure. Female sex (58.0%), the age group 29-39 years (38.0%), the epigastralgia as main symptom (66.6%) and the endoscopic images grades I and II prevailed as the most frequent (68.4 and 41.3%, respectively). The positivity index for giardiasis was relevant

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

    Directory of Open Access Journals (Sweden)

    Nehir Parlak

    2013-12-01

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

  2. The Incidence of Clinically Diagnosed Versus Research-Identified Autism in Olmsted County, Minnesota, 1976–1997: Results from a Retrospective, Population-Based Study

    OpenAIRE

    Barbaresi, William J.; Colligan, Robert C.; Weaver, Amy L.; Katusic, Slavica K.

    2008-01-01

    Autism prevalence studies have often relied on administrative prevalence or clinical diagnosis as case identification strategies. We report the incidence of clinical diagnoses of autism spectrum disorders, versus research-identified autism among residents of Olmsted County, Minnesota, age ? 21 years, from 1976–1997.

  3. Disfunción endotelial en hipertensos de reciente diagnóstico / Endothelial Dysfunction in Newly Diagnosed Hypertensive Patients

    Scientific Electronic Library Online (English)

    Jorge Luis, León Álvarez; Guillermo, Guerra Ibáñez; Miguel Ángel, Yanes Quesada; Raúl Orlando, Calderín Bouza; Ángela, Gutiérrez Rojas.

    2014-12-01

    Full Text Available Introducción: la aterosclerosis, la disfunción endotelial y la hipertensión arterial están estrechamente relacionadas. La vasorreactividad dependiente del endotelio es un equivalente de disfunción endotelial. Objetivo: evaluar la utilidad del diámetro basal de la arteria braquial medido por técnicas [...] ultrasonográficas en el diagnóstico de disfunción endotelial como lesión vascular subclínica, su asociación con factores de riesgo cardiovascular y el riesgo cardiovascular global. Métodos: investigación analítico transversal en 60 hipertensos de reciente diagnóstico sin lesión en órgano diana en comparación con 60 no hipertensos. Se pesquisaron los factores de riesgo cardiovascular, se les realizó microalbuminuria, colesterol total, colesterol HDL, triglicéridos, colesterol no HDL, medición por ultrasonografía del grosor íntima media carotídeo y del diámetro basal de la arteria braquial y se calculó el riesgo cardiovascular global. Resultados: en el grupo de hipertensos, el sexo masculino constituyó el 55 % del total y en el de los no hipertensos, el sexo femenino representó el 78,3 %. La microalbuminuria estuvo presente en 25 % de los hipertensos por el 13,3 % de los no hipertensos. Se encontraron valores medios más altos de colesterol total y colesterol-no HDL en los hipertensos (4,6 mmol/L y 3,6 mmol/L, respectivamente). La media del grosor íntima media en los hipertensos fue 0,6 mm y la de los no hipertensos fue 0,4 mm. En los hipertensos, el valor medio de diámetro basal de la arteria braquial fue 3,8 mm frente a 3,5 mm en los no hipertensos. En ambos grupos de estudio, a mayores valores medios de colesterol-HDL, hubo mayores valores medios de diámetro basal de la arteria braquial. Conclusiones: se encontró asociación positiva para el colesterol total, el colesterol-HDL, el grosor íntima media carotídeo, la microalbuminuria y el riesgo cardiovascular global con el diámetro basal de la arteria braquial. Se concluye que la determinación del diámetro basal de la arteria braquial mostró resultados promisorios como marcador de disfunción endotelial en la hipertensión arterial. Abstract in english Introduction: atherosclerosis, endothelial dysfunction and hypertension are closely related. Endothelium-dependent vasoreactivity is an equivalent of endothelial dysfunction. Objective: To evaluate the usefulness of baseline diameter of the brachial artery measured by ultrasonographic techniques in [...] the diagnosis of endothelial dysfunction and subclinical vascular lesion, its association with cardiovascular risk factors, and overall cardiovascular risk. Methods: Across-sectional analytical research was conducted in 60 newly diagnosed hypertensive patients without target organ damage. They were compared with 60 non-hypertensive subjects. Cardiovascular risk factors were screened; these patients underwent several tests such as microalbuminuria, total cholesterol, HDL cholesterol, triglycerides, non-HDL cholesterol, ultrasound measurement of carotid intima-media thickness and basal diameter of the brachial artery. The global cardiovascular risk was calculated. Results: In the hypertensive group, males constituted 55 % of the total and in the non-hypertensive group, females accounted for 78.3 %. Microalbuminuria was present in 25 % of hypertensive subejcts by 13.3 % of patients without the disease. Higher mean values of total cholesterol and non-HDL in hypertensive subjects (4.6 mmol / L and 3.6 mmol / L, respectively) were found. The mean intima-media thickness was 0.6 mm in hypertensive patients and 0.4 mm in non hypertensive subjects. In hypertensive patients, the mean baseline brachial artery diameter was 3.8 mm versus 3.5 mm in non-hypertensive subjects. In both study groups, higher mean levels of baseline diameter of the brachial artery when there were higher mean values of HDL-cholesterol. Conclusions: There is a positive association for total cholesterol, HDL-cholesterol, the carotid intima media thickness, microalbuminuria and global cardiovascular risk

  4. A case of Wilson's disease in an elderly patient initially diagnosed with NASH.

    Science.gov (United States)

    Seishima, Jun; Sakai, Yoshio; Kitahara, Noriaki; Kitamura, Kazuya; Arai, Kuniaki; Kagaya, Takashi; Yamashita, Tatsuya; Mizukoshi, Eishiro; Honda, Masao; Kaneko, Shuichi

    2015-01-01

    A 62-year-old female was admitted to our hospital for examination of icterus and thrombocytopenia. She had a history of diabetes mellitus (under treatment), and liver cirrhosis was evident on abdominal CT. Because she was clinically obese and had no past history of alcohol consumption, the initial diagnosis was NASH. However, subsequent MRI findings and normal serum transaminase levels were not consistent with this diagnosis. We then performed additional examinations, including liver biopsy, measurements of serum Cu and ceruloplasmin concentrations, and measurement of urinary Cu secretion, which resulted in a diagnosis of Wilson's disease. It is necessary to include Wilson's disease in the differential diagnosis of NASH in cases of unidentified liver disease even among elderly patients. PMID:25748158

  5. Uterine metastasis of invasive ductal breast carcinoma diagnosed by cytological examination in an asymptomatic patient: an unusual case report

    Directory of Open Access Journals (Sweden)

    Ça?da? Türky?lmaz

    2007-10-01

    Full Text Available Uterine metastasis of malignant tumors occurs very rarely. Despite abnormal uterine bleeding is the most common symptom of metastatic uterine disease, less than 5% of patients may have not any gynecologic symptoms and diagnosis is made usually following abnormal cervical cytology. Here we present a case of uterine metastasis of invasive ductal breast carcinoma that was diagnosed by cervical cytological examination during breast cancer follow up. Even if there are not any gynecologic symptoms and findings in a patient who has breast cancer history, a detail systematic pelvic examination of these patients must be done yearly.

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

    DEFF Research Database (Denmark)

    Jones, A.; Clausen, Loa

    2013-01-01

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

  7. Assessment of Agreement between Clinical Diagnosis and Pathologic Report in the Soft Tissue Lesions of the Patients Referring to Pathology Department of Dental School, Tehran and Shahid Beheshti University of Medical Sciences During 2005-2008

    Directory of Open Access Journals (Sweden)

    S Ravaei

    2013-01-01

    Full Text Available Introduction: Agreement between clinical and pathologic diagnoses plays an important role in an appropriate treatment plan and it may also prevent serious side effects and problems in patients. This study was conducted to assess the agreement between clinical diagnoses and pathologic reports in soft tissue lesions of patients referring to pathology department of dental school, Tehran and shahid Beheshti university of medical sciences during 2005-2008. Methods: In this retrospective and descriptive study, 300 soft tissue lesions of patients referring to pathology department were selected by census sampling method and then were analyzed. The lesions were classified according to the criteria proposed by reference pathology textbooks and the data records regarding the patients age, gender and clinical and pathologic diagnoses were noted. Concordance between two diagnoses was determined by descriptive statistics. Results: In this study, pathologic findings were golden standard (definitive diagnoses. The results showed the concordance between two clinical and pathologic diagnoses were more than 0/7 except POF and pemphigus. Conclusion: The results showed that the surgeons of oral and maxillofacial surgery in dental departments of Tehran and shahid Beheshti university of medical science provided acceptable diagnoses regarding pathologic lesions during 2005-2008. However, even the slight differences between two diagnoses necessitate all patients to be evaluated clinically and paraclinically in order to propose an accurate scientific diagnosis and prevent the harmful outcomes of the disease. Furthermore most efforts must be done to make more agreements between clinical and pathological diagnoses.

  8. Stability of HE4 and CA125 in blood samples from patients diagnosed with ovarian cancer

    DEFF Research Database (Denmark)

    Sandhu, Noreen; Karlsen, Mona A

    2014-01-01

    OBJECTIVE: To investigate the influence of handling and storage on HE4 and CA125 serum and EDTA plasma levels to clarify any important consequences for a clinical setting. METHODS: Blood samples from 13 ovarian cancer (OC) patients were collected and allowed to clot or sediment for up to 72 hours at 4 °C or 20 °C, then processed into serum and EDTA plasma. Furthermore, the effects of up to eight repetitive cycles of freeze/thaw were investigated. HE4 and CA125 were analyzed using a Chemiluminescent Microparticle Immunoassay on the Architect i2000sr System. RESULTS: No significant effect of processing time for HE4 could be shown. HE4 EDTA plasma levels were insignificantly lower (3%) than serum levels (p = 0.41). Similarly, no significant effect of processing time for CA125 could be demonstrated. CA125 levels at 4 °C were significantly reduced compared to levels at 20 °C (p = 0.024). No significant difference between CA125 serum and plasma levels were found (p = 0.46). Serum and EDTA plasma samples were stable during the eight cycles of freezing and thawing (CA125: all p > 0.2; HE4: all p > 0.5). CONCLUSION: No systematic difference could be demonstrated for HE4. CA125 is not dependent on processing time, EDTA plasma or serum. Levels of CA125 are significantly reduced at 4 °C compared to levels at 20°C, but this difference was less than 6% and is not considered clinically relevant.

  9. Comparison of the effects of Sertindole and Olanzapine on Cognition (SEROLA) : a double-blind randomized 12-week study of patients diagnosed with schizophrenia

    DEFF Research Database (Denmark)

    Ernst Nielsen, René; Odur, Florence

    2014-01-01

    OBJECTIVE: To assess the cognitive effects of sertindole and olanzapine in patients diagnosed with schizophrenia. Cognition was the primary outcome of the study. METHOD: This was a 12-week double-blinded randomized clinical controlled trial. Participants were randomized to either 16-24 mg of sertindole or 10-20 mg of olanzapine. RESULTS: The study had a low recruitment rate (N = 9) and was terminated before the expected number of patients was reached. No significant differences between groups were found at study end on any of the 32 cognitive subtests. A simple sign test did not show any of the comparator drugs trending towards being superior on the majority of tests. Mean change on Positive and Negative Syndrome Scale (PANSS) total and PANSS subscales from baseline to end of study were not significantly different between treatment groups. Similar results on cognition and PANSS was seen on completers and last observation carried forward analysis. CONCLUSION: In this study we did not find any significant differences between sertindole or olanzapine on PANSS subscales or neurocognitive tests in a population consisting of patients diagnosed with schizophrenia.

  10. Clinical value of 13C-UBT diagnosing infection of the Hp

    International Nuclear Information System (INIS)

    100 dyspeptic patients are performed an endoscopy with biopsy for histology, rapid urease test, 13C-urea breath test(13C-UBT) and ASSURETM Hp rapid Test(HpRT). Patients are considered to be infected if both histology and biopsies yield positive results, and not infected when both tests are negative. The pathology and persons responsible for endoscopy, urease test and 13C-UBT are unaware of the results from the other diagnostic methods. The 13C-UBT has the following results: sensitivity 96% ,specificity 95%; rapid urease test has the following results: sensitivity 79%, specificity 76%; HpRT has the following results: sensitivity 86%, specificity 88%. 13C-UBT provides excellent sensitivity and specificity for the diagnosis of Hp. Pylori infected Hp, it can be the first choice for detecting the infection of the Hp. (authors)

  11. The role of the Oregon State University Endophyte Service Laboratory in diagnosing clinical cases of endophyte toxicoses.

    Science.gov (United States)

    Craig, A Morrie; Blythe, Linda L; Duringer, Jennifer M

    2014-07-30

    The Oregon State University Colleges of Veterinary Medicine and Agricultural Sciences instituted the Endophyte Service Laboratory to aid in diagnosing toxicity problems associated with cool-season grasses in livestock. The endophyte (Neotyphodium coenophalum) present in tall fescue (Festuca arundinacea) produces ergopeptine alkaloids, of which ergovaline is the molecule used to determine exposure and toxicity thresholds for the vasoconstrictive conditions "fescue foot" and "summer slump". Another vasoconstrictive syndrome, "ergotism," is caused by a parasitic fungus, Claviceps purpurea, and its primary toxin, ergotamine. "Ryegrass staggers" is a neurological condition that affects livestock consuming endophyte (Neotyphodium lolii)-infected perennial ryegrass (Lolium perenne) with high levels of lolitrem B. HPLC-fluorescent analytical methods for these mycotoxins are described and were used to determine threshold levels of toxicity for ergovaline and lolitrem B in cattle, sheep, horses, and camels. In addition, six clinical cases in cattle are presented to illustrate diagnosis of these three diseases. PMID:25017309

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

    Directory of Open Access Journals (Sweden)

    Schauer Margarete

    2004-11-01

    Full Text Available Abstract Background A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples. Methods A total of 192 patients with diagnoses of alcohol-related disorders (n = 45, schizophrenic disorders (n = 52, affective disorders (n = 54, and personality disorders (n = 41 completed a 42-item self-rating scale (Traumatic Antecedents Questionnaire, TAQ. The TAQ assesses personal positive experiences (competence and safety and negative experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas, and alcohol and drugs abuse during four developmental periods, beginning from early childhood to adulthood. Patients were recruited from four Psychiatric hospitals in Germany, Switzerland, and Romania; 63 subjects without any history of mental illness served as controls. Results The amount of positive experiences did not differ significantly among groups, except for safety scores that were lower in patients with personality disorders as compared to the other groups. On the other side, negative experiences appeared more frequently in patients than in controls. Emotional neglect and abuse were reported in patients more frequently than physical and sexual abuse, with negative experiences encountered more often in late childhood and adolescence than in early childhood. The patients with alcohol-related and personality disorders reported more negative events than the ones with schizophrenic and affective disorders. Conclusions The present findings add evidence to the relationship between retrospectively reported childhood experiences and psychiatric diagnoses, and emphasize the fact that a emotional neglect and abuse are the most prominent negative experiences, b adolescence is a more 'sensitive' period for negative experiences as compared to early childhood, and c a high amount of reported emotional and physical abuse occurs in patients with alcohol-related and personality disorders respectively.

  13. Comparison of two ELISA versions for infliximab serum levels in patients diagnosed with ankylosing spondylitis.

    Science.gov (United States)

    Hernández-Flórez, Diana; Valor, Lara; de la Torre, Inmaculada; Nieto, Juan Carlos; Martínez-Estupiñán, Lina; González, Carlos; López-Longo, Francisco Javier; Monteagudo, Indalecio; Garrido, Jesús; Naredo, Esperanza; Carreño, Luis

    2015-06-01

    There are various immunosorbent assays which can be used to determine infliximab (IFX) levels. Results vary between assays complicating reliability in everyday clinical practice. The aim of this study was to determine whether quantitative or qualitative assay data prove more accurate in the assessment of infliximab levels in AS patients. We analyzed 40 serum samples, taken prior to infusion, from AS patients who had been undergoing IFX therapy as a first-line of biological treatment for more than a year. IFX levels and IFX-anti-drug antibodies (ADA) were measured using two different ELISA assays [Promonitor(®) IFX R1 and R2 (version 1), Promonitor(®) IFX and anti-IFX (version 2) (Progenika Biopharma, Spain)] strictly following the manufacturer's guidelines. Cohen's unweighted kappa and the intraclass correlation coefficient determined qualitative and quantitative agreement for serum levels in version 1 and version 2. Bland-Altman plots were drawn to compare both assays. The comparison of data measuring IFX levels for version 1 and version 2 resulted in questionable quantitative agreement (ICC 0.659; 95 % CI 0.317-0.830) and moderate qualitative agreement (? 0.607; 95 % CI 0.387-0.879) owing to systematically higher values in version 2 than version 1. Version 2 consistently detected higher levels of infliximab, particularly when analyzed in a quantitative context. Further research is needed to synchronize cutoff levels between essays and diseases so therapeutic drug ranges can be established. PMID:25410014

  14. Can advanced paramedics in the field diagnose patients and predict hospital admission?

    LENUS (Irish Health Repository)

    Cummins, Niamh Maria

    2013-02-13

    BACKGROUND: Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training. OBJECTIVES: The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission. METHODS: A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. RESULTS: A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525\\/748) for all cases of AP diagnosis, and is mirrored with 70% (604\\/859) correct hospital admission predictions. CONCLUSIONS: AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as \\'treat and refer\\'.

  15. Gastrointestinal diagnosis of classical whipple disease: clinical, endoscopic, and histopathologic features in 191 patients.

    Science.gov (United States)

    Günther, Ute; Moos, Verena; Offenmüller, Gabriel; Oelkers, Gerrit; Heise, Walther; Moter, Annette; Loddenkemper, Christoph; Schneider, Thomas

    2015-04-01

    Classic Whipple disease (CWD) is a systemic infection caused by Tropheryma whipplei. Different diagnostic tools have been developed over the last decades: periodic acid-Schiff (PAS) staining, T whipplei-specific polymerase chain reaction (PCR), and T whipplei-specific immunohistochemistry (IHC). Despite all these advances, CWD is still difficult to diagnose because of a variety of clinical symptoms and possibly a long time span between first unspecific symptoms and the full-blown clinical picture of the disease.Herein, we report an observational cohort study summarizing epidemiologic data, clinical manifestations, and diagnostic parameters of 191 patients with CWD collected at our institution. Gastrointestinal manifestations are the most characteristic symptoms of CWD affecting 76% of the cohort. Although the small bowel was macroscopically conspicuous in only 27% of cases, 173 (91%) patients presented with characteristic histological changes in small bowel biopsies (in 2 patients, these changes were only seen within the ileum). However, 18 patients displayed normal small bowel histology without typical PAS staining. In 9 of these patients, alternative test were positive from their duodenal specimens (ie, T whipplei-specific PCR and/or IHC). Thus, in 182 patients (95%) a diagnostic hint toward CWD was obtained from small bowel biopsies. Only 9 patients (5%) were diagnosed solely based on positive T whipplei-specific PCR and/or IHC of extraintestinal fluids (eg, cerebrospinal fluid, synovial fluid) or extraintestinal tissue (eg, lymph node, synovial tissue), respectively.Thus, despite efforts to diagnose CWD from alternative specimens, gastroscopy with duodenal biopsy and subsequent histological and molecular-biological examination is the most reliable diagnostic tool for CWD. PMID:25881849

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

    Scientific Electronic Library Online (English)

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

    2011-06-01

    Full Text Available The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL) in patients from the endemic areas of leishmaniasis were assessed. Differ [...] ent methods used in diagnosing the disease and the polymerase chain reaction (PCR) technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14.3% presented other etiologies such as vasculitis, syphilis, and paracoccidioidomycosis, with all tests negative for leishmaniasis. Out of the remaining 15 patients, 6.7% cases were confirmed for leishmaniasis by direct examination; 46.67% were positive for culture, which allowed isolating and identifying the parasite and - with the PCR technique - it was possible to diagnose 100% MCL patients for all the three repetitions of exams. The PCR optimized for the present work proved to be an auxiliary method for diagnosing leishmaniasis applicable in the patients carrying MCL due to Leishmania (Viannia) braziliensis and did not need culture to be performed, resulting in a faster diagnosis.

  17. Características clínicas e histopatológicas del cáncer de próstata diagnosticado a partir de la tercera biopsia / Clinical features and histopathology of prostate cancer diagnosed from the third biopsy

    Scientific Electronic Library Online (English)

    M.P., Bahílo Mateu; M., Ramírez Backhaus; M., Trassierra Villa; C., Di Capua Sacoto; S., Arlandis Guzmán; J.F., Jiménez Cruz.

    2008-12-01

    Full Text Available Objetivo: Estudiar las características histopatológicas y clínicas de los tumores diagnosticados a partir de terceras biopsias para valorar la relevancia clínica de éstos y descartar el sobrediagnóstico en el cáncer de próstata. Material y método: Revisamos las historias clínicas de 61 pacientes con [...] al menos tres o más biopsias de próstata transrectales, sextantes o de saturación según el esquema preestablecido, desde el año 2000 al 2006. Las variables analizadas son: edad del paciente, PSA, cociente PSA libre/PSA total, PSA densidad, tacto rectal, volumen prostático, hallazgos ecográficos y lesión premaligna fuertemente asociadas a la presencia de tumor en biopsias previas. Y estudiamos la anatomía patológica de los tumores diagnosticados a partir de la tercera biopsia, abordaje terapéutico y su evolución con un seguimiento mínimo de 3 meses. Resultados: De 61 pacientes con más de tres biopsias, a 15 pacientes se les diagnostica cáncer (24,6%) en la tercera biopsia. A 14 se les realiza nueva biopsia (cuarta), encontrando tumor en 5 de ellos (35,7%). Se realiza quinta biopsia en 2 pacientes siendo positiva en uno de ellos (50%). Según los resultados de la biopsia, 6 pacientes presentaban criterios de cáncer clínicamente no significativo (28,6%). En todos los pacientes se procedió a tratamiento curativo: 5 braquiterapia, 6 radioterapia externa y a 10 se les realizó una prostatectomía radical, que evidenció tumores clínicamente significativos: 2 tumores pT2b y 7 tumores pT2c sin invasión de los márgenes quirúrgicos y con un excelente control de la enfermedad tras un seguimiento mínimo de 13 meses y un pT4 por invasión del cuello vesical. Conclusiones: En nuestro medio, la tercera, cuarta y quinta biopsia alcanza una positividad del 34,42% y se corresponde con tumores que se benefician de un tratamiento con intención curativa. Abstract in english Objective: To study of histological and clinical features of prostate cancer diagnosed after three or more prostate biopsies in order to assess its clinical relevance and to discard the overdiagnosis of prostate cancer. Material and methods: We reviewed the clinical records of 61 patients who underw [...] ent three or more prostate biopsies between January 2000 and December 2006. The analyzed variables were: age, PSA level, free/total PSA ratio, PSA density, digital rectal examination, prostate volume, sonographic findings and previous malignant lesion strongly associated to the presence of tumor on previous biopsy. We studied the pathology of the tumors diagnosed from the third biopsy, therapeutical approach and its evolution with a minimum follow-up of 3 months. Results: Fifteen out of 61 patients with more than three biopsies had prostate cancer (24,59%) in the third biopsy, 5 out of 14 patients with 4 biopsies (35,71%) and 1 of the 2 cases (50%) who underwent a fifth biopsy. According to the results of biopsy, 6 patients met the criteria of clinically insignificant cancer (28,57%). Curative treatment was performed in all patients: brachytherapy in 5, external beam radiotherapy in 6 and radical prostatectomy in 10. Clinically significant tumors were found in all cases: 2 pT2b tumors and 7 pT2c tumors with negative surgical margins and with an excellent control of the cancer after a minimum follow up of 13 months, and one pT4 tumor with bladder neck infiltration. Conclusion: In our practice, overall detection rate of the third, fourth and fifth biopsy is 34,42% corresponding with tumors that could benefit from curative treatment.

  18. Diagnosing Lupus

    Science.gov (United States)

    ... Doctor Loss of Health Insurance Coverage Preparing for Financial Emergencies Important Documents Caring for Children and Teens For Healthcare Professionals Continuing Education Tools for Your Patients Research and Clinical Trials ...

  19. Radiology clinical synopsis: a simple solution for obtaining an adequate clinical history for the accurate reporting of imaging studies on patients in intensive care units

    International Nuclear Information System (INIS)

    Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years. (orig.)

  20. Extending the KCNQ2 encephalopathy spectrum: clinical and neuroimaging findings in 17 patients

    DEFF Research Database (Denmark)

    Weckhuysen, S.; Ivanovic, V.

    2013-01-01

    OBJECTIVES: To determine the frequency of KCNQ2 mutations in patients with neonatal epileptic encephalopathy (NEE), and to expand the phenotypic spectrum of KCNQ2 epileptic encephalopathy. METHODS: Eighty-four patients with unexplained NEE were screened for KCNQ2 mutations using classic Sanger sequencing. Clinical data of 6 additional patients with KCNQ2 mutations detected by gene panel were collected. Detailed phenotyping was performed with particular attention to seizure frequency, cognitive outcome, and video-EEG. RESULTS: In the cohort, we identified 9 different heterozygous de novo KCNQ2 missense mutations in 11 of 84 patients (13%). Two of 6 missense mutations detected by gene panel were recurrent and present in patients of the cohort. Seizures at onset typically consisted of tonic posturing often associated with focal clonic jerking, and were accompanied by apnea with desaturation. One patient diagnosed by gene panel had seizure onset at the age of 5 months. Based on seizure frequency at onset and cognitive outcome, we delineated 3 clinical subgroups, expanding the spectrum of KCNQ2 encephalopathy to patients with moderate intellectual disability and/or infrequent seizures at onset. Recurrent mutations lead to relatively homogenous phenotypes. One patient responded favorably to retigabine; 5 patients had a good response to carbamazepine. In 6 patients, seizures with bradycardia were recorded. One patient died of probable sudden unexpected death in epilepsy. CONCLUSION: KCNQ2 mutations cause approximately 13% of unexplained NEE. Patients present with a wide spectrum of severity and, although rare, infantile epilepsy onset is possible.

  1. Clinical significance of conventional rib series in patients with minor thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Hoffstetter, P.; Dornia, C. [Asklepios Medical Center, Bad Abbach (Germany). Radiology; University Medical Center Regensburg (Germany). Radiology; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G. [University Medical Center Regensburg (Germany). Radiology; Al Suwaidi, M.H. [Asklepios Medical Center, Bad Abbach (Germany). Rheumatology/Clinical Immmunology

    2014-09-15

    Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated by CR to exclude fracture-associated complications such as hemo- and pneumothorax. (orig.)

  2. Clinicoepidemiological characteristics of adult in 5patients with inflammatory bowel disease diagnosed Greek teaching hospitals during the year 2003

    OpenAIRE

    J.K. Triantafillidis1, G. Kitis2, D. Karamanolis3, I. Karagiannis4, D. Tzourmakliotits5

    2007-01-01

    Background: During the last two decades the incidence and prevalence of Ulcerative Colitis (UC) in some European countries reached a ?plateau?, a fact that is in sharp contrast to Crohn?s disease (CD) which has shown up to a sixfold increase in incidence rates over the same period. New cases of CD now account for at least equal number of cases with UC. Aim: To present the results of the analysis of some clinicoepidemiological parameters of patients with IBD diagnose...

  3. Multidetector computed tomography (MDCT) as a valuable method for diagnosing and planning surgery in acute limb ischemia patients

    International Nuclear Information System (INIS)

    In 52 patients, we investigated retrospectively the feasibility of MDCT as a diagnostic tool as well as a valuable source of information for decision making in planning surgery. Based on the information acquired solely by MDCT, we were able to diagnose acute limb ischemia in 8 patients (15.4%), and, in 17 patients (32.7%), we could detail the condition of diseased vessels. MDCT also was effective in 19 patients (36.5%) to determine the site responsible for occlusions. Our study found that in 44 patients (84.6%), MDCT provided indispensable information for planning the operation. Our study shows the feasibility of MDCT as a diagnostic tool as well as a useful source of information for the planning of operative strategies. (author)

  4. Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint

    International Nuclear Information System (INIS)

    Patients displaying temporomandibular joint clicking or with a history of clicking followed by limitation of opening were subjected to clinical and radiological examinations including arthrography. Arthrographically the patients were found to have anterior displacement of the disc. In patients with clicking the disc was repositioned in association with clicking during opening. In patients with limitation of opening the disc was constantly displaced anterior to the condyle, blocking anterior condylar translation. The patients with limitation of opening had more pain, more signs of mandibular disfunction, more hard tissue changes and more frequent perforation and deformation of the disc, compared to patients with clicking only. These findings may justify two different diagnoses, displacement with and without repositioning of the disc on opening. Displacement without repositioning seems to be the more advanced condition and may in some cases be a precursor of osteoarthrosis. (Authors)

  5. Assessment of spleen size using gamma camera scintigraphy in newly diagnosed patients with essential thrombocythaemia and polycythaemia vera

    International Nuclear Information System (INIS)

    By using gamma camera imaging the spleen size was assessed in 18 consecutive patients with essential thrombocythaemia (ET) and in 18 consecutive patients with polycythaemia vera (PV). All ET and PV patients were newly diagnosed and had not received any myelosuppressive therapy prior to study. The spleen areas in both posterior and left lateral projections were determined. Eighteen consecutive patients with idiopathic thrombocytopenic purpura (ITP) served as a control group since by definition they do not present with splenic enlargement; in these latter subjects the mean posterior and left lateral splenic areas were almost identical (48 ± 15 and 47 ± 17 cm2, respectively). In comparison with this control group patients with ET an dPV had significantly larger spleens. In both ET and in PV patients the left lateral spleen scan area exceeded the posterior one. Patients with PV had larger splenic areas in both projections than did patients with ET, but the differences were not statistically significant. Compared to the ITP patients it was found that at least 50% of the ET patients and at least 61% of the PV patients at diagnosis presented with splenomegaly. (au) 35 refs

  6. Assessment of spleen size using gamma camera scintigraphy in newly diagnosed patients with essential thrombocythaemia and polycythaemia vera

    Energy Technology Data Exchange (ETDEWEB)

    Carneskog, J.; Wadenvik, H.; Kutti, J. [Univ. of Goeteborg, Sahlgrenska Univ. Hospital, Dept. of Medicine, Haematology Section, Goeteborg (Sweden); Fjaeelling, M. [Univ. of Goeteborg, Sahlgrenska Univ. Hospital, Dept. of Clinical Physiology, Section of Nuclear Med., Goeteborg (Sweden)

    1996-03-01

    By using gamma camera imaging the spleen size was assessed in 18 consecutive patients with essential thrombocythaemia (ET) and in 18 consecutive patients with polycythaemia vera (PV). All ET and PV patients were newly diagnosed and had not received any myelosuppressive therapy prior to study. The spleen areas in both posterior and left lateral projections were determined. Eighteen consecutive patients with idiopathic thrombocytopenic purpura (ITP) served as a control group since by definition they do not present with splenic enlargement; in these latter subjects the mean posterior and left lateral splenic areas were almost identical (48 {+-} 15 and 47 {+-} 17 cm{sup 2}, respectively). In comparison with this control group patients with ET an dPV had significantly larger spleens. In both ET and in PV patients the left lateral spleen scan area exceeded the posterior one. Patients with PV had larger splenic areas in both projections than did patients with ET, but the differences were not statistically significant. Compared to the ITP patients it was found that at least 50% of the ET patients and at least 61% of the PV patients at diagnosis presented with splenomegaly. (au) 35 refs.

  7. CE-Magnetic Resonance mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer

    International Nuclear Information System (INIS)

    Purpose. To evaluate the role of contrast-enhanced Magnetic Resonance Mammography (MRM) in the evaluation of the contralateral breast in patients with recently diagnosed breast cancer. Materials and methods. Fifty patients with proved unilateral breast cancer, with a negative contralateral breast at physical examination, ultrasound and mammography, were studied with a 1.5 T magnet (Siemens, Vision Plus, Germany). A bilateral breast surface coil was used. Dynamic 3D Flash T1-weighted sequences were acquired in the axial plane before and 0, 2, 4, 6 and 8 minutes after the administration of 0.1 mmol/kg of Gd-BOPTA at a flow rate of 2 ml/s followed by 10 ml of saline. The level of suspicion was reported on a scale from 0 to 5 following the BI-RADS classification, based on lesion morphology and kinetic features. The results were compared with the histological findings after biopsy or surgery. Results. Fourteen out of 50 patients (28%) had contralateral lesions identified on MRM. Biopsy was performed in four of them for suspicious lesions (BI-RADS 4) while 10 patients underwent surgery because of highly suggestive malignant lesions (BI-RADS 5). Histology diagnosed three fibroadenomas, 5 ductal carcinoma in situ, 2 lobular carcinomas in situ, 3 invasive ductal carcinomas and 1 invasive lobular carcinoma. Contrast enhanced MRM yielded no false negative and three false positives. Conclusions. Our results demonstrate a very good accuracy of Magnetic Resonance Mammography in they of Magnetic Resonance Mammography in the detection of synchronous contralateral cancer in patients with newly diagnosed breast cancer. Therefore, contrast-enhanced MRM could be introduced to screen patients with proven breast cancer before they under-go surgery

  8. Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients

    Directory of Open Access Journals (Sweden)

    Kochhar P

    2007-01-01

    Full Text Available Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India. Aims: Translation and validation of the brief patient health questionnaire (BPHQ as a screening tool for depression in major Indian languages. Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods. Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil. Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.

  9. A Generalized Relational Schema for an Integrated Clinical Patient Database

    OpenAIRE

    Friedman, Carol; Hripcsak, George; Johnson, Stephen B.; Cimino, James J; Clayton, Paul D

    1990-01-01

    Patient data is central to a Clinical Information System (CIS). The organization of the data in a patient database is essential to the functioning of the system. If the CIS contains a medical decision support component, further requirements are imposed on the database. It must be capable of accurately representing a broad range of clinical information in coded form, and be organized for efficient retrievals by patient, time, and type of clinical term.

  10. Patient-centeredness in the design of clinical trials.

    Science.gov (United States)

    Mullins, C Daniel; Vandigo, Joseph; Zheng, Zhiyuan; Wicks, Paul

    2014-06-01

    Evidence from clinical trials should contribute to informed decision making and a learning health care system. People frequently, however, find participating in clinical trials meaningless or disempowering. Moreover, people often do not incorporate trial results directly into their decision making. The lack of patient centeredness in clinical trials may be partially addressed through trial design. For example, Bayesian adaptive trials designed to adjust in a prespecified manner to changes in clinical practice could motivate people and their health care providers to view clinical trials as more applicable to real-world clinical decisions. The way in which clinical trials are designed can transform the evidence generation process to be more patient centered, providing people with an incentive to participate or continue participating in clinical trials. To achieve the transformation to patient-centeredness in clinical trial decisions, however, there is a need for transparent and reliable methods and education of trial investigators and site personnel. PMID:24969009

  11. Diagnosticando o TDAH em adultos na prática clínica Diagnosing adult ADHD in clinical practice

    Directory of Open Access Journals (Sweden)

    Gabriela Dias

    2007-01-01

    Full Text Available Embora a forma adulta do transtorno de déficit de atenção e hiperatividade (TDAH seja oficialmente reconhecida e respaldada cientificamente, esse diagnóstico ainda é motivo de embates entre especialistas. A maior parte do conhecimento existente ainda se deve à extrapolação dos achados de estudos com populações de crianças e adolescentes, havendo necessidade de novos estudos para validar os critérios com populações adultas. O critério de idade de início dos sintomas, o ponto de corte de seis sintomas e a necessidade de atestar comprometimento funcional em ao menos dois ambientes distintos são algumas das principais dificuldades encontradas na prática clínica para o estabelecimento do diagnóstico em adultos que freqüentemente apresentam dificuldades para resgatar informações remontando à infância. Muitos sintomas descritos são também alvos de críticas, uma vez que são claramente inapropriados para adultos. A utilização de instrumentos adaptados para adultos (como o ASRS-18, a coleta de informações com outros informantes (cônjuge e pais, por exemplo, a flexibilização da idade de início dos sintomas e uma investigação abrangente dos ambientes comprometidos pelos sintomas podem minimizar essas dificuldades.Although attention deficit hyperactivity disorder (ADHD has been officially recognized as a valid disorder into adulthood, this diagnosis is still an issue of debates between specialists. Most of the existing knowledge regarding this condition is due to the excess of findings of studies with children. As the field studies that determined DSM-IV diagnostic criteria comprised only children and adolescents, more studies with adult populations are required to validate the criteria for this population. The age of onset criteria, the cut-off of six symptoms and the requirement of impairment in at least two different settings are some of the difficulties faced by clinicians to make the diagnosis in clinical practice. Moreover, adults with ADHD often show difficulties to recall the symptoms in childhood. The symptoms described by DSM-IV are also criticized. To minimize the aforementioned problems, the use of instruments adapted to adults (as ASRS-18, reports of other informants (like partner and parents, the broadened of the age of onset criterion and a broaden investigation of the different settings that might be impaired by the symptoms are recommended.

  12. Epidemiological and clinical characteristics of Reiter's syndrome in Jordanian patients

    International Nuclear Information System (INIS)

    Objective: To study the epidemiological and clinical features of Reiter's syndrome in patients who visited the rheumatology clinic in King Hussein Medical Centre (KHMC), Jordan. Methods: A prospective study, including 43 patients with the diagnosis of Reiter's syndrome was done. Patients were assessed by taking complete history, physical examination and appropriate investigations including urinalysis and culture, stool examination and culture, synovial fluid analysis, complement fixation test for Chlamydia trachomatis, complete blood count, erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibodies. HLA-B27 and radiological study. Results: All patients in this study were white men, with mean age of 26.3 years. HLA-B27 was positive in 37 patients (86%). Most cases were post venereal (32 patients, 74%) while the rest were dysenteric. The clinical manifestations were arthritis in all patients (100%), urethritis in 21 patients (48%), ocular involvement in 20 patients (46%), diarrhea in 12 patients (28%), painless oral ulcers in 11 patients (26%), skin lesions in 5 patients (12%) and constitutional symptoms in 7 patients (16%). Arthritis was mostly oligoarticular (25 patients, 58%) with asymmetrical pattern in 34 patients (78%). Large joints of lower extremity were most involved (29 patients, 68%). Rheumatoid factor and antinuclear antibodies were negative in all patients. Relapses occurred in 7 patients (16%) after a mean period of 6.2 months. Conclusion: Ia mean period of 6.2 months. Conclusion: It is concluded that the epidemiological and clinical features of Reiter's syndrome in Jordan are not different from those in the literature. (author)

  13. Risk Factors for the Progression of Intima-Media Thickness of Carotid Arteries: A 2-Year Follow-Up Study in Patients with Newly Diagnosed Type 2 Diabetes

    Science.gov (United States)

    Chin, Sang Ouk; Hwang, Jin Kyung; Rhee, Sang Youl; Chon, Suk; Hwang, You-Cheol; Oh, Seungjoon; Ahn, Kyu Jeung; Chung, Ho Yeon; Woo, Jeong-taek; Kim, Sung-Woon; Kim, Young Seol

    2013-01-01

    Background Intima-media thickness (IMT) of the carotid arteries is known to have a positive correlation with the risk of cardiovascular disease. This study was designed to identify risk factors affecting the progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM). Methods Patients with newly diagnosed T2DM with carotid IMT measurements were enrolled, and their clinical data and carotid IMT results at baseline and 2 years later were compared. Results Of the 171 patients, 67.2% of males and 50.8% of females had abnormal baseline IMT of the left common carotid artery. At baseline, systolic blood pressure, body mass index and smoking in male participants, and fasting plasma glucose and glycated hemoglobin levels in females were significantly higher in patients with abnormal IMT than in those with normal IMT. Low density lipoprotein cholesterol (LDL-C) levels in males and high density lipoprotein cholesterol (HDL-C) levels in females at the 2-year follow-up were significantly different between the nonprogression and the progression groups. Reduction of the United Kingdom Prospective Diabetes Study (UKPDS) 10-year coronary heart disease (CHD) risk score after 2 years was generally higher in the nonprogression group than the progression group. Conclusion LDL-C levels in males and HDL-C levels in females at the 2-year follow-up were significantly different between participants with and without progression of carotid IMT. Furthermore, a reduction in the UKPDS 10-year CHD risk score appeared to delay the advancement of atherosclerosis. Therefore, the importance of establishing the therapeutic goal of lipid profiles should be emphasized to prevent the progression of carotid IMT in newly diagnosed T2DM patients. PMID:24199166

  14. The nursing team’s knowledge of care for patients suspected of having or diagnosed with pulmonary tuberculosis – an exploratory study.

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Querido Avelar

    2006-08-01

    Full Text Available Nursing professionals at health care institutions should be prepared to suspect and identify cases of pulmonary tuberculosis at the earliest possible stage, in view of the risk of their contagion and consequent sickness. The prevention aspects should be valued in the performance of their activities, to the effect of remaining continuously attentive, to adopt safety measures that prevent the intra-hospital transmission of the disease. This study was aimed at identifying the knowledge of nursing team members of protective measures to be deployed in caring for adult patients suspected of having or diagnosed with pulmonary tuberculosis, confined in clinical-surgical and emergency units of a university hospital. This exploratory, transversal onsite study included 280 nursing professionals, comprising nurses (31-11.43% and nursing assistants (249-88.57%. The material was gathered by applying a questionnaire with closed and open-ended questions. The material gathered was organized and the content analysis was used for the handling of data. The nursing professionals expressed their understanding of the disease and their knowledge of protective measures in the care of patients suspected of having or diagnosed with pulmonary tuberculosis. The study provided means of identifying the needs of nursing professionals focused on biosafety aspects in relation to the performance of their practice, permitting the formulation of subsidies for the continued education service and Hospital Infection Control Service of the Institution (SCIH.

  15. Multi-institutional phase 2 clinical and pharmacogenomic trial of tipifarnib plus etoposide for elderly adults with newly diagnosed acute myelogenous leukemia

    Science.gov (United States)

    Vener, Tatiana I.; Raponi, Mitch; Ritchie, Ellen K.; Smith, B. Douglas; Gore, Steven D.; Morris, Lawrence E.; Feldman, Eric J.; Greer, Jacqueline M.; Malek, Sami; Carraway, Hetty E.; Ironside, Valerie; Galkin, Steven; Levis, Mark J.; McDevitt, Michael A.; Roboz, Gail R.; Gocke, Christopher D.; Derecho, Carlo; Palma, John; Wang, Yixin; Kaufmann, Scott H.; Wright, John J.; Garret-Mayer, Elizabeth

    2012-01-01

    Tipifarnib (T) exhibits modest activity in elderly adults with newly diagnosed acute myelogenous leukemia (AML). Based on preclinical synergy, a phase 1 trial of T plus etoposide (E) yielded 25% complete remission (CR). We selected 2 comparable dose levels for a randomized phase 2 trial in 84 adults (age range, 70-90 years; median, 76 years) who were not candidates for conventional chemotherapy. Arm A (T 600 mg twice a day × 14 days, E 100 mg days 1-3 and 8-10) and arm B (T 400 mg twice a day × 14 days, E 200 mg days 1-3 and 8-10) yielded similar CR, but arm B had greater toxicity. Total CR was 25%, day 30 death rate 7%. A 2-gene signature of high RASGRP1 and low aprataxin (APTX) expression previously predicted for T response. Assays using blasts from a subset of 40 patients treated with T plus E on this study showed that AMLs with a RASGRP1/APTX ratio of more than 5.2 had a 78% CR rate and negative predictive value 87%. This ratio did not correlate with outcome in 41 patients treated with conventional chemotherapies. The next T-based clinical trials will test the ability of the 2-gene signature to enrich for T responders prospectively. This study is registered at www.clinicaltrials.gov as #NCT00602771. PMID:22001391

  16. Impact of newly diagnosed abnormal glucose regulation on long-term prognosis in low risk patients with ST-elevation myocardial infarction: A follow-up study

    Directory of Open Access Journals (Sweden)

    Abdelnoor Michael

    2011-07-01

    Full Text Available Abstract Background Patients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI without known diabetes. Methods Patients (n = 224, age 58 years with a primary percutanous coronary intervention (PCI treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke. The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes. Results The number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47% and 50 (25%, respectively. During the follow up time of (median 33 (27, 39 months, 58 (25.9% patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4 and re-classified three months later (p = 0.3. Conclusions Patients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent long-term prognosis, independent of the glucometabolic state classified by an OGTT in-hospital or at three-month follow-up. Trial registration The trial is registered at http://www.clinicaltrials.gov, NCT00926133.

  17. Full Mouth Rehabilitation of an Ectodermal Dysplasia Patient with Implant-Supported Prostheses: A Clinical Report

    Directory of Open Access Journals (Sweden)

    Rahab Ghoveizi

    2013-01-01

    Full Text Available Full mouth rehabilitation in patients with ectodermal dysplasia (ED is difficult to manage, especially because the afflicted individuals are quite young when they are evaluated for treatment; therefore, esthetics is an important concern. This clinical report describes the rehabilitation of a 19-year-old girl diagnosed with ectodermal dysplasia. Eleven implants were placed in the maxilla and mandible along with bone grafting to the upper jaw and both arches were constructed by metal-ceramic implant-supported fixed prostheses. This treatment plan seems to be favorable for ED patients.

  18. Clinical, biochemical and epidemic characteristics of a group of patient with diagnostic imaginologic of fatty liver

    International Nuclear Information System (INIS)

    The paper describes the epidemiologic, clinical and biochemical features of a group of patients with diagnosis by image of hepatic steatosis in the Pablo Tobon Uribe Hospital (PTUH) and to compare this results with those found in previous studies. A descriptive retrospective study based on the ultrasound files of the radiology department of PTUV was done. In our series, the predominant features in patients with hepatic steatosis were obesity, female gender, hyperlipidaemia and DM. the consumption of alcohol was not an important risk factor. The hepatic steatosis is a under diagnosed disease in our environment and there isn't enough research in its etiology

  19. The pituitary gland in patients with Langerhans cell histiocytosis: a clinical and radiological evaluation.

    Science.gov (United States)

    Kurtulmus, Neslihan; Mert, Meral; Tanakol, Refik; Yarman, Sema

    2015-04-01

    Langerhans cell histiocytosis (LCH) is a rare disease in which the most common endocrine manifestation is diabetes insipidus (DI). Data on anterior pituitary function in patients with LCH are limited. Thus, the present study investigated anterior pituitary function in LCH patients with DI via the evaluation of clinical and radiological findings at disease onset and during follow-up. The present study retrospectively evaluated nine patients with LCH (five males and four females). All diagnoses of LCH were made following histological and/or immunophenotypic analyses of tissue biopsies, bronchoalveolar lavage, or cerebrospinal fluid (CSF). Basal and, if necessary, dynamic pituitary function tests were used to assess anterior pituitary function, and magnetic resonance imaging (MRI) scans were used to image the pituitary. The LCH treatment modality was based on organ involvement. The mean age at onset of DI was 27.6 years (range 15-60 years). One patient (11%) exhibited single organ involvement, while eight patients (89%) displayed multisystem organ involvement. On admittance, one patient had hypogonadotropic hypogonadism, one patient exhibited panhypopituitarism [hypogonadotropic hypogonadism, central hypothyroidism, hypocortisolism, and growth hormone (GH) deficiency], and four patients (44%) displayed hyperprolactinemia. The MRI data revealed infundibular enlargement in seven patients (78%), a thalamic mass in one patient (11%), and the absence of the bright spot in all patients. A single patient (11%) showed a mass in the pons that had a partially empty sella. The patients were treated with radiation therapy (RT), chemotherapy (CT), or a combination of both (RT+CT) and were followed up for a median of 91.8 months (range 2-318 months). Seven patients were assessed during the follow-up period, of whom four patients (57.1%) developed anterior pituitary hormone deficiency, three (43%) were diagnosed with GH deficiency, and one (14%) exhibited gonadotropin deficiency. The gonadotropin deficiency in the patient, which was diagnosed on admittance, was resolved during the follow-up period. DI persisted in all patients, and the conditions of the seven patients who have remained on follow-up are stable. In the present study, patients with LCH exhibited altered function in the anterior pituitary as well as the posterior pituitary, which may be due to the natural course of the disease or the effects of treatment. The present findings indicate that anterior pituitary function should be assessed in LCH patients on admittance and during follow-up, especially in LCH patients with multisystem organ involvement. PMID:25209890

  20. Prevalence of drug resistance mutations and non-B subtypes in newly diagnosed HIV-1 patients in Denmark

    DEFF Research Database (Denmark)

    Jorgensen, LB; Christensen, MB

    2003-01-01

    The aim of this study was to monitor the prevalence of drug resistance mutations in newly diagnosed HIV-1 positive individuals in Denmark. In addition we assessed the prevalence of non-B subtypes based on phylogenetic analysis of the pol gene. Plasma samples from 104 newly diagnosed HIV-1 positive patients were obtained in the year 2000. The entire protease gene and 320 amino acids of the reverse transcriptase gene were genotyped. Sequences were obtained from 97 patients. No subjects displayed primary resistance mutations in the protease gene, whereas all carried 1 or more secondary mutations. Resistance mutations in the RT-gene associated with NRTI-resistance were found in 1 patient, who was infected with zidovudine resistant HIV-1 harbouring the M41L mutation in combination with T215S and L210S. The T215S mutation has been showed to be associated with reversion of zidovudine resistance. The T215S mutation was found in 1 additional patient. The subtype distribution was subtype B 59%, C 18%, A 8%, CRF02_AG 5%, CRF01_AE 4%, D 3% and G 2%. We found 2 patients (2%) with mutations associated with resistance in the RT-gene and none in the protease gene indicating a low prevalence of resistant HIV-1 in Denmark in the year 2000.

  1. Clinical profile of pulmonary aspergilloma complicating residual tubercular cavitations in Northen Indian patients

    Directory of Open Access Journals (Sweden)

    Gupta P

    2010-01-01

    Full Text Available Background: Little is known regarding the clinical profile of Aspergilloma in Indian patients. Such a study was undertaken at Hospital for Chest and TB, Jaipur. Materials and Methods: Old, treated patients of pulmonary tuberculosis showing ball like lesion/s inside cavity/ies or a recent thickening of cavity wall were enrolled. Morning sputa samples were collected in the patients who were able to raise sputum and were examined by KOH mount and fungal culture. Serum anti-aspergillus antibodies were estimated in all the patients. Twenty normal healthy subjects were included to serve as control. All patients showing a positive or borderline positive serology were diagnosed as pulmonary aspergilloma (PA group. The remaining patients formed the non-aspergilloma group (Non PA group. Results: A total of 98 study patients could be classified as PA group (54 patients by serology alone, 44 patients by serology as well as sputum culture. The remaining 152 patients were classified as non PA group. Hemoptysis alone or along with other chest symptoms was significantly more common in PA group as compared to non PA group patients (P<0.001, more so in those with ball like lesions. But chest symptoms other than hemoptysis were more common in non PA group. Within the PA group, 21 (13 with ball like lesions and 8 with thickening of cavity wall had clinical symptoms suggestive of CNPA and two patients (one each with ball like lesions and thickening of cavity wall had clinical symptoms suggestive of ABPA. Conclusion: The clinical profile of pulmonary Aspergilloma in Indian patients is very protean ranging from saprophytic disease to CNPA and less commonly to ABPA.

  2. MRI criteria for MS in patients with clinically isolated syndromes

    DEFF Research Database (Denmark)

    Montalban, X.; Tintore, M.

    2010-01-01

    In recent years, criteria for the diagnosis of multiple sclerosis (MS) have changed, mainly due to the incorporation of new MRI criteria. While the new criteria are a logical step forward, they are complex and-not surprisingly-a good working knowledge of them is not always evident among neurologists and neuroradiologists. In some circumstances, several MRI examinations are needed to achieve an accurate and prompt diagnosis. This provides an incentive for continued efforts to refine the incorporation of MRI-derived information into the diagnostic workup of patients presenting with a clinically isolated syndrome. Within the European multicenter collaborative research network that studies MRI in MS (MAGNIMS), a workshop was held in London in November 2007 to review information that may simplify the existing MS diagnostic criteria, while maintaining a high specificity that is essential to minimize false positive diagnoses. New data that are now published were reviewed and discussed and together with a new proposal are integrated in this position paper. Neurology(R) 2010;74:427-434

  3. The impact of patients’ involvement in cooking on their mortality and morbidity: A 19-year follow-up of patients diagnosed with type 2 diabetes mellitus

    Science.gov (United States)

    Siersma, Volkert; Køster-Rasmussen, Rasmus; Olivarius, Niels De Fine; Waldorff, Frans Boch

    2015-01-01

    Abstract Objective. This study explored the impact of involvement in cooking on long-term morbidity and mortality among patients newly diagnosed with type 2 diabetes mellitus (T2DM). Design and subjects. Data are from the population-based study Diabetes Care in General Practice. In baseline questionnaires, 1348 patients newly diagnosed with T2DM gave information on how frequently they consumed a warm main meal and how often they cooked it themselves. The selected patients were followed up for 19 years in the Danish National Patient Registry and the Danish Register of Causes of Death. Main outcome measures. This study analysed the association between involvement in cooking and each of seven pre-specified outcomes was analysed in Cox regression models with stepwise adjustment for possible confounders and mediators. Results. 92% of the patients with T2DM consumed a warm main meal = five times per week. Among these, women who cooked for themselves less than once a week had a higher risk of diabetes-related deaths (HR 1.86 [95% CI 1.03–3.35], p = 0.039) and stroke (HR 2.47 [95% CI 1.08–5.65], p = 0.033), after adjustment for confounders. For men, infrequent cooking was not related to increased risk for the outcomes investigated. Conclusions. In patients newly diagnosed with T2DM and with a regular intake of warm main meals, infrequent involvement in cooking was associated with an increased risk of diabetes-related death and stroke for women, but not for men. General practitioners should pay special attention to managing diabetes treatment in female patients newly diagnosed with T2DM who report infrequent involvement in cooking. PMID:25592166

  4. Evaluation of the TMJ by means of Clinical TMD Examination and MRI Diagnostics in Patients with Rheumatoid Arthritis

    OpenAIRE

    Silke Witulski; Vogl, Thomas J.; Stefan Rehart; Peter Ottl

    2014-01-01

    This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA...

  5. Clinical value of combined determination of plasma TNF-? and ?2-m levels in patients with multiple myeloma (MM)

    International Nuclear Information System (INIS)

    Objective: To study the clinical significance of determination of plasma levels of TNF-? and ?2-m in patients with multiple myeloma (MM). Methods: Plasma levels of TNF-? and ?2-m were determined with RIA in 1) 14 patients with newly diagnosed MM 2) 16MM patients in relapse 3) 8 MM patients in remission and 30 controls. Results: 1) The plasma levels of TNF-? and ?2-m in the newly diagnosed MM patients and MM patients in relapse were significantly higher than those in MM patients in remission and controls (P2-m continuously increased from stage I patients through stage III with significant differences between those in consecutive stages. 3) Detailed analysis revealed that the TNF-? levels in patients of stage IIIb (n=9) were significantly higher than those in patients of stage IIIa (n=9) but ?2-m levels in these two groups of patients were not much different. On the other hand, ?2-m levels in patients of stage IIb (n=6) were significantly higher than those in patients of stage IIa (n=6) while the TNF-? levels were not much different. Conclusion: Combined determination of plasma levels of TNF-? and ?2-m might be helpful for clinical stage classification in patients with multiple myeloma. (authors)

  6. Clinical Characteristics and Metabolic Features of Patients with Adrenal Incidentalomas with or without Subclinical Cushing's Syndrome

    Science.gov (United States)

    Kim, Bo-Yeon; Chun, A-Reum; Kim, Kyu-Jin; Jung, Chan-Hee; Kang, Sung Koo; Mok, Ji-Oh

    2014-01-01

    Background The aim of this study was to examine the clinical characteristics of adrenal incidentalomas discovered by computed tomography (CT) and to investigate metabolic features of subclinical Cushing's syndrome (SCS) in patients with adrenal incidentalomas in a tertiary hospital in Korea. Methods This retrospective study examined the clinical aspects of 268 patients with adrenal incidentalomas discovered by CT at Soonchunhyang University Bucheon Hospital. Clinical data and endocrine function of the patients as well as histological findings were obtained from medical records, while anatomic characteristics were analyzed by reviewing imaging studies. Hormonal tests for pheochromocytoma, Cushing's syndrome, and aldosterone-secreting adenoma were performed. Results Most (n=218, 81.3%) cases were nonfunctioning tumors. Of the 50 patients with functioning tumors (18.7%), 19 (7.1%) were diagnosed with SCS, nine (3.4%) with overt Cushing's syndrome, 12 (4.5%) with primary aldosteronism, and 10 (3.7%) with pheochromocytoma. Malignant tumors (both primary and metastatic) were rare (n=2, 0.7%). Body mass index, fasting glucose, hemoglobin A1c, and total cholesterol were significantly higher in patients with SCS in comparison with those with nonfunctioning tumors. The prevalence of type 2 diabetes mellitus and hypertension were significantly higher in patients with SCS compared with those with nonfunctioning tumors. Conclusion Functioning tumors, especially those with subclinical cortisol excess, are commonly found in patients with adrenal incidentalomas, although malignancy is rare. In addition, patients with SCS in adrenal incidentalomas have adverse metabolic and cardiovascular profiles. PMID:25325264

  7. The clinical characteristics of patients with glaucoma presenting to Botswana healthcare facilities: an observational study

    Science.gov (United States)

    Jackson, Daniel J; Razai, Mohammad S; Falama, Rosemary; Mongwa, Matlhogonolo; Mutapanduwa, Mishell; Baemisi, Chao; Josiah, Engelinah; Nkomazana, Oathokwa; Lehasa, Alice; Brealey, Evelyn; White, Andrew J; Jankowski, Deborah; Kerr-Muir, Malcolm G; Martin, Keith R; Ngondi, Jeremiah M

    2014-01-01

    Objective This study aimed to establish the clinical characteristics of patients with glaucoma attending eye care facilities in Botswana, and management of glaucoma among patients who received care in these facilities. The study also aimed to calculate the number of new diagnoses of glaucoma within the glaucoma service. Design A prospective, hospital-based, observational study. Setting A multicentre study was undertaken in government-run eye departments in Botswana from June to August 2012. Participants All patients with a diagnosis of glaucoma attending clinics at seven study sites were invited to participate. Outcome measures Examination findings, diagnosis and management were extracted from individual patient-held medical charts. Sociodemographic characteristics, patient knowledge and understanding of glaucoma were assessed through face-to-face interviews. In addition, details of outpatient attendances for 2011 were collected from 21 government-run hospitals. Results The majority of the 366 patients interviewed had a diagnosis of primary glaucoma (86.6%). The diagnoses were mainly made by ophthalmologists (48.6%) and ophthalmic nurses (44.0%). Many patients (38.5%) had been symptomatic for over 6?months before visiting an eye clinic. The mean presenting intraocular pressure was 28.2?mm?Hg (SD 11.9?mm?Hg). Most follow-up patients (79.2%) had not received surgery, however, many (89.5%) would accept surgery. Only 11.5% of participants had heard of glaucoma prior to diagnosis. Many participants (35.9%) did not understand glaucoma after being diagnosed. The majority (94.9%) of living first-degree relatives had never been examined. The number of newly diagnosed glaucoma cases for 2011 in the south of the country was 14.1/100?000; 95% CI (12.0 to 16.5), in the north it was 16.2/100?000; 95% CI (13.8 to 19.0). Conclusions Glaucoma is a significant burden that presents challenges to ophthalmic services in Botswana. Many patients have limited understanding of the condition and poor access to services. There is a need to develop a treatment infrastructure to include safe surgery and a reliable supply of effective medication. PMID:25472657

  8. Differential diagnoses of solitary pulmonary nodule in patients with extrapulmonary malignant tumor: CT and pathologic correlation

    International Nuclear Information System (INIS)

    Objective: To determine the definitive diagnostic possibility of solitary pulmonary nodule in patients with a primary extrapulmonary neoplasm (ETM-SPN), and to further evaluate the differential diagnosis value of CT in ETM-SPN with a multivariate retrospective study. Methods: Eighty-three patients with pathologically and clinically proved extrapulmonary malignant neoplasm and a solitary pulmonary nodule smaller than 3 cm in diameter were included in this study. the histologic characteristics of the nodules were correlated with those of the extrapulmonary neoplasm, and patient age, gender, smoking history, disease free interval between extrapulmonary malignancy and diagnosis of lung lesion. In all 83 cases, CT scans were reviewed to confirm the solitary nature, size, and nodular morphology of the lung lesion. Results: Of all 83 cases, the mean age was (57.42±15.33) years. There were 51 males and 32 females, with the ratio of 1.59:1. The lesions included solitary metastasis in 43 cases, pulmonary malignant lesion in 33, and benign lesion in 7. Between primary lung cancer group and solitary metastasis group, there was no significant difference for gender ratio (1.20:1 vs 2.31:1, ?2=0.0209, P>0.05), but there was significant difference between the mean age [(62.48±11.96) yrs vs (54.10 ± 16.49) yrs, t=3.34, P2=0.640, P>0.05). Of 81 cases who had followed up. The mean time of diseases free interval between extrapulmonary malignancy and pulmonary lesion was (39.73±6.29) months (range: 0-300 months, median, 20.00 months), those of primary lung cancer and metastatic group were (65.62 ± 13.45) months and (22.83 ± 4.19) months, respectively, which had significant difference between the two groups (Wilcoxon rank sum test, U=2.796, P2=1.781, P>0.05), and it did not show statistical significant relevance between pathologic patterns of extrapulmonary malignancy and characteristics of lung nodule. Of all 83 cases, the mean diameter was (2.77 ± 1.25) cm, and that of 33 cases of primary lung cancer and 43 cases of solitary metastasis lesion were (2.86±1.18) cm and (2.62±1.31) cm, respectively, which had no significant difference between the two groups (t=1.29, P>0.05). there was a statistically significant association between primary lung cancer and metastasis group for spiculate and smooth edge of lung lesion (?2=8.562, P2=15.220, P2=2.801, P>0.05). Conclusion: The likelihood of a primary lung cancer versus a metastasis of ETM-SPN smaller than 3 cm mainly depends on the patient's age, free interval between two tumors, CT morphological characteristics of lung lesion. This study shows there has no significant relevancy to the factors as gender, smoking history, the histologic patterns of the extrapulmonary neoplasm or whether there has hilar or mediastinal adenopathy

  9. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients.

    LENUS (Irish Health Repository)

    Bracken, Jennifer

    2012-02-01

    BACKGROUND: PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. OBJECTIVE: To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. MATERIALS AND METHODS: A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. RESULTS: Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin\\/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). CONCLUSION: Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosis of PHACE syndrome.

  10. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients

    International Nuclear Information System (INIS)

    PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosish anomalies is important for the diagnosis of PHACE syndrome. (orig.)

  11. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer; Robinson, Ian; Snow, Aisling; Rea, David; Phelan, Ethna [Our Lady' s Children' s Hospital, Department of Radiology, Dublin (Ireland); Watson, Rosemarie; Irvine, Alan D. [Our Lady' s Children' s Hospital, Department of Dermatology, Dublin (Ireland)

    2011-09-15

    PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosis of PHACE syndrome. (orig.)

  12. In-hospital outcome of patients with culture-confirmed tuberculous pleurisy: clinical impact of pulmonary involvement

    OpenAIRE

    Wang Jann-Yuan; Wang Jann-Tay; Shu Chin-Chung; Lee Li-Na; Yu Chong-Jen

    2011-01-01

    Abstract Background Outcomes for hospitalized patients with tuberculous pleurisy (TP) have rarely been reported, and whether or not pulmonary involvement affects outcomes is uncertain. This study aimed to analyze the in-hospital mortality rate of culture-confirmed TP with an emphasis on the clinical impact of pulmonary involvement. Methods Patients who were hospitalized for pleural effusion (PE) of unconfirmed diagnosis and finally diagnosed as TP were identified. We classified them according...

  13. The clinical and molecular spectrum of galactosemia in patients from the Cape Town region of South Africa

    OpenAIRE

    Brown Ruth; Leisegang Felicity; Henderson Howard; Eley Brian

    2002-01-01

    Abstract Background The objective of this study was to document the clinical, laboratory and genetic features of galactosemia in patients from the Cape Town metropolitan region. Methods Diagnoses were based on thin layer chromatography for galactosuria/galactosemia and assays of erythrocyte galactose-1-phosphate uridyltransferase (GALT) and galactokinase activities. Patients were screened for the common S135L and Q188R transferase gene mutations, using PCR-based assays. Screening for the S135...

  14. Diagnósticos de Enfermagem sobre alterações urinárias na doença de Parkinson / Nursing diagnoses for urinary disorders in patients with Parkinson's disease

    Scientific Electronic Library Online (English)

    Débora Moraes, Campos; Michelle Hyczy de Siqueira, Tosin; Luciana, Blanco; Rosimere Ferreira, Santana; Beatriz Guitton Renaud Baptista de, Oliveira.

    2015-04-01

    Full Text Available Objetivo: Analisar os Diagnósticos de Enfermagem mapeados e contidos na classe “Função Urinária” do domínio Eliminação e Troca da taxonomia proposta pela NANDA- Internacional, em portadores de doença de Parkinson em programa de reabilitação. Métodos: Estudo descritivo de mapeamento cruzado cuja a f [...] onte primária de dados foram 67 prontuários eletrônicos com registro de cinco ou mais evoluções de enfermagem. A coleta eletrônica de dados foi realizada em três etapas: levantamento dos termos, mapeamento e validação. Resultados: Foi observada a abrangência da taxonomia na identificação das alterações urinárias. Foram mapeados sete diagnósticos de enfermagem. A “Eliminação urinária prejudicada” foi o mais frequente (60%) e, na maioria dos casos, esteve associada a outros diagnósticos específicos, como as incontinências urinárias por urgência (55%), reflexa (25%), por esforço (12%), por transbordamento (10%) e funcional (6%). Conclusão: A análise sobre os diagnósticos de enfermagem mapeados indicam a complexidade das alterações urinárias em pacientes com doença de Parkinson. Abstract in english Objective: To analyze the mapped nursing diagnoses included in the Urinary Function class, Elimination and Exchange domain of the NANDA International taxonomy, for Parkinson's disease patients from a rehabilitation program. Methods: A descriptive, cross mapping study whose primary source of data wa [...] s 67 electronic medical records with five or more nursing assessments recorded. Electronic data collection was performed in three steps: identification of terms, mapping and validation. Results: The scope of the taxonomy was observed for identifying urinary changes. Seven nursing diagnoses were mapped. Impaired urinary elimination was the most common (60%) and, in most cases, was associated with other specific diagnoses, such as urge (55%), reflex (25%) stress (12%), overflow (10%) and functional urinary incontinence (6%). Conclusion: The analysis of the mapped nursing diagnoses indicates the complexity of urinary disturbances in patients with Parkinson's disease.

  15. A survey of patients' attitudes to clinical research.

    LENUS (Irish Health Repository)

    Desmond, A

    2011-04-01

    Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants\\' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.

  16. Genetic and clinical profile of Indian patients of idiopathic restrictive cardiomyopathy with and without hypertrophy

    DEFF Research Database (Denmark)

    Rai, Taranjit Singh; Ahmad, Shamim

    2009-01-01

    Both idiopathic restrictive cardiomyopathy (IRCM) and hypertrophic cardiomyopathy (HCM) are part of the same disease spectrum and are due to sarcomeric gene mutations. A patient with restrictive physiology without left ventricular hypertrophy (LVH) would be diagnosed as IRCM, while one with LVH would be diagnosed as HCM with restrictive physiology. We studied a group of patients with restrictive physiology for mutations in beta-myosin heavy chain (MYH7) and troponin I (TNNI3) gene. Consecutive probands in the HCM and IRCM cohort over a 4-year period were considered for this study. These included 10 IRCM and 102 HCM patients. All were Asian Indians. Among the 17 patients who had restrictive physiology 10 were IRCM patients and seven were HCM patients. Of the HCM patients, seven (6.9%) had restrictive physiology. Mean age of these 17 patients was 40.1 +/- 19.2 years (range: 15-67 ), six (35.3%) were males. Maximal left ventricular wall thickness of the seven HCM probands was 20.7 +/- 5.2 mm (range: 16-31), while it was normal in the IRCM probands. Ten probands (58.8%) were in NYHA class III or IV. Seven patients (41.2%) had atrial fibrillation. All the probands were screened for mutations in selected exons of MYH7 and TNNI3 genes. One IRCM patient was found to have p.Arg721Lys mutation in the MYH7 gene. She died due to progressive congestive cardiac failure at the age of 47 years. One HCM proband with a maximal left ventricular wall thickness of 17 mm had p.Arg192His mutation in the TNNI3 gene. She had features consistent with restrictive physiology. Her father and sister had died of restrictive cardiomyopathy. IRCM and HCM with restrictive physiology, both are part of the clinical expression of MYH7 and TNNI3 mutations and lead to worse clinical onset and progression of the disease.

  17. Molecular alterations of isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2 metabolic genes and additional genetic mutations in newly diagnosed acute myeloid leukemia patients

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    Chotirat Sadudee

    2012-03-01

    Full Text Available Abstract Background Isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2 metabolic genes encode cytosolic and mitochondrial enzymes that catalyze the conversion of isocitrate to ?-ketoglutarate. Acquired somatic mutations of IDH1 and IDH2 have recently been reported in some types of brain tumors and a small proportion of acute myeloid leukemia (AML cases. Methods Two-hundred and thirty newly diagnosed AML patients were analyzed for the presence of IDH1 and IDH2 heterozygous mutations by polymerase chain reaction-denaturing high performance liquid chromatography (PCR-DHPLC followed by direct sequencing. Clinical and biological characteristics were analyzed and correlated to the IDH mutational status. Coexisting mutations such as FLT3, PML-RARA, RAS, AML1, and NPM1 mutations were additionally explored. Results The prevalence of IDH1 and IDH2 mutations was 8.7% (20/230 and 10.4% (24/230, respectively. Six missense mutations were identified among IDH1-mutated cases; p.R132H (n = 8, p.R132C (n = 6, p.R132S (n = 2, p.R132G (n = 2, p.R132L (n = 1, and p.I99M (n = 1. Two missense mutations were found in IDH2-mutated cases; p.R140Q (n = 20 and p.R172K (n = 4. No patients had dual IDH1 and IDH2 mutations. About 18% of AML with normal cytogenetics and 31% of acute promyelocytic leukemia had IDH mutations. Half of the IDH-mutated cohort had normal karyotype and the major FAB subtype was AML-M2. Interestingly, IDH1- and IDH2-mutated cases predominantly had NPM1 mutations (60-74% as compared to the wild type (P IDH-mutated cases had FLT3 and/or RAS abnormalities and none of them had AML1 mutations. Older age and higher median platelet counts were significantly associated with IDH2 mutations although the clinical impact of either IDH1 or IDH2 mutations on patients' overall survival could not be observed. Conclusion Overall, 19% of newly diagnosed AML patients had alterations of IDH genes. No patients concurrently carried both IDH1 and IDH2 mutations suggesting that these mutations were mutually exclusive. NPM1 mutation appears as a major coexisting genetic mutation in IDH-mutated patients. Our present data failed to support the prognostic relevance of IDH mutations although alterations of these metabolic genes potentially have an important role in leukemia development.

  18. A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna.

    OpenAIRE

    Hippler, Kathrin; Klicpera, Christian

    2003-01-01

    To date, it is questionable whether the diagnostic criteria for Asperger syndrome (AS) as stated by ICD-10 or DSM-IV still reflect Asperger's original account of 'autistic psychopathy' (AP) from the 1940s. The present study examined 74 clinical case records of children with AP diagnosed by Hans Asperger and his team at the Viennese Children's Clinic and Asperger's private practice between 1950 and 1986. The characteristic features of the children are outlined, including reasons for referral, ...

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

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    Ahmad Ghanizadeh

    2012-09-01

    Full Text Available Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD. This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-IV-TR, diagnostic criteria according to face-to-face interview with the children and their parents. ADHD DSM-IV checklist was used to measure inattentiveness and hyperactivity/impulsivity scores.Results: The association of birth order and diagnosis of ADHD was not statistically significant after adjusting for covariate factors. The gender ratio of siblings is not associated with ADHD.Conclusion: Birth order and siblings gender ratio are independent of ADHD diagnosis. The results of this study support the fact that genetic factors rather than environmental factor of birth order is associated with ADHD. Moreover, contrary to autism, the current results do not suggest the androgen theory for ADHD.

  20. Geographic variation of clinically diagnosed mood and anxiety disorders in Christchurch after the 2010/11 earthquakes.

    Science.gov (United States)

    Hogg, Daniel; Kingham, Simon; Wilson, Thomas M; Griffin, Edward; Ardagh, Michael

    2014-11-01

    The 22nd February 2011 Christchurch earthquake killed 185 people, injured over 8000, damaged over 100,000 buildings and on-going aftershocks maintained high anxiety levels. This paper examines the dose of exposure effect of earthquake damage assessments, earthquake intensity measures, liquefaction and lateral spreading on mood and anxiety disorders in Christchurch after this event. We hypothesise that such disorders are more likely to develop in people who have experienced greater exposure to these impacts within their neighborhood than others who have been less exposed, but also live in the city. For this purpose, almost all clinically diagnosed incident and relapsed cases in Christchurch in a 12 months period after the 2011 earthquake were analysed. Spatio-temporal cluster analysis shows that people living in the widely affected central and eastern parts after the 2010/11 earthquakes have a 23% higher risk of developing a mood or anxiety disorder than people living in other parts of the city. Generally, mood and anxiety-related disorders increase with closer proximity to damage from liquefaction and moderate to major lateral spreading, as well as areas that are more likely to suffer from damage in future earthquakes. PMID:25460910

  1. Unique perception of clinical trials by Korean cancer patients

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    Lee Su Jin

    2012-12-01

    Full Text Available Abstract Background In the past few years, the number of clinical trials has increased rapidly in East Asia, especially for gastric and hepatobiliary cancer that are prevalent in Asian populations. However, the actual degree of understanding or perceptions of clinical trials by cancer patients in East Asian countries have seldom been studied. Methods Between July 1st and November 30th of 2011, we conducted a prospective study to survey cancer patients regarding their awareness of, and willingness to participate in, a clinical trial. Patients with gastrointestinal/hepatobiliary cancer who visited the Hematology-Oncology outpatient clinic at Samsung Medical Center (SMC were enrolled. A total of 21 questions were asked including four questions which used the Visual analogue scale (VAS score. Results In this survey study, 1,000 patients were asked to participate and 675 patients consented to participate (67.5%. The awareness of clinical trials was substantially higher in patients who had a higher level of education (pp=0.004, and had a higher economic status (p=0.001. However, the willingness to participate in a clinical trial was not affected by the level of education or economic status of patients. The most influential factors for patient willingness to participate were a physician recommendation (n=181, 26.8%, limited treatment options (n=178, 26.4%, and expectations of effectiveness of new anti-cancer drugs (n=142, 21.0%. Patients with previous experience in clinical trials had a greater willingness to participate in clinical trials compared to patients without previous experience (p Conclusions This large patient cohort survey study showed that Korean cancer patients are more aware of clinical trials, but awareness did not translate into willingness to participate.

  2. Patient perspectives on antipsychotic treatments and their association with clinical outcomes

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    Hong Liu-Seifert

    2010-09-01

    Full Text Available Hong Liu-Seifert1, Olawale O Osuntokun1, Jenna L Godfrey2, Peter D Feldman11Lilly Research Laboratories, Indianapolis, IN, USA; 2Durham Veterans Affairs Medical Center, Durham, NC, USAAbstract: This analysis examined patient-reported attitudes toward antipsychotic medication and the relationship of these attitudes with clinical outcomes and pharmacotherapy adherence. The analysis included three randomized, double-blind studies in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition and randomly assigned to treatment with olanzapine 5–20 mg/day or another antipsychotic (haloperidol 2–20 mg/day, risperidone 2–10 mg/day, or ziprasidone 80–160 mg/day. Patient-reported improvements were significantly greater for olanzapine (n = 488 versus other treatments (haloperidol n = 145, risperidone n = 158, or ziprasidone n = 271 on multiple Drug Attitude Inventory items. A positive attitude toward medication reported by patients was significantly associated with greater clinical improvement on the Positive and Negative Syndrome Scale and lower discontinuation rates. These results suggest that patients’ perceptions of treatment benefits are associated with objective clinical measures, including reduction of symptom severity and lower discontinuation rates. Furthermore, olanzapine may be associated with more positive treatment attitudes. These findings may contribute to a better understanding of reasons for treatment adherence from patients’ own perspectives.Keywords: antipsychotic agents, medication adherence, patient satisfaction, schizophrenia, treatment efficacy

  3. Clinical subjectivity. Advocacy with silent patients.

    Science.gov (United States)

    Gadow, S

    1989-06-01

    Advocacy typically has been understood as assistance to patients in giving voice to their values. With silent patients, however, advocacy involves more: the nurse speaking with the patient's voice. That dimension of advocacy represents its greatest challenge as a moral position. Other positions offer easier approaches to moral issues with silent patients. Utilitarianism and beneficence require little, if any, access to patient subjectivity. For the nurse committed to regard for patient self-determination, access to the subjective world of silent patients is crucial. That access is possible only when the nurse's voice, like the patient's, arises from the experience of embodiment. Silent patients cannot be represented by the words of bodiless advocates. Embodiment--of nurse and patient--is the avenue to subjectivity and the essential basis for a moral commitment to advocacy. PMID:2726575

  4. Propionic acidemia: clinical course and outcome in 55 pediatric and adolescent patients

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    Grünert Sarah C

    2013-0