WorldWideScience

Sample records for suspect spiculated mass

  1. Multilevel learning-based segmentation of ill-defined and spiculated masses in mammograms

    Energy Technology Data Exchange (ETDEWEB)

    Tao, Yimo; Lo, Shih-Chung B.; Freedman, Matthew T.; Makariou, Erini; Xuan, Jianhua [Department of Electrical and Computer Engineering, Virginia Polytechnic Institute and State University, Arlington, Virginia 22203 (United States) and Department of Radiology, ISIS Center, Georgetown University Medical Center, Washington, DC 20007 (United States); Department of Radiology, ISIS Center, Georgetown University Medical Center, Washington, DC 20007 (United States); Department of Oncology, Georgetown University Medical Center, Washington, DC 20007 (United States); Department of Radiology, Georgetown University Medical Center, Washington, DC 20007 (United States); Department of Electrical and Computer Engineering, Virginia Polytechnic Institute and State University, Arlington, Virginia 22203 (United States)

    2010-11-15

    Purpose: A learning-based approach integrating the use of pixel-level statistical modeling and spiculation detection is presented for the segmentation of mammographic masses with ill-defined margins and spiculations. Methods: The algorithm involves a multiphase pixel-level classification, using a comprehensive group of features computed from regional intensity, shape, and textures, to generate a mass-conditional probability map (PM). Then, the mass candidate, along with the background clutters consisting of breast fibroglandular and other nonmass tissues, is extracted from the PM by integrating the prior knowledge of shape and location of masses. A multiscale steerable ridge detection algorithm is employed to detect spiculations. Finally, all the object-level findings, including mass candidate, detected spiculations, and clutters, along with the PM, are integrated by graph cuts to generate the final segmentation mask. Results: The method was tested on 54 masses (51 malignant and 3 benign), all with ill-defined margins and irregular shape or spiculations. The ground truth delineations were provided by five experienced radiologists. Area overlapping ratio of 0.689 ({+-}0.160) and 0.540 ({+-}0.164) were obtained for segmenting entire mass and margin portion only, respectively. Williams index of area and contour based measurements indicated that the segmentation results of the algorithm agreed well with the radiologists' delineation. Conclusions: The proposed approach could closely delineate the mass body. Most importantly, it is capable of including mass margin and its spicule extensions which are considered as key features for breast lesion analyses.

  2. Is there a correlation between the presence of a spiculated mass on mammogram and luminal a subtype breast cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Song; Wu, Xiao Dong; Xu, Wen Jian; Lin, Qing; Liu, Xue Jun; Li, Ying [The Affiliated Hospital of Qingdao University, Qingdao (China)

    2016-11-15

    To determine whether the appearance of a spiculated mass on a mammogram is associated with luminal A subtype breast cancer and the factors that may influence the presence or absence of the spiculated mass. Three hundred seventeen (317) patients who underwent image-guided or surgical biopsy between December 2014 and April 2015 were included in the study. Radiologists conducted retrospective assessments of the presence of spiculated masses according to the criteria of Breast Imaging Reporting and Data System. We used combinations of estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), and Ki67 as surrogate markers to identify molecular subtypes of breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations. Furthermore, we built a bi-variate logistic regression model to quantify the relative contribution of the factors that may influence the presence or absence of the spiculated mass. Seventy-one percent (71%) of the spiculated masses were classified as luminal A. Masses classified as luminal A were 10.3 times more likely to be presented as spiculated mass on a mammogram than all other subtypes. Patients with low Ki67 index (< 14%) and HER2 negative were most likely to present with a spiculated mass on their mammograms (p <0.001) than others. The hormone receptor status (ER and PR), pathology grade, overall breast composition, were all associated with the presence of a spiculated mass, but with less weight in contribution than Ki67 and HER2. We observed an association between the luminal A subtype of invasive breast cancer and the presence of a spiculated mass on a mammogram. It is hypothesized that lower Ki67 index and HER2 negativity may be the most significant factors in the presence of a spiculated mass.

  3. Can coronal hole spicules reach coronal temperatures?

    Science.gov (United States)

    Madjarska, M. S.; Vanninathan, K.; Doyle, J. G.

    2011-08-01

    Aims: The present study aims to provide observational evidence of whether coronal hole spicules reach coronal temperatures. Methods: We combine multi-instrument co-observations obtained with the SUMER/SoHO and with the EIS/SOT/XRT/Hinode. Results: The analysed three large spicules were found to be comprised of numerous thin spicules that rise, rotate, and descend simultaneously forming a bush-like feature. Their rotation resembles the untwisting of a large flux rope. They show velocities ranging from 50 to 250 kms-1. We clearly associated the red- and blue-shifted emissions in transition region lines not only with rotating but also with rising and descending plasmas. Our main result is that these spicules although very large and dynamic, are not present in the spectral lines formed at temperatures above 300 000 K. Conclusions: In this paper we present the analysis of three Ca ii H large spicules that are composed of numerous dynamic thin spicules but appear as macrospicules in lower resolution EUV images. We found no coronal counterpart of these and smaller spicules. We believe that the identification of phenomena that have very different origins as macrospicules is due to the interpretation of the transition region emission, and especially the He ii emission, wherein both chromospheric large spicules and coronal X-ray jets are present. We suggest that the recent observation of spicules in the coronal AIA/SDO 171 Å and 211 Å channels probably comes from the existence of transition region emission there. Movie is available in electronic form at http://www.aanda.org

  4. Dynamic Behavior of Spicules Inferred from Perpendicular Velocity Components

    Science.gov (United States)

    Sharma, Rahul; Verth, Gary; Erdélyi, Robertus

    2017-05-01

    Understanding the dynamic behavior of spicules, e.g., in terms of magnetohydrodynamic (MHD) wave mode(s), is key to unveiling their role in energy and mass transfer from the photosphere to corona. The transverse, torsional, and field-aligned motions of spicules have previously been observed in imaging spectroscopy and analyzed separately for embedded wave-mode identification. Similarities in the Doppler signatures of spicular structures for both kink and torsional Alfvén wave modes have led to the misinterpretation of the dominant wave mode in these structures and is a subject of debate. Here, we aim to combine line- of-sight (LOS) and plane-of-sky (POS) velocity components using the high spatial/temporal resolution Hα imaging-spectroscopy data from the CRisp Imaging SpectroPolarimeter based at the Swedish Solar Telescope to achieve better insight into the underlying nature of these motions as a whole. The resultant three-dimensional velocity vectors and the other derived quantities (e.g., magnetic pressure perturbations) are used to identify the MHD wave mode(s) responsible for the observed spicule motion. We find a number of independent examples where the bulk transverse motion of the spicule is dominant either in the POS or along the LOS. It is shown that the counterstreaming action of the displaced external plasma due to spicular bulk transverse motion has a similar Doppler profile to that of the m = 0 torsional Alfvén wave when this motion is predominantly perpendicular to the LOS. Furthermore, the inferred magnetic pressure perturbations support the kink wave interpretation of observed spicular bulk transverse motion rather than any purely incompressible MHD wave mode, e.g., the m = 0 torsional Alfvén wave.

  5. Kelvin-Helmholtz instability in solar spicules

    Directory of Open Access Journals (Sweden)

    H Ebadi

    2016-12-01

    Full Text Available Magneto hydrodynamic waves, propagating along spicules, may become unstable and the expected instability is of Kelvin-Helmholtz type. Such instability can trigger the onset of wave turbulence leading to an effective plasma heating and particle acceleration. In present study, two-dimensional magneto hydrodynamic simulations performed on a Cartesian grid is presented in spicules with different densities, moving at various speeds depending on their environment. Simulations being applied in this study show the onset of Kelvin-Helmholtz type instability and transition to turbulent flow in spicules. Development of Kelvin-Helmholtz instability leads to momentum and energy transport, dissipation, and mixing of fluids. When magnetic fields are involved, field amplification is also possible to take place

  6. [Value of laparoscopic surgery in the diagnosis of suspected gestational trophoblastic neoplasia cases with uterine mass].

    Science.gov (United States)

    Li, Xiaochuan; Feng, Fengzhi; Xiang, Yang; Wan, Xirun; Ren, Tong; Yang, Junjun

    2015-12-01

    To evaluate the value of laparoscopic surgery in the diagnosis of suspected gestational trophoblastic neoplasia (GTN) cases with uterine mass. The clinical characteristics of patients underwent laparoscopic surgery for a suspected diagnosis of GTN with uterine mass in Peking Union Medical College Hospital from November 2009 to November 2014 were retrospectively reviewed and analyzed. GTN and other pregnant-related disease were definitely diagnosed by pathological findings. The prognoses of the GTN cases were also investigated. Sixty-two patients with a suspected diagnosis of GTN with uterine mass were studied. Among them, 17 cases were definitely diagnosed as GTN, including 8 choriocarcinoma, 5 invasive mole and 4 placental site trophoblastic tumor (PSTT). The other 45 cases were diagnosed as benign pregnancy-related diseases, including 29 cornual pregnancy, 6 cesarean scar pregnancy, 5 placenta accreta, 4 intramural uterine pregnancy and 1 exaggerated placental site. There were no significantly differences between the two groups in average age, preoperative value or tendency of β-hCG, and location or size of lesions (P>0.05). More GTN patients showed a history of hydatidiform mole [5/17 vs 4% (2/45) , P>0.05], and more patients with benign pregnancy-related disease showed a history of cesarean section [38% (17/45) vs 1/17, P>0.05]. No serious perioperative complication was found in these patients received laparoscopic surgery. All GTN patients achieved complete remission by chemotherapy later. Except for 1 case loss, no recurrence was found in 11 low-risk stage I cases with an average follow-up period of 11- 66 months, 1 high-risk stage I case with a follow-up period of 61 months and 4 cases PSTT with a follow-up period of 13-66 months. There were some atypical GTN cases with uterine mass, which were difficult to be differentiated from benign pregnancy-related diseases according to the clinical characteristics. Laparoscopic surgery with a pathologic diagnosis

  7. What Causes the High Apparent Speeds in Chromospheric and Transition Region Spicules on the Sun?

    Energy Technology Data Exchange (ETDEWEB)

    De Pontieu, Bart; Martínez-Sykora, Juan; Chintzoglou, Georgios, E-mail: bdp@lmsal.com [Lockheed Martin Solar and Astrophysics Laboratory, Palo Alto, CA 94304 (United States)

    2017-11-01

    Spicules are the most ubuiquitous type of jets in the solar atmosphere. The advent of high-resolution imaging and spectroscopy from the Interface Region Imaging Spectrograph ( IRIS ) and ground-based observatories has revealed the presence of very high apparent motions of order 100–300 km s{sup −1} in spicules, as measured in the plane of the sky. However, line of sight measurements of such high speeds have been difficult to obtain, with values deduced from Doppler shifts in spectral lines typically of order 30–70 km s{sup −1}. In this work, we resolve this long-standing discrepancy using recent 2.5D radiative MHD simulations. This simulation has revealed a novel driving mechanism for spicules in which ambipolar diffusion resulting from ion-neutral interactions plays a key role. In our simulation, we often see that the upward propagation of magnetic waves and electrical currents from the low chromosphere into already existing spicules can lead to rapid heating when the currents are rapidly dissipated by ambipolar diffusion. The combination of rapid heating and the propagation of these currents at Alfvénic speeds in excess of 100 km s{sup −1} leads to the very rapid apparent motions, and often wholesale appearance, of spicules at chromospheric and transition region temperatures. In our simulation, the observed fast apparent motions in such jets are actually a signature of a heating front, and much higher than the mass flows, which are of order 30–70 km s{sup −1}. Our results can explain the behavior of transition region “network jets” and the very high apparent speeds reported for some chromospheric spicules.

  8. Observations and Numerical Models of Solar Coronal Heating Associated with Spicules

    Energy Technology Data Exchange (ETDEWEB)

    Pontieu, B. De; Martinez-Sykora, J. [Lockheed Martin Solar and Astrophysics Laboratory, 3251 Hanover Street, Org. A021S, Building 252, Palo Alto, CA 94304 (United States); Moortel, I. De [School of Mathematics and Statistics, University of St Andrews, St Andrews, Fife KY16 9SS (United Kingdom); McIntosh, S. W. [High Altitude Observatory, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307 (United States)

    2017-08-20

    Spicules have been proposed as significant contributors to the mass and energy balance of the corona. While previous observations have provided a glimpse of short-lived transient brightenings in the corona that are associated with spicules, these observations have been contested and are the subject of a vigorous debate both on the modeling and the observational side. Therefore, it remains unclear whether plasma is heated to coronal temperatures in association with spicules. We use high-resolution observations of the chromosphere and transition region (TR) with the Interface Region Imaging Spectrograph and of the corona with the Atmospheric Imaging Assembly on board the Solar Dynamics Observatory to show evidence of the formation of coronal structures associated with spicular mass ejections and heating of plasma to TR and coronal temperatures. Our observations suggest that a significant fraction of the highly dynamic loop fan environment associated with plage regions may be the result of the formation of such new coronal strands, a process that previously had been interpreted as the propagation of transient propagating coronal disturbances. Our observations are supported by 2.5D radiative MHD simulations that show heating to coronal temperatures in association with spicules. Our results suggest that heating and strong flows play an important role in maintaining the substructure of loop fans, in addition to the waves that permeate this low coronal environment.

  9. [A case of secondary pulmonary malignant lymphoma with multiple pulmonary nodules and spiculation].

    Science.gov (United States)

    Furuhashi, Naohiro; Sugino, Yasuteru; Okumura, Junya; Saito, Yushi; Hiraga, Junji; Kitagawa, Satoshi

    2011-11-01

    A 72-year-old man presented to our hospital with fatigue and anemia. Chest CT showed multiple nodular shadows. We first suspected lung cancer and multiple metastatic lesions because some nodules had spiculation. However, PET-CT revealed the small intestine, thyroid and rib as well as these nodules to be positive for FDG uptake, suggesting malignant lymphoma and lung involvement. For diagnosis, lung biopsy by video-assisted thoracic surgery (VATS) was performed. Pathologic examination of the lung biopsy specimen showed diffuse large B-cell lymphoma. We diagnosed secondary pulmonary malignant lymphoma.

  10. Suspected-target pesticide screening using gas chromatography-quadrupole time-of-flight mass spectrometry with high resolution deconvolution and retention index/mass spectrum library.

    Science.gov (United States)

    Zhang, Fang; Wang, Haoyang; Zhang, Li; Zhang, Jing; Fan, Ruojing; Yu, Chongtian; Wang, Wenwen; Guo, Yinlong

    2014-10-01

    A strategy for suspected-target screening of pesticide residues in complicated matrices was exploited using gas chromatography in combination with hybrid quadrupole time-of-flight mass spectrometry (GC-QTOF MS). The screening workflow followed three key steps of, initial detection, preliminary identification, and final confirmation. The initial detection of components in a matrix was done by a high resolution mass spectrum deconvolution; the preliminary identification of suspected pesticides was based on a special retention index/mass spectrum (RI/MS) library that contained both the first-stage mass spectra (MS(1) spectra) and retention indices; and the final confirmation was accomplished by accurate mass measurements of representative ions with their response ratios from the MS(1) spectra or representative product ions from the second-stage mass spectra (MS(2) spectra). To evaluate the applicability of the workflow in real samples, three matrices of apple, spinach, and scallion, each spiked with 165 test pesticides in a set of concentrations, were selected as the models. The results showed that the use of high-resolution TOF enabled effective extractions of spectra from noisy chromatograms, which was based on a narrow mass window (5 mDa) and suspected-target compounds identified by the similarity match of deconvoluted full mass spectra and filtering of linear RIs. On average, over 74% of pesticides at 50 ng/mL could be identified using deconvolution and the RI/MS library. Over 80% of pesticides at 5 ng/mL or lower concentrations could be confirmed in each matrix using at least two representative ions with their response ratios from the MS(1) spectra. In addition, the application of product ion spectra was capable of confirming suspected pesticides with specificity for some pesticides in complicated matrices. In conclusion, GC-QTOF MS combined with the RI/MS library seems to be one of the most efficient tools for the analysis of suspected-target pesticide residues

  11. Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta-analysis.

    Science.gov (United States)

    Patel, Hiten D; Druskin, Sasha C; Rowe, Steven P; Pierorazio, Phillip M; Gorin, Michael A; Allaf, Mohamad E

    2017-05-01

    To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34-94%) with significant heterogeneity between studies (I2 = 71.8%, P renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  12. Study of Grape Polyphenols by Liquid Chromatography-High-Resolution Mass Spectrometry (UHPLC/QTOF and Suspect Screening Analysis

    Directory of Open Access Journals (Sweden)

    Riccardo Flamini

    2015-01-01

    Full Text Available Suspect screening analysis is a targeted metabolomics method in which the identification of compounds relies on specific available information, such as their molecular formula and isotopic pattern. This method, coupled to liquid chromatography-high-resolution mass spectrometry, is effective in the study of grape metabolomics, in particular for characterization of flavonols, stilbene derivatives, and anthocyanins. For identification of compounds expected in the samples, a new database of putative compounds was expressly constructed by using the molecular information on potential metabolites of grape and wine from the literature and other electronic databases. Currently, this database contains around 1,100 compounds. The method allows identification of several hundred grape metabolites with two analyses (positive and negative ionization modes, and performing of data reprocessing using “untargeted” algorithms also provided the identification of some flavonols and resveratrol trimers and tetramers in grape for the first time. This approach can be potentially used in the study of metabolomics of varieties of other plant species.

  13. [Scanning electron microscopic observations on the copulatory spicules of the male Necator americanus and Ancylostoma duodenale].

    Science.gov (United States)

    Xu, S E; Lu, X J; Xie, L C; Zhang, D P

    1993-01-01

    Scanning electron microscopic observations were made on the morphological structures of the two copulatory spicules of the male Necator americanus and Ancylostoma duodenale. In both species, one of the two copulatory spicules was in the shape of a concave groove and the other, in the shape of an oblate tube. Owing to the difference in the concavity of the groove shaped copulatory spicule between the two species as shown by the cross sections, Necator americanus usually appear to have only one copulatory spicule whereas Ancylostoma duodenale usually show two separate copulatory spicules in appearance (Figs 1-10).

  14. HEIGHT VARIATION OF THE VECTOR MAGNETIC FIELD IN SOLAR SPICULES

    Energy Technology Data Exchange (ETDEWEB)

    Suárez, D. Orozco; Ramos, A. Asensio; Bueno, J. Trujillo, E-mail: dorozco@iac.es [Instituto de Astrofísica de Canarias, E-38205 La Laguna, Tenerife (Spain)

    2015-04-20

    Proving the magnetic configuration of solar spicules has hitherto been difficult due to the lack of spatial resolution and image stability during off-limb ground-based observations. We report spectropolarimetric observations of spicules taken in the He i 1083 nm spectral region with the Tenerife Infrared Polarimeter II at the German Vacuum Tower Telescope of the Observatorio del Teide (Tenerife, Canary Islands, Spain). The data provide the variation with geometrical height of the Stokes I, Q, U, and V profiles, whose encoded information allows the determination of the magnetic field vector by means of the HAZEL inversion code. The inferred results show that the average magnetic field strength at the base of solar spicules is about 80 gauss, and then it decreases rapidly with height to about 30 gauss at a height of 3000 km above the visible solar surface. Moreover, the magnetic field vector is close to vertical at the base of the chromosphere and has mid-inclinations (about 50°) above 2 Mm height.

  15. Spatial and temporal variation in sponge spicule patches at Station M, northeast Pacific

    OpenAIRE

    Laguionie-Marchais, C.; Kuhnz, L.A.; Huffard, C. L.; Ruhl, H.A.; Smith, K.L.

    2015-01-01

    Changes in habitat-forming organisms can have complex consequences for associated species. Sessile epibenthic glass ?plate? sponges (Porifera: Hexactinellida) are conspicuous inhabitants of soft-sediment abyssal areas and their siliceous spicules create persistent spicule patches on the seafloor. Sponge spicule patch density, spatial dispersion, and percent cover were examined over a seven-year period (2006?2013) using remotely operated vehicle videos from Station M in the abyssal northeast P...

  16. Impact of Type II Spicules into the Corona

    Science.gov (United States)

    Martinez-Sykora, Juan; De Pontieu, Bart; Carlsson, Mats; Hansteen, Viggo H.; Pereira, Tiago M. D.

    2017-08-01

    In the lower solar atmosphere, the chromosphere is permeated by jets, in which plasma is propelled at speeds of 50-150 km/s into the Sun’s atmosphere or corona. Although these spicules may play a role in heating the million-degree corona and are associated with Alfvén waves that help drive the solar wind, their generation remains mysterious. We implemented in the radiative MHD Bifrost code the effects of partial ionization using the generalized Ohm’s law. This code also solves the full MHD equations with non-grey and non-LTE radiative transfer and thermal conduction along magnetic field lines. The ion-neutral collision frequency is computed using recent studies that improved the estimation of the cross sections under chromospheric conditions (Vranjes & Krstic 2013). Self-consistently driven jets (spicules type II) in magnetohydrodynamic simulations occur ubiquitously when magnetic tension is confined and transported upwards through interactions between ions and neutrals, and impulsively released to drive flows, heat plasma, generate Alfvén waves, and may play an important role in maintaining the substructure of loop fans. This mechanism explains how spicular plasma can be heated to millions of degrees and how Alfvén waves are generated in the chromosphere.

  17. Spooky Suspects

    Science.gov (United States)

    Pacifici, Lara

    2011-01-01

    This activity presents an option for covering biology content while engaging students in an investigation that highlights the spirit of Halloween. Students are engaged in the story line and have fun trying to solve the mystery kidnapping by using science skills to examine the evidence and eliminate some ghoulish suspects. (Contains 1 figure.)

  18. Prevalence and characterization of small tympanic bone spicules and drumstick-like hyperostotic tympanic bone spicules in the middle ear cavity of dogs.

    Science.gov (United States)

    Parzefall, Birgit; Rieger, Alexandra; Volk, Holger A; Maierl, Johann; Brühschwein, Andreas; Blutke, Andreas

    2015-01-01

    Rounded, sessile, hyperattenuating structures detected in computed tomography (CT) studies of canine tympanic bullae have been termed "otoliths." These have been proposed to represent dystrophic mineralizations or heterotopic bone formations in the middle ear that are potentially related to chronic otitis media. Aims of the current study were to describe the prevalence, macroscopic, and histological features of structures consistent with "otoliths" in the canine tympanic cavity. Tympanic bullae from 50 routinely necropsied dogs and 139 retrospectively retrieved CT scans of canine clinical cases were examined. Small tympanic bone spicules with pointed or clubbed tips essentially arising from the free margin of the septum bullae were bilaterally present in the tympanic cavities of all 50 of the necropsied dogs. In 48% of the dogs, "otolith"-like CT-detectable bone spicules carrying drumstick-like hyperostoses that were 1-6 mm in diameter were also present. In the retrospective survey of bulla CT scans of 139 cases, the prevalence of hyperostotic tympanic bone spicules (HTBS) was 20%. Findings from the current study indicated that the presence of small tympanic bone spicules in adult dogs is most likely due to physiological bone growth in the septum bullae and that HTBS represent osseous proliferations of small tympanic bone spicules. However, the factors inducing formation of hyperostotic spicules from small tympanic bone spicules remain unknown. The high prevalence of HTBS displaying a similar appearance in bulla CT scans in dogs suggests that these spicules should be included in a differential diagnosis list for "otoliths." © 2014 American College of Veterinary Radiology.

  19. Siliceous sponge spicule dissolution: In field experimental evidences from temperate and tropical waters

    Science.gov (United States)

    Bertolino, Marco; Cattaneo-Vietti, Riccardo; Pansini, Maurizio; Santini, Chiara; Bavestrello, Giorgio

    2017-01-01

    Sponge siliceous spicules are considered a sink in the silica balance of the oceans as their dissolution rate seems to be negligible, but no field data are available about this process. The aim of this study was a first evaluation of the quantitative dissolution rates of some demosponge and hexactinellid spicules (collected in different localities at different latitudes), left at sea for six months in two localities characterised by different water average temperatures: Mediterranean Sea and Celebes Sea. The effects of silica dissolution on the experimented spicules, studied by SEM analysis, produced an enlargement of the axial canal sometimes resulting in empty spicules. While in demosponges the axial canal wall of eroded spicules was perfectly smooth or slightly rough, the hexactinellid Rossella racovitzae showed a cavernous, well recognisable pattern of dissolution. The dissolution rates were determined evaluating the decrease in outer diameter and in the expansion of the axial channel of about 300 spicules for each considered species and locality. The spicules from the Mediterranean Geodia cydonium did not show any detectable dissolution in both localities, while those from Tethya citrina showed a loose of silica of about 23% in the Mediterranean and 47% in the Celebes Sea. Paratetilla bacca from the Red Sea decreased the silica content of about 30% in both the localities. Tetilla leptoderma from Mar del Plata lost about 8% and 42% of silica respectively in Mediterranean and Celebes Sea. Finally, the hexactinellid spicules from the Antarctic Rossella racovitzae showed highest dissolution rates in both experimental sites (37% and 66% in the Mediterranean and Celebes Sea, respectively). The different levels of dissolution can be related to the different taxonomic position in terms of specular structures as well as to the temperatures at which the spicules have been deposited and exposed. In fact, spicules from the same species showed a dissolution rate generally

  20. Body Mass Index Is Associated With Microvascular Endothelial Dysfunction in Patients With Treated Metabolic Risk Factors and Suspected Coronary Artery Disease.

    Science.gov (United States)

    van der Heijden, Dirk J; van Leeuwen, Maarten A H; Janssens, Gladys N; Lenzen, Mattie J; van de Ven, Peter M; Eringa, Etto C; van Royen, Niels

    2017-09-14

    Obesity is key feature of the metabolic syndrome and is associated with high cardiovascular morbidity and mortality. Obesity is associated with macrovascular endothelial dysfunction, a determinant of outcome in patients with coronary artery disease. Here, we compared the influence of obesity on microvascular endothelial function to that of established cardiovascular risk factors such as diabetes mellitus, hypertension, hypercholesterolemia, and smoking in patients with suspected coronary artery disease. Endothelial function was assessed during postocclusive reactive hyperemia of the brachial artery and downstream microvascular beds in 108 patients who were scheduled for coronary angiography. In all patients, microvascular vasodilation was assessed using peripheral arterial tonometry; laser Doppler flowmetry and digital thermal monitoring were performed. Body mass index was significantly associated with decreased endothelium-dependent vasodilatation measured with peripheral arterial tonometry (r=0.23, P=0.02), laser Doppler flowmetry (r=0.30, Pmicrovascular vasodilatation. Especially in diabetic patients, endothelial function was not significantly reduced (control versus diabetes mellitus, mean±SEM or median [interquartile range], peripheral arterial tonometry: 1.90±0.20 versus 1.67±0.20, P=0.19, laser Doppler flowmetry: 728% [interquartile range, 427-1110] versus 589% [interquartile range, 320-1067] P=0.28, and digital thermal monitoring: 6.6±1.0% versus 2.5±1.7%, P=0.08). In multivariate linear regression analysis, body mass index was the only risk factor that significantly attenuated endothelium-dependent vasodilatation using all 3 microvascular function tests. Higher body mass index is associated with reduced endothelial function in patients with suspected coronary artery disease, even after adjustment for treated diabetes mellitus, hypertension, hypercholesterolemia, and smoking. © 2017 The Authors. Published on behalf of the American Heart Association

  1. Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer

    DEFF Research Database (Denmark)

    Bodtger, Uffe; Vilmann, Peter; Clementsen, Paul

    2009-01-01

    INTRODUCTION: Correct lung cancer staging is pivotal for optimal allocation to surgical and nonsurgical treatment. A left adrenal gland (LAG) mass is found in 5 to 16%, and malignancy preclude surgery. Endoscopic ultrasound (EUS) is superior to other imaging procedures in visualizing LAG, but the......INTRODUCTION: Correct lung cancer staging is pivotal for optimal allocation to surgical and nonsurgical treatment. A left adrenal gland (LAG) mass is found in 5 to 16%, and malignancy preclude surgery. Endoscopic ultrasound (EUS) is superior to other imaging procedures in visualizing LAG...

  2. Automatic detection of spiculation of pulmonary nodules in computed tomography images

    Science.gov (United States)

    Ciompi, F.; Jacobs, C.; Scholten, E. T.; van Riel, S. J.; W. Wille, M. M.; Prokop, M.; van Ginneken, B.

    2015-03-01

    We present a fully automatic method for the assessment of spiculation of pulmonary nodules in low-dose Computed Tomography (CT) images. Spiculation is considered as one of the indicators of nodule malignancy and an important feature to assess in order to decide on a patient-tailored follow-up procedure. For this reason, lung cancer screening scenario would benefit from the presence of a fully automatic system for the assessment of spiculation. The presented framework relies on the fact that spiculated nodules mainly differ from non-spiculated ones in their morphology. In order to discriminate the two categories, information on morphology is captured by sampling intensity profiles along circular patterns on spherical surfaces centered on the nodule, in a multi-scale fashion. Each intensity profile is interpreted as a periodic signal, where the Fourier transform is applied, obtaining a spectrum. A library of spectra is created by clustering data via unsupervised learning. The centroids of the clusters are used to label back each spectrum in the sampling pattern. A compact descriptor encoding the nodule morphology is obtained as the histogram of labels along all the spherical surfaces and used to classify spiculated nodules via supervised learning. We tested our approach on a set of nodules from the Danish Lung Cancer Screening Trial (DLCST) dataset. Our results show that the proposed method outperforms other 3-D descriptors of morphology in the automatic assessment of spiculation.

  3. Spicule size variation in Xestospongia testudinaria Lamarck, 1815 at Probolinggo-Situbondo coastal

    Science.gov (United States)

    Subagio, Iwenda Bella; Setiawan, Edwin; Hariyanto, Sucipto; Irawan, Bambang

    2017-06-01

    Xestospongia testudinaria Lamarck, 1815 is a marine sponge that become a main constituent in reef ecosystems at northern waters Probolinggo-Situbondo. This barrel sponge species possesses an oxea type of spicule that varies in dimensions (length and width) in concordance to condition and location of habitat. The experiment aimed to understand how spicules condition of this sponge reacted to environment variables. Sponges' specimen were taken by SCUBA equipment in 6-7 m, 10-11 m, and 14-15 m depths in addition to four different localities and three different part of sponges' body (upper, middle and basal parts). Environmental variables data were also retrieved (salinity, water clarity, temperature, dissolve silica, and depth) in each locations. Results confirmed that oxea spicule size either in length or width dimensions in four locations (Batu Lawang coral cluster [BL], Karang Mayit coral cluster [KM], Paiton coral cluster [PT], and Takat Palapa [TP]) relatively increased toward depth. Likewise, the size of spicules in the TP relatively longer than three other locations. In contrast, spicules oxea in PT relatively wider than three other locations. Salinity gave negative impact to spicules length, while depth gave positive impact. Depth, water clarity, dissolve silica, and temperature gave negative effect to spicules width while salinity gave positive impact.

  4. Structure and composition of calcareous sponge spicules: a review and comparison to structurally related biominerals.

    Science.gov (United States)

    Sethmann, Ingo; Wörheide, Gert

    2008-01-01

    Since the early 19th century, the skeletons of calcareous sponges (Porifera: Calcarea) with their mineralized spicules have been investigated for their morphologies, structures, and mineralogical and organic compositions. These biomineral spicules, up to about 10mm in size, with one to four rays called actines, have various specific shapes and consist mainly of magnesium-calcite: in only one case has an additional phase of stabilized amorphous CaCO3 (ACC) been discovered. The spicules are invariably covered by a thin organic sheath and display a number of intriguing properties. Despite their complex morphologies and rounded surfaces without flat crystal faces they behave largely as single crystal individuals of calcite, and to some degree crystallographic orientation is related to morphology. Despite their single-crystalline nature, most spicules show nearly isotropic fracture behaviour, not typical for calcite crystals, indicating enhanced fracture resistance. These unusual morphological and mechanical properties are the result of their mechanism of growth. Each spicule is formed by specialized cells (sclerocytes) that supply mineral ions or particles associated by organic macromolecules to extracellular cavities, where assembly and crystallization in alignment with an initial seed crystal (nucleus) takes place. As a result of discontinuous mineral deposition, cross-sections of larger spicules display concentric layering that mantles a central calcitic rod. On a smaller scale, the entire spicule displays a 'nano-cluster' structure with crystallographically aligned and putatively semicoherent crystal domains as well as a dispersed organic matrix intercalated between domain boundaries. This ultrastructure dissipates mechanical stress and deflects propagating fractures. Additionally, this nano-cluster construction, probably induced by intercalated organic substances, enables the formation of complex crystal morphologies independent of crystal faces. In this review

  5. IRIS Observations of Spicules and Structures Near the Solar Limb

    Science.gov (United States)

    Alissandrakis, C. E.; Vial, J.-C.; Koukras, A.; Buchlin, E.; Chane-Yook, M.

    2018-02-01

    We have analyzed Interface Region Imaging Spectrograph (IRIS) spectral and slit-jaw observations of a quiet region near the South Pole. In this article we present an overview of the observations, the corrections, and the absolute calibration of the intensity. We focus on the average profiles of strong (Mg ii h and k, C ii and Si iv), as well as of weak spectral lines in the near ultraviolet (NUV) and the far ultraviolet (FUV), including the Mg ii triplet, thus probing the solar atmosphere from the low chromosphere to the transition region. We give the radial variation of bulk spectral parameters as well as line ratios and turbulent velocities. We present measurements of the formation height in lines and in the NUV continuum from which we find a linear relationship between the position of the limb and the intensity scale height. We also find that low forming lines, such as the Mg ii triplet, show no temporal variations above the limb associated with spicules, suggesting that such lines are formed in a homogeneous atmospheric layer and, possibly, that spicules are formed above the height of 2''. We discuss the spatio-temporal structure of the atmosphere near the limb from images of intensity as a function of position and time. In these images, we identify p-mode oscillations in the cores of lines formed at low heights above the photosphere, slow-moving bright features in O i and fast-moving bright features in C ii. Finally, we compare the Mg ii k and h line profiles, together with intensity values of the Balmer lines from the literature, with computations from the PROM57Mg non-LTE model, developed at the Institut d' Astrophysique Spatiale, and estimated values of the physical parameters. We obtain electron temperatures in the range of {˜} 8000 K at small heights to {˜} 20 000 K at large heights, electron densities from 1.1× 10^{11} to 4× 10^{10} cm^{-3} and a turbulent velocity of {˜} 24 km s^{-1}.

  6. Automatic detection of spiculation of pulmonary nodules in computed tomography images

    DEFF Research Database (Denmark)

    Ciompi, F; Jacobs, C; Scholten, E.T.

    2015-01-01

    We present a fully automatic method for the assessment of spiculation of pulmonary nodules in low-dose Computed Tomography (CT) images. Spiculation is considered as one of the indicators of nodule malignancy and an important feature to assess in order to decide on a patient-tailored follow-up pro......) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only....

  7. Suspect screening of halogenated carboxylic acids in drinking water using ion exchange chromatography - high resolution (Orbitrap) mass spectrometry (IC-HRMS).

    Science.gov (United States)

    Gallidabino, Matteo D; Hamdan, Laurence; Murphy, Bronagh; Barron, Leon P

    2018-02-01

    Retrospective in silico screening of analytical data for the identification of new or emerging disinfection by-products in drinking waters could be useful to assess quality and potential hazards, as well as help implement mitigation procedures more rapidly. Herein, the first study coupling ion exchange chromatography (IC) with high resolution mass spectrometry (HRMS) for the determination of halogenated carboxylic acid disinfectant by-products is reported. Separation was achieved using a Metrohm A Supp 5 column and a Na2CO3/NaHCO3 gradient eluent from 1/0.31 to 10/3.1mM. A variety of solid phase extraction (SPE) sorbents were tested for added selectivity to organic ions and Isolute ENV+ cartridges were selected because of their best overall extraction performance. Method LODs were in the μgL-1 concentration range, with R2 ≥ 0.99 for all the analytes, and isobaric ions could be easily discriminated using HRMS. The method was applied to municipal drinking water. Targeted quantitative analysis revealed the presence of 10 haloacetic acids at levels not exceeding the limits set by WHO and USEPA. Furthermore, suspect screening for additional halogenated carboxylic acids via retrospective HRMS data analysis also indicated the presence of other iodinated HAAs and chlorinated propionic acids, of which one (i.e. monochloropropionic acid) is discussed here for the first time. Most importantly, several potential suspects could be eliminated from further consideration through HRMS data analysis alone. To our knowledge, this represents the first time that a retrospective IC-HRMS screen of halogenated carboxylic acids in drinking water has been reported. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Outbreak of mass mortality of yearling groupers of Epinephelus (Perciformes, Serranidae) associated with the infection of a suspected new enteric Sphaerospora (Myxozoa: Myxosporea) species in South China Sea.

    Science.gov (United States)

    Liu, X H; Xu, L W; Luo, D; Zhao, Y L; Zhang, Q Q; Liu, G F; Zhang, J Y

    2017-12-19

    A suspected new enteric Sphaerospora species was believed to be directly associated with the mass mortality of yearling groupers of Epinephelus spp. in South China. The epizootic generally emerged from late September to late April of the following year. The infection prevalence and mortality rate were significantly negatively correlated with fish size. Clinical signs included anorexia, cachexia and extrusion of white pulp-like substance from anus after gentle pressure on the abdomen. Upon necropsy, severe intestinal oedema, thin and transparent intestinal wall, swollen spleen, kidney and gall bladder could be observed. Wet preparation of the infected samples showed large amount of typical disporous plasmodia of the genus Sphaerospora, but no mature spores were observed. Epidemiological investigation showed that this parasite exclusively infected Epinephelus groupers. Histopathologically, this species mainly infected the epithelium of intestine and kidney tubules and caused severe epithelia sloughing and the collapse of intestinal villus. Interestingly, this enteric myxosporidiosis did not cause severe emaciation of infected fish for mass mortality usually emerged within 2-3 days after appearance of clinical signs. The species was most genetically related to Sphaerospora fugu (89% sequence identity) and phylogenetically positioned within marine Sphaerospora lineage. This is the first report of enteric sphaerosporosis of groupers. © 2017 John Wiley & Sons Ltd.

  9. A novel matrix-assisted laser desorption/ionisation mass spectrometry imaging based methodology for the identification of sexual assault suspects.

    Science.gov (United States)

    Bradshaw, Robert; Wolstenholme, Rosalind; Blackledge, Robert D; Clench, Malcolm R; Ferguson, Leesa S; Francese, Simona

    2011-02-15

    An increase in the use of condoms by sexual offenders has been observed. This is likely to be due both to the risk of sexually transmitted diseases and to prevent the transfer of DNA evidence. In this scenario the detection of condom lubricants at a crime scene could aid in proving corpus delicti. Here we show a novel application of Matrix-Assisted Laser Desorption/Ionisation Mass Spectrometry Imaging (MALDI MSI) for mapping the fingermark ridge pattern simultaneously to the detection of the condom lubricant within the fingermark itself. Two condom brands have been investigated to prove the concept. Condoms were handled producing lubricant-contaminated fingermarks. Images of the ridge pattern were obtained simultaneously to the detection of two lubricants, even several weeks after the fingermark deposition. The results therefore show the potential of MALDI MSI to link the suspect (identification through fingermark ridge pattern) to the crime (detection of condom lubricant) in one analysis. This would enable forensic scientists to provide evidence with stronger support in alleged cases of sexual assault. Copyright © 2011 John Wiley & Sons, Ltd.

  10. Siliceous spicules enhance fracture-resistance and stiffness of pre-colonial Amazonian ceramics

    Science.gov (United States)

    Natalio, Filipe; Corrales, Tomas P.; Wanka, Stephanie; Zaslansky, Paul; Kappl, Michael; Lima, Helena Pinto; Butt, Hans-Jürgen; Tremel, Wolfgang

    2015-08-01

    Pottery was a traditional art and technology form in pre-colonial Amazonian civilizations, widely used for cultural expression objects, utensils and as cooking vessels. Abundance and workability of clay made it an excellent choice. However, inferior mechanical properties constrained their functionality and durability. The inclusion of reinforcement particles is a possible route to improve its resistance to mechanical and thermal damage. The Amazonian civilizations incorporated freshwater tree sponge spicules (cauixí) into the clay presumably to prevent shrinkage and crack propagation during drying, firing and cooking. Here we show that isolated siliceous spicules are almost defect-free glass fibres with exceptional mechanical stability. After firing, the spicule Young’s modulus increases (from 28 ± 5 GPa to 46 ± 8 GPa) inferring a toughness increment. Laboratory-fabricated ceramic models containing different inclusions (sand, glass-fibres, sponge spicules) show that mutually-oriented siliceous spicule inclusions prevent shrinkage and crack propagation leading to high stiffness clays (E = 836 ± 3 MPa). Pre-colonial amazonian potters were the first civilization known to employ biological materials to generate composite materials with enhanced fracture resistance and high stiffness in the history of mankind.

  11. Evagination of cells controls bio-silica formation and maturation during spicule formation in sponges.

    Directory of Open Access Journals (Sweden)

    Xiaohong Wang

    Full Text Available The enzymatic-silicatein mediated formation of the skeletal elements, the spicules of siliceous sponges starts intracellularly and is completed extracellularly. With Suberites domuncula we show that the axial growth of the spicules proceeds in three phases: (I formation of an axial canal; (II evagination of a cell process into the axial canal, and (III assembly of the axial filament composed of silicatein. During these phases the core part of the spicule is synthesized. Silicatein and its substrate silicate are stored in silicasomes, found both inside and outside of the cellular extension within the axial canal, as well as all around the spicule. The membranes of the silicasomes are interspersed by pores of ≈ 2 nm that are likely associated with aquaporin channels which are implicated in the hardening of the initial bio-silica products formed by silicatein. We can summarize the sequence of events that govern spicule formation as follows: differential GENETIC READOUT (of silicatein → FRACTAL ASSOCIATION of the silicateins → EVAGINATION of cells by hydro-mechanical forces into the axial canal → and finally PROCESSIVE BIO-SILICA POLYCONDENSATION around the axial canal. We termed this process, occurring sequentially or in parallel, BIO-INORGANIC SELF-ORGANIZATION.

  12. Spicules of Litistidic sponges from the upper Eocene Verhivtsevska depression (Miiddle Dniprean

    Directory of Open Access Journals (Sweden)

    Ivanova T.A.

    2014-12-01

    Full Text Available For the first time a taxonomic composition of lithistid sponges which are lived in the Late Eocene basin of Verchovtzev depression Ukrainian Shield is supposed by the spicules morphological analysis. There are sponges of ten geneses and seven families presented in paleocoenosis, but families Theonellidae (geneses Lerouxia, Rhagadinia andPlinthosellidae (genusPlinthosella are dominated. Threenewmorphospeciesof spicules aredescribed: Phyllotriaenapartita T.A.Ivanova morphosp.n., Ph. araneola T.A.Ivanova, morphosp.n., Tetracrepides semiornatus T.A.Ivanova, morphosp.n. Their stratigraphical meaning is determined. These spicules are characteristic for the Obuchovian Suite and would be used as the paleontological criterion of the Obuchovian Suite determination in geological sections of the Middle Dnieper region.

  13. Quantitative determination of some volatile suspected allergens in cosmetic creams spread on skin by direct contact sorptive tape extraction-gas chromatography-mass spectrometry.

    Science.gov (United States)

    Sgorbini, B; Ruosi, M R; Cordero, C; Liberto, E; Rubiolo, P; Bicchi, C

    2010-04-16

    This study describes a method based on direct contact sorptive tape extraction followed by on-line thermal desorption gas chromatography-mass spectrometry (DC-STE-GC-MS) to detect and quantify a group of suspected volatile allergens on the European Union (E.U.) list and a related compound on the skin (the stratum corneum) of volunteers treated with a cream of known composition fortified with the reference allergens. The following compounds were tested: citronellol, Z-citral (neral), geraniol, cinnamaldehyde, anisyl alcohol, cinnamyl alcohol, eugenol, methyleugenol, coumarin, isoeugenol, alpha-isomethylionone, 2-(4-tert-butylbenzyl)propionaldehyde (lilial), alpha-amylcinnamaldehyde, alpha-hexylcinnamaldehyde. Sorptive tape extraction (STE) is a sorption-based sampling technique in which a flexible polydimethylsiloxane (PDMS) tape is used to recover analytes by direct contact with the surface of a solid matrix or from the headspace in equilibrium with it. The reliability of the method was confirmed by: (i) allergen recoveries varying from 52.3% for lilial to 95.7% for neral, (ii) linearity in the range 10-150ppm, with regression coefficient R(2) always above 0.97, (iii) repeatability of each analyte, RSD% never exceeding 10%, (iv) intermediate precision, always below 15%, and (v) LOD and LOQ in the ppb range, therefore fully compatible with E.U. prescriptions (ppm). Other parameters such as substantivity analyte, approximate permeation through skin and influence of different nature of stratum corneum on recovery were also investigated. The method was also successfully applied to five commercially available creams declared to contain some of the allergens in question spread on the skin of the same volunteers. Copyright 2010 Elsevier B.V. All rights reserved.

  14. Collagen in the spicule organic matrix of the gorgonian Leptogorgia virgulata

    Science.gov (United States)

    Kingsley, R. J.; Tsuzaki, M.; Watabe, N.; Mechanic, G. L.

    1990-01-01

    Decalcification of the calcareous spicules from the gorgonian Leptogorgia virgulata reveals an organic matrix that may be divided into water insoluble and soluble fractions. The insoluble fraction displays characteristics typical of collagen, which is an unusual component of an invertebrate calcium carbonate structure. This matrix fraction exhibits a collagenous amino acid profile and behavior upon SDS-PAGE. Furthermore, the reducible crosslink, dihydroxylysinonorleucine (DHLNL), is detected in this fraction. The composition of the matrix varies seasonally; i.e., the collagenous composition is most prevalent in the summer. These results indicate that the insoluble matrix is a dynamic structure. Potential roles of this matrix in spicule calcification are discussed.

  15. Organic matrix-related mineralization of sea urchin spicules, spines, test and teeth.

    Science.gov (United States)

    Veis, Arthur

    2011-06-01

    The camarodont echinoderms have five distinct mineralized skeletal elements: embryonic spicules, mature test, spines, lantern stereom and teeth. The spicules are transient structural elements whereas the spines, and test plates are permanent. The teeth grow continuously. The mineral is a high magnesium calcite, but the magnesium content is different in each type of skeletal element, varying from 5 to 40 mole% Mg. The organic matrix creates the spaces and environments for crystal initiation and growth. The detailed mechanisms of crystal regulation are not known, but acidic and phosphorylated matrix proteins may be of special importance. Biochemical studies, sequencing of the complete genome, and high-throughput proteomic analysis have not yet provided insight into the mechanisms of crystallization, calcite composition, and orientation applicable to all skeletal elements. The embryonic spicules are not representative of the mature skeletal elements. The next phase of research will have to focus on the specific localization of the proteins and individual biochemistries of each system with regard to mineral content and placement.

  16. Sponge spicules as blueprints for the biofabrication of inorganic-organic composites and biomaterials.

    Science.gov (United States)

    Müller, Werner E G; Wang, Xiaohong; Cui, Fu-Zhai; Jochum, Klaus Peter; Tremel, Wolfgang; Bill, Joachim; Schröder, Heinz C; Natalio, Filipe; Schlossmacher, Ute; Wiens, Matthias

    2009-06-01

    While most forms of multicellular life have developed a calcium-based skeleton, a few specialized organisms complement their body plan with silica. However, of all recent animals, only sponges (phylum Porifera) are able to polymerize silica enzymatically mediated in order to generate massive siliceous skeletal elements (spicules) during a unique reaction, at ambient temperature and pressure. During this biomineralization process (i.e., biosilicification) hydrated, amorphous silica is deposited within highly specialized sponge cells, ultimately resulting in structures that range in size from micrometers to meters. Spicules lend structural stability to the sponge body, deter predators, and transmit light similar to optic fibers. This peculiar phenomenon has been comprehensively studied in recent years and in several approaches, the molecular background was explored to create tools that might be employed for novel bioinspired biotechnological and biomedical applications. Thus, it was discovered that spiculogenesis is mediated by the enzyme silicatein and starts intracellularly. The resulting silica nanoparticles fuse and subsequently form concentric lamellar layers around a central protein filament, consisting of silicatein and the scaffold protein silintaphin-1. Once the growing spicule is extruded into the extracellular space, it obtains final size and shape. Again, this process is mediated by silicatein and silintaphin-1, in combination with other molecules such as galectin and collagen. The molecular toolbox generated so far allows the fabrication of novel micro- and nanostructured composites, contributing to the economical and sustainable synthesis of biomaterials with unique characteristics. In this context, first bioinspired approaches implement recombinant silicatein and silintaphin-1 for applications in the field of biomedicine (biosilica-mediated regeneration of tooth and bone defects) or micro-optics (in vitro synthesis of light waveguides) with promising

  17. Stall, Spiculate, or Run Away: The Fate of Fibers Growing towards Fluctuating Membranes

    Science.gov (United States)

    Daniels, D. R.; Marenduzzo, D.; Turner, M. S.

    2006-09-01

    We study the dynamics of a growing semiflexible fiber approaching a membrane at an angle. At late times we find three regimes: fiber stalling, when growth stops, runaway, in which the fiber bends away from the membrane, and another regime in which spicules form. We discuss which regions of the resulting “phase diagram” are explored by (i) single and bundled actin fibers in living cells, (ii) sickle hemoglobin fibers, and (iii) microtubules inside vesicles. We complement our analysis with 3D stochastic simulations.

  18. Fibrillar Chromospheric Spicule-Like Counterparts to an EUV and Soft X-Ray Blowout Coronal Jet

    Science.gov (United States)

    Sterling, Alphonse C.; Harra, Louise K.; Moore, Ronald L.

    2010-01-01

    We observe an erupting jet feature in a solar polar coronal hole, using data from Hinode/SOT, EIS, and XRT, with supplemental data from STEREO/EUVI. From EUV and soft X-ray (SXR) images we identify the erupting feature as a blowout coronal jet: in SXRs it is a jet with bright base, and in EUV it appears as an eruption of relatively cool (approximately 50,000 K) material of horizontal size scale approximately 30" originating from the base of the SXR jet. In SOT Ca II H images the most pronounced analog is a pair of thin (approximately 1") ejections, at the locations of either of the two legs of the erupting EUV jet. These Ca II features eventually rise beyond 45", leaving the SOT field of view, and have an appearance similar to standard spicules except that they are much taller. They have velocities similar to that of "type II" spicules, approximately 100 kilometers per second, and they appear to have spicule-like substructures splitting off from them with horizontal velocity approximately 50 kilometers per second, similar to the velocities of splitting spicules measured by Sterling et al. (2010). Motions of splitting features and of other substructures suggest that the macroscopic EUV jet is spinning or unwinding as it is ejected. This and earlier work suggests that a sub-population of Ca II type II spicules are the Ca II manifestation of portions of larger-scale erupting magnetic jets. A different sub-population of type II spicules could be blowout jets occurring on a much smaller horizontal size scale than the event we observe here.

  19. A novel diagnostic index combining HE4, CA125 and age may improve triage of women with suspected ovarian cancer - An international multicenter study in women with an ovarian mass

    DEFF Research Database (Denmark)

    Karlsen, Mona Aarenstrup; Høgdall, Estrid V S; Christensen, Ib J

    2015-01-01

    AIM: To develop and validate a biomarker-based index to optimize referral and diagnosis of patients with suspected ovarian cancer. Furthermore, to compare this new index with the Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA). PATIENTS AND METHODS: A training study......, consisting of patients with benign ovarian disease (n=809) and ovarian cancer (n=246), was used to develop the Copenhagen Index (CPH-I) utilizing the variables serum HE4, serum CA125 and patient age. Eight international studies provided the validation population; comprising 1060 patients with benign ovarian...... masses and 550 patients with ovarian cancer. RESULTS: Overall, 2665 patients were included. CPH-I was highly significant in discriminating benign from malignant ovarian disease. At the defined cut-off of 0.070 for CPH-I the sensitivity and specificity were 95.0% and 78.4% respectively in the training...

  20. Where's the glass? Biomarkers, molecular clocks, and microRNAs suggest a 200-Myr missing Precambrian fossil record of siliceous sponge spicules

    Science.gov (United States)

    Sperling, E. A.; Robinson, J.; Pisani, D.; Peterson, K.

    2010-12-01

    The earliest evidence for animal life comes from the fossil record of 24-isopropylcholestane, a sterane found in Cryogenian deposits, and whose precursors are found in modern demosponges, but not choanoflagellates, calcareans, hexactinellids, or eumetazoans. However, many modern demosponges are also characterized by the presence of siliceous spicules, and there are no convincing demosponge spicules in strata older than the Cambrian. This temporal disparity highlights a problem with our understanding of the Precambrian fossil record - either these supposed demosponge-specific biomarkers were derived from the sterols of some other organism and are simply retained in modern demosponges, or spicules do not primitively characterize crown-group demosponges. Resolving this issue requires resolving the phylogenetic placement of another group of sponges, the hexactinellids, which not only make a spicule thought to be homologous to the spicules of demosponges, but also make their first appearance near the Precambrian/Cambrian boundary. Using two independent analytical approaches and data sets - traditional molecular phylogenetic analyses and the presence or absence of specific microRNA genes - we show that demosponges are monophyletic, and that hexactinellids are their sister group (together forming the Silicea). Thus, spicules must have evolved before the last common ancestor of all living siliceans, suggesting the presence of a significant gap in the silicean spicule fossil record. Molecular divergence estimates date the origin of this last common ancestor well within the Cryogenian, consistent with the biomarker record, and strongly suggests that siliceous spicules were present during the Precambrian but were not preserved.

  1. Numerical Simulations of Solar Spicule Jets at a Magnetic Null-Point

    Science.gov (United States)

    Smirnova, V.; Konkol, P. M.; Solov'ev, A. A.; Murawski, K.

    2016-11-01

    Two-dimensional numerical simulations of jet-like structures in the solar atmosphere are performed. These structures result from a pressure pulse that is launched at the null point of a potential magnetic arcade. The plasma jet exhibits a double structure with two components: (a) dense, cool, and short vertical stream and (b) a less dense, hot and tall part of the jet. The upper part of the hot and tall jet may represent a direct response of the system to the pressure pulse launched at the null point, and the second, slower cool and dense part of the jet is formed later through the stretching up of the stream as a result of plasma evacuation from the top of the magnetic arcade. Numerical results show that jet-like structures mimic some properties of both type I and type II spicules, according to the classification provided by De Pontieu et al. ( Publ. Astron. Soc. Japan 59, S655, 2007).

  2. The incidence of Zolpidem use in suspected DUI drivers in Miami-Dade Florida: a comparative study using immunalysis Zolpidem ELISA KIT and gas chromatography-mass spectrometry screening.

    Science.gov (United States)

    Reidy, L; Gennaro, W; Steele, B W; Walls, H C

    2008-10-01

    In 1993, Zolpidem (Ambien), a non-benzodiazepine hypnotic agent, was approved for use in the United States for the short-term treatment of insomnia. Zolpidem has a rapid onset of action and short elimination half-life, rendering it ideal as a sleep aid. The objective of this study was to evaluate, and retrospectively compare, the use of the Immunalysis ELISA kit and gas chromatograpy-mass spectrometry (GC-MS) to screen blood/urine specimens for zolpidem. In addition, results for the incidence of zolpidem in suspected DUI drivers in 2007 are compared to previous years' data. The ELISA kit was evaluated for cross-reactivity with zaleplon and zopiclone and zolpidem metabolite I. Urine samples (n = 100) and blood samples (n = 100) were selected from specimens received into the DUI laboratory in 2007 and were screened via the Immunalysis Zolpidem ELISA kit and on GC-MS in full EI scan mode following an alkaline liquid-liquid extraction. Results show 5% of the urine and blood samples screened positive for zolpidem using the ELISA kits, and all 5% confirmed positive for zolpidem using GC-MS. The ELISA kit demonstrated no cross-reactivity to zaleplon or zopiclone at a spiked urine concentration of 1000 ng/mL. Ten cases of suspected DUI drivers in 2007 confirmed positive for zolpidem by ELISA and GC-MS in blood/urine, a higher incidence rate than in the previous years. Because of the low percentage elimination of the parent compound in urine, a screening method for the detection of the main metabolite of zolpidem may be needed for better detection of drug impairment driving due to zolpidem.

  3. Toward Understanding the Size Dependence of Shape Features for Predicting Spiculation in Lung Nodules for Computer-Aided Diagnosis.

    Science.gov (United States)

    Niehaus, Ron; Raicu, Daniela Stan; Furst, Jacob; Armato, Samuel

    2015-12-01

    We analyze the importance of shape features for predicting spiculation ratings assigned by radiologists to lung nodules in computed tomography (CT) scans. Using the Lung Image Database Consortium (LIDC) data and classification models based on decision trees, we demonstrate that the importance of several shape features increases disproportionately relative to other image features with increasing size of the nodule. Our shaped-based classification results show an area under the receiver operating characteristic (ROC) curve of 0.65 when classifying spiculation for small nodules and an area of 0.91 for large nodules, resulting in a 26% difference in classification performance using shape features. An analysis of the results illustrates that this change in performance is driven by features that measure boundary complexity, which perform well for large nodules but perform relatively poorly and do no better than other features for small nodules. For large nodules, the roughness of the segmented boundary maps well to the semantic concept of spiculation. For small nodules, measuring directly the complexity of hard segmentations does not yield good results for predicting spiculation due to limits imposed by spatial resolution and the uncertainty in boundary location. Therefore, a wider range of features, including shape, texture, and intensity features, are needed to predict spiculation ratings for small nodules. A further implication is that the efficacy of shape features for a particular classifier used to create computer-aided diagnosis systems depends on the distribution of nodule sizes in the training and testing sets, which may not be consistent across different research studies.

  4. Pediatric glaucoma suspects

    Directory of Open Access Journals (Sweden)

    Kooner K

    2014-06-01

    Full Text Available Karanjit Kooner,1 Matthew Harrison,1 Zohra Prasla,1 Mohannad Albdour,1 Beverley Adams-Huet21Department of Ophthalmology, 2Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: To report demographic and ocular features of pediatric glaucoma suspects in an ethnically diverse population of North Central Texas.Design: Retrospective cross-sectional chart review.Participants: Subjects included 75 (136 eyes pediatric glaucoma suspects. Patients with one or more of the following risk factors were included: cup-to disc (C/D ratio of ≥0.6; intraocular pressure (IOP ≥21 mmHg; family history of glaucoma; congenital glaucoma in the opposite eye; history of blunt trauma to either eye; and presence of either Sturge–Weber or Axenfeld–Rieger syndrome, or oculodermal melanocytosis.Methods: Data were extracted from electronic patient medical records. Patient records with incomplete data were excluded. The main outcome measures were race, sex, age, IOP, C/D, family history of glaucoma; and glaucoma treatment.Results: Subjects included 28 (37.3% Hispanics, 20 (26.6% African Americans, 20 (26.6% Caucasians, and seven (9.3% Asians. Forty (53.3% of the patients were male. Suspicious optic disc was seen in 57 (76%; elevated IOP in 25 (33.3%; presence of family history in 13 (17.3%, and Sturge–Weber syndrome in nine (12% patients. The average C/D ratio was 0.58±0.2. The C/D ratios of African American (0.65±0.2, Hispanic (0.63±0.2, and Asian (0.62±0.15 patients were significantly greater than those of Caucasians (0.43±0.18; P=0.0004, 0.0003, and 0.0139, respectively. Caucasian patients were the youngest (7.9±4.8 years. Eleven cases (14.7% required medication.Conclusion: Thirty-three point seven percent of patients seen in the glaucoma clinic were glaucoma suspects. The most common risk factors for suspected glaucoma were suspicious optic discs, elevated IOP, and family history

  5. A late Frasnian (Late Devonian) radiolarian, sponge spicule, and conodont fauna from the Slaven Chert, northern Shoshone Range, Roberts Mountains allochthon, Nevada

    Science.gov (United States)

    Boundy-Sanders, S. Q.; Sandberg, C.A.; Murchey, B.L.; Harris, A.G.

    1999-01-01

    Co-occuring conodonts, radiolarians, and sponge spicules from the type locality of the Slaven Chert, northern Shoshone Range, Nevada, indicate that the radiolarian and sponge spicule assemblage described herein correlates with the Late rhenana conodont Zone (late Frasnian). The moderately well preserved radiolarians are the first Frasnian-age fauna described from the Western Hemisphere. They include spumellarians, Ceratoikiscum, and Paleoscenidium, and a radiolarian which we have assigned to a new genus, Durahelenifore Boundy-Sanders and Murchey, with its type species, Durahelenifore robustum Boundy-Sanders and Murchey. Sponge spicules include umbellate microscleres of the Subclass Amphidiscophora, Order Hemidiscosa, previously documented only in Pennsylvanian and younger rocks.

  6. Siliceous spicules in a vauxiid sponge (Demospongia) from the Kaili Biota(Cambrian Stage 5), Guizhou, South China

    OpenAIRE

    Yang, X.-L.; Zhao, Y.-L.; Babcock, L. E.; Peng, J.

    2017-01-01

    Fossils of the sponge Angulosuspongia sinensis from calcareous mudstones of the middle and upper part of the Kaili Formation (Cambrian Stage 5) in the Jianhe area of Guizhou province, South China, exhibit an apparently reticulate pattern, characteristic of the Vauxiidae. Energy Dispersive X-Ray Spectrometry (EDS) and Raman spectroscopy analysis indicate the presence of silica in the skeletal elements of these fossils, suggesting that this taxon possessed a skeleton comprised of spicules. This...

  7. Development of suspect and non-target screening methods for detection of organic contaminants in highway runoff and fish tissue with high-resolution time-of-flight mass spectrometry.

    Science.gov (United States)

    Du, Bowen; Lofton, Jonathan M; Peter, Katherine T; Gipe, Alexander D; James, C Andrew; McIntyre, Jenifer K; Scholz, Nathaniel L; Baker, Joel E; Kolodziej, Edward P

    2017-09-20

    Untreated urban stormwater runoff contributes to poor water quality in receiving waters. The ability to identify toxicants and other bioactive molecules responsible for observed adverse effects in a complex mixture of contaminants is critical to effective protection of ecosystem and human health, yet this is a challenging analytical task. The objective of this study was to develop analytical methods using liquid chromatography coupled to high-resolution quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) to detect organic contaminants in highway runoff and in runoff-exposed fish (adult coho salmon, Oncorhynchus kisutch). Processing of paired water and tissue samples facilitated contaminant prioritization and aided investigation of chemical bioavailability and uptake processes. Simple, minimal processing effort solid phase extraction (SPE) and elution procedures were optimized for water samples, and selective pressurized liquid extraction (SPLE) procedures were optimized for fish tissues. Extraction methods were compared by detection of non-target features and target compounds (e.g., quantity and peak area), while minimizing matrix interferences. Suspect screening techniques utilized in-house and commercial databases to prioritize high-risk detections for subsequent MS/MS characterization and identification efforts. Presumptive annotations were also screened with an in-house linear regression (log Kowvs. retention time) to exclude isobaric compounds. Examples of confirmed identifications (via reference standard comparison) in highway runoff include ethoprophos, prometon, DEET, caffeine, cotinine, 4(or 5)-methyl-1H-methylbenzotriazole, and acetanilide. Acetanilide was also detected in runoff-exposed fish gill and liver samples. Further characterization of highway runoff and fish tissues (14 and 19 compounds, respectively with tentative identification by MS/MS data) suggests that many novel or poorly characterized organic contaminants exist in urban stormwater

  8. Technology and the Glaucoma Suspect

    National Research Council Canada - National Science Library

    Blumberg, Dana M; De Moraes, Carlos Gustavo; Liebmann, Jeffrey M; Garg, Reena; Chen, Cynthia; Theventhiran, Alex; Hood, Donald C

    2016-01-01

    ...), stereoscopic disc photographs, and automated perimetry as assessed by a group of glaucoma specialists in differentiating individuals with early glaucoma from suspects. Forty-six eyes (46 patients...

  9. Magnetic resonance imaging of suspected atrial tumors.

    Science.gov (United States)

    Menegus, M A; Greenberg, M A; Spindola-Franco, H; Fayemi, A

    1992-05-01

    Two-dimensional echocardiography has become the standard technique for evaluation of cardiac and paracardiac mass lesions. We have used magnetic resonance imaging (MRI) as an independent assessment of cardiac-associated masses in patients with echocardiograms demonstrating sessile atrial tumors. MRI was performed in seven patients, ages 33 to 84, whose echocardiographic diagnoses included left atrial mass (five), right atrial mass (one), and interatrial mass (one). In four of the patients with a diagnosis of left atrial mass, MRI showed extracardiac compression of the atrium, simulating a tumor (hiatal hernia, tortuous descending aorta, bronchogenic cyst). MRI was entirely normal in one patient with an apparent left atrial mass. MRI elucidated extension of an extracavitary mass into the interatrial septum in two patients. One of these patients with an echocardiographic right atrial mass had extension of a lipoma into the interatrial septum without atrial tumor. MRI confirmed the echocardiographic diagnosis of an interatrial mass in the other patient. We conclude that MRI, because of its ability to define anatomic relationships and tissue characteristics, is a powerful noninvasive tool for evaluating suspected cardiac mass lesions. Although echocardiography remains the primary screening test for the detection of cardiac masses, MRI is a more specific modality for precise diagnosis. Correct MRI interpretation may obviate the need for invasive studies or surgery.

  10. Characterization of suspected illegal skin whitening cosmetics.

    Science.gov (United States)

    Desmedt, B; Van Hoeck, E; Rogiers, V; Courselle, P; De Beer, J O; De Paepe, K; Deconinck, E

    2014-03-01

    An important group of suspected illegal cosmetics consists of skin bleaching products, which are usually applied to the skin of the face, hands and décolleté for local depigmentation of hyper pigmented regions or more importantly, for a generalized reduction of the skin tone. These cosmetic products are suspected to contain illegal active substances that may provoke as well local as systemic toxic effects, being the reason for their banning from the EU market. In that respect, illegal and restricted substances in cosmetics, known to have bleaching properties, are in particular hydroquinone, tretinoin and corticosteroids. From a legislative point of view, all cosmetic products containing a prohibited whitening agent are illegal and must be taken off the EU market. A newly developed screening method using ultra high performance liquid chromatography-time off flight-mass spectrometry allows routine analysis of suspected products. 163 suspected skin whitening cosmetics, collected by Belgian inspectors at high risk sites such as airports and so-called ethnic cosmetic shops, were analyzed and 59% were classified as illegal. The whitening agents mostly detected were clobetasol propionate and hydroquinone, which represent a serious health risk when repeatedly and abundantly applied to the skin. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. The Largest Bio-Silica Structure on Earth: The Giant Basal Spicule from the Deep-Sea Glass Sponge Monorhaphis chuni

    Directory of Open Access Journals (Sweden)

    Xiaohong Wang

    2011-01-01

    Full Text Available The depth of the ocean is plentifully populated with a highly diverse fauna and flora, from where the Challenger expedition (1873–1876 treasured up a rich collection of vitreous sponges [Hexactinellida]. They have been described by Schulze and represent the phylogenetically oldest class of siliceous sponges [phylum Porifera]; they are eye-catching because of their distinct body plan, which relies on a filigree skeleton. It is constructed by an array of morphologically determined elements, the spicules. Later, during the German Deep Sea Expedition “Valdivia” (1898-1899, Schulze could describe the largest siliceous hexactinellid sponge on Earth, the up to 3 m high Monorhaphis chuni, which develops the equally largest bio-silica structures, the giant basal spicules (3 m × 10 mm. With such spicules as a model, basic knowledge on the morphology, formation, and development of the skeletal elements could be elaborated. Spicules are formed by a proteinaceous scaffold which mediates the formation of siliceous lamellae in which the proteins are encased. Up to eight hundred 5 to 10 μm thick lamellae can be concentrically arranged around an axial canal. The silica matrix is composed of almost pure silicon and oxygen, providing it with unusual optophysical properties that are superior to those of man-made waveguides. Experiments indicated that the spicules function in vivo as a nonocular photoreception system. In addition, the spicules have exceptional mechanical properties, combining mechanical stability with strength and stiffness. Like demosponges the hexactinellids synthesize their silica enzymatically, via the enzyme silicatein. All these basic insights will surely contribute also to a further applied utilization and exploration of bio-silica in material/medical science.

  12. SEM study of gemmules and spicules of Indian Trochospongilla latouchiana Annandale and Chinese T. latouchiana sinensis Annandale (Porifera: Demospongiae: Spongillina: Spongillidae

    Directory of Open Access Journals (Sweden)

    S.S. Jakhalekar

    2014-08-01

    Full Text Available Gemmules and spicules of Trochospongilla latouchiana Annandale, 1907 from India and its subspecies T. latouchiana sinensis Annandale, 1919 from China have not been studied under SEM so far, as only optical microscopic illustrations are available. These illustrations are now provided using material from the Smithsonian Institution, USA. T. latouchiana sinensis has already been treated as a synonym of T. latouchiana. SEM observations reveal identical morphology of gemmules and spicules and it seems that synonymising the subspecies with T. latouchiana is justified, however more material must be studied to understand the variability of characters in these species.

  13. Siliceous spicules in a vauxiid sponge (Demospongia) from the Kaili Biota(Cambrian Stage 5), Guizhou, South China

    Science.gov (United States)

    Yang, X.-L.; Zhao, Y.-L.; Babcock, L. E.; Peng, J.

    2017-02-01

    Fossils of the sponge Angulosuspongia sinensis from calcareous mudstones of the middle and upper part of the Kaili Formation (Cambrian Stage 5) in the Jianhe area of Guizhou province, South China, exhibit an apparently reticulate pattern, characteristic of the Vauxiidae. Energy Dispersive X-Ray Spectrometry (EDS) and Raman spectroscopy analysis indicate the presence of silica in the skeletal elements of these fossils, suggesting that this taxon possessed a skeleton comprised of spicules. This is the first confirmation of siliceous skeletal elements in fossils of the family Vauxiidae, and it lends support to the hypothesis that some early demosponges possessed biomineralized siliceous skeletons, which were subsequently lost and replaced by spongin later in the evolutionary history of this lineage. The new materials provide critical insight into the phylogeny and evolution of biomineralization in the Demosopongiae.

  14. Suspected Rhinolithiasis Associated With Endodontic Disease in a Cat.

    Science.gov (United States)

    Ng, Kevin; Fiani, Nadine; Peralta, Santiago

    2017-12-01

    Rhinoliths are rare, intranasal, mineralized masses formed via the precipitation of mineral salts around an intranasal nidus. Clinical signs are typically consistent with inflammatory rhinitis and nasal obstruction, but asymptomatic cases are possible. Rhinoliths may be classified as exogenous or endogenous depending on the origin of the nidus, with endogenous rhinoliths reportedly being less common. This case report describes a suspected case of endogenous rhinolithiasis in a cat which was detected as an incidental finding during radiographic assessment of a maxillary canine tooth with endodontic disease. Treatment consisted of removal of the suspected rhinolith via a transalveolar approach after surgical extraction of the maxillary canine tooth.

  15. CT-guided biopsy of suspected malignancy: A potential pitfall

    Directory of Open Access Journals (Sweden)

    Steven Henderson

    2013-11-01

    Full Text Available Paragangliomas are rare catecholamine-secreting neuro-endocrine tumours that can arise from sympathetic or parasympathetic tissue. Any manipulation of these tumours, without appropriate medical therapy, can result in excess catecholamine release leading to a catecholamine crisis. Neuro-endocrine tumours must be considered prior to interventional biopsy of an unknown soft-tissue mass, and appropriate biochemical investigations should be performed in suspected cases to prevent catastrophic complications.

  16. Suspected levamisole intoxication in calves.

    Science.gov (United States)

    Müller, K R; Dwyer, C

    2016-07-01

    A group of 32 Friesian and four Hereford calves, 3-4 months old with body weights between 100-120 kg, were purchased from a weaner sale. On arrival at the property the Hereford calves were treated with a combination anthelmintic containing 2 g/L abamectin and 80 g/L levamisole hydrochloride. Shortly afterwards they developed tremors and frothing from the mouth, and two died overnight. The Friesian calves were treated with the same anthelmintic on the following day, when some showed hypersalivation and frothing from the mouth. Examination of the three most severely affected Friesian calves revealed severe nicotinic-type symptoms including hypersalivation, frothing from the mouth, muscle tremors, recumbency, rapid respiration, hyperaesthesia, and central nervous system depression. Other calves showed mild to moderate signs of intoxication including restlessness, tail switching, salivation, tremors, frequent defaecation, mild colic and jaw chomping. Two calves died shortly afterwards. An adverse drug event investigation revealed that the formulation and quality of the anthelmintic was within the correct specification, and that the drench gun was functioning correctly. Suspected levamisole intoxication due to a combination of possible overdosing, dehydration, and stress caused by transportation and prolonged yarding. Susceptibility to levamisole toxicity in New Zealand calves can be increased if factors like dehydration or stress are present. Levamisole has a narrow margin of safety, and overdosing in calves can easily occur if the dose rate is not based on their actual weight or health status.

  17. Pararenal splenosis encountered during the evaluation of a suspected pheochromocytoma.

    Science.gov (United States)

    Brown, Joel D; Kwee, Sandi

    2010-11-01

    The authors describe a patient in whom pararenal splenosis nodules were initially interpreted as probable pheochromocytoma. A 22-year-old man with chronic glomerulonephritis, hypertension and a childhood history of splenectomy was hospitalized for a hypertensive emergency. He did not improve with aggressive antihypertensive therapy. A pheochromocytoma was suspected, and a renal ultrasound and a magnetic resonance imaging showed 2 left pararenal masses. Laboratory evaluation for pheochromocytoma and aldosteronoma were negative. Biopsies of the masses were planned, but the masses were subsequently shown to be splenic tissue by a (99m)technnetium heat-damaged red blood cell scan. Ectopic splenic masses, eg, splenosis or accessory spleens, should be considered in patients with undiagnosed abdominal or kidney masses and a history of splenectomy.

  18. Evidence for coherent spicule oscillations from correcting Hinode/SOT Ca II H in the south-east limb of the Sun

    Science.gov (United States)

    Ahangarzadeh Maralani, A. R.; Tavabi, E.; Ajabshirizadeh, A.

    2017-05-01

    Wave theories of heating of the chromosphere, corona and solar wind due to photospheric fluctuations are strengthened by the existence of the wave coherency observed up to the transition region. The coherency of intensity oscillations of solar spicules was explored using the Solar Optical Telescope (SOT) on the Hinode spacecraft with increasing height above the solar limb in the active region. We used time sequences near the south-east region from the Hinode/SOT for the Ca II H line obtained on 2015 April 3 and applied the de-convolution procedure to the spicule to illustrate how effectively our restoration method works on fine structures such as spicules. Moreover, the intensity oscillations at different heights above the solar limb were analysed through wavelet transforms. Afterwards, the phase difference was measured between oscillations at two heights in search of evidence for coherent oscillations. The results of the wavelet transformations revealed dominant period peaks for 2, 4, 5.5 and 6.5 min at four separate heights. The dominant frequencies for a coherency level higher than 75 per cent were found to be around 5.5 and 8.5 mHz. Mean phase speeds of 155-360 km s-1 were measured. We found that the mean phase speeds increased with height. The results suggest that the energy flux carried by coherent waves into the corona and heliosphere may be several times larger than previous estimates that were based solely on constant velocities. We provide compelling evidence for the existence of upwardly propagating coherent waves.

  19. A case of suspect “cyanosis”

    OpenAIRE

    Elisabetta Antonucci; Matteo Conte; Michele Di Pumpo; Giuseppe Antonucci

    2013-01-01

    CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO). Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed...

  20. The phenomenology of specialization of criminal suspects.

    Directory of Open Access Journals (Sweden)

    Michele Tumminello

    Full Text Available A criminal career can be either general, with the criminal committing different types of crimes, or specialized, with the criminal committing a specific type of crime. A central problem in the study of crime specialization is to determine, from the perspective of the criminal, which crimes should be considered similar and which crimes should be considered distinct. We study a large set of Swedish suspects to empirically investigate generalist and specialist behavior in crime. We show that there is a large group of suspects who can be described as generalists. At the same time, we observe a non-trivial pattern of specialization across age and gender of suspects. Women are less prone to commit crimes of certain types, and, for instance, are more prone to specialize in crimes related to fraud. We also find evidence of temporal specialization of suspects. Older persons are more specialized than younger ones, and some crime types are preferentially committed by suspects of different ages.

  1. A case of suspect “cyanosis”

    Directory of Open Access Journals (Sweden)

    Elisabetta Antonucci

    2013-05-01

    Full Text Available CLINICAL CASE A 70-year old woman was admitted to our hospital because of fever, asthenia and a suspected stroke. Her medical history showed a congenital cardiopathy (Patent Foramen Ovale, PFO. Skin and oral mucosa pigmentation, orthostatic hypotension, hypoglycemia and hyponatriemia arose the suspect of Addison’s disease. The diagnosis was confirmed by the evaluation of basal levels of plasma ACTH and serum cortisol, and serum cortisol levels after ACTH stimulation. Abdominal CT scan showed atrophy and calcification of adrenal glands. CONCLUSIONS In most cases, Addison’s disease is provoked by autoimmune destruction of the adrenal cortex; however, in our reported patient, tuberculosis could be a possible cause.

  2. Congenital Malaria Among Newborns Admitted for Suspected ...

    African Journals Online (AJOL)

    Background: Signs and symptoms of congenital malaria do not differ much from those of neonatal sepsis: both can co-exist, and most times very difficult to differentiate clinically. Objective: To document the prevalence, risk factors for congeni tal malar ia among neonates admitted for suspected neonatal sepsis, and ...

  3. Congenital Malaria Among Newborns Admitted for Suspected ...

    African Journals Online (AJOL)

    None of the clinical feature had good sensitivity, specificity or predictive value for congenital malaria, and only 1.6% death was recorded in a baby with high parasite density. Conclusion: Congenital malaria is common in newborns with suspected neonatal sepsis. History of peripartum pyrexia, prematurity and intrauterine ...

  4. MRI for clinically suspected appendicitis during pregnancy.

    NARCIS (Netherlands)

    Cobben, L.P.; Groot, I.; Haans, L.; Blickman, J.G.; Puylaert, J.

    2004-01-01

    OBJECTIVE: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis. CONCLUSION: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in

  5. Biomechanical properties of keratoconus suspect eyes.

    Science.gov (United States)

    Saad, Alain; Lteif, Yara; Azan, Elodie; Gatinel, Damien

    2010-06-01

    Measuring corneal biomechanical properties may help detect keratoconus suspect corneas and eliminate the risk of ectasia after LASIK. Data of 504 eyes separated into three groups were retrospectively reviewed: normal (n = 252), keratoconus suspect (n = 80), and keratoconus (n = 172). Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with an ocular biomechanics analyzer. Mean corneal hysteresis was 10.6 +/- 1.4 (SD) mm Hg in the normal group, compared with 10.0 +/- 1.6 mm Hg in the keratoconus suspect group and 8.1 +/- 1.4 mm Hg in the keratoconus group. The mean CRF was 10.6 +/- 1.6 mm Hg in the normal group compared with 9.7 +/- 1.7 in the keratoconus suspect group and 7.1 +/- 1.6 mm Hg in the keratoconus group. Mean CH and CRF were significantly different between the three groups (P corneas. Analyzing signal curves obtained with the biomechanics analyzer may provide additional valuable information for selecting qualified patients for refractive surgery.

  6. Suspecting Neurological Dysfunction From E Mail Messages ...

    African Journals Online (AJOL)

    A non medical person suspected and confirmed neurological dysfunction in an individual, based only on e mail messages sent by the individual. With email communication becoming rampant “peculiar” email messages may raise the suspicion of neurological dysfunction. Organic pathology explaining the abnormal email ...

  7. Suspected poisoning of domestic animals by pesticides.

    Science.gov (United States)

    Caloni, Francesca; Cortinovis, Cristina; Rivolta, Marina; Davanzo, Franca

    2016-01-01

    A retrospective study was carried out by reviewing all suspected cases of domestic animal poisoning attributed to pesticides, reported to the Milan Poison Control Centre (MPCC) between January 2011 and December 2013. During this period, pesticides were found to be responsible for 37.3% of all suspected poisoning enquiries received (815). The most commonly species involved was the dog (71.1% of calls) followed by the cat (15.8%), while a limited number of cases involved horses, goats and sheep. Most cases of exposure (47.1%) resulted in mild to moderate clinical signs. The outcome was reported in 59.9% of these cases, with death occurring in 10.4% of them. Insecticides (40.8%) proved to be the most common group of pesticides involved and exposure to pyrethrins-pyrethroids accounted for the majority of calls. According to the MPCC data, there has been a decrease in the number of suspected poisonings cases attributed to pesticides that have been banned by the EU, including aldicarb, carbofuran, endosulfan and paraquat. In contrast, there has been an increase of suspected poisoning cases attributed to the neonicotinoids, imidacloprid and acetamiprid, probably due to their widespread use in recent years. Cases of suspected poisoning that involved exposure to rodenticides accounted for 27.6% of calls received by the MPCC and anticoagulant rodenticides were the primary cause of calls, with many cases involving brodifacoum and bromadiolone. Herbicides were involved in 14.2% of calls related to pesticides and glyphosate was the main culprit in cases involving dogs, cats, horses, goats and sheep. As far as exposure to molluscicides (11.5%) and fungicides (5.9%), most of the cases involved dogs and the suspected poisoning agents were metaldehyde and copper compounds respectively. The data collected are useful in determining trends in poisoning episodes and identifying newly emerging toxicants, thus demonstrating the prevalence of pesticides as causative agents in animal

  8. Medullary Thyroid Carcinoma Presenting as a Predominantly Cystic Mass on Ultrasonography: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young; Kim, Ah Hyun; Moon, Hee Jung; Kim, Eun Kyung; Kwak, Jin Young [Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Jun Jeong [Wonju College of Medicine, Wonju (Korea, Republic of); Kim, Myung Hyun [Gangnam MizMedi Hospital, Seoul (Korea, Republic of)

    2012-03-15

    Most medullary thyroid carcinomas show suspicious malignant features such as hypoechogenicity, a spiculated margin and/or intranodular calcifications, which are well known features of papillary carcinoma. We report here on a case of medullary carcinoma that was seen as a predominantly cystic thyroid mass on ultrasonography. This type of case is not common in the literature and we discuss the way to diagnose a medullary thyroid carcinoma

  9. The evaluation of suspected child physical abuse.

    Science.gov (United States)

    Christian, Cindy W

    2015-05-01

    Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children. Copyright © 2015 by the American Academy of Pediatrics.

  10. Suspects in criminal investigations of rape

    Directory of Open Access Journals (Sweden)

    Marinković Darko

    2014-01-01

    Full Text Available Investigations of sexual assaults mostly focus on victims and their credibility, which may cause lack of firm evidence in relation to suspects. Given the fact that the criminal offence of rape is characterised by a high incidence of false reports and accusations, frequently indicating specific persons as the perpetrators, certain caution is necessary in the investigation in order to avoid false accusations and/or convictions. As regards the personality of the rapist and motives for committing a forcible sexual act, certain types or rather certain categories of perpetrators can be distinguished, although it should be noted that a large number of rapists do not belong to one category only, but rather combine characteristics of several different types. During a criminal investigation it is of vital importance to differentiate between a rape as a surprise attack and a rape as abuse of trust, as they are compatible with the nature of the suspect's defence. The suspect shall be subjected to a forensic examination in the course of the investigation in order to find traces which prove vaginal, anal or oral penetration, coerced sexual intercourse and identity of the rapist. While conducting an interrogation of a suspected rapist, a crime investigating officer shall use either factual or emotional approach to his interviewee, depending on his psychological and motivational characteristics. In this regard, the factual approach is believed to be more efficient with anger rapists and sadistic rapists, whereas the compassionate approach gives good results with the gentlemen-rapists and partly with the power asserting rapists.

  11. Glaucoma suspect & Humphrey Field Analyzer a correlation

    Directory of Open Access Journals (Sweden)

    P Dahal

    2012-09-01

    Full Text Available Glaucoma originally meant "clouded", in Greek.The term glaucoma refers to a group of diseases that have in common characteristic optic neuropathy with associated visual field loss for which elevated intraocular pressure is one of the primary risk factor. The purpose of the study is to correlate the clinically diagnosed cases of glaucoma suspect with the Humphrey Field Analyzer (HFA. Fifty cases of glaucoma suspect who attended the glaucoma clinic of Nepal Eye Hospital Tripureswor, Kathmandu, Nepal and who meets at least two criteria, among the four types of glaucoma suspects were advised for the HFA for the study. In this study out of 50 patient, 36 (72% patients had normal visual field. 14 (28% patients had thinning of the neural retinal rim (NRR in both eyes. The significant relation with thinning of neural retina rim and glaucomatous hemifield test was found in the study. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 23-28 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6822

  12. Tocolytics for suspected intrapartum fetal distress.

    Science.gov (United States)

    Kulier, R; Hofmeyr, G J

    2000-01-01

    Prophylactic tocolysis with betamimetics and other agents has become widespread as a treatment for fetal distress. Uterine relaxation may improve placental blood flow and therefore fetal oxygenation. However there may also be adverse maternal cardiovascular effects. The objective of this review was to assess the effects of tocolytic therapy for suspected fetal distress on fetal, maternal and perinatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: February 1999. Randomised trials comparing tocolytic therapy with no treatment or treatment with another tocolytic agent for suspected fetal distress. Two reviewers assessed trial quality and extracted data. Three studies were included. Compared with no treatment, there were fewer failed improvements in fetal heart rate abnormalities with tocolytic therapy (relative risk 0.26, 95% 0.13 to 0.53). Betamimetic therapy compared with magnesium sulphate showed a non-significant trend towards reduced uterine activity (relative risk 0.07, 95% confidence interval 0.00 to 1.10). Betamimetic therapy appears to be able to reduce the number of fetal heart rate abnormalities and perhaps reduce uterine activity. However there is not enough evidence based on clinically important outcomes to evaluate the use of betamimetics for suspected fetal distress.

  13. Prevalence of glaucoma suspects and pattern of intra-ocular ...

    African Journals Online (AJOL)

    Background: Glaucoma is the commonest cause of irreversible blindness in the world. Some glaucoma patients start out as glaucoma suspects for years. Aim: To determine the prevalence of glaucoma suspects and pattern of intra-ocular pressure distribution in glaucoma suspects. Methods: This survey was carried out in ...

  14. Nuclear Pedigree Criteria of Suspected HNPCC

    Directory of Open Access Journals (Sweden)

    Kładny Józef

    2003-01-01

    Full Text Available Abstract The criteria for the diagnosis of HNPCC established by the ICG-HNPCC are very restrictive as they do not allow for the diagnosis of a large number of "suspected HNPCC" cases - these are families which do no fulfill the strict diagnostic "Amsterdam criteria", but do present with several pedigree and clinical features characteristic for HNPCC. Several series of families suspected of harboring germline mutations in DNA mismatch repair genes have been studied for germline changes in DNA mismatch repair genes and a mutation rate of somewhere between 8-60% was found. Therefore a subgroup of members of the ICG-HNPCC has been working on pedigree/clinical diagnostic criteria for suspected HNPCC. Materials and methods Part I The study was based on two series of colorectal cancer (CRC cases: 1 HNPCC - this group comprised 190 patients affected by CRC from randomly selected families which fulfilled the Amsterdam II criteria registered in Düsseldorf, Germany (102 cases of CRC, Denmark (18 CRCs, Leiden, Holland (23 CRCs and Szczecin, Poland (47 CRCs. 2 Consecutive CRCs - this group comprised 629 (78.0% of 806 individuals with CRC diagnosed in 1991-1997 in the city of Szczecin (ca. 400,000 of inhabitants, Poland. Nuclear pedigrees in both groups were compared for frequency of occurrence of clinical features, that have been shown to be associated with HNPCC. Part II 52 consecutive CRC cases from Szczecin, matching the criteria recognized in part I as appropriate for diagnosis of cases "suspected of HNPCC" were studied for the occurrence of germline hMSH2/hMLH1 constitutional mutations using "exon by exon" sequencing. Results The combination of features - i.e. the occurrence of an HNPCC associated cancer (CRC or cancer of the endometrium, small bowel or urinary tract in a 1st degree relative of a CRC patient; at least one of the patients being diagnosed under age of 50 - appeared to be strongly associated to HNPCC with an OR - 161. Constitutional

  15. Biocalcite, a multifunctional inorganic polymer: Building block for calcareous sponge spicules and bioseed for the synthesis of calcium phosphate-based bone

    Directory of Open Access Journals (Sweden)

    Xiaohong Wang

    2014-05-01

    Full Text Available Calcium carbonate is the material that builds up the spicules of the calcareous sponges. Recent results revealed that the calcium carbonate/biocalcite-based spicular skeleton of these animals is formed through an enzymatic mechanism, such as the skeleton of the siliceous sponges, evolutionarily the oldest animals that consist of biosilica. The enzyme that mediates the calcium carbonate deposition has been identified as a carbonic anhydrase (CA and has been cloned from the calcareous sponge species Sycon raphanus. Calcium carbonate deposits are also found in vertebrate bones besides the main constituent, calcium phosphate/hydroxyapatite (HA. Evidence has been presented that during the initial phase of HA synthesis poorly crystalline carbonated apatite is deposited. Recent data summarized here indicate that during early bone formation calcium carbonate deposits enzymatically formed by CA, act as potential bioseeds for the precipitation of calcium phosphate mineral onto bone-forming osteoblasts. Two different calcium carbonate phases have been found during CA-driven enzymatic calcium carbonate deposition in in vitro assays: calcite crystals and round-shaped vaterite deposits. The CA provides a new target of potential anabolic agents for treatment of bone diseases; a first CA activator stimulating the CA-driven calcium carbonate deposition has been identified. In addition, the CA-driven calcium carbonate crystal formation can be frozen at the vaterite state in the presence of silintaphin-2, an aspartic acid/glutamic acid-rich sponge-specific protein. The discovery that calcium carbonate crystals act as bioseeds in human bone formation may allow the development of novel biomimetic scaffolds for bone tissue engineering. Na-alginate hydrogels, enriched with biosilica, have recently been demonstrated as a suitable matrix to embed bone forming cells for rapid prototyping bioprinting/3D cell printing applications.

  16. Acute aortic dissection in patient with suspected pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Lešanović Jelena

    2016-01-01

    Full Text Available Introduction: Aortic dissection is one of the most fatal vascular emergencies. Almost 40% of the patients do not reach hospital in time while more than quarter die in the first 24 hours after the dissection begins. Case Report: A 37-year old man was admitted to our hospital with severe anterior chest pain which had lasted for over a week. Suspected aortic dissection was rapidly confirmed using imaging modalities - MDCT chest scan and TTE, followed by an urgent surgical management - Bentall procedure. MDCT chest scan also discovered adrenal incidentaloma defined as malignant, pheochromocytoma like mass. Due to the critical state of the patient, there was not enough time for further endocrinologic testing. Discussion and conclusion: When treating patients with pheochromocytoma and acute aortic disection, it is crucial to obtain a stable hemodynamic state before the surgery, since they can trigger a severe hypertensive crisis due to high levels of cathecholamines induced chronic vasoconctriction. The most vulnerable periods are the induction of anesthesia and perioperative hemodynamic oscillations, so treating patients with short acting alpha- 1 adrenergic blocking agents preoperatively has proven to be helpful - Phentolamine. Both dissection of aorta and pheochromocytoma present challenges for anesthesiologists and early recognition of symptoms is essential in establishing the diagnosis and reducing the mortality rate.

  17. Detection of Rabies antigen in brains of suspected Rabid dogs ...

    African Journals Online (AJOL)

    Objective: To detect the presence of rabies antigen in brains of suspected rabid dogs. Materials and Methods: Ninety six (96) brain specimens from suspected rabid dogs were examined for the presence of rabies antigen using Seller's staining technique and enzyme immunoassay. Results: The two techniques were both ...

  18. 48 CFR 803.806 - Processing suspected violations.

    Science.gov (United States)

    2010-10-01

    ... GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Limitation on the Payment of Funds to Influence Federal Transactions 803.806 Processing suspected violations. A VA employee must report suspected violations of 31 U.S.C. 1352, Limitation on Use of Appropriated Funds to Influence Certain Federal...

  19. The clinical course of patients with suspected pulmonary embolism

    NARCIS (Netherlands)

    van Beek, E. J.; Kuijer, P. M.; Büller, H. R.; Brandjes, D. P.; Bossuyt, P. M.; ten Cate, J. W.

    1997-01-01

    BACKGROUND: The outcome of patients with suspected pulmonary embolism is known to a limited extent only. OBJECTIVE: To address this limited knowledge in a cohort in whom pulmonary embolism was proved or ruled out. METHODS: Consecutive patients with clinically suspected pulmonary embolism underwent

  20. Seasonal variation among tuberculosis suspects in four countries

    DEFF Research Database (Denmark)

    Mabaera, Biggie; Naranbat, Nymadawa; Katamba, Achilles

    2009-01-01

    The objective of the study was to analyze monthly trends across a calendar year in tuberculosis suspects and sputum smear-positive cases based on nationally representative samples of tuberculosis laboratory registers from Moldova, Mongolia, Uganda and Zimbabwe. Out of the 47 140 suspects registered...... in the tuberculosis laboratory registers, 13.4% (6312) were cases. The proportion varied from country to country, Moldova having the lowest (9%) and Uganda the highest (21%). From the monthly proportion of suspects and cases among total suspects and cases, seasonal variations were most marked in Mongolia which, among...... attendance to diagnostic laboratory services, evidenced by the contrasting findings of Mongolia (extreme continental northern climate) compared to Uganda (equatorial climate). A combination of external and possibly endogenous factors seems to determine whether tuberculosis suspects and cases present...

  1. Prediction of Suspect Location Based on Spatiotemporal Semantics

    Directory of Open Access Journals (Sweden)

    Lian Duan

    2017-06-01

    Full Text Available The prediction of suspect location enables proactive experiences for crime investigations and offers essential intelligence for crime prevention. However, existing studies have failed to capture the complex social location transition patterns of suspects and lack the capacity to address the issue of data sparsity. This paper proposes a novel location prediction model called CMoB (Crime Multi-order Bayes model based on the spatiotemporal semantics to enhance the prediction performance. In particular, the model groups suspects with similar spatiotemporal semantics as one target suspect. Then, their mobility data are applied to estimate Markov transition probabilities of unobserved locations based on a KDE (kernel density estimating smoothing method. Finally, by integrating the total transition probabilities, which are derived from the multi-order property of the Markov transition matrix, into a Bayesian-based formula, it is able to realize multi-step location prediction for the individual suspect. Experiments with the mobility dataset covering 210 suspects and their 18,754 location records from January to June 2012 in Wuhan City show that the proposed CMoB model significantly outperforms state-of-the-art algorithms for suspect location prediction in the context of data sparsity.

  2. B Plant/WESF suspect/counterfeit parts identification program

    Energy Technology Data Exchange (ETDEWEB)

    Mertz, D.W.

    1996-01-12

    This document describes a suspect/counterfeit parts inspection program required by DOE conducted in accordance with Internal Memo 16710-94-DWM-048, J.A. O`Brien to J. N. Nansen, B Plant Suspect/ Counterfeit Parts Action Plan, dated May 24, 1994. The program included: physical inspection of all spare parts inventories within the plant; screening of installed B Plant/WESF (Waste Encapsulation and Storage Facility) systems for applications where the use and subsequent potential failure of suspect/counterfeit parts could have critical consequences; and a physical inspection based upon this screening.

  3. Stopping and Questioning Suspected Shoplifters Without Creating Civil Liability

    Science.gov (United States)

    Reed, Jack R., Jr.

    1977-01-01

    Legal problems concerned with shoplifting suspects are addressed, including common law, criminal penalties, and the merchant's liability. Tangential questions and answers are presented along with discussion of pertinent court cases. (LBH)

  4. ALGORITHM OF MANAGEMENT OF PATIENTS WITH SUSPECTED BLUNT CARDIAC TRAUMA

    Directory of Open Access Journals (Sweden)

    S. R. Gilarevsky

    2013-01-01

    Full Text Available Abstract. Contemporary algorithm of diagnostic examination of patients with suspected blunt cardiac trauma is presented. General aspects of monitoring and treatment of such patients are also discussed. 

  5. Suspect confession of child sexual abuse to investigators.

    Science.gov (United States)

    Lippert, Tonya; Cross, Theodore P; Jones, Lisa; Walsh, Wendy

    2010-05-01

    Increasing the number of suspects who give true confessions of sexual abuse serves justice and reduces the burden of the criminal justice process on child victims. With data from four communities, this study examined confession rates and predictors of confession of child sexual abuse over the course of criminal investigations (final N = 282). Overall, 30% of suspects confessed partially or fully to the crime. This rate was consistent across the communities and is very similar to the rates of suspect confession of child sexual abuse found by previous research, although lower than that from a study focused on a community with a vigorous practice of polygraph testing. In a multivariate analysis, confession was more likely when suspects were younger and when more evidence of abuse was available, particularly child disclosure and corroborative evidence. These results suggest the difficulty of obtaining confession but also the value of methods that facilitate child disclosure and seek corroborative evidence, for increasing the odds of confession.

  6. Investigation of a suspected outbreak of lipoatrophia semicircularis in children.

    Science.gov (United States)

    Rius, Cristina; Baselga, Eulalia; Tizón, Jorge; Fuentes, Paulina; Muñoz-Garza, Fania Zamantta; Roigé, Glòria; Llebaria, Xavier; Caylà, Joan A

    2017-08-10

    Recent reports of outbreaks of lipoatrophia semicircularis (LS) in various countries have generated discussion regarding the potential role of the environmental characteristics of office workplaces in new buildings. The objective of this study was to investigate a suspected outbreak of LS among children in a public school in Barcelona, which generated tremendous alarm. We performed an epidemiological assessment including descriptive and prevalence analyses, and an environmental investigation followed by a psychiatric assessment according to Small's criteria. We compared the prevalence of LS and its 95% confidence interval between children and staff attending the day-care centre under study and other centres. Among 86 children attending a day-care centre we detected 11 confirmed and 2 possible cases of LS (15.1%) while among 41 children attending other day-care centres we identified 8 cases and 4 possible cases (29.3%) (P=.10). Among 12 day-care staff, we detected 8 cases of LS (66.7%) while among 19 women working different jobs we identified 14 with the same condition as the staff (73.7%) (P=.98). All lesions were finally classified as indentations with different locations. The environmental evaluation didn't identify any exposure factors with a significant role in the onset of the outbreak. The outbreak shared 13 of Small's 16 criteria regarding epidemic somatoform disorder ("mass hysteria"). The presence of indentations can be considered a normal variant in the lower extremities of children. The characteristic development of the process leads us to the conclusion that this outbreak was an epidemic somatoform disorder. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. A computational model to generate simulated three-dimensional breast masses

    Energy Technology Data Exchange (ETDEWEB)

    Sisternes, Luis de; Brankov, Jovan G.; Zysk, Adam M.; Wernick, Miles N., E-mail: wernick@iit.edu [Medical Imaging Research Center, Department of Electrical and Computer Engineering, Illinois Institute of Technology, Chicago, Illinois 60616 (United States); Schmidt, Robert A. [Kurt Rossmann Laboratories for Radiologic Image Research, Department of Radiology, The University of Chicago, Chicago, Illinois 60637 (United States); Nishikawa, Robert M. [Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 (United States)

    2015-02-15

    Purpose: To develop algorithms for creating realistic three-dimensional (3D) simulated breast masses and embedding them within actual clinical mammograms. The proposed techniques yield high-resolution simulated breast masses having randomized shapes, with user-defined mass type, size, location, and shape characteristics. Methods: The authors describe a method of producing 3D digital simulations of breast masses and a technique for embedding these simulated masses within actual digitized mammograms. Simulated 3D breast masses were generated by using a modified stochastic Gaussian random sphere model to generate a central tumor mass, and an iterative fractal branching algorithm to add complex spicule structures. The simulated masses were embedded within actual digitized mammograms. The authors evaluated the realism of the resulting hybrid phantoms by generating corresponding left- and right-breast image pairs, consisting of one breast image containing a real mass, and the opposite breast image of the same patient containing a similar simulated mass. The authors then used computer-aided diagnosis (CAD) methods and expert radiologist readers to determine whether significant differences can be observed between the real and hybrid images. Results: The authors found no statistically significant difference between the CAD features obtained from the real and simulated images of masses with either spiculated or nonspiculated margins. Likewise, the authors found that expert human readers performed very poorly in discriminating their hybrid images from real mammograms. Conclusions: The authors’ proposed method permits the realistic simulation of 3D breast masses having user-defined characteristics, enabling the creation of a large set of hybrid breast images containing a well-characterized mass, embedded within real breast background. The computational nature of the model makes it suitable for detectability studies, evaluation of computer aided diagnosis algorithms, and

  8. Suspect aggression and victim resistance in multiple perpetrator rapes.

    Science.gov (United States)

    Woodhams, Jessica; Cooke, Claire

    2013-11-01

    Several research studies have reported an elevated level of aggression in rapes committed by multiple perpetrators compared to rapes committed by lone suspects. Several factors that have been linked to elevated aggression in generic samples of rape were examined for the first time with a sample of multiple perpetrator rapes. Factors that might be associated with victim resistance were also investigated. Victim and offender characteristics, as well as the behaviors displayed by victims and offenders, were extracted from the police files of 89 multiple perpetrator stranger rapes perpetrated against female victims in the United Kingdom. These behaviors were rated for their level of suspect (non-sexual) aggression and victim resistance, respectively. Degree of victim resistance was significantly and positively associated with suspect aggression. Older victims were the recipients of significantly higher levels of suspect aggression. Victims who were incapacitated from drugs and/or alcohol were less likely to be the recipients of suspect aggression. Group leaders displayed more aggression towards the victim than the followers in the groups. The number of perpetrators was significantly related to the degree of resistance displayed by the victim with offences perpetrated by fewer suspects being characterized by more victim resistance. Research regarding cognitive appraisal during criminal interactions and the respective roles of offenders is referred to in considering these relationships.

  9. Interviewing strategically to elicit admissions from guilty suspects.

    Science.gov (United States)

    Tekin, Serra; Granhag, Pär Anders; Strömwall, Leif; Giolla, Erik Mac; Vrij, Aldert; Hartwig, Maria

    2015-06-01

    In this article we introduce a novel interviewing tactic to elicit admissions from guilty suspects. By influencing the suspects' perception of the amount of evidence the interviewer holds against them, we aimed to shift the suspects' counterinterrogation strategies from less to more forthcoming. The proposed tactic (SUE-Confrontation) is a development of the Strategic Use of Evidence (SUE) framework and aims to affect the suspects' perception by confronting them with statement-evidence inconsistencies. Participants (N = 90) were asked to perform several mock criminal tasks before being interviewed using 1 of 3 interview techniques: (a) SUE-Confrontation, (b) Early Disclosure of Evidence, or (c) No Disclosure of Evidence. As predicted, the SUE-Confrontation interview generated more statement-evidence inconsistencies from suspects than the Early Disclosure interview. Importantly, suspects in the SUE-Confrontation condition (vs. Early and No disclosure conditions) admitted more self-incriminating information and also perceived the interviewer to have had more information about the critical phase of the crime (the phase where the interviewer lacked evidence). The findings show the adaptability of the SUE-technique and how it may be used as a tool for eliciting admissions. (c) 2015 APA, all rights reserved).

  10. The simulation of 3D mass models in 2D digital mammography and breast tomosynthesis

    Energy Technology Data Exchange (ETDEWEB)

    Shaheen, Eman, E-mail: eman.shaheen@uzleuven.be; De Keyzer, Frederik; Bosmans, Hilde; Ongeval, Chantal Van [Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven (Belgium); Dance, David R.; Young, Kenneth C. [National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom and Department of Physics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH (United Kingdom)

    2014-08-15

    Purpose: This work proposes a new method of building 3D breast mass models with different morphological shapes and describes the validation of the realism of their appearance after simulation into 2D digital mammograms and breast tomosynthesis images. Methods: Twenty-five contrast enhanced MRI breast lesions were collected and each mass was manually segmented in the three orthogonal views: sagittal, coronal, and transversal. The segmented models were combined, resampled to have isotropic voxel sizes, triangularly meshed, and scaled to different sizes. These masses were referred to as nonspiculated masses and were then used as nuclei onto which spicules were grown with an iterative branching algorithm forming a total of 30 spiculated masses. These 55 mass models were projected into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. The realism of the appearance of these mass models was assessed by five radiologists via receiver operating characteristic (ROC) analysis when compared to 54 real masses. All lesions were also given a breast imaging reporting and data system (BIRADS) score. The data sets of 2D mammography and tomosynthesis were read separately. The Kendall's coefficient of concordance was used for the interrater observer agreement assessment for the BIRADS scores per modality. Further paired analysis, using the Wilcoxon signed rank test, of the BIRADS assessment between 2D and tomosynthesis was separately performed for the real masses and for the simulated masses. Results: The area under the ROC curves, averaged over all observers, was 0.54 (95% confidence interval [0.50, 0.66]) for the 2D study, and 0.67 (95% confidence interval [0.55, 0.79]) for the tomosynthesis study. According to the BIRADS scores, the nonspiculated and the spiculated masses varied in their degrees of malignancy from normal (BIRADS 1) to highly

  11. The simulation of 3D mass models in 2D digital mammography and breast tomosynthesis.

    Science.gov (United States)

    Shaheen, Eman; De Keyzer, Frederik; Bosmans, Hilde; Dance, David R; Young, Kenneth C; Van Ongeval, Chantal

    2014-08-01

    This work proposes a new method of building 3D breast mass models with different morphological shapes and describes the validation of the realism of their appearance after simulation into 2D digital mammograms and breast tomosynthesis images. Twenty-five contrast enhanced MRI breast lesions were collected and each mass was manually segmented in the three orthogonal views: sagittal, coronal, and transversal. The segmented models were combined, resampled to have isotropic voxel sizes, triangularly meshed, and scaled to different sizes. These masses were referred to as nonspiculated masses and were then used as nuclei onto which spicules were grown with an iterative branching algorithm forming a total of 30 spiculated masses. These 55 mass models were projected into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. The realism of the appearance of these mass models was assessed by five radiologists via receiver operating characteristic (ROC) analysis when compared to 54 real masses. All lesions were also given a breast imaging reporting and data system (BIRADS) score. The data sets of 2D mammography and tomosynthesis were read separately. The Kendall's coefficient of concordance was used for the interrater observer agreement assessment for the BIRADS scores per modality. Further paired analysis, using the Wilcoxon signed rank test, of the BIRADS assessment between 2D and tomosynthesis was separately performed for the real masses and for the simulated masses. The area under the ROC curves, averaged over all observers, was 0.54 (95% confidence interval [0.50, 0.66]) for the 2D study, and 0.67 (95% confidence interval [0.55, 0.79]) for the tomosynthesis study. According to the BIRADS scores, the nonspiculated and the spiculated masses varied in their degrees of malignancy from normal (BIRADS 1) to highly suggestive for malignancy (BIRADS 5

  12. Presumed prevalence analysis on suspected and highly suspected breast cancer lesions in São Paulo using BIRADS® criteria

    Directory of Open Access Journals (Sweden)

    Vivian Milani

    Full Text Available CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI, Institute of Diagnostic Imaging (IDI and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR criteria (Breast Imaging Reporting and Data System, BIRADS®, the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS® 4 and highly suspected (BIRADS® 5 lesions increased with age, especially after the fourth decade. Accordingly, BIRADS® 4 and BIRADS® 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6% and it is similar to the prevalence of breast cancer observed in other populations.

  13. Identification and characterization of tebuconazole transformation products in soil by combining suspect screening and molecular typology.

    Science.gov (United States)

    Storck, Veronika; Lucini, Luigi; Mamy, Laure; Ferrari, Federico; Papadopoulou, Evangelia S; Nikolaki, Sofia; Karas, Panagiotis A; Servien, Remi; Karpouzas, Dimitrios G; Trevisan, Marco; Benoit, Pierre; Martin-Laurent, Fabrice

    2016-01-01

    Pesticides generate transformation products (TPs) when they are released into the environment. These TPs may be of ecotoxicological importance. Past studies have demonstrated how difficult it is to predict the occurrence of pesticide TPs and their environmental risk. The monitoring approaches mostly used in current regulatory frameworks target only known ecotoxicologically relevant TPs. Here, we present a novel combined approach which identifies and categorizes known and unknown pesticide TPs in soil by combining suspect screening time-of-flight mass spectrometry with in silico molecular typology. We used an empirical and theoretical pesticide TP library for compound identification by both non-target and target time-of-flight (tandem) mass spectrometry, followed by structural proposition through a molecular structure correlation program. In silico molecular typology was then used to group TPs according to common molecular descriptors and to indirectly elucidate their environmental parameters by analogy to known pesticide compounds with similar molecular descriptors. This approach was evaluated via the identification of TPs of the triazole fungicide tebuconazole occurring in soil during a field dissipation study. Overall, 22 empirical and 12 yet unknown TPs were detected, and categorized into three groups with defined environmental properties. This approach combining suspect screening time-of-flight mass spectrometry with molecular typology could be extended to other organic pollutants and used to rationalize the choice of TPs to be investigated towards a more comprehensive environmental risk assessment scheme. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Ultrasonography of pelvic masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chu Wan; Lee, Kyung Hi; Yeon, Kyung Mo; Choo, Dong Woon; Rha, Keun Yung; Kim, Syng Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1980-06-15

    56 cases of ultrasonography in patient with proven pelvic mass were reviewed. Ultrasonography is a very useful noninvasive diagnostic modality in the patient with clinically suspected pelvic masses giving accurate assessment of the size, location, internal structure and origin as well as its existence. A specific diagnosis was possible in selected patients with ovarian cystadenoma, dermoids, uterine myoma, and H-mode. Nonspecific pattern was common in pelvic abscess and ectopic pregnancy. Diagnostic errors were primarily due to small lesions (2 cm or less in diameter) or misinterpretation of the lesion.

  15. The use of psychoactive prescription drugs among DUI suspects.

    Science.gov (United States)

    Karjalainen, Karoliina; Haukka, Jari; Lintonen, Tomi; Joukamaa, Matti; Lillsunde, Pirjo

    2015-10-01

    The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Book Review: Placing the Suspect behind the Keyboard: Using Digital Forensics and Investigative Techniques to Identify Cybercrime Suspects

    Directory of Open Access Journals (Sweden)

    Thomas Nash

    2013-06-01

    Full Text Available Shavers, B. (2013. Placing the Suspect behind the Keyboard: Using Digital Forensics and Investigative Techniques to Identify Cybercrime Suspects. Waltham, MA: Elsevier, 290 pages, ISBN-978-1-59749-985-9, US$51.56. Includes bibliographical references and index.Reviewed by Detective Corporal Thomas Nash (tnash@bpdvt.org, Burlington Vermont Police Department, Internet Crime against Children Task Force. Adjunct Instructor, Champlain College, Burlington VT.In this must read for any aspiring novice cybercrime investigator as well as the seasoned professional computer guru alike, Brett Shaver takes the reader into the ever changing and dynamic world of Cybercrime investigation.  Shaver, an experienced criminal investigator, lays out the details and intricacies of a computer related crime investigation in a clear and concise manner in his new easy to read publication, Placing the Suspect behind the Keyboard. Using Digital Forensics and Investigative techniques to Identify Cybercrime Suspects. Shaver takes the reader from start to finish through each step of the investigative process in well organized and easy to follow sections, with real case file examples to reach the ultimate goal of any investigation: identifying the suspect and proving their guilt in the crime. Do not be fooled by the title. This excellent, easily accessible reference is beneficial to both criminal as well as civil investigations and should be in every investigator’s library regardless of their respective criminal or civil investigative responsibilities.(see PDF for full review

  17. Cholescintigraphy and ultrasonography in patients suspected of having acute cholecystitis

    DEFF Research Database (Denmark)

    Lauritsen, K B; Sommer, W; Hahn, L

    1988-01-01

    The diagnostic power of combined cholescintigraphy and ultrasonography was tested in 67 patients suspected of having acute cholecystitis; of these, 42 (63%) had acute cholecystitis. The predictive value of a positive scintigraphy (PVpos) was 95% and that of a negative (PVneg) was 91% (n = 67...... that in patients suspected of having acute cholecystitis cholescintigraphy should be the first diagnostic procedure performed. If the scintigraphy is positive, additional ultrasonographic detection of gallstones makes the diagnosis almost certain. If one diagnostic modality is inconclusive, the other makes a fair...

  18. Symptomatic Patency Capsule Retention in Suspected Crohn's Disease

    DEFF Research Database (Denmark)

    Rasmussen, Bjørn; Nathan, Torben; Jensen, Michael Dam

    2016-01-01

    The main limitation of capsule endoscopy is the risk of capsule retention. In patients with suspected Crohn's disease, however, this complication is rare, and if a small bowel stenosis is not reliably excluded, small bowel patency can be confirmed with the Pillcam patency capsule. We present two...... patients examined for suspected Crohn's disease who experienced significant symptoms from a retained patency capsule. Both patients had Crohn's disease located in the terminal ileum. In one patient, the patency capsule caused abdominal pain and vomiting and was visualized at magnetic resonance enterography...

  19. Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique?

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, Nyree; Grant, Lee A.; Freeman, Susan J.; Berman, Laurence H.; Sala, Evis [Addenbrooke' s Hospital, Department of Radiology, Cambridge (United Kingdom); Jimenez-Linan, Mercedes [Addenbrooke' s Hospital, Department of Histopathology, Cambridge (United Kingdom); Earl, Helena; Ahmed, Ahmed Ashour; Crawford, Robin; Brenton, James [Addenbrooke' s Hospital, Department of Oncology, Cambridge (United Kingdom)

    2009-01-15

    In patients with suspected advanced ovarian carcinoma, a precise histological diagnosis is required before commencing neo-adjuvant chemotherapy. This study aims to determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under ultrasound or computed tomography guidance. Between 2002 to 2007, 60 consecutive image-guided percutaneous biopsies were performed in patients with suspected ovarian cancer. The following variables were recorded: tissue biopsied, imaging technique, experience of operator, biopsy needle gauge, number of passes, complications, and final histology. Forty-seven patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. Thirty-five biopsies were performed under ultrasound, 25 under computed tomography guidance. Biopsy needle gauges ranged from 14-20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies. (orig.)

  20. PMS2 Involvement in Patients Suspected of Lynch Syndrome

    NARCIS (Netherlands)

    Niessen, Renee C.; Kleibeuker, Jan H.; Westers, Helga; Jager, Paul O. J.; Rozeveld, Dennie; Bos, Krista K.; Boersma-van Ek, Wytske; Hollema, Harry; Sijmons, Rolf H.; Hofstra, Robert M. W.

    It is well-established that germline mutations in the mismatch repair genes MLH1, MSH2, and MSH6 cause Lynch syndrome. However, mutations in these three genes do not account for all Lynch syndrome (suspected) families. Recently, it was shown that germline mutations in another mismatch repair gene,

  1. Faecal Calprotectin in Suspected Paediatric Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Degraeuwe, Pieter L. J.; Beld, Monique P. A.; Ashorn, Merja; Canani, Roberto Berni; Day, Andrew S.; Diamanti, Antonella; Fagerberg, Ulrika L.; Henderson, Paul; Kolho, Kaija-Leena; Van de Vijver, Els; van Rheenen, Patrick F.; Wilson, David C.; Kessels, Alfons G. H.

    Objectives: The diagnostic accuracy of faecal calprotectin (FC) concentration for paediatric inflammatory bowel disease (IBD) is well described at the population level, but not at the individual level. We reassessed the diagnostic accuracy of FC in children with suspected IBD and developed an

  2. Stabilization of the spine in patients with suspected cervical spine ...

    African Journals Online (AJOL)

    Stabilization of the spine in patients with suspected cervical spine injury in Mulago Hospital. BM Ndeleva, T Beyeza. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/eaoj.v5i1.67487 · AJOL African Journals ...

  3. Talking heads : interviewing suspects from a cultural perspective

    NARCIS (Netherlands)

    Beune, K.

    2009-01-01

    Although the literature on the interviewing of suspects has increased over the past decade, research on the use and effectiveness of police strategies and their boundary conditions is very rare. The present dissertation aims to fill this void by identifying behaviors that appeal to and persuade

  4. Nonreferral of Nursing Home Patients With Suspected Breast Cancer

    NARCIS (Netherlands)

    Hamaker, Marije E.; Hamelinck, Victoria C.; van Munster, Barbara C.; Bastiaannet, Esther; Smorenburg, Carolien H.; Achterberg, Wilco P.; Liefers, Gerrit-Jan; de Rooij, Sophia E.

    2012-01-01

    Introduction: People with suspected breast cancer who are not referred for diagnostic testing remain unregistered and are not included in cancer statistics. Little is known about the extent of and motivation for nonreferral of these patients. Methods: A Web-based survey was sent to all elderly care

  5. DNA typing from vaginal smear slides in suspected rape cases

    Directory of Open Access Journals (Sweden)

    Dayse Aparecida da Silva

    Full Text Available In an investigation of suspected rape, proof of sexual assault with penetration is required. In view of this, detailed descriptions of the genitalia, the thighs and pubic region are made within the forensic medical service. In addition, vaginal swabs are taken from the rape victim and some of the biological material collected is then transferred to glass slides. In this report, we describe two rape cases solved using DNA typing from cells recovered from vaginal smear slides. In 1999, two young women informed the Rio de Janeiro Police Department that they had been victims of sexual assaults. A suspect was arrested and the victims identified him as the offender. The suspect maintained that he was innocent. In order to elucidate these crimes, vaginal smear slides were sent to the DNA Diagnostic Laboratory for DNA analysis three months after the crimes, as unique forensic evidence. To get enough epithelial and sperm cells to perform DNA analysis, we used protocols modified from the previously standard protocols used for DNA extraction from biological material fixed on glass slides. The quantity of cells was sufficient to perform human DNA typing using nine short tandem repeat (STR loci. It was 3.3 billion times more probable that it was the examined suspect who had left sperm cells in the victims, rather than any other individual in the population of Rio de Janeiro.

  6. Cognitive Linguistic Performances of Multilingual University Students Suspected of Dyslexia

    Science.gov (United States)

    Lindgren, Signe-Anita; Laine, Matti

    2011-01-01

    High-performing adults with compensated dyslexia pose particular challenges to dyslexia diagnostics. We compared the performance of 20 multilingual Finnish university students with suspected dyslexia with 20 age-matched and education-matched controls on an extensive test battery. The battery tapped various aspects of reading, writing, word…

  7. Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech

    Science.gov (United States)

    Murray, Elizabeth; McCabe, Patricia; Heard, Robert; Ballard, Kirrie J.

    2015-01-01

    Purpose: The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders. Method: Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language…

  8. A suspected case of Addison’s disease in cattle

    OpenAIRE

    Lambacher, Bianca; Wittek, Thomas

    2015-01-01

    A 4.75-year old Simmental cow was presented with symptoms of colic and ileus. The clinical signs and blood analysis resulted in the diagnosis of suspected primary hypoadrenocorticism (Addison’s disease). Although Addison’s disease has been frequently described in other domestic mammals, to our knowledge, this disease has not previously been reported in cattle.

  9. Is extended biopsy protocol justified in all patients with suspected ...

    African Journals Online (AJOL)

    Objective: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. Materials and Methods: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided ...

  10. Correlates and Suspected Causes of Obesity in Children

    Science.gov (United States)

    Crothers, Laura M.; Kehle, Thomas J.; Bray, Melissa A.; Theodore, Lea A.

    2009-01-01

    The correlates and suspected causes of the intractable condition obesity are complex and involve environmental and heritable, psychological and physical variables. Overall, the factors associated with and possible causes of it are not clearly understood. Although there exists some ambiguity in the research regarding the degree of happiness in…

  11. Medical Evaluation of Suspected Child Sexual Abuse: 2011 Update

    Science.gov (United States)

    Adams, Joyce A.

    2011-01-01

    The medical evaluation of children with suspected sexual abuse includes more than just the physical examination of the child. The importance of taking a detailed medical history from the parents and a history from the child about physical sensations following sexual contact has been emphasized in other articles in the medical literature. The…

  12. Selective screening in neonates suspected to have inborn errors of ...

    African Journals Online (AJOL)

    Background: Inborn errors of metabolism (IEM) have a high morbidity and mortality in neonates. Unfortunately, there is no nationwide neonatal screen in Egypt, so several cases may be missed. Objective: The aim of this work was to detect the prevalence of IEM among neonates with suspected IEM, and to diagnose IEM as ...

  13. Sexual Health Before Treatment in Women with Suspected Gynecologic Malignancy.

    Science.gov (United States)

    Bretschneider, C Emi; Doll, Kemi M; Bensen, Jeannette T; Gehrig, Paola A; Wu, Jennifer M; Geller, Elizabeth J

    2017-08-22

    Sexual health in survivors of gynecologic cancer has been studied; however, sexual health in these women before treatment has not been thoroughly evaluated. The objective of our study was to describe the pretreatment characteristics of sexual health of women with suspected gynecologic cancer before cancer treatment. We performed a cross-sectional analysis of women with a suspected gynecologic cancer, who were prospectively enrolled in a hospital-based cancer survivorship cohort from August 2012 to June 2013. Subjects completed the validated Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire. Pretreatment sexual health was assessed in terms of sexual interest, desire, lubrication, discomfort, orgasm, enjoyment, and satisfaction. Of 186 eligible women with suspected gynecologic cancer, 154 (82%) completed the questionnaire pretreatment. Mean age was 58.1 ± 13.3 years. Sexual health was poor: 68.3% reported no sexual activity, and 54.7% had no interest in sexual activity. When comparing our study population to the general U.S. population, the mean pretreatment scores for the subdomains of lubrication and vaginal discomfort were similar, while sexual interest was significantly lower and global satisfaction was higher. In a linear regression model, controlling for cancer site, age remained significantly associated with sexual function while cancer site did not. Problems with sexual health are prevalent in women with suspected gynecologic malignancies before cancer treatment. Increasing awareness of the importance of sexual health in this population will improve quality of life for these women.

  14. Use of budesonide Turbuhaler in young children suspected of asthma

    DEFF Research Database (Denmark)

    Bisgaard, H; Pedersen, S; Nikander, K

    1994-01-01

    The question addressed in this study was the ability of young children to use a dry-powder inhaler, Turbuhaler. One hundred and sixty five children suspected of asthma, equally distributed in one year age-groups from 6 months to 8 yrs, inhaled from a Pulmicort Turbuhaler, 200 micrograms budesonid...

  15. Doppler ultrasound in the assessment of suspected intra-uterine ...

    African Journals Online (AJOL)

    Ramakantb

    obesity with hypertension and non-insulin-dependent diabetes mellitus.[3] In this review, a brief discussion about the ultrasound diagnosis of suspected IUGR, and thereafter about the use of Doppler ultrasound in the diagnosis of IUGR, will be ... before that, all fetuses have relatively larger heads, which will mask the brain-.

  16. Candida meningitis in a suspected immunosuppressive patient - A ...

    African Journals Online (AJOL)

    Candida meningitis in a suspected immunosuppressive patient - A case report. EO Sanya, NB Ameen, BA Onile. Abstract. No Abstract. West African Journal of Medicine Vol. 25 (1) 2006: pp.79-81. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  17. Ajmaline challenge in young individuals with suspected Brugada syndrome

    NARCIS (Netherlands)

    Sorgente, A.; Sarkozy, A.; Asmundis, C. de; Chierchia, G.B.; Capulzini, L.; Paparella, G.; Henkens, S.; Brugada, P.

    2011-01-01

    BACKGROUND: The clinical characteristics and the results of ajmaline challenge in young individuals with suspected Brugada syndrome (BS) have not been systematically investigated. METHODS: Among a larger series of patients included in the BS database of our Department, 179 patients undergoing

  18. A Diagnostic Program for Patients Suspected of Having Lung Cancer

    NARCIS (Netherlands)

    Stigt, Jos A.; Uil, Steven M.; Oostdijk, Ad H.; Boers, James E.; van den Berg, Jan-Willem K.; Groen, Harry J. M.

    2012-01-01

    In 297 patients suspected of having lung cancer, invasive diagnostic procedures followed positron emission tomography/computed tomography (PET-CT) on the same day. For patients with a diagnosis of malignancy (215/297), investigations were finalized on 1 day in 85%, and bronchoscopy was performed in

  19. Use of Chest Radiography In Patients Suspected of Pulmonary ...

    African Journals Online (AJOL)

    may be rushed into treatfng all cases of cough, fever and weight loss with negative sputums as PTB, and other diagnoses may be overlooked. A cheaper, quicker way of screening TB suspects would help con- siderably in this common problem. In Febuary 1991, the Norwegian Government do- nated two Odelka camer;l,s to ...

  20. Opioid analgesic administration in patients with suspected drug use.

    Science.gov (United States)

    Kreling, Maria Clara Giorio Dutra; Mattos-Pimenta, Cibele Andrucioli de

    2017-01-01

    To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a significance level of 5% were used for the analyzes. The prevalence of suspected patients was 6.7%. The prevalence ratio of administration of opioid analgesics 'if necessary' is twice higher among patients suspected of drug use compared to patients not suspected of drug use (p = 0.037). The prevalence of patients suspected of drug use was similar to that of studies performed in emergency departments. Patients suspected of drug use receive more opioids than patients not suspected of drug use. Identificar a prevalência de pacientes com suspeita de uso de drogas conforme opinião de profissionais de enfermagem e comparar a conduta desses profissionais na administração de opioides quando há ou não suspeita de que o paciente seja usuário de drogas. Estudo transversal com 507 pacientes e 199 profissionais de enfermagem responsáveis pela administração de medicamentos a esses pacientes. Para as análises foram utilizados os testes de Qui-Quadrado, Exato de Fisher e um nível de significância de 5%. A prevalência de pacientes suspeitos foi 6,7%. A razão de prevalência de administração de analgésicos opioides "se necessário" é duas vezes maior entre os pacientes suspeitos em relação aos não suspeitos (p=0,037). A prevalência de suspeitos foi semelhante à de estudos realizados em departamentos de emergência. Os suspeitos de serem usuários de drogas recebem mais opioides do que os não suspeitos.

  1. Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture

    Energy Technology Data Exchange (ETDEWEB)

    Tiel-van Buul, M.M.C. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Roolker, W. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Verbeeten, B.W.B. Jr. [Dept. of Radiology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Broekhuizen, A.H. [Dept. of Traumatology, Academic Medical Center, Univ. of Amsredam (Netherlands)

    1996-08-01

    Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy. (orig.)

  2. Square-wave anodic-stripping voltammetric determination of Cd, Pb, and Cu in a hydrofluoric acid solution of siliceous spicules of marine sponges (from the Ligurian Sea, Italy, and the Ross Sea, Antarctica)

    Energy Technology Data Exchange (ETDEWEB)

    Truzzi, C.; Annibaldi, A.; Illuminati, S.; Bassotti, E.; Scarponi, G. [Polytechnic University of Marche, Ancona (Italy). Department of Marine Science

    2008-09-15

    Square-wave anodic-stripping voltammetry (SWASV) was set up and optimized for simultaneous determination of cadmium, lead, and copper in siliceous spicules of marine sponges, directly in the hydrofluoric acid solution ({proportional_to}0.55 mol L{sup -1} HF, pH {proportional_to}1.9). A thin mercury-film electrode (TMFE) plated on to an HF-resistant epoxy-impregnated graphite rotating-disc support was used. The optimum experimental conditions, evaluated also in terms of the signal-to-noise ratio, were as follows: deposition potential -1100 mV vs. Ag/AgCl, KCl 3 mol L{sup -1}, deposition time 3-10 min, electrode rotation 3000 rpm, SW scan from -1100 mV to +100 mV, SW pulse amplitude 25 mV, frequency 100 Hz, {delta}E{sub step} 8 mV, t{sub step} 100 ms, t{sub wait} 60 ms, t{sub delay} 2 ms, t{sub meas} 3 ms. Under these conditions the metal peak potentials were Cd -654{+-}1 mV, Pb -458 {+-} 1 mV, Cu -198{+-}1 mV. The electrochemical behaviour was reversible for Pb, quasi-reversible for Cd, and kinetically controlled (possibly following chemical reaction) for Cu. The linearity of the response with concentration was verified up to {proportional_to}4 {mu}g L{sup -1} for Cd and Pb and {proportional_to}20 {mu}g L{sup -1} for Cu. The detection limits were 5.8 ng L{sup -1}, 3.6 ng L{sup -1}, and 4.3 ng L{sup -1} for Cd, Pb, and Cu, respectively, with t{sub d}=5 min. The method was applied for determination of the metals in spicules of two specimens of marine sponges (Demosponges) from the Portofino natural reserve (Ligurian Sea, Italy, Petrosia ficiformis) and Terra Nova Bay (Ross Sea, Antarctica, Sphaerotylus antarcticus). The metal contents varied from tens of ng g{sup -1} to {proportional_to}1 {mu}g g{sup -1}, depending on the metal considered and with significant differences between the two sponge species. (orig.)

  3. Target and suspect screening of psychoactive substances in sewage-based samples by UHPLC-QTOF.

    Science.gov (United States)

    Baz-Lomba, J A; Reid, Malcolm J; Thomas, Kevin V

    2016-03-31

    The quantification of illicit drug and pharmaceutical residues in sewage has been shown to be a valuable tool that complements existing approaches in monitoring the patterns and trends of drug use. The present work delineates the development of a novel analytical tool and dynamic workflow for the analysis of a wide range of substances in sewage-based samples. The validated method can simultaneously quantify 51 target psychoactive substances and pharmaceuticals in sewage-based samples using an off-line automated solid phase extraction (SPE-DEX) method, using Oasis HLB disks, followed by ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC-QTOF) in MS(e). Quantification and matrix effect corrections were overcome with the use of 25 isotopic labeled internal standards (ILIS). Recoveries were generally greater than 60% and the limits of quantification were in the low nanogram-per-liter range (0.4-187 ng L(-1)). The emergence of new psychoactive substances (NPS) on the drug scene poses a specific analytical challenge since their market is highly dynamic with new compounds continuously entering the market. Suspect screening using high-resolution mass spectrometry (HRMS) simultaneously allowed the unequivocal identification of NPS based on a mass accuracy criteria of 5 ppm (of the molecular ion and at least two fragments) and retention time (2.5% tolerance) using the UNIFI screening platform. Applying MS(e) data against a suspect screening database of over 1000 drugs and metabolites, this method becomes a broad and reliable tool to detect and confirm NPS occurrence. This was demonstrated through the HRMS analysis of three different sewage-based sample types; influent wastewater, passive sampler extracts and pooled urine samples resulting in the concurrent quantification of known psychoactive substances and the identification of NPS and pharmaceuticals. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. A rational clinical approach to suspected insulin allergy

    DEFF Research Database (Denmark)

    Bødtger, Uffe; Wittrup, M

    2005-01-01

    AIMS: Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy...... technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom...... relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms. CONCLUSION: Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41...

  5. Interdisciplinary action of nurses to children with suspected sexual abuse

    Directory of Open Access Journals (Sweden)

    Lia Leão Ciuffo

    2014-04-01

    Full Text Available Objective. Understanding the role of nurses as members of interdisciplinary teams in the care of children with suspected sexual abuse. Methodology. This is a qualitative research based on the sociological phenomenology of Alfred Schutz. In 2008 were interviewed eleven nurses who worked in reference institutions for the care of child victims of sexual abuse in Rio de Janeiro. Results. The category called 'Interacting with other professionals in child care' emerged from the analysis of performance of professionals. The intersubjective relations between the nurses and the interdisciplinary team will enable to understand the intent of care from the perspective of social, emotional and psychological needs of children and their families. Conclusion. Interdisciplinarity favored the development of actions based on acceptance, listening and agreements on possible solutions in the care of children with suspected sexual abuse.

  6. Atlantoaxial subluxation and nasopharyngeal necrosis complicating suspected granulomatosis with polyangiitis.

    Science.gov (United States)

    Mohapatra, Anand; Holekamp, Terrence F; Diaz, Jason A; Zebala, Lukas; Brasington, Richard

    2015-04-01

    Granulomatosis polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. The 2 established methods to confirm a suspicion of GPA are the antineutrophil cytoplasmic antibody (ANCA) test and biopsy. However, ANCA-negative cases have been known to occur, and it can be difficult to find biopsy evidence of granulomatous disease.We report a case of suspected granulomatosis with polyangiitis limited to the nasopharynx. With a negative ANCA and no histological evidence, our diagnosis was founded on the exclusion of other diagnoses and the response to cyclophosphamide therapy. This case is unique because the patient's lesion resulted in atlantoaxial instability, which required a posterior spinal fusion at C1-C2. This is the first reported case of suspected GPA producing damage to the cervical spine and threatening the spinal cord.

  7. Suspected side effects to the quadrivalent human papilloma vaccine

    DEFF Research Database (Denmark)

    Brinth, Louise; Theibel, Ann Cathrine; Pors, Kirsten

    2015-01-01

    INTRODUCTION: The quadrivalent vaccine that protects against human papilloma virus types 6, 11, 16 and 18 (Q-HPV vaccine, Gardasil) was included into the Danish childhood vaccination programme in 2009. During the past years, a collection of symptoms primarily consistent with sympathetic nervous...... system dysfunction have been described as suspected side effects to the Q-HPV vaccine. METHODS: We present a description of suspected side effects to the Q-HPV vaccine in 53 patients referred to our Syncope Unit for tilt table test and evaluation of autonomic nervous system function. RESULTS: All...... consistency in the reported symptoms as well as between our findings and those described by others. Our findings neither confirm nor dismiss a causal link to the Q-HPV vaccine, but they suggest that further research is urgently warranted to clarify the pathophysiology behind the symptoms experienced...

  8. Radiological (scintigraphic) evaluation of patients with suspected pulmonar thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Biello, D.R.

    1987-06-19

    The optimal strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism (PE) is subject of controversial and often conflicting opinions. If untreated, as many as 30% of patients with PE may die. Conversely, anticoagulant therapy significantly decreases mortality from PE, but bleeding complications occur. Underdiagnosis may result in a preventable death, and overdiagnosis may lead to significant hemorrhage from unnecessary anticoagulant therapy. This article outlines a practical guide for the use of pulmonary ventilation-perfusion (V-P) scintigraphy in patients with suspected PE. Perfusion imaging involves the intravenous injection of radiolabeled particles ranging from 10 to 60 ..mu..m in diameter (technetium Tc 99m macroaggregated albumin or technetium Tc 99m serum albumin microspheres); these particles are trapped in the capillaries and precapillary arterioles of the lung. The radiolabeled particles are distributed to the lungs in proportion to regional pulmonary blood flow. The correspondence of perfusion defects to bronchopulmonary segments is best appreciated in the posterior oblique views.

  9. Radiotherapy in three suspect cases of feline thymoma.

    Science.gov (United States)

    Kaser-Hotz, B; Rohrer, C R; Fidel, J L; Nett, C S; Hörauf, A; Hauser, B

    2001-01-01

    Radiation therapy for three cases of suspect feline thymoma is described. The thymoma was controlled for 4 years in case no. 1. Case no. 2 responded well to radiation therapy but was euthanized after 2 months because of a nasal adenocarcinoma. Case no. 3 continues to do well more than 8 months after radiotherapy. Difficulties in diagnosing feline thymomas are discussed, and biological behavior as well as different treatment modalities of feline and human thymomas are compared.

  10. Percutaneous cholecystocentesis in cats with suspected hepatobiliary disease.

    Science.gov (United States)

    Byfield, Victoria L; Callahan Clark, Julie E; Turek, Bradley J; Bradley, Charles W; Rondeau, Mark P

    2017-12-01

    Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.

  11. Interviewing strategically to elicit admissions from guilty suspects

    OpenAIRE

    Tekin, Serra; Granhag, Pär Anders; Strömwall, Leif; Giolla, Erik Mac; Vrij, Aldert; Hartwig, Maria

    2015-01-01

    In this article we introduce a novel interviewing tactic to elicit admissions from guilty suspects. By influencing the suspects’ perception of the amount of evidence the interviewer holds against them, we aimed to shift the suspects’ counterinterrogation strategies from less to more forthcoming. The proposed tactic (SUE-Confrontation) is a development of the Strategic Use of Evidence (SUE) framework and aims to affect the suspects’ perception by confronting them with statement-evidence incons...

  12. MRI for clinically suspected pediatric appendicitis: case interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Brian, James M.; Methratta, Sosamma T.; Hulse, Michael A.; Choudhary, Arabinda K.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Division of Pediatric Radiology, Department of Radiology, Hershey, PA (United States)

    2014-05-15

    As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed. (orig.)

  13. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

  14. Epidemiology of suspected wrist joint infection versus inflammation.

    Science.gov (United States)

    Skeete, Kshamata; Hess, Erik P; Clark, Tod; Moran, Steven; Kakar, Sanjeev; Rizzo, Marco

    2011-03-01

    To determine the cumulative prevalence of septic arthritis presenting to the emergency department of an academic medical center and evaluate the use of clinical data to diagnose infection versus inflammation. We conducted a records review of a single institution with 80,000 annual emergency room visits. We included a consecutive series of patients with suspected wrist infection from January 1, 2007, to December 31, 2008. Adults complaining of atraumatic wrist pain with either erythema or swelling on physical examination or a final diagnosis of septic arthritis, gout, pseudogout, cellulitis, wrist hematoma/edema, or wrist arthritic flare were suspected to have infection. We collected data using a standardized data abstraction form. We reviewed 804 patient records. A total of 104 patients meeting inclusion criteria for suspected wrist joint infection during the 2-year study period were included. Mean age was 62.5 years (SD, 20.2 y); 63 were men. There were 12 patients with a history of gout, 4 with a history of pseudogout, and 19 with a history of diabetes. Wrist arthrocentesis was performed in 31 patients, and 11 underwent surgical treatment. There were 16 patients with a final diagnosis of gout, 11 with pseudogout, 43 with cellulitis, 13 with upper extremity hematoma/edema, and 15 with wrist arthritic flare. The cumulative prevalence of septic arthritis was 5%. In this series of emergency department patients with suspected wrist joint infection, gout, pseudogout, and cellulitis were the most common etiologies. The cumulative incidence of septic wrist arthritis was low. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Suspected spinocellular carcinoma of the inferior eyelid resulted multiple chalazion.

    Science.gov (United States)

    Onesti, Maria Giuseppina; Troccola, Antonietta; Maruccia, Michele; Conversi, Andrea; Scuderi, Gianluca

    2013-01-01

    Chalazion is a subacute granulomatous inflammation of the eyelid caused by retention of tarsal gland secretions and it's the most common inflammatory lesion of the eyelid. In cases of doubtful clinical presentation the diagnosis with a biopsy and a histopathological examination is important because it can orientate an appropriate surgical treatment. We report a case of a 64-years-old diabetic man, suspected for a spinocellular lesion of the inferior eyelid of the left eye, it resulted unexpectedly a chalazion.

  16. [Three cases of suspected re-infection of mumps virus].

    Science.gov (United States)

    Hatanaka, Akio; Kamada, Tomoko; Honda, Keiji; Tazaki, Akihisa; Kishine, Naomi; Kawashima, Yoshiyuki

    2012-08-01

    A 32-year-old woman, 5-year-old girl, and 33-year-old man visited our otorhinolaryngology outpatient clinic with tumentia of the unilateral parotid gland. A high titer of serum IgG antibodies against the mumps virus was detected. Around the same time, other members of their families had the same parotid tumentia, and they were diagnosed as having their first mumps infection. Therefore, the diagnosis of the three cases was strongly suspected to be re-infection with mumps. In Japan, it was classically believed that the mumps virus infection occurs only once in patients and reinfection doesn't occur. However, some pediatricians in Japan have reported that re-infection with mumps is strongly suspected when high titers of serum IgG antibodies against the mumps virus are found at the initial visit. It is now believed many more examples of mumps re-infection cases have existed than we previously believed. When high titers of serum IgG antibodies against the mumps virus are detected at an initial visit in patients who have had mumps previously, re-infection should be strongly suspected. And to make it certain, we suggest that the mumps IgG antibodies should be checked twice to confirm the diagnosis. If elevation of the IgG antibodies persist, the diagnosis will be much more certain.

  17. Ten-day observation of live rabies suspected dogs.

    Science.gov (United States)

    Tepsumethanon, V; Wilde, H; Sitprija, V

    2008-01-01

    This study aimed at analyzing a ten-day observation period of rabies suspected dogs and cats according to six criteria. Dogs and cats suspected of being rabid were brought for observation when they had either bitten a person or another animal or when abnormal behaviour or unusual illness was observed. Between 1985 and 2005, retrospective and prospective data from 1,222 dogs and 303 cats was collected during the ten-day observation period. If an animal had died, brain examination using fluorescent antibody testing was routinely performed. If an animal had survived for > or =10 days, it was released to its owner or transferred to the municipal dog shelter. A total of 644 dogs and 58 cats found rabid died within 10 days of observation. In addition, for 208 dogs confirmed rabid with laboratory tests between 1997 and 2005, six criteria were analysed from the day of submission. This experience with the implemented 10-day observation period confirms the WHO recommendation on identifying suspected rabid dogs or cats under veterinary supervision following a human exposure.

  18. MR delayed enhancement imaging findings in suspected acute myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Gahide, Gerald [CHU de Montpellier, Radiologie centrale - Pole Cardiovasculaire et Thoracique, Montpellier (France); Centre Hospitalo-Universitaire de Montpellier, Hopital A de Villeneuve, Montpellier (France); Bertrand, D.; Dacher, J.N. [CHU de Rouen, Radiologie centrale - Hopital Charles Nicolle, Rouen (France); Roubille, F.; Skaik, S.; Piot, C.; Leclerq, F. [CHU de Montpellier, Departement de Cardiologie - Pole Cardiovasculaire et Thoracique, Montpellier (France); Tron, C.; Cribier, A. [CHU de Rouen, Departement de Cardiologie - Hopital Charles Nicolle, Rouen (France); Vernhet, H. [CHU de Montpellier, Radiologie centrale - Pole Cardiovasculaire et Thoracique, Montpellier (France)

    2010-01-15

    The purpose of the study was to prospectively assess the clinical impact of routinely performed delayed enhancement imaging in suspected acute myocarditis. A two-centre prospective study was performed in patients with suspected acute myocarditis. The protocol included horizontal long axis, vertical long axis and short axis cine MR and delayed enhancement imaging after Gd-DTPA infusion (0.2 mmol/kg). Sixty consecutive patients were enrolled (aged 49.4{+-}17.8 years). MRI demonstrated delayed enhancement sparing the subendocardicardial layer in 51.6% of patients, concordant with the diagnosis of acute myocarditis; 16.7% of patients exhibited delayed enhancement involving the subendocardial layer with irregular margins, concordant with the diagnosis of acute myocardial infarction; 31.7% of patients had delayed enhancement imaging that was considered normal. Routine imaging to identify delayed enhancement provided crucial information in suspected acute myocarditis by reinforcing the diagnosis in 51.6% of patients and correcting a misdiagnosed acute myocardial infarction in 16.7% of patients. (orig.)

  19. Low dose computed tomography in suspected acute renal colic.

    Science.gov (United States)

    Meagher, T; Sukumar, V P; Collingwood, J; Crawley, T; Schofield, D; Henson, J; Lakin, K; Connolly, D; Giles, J

    2001-11-01

    To evaluate whether computed tomography (CT) of the renal tract in suspected renal colic using reduced exposure factors maintains diagnostic accuracy. Prospective multi-centre cohort study. Patients with suspected renal colic were examined using computed tomography (CT) of the renal tract followed by intravenous urography (IVU) in four different centres with five different CT systems. Sixty-nine patients with suspected renal colic had CT of the renal tract followed by IVU. CT was performed with reduced exposure factors, giving a mean CT effective dose of 3.5 (range 2.8-4.5) mSv compared with 1.5 mSv for IVU. Ureteric calculi were detected in 43 patients: CT and IVU detected 40 (93%) ureteric calculi. CT identified other lesions causing symptoms in five patients and identified renal calculi in 24 patients. IVU identified renal calculi in six patients and made false positive diagnosis of renal calculi in seven patients. Mean examination time for CT was 5 minutes and for IVU was 80 minutes. CT examination at reduced exposure factors maintains the diagnostic accuracy recorded in other series. Copyright 2001 The Royal College of Radiologists.

  20. The economics of cardiac biomarker testing in suspected myocardial infarction.

    Science.gov (United States)

    Goodacre, Steve; Thokala, Praveen

    2015-03-01

    Suspected myocardial infarction (MI) is a common reason for emergency hospital attendance and admission. Cardiac biomarker measurement is an essential element of diagnostic assessment of suspected MI. Although the cost of a routinely available biomarker may be small, the large patient population and consequences in terms of hospital admission and investigation mean that the economic impact of cardiac biomarker testing is substantial. Economic evaluation involves comparing the estimated costs and effectiveness (outcomes) of two or more interventions or care alternatives. This process creates some difficulties with respect to cardiac biomarkers. Estimating the effectiveness of cardiac biomarkers involves identifying how they help to improve health and how we can measure this improvement. Comparison to an appropriate alternative is also problematic. New biomarkers may be promoted on the basis of reducing hospital admission or length of stay, but hospital admission for low risk patients may incur significant costs while providing very little benefit, making it an inappropriate comparator. Finally, economic evaluation may conclude that a more sensitive biomarker strategy is more effective but, by detecting and treating more cases, is also more expensive. In these circumstances it is unclear whether we should use the more effective or the cheaper option. This article provides an introduction to health economics and addresses the specific issues relevant to cardiac biomarkers. It describes the key concepts relevant to economic evaluation of cardiac biomarkers in suspected MI and highlights key areas of uncertainty and controversy. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  1. Limitation of personal freedom by detention of suspect

    Directory of Open Access Journals (Sweden)

    Knežević Saša

    2011-01-01

    Full Text Available The right of personal freedom is one of the most important right from the set of basic human rights and freedoms, contained in the most important acts of international legal character, and the constitutions of states based on the rule of law. This right is directly related to the very human existence, and, therefore, it is necessary to make its legal articulation. Personal freedom means the right to security of the citizen, that he will not be arrested and detained in prison by the state authorities, as well as the right to be free to move and inhabit. However, from the very nature of Criminal Law protection of social values, arises the need to limit the right to personal freedom in exceptional circumstances, including the detention of the suspect. Keeping the suspect is a measure of procedural compulsion, by which, through the police decision, detained prison is temporarily imprisoned, for gathering information and hearing. The basic principles of humanity require that the detained suspect retains all the rights, derived from the principle of personal liberty.

  2. MIBG in the evaluation of suspected pheochromocytoma: Mayo Clinic experience

    Energy Technology Data Exchange (ETDEWEB)

    Brown, M.L.; Sheps, S.G.; Sizemore, G.; Swensen, S.J.; Gharib, H.; Grant, C.S.; van Heerden, J.A.

    1984-01-01

    Work done at the University of Michigan has shown that I-131 metaiodobenzylguanidine (MIBG) is an effective agent for the diagnosis and localization of pheochromocytoma. A recent report questioned the sensitivity of this test. In 1983, 40 patients at Mayo Clinic had 42 scans during the workup of suspected spontaneous pheochromocytoma or metastatic pheochromocytoma. All patients were given 500 ..mu..Ci I-131 MIBG supplied by the University of Michigan. The final diagnosis of pheochromocytoma (true positive (TP) and false negative (FN) and false positive (FP)) was made by surgery and pathology. True negative (TN) diagnosis was made by normal plasma and urinary catecholamines, and in many patients CT. There were 15 TP studies (six spontaneous pheochrocytoma, nine metastatic or recurrent pheochromoctyoma), and 22 TN studies. There was one FP study of recurrent paraganglioma near the bladder (CT was also FP) and four FN studies (two spontaneous and two metastatic) where one CT was also FN. This results in a sensitivity of 79%, specificity of 96%, and accuracy of 88%. MIBG is very useful in the workup of patients with known or suspected recurrent or metastatic pheochromocytoma and is helpful in the evaluation of the patient suspected of having a spontaneous pheochromocytoma when CT is normal.

  3. Depressed mood, positive affect, and heart rate variability in patients with suspected coronary artery disease.

    Science.gov (United States)

    Bhattacharyya, Mimi R; Whitehead, Daisy L; Rakhit, Roby; Steptoe, Andrew

    2008-11-01

    To test associations between heart rate variability (HRV), depressed mood, and positive affect in patients with suspected coronary artery disease (CAD). Depression is associated with impaired HRV post acute cardiac events, but evidence in patients with stable coronary artery disease (CAD) is inconsistent. Seventy-six patients (52 men, 24 women; mean age = 61.1 years) being investigated for suspected CAD on the basis of symptomatology and positive noninvasive tests, completed 24-hour electrocardiograms. The Beck Depression Inventory (BDI) was administered, and positive and depressed affect was measured over the study period with the Day Reconstruction Method (DRM). A total of 46 (60.5%) patients were later found to have definite CAD. HRV was analyzed, using spectral analysis. Typical diurnal profiles of HRV were observed, with greater normalized high frequency (HF) and lower normalized low frequency (LF) power in the night compared with the day. BDI depression scores were not consistently associated with HRV. But positive affect was associated with greater normalized HF power (p = .039) and reduced normalized LF power (p = .007) independently of age, gender, medication with beta blockers, CAD status, body mass index, smoking, and habitual physical activity level. In patients with definite CAD, depressed affect assessed using the DRM was associated with reduced normalized HF power and heightened normalized LF power (p = .007) independently of covariates. Relationships between depression and HRV in patients with CAD may depend on affective experience over the monitoring period. Enhanced parasympathetic cardiac control may be a process through which positive affect protects against cardiovascular disease.

  4. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic.

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Platon, Alexandra; Rutschmann, Olivier T; Schmidlin, Franz R; Iselin, Christophe E; Becker, Christoph D

    2007-04-01

    The purpose of our study was to compare a low-dose abdominal CT protocol, delivering a dose of radiation close to the dose delivered by abdominal radiography, with standard-dose unenhanced CT in patients with suspected renal colic. One hundred twenty-five patients (87 men, 38 women; mean age, 45 years) who were admitted with suspected renal colic underwent both abdominal low-dose CT (30 mAs) and standard-dose CT (180 mAs). Low-dose CT and standard-dose CT were independently reviewed, in a delayed fashion, by two radiologists for the characterization of renal and ureteral calculi (location, size) and for indirect signs of renal colic (renal enlargement, pyeloureteral dilatation, periureteral or renal stranding). Results reported for low-dose CT, with regard to the patients' body mass indexes (BMIs), were compared with those obtained with standard-dose CT (reference standard). The presence of non-urinary tract-related disorders was also assessed. Informed consent was obtained from all patients. In patients with a BMI 3 mm. Low-dose CT was 100% sensitive and specific for depicting non-urinary tract-related disorders (n = 6). Low-dose CT achieves sensitivities and specificities close to those of standard-dose CT in assessing the diagnosis of renal colic, depicting ureteral calculi > 3 mm in patients with a BMI < 30, and correctly identifying alternative diagnoses.

  5. Core and Wing Densities of Asymmetric Coronal Spectral Profiles: Implications for the Mass Supply of the Solar Corona

    Science.gov (United States)

    Patsourakos, S.; Klimchuk, J. A.; Young, P. R.

    2014-01-01

    Recent solar spectroscopic observations have shown that coronal spectral lines can exhibit asymmetric profiles, with enhanced emissions at their blue wings. These asymmetries correspond to rapidly upflowing plasmas at speeds exceeding approximately equal to 50 km per sec. Here, we perform a study of the density of the rapidly upflowing material and compare it with that of the line core that corresponds to the bulk of the plasma. For this task, we use spectroscopic observations of several active regions taken by the Extreme Ultraviolet Imaging Spectrometer of the Hinode mission. The density sensitive ratio of the Fe(sub XIV) lines at 264.78 and 274.20 Angstroms is used to determine wing and core densities.We compute the ratio of the blue wing density to the core density and find that most values are of order unity. This is consistent with the predictions for coronal nanoflares if most of the observed coronal mass is supplied by chromospheric evaporation driven by the nanoflares. However, much larger blue wing-to-core density ratios are predicted if most of the coronal mass is supplied by heated material ejected with type II spicules. Our measurements do not rule out a spicule origin for the blue wing emission, but they argue against spicules being a primary source of the hot plasma in the corona. We note that only about 40% of the pixels where line blends could be safely ignored have blue wing asymmetries in both Fe(sub XIV) lines. Anticipated sub-arcsecond spatial resolution spectroscopic observations in future missions could shed more light on the origin of blue, red, and mixed asymmetries.

  6. Imaging trends in suspected appendicitis-a Canadian perspective.

    Science.gov (United States)

    Tan, Victoria F; Patlas, Michael N; Katz, Douglas S

    2017-06-01

    The purpose of our study was to assess trends in the imaging of suspected appendicitis in adult patients in emergency departments of academic centers in Canada. A questionnaire was sent to all 17 academic centers in Canada to be completed by a radiologist who works in emergency radiology. The questionnaires were sent and collected over a period of 4 months from October 2015 to February 2016. Sixteen centers (94%) responded to the questionnaire. Eleven respondents (73%) use IV contrast-enhanced computed tomography (CT) as the imaging modality of choice for all patients with suspected appendicitis. Thirteen respondents (81%) use ultrasound as the first modality of choice in imaging pregnant patients with suspected appendicitis. Eleven respondents (69%) use ultrasound (US) as the first modality of choice in patients younger than 40 years of age. Ten respondents (67%) use ultrasound as the first imaging modality in female patients younger than 40 years of age. When CT is used, 81% use non-focused CT of the abdomen and pelvis, and 44% of centers use oral contrast. Thirteen centers (81%) have ultrasound available 24 h a day/7 days a week. At 12 centers (75%), ultrasound is performed by ultrasound technologists. Four centers (40%) perform magnetic resonance imaging (MRI) in suspected appendicitis in adult patients at the discretion of the attending radiologist. Eleven centers (69%) have MRI available 24/7. All 16 centers (100%) use unenhanced MRI. Various imaging modalities are available for the work-up of suspected appendicitis. Although there are North American societal guidelines and recommendations regarding the appropriateness of the multiple imaging modalities, significant heterogeneity in the first-line modalities exist, which vary depending on the patient demographics and resource availability. Imaging trends in the use of the first-line modalities should be considered in order to plan for the availability of the imaging examinations and to consider plans for

  7. Predictors of bacteremia in emergency department patients with suspected infection.

    Science.gov (United States)

    Chase, Maureen; Klasco, Richard S; Joyce, Nina R; Donnino, Michael W; Wolfe, Richard E; Shapiro, Nathan I

    2012-11-01

    The goal of this study is to identify clinical variables associated with bacteremia. Such data could provide a rational basis for blood culture testing in emergency department (ED) patients with suspected infection. This is a secondary analysis of a prospective cohort of ED patients with suspected infection. Data collected included demographics, vital signs, medical history, suspected source of infection, laboratory and blood culture results and outcomes. Bacteremia was defined as a positive blood culture by Centers for Disease Control criteria. Clinical variables associated with bacteremia on univariate logistic regression were entered into a multivariable model. There were 5630 patients enrolled with an average age of 59.9 ± 19.9 years, and 54% were female. Blood cultures were obtained on 3310 (58.8%). There were 409 (12.4%) positive blood cultures, of which 68 (16.6%) were methicillin-resistant Staphylococcus aureus (MRSA) and 161 (39.4%) were Gram negatives. Ten covariates (respiratory failure, vasopressor use, neutrophilia, bandemia, thrombocytopenia, indwelling venous catheter, abnormal temperature, suspected line or urinary infection, or endocarditis) were associated with all-cause bacteremia in the final model (c-statistic area under the curve [AUC], 0.71). Additional factors associated with MRSA bacteremia included end-stage renal disease (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.9-7.8) and diabetes (OR, 2.0; 95% CI, 1.1-3.6) (AUC, 0.73). Factors strongly associated with Gram-negative bacteremia included vasopressor use in the ED (OR, 2.8; 95% CI, 1.7-4.6), bandemia (OR, 3.5; 95% CI, 2.3-5.3), and suspected urinary infection (OR, 4.0; 95% CI, 2.8-5.8) (AUC, 0.75). This study identified several clinical factors associated with bacteremia as well as MRSA and Gram-negative subtypes, but the magnitude of their associations is limited. Combining these covariates into a multivariable model moderately increases their predictive value. Copyright

  8. SuSpect a Fortran Code for the Supersymmetric and Higgs Particle Spectrum in the MSSM

    CERN Document Server

    Djouadi, Abdelhak; Moultaka, G; Djouadi, Abdelhak; Kneur, Jean-Loic; Moultaka, Gilbert

    2007-01-01

    We present the Fortran code SuSpect version 2.1, which calculates the Supersymmetric and Higgs particle spectrum in the Minimal Supersymmetric Standard Model (MSSM). The calculation can be performed in constrained models with universal boundary conditions at high scales such as the gravity (mSUGRA), anomaly (AMSB) or gauge (GMSB) mediated breaking models, but also in the non-universal MSSM case with R-parity and CP conservation. Care has been taken to treat important features such as the renormalization group evolution of parameters between low and high energy scales, the consistent implementation of radiative electroweak symmetry breaking and the calculation of the physical masses of the Higgs bosons and supersymmetric particles taking into account the dominant radiative corrections. Some checks of important theoretical and experimental features, such as the absence of non desired minima, large fine-tuning in the electroweak symmetry breaking condition, as well as agreement with precision measurements can be...

  9. Prognostic importance of quantitative echocardiographic evaluation in patients suspected of first non-massive pulmonary embolism

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Schaadt, Bente Krogsgaard; Lund, Jens Otto

    2008-01-01

    AIMS: Patients suspected of acute pulmonary embolism (PE) frequently undergo echocardiography as a part of the initial work-up. Prognostic implication of routine echocardiography in patients suspected of PE remain to be established. METHODS AND RESULTS: Transthoracic echocardiography, including...

  10. Critical evaluation of pancreatic masses

    Directory of Open Access Journals (Sweden)

    John DeWitt

    2012-01-01

    Full Text Available Evaluation of a patient with a pancreatic mass on a CT or MRI requires consideration of the gender and age of the patient, presenting symptoms, quality of the imaging study performed and relevant medical history. CT is generally preferred over MRI for suspected pancreatic cancer but MRI is best considered for evaluation of ductal anatomy and possible cystic neoplasms. EUS should be considered when further characterization of morphology or tissue sampling is required.

  11. Icare rebound tonometry in children with known and suspected glaucoma.

    Science.gov (United States)

    Flemmons, Meghan S; Hsiao, Ya-Chuan; Dzau, Jacqueline; Asrani, Sanjay; Jones, Sarah; Freedman, Sharon F

    2011-04-01

    Accurate intraocular pressure (IOP) measurement, important in managing pediatric glaucoma, often presents challenges. The Icare rebound tonometer shows promise for screening healthy children and has been reported comparable with Goldmann applanation in adults with glaucoma. The purpose of this study was to evaluate the Icare tonometer against Goldmann applanation for clinic IOP measurement in pediatric glaucoma. This was a prospective study comparing Icare versus Goldmann tonometry in pediatric glaucoma. Children with known or suspected glaucoma were recruited from scheduled clinic visits. IOP was measured with the Icare tonometer by a clinician and subsequently measured with Goldmann applanation tonometry (GAT) by a different single masked clinician. A total of 71 eyes of 71 children with known or suspected glaucoma were included. IOP by GAT ranged from 9 to 36 mm Hg. Icare readings ranged from 11 to 44 mm Hg. Mean difference between Icare and GAT was 2.3 ± SD 3.7 mm Hg, p IOPs were within ± 3 mm Hg of GAT in 63%. Icare IOPs were ≥GAT IOPs in 75%. The following factors were not associated with Icare IOPs greater than GAT: child's age, glaucoma diagnosis, strabismus, nystagmus, central corneal thickness, Icare instrument-reported reliability, number of glaucoma surgeries or medications, corneal abnormalities, and visual acuity. IOP by Icare tonometry was within 3 mm Hg of IOP by GAT in 63% and greater than GAT in 75%. This device may be reasonable to estimate IOP in selected children with known or suspected glaucoma whose IOP cannot otherwise be obtained in clinic; however, correlation of Icare IOPs with clinical findings must continue to be considered in each case. Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  12. Herbal hepatotoxicity: suspected cases assessed for alternative causes.

    Science.gov (United States)

    Teschke, Rolf; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel; Frenzel, Christian

    2013-09-01

    Alternative explanations are common in suspected drug-induced liver injury (DILI) and account for up to 47.1% of analyzed cases. This raised the question of whether a similar frequency may prevail in cases of assumed herb-induced liver injury (HILI). We searched the Medline database for the following terms: herbs, herbal drugs, herbal dietary supplements, hepatotoxic herbs, herbal hepatotoxicity, and herb-induced liver injury. Additional terms specifically addressed single herbs and herbal products: black cohosh, Greater Celandine, green tea, Herbalife products, Hydroxycut, kava, and Pelargonium sidoides. We retrieved 23 published case series and regulatory assessments related to hepatotoxicity by herbs and herbal dietary supplements with alternative causes. The 23 publications comprised 573 cases of initially suspected HILI; alternative causes were evident in 278/573 cases (48.5%). Among them were hepatitis by various viruses (9.7%), autoimmune diseases (10.4%), nonalcoholic and alcoholic liver diseases (5.4%), liver injury by comedication (DILI and other HILI) (43.9%), and liver involvement in infectious diseases (4.7%). Biliary and pancreatic diseases were frequent alternative diagnoses (11.5%), raising therapeutic problems if specific treatment is withheld; pre-existing liver diseases including cirrhosis (9.7%) were additional confounding variables. Other diagnoses were rare, but possibly relevant for the individual patient. In 573 cases of initially assumed HILI, 48.5% showed alternative causes unrelated to the initially incriminated herb, herbal drug, or herbal dietary supplement, calling for thorough clinical evaluations and appropriate causality assessments in future cases of suspected HILI.

  13. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis.

    Science.gov (United States)

    King, Welfur C; Shuaib, Waqas; Vijayasarathi, Arvind; Fajardo, Carlos G; Cabrera, Waldo E; Costa, Juan L

    2015-01-01

    Despite evidence demonstrating equivalent accuracy of sonography and computed tomography (CT) in the workup of mild/uncomplicated acute diverticulitis, CT is overwhelmingly performed as the initial diagnostic test, particularly in the acute setting. Our study evaluated potential radiation and turnaround time savings associated with performing sonography instead of CT as the initial diagnostic examination in the workup of suspected uncomplicated acute diverticulitis. We retrospectively reviewed medical records from January 2010 to December 2012 for patients presenting with clinical symptoms of acute diverticulitis. Patients were categorized as a whole and subgrouped by age (>40 and 40 years and 121 diverticulitis. © 2015 by the American Institute of Ultrasound in Medicine.

  14. A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy

    Directory of Open Access Journals (Sweden)

    Rayan Elkattah

    2013-01-01

    Full Text Available Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

  15. Patch Testing in Suspected Allergic Contact Dermatitis to Cosmetics

    OpenAIRE

    Pramod Kumar; Rekha Paulose

    2014-01-01

    Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1–5.4% of the population is sensitized to a cosmetic ingredient. Patch testing helps to confirm the presence of an allergy and to identify the actual allergens which are chemical mixtures of various ingredients. Objectives. The aims of this study are to perform patch testing in suspected ACD to cosmetics and to identify the most common alle...

  16. Investigation of suspected chronic fatigue syndrome/myalgic encephalopathy.

    Science.gov (United States)

    Owe, Jone Furlund; Næss, Halvor; Gjerde, Ivar Otto; Bødtker, Jørn Eilert; Tysnes, Ole-Bjørn

    2016-02-09

    Chronic fatigue is a frequently occurring problem in both the primary and specialist health services. The Department of Neurology at Haukeland University Hospital has established a standard assessment for patients referred with suspected CFS/ME. This study reports diagnoses and findings upon assessment, and considers the benefit of supplementary examinations. Diagnoses and findings from examinations of 365 patients assessed for suspected CFS/ME are retrospectively reported. A total of 48 patients (13.2%) were diagnosed with CFS/ME, while a further 18 patients (4.9%) were diagnosed with post-infectious fatigue. Mental and behavioural disorders were diagnosed in 169 patients (46.3%), and these represented by far the largest group. Serious, but unrecognised somatic illness was discovered in two patients, while changes of uncertain significance were identified by MRI and lumbar puncture in a few patients. Fatigue is a frequently occurring symptom in the population. Thorough somatic and psychiatric investigation is necessary before referral to the specialist health services. Mental disorders and reactions to life crises are common and important differential diagnoses for CFS/ME. Long waiting times in the specialist health services may result in delayed diagnosis for these patients.

  17. Perioperative sexual interest in women with suspected gynecologic malignancies.

    Science.gov (United States)

    Bretschneider, C E; Bensen, Jeannette T; Geller, Elizabeth J; Gehrig, Paola A; Wu, Jennifer M; Doll, Kemi M

    2017-07-01

    For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies. This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014. Subjects completed the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire (PROMIS-SFQ) preoperatively and questions on sexual interest and desire at one, three, and six months postoperatively. Bivariate tests and multiple linear regression were used to analyze data. Of 231 women who completed a baseline PROMIS-SFQ, 187 (81%) completed one-month, 170 (74%) three-month, and 174 (75%) six-month follow-up interviews. Following surgery, 71% of enrolled subjects were diagnosed with a malignancy. Women age women age >55 (-5.5±1.0 vs -2.3±0.9, p=0.02). In a multivariable analysis, age women of all ages (-5.6, 95% CI: -9.6, -1.5). This study provides new data regarding the timing and magnitude of changes in sexual interest following gynecologic oncology procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. MRI diagnosis of suspected atlanto-occipital dissociation in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Grabb, B.C.; Frye, T.A.; Hedlund, G.L.; Vaid, Y.N.; Royal, S.A. [Department of Radiology, The Children`s Hospital of Alabama, Birmingham (United States); Grabb, P.A. [Department of Neurosurgery, University of Alabama at Birmingham (United States)

    1999-04-01

    Objective. To demonstrate the utility of magnetic resonance (MR) imaging in the diagnosis of complete and partial ligamentous injuries in patients with suspected atlanto-occipital dissociation (AOD). Materials and methods. Five patients with suspected AOD had MR imaging performed within an average of 4 days after injury. MR scans were reviewed with specific analysis of craniocervical ligamentous structures. Charts were reviewed to obtain clinical information regarding presentation, treatment, hospital course, and outcome. Results. Two patients demonstrated MR evidence of complete AOD. One had disruption of all visualized major ligamentous structures at the craniocervical junction with anterolisthesis and evidence of cord damage. The second had injuries to the tectorial membrane, superior band of the cruciform ligament, apical ligament, and interspinous ligament at C 1-2. The remaining three patients sustained incomplete severance of the ligamentous structures at the craniocervical junction. All patients demonstrated subtle radiographic findings suggestive of AOD, including soft tissue swelling at the craniocervical junction without fracture. The two patients with complete AOD died. The three patients with partial AOD were treated with stabilization. On follow-up, these three children were asymptomatic following their craniocervical injury. Conclusion. MR imaging of acute AOD provides accurate identification of the craniocervical ligaments injured, classification of full versus partial ligamentous disruption, and analysis of accompanying spinal cord injury. This information is important for early appropriate neurosurgical management and preservation of neurologic function in survivors. (orig.) With 7 figs., 1 tab., 14 refs.

  19. MRI diagnosis of suspected atlanto-occipital dissociation in childhood.

    Science.gov (United States)

    Grabb, B C; Frye, T A; Hedlund, G L; Vaid, Y N; Grabb, P A; Royal, S A

    1999-04-01

    To demonstrate the utility of magnetic resonance (MR) imaging in the diagnosis of complete and partial ligamentous injuries in patients with suspected atlanto-occipital dissociation (AOD). Five patients with suspected AOD had MR imaging performed within an average of 4 days after injury. MR scans were reviewed with specific analysis of craniocervical ligamentous structures. Charts were reviewed to obtain clinical information regarding presentation, treatment, hospital course, and outcome. Two patients demonstrated MR evidence of complete AOD. One had disruption of all visualized major ligamentous structures at the craniocervical junction with anterolisthesis and evidence of cord damage. The second had injuries to the tectorial membrane, superior band of the cruciform ligament, apical ligament, and interspinous ligament at C 1-2. The remaining three patients sustained incomplete severance of the ligamentous structures at the craniocervical junction. All patients demonstrated subtle radiographic findings suggestive of AOD, including soft tissue swelling at the craniocervical junction without fracture. The two patients with complete AOD died. The three patients with partial AOD were treated with stabilization. On follow-up, these three children were asymptomatic following their craniocervical injury. MR imaging of acute AOD provides accurate identification of the craniocervical ligaments injured, classification of full versus partial ligamentous disruption, and analysis of accompanying spinal cord injury. This information is important for early appropriate neurosurgical management and preservation of neurologic function in survivors.

  20. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  1. Ocular lesions following suspected lightning injury in a horse.

    Science.gov (United States)

    Evans, Paige M; Armour, Micki D; Dubielzig, Richard R

    2012-07-01

      To describe the gross and histopathological ocular findings in a horse following suspected lightning injury.   The eyes of a 2-year-old thoroughbred gelding were clinically and histopathologically evaluated following a severe lightning storm following euthanasia because of visual impairment.   Severe corneal edema and hydrops were noted clinically oculus dexter. Indirect ophthalmoscopy revealed bilateral symmetrical raised hyporeflective peripapillary geographic lesions. Histopathologic evaluation revealed corneal edema in the right eye with normal corneal endothelium. Posterior segment evaluation revealed localized, pericentral choroidal lesions characterized by the presence of hemorrhage, early fibrosis, and minimal lymphoplasmacytic, neutrophilic, and histiocytic inflammation with spindle cell proliferation. The retinas overlying the choroidal lesions were necrotic and mostly absent. Peripheral to the focal lesion, the retina abruptly returned to normal architecture peripheral to a zone of apoptotic photoreceptors. Centrally, swollen axons extended into the optic disc.   There have been few descriptions of ocular lesions in animals following suspected lightning injury. We believe these findings to be unique because of the type of thermal injury that may be characteristic of lightening injury. We do not know whether these lesions would have progressed over time. © 2011 American College of Veterinary Ophthalmologists.

  2. Suspected side effects to the quadrivalent human papilloma vaccine.

    Science.gov (United States)

    Brinth, Louise; Theibel, Ann Cathrine; Pors, Kirsten; Mehlsen, Jesper

    2015-04-01

    The quadrivalent vaccine that protects against human papilloma virus types 6, 11, 16 and 18 (Q-HPV vaccine, Gardasil) was included into the Danish childhood vaccination programme in 2009. During the past years, a collection of symptoms primarily consistent with sympathetic nervous system dysfunction have been described as suspected side effects to the Q-HPV vaccine. We present a description of suspected side effects to the Q-HPV vaccine in 53 patients referred to our Syncope Unit for tilt table test and evaluation of autonomic nervous system function. All patients had symptoms consistent with pronounced autonomic dysfunction including different degrees of orthostatic intolerance, severe non-migraine-like headache, excessive fatigue, cognitive dysfunction, gastrointestinal discomfort and widespread pain of a neuropathic character. We found consistency in the reported symptoms as well as between our findings and those described by others. Our findings neither confirm nor dismiss a causal link to the Q-HPV vaccine, but they suggest that further research is urgently warranted to clarify the pathophysiology behind the symptoms experienced in these patients and to evaluate the possibility and the nature of any causal link and hopefully establish targeted treatment options. not relevant. not relevant.

  3. Patch Testing in Suspected Allergic Contact Dermatitis to Cosmetics

    Science.gov (United States)

    Paulose, Rekha

    2014-01-01

    Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1–5.4% of the population is sensitized to a cosmetic ingredient. Patch testing helps to confirm the presence of an allergy and to identify the actual allergens which are chemical mixtures of various ingredients. Objectives. The aims of this study are to perform patch testing in suspected ACD to cosmetics and to identify the most common allergen and cosmetic product causing dermatitis. Methods. Fifty patients with suspected ACD to cosmetics were patch-tested with 38 antigens of the Indian Cosmetic Series and 12 antigens of the Indian Standard Series. Results. The majority (58%) of patients belonged to the 21–40 years age group. The presence of ACD to cosmetics was confirmed in 38 (76%) patients. Face creams (20%), hair dyes (14%), and soaps (12%) were the most commonly implicated. The most common allergens identified were gallate mix (40%), cetrimide (28%), and thiomersal (20%). Out of a total of 2531 patches applied, positive reactions were obtained in 3.75%. Conclusion. Incidence of ACD to cosmetics was greater in females. Face creams and hair dyes were the most common cosmetic products implicated. The principal allergens were gallate mix, cetrimide, and thiomersal. PMID:25295057

  4. Feline toxicological emergencies: when to suspect and what to do.

    Science.gov (United States)

    Grave, Tobias W; Boag, Amanda K

    2010-11-01

    Confirmed or suspected intoxications with a wide variety of agents represent a small but important group of feline emergency cases. Generally it is thought that toxicities are less common in cats compared with dogs, with a higher proportion relating to dermal as opposed to oral exposure. Once toxicity is suspected or diagnosed, it must be recognised that treatment regimes may need modification compared with those established for dogs. Different drugs or different dosages may be warranted and the choice of available drugs may be reduced. This review draws on published studies, case reports and clinical experience to summarise key features of the general management of the intoxicated feline patient before describing some of the more serious and common intoxications in more detail. The focus throughout the review is on the peculiarities of feline metabolism and how they may impact on presentation and treatment. The aim is to assist companion animal and feline practitioners, who are in the frontline when it comes to managing these emergency cases. Copyright © 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  5. Influenza Illness among Case-Patients Hospitalized for Suspected Dengue, El Salvador, 2012.

    Directory of Open Access Journals (Sweden)

    Rafael Chacon

    Full Text Available We estimate the proportion of patients hospitalized for suspected dengue that tested positive for influenza virus in El Salvador during the 2012 influenza season. We tested specimens from 321 hospitalized patients: 198 patients with SARI and 123 patients with suspected dengue. Among 121 hospitalized suspected dengue (two co-infected excluded patients, 28% tested positive for dengue and 19% positive for influenza; among 35 with suspected dengue and respiratory symptoms, 14% were positive for dengue and 39% positive for influenza. One percent presented co-infection between influenza and dengue. Clinicians should consider the diagnosis of influenza among patients with suspected dengue during the influenza season.

  6. Influenza Illness among Case-Patients Hospitalized for Suspected Dengue, El Salvador, 2012.

    Science.gov (United States)

    Chacon, Rafael; Clara, Alexey Wilfrido; Jara, Jorge; Armero, Julio; Lozano, Celina; El Omeiri, Nathalie; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo

    2015-01-01

    We estimate the proportion of patients hospitalized for suspected dengue that tested positive for influenza virus in El Salvador during the 2012 influenza season. We tested specimens from 321 hospitalized patients: 198 patients with SARI and 123 patients with suspected dengue. Among 121 hospitalized suspected dengue (two co-infected excluded) patients, 28% tested positive for dengue and 19% positive for influenza; among 35 with suspected dengue and respiratory symptoms, 14% were positive for dengue and 39% positive for influenza. One percent presented co-infection between influenza and dengue. Clinicians should consider the diagnosis of influenza among patients with suspected dengue during the influenza season.

  7. Using Internet Artifacts to Profile a Child Pornography Suspect

    Directory of Open Access Journals (Sweden)

    Marcus K. Rogers

    2014-03-01

    Full Text Available Digital evidence plays a crucial role in child pornography investigations. However, in the following case study, the authors argue that the behavioral analysis or “profiling” of digital evidence can also play a vital role in child pornography investigations. The following case study assessed the Internet Browsing History (Internet Explorer Bookmarks, Mozilla Bookmarks, and Mozilla History from a suspected child pornography user’s computer. The suspect in this case claimed to be conducting an ad hoc law enforcement investigation. After the URLs were classified (Neutral; Adult Porn; Child Porn; Adult Dating sites; Pictures from Social Networking Profiles; Chat Sessions; Bestiality; Data Cleaning; Gay Porn, the Internet history files were statistically analyzed to determine prevalence and trends in Internet browsing. First, a frequency analysis was used to determine a baseline of online behavior. Results showed 54% (n = 3205 of the URLs were classified as “neutral” and 38.8% (n = 2265 of the URLs were classified as a porn website. Only 10.8% of the URLs were classified as child pornography websites. However when the IE history file was analyzed by visit, or “hit,” count, the Pictures/Profiles (31.5% category had the highest visit count followed by Neutral (19.3%, Gay Porn (17%, and Child Porn (16.6%. When comparing the frequency of URLs to the Hit Count for each pornography type, it was noted that the accused was accessing gay porn, child porn, chat rooms, and picture profiles (i.e., from Facebook more often than adult porn and neutral websites. The authors concluded that the suspect in this case was in fact a child pornography user and not an ad hoc investigator, and the findings from the behavioral analysis were admitted as evidence in the sentencing hearing for this case. The authors believe this case study illustrates the ability to conduct a behavioral analysis of digital evidence. More work is required to further validate the

  8. Teicoplanin versus vancomycin for proven or suspected infection.

    Science.gov (United States)

    Cavalcanti, Alexandre B; Goncalves, Anderson R; Almeida, Claudia S; Bugano, Diogo Dg; Silva, Eliezer

    2010-06-16

    Vancomycin and teicoplanin are commonly used to treat gram-positive infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). There is uncertainty regarding the effects of teicoplanin compared to vancomycin on kidney function with some previous studies suggesting teicoplanin is less nephrotoxic than vancomycin. To investigate the efficacy and safety of vancomycin versus teicoplanin in patients with proven or suspected infection. We searched the Cochrane Renal Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, reference lists of nephrology textbooks, review articles with relevant studies and sent letters seeking information about unpublished or incomplete studies to investigators involved in previous studies. We searched for randomised controlled trials (RCTs) in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. Two authors independently evaluated methodological quality and extracted data using standardised data extraction forms. Study investigators were contacted for information not available in the original manuscripts. Random effects model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). We included 24 studies (2,610 patients) in this review. Teicoplanin reduced the risk of nephrotoxicity compared to vancomycin (RR 0.66, 95% CI 0.48 to 0.90).The effects of teicoplanin or vancomycin were similar for clinical cure (RR 1.03, 95% CI 0.98 to 1.08), microbiological cure (RR 0.98, 95% CI 0.93 to 1.03) and mortality (RR 1.02, 95% CI 0.79 to1.30). Six studies reported no cases of acute kidney injury (AKI) needing dialysis. Adverse events were less frequent with teicoplanin including cutaneous rash (RR 0.57, 95% CI 0.35 to 0.92), red man syndrome (RR 0.21, 95% CI 0.08 to 0.59) and total adverse events (RR 0.73, 95% CI 0.53 to 1.00). A lower risk of nephrotoxicity with teicoplanin was observed in patients either with (RR 0.51, 95% CI 0.30 to 0.88) or

  9. Imaging in cardiac mass lesions

    Energy Technology Data Exchange (ETDEWEB)

    Mundinger, A.; Gruber, H.P.; Dinkel, E.; Geibel, A.; Beck, A.; Wimmer, B.; Schlosser, V. (Freiburg Univ. (Germany))

    In 26 patients with cardiac mass lesions confirmed by surgery, diagnostic imaging was performed preoperatively by means of two-dimensional echocardiography (26 patients), angiography (12 patients), correlative computed tomography (CT, 8 patients), and magnetic resonance imaging (MRI, 3 patients). Two-dimensional echocardiography correctly identified the cardiac masses in all patients. Angiography missed two of 12 cardiac masses; CT missed one of eight. MRI identified three of three cardiac masses. Although the sensitivity of two-dimensional echocardiography was high (100%), all methods lacked specificity. None of the methods allowed differentiation between myxoma (n=13) and thrombus (n=7). Malignancy of the lesions was successfully predicted by noninvasive imaging methods in all six patients. However, CT and MRI provided additional information concerning cardiac mural infiltration, pericardial involvement, and extracardiac tumor extension, and should be integrated within a preoperative imaging strategy. Thus two-dimensional echocardiography is the method of choice for primary assessment of patients with suspected cardiac masses. Further preoperative imaging by CT or MRI can be limited to patients with malignancies suspected on the grounds of pericardial effusion or other clinical results. (author).

  10. Target and suspect screening of psychoactive substances in sewage-based samples by UHPLC-QTOF

    Energy Technology Data Exchange (ETDEWEB)

    Baz-Lomba, J.A., E-mail: jba@niva.no [Norwegian Institute for Water Research, Gaustadalléen 21, NO-0349, Oslo (Norway); Faculty of Medicine, University of Oslo, PO box 1078 Blindern, 0316, Oslo (Norway); Reid, Malcolm J.; Thomas, Kevin V. [Norwegian Institute for Water Research, Gaustadalléen 21, NO-0349, Oslo (Norway)

    2016-03-31

    The quantification of illicit drug and pharmaceutical residues in sewage has been shown to be a valuable tool that complements existing approaches in monitoring the patterns and trends of drug use. The present work delineates the development of a novel analytical tool and dynamic workflow for the analysis of a wide range of substances in sewage-based samples. The validated method can simultaneously quantify 51 target psychoactive substances and pharmaceuticals in sewage-based samples using an off-line automated solid phase extraction (SPE-DEX) method, using Oasis HLB disks, followed by ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC-QTOF) in MS{sup e}. Quantification and matrix effect corrections were overcome with the use of 25 isotopic labeled internal standards (ILIS). Recoveries were generally greater than 60% and the limits of quantification were in the low nanogram-per-liter range (0.4–187 ng L{sup −1}). The emergence of new psychoactive substances (NPS) on the drug scene poses a specific analytical challenge since their market is highly dynamic with new compounds continuously entering the market. Suspect screening using high-resolution mass spectrometry (HRMS) simultaneously allowed the unequivocal identification of NPS based on a mass accuracy criteria of 5 ppm (of the molecular ion and at least two fragments) and retention time (2.5% tolerance) using the UNIFI screening platform. Applying MS{sup e} data against a suspect screening database of over 1000 drugs and metabolites, this method becomes a broad and reliable tool to detect and confirm NPS occurrence. This was demonstrated through the HRMS analysis of three different sewage-based sample types; influent wastewater, passive sampler extracts and pooled urine samples resulting in the concurrent quantification of known psychoactive substances and the identification of NPS and pharmaceuticals. - Highlights: • A novel reiterative workflow

  11. Impact of transesophageal echocardiography on management in patients with suspected cardioembolic stroke.

    Science.gov (United States)

    Khariton, Yevgeniy; House, John A; Comer, Lynn; Coggins, Tina R; Magalski, Anthony; Skolnick, David G; Good, Thomas H; Main, Michael L

    2014-12-15

    Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report. The medical record was reviewed for baseline, clinical, and demographic variables and to determine whether significant management changes occurred as a result of the TEE findings. Potential significant changes in management included initiation of anticoagulation, placement of a patent foramen ovale (PFO) closure device, initiation of antibiotic therapy for endocarditis, surgical PFO closure, other cardiac surgery, and coil embolization of a pulmonary arteriovenous malformation. A significant change in management occurred in 243 patients (16.7%); 173 (71%) underwent treatment for PFO with a percutaneous PFO closure device (n = 100), initiation of chronic systemic anticoagulation (n = 68), or surgical PFO closure (n = 5). Additional findings leading to a change in management included endocarditis (n = 20), aortic arch atheroma (n = 14), intracardiac thrombus (n = 13), pulmonary arteriovenous malformation (n = 2), aortic valve fibroelastoma (n = 2), other valve masses (n = 4), and miscellaneous causes (n = 15). In conclusion, in patients with suspected cardioembolic stroke, TEE findings led to a change in management in 16.7% of patients. Of these, most (71%) were directed at prevention of subsequent paradoxical emboli in patients with PFO. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Seroprevalance of brucellosis among suspected cases in Malaysia.

    Science.gov (United States)

    Jama'ayah, M Z; Heu, J Y; Norazah, A

    2011-06-01

    Brucellosis is a zoonotic disease which can be transmitted by direct or indirect contact with infected animal or their products. It is an important public health problem but little is known on brucellosis in the Malaysian population. The aim of this study was to determine the presence of Brucella antibodies using commercial Brucella IgG and IgM ELISA kits (Vircell, SL, Barcelona Spain). A total of 184 sera from suspected patients were received from 16 hospitals in Malaysia over the years 2004 to 2009. Only 10 serum samples (5.4%) were positive for Brucella antibodies in which 5 showed the presence of both IgM and IgG. Most of the positive patients were occupationally involved with animals. This study suggests the seroprevalance of brucellosis among individuals who have contact with infected animals in Malaysia is low.

  13. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    DEFF Research Database (Denmark)

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael

    2011-01-01

    PURPOSE: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. MATERIALS...... radiologists and one surgeon independent of each other and compared with surgical and pathological records. RESULTS: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14...... patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (kappa=0.51) and fair (kappa=0.31) interobserver agreements in the MR diagnosis of acute...

  14. CT diagnosis of suspected acute appendicitis in adult patients

    Energy Technology Data Exchange (ETDEWEB)

    Yamase, Hiroshi; Sahashi, Kiyomi; Kawai, Masayuki; Kishida, Yoshihiko; Sumida, Kei; Kawamura, Ken-ichi [Gifu Syakaihoken Hospital (Japan)

    1998-06-01

    In order to assess the CT diagnosis of suspected acute appendicitis, we performed abdominal contrasted CT measurements in 77 patients from 20 to 86 years old, and of 50 men and 27 women from June 1993 to June 1996. The surgical findings were compared with the preoperative CT findings. By the preoperative CT imaging, we can know the degree and the position of inflammation in appendix vermiformis and the degree and the spread of periappendicular inflammation in the case of appendicitis, and can make a differential diagnosis of diverticulitis or gynecological diseases from appendicitis. It is important to make a preoperative diagnosis by the objectively excellent abdominal CT imaging and to avoid unnecessary surgery. (K.H.)

  15. Cost-effectiveness of routine imaging of suspected appendicitis.

    Science.gov (United States)

    D'Souza, N; Marsden, M; Bottomley, S; Nagarajah, N; Scutt, F; Toh, S

    2018-01-01

    Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

  16. Reliability of Examination Findings in Suspected Community-Acquired Pneumonia.

    Science.gov (United States)

    Florin, Todd A; Ambroggio, Lilliam; Brokamp, Cole; Rattan, Mantosh S; Crotty, Eric J; Kachelmeyer, Andrea; Ruddy, Richard M; Shah, Samir S

    2017-09-01

    The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95% confidence limit >0.4: wheezing, retractions, and respiratory rate. In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP. Copyright © 2017 by the American Academy of Pediatrics.

  17. Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

    Energy Technology Data Exchange (ETDEWEB)

    McQueen, A.S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)], E-mail: andrewmcqueen7@hotmail.com; Worthy, S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom); Keir, M.J. [Department of Medical Physics, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)

    2008-06-15

    Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

  18. Role of DR-70 immunoassay in suspected malignant pleural effusion

    Science.gov (United States)

    Sengupta, Amitabha; Saha, Kaushik; Jash, Debraj; Banerjee, Sourindra Nath; Biswas, Nirendra Mohan; Dey, Atin

    2013-01-01

    Context: A good proportion of patients with undiagnosed pleural effusion (PE) turn into malignancy over a period of time. Identification of positive biomarker may help in selecting the individuals who require close follow-up. Aims: The aims of this study were to evaluate the role of DR-70 immunoassay in suspected malignant PE. Settings and Design: We conducted a cross-sectional study among 89 patients of suspected malignant PE and 50 normal subjects (NS) were taken as control. Materials and Methods: Patients with exudative PE; who had pleural fluid lymphocyte count greater than 50% and adenosine deaminase less than 30 U/L were taken as cases. We had selected NSs among relatives of patients having normal blood chemistry and radiological investigations. Sensitivity and specificity of the test to differentiate malignant and non-malignant PE and also to identify PE with underlying malignancy was analyzed. Results: Mean value of DR-70 in NS was found to be 0.83 ± 0.273 mg/L without any significant difference between males (0.82 mg/L) and females (0.85 mg/L). Mean value of DR-70 in PE with underlying cancer was 5.03 ± 3.79 mg/L. Sensitivity (80%) and specificity (77.78%) of the test was maximum in PE with underlying cancer using cut-off value of 2 mg/L. Mean value DR-70 in malignant PE was 5.18 ± 3.75 mg/L and in non-malignant PE was 3.73 ± 3.74 mg/L without any statistically significant difference (P = 0.08). Conclusions: DR-70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non-malignant PE. PMID:24339491

  19. Graph-based region growing for mass-segmentation in digital mammography

    Science.gov (United States)

    Chu, Yong; Li, Lihua; Clark, Robert A.

    2002-05-01

    Mass segmentation is a vital step in CAD mass detection and classification. A challenge for mass segmentation in mammograms is that masses may contact with some surrounding tissues, which have the similar intensity. In this paper, a novel graph-based algorithm has been proposed to segment masses in mammograms. In the proposed algorithm, the procedure of region growing is represented as a growing tree whose root is the selected seed. Active leaves, which have the ability to grow, in the connection area between adjacent regions are deleted to stop growing, then separating the adjacent regions while keeping the spiculation of masses, which is a primary sign of malignancy for masses. The new constrained segmentation was tested with 20 cases in USF moffitt mammography database against the conventional region growing algorithm. The segmented mass regions were evaluated in terms of the overlap area with annotations made by the radiologist. We found that the new graph-based segmentation more closely match radiologists' outlines of these masses.

  20. Pre-admission antibiotics for suspected cases of meningococcal disease.

    Science.gov (United States)

    Sudarsanam, Thambu D; Rupali, Priscilla; Tharyan, Prathap; Abraham, Ooriapadickal Cherian; Thomas, Kurien

    2013-08-02

    Meningococcal disease can lead to death or disability within hours after onset. Pre-admission antibiotics aim to reduce the risk of serious disease and death by preventing delays in starting therapy before confirmation of the diagnosis. To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and different pre-admission antibiotic regimens in decreasing mortality, clinical failure and morbidity in people suspected of meningococcal disease. We updated searches of CENTRAL (2013, Issue 4), MEDLINE (1966 to April week 4, 2013), EMBASE (1980 to May 2013), Web of Science (1985 to May 2013), CAB Abstracts (1985 to May 2013), LILACS (1982 to May 2013) and prospective trials registries to May 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotics versus placebo or no intervention, in people with suspected meningococcal infection, or different antibiotics administered before admission to hospital or confirmation of the diagnosis. Two review authors independently assessed trial quality and extracted data from the search results. We calculated the risk ratio (RR) and 95% confidence interval (CI) for dichotomous data. We included only one trial so data synthesis was not performed. We assessed the overall quality of the evidence using the GRADE approach. We found no RCTs that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label, non-inferiority RCT, conducted during an epidemic in Niger, evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long-acting (oily) chloramphenicol. Ceftriaxone was not inferior to chloramphenicol in reducing mortality (RR 1.2, 95% CI 0.6 to 2.6; N = 503; 308 confirmed meningococcal meningitis; 26 deaths; moderate-quality evidence), clinical failures (RR 0.8, 95% CI 0.3 to 2.2; N = 477, 18 clinical failures; moderate-quality evidence) or neurological sequelae (RR 1.3, 95% CI 0.6 to 2.6; N

  1. Suspected vitreous seeding of uveal melanoma: relevance of diagnostic vitrectomy.

    Science.gov (United States)

    Metz, Claudia H D; Bornfeld, Norbert; Metz, Klaus A; Gök, Mete

    2016-05-01

    To review all cases of suspected vitreous seeding of treated or untreated uveal melanoma at our clinic and to compare clinical, cytological and histological findings with patients' survival. Retrospective non-randomised study of 23 patients with consecutive uveal melanoma who underwent diagnostic vitrectomy in our clinic between January 2000 and November 2013. Reason for vitrectomy was suspected dissemination of tumour cells inside the eye. Treated as well as treatment-naïve primary uveal melanomas were included in this study. Follow-up data of all patients were collected. The study included 23 patients with a mean age of 66 years. Four patients presented pigmented vitreous debris at initial presentation prior to treatment of the uveal melanoma. All but one of these four patients has been enucleated as a consequence of cytology-proven vitreous spreading of vital melanoma cells. The remaining 19 patients presented pigmented vitreous debris at a mean of 60 months following local tumour treatment. Thirteen of these patients had been treated with a ruthenium plaque (mean scleral dose 1295 Gy, mean apex dose 152 Gy), three with binuclid plaque (mean scleral dose 1005 Gy, mean apex dose 70 Gy) and three with proton beam radiation. Of the 19 patients, 10 showed only melanophages in the vitreous specimen, while the remaining 9 patients had vital tumour cells in vitreous cytology. Four out of these nine patients have been enucleated in the course of follow-up. During follow-up of our cohort of 23 patients, 4 patients died, but only 1 of them due to metastatic disease. The outcome of this small cohort study shows that obtaining a vitreous specimen helps to distinguish melanophages from vital tumour cells. We could not observe an increased risk of metastasis in patients who showed melanoma cell dissemination inside the eye, compared with those patients only showing melanophages. We therefore suggest to carefully re-evaluate the necessity of enucleation in every

  2. Cost analysis of inappropriate treatments for suspected dermatomycoses

    Directory of Open Access Journals (Sweden)

    Emanuela Fiammenghi

    2015-06-01

    Full Text Available Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1 to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2 to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II” in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination were defined as inappropriate: (1 cortisone in a patient with at least one positive site; (2 antifungals in (a patients with all negative sites or (b ineffective antifungal treatment (in terms of drug chosen, dose or duration in those with all positive sites; or (3 antibiotics; (4 antivirals or (5 antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease

  3. [Suspected pathogenic mutation identified in two cases with oculocutaneous albinism].

    Science.gov (United States)

    He, Jiangmei; Zheng, Meiling; Zhang, Guilin; Hua, Ailing

    2015-08-01

    To detect potential mutations in genes related with non-syndromic oculocutaneous albinism I-IV and ocular albinism type I in two couples who had given births to children with albinism. All exons of the non-syndromic albinism related genes TYR, OCA2, TYRP-1, MITF, SLC45A2 and GPR143 were subjected to deep sequencing. The results were verified with Sanger sequencing. For the two female carriers, the coding region of the TYR gene was found to harbor a frameshift mutation c.925_926insC, which was also suspected to have been pathogenic. In one of the male partners, a nonsense mutations c.832C>T was found, which was also known to be pathogenic. Another male partner was found to harbor a TYR gene mutation c.346C>T, which was also known to be a pathogenic nonsense mutation. The coding region of the TYR gene c.925_926insC (p.Thr309ThrfsX9) probably underlies the OCA1 disease phenotype.

  4. Chest pain and behavior in suspected coronary artery disease.

    Science.gov (United States)

    Young, L D; Barboriak, J J; Anderson, A J

    1988-01-01

    This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.

  5. [Predictive value of procalcitonin in children with suspected sepsis].

    Science.gov (United States)

    Bustos B, Raúl; Padilla P, Oslando

    2015-01-01

    The use of biomarkers could be a tool for diagnosis, prognosis and stratifying children with sepsis. Our main goal was to analyze the value of procalcitonin (PCT), C reactive protein (CRP) and lactate in predicting mortality, septic shock and the stratification in children with suspected sepsis Prospective study in 81 patients. Plasma levels of PCT, CRP and lactate were measured at admission in the pediatric intensive care unit. Patients were categorized into systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock. Concentrations of PCT (ng/mL) increased significantly according to the severity of sepsis: 0.36 (0-1.2) for systemic inflammatory response syndrome; 1.96 (0.4-3.5) for sepsis; 7.5 (3.9-11.1) for severe sepsis; and 58.9 (35.1-82.7) for septic shock (P<.001). Compared to CRP and lactate, the area under the ROC curve revealed a good discriminative power of PCT to predict septic shock and mortality, 0.91 (95% CI: 0.83-0.97) and 0.80 (95% CI: 0.69-0.88), respectively. In contrast to CRP and lactate, the determination of PCT in pediatric intensive care unit admission is a good predictor of mortality and septic shock and can stratify patients according to severity of sepsis. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. The optimal diagnostic workup for children with suspected food allergy.

    Science.gov (United States)

    Berni Canani, Roberto; Di Costanzo, Mara; Troncone, Riccardo

    2011-10-01

    Food allergy is defined as an abnormal immunologic reaction to food proteins that causes an adverse clinical reaction. In addition to well-known acute allergic reactions and anaphylaxis triggered by immunoglobulin E antibody-mediated immune responses to food proteins, there is an increasing recognition of cell-mediated disorders such as eosinophilic esophagitis and food protein-induced enterocolitis syndrome. More than 90% of food allergies in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish, and shellfish. The diagnostic workup for a child with suspected food allergy includes a detailed medical history, physical examination, food allergy screening tests, and responses to an elimination diet and an oral food challenge. None of the screening tests, alone or in combination, can definitely diagnose or exclude a food allergy. Novel diagnostic methods including those that focus on immune responses to specific food proteins or epitopes of specific proteins are under active study. Unconventional diagnostic methods are increasingly used, but they lack scientific rationale, standardization, and reproducibility. In selected cases, such as eosinophilic esophageal gastroenteropathies or food protein-induced gastroesophageal reflux disease, invasive procedures are mandatory for an accurate diagnosis. Properly done, an oral food challenge is still the gold standard in the diagnostic workup. An incorrect diagnosis is likely to result in unnecessary dietary restrictions, which, if prolonged, may adversely affect the child's nutritional status and growth. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Control of Suspect/Counterfeit and Defective Items

    Energy Technology Data Exchange (ETDEWEB)

    Sheriff, Marnelle L.

    2013-09-03

    This procedure implements portions of the requirements of MSC-MP-599, Quality Assurance Program Description. It establishes the Mission Support Alliance (MSA) practices for minimizing the introduction of and identifying, documenting, dispositioning, reporting, controlling, and disposing of suspect/counterfeit and defective items (S/CIs). employees whose work scope relates to Safety Systems (i.e., Safety Class [SC] or Safety Significant [SS] items), non-safety systems and other applications (i.e., General Service [GS]) where engineering has determined that their use could result in a potential safety hazard. MSA implements an effective Quality Assurance (QA) Program providing a comprehensive network of controls and verification providing defense-in-depth by preventing the introduction of S/CIs through the design, procurement, construction, operation, maintenance, and modification of processes. This procedure focuses on those safety systems, and other systems, including critical load paths of lifting equipment, where the introduction of S/CIs would have the greatest potential for creating unsafe conditions.

  8. Chain Lakes massif, west central Maine: northern Appalachian basement or suspect terrane

    Energy Technology Data Exchange (ETDEWEB)

    Cheatham, M.M.; Olszewski, W.J. Jr.; Gaudette, H.E.

    1985-01-01

    The Chain Lakes massif of west-central Main is a 3 km thick sequence of diamictite and aquagene metavolcanics and metasediments, which contrasts strikingly with its surrounding Paleozoic rocks in lithology, structural style and metamorphic grade. The rocks of the massif are characterized by mineral assemblages developed during two separate metamorphic events. The first, of second sillimanite grade, is reflected by qtz-oligoclase-Kspar-sillimanite-biotite and muscovite. The second metamorphism is a retrograde event of greenschist facies, and chlorite grade. Isotopic Rb-Sr and Sm-Nd whole rock, and Rb-Sr mineral analyses of samples of the diamictite members, now gneiss and granofels, indicate that the first prograde metamorphism occurred at 770 Ma. with the retrograde event at approximately 405 Ma. Due to the restricted range of /sup 147/Sm//sup 144/Nd, no Sm-Nd isochron age could be determined. However, model ages for both Sr and Nd are approximately 1500 Ma for derivation of the Chain Lakes protolith material from depleted mantle. Lithology, bounding formations, complexes and plutons, and the isotopic data support previous contentions that the Chain Lakes massif is a suspect terrane. However, similarities with Proterozoic rocks along the Eastern Margin, as well as recent suggestions of similar rocks underlying the Kearsarge-Central Main synclinorium may suggest the possible widespread occurrence of dismembered masses of a perhaps once coherent, Precambrian terrane underlying the Northern Appalachians.

  9. Paradoxical protective effect of central obesity in patients with suspected stable coronary artery disease.

    Science.gov (United States)

    Bechlioulis, Aris; Vakalis, Konstantinos; Naka, Katerina K; Bourantas, Christos V; Papamichael, Nikolaos D; Kotsia, Anna; Tzimas, Thomas; Pappas, Konstantinos; Katsouras, Christos S; Michalis, Lampros K

    2013-03-01

    Increased body mass index (BMI) has been paradoxically inversely associated with the presence of angiographic coronary artery disease (CAD). Central obesity measures, considered to be more appropriate for assessing obesity-related cardiovascular risk, have been little studied in relation to the presence of CAD. The aim was to investigate the association of central obesity with the presence of angiographic CAD as well as the prognostic significance of obesity measures in CAD prediction when added to other cardiovascular risk factors. Patients with suspected stable CAD (n = 403, age 61 ± 10 years, 302 males) referred for diagnostic coronary angiography with documented anthropometric data were enrolled. Significant angiographic CAD was found in 51% of patients. Both BMI (OR = 0.64 per 1 SD increase, P = 0.001) and waist circumference (WC) (OR = 0.54 per 1 SD increase, P cardiovascular risk factors. In subgroup analysis, BMI and WC were significantly inversely associated with the presence of CAD in males, non diabetics, patients >60 years old and patients with Framingham risk score (FRS) >20% (P obesity were independently associated with a reduced prevalence of angiographic CAD, lending further credence to the existence of the 'obesity paradox'. Obesity measures may further improve risk discrimination for the presence of CAD when added in an established risk score such as FRS. Copyright © 2013 The Obesity Society.

  10. Prevalence of IgE sensitization in Danish children with suspected asthma

    DEFF Research Database (Denmark)

    Hoffmann-Petersen, Benjamin; Høst, Arne; Larsen, Kirsten Toksvig

    2013-01-01

    OBJECTIVE: The aim of this article was to estimate the prevalence of IgE sensitization in Danish children with suspected asthma and to characterize the pattern of sensitization. STUDY DESIGN: We performed a cross-sectional study including 1744 children from 0 to 15 yr suspected of asthma who were...

  11. Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis

    NARCIS (Netherlands)

    Thieme, Mai E.; Leeuwenburgh, Marjolein M. N.; Valdehueza, Zaldy D.; Bouman, Donald E.; de Bruin, Ivar G. J. M.; Schreurs, W. Hermien; Houdijk, Alexander P. J.; Stoker, Jaap; Wiarda, Bart M.

    2014-01-01

    To compare magnetic resonance imaging (MRI) and ultrasound in children with suspected appendicitis. In a single-centre diagnostic accuracy study, children with suspected appendicitis were prospectively identified at the emergency department. All underwent abdominal ultrasound and MRI within 2 h,

  12. 9 CFR 354.123 - Segregation of suspects on ante-mortem inspection.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Segregation of suspects on ante-mortem inspection. 354.123 Section 354.123 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Inspection Procedures; Ante-Mortem Inspections § 354.123 Segregation of suspects on ante-mortem inspection...

  13. 9 CFR 381.72 - Segregation of suspects on ante mortem inspection.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Segregation of suspects on ante mortem inspection. 381.72 Section 381.72 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT... Inspection § 381.72 Segregation of suspects on ante mortem inspection. (a) All birds, except ratites, that on...

  14. D-dimer test in cancer patients with suspected acute pulmonary embolism

    NARCIS (Netherlands)

    Di Nisio, M.; Sohne, M.; Kamphuisen, P. W.; Büller, H. R.

    2005-01-01

    Background: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. Objectives: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. Methods: The

  15. D-Dimer test in cancer patients with suspected acute pulmonary embolism.

    NARCIS (Netherlands)

    Nisio, M. Di; Sohne, M.; Kamphuisen, P.W.; Buller, H.R.

    2005-01-01

    BACKGROUND: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. OBJECTIVES: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. METHODS: The

  16. The Lawyer in the Dutch Interrogation Room: Influence on Police and Suspect

    NARCIS (Netherlands)

    W-J. Verhoeven (Willem-Jan); L. Stevens (Lonneke)

    2012-01-01

    textabstractIn many European countries, providing a suspect in custody with legal aid before the first police interrogation is a heavily debated issue. In this paper, we report on an exploratory study on the use of coercion by the police and the use of the right to silence by suspects in 70 Dutch

  17. Occurrence of antibodies to Anaplasma phagocytophilum in patients with suspected tick-borne encephalitis

    Directory of Open Access Journals (Sweden)

    Zuzana Kalinová

    2015-09-01

    None of the examined patients with suspected TBE had the disease confirmed. Hoever, as shown by the results, the relative risk of occurrence of anaplasmosis is higher in people examined for some another vector-borne disease (in this case TBE. Therefore, the performance of screening examinations in patients suspected of having any tick-borne disease is very important.

  18. Screening for keratoconus suspects among candidates for refractive surgery.

    Science.gov (United States)

    McMonnies, Charles W

    2014-11-01

    This review examines methods for estimating the risk of post-surgical ectasia in candidates for refractive surgery by establishing a diagnosis of keratoconus suspect as a contraindication for proceeding with surgery. Notwithstanding the desirability of achieving 100 per cent sensitivity, any associated reduction in specificity and increased numbers of false positives might deny some candidates the opportunity to proceed with refractive surgery. The introduction of a model for the risk of ectasia involving both pre- and post-surgical findings has been followed by a plethora of attempts to achieve the same purpose based on topographic and/or tomographic evaluation before surgery. The desirability of being able to depend on objective assessment using one type of instrument needs to be weighed against the possibility that subjective assessments may contribute significantly to screening success. For example, consideration of ethnicity, family history of keratoconus, a history of atopy or ocular allergies in particular, a history of significant exposure to corneal trauma associated with abnormal rubbing habits or with vocational, leisure or geographically increased exposure to ultraviolet radiation or with contact lens wear trauma or a history of significant exposure to activities which elevate intraocular pressure may improve screening success. To the extent that these factors could contribute to increased risk of the development of keratoconus, they may be useful in estimating the risk of post-surgical ectasia. If any combination of these factors helps to explain the development of keratoconus in normal or even thicker than normal corneas, they may have more significance for those corneas, which have been thinned surgically. © 2014 The Author. Clinical and Experimental Optometry © 2014 Optometrists Association Australia.

  19. [Breath tests in children with suspected lactose intolerance].

    Science.gov (United States)

    Parra, P Ángela; Furió, C Simone; Arancibia, A Gabriel

    2015-01-01

    Up to 70% of the world population is lactose intolerance. However, there are no epidemiological studies among Chilean pediatric population affected by this condition. Clinical characterization of a series of children who underwent the lactose intolerance breath test for lactose intolerance study, establishing intolerance and malabsorption frequencies, the most frequent symptoms, and test performance depending on the origin. Patients under 18 years old who took the lactose intolerance breath test in the Gastroenterology Laboratory of the Catholic University of Chile, and who were admitted due to clinically suspected lactose intolerance. Malabsorption was considered when there was as an increase of ≥20ppm above the baseline (H2) or ≥34ppm of H2 and methane (CH4) combined. Intolerance was considered when the above was associated with a symptom intensity score ≥7 during registration. The analysis included194 patients aged 1 to17 years of age. Of these, 102 (53%) presented with malabsorption, and 53 (27%) were intolerant. The frequency of lactose intolerance varied from 7.1 to 45.4%, and it occurred more frequently at older ages. The most common reported symptoms were abdominal pain, bloating and rumbling. Lactose malabsorption and intolerance can be investigated from the first years of life using the lactose breath test plus a symptom questionnaire. An increase in the frequency of intolerance with age, and a greater number of positive tests, if they were requested by a gastroenterologist, were observed. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Chabanova, Elizaveta, E-mail: elcha@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Balslev, Ingegerd, E-mail: inbal@heh.regionh.dk [Department of Pathology, Copenhagen University Hospital at Herlev (Denmark); Achiam, Michael, E-mail: micach01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Nielsen, Yousef W., E-mail: yujwni01@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Adamsen, Sven, E-mail: svad@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Gocht-Jensen, Peter, E-mail: petgoc01@heh.reginh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Brisling, Steffen K., E-mail: stkibr01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Logager, Vibeke B., E-mail: viloe@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Thomsen, Henrik S., E-mail: heth@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark)

    2011-08-15

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate ({kappa} = 0.51) and fair ({kappa} = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  1. Suspected dog bite associated HIV horizontal transmission in Swaziland

    Directory of Open Access Journals (Sweden)

    Ganizani Mlawanda

    2013-01-01

    Full Text Available Background: Dog bites may lead to transmission of bacteria and viruses over and above tetanus and rabies. Theoretically human immunodeficiency virus (HIV, Hepatitis B and Hepatitis C may be transmitted after dog bites where transfer of blood from one victim to another occur in clinical practice HIV, Hepatitis B and Hepatitis C are not considered when making treatment decisions, nor adequate patient history taken to consider all potential risks after dog bites in succession.Objective: To present case of suspected HIV transmission after dog bites in close succession involving two HIV sero-discordant victims.Management and outcome: HIV rapid test and/or HIV Ribonucleic acid (RNA polymerasechain reaction (PCR results for the victim(s at presentation and a month later.Results: Two night patrol guards presented to casualty after dog bites in close succession by the same dog. They were managed according to the dog bite protocol. Thinking out of the box, the first victim was found to be HIV positive by rapid test whilst the second victim was negative based on both HIV rapid test and HIV RNA PCR. One month after the dogbites, a case of HIV sero-conversion was confirmed in the second victim despite post-exposure prophylaxis (PEP.Discussion: Although an isolated case, shouldn’t clinicians re-think the significance of HIV transmission after animal bites where there is repeated blood exposure in several people insuccession?Conclusion: Clinicians should be aware of the potential of HIV, Hepatitis B and C transmission, when faced with dog bites in succession. 

  2. Suspect/Counterfeit Items Information Guide for Subcontractors/Suppliers

    Energy Technology Data Exchange (ETDEWEB)

    Tessmar, Nancy D. [Los Alamos National Laboratory; Salazar, Michael J. [Los Alamos National Laboratory

    2012-09-18

    Counterfeiting of industrial and commercial grade items is an international problem that places worker safety, program objectives, expensive equipment, and security at risk. In order to prevent the introduction of Suspect/Counterfeit Items (S/CI), this information sheet is being made available as a guide to assist in the implementation of S/CI awareness and controls, in conjunction with subcontractor's/supplier's quality assurance programs. When it comes to counterfeit goods, including industrial materials, items, and equipment, no market is immune. Some manufactures have been known to misrepresent their products and intentionally use inferior materials and processes to manufacture substandard items, whose properties can significantly cart from established standards and specifications. These substandard items termed by the Department of Energy (DOE) as S/CI, pose immediate and potential threats to the safety of DOE and contractor workers, the public, and the environment. Failure of certain systems and processes caused by an S/CI could also have national security implications at Los Alamos National Laboratory (LANL). Nuclear Safety Rules (federal Laws), DOE Orders, and other regulations set forth requirements for DOE contractors to implement effective controls to assure that items and services meet specified requirements. This includes techniques to implement and thereby minimizing the potential threat of entry of S/CI to LANL. As a qualified supplier of goods or services to the LANL, your company will be required to establish and maintain effective controls to prevent the introduction of S/CI to LANL. This will require that your company warrant that all items (including their subassemblies, components, and parts) sold to LANL are genuine (i.e. not counterfeit), new, and unused, and conform to the requirements of the LANL purchase orders/contracts unless otherwise approved in writing to the Los Alamos National Security (LANS) contract administrator

  3. High rate of benign histology in radiologically suspect renal lesions

    DEFF Research Database (Denmark)

    Lindkvist Pedersen, Christina; Winck-Flyvholm, Lili; Dahl, Claus

    2014-01-01

    INTRODUCTION: The objective of this study was to determine the incidence of benign renal lesions for clinically localised renal masses and the need for new diagnostic procedures to assess these lesions. MATERIAL AND METHODS: This retrospective study included patients who underwent partial or radi...

  4. Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing.

    Science.gov (United States)

    Crabtree, Valerie McLaughlin; Varni, James W; Gozal, David

    2004-09-15

    Snoring and sleep-disordered breathing (SDB) are highly prevalent among children. The increasing trends of obesity in the pediatric population further predict an exacerbation of this public health problem. However, the impact of SDB on mood and quality of life and the confounder effect of obesity in this setting are unclear. We studied a group of 85 clinically referred children, aged 8 to 12 years, with snoring and suspected SDB and 35 asymptomatic children (controls). All children completed validated questionnaires for the presence of depression (Children's Depression Inventory) and for health-related quality of life (PedsQL), and parents completed the Parent Report version of the PedsQL. Children referred to the Sleep Medicine Center for sleep-disordered breathing were further subdivided according to their body mass index > 95% for age and sex (n = 44) and with BMI children. However, both groups with SDB had more-impaired quality of life and depressive symptoms than did controls. Children with suspected SDB, regardless of the severity of apnea-hypopnea index or the presence of obesity, had more impairments in quality of life and depressive symptoms than did children who did not snore.

  5. Nominal Mass?

    Science.gov (United States)

    Attygalle, Athula B.; Pavlov, Julius

    2017-08-01

    The current IUPAC-recommended definition of the term "nominal mass," based on the most abundant naturally occurring stable isotope of an element, is flawed. We propose that Nominal mass should be defined as the sum of integer masses of protons and neutrons in any chemical species. In this way, all isotopes and isotopologues can be assigned a definitive identifier.

  6. The role of ultrasound-guided transcutaneous tru-cut biopsy in diagnosing untreated and recurrent laryngo-hypopharyngeal masses.

    Science.gov (United States)

    De Fiori, Elvio; Conte, Giorgio; Ansarin, Mohssen; De Benedetto, Luigi; Bonello, Luke; Alterio, Daniela; Maffini, Fausto; Bellomi, Massimo; Preda, Lorenzo

    2016-01-01

    To evaluate the diagnostic performance of Ultrasound-guided Transcutaneous Tru-Cut biopsy (USGTCB) of laryngo-hypopharyngeal masses suspicious for malignancy. Furthermore we investigated whether USGTCB is accurate for both untreated masses and suspected recurrences. From August 2004 to July 2014 we prospectively enrolled 66 patients for a total of 68 USGTCBs: 38 USGTCB were performed for a suspicious untreated mass and in 30 for a suspected recurrence. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for all procedures and separately for untreated masses and suspected recurrences. USGTCB diagnosed 57 malignancies (51 squamous cell carcinomas, 6 other tumors) and 11 benign lesions. There were no false positives reported, whereas five false negatives were observed: two in patients with an untreated mass, three in patients with a suspected recurrence. Overall, the sensitivity of the technique was 91.9% (95% confidence interval [CI]: 82.2-97.3%); the specificity was 100% (95% CI: 54.1-100%); positive and negative predictive values were 100% (95% CI: 93.7-100%) and 54.5% (95% CI: 23.5-83.1%) respectively, with similar performances in untreated masses and suspected recurrences of SCC. USGTCB is an effective procedure for the histological diagnosis of laryngo-hypopharyngeal masses suspicious for malignancy in patients showing contraindications to biopsy via microlaryngoscopy under general, with similar performances for untreated masses and suspected recurrences. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. The value of recognizing suspect diagnoses in the triple diagnosis of giant cell tumor of bone

    Directory of Open Access Journals (Sweden)

    Kotru Mrinalini

    2007-01-01

    Full Text Available Giant cell tumor (GCT of bone is the most frequently over-diagnosed neoplasm in orthopedic pathology because giant cells are a common component of many neoplastic and nonneoplastic conditions of bone. Triple diagnosis, requiring substantial individual and collective inputs by orthopedic surgeons, radiologists and pathologists, is the preferred method for the workup of patients with suspected bone neoplasms. At each stage in triple diagnosis, deviations from the typical must be regarded as clues to alternate diagnoses: the greater the deviation, the more a diagnosis of GCT must be considered suspect. A suspect diagnosis must trigger renewed analysis of the available data and a diligent search to exclude alternate diagnoses.

  8. Towards Rational Use of Antibiotics for Suspected Secondary Infections in Buruli Ulcer Patients

    NARCIS (Netherlands)

    Barogui, Yves T.; Klis, Sandor; Bankole, Honore Sourou; Sopoh, Ghislain E.; Mamo, Solomon; Baba-Moussa, Lamine; Manson, Willem L.; Johnson, Roch Christian; van der Werf, Tjip S.; Stienstra, Ymkje

    2013-01-01

    Background: The emerging disease Buruli ulcer is treated with streptomycin and rifampicin and surgery if necessary. Frequently other antibiotics are used during treatment. Methods/Principal Findings: Information on prescribing behavior of antibiotics for suspected secondary infections and for

  9. High Resolution Imagery of Nikunau Island Coral Reef Systems Prior to and During Suspected Bleaching Events

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This dataset is a collection of imagery of Nikunau Island coral reef systems. They are pairs of imagery where one image was acquired during a suspected bleaching...

  10. High Resolution Imagery of Keppel Island Coral Reef Systems Prior to and During Suspected Bleaching Events

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This dataset is a collection of imagery of Keppel Island coral reef systems. They are pairs of imagery where one image was acquired during a suspected bleaching...

  11. Metagenomic analysis reveals Hepatitis A virus in suspected yellow fever cases in Brazil.

    Science.gov (United States)

    Conteville, Liliane C; Filippis, Ana Maria B de; Nogueira, Rita Maria R; Mendonça, Marcos César L de; Vicente, Ana Carolina P

    2018-01-01

    Using a metagenomic approach, we identified hepatitis A virus among cases of acute febrile illnesses that occurred in 2008-2012 in Brazil suspected as yellow fever. These findings reinforce the challenge facing routine clinical diagnosis in complex epidemiological scenarios.

  12. High Resolution Imagery of Howland Island Coral Reef Systems Prior to and During Suspected Bleaching Events

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This dataset is a collection of imagery of Howland Island coral reef systems. They are pairs of imagery where one image was acquired during a suspected bleaching...

  13. Frequency of rapid growing mycobacteria among tuberculosis suspected patients in Basra-Iraq

    National Research Council Canada - National Science Library

    Sulami, Amin A. Al; Taee, Asaad Al; Hasan, Zainab A

    2016-01-01

    Objective: The purpose of this study was to estimate the frequency of rapid growing mycobacteria among tuberculosis suspected patients in Basra governorate and study their resistance to drugs. Methods...

  14. Confirmation test of suspected Mycobacterium avium subspecies paratuberculosis (MAP isolated using PCR F57

    Directory of Open Access Journals (Sweden)

    Widagdo Sri Nugroho

    2008-06-01

    Full Text Available Seropositive and isolate suspected as Mycobacterium avium subspecies paratuberculosis (MAP was detected at dairy cows in West Java. This bacteria causes Johne’s disease (JD and potentially becomes a new emerging disease for Indonesian dairy cows. The aim of this study was to confirm the suspected local isolate as a MAP distinctively by PCR. Reculture of MAP reference isolate, suspected local isolate done by resuspending bacteria in PBS 0.5% and inoculating it in Herrold’s egg yolk medium with mycobactin J (HEYM and than inoculating it in 37oC for 16 weeks. The cultures grew in various time, Mycobacterium avium subspecies avium was detected in 3rd week, MAP reference was detected in 7th week, and local isolate was detected in 14th week. The confirmation test was carried out by PCR with primer F57. The PCR F57 result showed that MAP suspected isolate was not a Mycobacterium avium subspecies paratuberculosis.

  15. Ileoscopy reduces the need for small bowel imaging in suspected Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Rafaelsen, Søren Rafael

    2012-01-01

    In suspected Crohn's disease (CD), current diagnostic guidelines recommend additional small bowel imaging irrespective of the findings at ileocolonoscopy. Magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) are regarded first line imaging techniques and should...

  16. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, MSE; Schmand, B; Wekking, EM; Hageman, G; Deelman, BG

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  17. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, Moniek S. E.; Schmand, Ben; Wekking, Ellie M.; Hageman, Gerard; Deelman, Betto G.

    2003-01-01

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  18. Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

    Science.gov (United States)

    Tsai, Timothy L; Marine, Megan B; Wanner, Matthew R; Cooper, Matthew L; Steiner, Steven J; Ouyang, Fangqian; Gregory Jennings, S; Karmazyn, Boaz

    2017-07-01

    There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease. A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

  19. 9 CFR 381.78 - Condemnation of carcasses and parts: separation of poultry suspected of containing biological...

    Science.gov (United States)

    2010-01-01

    ...: separation of poultry suspected of containing biological residues. 381.78 Section 381.78 Animals and Animal... carcasses and parts: separation of poultry suspected of containing biological residues. (a) At the time of... to be not adulterated. (b) When a lot of poultry suspected of containing biological residues is...

  20. Incidental breast masses detected by computed tomography: are any imaging features predictive of malignancy?

    Energy Technology Data Exchange (ETDEWEB)

    Porter, G. [Primrose Breast Care Unit, Derriford Hospital, Plymouth (United Kingdom)], E-mail: Gareth.Porter@phnt.swest.nhs.uk; Steel, J.; Paisley, K.; Watkins, R. [Primrose Breast Care Unit, Derriford Hospital, Plymouth (United Kingdom); Holgate, C. [Department of Histopathology, Derriford Hospital, Plymouth (United Kingdom)

    2009-05-15

    Aim: To review the outcome of further assessment of breast abnormalities detected incidentally by multidetector computed tomography (MDCT) and to determine whether any MDCT imaging features were predictive of malignancy. Material and methods: The outcome of 34 patients referred to the Primrose Breast Care Unit with breast abnormalities detected incidentally using MDCT was prospectively recorded. Women with a known diagnosis of breast cancer were excluded. CT imaging features and histological diagnoses were recorded and the correlation assessed using Fisher's exact test. Results: Of the 34 referred patients a malignant diagnosis was noted in 11 (32%). There were 10 breast malignancies (seven invasive ductal carcinomas, one invasive lobular carcinoma, two metastatic lesions) and one axillary lymphoma. CT features suggestive of breast malignancy were spiculation [6/10 (60%) versus 0/24 (0%) p = 0.0002] and associated axillary lymphadenopathy [3/10 (33%) versus 0/20 (0%) p = 0.030]. Conversely, a well-defined mass was suggestive of benign disease [10/24 (42%) versus 0/10 (0%); p = 0.015]. Associated calcification, ill-definition, heterogeneity, size, and multiplicity of lesions were not useful discriminating CT features. There was a non-significant trend for lesions in involuted breasts to be more frequently malignant than in dense breasts [6/14 (43%) versus 4/20 (20%) p = 0.11]. Conclusion: In the present series there was a significant rate (32%) of malignancy in patients referred to the breast clinic with CT-detected incidental breast lesions. The CT features of spiculation or axillary lymphadenopathy are strongly suggestive of malignancy.

  1. Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis

    DEFF Research Database (Denmark)

    Kleif, J.; Kirkegaard, A.; Vilandt, J.

    2017-01-01

    Background: Few studies have investigated the effects of preoperative dexamethasone in acute surgical patients. This study examined the effects of 8 mg dexamethasone administered intravenously 30 min before surgery for suspected acute appendicitis. Methods: A multicentre, parallel-group, double......-blind, placebo-controlled study was conducted at two university hospitals in Denmark. Adults undergoing laparoscopic surgery for suspected appendicitis were eligible for inclusion. Participants, healthcare staff and investigators were blinded until all data analysis had been done. The primary outcome...

  2. [A case of paragonimiasis miyazakii suspected after pathologic examination and subsequently confirmed].

    Science.gov (United States)

    Ota, Kyoko; Matsuyama, Masashi; Kokuho, Nariaki; Masuko, Hironori; Hayashi, Hiroki; Iizuka, Takashi; Hayashibara, Kenji; Saito, Takefumi; Kawabata, Yoshinori; Tomichi, Nobukazu

    2009-03-01

    A 58-year-old man presented with right backache and bloody sputum. Chest X-ray revealed a nodular opacity in the right lung. Since could not obtain a diagnosis by bronchoscopy, we performed a lower lobectomy. Histopathologically, there were irregularly shaped necrotizing granulomas and an area of acute hemorrhagic, eosinophilic abscess. We suspected paragonimiasis. The diagnosis of paragonimiasis miyazakii was confirmed by ELISA. This is a valuable case of suspected paragonimiasis confirmed pathologically.

  3. [Association between time spent on physical exercise, sleep, homework and suspected myopia among students].

    Science.gov (United States)

    Xu, S J; Wan, Y H; Xu, Z H; Zhang, H; Xu, L; Wang, B; Tao, F B

    2016-02-01

    To investigate the prevalence of suspected myopia among students and to examine the relationship between time spent on physical exercise, sleep, homework and suspected myopia. A total of 8 030 primary and secondary school students from 4(th) to 12(th) grades were selected from the National Student Constitution and Health Survey (NSCHS) in Anhui province in 2014. Time spent on exercise, sleep and homework per day were collected using a self-administrated questionnaire. Visual acuity was examined using the Standard Logarithmic Visual Acuity Chart. The overall prevalence of suspected myopia was 69.03%. Prevalence rates of suspected myopia appeared higher in girls, in urban students, with the highest in the 16 to 18 year-old groups. RESULTS from the multiple logistic regression analysis showed that the amount of time spent on physical exercise, sleep and homework per day were all significantly associated with suspected myopia. Suspected myopia was associated with longer time on physical exercise among students aged 8 to 12 years (OR=0.80, 95%CI: 0.64-0.99), and longer sleep time among students in the age groups of 13 to 15 years and 16 to 18 years (OR=0.73, 95% CI: 0.56-0.94;OR=0.38, 95% CI: 0.21-0.68, respectively). Longer time spent on homework significantly increased the risk of suspected myopia among students in the age groups of 8 to 12 years and 13 to 15 years (OR=1.41, 95%CI: 1.11-1.79; OR=1.74, 95% CI: 1.36-2.23, respectively). Suspected myopia appeared common among students. Comprehensive intervention programs focusing on sufficient physical exercise and sleep but less homework might help to prevent myopia among students at different ages.

  4. The changing rate of suspected rabies bites after begin to act animal shelter in erzurum city.

    Science.gov (United States)

    Vancelik, Serhat; Set, Turan; Akturk, Zekeriya; Calikoglu, Oksan; Kosan, Zahide

    2014-10-01

    We aimed to evaluate the relationship between establishing an animal shelter in Erzurum and the number of suspected rabies bites between the years 2005 and 2012. A retrospective, repeated cross-sectional study was planned in Erzurum in the year 2013. Records between the years 2005 and 2012 were obtained from the Communicable Diseases Department of the Erzurum Health Directorate. Data for 5789 cases exposed to suspected rabies bites were analyzed. 5789 suspected rabies bites were encountered in Erzurum between the years 2005 and 2012. After establishing the animal shelter in 2009, 4239 dogs were collected from the streets within four years and 426 of them were released after immunization. Additionally, the following services were given in the animal shelter between 2009 and 2012: immunization of 2935 dogs, sterilization of 1735 dogs, and release of 2082 dogs back to the street. 4-years before the establishment of the animal shelter, the number of dog-bites had decreased from 3403 cases to 2386 cases; 4-years after the establishment of the shelter, it declined by 29.8%. While there were 1096 suspected rabies cases during the year 2008, this ratio decreased by 40.9% after the establishment of the animal shelter in the year 2009. During the year 2010, where we had the highest number of homeless dog collection to the animal shelter, the decrease in suspected rabies bites reached the maximum decrease, namely 51.0%. Spearman correlation analysis showed a strong negative correlation between the number of collected animals and suspected rabies bites (r = -0,862; p=0.006). Suspected rabies cases are common in Turkey and some cases of rabies are encountered. The number of suspected rabies bites in Erzurum has decreased significantly after establishing the animal shelter. It is an evident that establishing rehabilitation centers for homeless animals in all cities will have an important role in controlling zoonotic diseases including rabies.

  5. Sudden Suspected Death in Emergency Department: Autopsy Results

    Directory of Open Access Journals (Sweden)

    Mehtap GURGER

    2014-09-01

    Full Text Available SUMMARY: Objectives: Sudden deaths occur within 24 hours after symptoms' onset and are caused by cardiac, neurological and pulmonary diseases. Autopsy is the gold standard in determining cause of death. In this study, death's etiology was evaluated in cases applied to our department that underwent autopsy with sudden death indication. Methods: This study included cases aged 18 or older with sudden, suspected, non-traumatic death applying to our department between 2008 and 2012. Patients' age, sex, death time, co-morbid diseases, initial signs, cardiac rhythm, and autopsy findings were recorded after reviewing patient charts. Results: The study included 46 patients. Mean age was 45.73±19.6. Of the cases, 84.78% applied to emergency with cardiopulmonary arrest. Thirty-two cases (69.6% were male. The most frequent cause of death was cardiovascular diseases (52.2%, followed by central nervous system disorders (21.7%, intoxications (15.2%, and respiratory diseases (10.9%. The most common diseases were myocardial infarction (45.7%, subarachnoid hemorrhage (8.7%, and chronic obstructive pulmonary disease. There were three drug ingestions, three carbon monoxide intoxications, and one corrosive material ingestion among the intoxication cases. Conclusions: Sudden deaths are rarely encountered. Emergency clinicians should consider cause in differential diagnosis and provide appropriate approaches at first evaluation. ÖZET: Amaç: Ani ölümler semptomlar başladıktan sonra 24 saat içerisinde oluşur. En yaygın nedenleri kardiyak, nörolojik ve pulmoner hastalıkları içerir. Otopsi bu ölümlerin nedenini tespit etmede altın standarttır. Bu çalışmada acil servisimize başvuran ani ölüm olgularının otopsi bulgularına göre ölüm nedenlerini değerlendirdik. Gereç ve Yöntem: Bu retrospektif çalışmaya 2008–2012 yılları arasında acil servisimize başvuran, yaşları 18 ve üzeri olan, nontravmatik, ani, şüpheli ölüm vakaları al

  6. Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest.

    Science.gov (United States)

    Koller, Allison C; Salcido, David D; Callaway, Clifton W; Menegazzi, James J

    2014-10-01

    We sought to compare characteristics of emergency medical services-treated out-of-hospital cardiac arrests resulting from suspected drug overdose with non-overdose cases and test the relationship between suspected overdose and survival to hospital discharge. Data from emergency medical services-treated, non-traumatic out-of-hospital cardiac arrests from 2006 to 2008 and late 2009 to 2011 were obtained from four EMS agencies in the Pittsburgh, Pennsylvania metropolitan area. Case definition for suspected drug overdose was naloxone administration, indication on the patient care report and/or indication by a review of hospital records. Resuscitation parameters included chest compression fraction, rate, and depth and the administration of resuscitation drugs. Demographic and outcome variables compared by suspected overdose status included age, sex, and survival to hospital discharge. From 2342 treated out-of-hospital cardiac arrests, 180 were suspected overdose cases (7.7%) and were compared to 2162 non-overdose cases. Suspected overdose cases were significantly younger (45 vs. 65, pcardiac arrest were younger, received different resuscitative care, and survived more often than non-overdose cases. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Neutrino masses

    CERN Document Server

    Gelmini, Graciela B; Gelmini, Graciela; Roulet, Esteban

    1995-01-01

    This is a review for Reports of Progress in Physics. After an introduction we start by explaining the different neutrino masses corresponding to different types of neutrinos, Dirac or Majorana, in section 2. In section 3 we discuss the main elementary particle models for neutrino masses and their distinctive phenomenological consequences. In section 4 we describe the status of direct mass searches and Majorana mass searches in neutrinoless double beta decays. In section 5 we go over the many cosmological implications of, and constraints on, neutrino properties, mainly masses and lifetimes. Sections 6, 7 and 8 review neutrino oscillations, the solar neutrino problem and the atmospheric neutrino problem, their implications and the current and future experiments. In particular, we explain oscillations in vacuum in section 6 and oscillations in matter in section 7. Section 9 summarizes the main bounds imposed by stars, mainly SN1987A. A few concluding remarks follow.

  8. Mass Society

    DEFF Research Database (Denmark)

    Borch, Christian

    2017-01-01

    the negative features usually ascribed by late nineteenth-century crowd psychology to spontaneous crowds, and attributes these to the entire social fabric. However, in contrast to crowd psychology, theorists of mass society often place greater emphasis on how capitalism, technological advances, or demographic......Mass society is a societal diagnosis that emphasizes – usually in a pejorative, modernity critical manner – a series of traits allegedly associated with modern society, such as the leveling of individuality, moral decay, alienation, and isolation. As such, the notion of mass society generalizes...... developments condition such negative features, and some theorists argue that mass society produces a propensity to totalitarianism. Discussions of mass society culminated in the early and mid-twentieth century....

  9. Prevalence of suspected nonalcoholic fatty liver disease in Hispanic/Latino individuals differs by heritage.

    Science.gov (United States)

    Kallwitz, Eric R; Daviglus, Martha L; Allison, Matthew A; Emory, Kristen T; Zhao, Lihui; Kuniholm, Mark H; Chen, Jinsong; Gouskova, Natalia; Pirzada, Amber; Talavera, Gregory A; Youngblood, Marston E; Cotler, Scott J

    2015-03-01

    Nonalcoholic fatty liver disease (NAFLD) was shown to disproportionally affect Hispanic persons. We examined the prevalence of suspected NAFLD in Hispanic/Latino persons with diverse backgrounds. We studied the prevalence of suspected NAFLD among 12,133 persons included in the Hispanic Community Health Study/Study of Latinos. We collected data on levels of aminotransferase, metabolic syndrome (defined by National Cholesterol Education Program-Adult Treatment Panel III guidelines), demographics, and health behaviors. Suspected NAFLD was defined on the basis of increased level of aminotransferase in the absence of serologic evidence for common causes of liver disease or excessive alcohol consumption. In multivariate analyses, data were adjusted for metabolic syndrome, age, acculturation, diet, physical activity, sleep, and levels of education and income. In multivariate analysis, compared with persons of Mexican heritage, persons of Cuban (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.57-0.85), Puerto Rican (OR, 0.67; 95% CI, 0.52-0.87), and Dominican backgrounds (OR, 0.71; 95% CI, 0.54-0.93) had lower rates of suspected NAFLD. Persons of Central American and South American heritage had a similar prevalence of suspected NAFLD compared with persons of Mexican heritage. NAFLD was less common in women than in men (OR, 0.49; 95% CI, 0.40-0.60). Suspected NAFLD associated with metabolic syndrome and all 5 of its components. On the basis of an analysis of a large database of health in Latino populations, we found the prevalence of suspected NAFLD among Hispanic/Latino individuals to vary by region of heritage. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  10. Pattern Electroretinography in Glaucoma Suspects and Early Primary Open Angle Glaucoma

    Directory of Open Access Journals (Sweden)

    Ebrahim Jafarzadehpour

    2013-01-01

    Full Text Available Purpose: To explore retinal ganglion cell (RGC dysfunction in glaucoma suspects and patients with early primary open angle glaucoma (POAG using pattern electroretinography (PERG. Methods: Twenty glaucoma suspects (glaucomatous optic disc appearance, 15 early POAG (based on abnormal discs and abnormal visual fields and 16 normal controls were enrolled. Transient PERG was recorded in response to 0.8΀ and 16΀ black and white checkerboard stimuli. Amplitude and peak time (latency of the P50 and N95 components of the PERG response, and the ratio of N95 amplitude in response to 0.8΀ and 16΀ checks were measured. Results: N95 peak time (latency was significantly increased in both early manifest POAG and glaucoma suspects as compared to normal controls (P<0.001. In early POAG, N95 amplitude in response to small (0.8΀ checks and the small/large check ratio were reduced in comparison to normal eyes (P<0.05. However, in glaucoma suspects no significant N95 amplitude reduction was observed. No significant difference was observed among the study groups in terms of P50 amplitude or peak time. Conclusion: The N95 PERG response demonstrated uncoupled peak time and amplitude alterations in glaucoma. N95 peak time was significantly increased both in glaucoma suspects and early POAG; N95 amplitude reduction was present only in early POAG. PERG may detect RGC dysfunction (increased latency before cell death (decreased amplitude occurs.

  11. Facing suspected child abuse--what keeps Swedish general practitioners from reporting to child protective services?

    Science.gov (United States)

    Talsma, Marijke; Bengtsson Boström, Kristina; Östberg, Anna-Lena

    2015-03-01

    The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS). A cross-sectional questionnaire study. Primary health care centres in western Sweden. 177 GPs and GP trainees. Demographic and educational background, education on child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse, and need of support. Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS's methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden. This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse.

  12. Are irregular hypoechoic breast masses on ultrasound always malignancies?: A Pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Youe Ree; Kim, Hun Soo; Kim, Hye Won [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2015-12-15

    Irregular hypoechoic masses in the breast do not always indicate malignancies. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. Some of these diseases such as inflammation and trauma-related breast lesions could be suspected from a patient's symptoms and personal history. Careful ultrasonographic examination and biopsy could help to differentiate these from malignancies.

  13. Mass Screening of Suspected Febrile Patients with Remote-sensing Infrared Thermography: Alarm Temperature and Optimal Distance

    Directory of Open Access Journals (Sweden)

    Ming-Fu Chiang

    2008-12-01

    Conclusion: The temperature readings obtained by IRT may be used as a proxy for core temperature. An effective IRT system with a strict operating protocol can be rapidly implemented at the entrance of a hospital during SARS or avian influenza epidemics.

  14. Outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. A retrospective survey

    DEFF Research Database (Denmark)

    Møller, Søren; Madsen, Jan Lysgård

    2002-01-01

    BACKGROUND: Different diagnostic examinations have been applied in the management of patients with suspected intestinal ischaemia. In some centres, invasive determination of a meal-induced increase in splanchnic blood flow is used in the diagnostic process and in the selection of patients for sur...... underwent angioplasty. Future studies are needed to validate the determination of splanchnic blood flow in relation to splanchnic angiography and other imaging modalities in patients with chronic intestinal ischaemia.......BACKGROUND: Different diagnostic examinations have been applied in the management of patients with suspected intestinal ischaemia. In some centres, invasive determination of a meal-induced increase in splanchnic blood flow is used in the diagnostic process and in the selection of patients...... for surgery. However, no studies have evaluated the impact of splanchnic blood flow determination on therapy in such patients. OBJECTIVE: The aim of the present study was therefore to analyse the outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. METHODS...

  15. Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI

    DEFF Research Database (Denmark)

    Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian

    2017-01-01

    BACKGROUND: QRS duration has previously shown association with mortality in patients with acute myocardial infarction treated with thrombolytics, less is known in patients with suspected ST segment elevation myocardial infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus......, the objective was to investigate the prognostic effect of QRS duration on prehospital ECG and presence of classic left and right bundle branch block (LBBB/RBBB) for all-cause mortality in patients with suspected STEMI. METHOD: In total 2105 consecutive patients (mean age 64±13years, 72% men) with suspected...... STEMI were prospectively included. QRS duration was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (111ms). Primary endpoint was all-cause 30-day mortality. Predictors of all-cause mortality were...

  16. Prevalence and Correlates of Suspected Nonalcoholic Fatty Liver Disease in Chinese Children

    Directory of Open Access Journals (Sweden)

    Peige Song

    2017-04-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD has become a serious public health problem worldwide; however, the availability of information on the prevalence of NAFLD in the general pediatric population is still limited. The primary aim of this study was to reveal the prevalence and correlates of suspected NAFLD in Chinese children at the national level. Data from the China Health and Nutrition Surveys (CHNS was used. Weight, height, waist circumference (WC, blood pressure (BP were measured for children aged 7–18 years. Blood samples were collected and analyzed. Children were classified as having suspected NAFLD if common causes of liver disease were excluded, and serum alanine aminotransferase (ALT values were above the established thresholds (>22.1 IU/L for girls and >25.8 IU/L for boys. A percentage of 9.03% (75 out of 831 of Chinese children was found to have suspected NAFLD. Overweight and obesity according to BMI percentiles, abdominal obesity, hyperuricemia (uric acid (UA > 327 μmol/L, and elevated total cholesterol (TC were all detected as the correlates of childhood suspected NAFLD when adjusting for other factors. Our study revealed the prevalence of suspected NAFLD in general Chinese children at the national level for the first time. Our findings indicate that suspected NAFLD in children is associated with increasing childhood morbidities, further studies are needed to better understand the prevalence of childhood NAFLD and its correlates, and large-scale programs should be launched to screen NAFLD in the pediatric population in China.

  17. Prevalence of Clostridium perfringens toxin genotypes in enterotoxemia suspected sheep flocks of Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    N. Vinod Kumar

    2014-12-01

    Full Text Available Aim: To identify the Clostridium perfringens toxin genotypes prevailing in enterotoxemia suspected sheep flocks in Andhra Pradesh by using multiplex PCR. Materials and Methods: Intestinal scrapings were collected from lambs below three months of age from flocks with similar management from different Districts of Andhra Pradesh, in India. A total of 208 samples were collected with 140 from enterotoxemia suspected flocks and 68 from healthy flocks. Following processing and culture of the samples, colonies were identified by morphological and biochemical tests. All the clostridial isolates were analyzed by multiplex PCR. Results: C. pefringens were isolated from 97 out of 140 enterotoxemia suspected flocks (69.29% and 27 out of 68 healthy flocks (39.71 %. Genotyping of the 97 iolates by multiplex PCR from enterotoxemia suspected flocks indicated C. perfringens type A, C and D 67.01% (65 out of 97; 11.34% (11 out of 97 and 21.65% (21 out of 97 respectively. Isolates from healthy flocks indicated the presence of type A and D 92.59% (25 out of 27 and 7.40% (2 out of 27 respectively. Number of isolates from enterotoxaemia suspected flocks were significantly high (P<0.001 than healthy flocks. Type A is found to be predominant in both enterotoxemia suspected and healthy flocks (67.01% and 92.59%. Conclusions: Prevalence of C. perfringens type C was reported for the first time in India. Clostridium perfringens type D and type C were found to be the major causative types for enterotoxemia.

  18. Cost-benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals.

    Science.gov (United States)

    Diel, Roland; Nienhaus, Albert; Hillemann, Doris; Richter, Elvira

    2016-02-01

    Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects. Copyright ©ERS 2016.

  19. Successful conservative management of suspected Fournier’s gangrene in cats: three cases

    Directory of Open Access Journals (Sweden)

    Heather H Vaske

    2015-06-01

    Full Text Available Case series summary Three cats with suspected Fournier’s gangrene had an acute onset of clinical signs and bloodwork changes consistent with sepsis. All cases had similar progression of wounds that were managed without aggressive surgical debridement, which is the currently accepted treatment of choice. All cats survived and have maintained an excellent long-term quality of life. Relevance and novel information Fournier’s gangrene is a potentially fatal disease, with few cases reported in the veterinary literature. This retrospective case series describes the only known reports of survival from suspected Fournier’s gangrene cats, none of which required aggressive surgical debridement.

  20. The Lawyer in the Dutch Interrogation Room: Influence on Police and Suspect

    OpenAIRE

    Verhoeven, Willem-Jan; Stevens, Lonneke

    2012-01-01

    textabstractIn many European countries, providing a suspect in custody with legal aid before the first police interrogation is a heavily debated issue. In this paper, we report on an exploratory study on the use of coercion by the police and the use of the right to silence by suspects in 70 Dutch homicide cases and their relation to prior consultation and presence of a lawyer. Analysis of the data indicates that there is a relation between the presence of a lawyer in the interrogation room an...

  1. Mass metrology

    CERN Document Server

    Gupta, S V

    2012-01-01

    This book presents the practical aspects of mass measurements. Concepts of gravitational, inertial and conventional mass and details of the variation of acceleration of gravity are described. The Metric Convention and International Prototype Kilogram and BIPM standards are described. The effect of change of gravity on the indication of electronic balances is derived with respect of latitude, altitude and earth topography. The classification of weights by OIML is discussed. Maximum permissible errors in different categories of weights prescribed by national and international organizations are p

  2. Validation of results from knowledge discovery: mass density as a predictor of breast cancer.

    Science.gov (United States)

    Woods, Ryan W; Oliphant, Louis; Shinki, Kazuhiko; Page, David; Shavlik, Jude; Burnside, Elizabeth

    2010-10-01

    The purpose of our study is to identify and quantify the association between high breast mass density and breast malignancy using inductive logic programming (ILP) and conditional probabilities, and validate this association in an independent dataset. We ran our ILP algorithm on 62,219 mammographic abnormalities. We set the Aleph ILP system to generate 10,000 rules per malignant finding with a recall >5% and precision >25%. Aleph reported the best rule for each malignant finding. A total of 80 unique rules were learned. A radiologist reviewed all rules and identified potentially interesting rules. High breast mass density appeared in 24% of the learned rules. We confirmed each interesting rule by calculating the probability of malignancy given each mammographic descriptor. High mass density was the fifth highest ranked predictor. To validate the association between mass density and malignancy in an independent dataset, we collected data from 180 consecutive breast biopsies performed between 2005 and 2007. We created a logistic model with benign or malignant outcome as the dependent variable while controlling for potentially confounding factors. We calculated odds ratios based on dichomotized variables. In our logistic regression model, the independent predictors high breast mass density (OR 6.6, CI 2.5-17.6), irregular mass shape (OR 10.0, CI 3.4-29.5), spiculated mass margin (OR 20.4, CI 1.9-222.8), and subject age (β = 0.09, p < 0.0001) significantly predicted malignancy. Both ILP and conditional probabilities show that high breast mass density is an important adjunct predictor of malignancy, and this association is confirmed in an independent data set of prospectively collected mammographic findings.

  3. Mass spectrometry

    DEFF Research Database (Denmark)

    Nyvang Hartmeyer, Gitte; Jensen, Anne Kvistholm; Böcher, Sidsel

    2010-01-01

    Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is currently being introduced for the rapid and accurate identification of bacteria. We describe 2 MALDI-TOF MS identification cases - 1 directly on spinal fluid and 1 on grown bacteria. Rapidly obtained r...

  4. MR enterography versus capsule endoscopy in paediatric patients with suspected Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Casciani, Emanuele; Masselli, Gabriele; Polettini, Elisabetta; Bertini, Luca; Gualdi, Gianfranco [University, Radiology DEA, Azienda Policlinico Umberto I, Rome (Italy); Di Nardo, Giovanni; Oliva, Salvatore; Cucchiara, Salvatore [University, Pediatric Gastroenterology, Rome (Italy); Floriani, Irene [Istituto di Ricerche Farmacologiche ' ' Mario Negri' ' , Milan (Italy)

    2011-04-15

    The aim of this prospective study was to compare the diagnostic yield of MR enterography (MRE) with small-bowel capsule endoscopy (SBCE) in paediatric patients with suspected Crohn's disease (CD). Paediatric patients with suspected CD were considered eligible to be enrolled in the study. All patients underwent diagnostic work-up including 1.5-T MRE, ileo-colonoscopy and oesophagogastroduodenoscopy. SBCE was not performed if MRE showed SB stricture or extra-intestinal findings consistent with symptoms. Sixty consecutive paediatric patients (36 male; average age 14) were enrolled into the study. A positive diagnosis for CD was made in 19 patients, 29 had a negative result and 12 were affected by other gastro-intestinal conditions. SBCE was performed in 37 patients (61.7%); 23 patients were excluded (strictures in five, extra-intestinal findings in 11 and parents' refusal in seven cases). The accuracy, sensitivity, and specificity of MRE and SBCE were 98.3%, 100%, 97.6%, and 91.9%, 90.9%, 92.3%, respectively. Both MRE and SBCE are accurate methods for patients with suspected CD. MRE can be used as a primary imaging technique in suspected CD, in that it allows access to the ileal stricture, which forms a contra-indication for SBCE and provides extra-intestinal information. (orig.)

  5. Factors Affecting Special Education Services for English Language Learners with Suspected Language Learning Disabilities

    Science.gov (United States)

    Langdon, Henriette W.

    2002-01-01

    This article focuses on factors that impact identification of and services for English-language learners (ELLs) with suspected language-learning disabilities. These factors include (a) home and school environments, (b) the school's philosophy, (c) instructional strategies, and (d) other contextual variables that affect language use. In addition,…

  6. Study of topical corticosteroid response in glaucoma suspects and family members of established glaucoma patients

    Directory of Open Access Journals (Sweden)

    Jilani F

    1987-01-01

    Full Text Available The present study was conducted to study the topical steroid response in glaucoma suspects and family members of established glaucoma patients and its hereditary pattern The cases understudy were divided into three groups, namely normal (25 cases, suspected open angle glaucoma cases (20 and family members of established open angle glaucoma cases (33. After preliminary examination each patient was advised to put dexamethasone drop 1 % in one eye and a placebo in other eye. The IOP was noted after three weeks It was found that 80% of all eyes under study showed a rise in IOP after use of topical dexamethasone. The highest mean IOP was found in primary open angle glaucoma suspects, and the highest mean post-corticosteroid rise in IOP of 8.91 mm Hg was found among family members of established open angle glaucoma patients. The lOP response to topical corticosteroids was found to be of three phenotypical types viz., poor responders (nn, moderate responders (ng and high responders (gg. Normal subjects were generally poor responders. Suspected open angle glaucoma cases were generally high responders. However, family members of established open angle glaucoma cases showed the highest percentage of presence of responder gene.

  7. Teachers' Reporting of Suspected Child Abuse and Neglect: Behaviour and Determinants

    Science.gov (United States)

    Goebbels, A. F. G.; Nicholson, J. M.; Walsh, K.; De Vries, H.

    2008-01-01

    By reporting suspected child abuse and neglect, teachers can make an important contribution to the early detection and prevention of abuse. However, teachers are sometimes reluctant to report their suspicions. This study investigated the determinants of teachers' reporting behaviour using concepts from the Integrated Change Model. Self-report data…

  8. Correlation of serum apelin level with coronary calcium score in patients with suspected coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mohammed Hassan Zeitoun

    2014-03-01

    Conclusion: To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

  9. Retributive reactions to suspected offenders: The importance of social categorizations and guilt probability

    NARCIS (Netherlands)

    van Prooijen, J.W.

    2006-01-01

    In the current research, the author investigates the influence of social categorizations on retributive emotions (e.g., anger) and punishment intentions when people evaluate suspected offenders as independent observers. It is argued that information that guilt is certain or uncertain (i.e., guilt

  10. Metrical Analysis of the Speech of Children with Suspected Developmental Apraxia of Speech.

    Science.gov (United States)

    Velleman, Shelley L.; Shriberg, Lawrence D.

    1999-01-01

    This study attempted to identify diagnostic markers for suspected developmental apraxia of speech (SD-DAS) in 30 children with either SD-DAS or speech delay using analytic procedures from metrical phonology. Findings indicated that, although lexical metrical patterns did not differentiate the groups, syllable omissions persisted until much later…

  11. Neurohormonal activation and diagnostic value of cardiac peptides in patients with suspected mild heart failure

    DEFF Research Database (Denmark)

    Mikkelsen, Kirsten V.; Bie, Peter; Møller, Jacob E.

    2006-01-01

    accuracy of cardiac peptides to detect any left ventricular dysfunction (LVD) in patients referred from primary care with suspected HF before institution of medical therapy. METHODS: Of 166 referred patients 150 were consecutively included (14 were excluded and two refused consent). Echocardiography...

  12. Cortical capillary dysfunction in patients suspected of Alzheimer’s disease

    DEFF Research Database (Denmark)

    Eskildsen, Simon Fristed; Gyldensted, Louise; Nagenthiraja, Kartheeban

    Vascular risk factors are suspected to play a role in the etiology of Alzheimer’s disease. Recently, a model that relates capillary dysfunction to the development of AD was proposed[1]. The model predicts that capillary dysfunction in form of increased capillary transit time heterogeneity (CTH...

  13. 32 CFR 644.530 - Conditions in conveying land suspected of contamination.

    Science.gov (United States)

    2010-07-01

    ... contamination. 644.530 Section 644.530 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... Contamination from Proposed Excess Land and Improvements § 644.530 Conditions in conveying land suspected of contamination. The following conditions, appropriately modified to conform to local law, will be included in...

  14. Dynamics of Forensic Interviews with Suspected Abuse Victims Who Do Not Disclose Abuse

    Science.gov (United States)

    Hershkowitz, Irit; Orbach, Yael; Lamb, Michael E.; Sternberg, Kathleen J.; Horowitz, Dvora

    2006-01-01

    Objectives: The present study was designed to explore structural differences between forensic interviews in which children made allegations and those in which children did not make allegations. Methodology: Fifty forensic interviews of 4- to 13-year-old suspected victims of abuse who did not disclose abuse during the interview were compared with…

  15. Hypocholesterolemia and nonregenerative, suspected immune-mediated, anemia: Report of 3 canine cases.

    Science.gov (United States)

    Robbins, Rachel; Viviano, Katrina R

    2017-10-01

    This report describes hypocholesterolemia in 3 dogs with nonregenerative, suspected immune-mediated anemias. Common causes of hypocholesterolemia were ruled out, raising suspicion for a mechanistic link between anemia and hypocholesterolemia in dogs. As observed in humans with concurrent anemia and hypocholesterolemia, cholesterol concentrations increased to within the reference interval once the dogs' anemia resolved.

  16. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial

    NARCIS (Netherlands)

    Hull, R. D.; Hirsh, J.; Carter, C. J.; Jay, R. M.; Ockelford, P. A.; Buller, H. R.; Turpie, A. G.; Powers, P.; Kinch, D.; Dodd, P. E.

    1985-01-01

    Impedance plethysmography is an accurate noninvasive method to test for proximal vein thrombosis, but it is insensitive to calf-vein thrombi. We randomly assigned patients on referral with clinically suspected deep-vein thrombosis and normal impedance plethysmographic findings to either serial

  17. Parents with Schizophrenia – Insights from notifications of suspected child abuse and neglect

    DEFF Research Database (Denmark)

    Wulf-Andersen, Trine Østergaard; Ranning, Anne

    2016-01-01

    with schizophrenia. In this study, notifications of suspected child abuse and neglect was used to elicit difficulties in parental role functioning in schizophrenia patients. Qualitative text analysis was used to elicit common themes in 49 written documents from social workers at mental health centres expressing...

  18. Experiences of School Counselors during and after Making Suspected Child Abuse Reports

    Science.gov (United States)

    Sikes, April; Remley, Theodore P., Jr.; Hays, Danica G.

    2010-01-01

    The purpose of this study was to explore the experiences of school counselors during and after making suspected child abuse and neglect reports. A total of 847 school counselors who were members of the American School Counselor Association (ASCA) participated in this study. Results showed that professional school counselors encountered some…

  19. STATUS GIZI DAN STATUS IODIUM PADA BALITA DENGAN SUSPECT DOWN SYNDROME

    Directory of Open Access Journals (Sweden)

    Hastin Dyah K.

    2012-10-01

    Full Text Available Background: Nutritional status is one of the factor that determines the human resources and quality of life. Toddlers are one of vulnerable groups for nutritional problems. One of the nutrition problem in Indonesia is Iodine deficiency disorder. Clinical manifestations are not only endemic goiter and cretins, but also abortion, stillbirth, and congenital abnormalities. Congenital abnormalities are commonly found in areas ofendemic iodine deficiency disorder such as Down Syndrome. Objectives: This study aims to determine the iodine nutrition status of children under jive with Down Syndrome Suspect in endemic areas ofiodine deficiency disorder. Method: This research is descriptive study with cross sectional design. The study was conducted in Magelang district, which is endemic iodine deficiency disorder. Total sample of30 under jive years old with Down Syndrome Suspect. Result: The result showed that the nutritional status of respondents based on the weight/age index was 50% had good nutritional status. According to height/age index as much as 70% are short and very short. Based on weight/height index was 73,3% with normal nutritional status. At least 33% of children with Down Syndrome Suspect accompanied hypothyroidism.  Keywords: Suspect Down Syndrome, Nutritional Status, Iodine Status

  20. Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

    Science.gov (United States)

    Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

    2010-01-01

    Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy. PMID:20811612

  1. Mitochondrial DNA haplogroup background affects LHON, but not suspected LHON, in Chinese patients.

    Science.gov (United States)

    Zhang, A-Mei; Jia, Xiaoyun; Bi, Rui; Salas, Antonio; Li, Shiqiang; Xiao, Xueshan; Wang, Panfeng; Guo, Xiangming; Kong, Qing-Peng; Zhang, Qingjiong; Yao, Yong-Gang

    2011-01-01

    Recent studies have shown that mtDNA background could affect the clinical expression of Leber hereditary optic neuropathy (LHON). We analyzed the mitochondrial DNA (mtDNA) variation of 304 Chinese patients with m.11778G>A (sample #1) and of 843 suspected LHON patients who lack the three primary mutations (sample #2) to discern mtDNA haplogroup effect on disease onset. Haplogroup frequencies in the patient group was compared to frequencies in the general Han Chinese population (n = 1,689; sample #3). The overall matrilineal composition of the suspected LHON population resembles that of the general Han Chinese population, suggesting no association with mtDNA haplogroup. In contrast, analysis of these LHON patients confirms mtDNA haplogroup effect on LHON. Specifically, the LHON sample significantly differs from the general Han Chinese and suspected LHON populations by harboring an extremely lower frequency of haplogroup R9, in particular of its main sub-haplogroup F (#1 vs. #3, P-value = 1.46×10(-17), OR = 0.051, 95% CI: 0.016-0.162; #1 vs. #2, P-value = 4.44×10(-17), OR = 0.049, 95% CI: 0.015-0.154; in both cases, adjusted P-value LHON in Chinese patients with m.11778G>A but not suspected LHON. Haplogroup F has a protective effect against LHON, while M7b is a risk factor.

  2. A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism

    NARCIS (Netherlands)

    Kruip, M. J. H. A.; Söhne, M.; Nijkeuter, M.; Kwakkel-van Erp, H. M.; Tick, L. W.; Halkes, S. J. M.; Prins, M. H.; Kramer, M. H. H.; Huisman, M. V.; Büller, H. R.; Leebeek, F. W. G.

    2006-01-01

    OBJECTIVES: Diagnostic strategies in patients with suspected pulmonary embolism have been extensively studied in outpatients; their value in hospitalized patients has not been well established. Our aim was to determine the safety and clinical utility of a simple diagnostic strategy in hospitalized

  3. Endoscopic pH Monitoring for Patients with Suspected or Refractory Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Brian G Turner

    2007-01-01

    Full Text Available BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD. The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms.

  4. Temporal artery biopsy is not required in all cases of suspected giant cell arteritis.

    LENUS (Irish Health Repository)

    Quinn, Edel Marie

    2012-07-01

    Temporal artery biopsy (TAB) is performed during the diagnostic workup for giant cell arteritis (GCA), a vasculitis with the potential to cause irreversible blindness or stroke. However, treatment is often started on clinical grounds, and TAB result frequently does not influence patient management. The aim of this study was to assess the need for TAB in cases of suspected GCA.

  5. 45 CFR 681.5 - What happens if program fraud is suspected?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false What happens if program fraud is suspected? 681.5 Section 681.5 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Procedures Leading to Issuance of A Complaint § 681.5...

  6. Unexpected MRI findings in clinically suspected Legg-Calve-Perthes disease

    Energy Technology Data Exchange (ETDEWEB)

    Lobert, Philip F.; Dillman, Jonathan R.; Strouse, Peter J.; Hernandez, Ramiro J. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital/F3503, Ann Arbor, MI (United States)

    2011-03-15

    In the setting of clinically suspected Legg-Calve-Perthes (LCP) disease and negative/equivocal radiographs, contrast-enhanced MRI can be performed to confirm the diagnosis. To determine the frequency of unexpected causes of hip pain as identified by MRI in children with clinically suspected LCP disease and negative/equivocal radiographs. All pediatric contrast-enhanced MRI examinations of the pelvis and hips performed between January 2000 and February 2009 to evaluate for possible LCP disease in the setting of negative/equivocal radiographs were identified. MRI examinations performed to evaluate for secondary avascular necrosis were excluded. Imaging reports were retrospectively reviewed for unexpected clinically important causes of hip pain. Thirty-six pediatric patients underwent contrast-enhanced MRI examinations for clinically suspected LCP disease in the setting of negative/equivocal radiographs. Twenty-two (61%) imaging studies were normal, while four (11%) imaging studies demonstrated findings consistent with LCP disease. Ten (28%) imaging studies revealed unexpected clinically important causes of hip pain, including nonspecific unilateral joint effusion and synovitis (n = 7, juvenile chronic arthritis was eventually diagnosed in 3 patients), sacral fracture (n = 1), apophyseal injury (n = 1), and femoral head subluxation (n = 1). MRI frequently reveals unexpected clinically important causes of hip pain in children with suspected LCP disease and negative/equivocal radiographs. (orig.)

  7. MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis

    NARCIS (Netherlands)

    Maas, Mario; Slim, Erik J.; Heoksma, Agnes F.; van der Kleij, Ad J.; Akkerman, Erik M.; den Heeten, Gerard J.; Faber, William R.

    2002-01-01

    This study was undertaken to analyze MRI findings in leprosy patients with neuropathic feet, which are suspected of having osteomyelitis. As far as we know, there is no literature concerning osteomyelitis and MRI in neuropathic leprosy feet at present. Therefore, we have included MRI examination of

  8. Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

    NARCIS (Netherlands)

    Buijze, Geert A.; Mallee, Wouter H.; Beeres, Frank J. P.; Hanson, Timothy E.; Johnson, Wesley O.; Ring, David

    2011-01-01

    Evaluation of the diagnostic performance characteristics of radiographic tests for diagnosing a true fracture among suspected scaphoid fractures is hindered by the lack of a consensus reference standard. Latent class analysis is a statistical method that takes advantage of unobserved, or latent,

  9. Arm and Hand Movement in Children Suspected of Having Autism Spectrum Disorder

    Science.gov (United States)

    Braddock, Barbara A.; Hilton, Jane C.

    2016-01-01

    The aim of this study was to describe arm and hand movement in children suspected of having autism spectrum disorder (ASD; age range 29-43 months). A videotaped retrospective review of five children with symptoms of ASD during "Communication Temptation Tasks" was completed at two time points (pre-testing and 6 weeks later). Categories of…

  10. Evaluation of quantitative IFN-gamma response for risk stratification of active tuberculosis suspects.

    Science.gov (United States)

    Metcalfe, John Z; Cattamanchi, Adithya; Vittinghoff, Eric; Ho, Christine; Grinsdale, Jennifer; Hopewell, Philip C; Kawamura, L Masae; Nahid, Payam

    2010-01-01

    The contribution of interferon-gamma release assays (IGRAs) to appropriate risk stratification of active tuberculosis suspects has not been studied. To determine whether the addition of quantitative IGRA results to a prediction model incorporating clinical criteria improves risk stratification of smear-negative-tuberculosis suspects. Clinical data from tuberculosis suspects evaluated by the San Francisco Department of Public Health Tuberculosis Control Clinic from March 2005 to February 2008 were reviewed. We excluded tuberculosis suspects who were acid fast-bacilli smear-positive, HIV-infected, or under 10 years of age. We developed a clinical prediction model for culture-positive disease and examined the benefit of adding quantitative interferon (IFN)-gamma results measured by QuantiFERON-TB Gold (Cellestis, Carnegie, Australia). Of 660 patients meeting eligibility criteria, 65 (10%) had culture-proven tuberculosis. The odds of active tuberculosis increased by 7% (95% confidence interval [CI], 3-11%) for each doubling of IFN-gamma level. The addition of quantitative IFN-gamma results to objective clinical data significantly improved model performance (c-statistic 0.71 vs. 0.78; P added clinical value to a prediction model incorporating conventional risk factors. Although this benefit may be attenuated within highly experienced centers, the predictive accuracy of quantitative IFN-gamma levels should be evaluated in other settings.

  11. Diagnostic value of a psychological test in cases of suspected child abuse.

    Science.gov (United States)

    Geddis, D C; Turner, I F; Eardley, J

    1977-01-01

    The use of the Bene-Anthony Family Relations Test is described and illustrated by three examples of child abuse. This test should be considered in the investigation of definite or suspected cases of abuse and as part of the preparation of court evidence. PMID:921320

  12. Expected Consequences of Disclosure Revealed in Investigative Interviews with Suspected Victims of Child Sexual Abuse

    Science.gov (United States)

    Malloy, Lindsay C.; Brubacher, Sonja P.; Lamb, Michael E.

    2011-01-01

    The current study explored the expected consequences of disclosure discussed by 204 5- to 13-year-old suspected victims of child sexual abuse during the course of investigative interviews conducted using the NICHD Investigative Interview Protocol. Expected consequences were mentioned in nearly half of all interviews, with older children and those…

  13. Mitochondrial DNA haplogroup background affects LHON, but not suspected LHON, in Chinese patients.

    Directory of Open Access Journals (Sweden)

    A-Mei Zhang

    Full Text Available Recent studies have shown that mtDNA background could affect the clinical expression of Leber hereditary optic neuropathy (LHON. We analyzed the mitochondrial DNA (mtDNA variation of 304 Chinese patients with m.11778G>A (sample #1 and of 843 suspected LHON patients who lack the three primary mutations (sample #2 to discern mtDNA haplogroup effect on disease onset. Haplogroup frequencies in the patient group was compared to frequencies in the general Han Chinese population (n = 1,689; sample #3. The overall matrilineal composition of the suspected LHON population resembles that of the general Han Chinese population, suggesting no association with mtDNA haplogroup. In contrast, analysis of these LHON patients confirms mtDNA haplogroup effect on LHON. Specifically, the LHON sample significantly differs from the general Han Chinese and suspected LHON populations by harboring an extremely lower frequency of haplogroup R9, in particular of its main sub-haplogroup F (#1 vs. #3, P-value = 1.46×10(-17, OR = 0.051, 95% CI: 0.016-0.162; #1 vs. #2, P-value = 4.44×10(-17, OR = 0.049, 95% CI: 0.015-0.154; in both cases, adjusted P-value A but not suspected LHON. Haplogroup F has a protective effect against LHON, while M7b is a risk factor.

  14. Mild cognitive impairment with suspected nonamyloid pathology (SNAP) Prediction of progression

    NARCIS (Netherlands)

    Caroli, A.; Prestia, A.; Galluzzi, S.; Ferrari, C.; van der Flier, W.M.; Ossenkoppele, R.; van Berckel, B.; Barkhof, F.; Teunissen, C.; Wall, A.E.; Carter, S.F.; Scholl, M.; Choo, I.H.; Grimmer, T.; Redolfi, A.; Nordberg, A.; Scheltens, P.; Drzezga, A.; Frisoni, G. B.

    2015-01-01

    Objectives: The aim of this study was to investigate predictors of progressive cognitive deterioration in patients with suspected non-Alzheimer disease pathology (SNAP) and mild cognitive impairment (MCI). Methods: We measured markers of amyloid pathology (CSF b-amyloid 42) and neurodegeneration

  15. Video Game Effects--Confirmed, Suspected, and Speculative: A Review of the Evidence

    Science.gov (United States)

    Barlett, Christopher P.; Anderson, Craig A.; Swing, Edward L.

    2009-01-01

    This literature review focuses on the confirmed, suspected, and speculative effects of violent and non-violent video game exposure on negative and positive outcomes. Negative outcomes include aggressive feelings, aggressive thoughts, aggressive behavior, physiological arousal, and desensitization, whereas positive outcomes include various types of…

  16. Comparison of CT and MRI for Diagnosis of Suspected Scaphoid Fractures

    NARCIS (Netherlands)

    Mallee, W.; Doornberg, J.N.; Ring, D.; van Dijk, C.N.; Maas, M.; Goslings, J.C.

    2011-01-01

    Background: There is no consensus on the optimum imaging method to use to confirm the diagnosis of true scaphoid fractures among patients with suspected scaphoid fractures. This study tested the null hypothesis that computed tomography (CT) and magnetic resonance imaging (MRI) have the same

  17. Nurse Reporting of Known and Suspected Child Abuse and Neglect Cases in Taiwan

    Directory of Open Access Journals (Sweden)

    Pei-Yu Lee

    2007-03-01

    Full Text Available Despite the frontline role of taking care of children, nurses in Taiwan have been reluctant to report known and suspected cases of child abuse and neglect (CAN. This problem threatens the success of legislation aimed at reducing CAN cases in Taiwan. The purpose of this study was to examine the influence of nurses' perceptions, attitudes, and knowledge on suspecting and reporting CAN cases in health care settings in Taiwan. Two hundred and thirty-eight nurses were surveyed using structured questionnaires with a return rate of 79.3%. Health care settings surveyed in this study included emergency units, pediatric units, and community centers from eight hospitals in southern Taiwan. Almost 3/4 (70% of the sample of nurses thought they needed more training courses on CAN. Correlation analysis showed a significant relationship between suspecting and reporting CAN with perception, attitude, and knowledge. Stepwise multiple regression analysis revealed that perception (β= 0.475, knowledge (β= 0.265, and attitude (β= 0.246 accounted for 60% of the variance in suspecting and reporting CAN. The focus and scope of training programs for nurses in Taiwan should take these findings into consideration.

  18. The incidence of suspected myocardial infarction in Dutch general practice in the period 1978-1994.

    NARCIS (Netherlands)

    Pal-de Bruin, K.M. van der; Verkleij, H.; Jansen, J.; Bartelds, A.; Kromhout, D.

    1998-01-01

    Aim: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. Methods: In three periods (1978, 1983-1985 and 1991-1994) the incidence of

  19. The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population

    DEFF Research Database (Denmark)

    Borch, Jacob Eli; Andersen, Klaus Ejner; Bindslev-Jensen, Carsten

    2006-01-01

    -allergic. The prevalence of suspected penicillin allergy was lower than reported elsewhere. A substantial number of patients failed to recall basic information about their alleged allergy. Patients reporting penicillin allergy upon admission and labels stating penicillin allergy on medical files are ignored in almost...

  20. Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

    Directory of Open Access Journals (Sweden)

    Jing-Min Guo

    2015-10-01

    Full Text Available AIM:To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls.METHODS:The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sex-matched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software.RESULTS:Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls. Pharmacologic mydriasis led to significant increments in iris thickness at 750 μm, anterior chamber depth and volume, whereas significant decrements in iris curve, cross sectional area and volume in both groups. Angle opening distance at 500 μm was increased significantly in normal controls (from 0.465±0.115 mm to 0.539±0.167 mm, P=0.009, but not in angle closure suspects (from 0.125±0.100 mm to 0.145±0.131 mm, P=0.326. Iris volume change per millimeter of pupil dilation (△IV/△PD decreased significantly less in angle closure suspects than normal controls (-2.47±1.33 mm2 vs -3.63±1.58 mm2, P=0.019. Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth (β=0.841, P=0.002 and △IV/△PD (β=0.028, P=0.002, followed by gender (β=0.062, P=0.032.CONCLUSION:Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic

  1. Optimizing imaging in suspected appendicitis (OPTIMAP-study: A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. Study Protocol

    Directory of Open Access Journals (Sweden)

    Bossuyt Patrick MM

    2010-10-01

    Full Text Available Abstract Background In patients with clinically suspected appendicitis, imaging is needed to substantiate the clinical diagnosis. Imaging accuracy of ultrasonography (US is suboptimal, while the most accurate technique (CT is associated with cancer related deaths through exposure to ionizing radiation. MRI is a potential replacement, without associated ionizing radiation and no need for contrast medium administration. If MRI is proven to be sufficiently accurate, it could be introduced in the diagnostic pathway of patients with suspected appendicitis, increasing diagnostic accuracy and improving clinical outcomes, without the risk of radiation induced cancer or iodinated contrast medium-related drawbacks. The multicenter OPTIMAP study was designed to estimate the diagnostic accuracy of MRI in patients with suspected acute appendicitis in the general population. Methods/Design Eligible for this study are consecutive patients presenting with clinically suspected appendicitis at the emergency department in six centers. All patients will undergo imaging according to the Dutch guideline for acute appendicitis: initial ultrasonography in all and subsequent CT whenever US does not confirm acute appendicitis. Then MRI is performed in all patients, but the results are not used for patient management. A final diagnosis assigned by an expert panel, based on all available information including 3-months follow-up, except MRI findings, is used as the reference standard in estimating accuracy. We will calculate the sensitivity, specificity, predictive values and inter-observer agreement of MRI, and aim to include 230 patients. Patient acceptance and total imaging costs will also be evaluated. Discussion If MRI is found to be sufficiently accurate, it could replace CT in some or all patients. This will limit or obviate the ionizing radiation exposure associated risk of cancer induction and contrast medium induced nephropathy with CT, preventing the burden and

  2. CT pulmonary angiography: an over-utilized imaging modality in hospitalized patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Erin Smith

    2013-04-01

    Full Text Available Aims: To determine if computed tomographic pulmonary angiography (CTPA was overemployed in the evaluation of hospitalized patients with suspected acute pulmonary embolism (PE. Methods: Data were gathered retrospectively on hospitalized patients (n=185 who had CTPA for suspected PE between June and August 2009 at our institution. Results: CTPA was done in 185 hospitalized patients to diagnose acute PE based on clinical suspicion. Of these, 30 (16.2% patients were tested positive for acute PE on CTPA. The Well's pretest probability for PE was low, moderate, and high in 77 (41.6%, 83 (44.9%, and 25 (13.5% patients, respectively. Out of the 30 PE-positive patients, pretest probability was low in 2 (6.6%, moderate in 20 (66.7%, and high in 8 (26.6% (p=0.003. Modified Well's criteria applied to all patients in our study revealed 113 (61% with low and 72 (39% with high clinical pretest probability. When modified Well's criteria was applied to 30 PE-positive patients, 10 (33.3% and 20 (66.6% were found to have low and high pretest probability, respectively (p=0.006. D-dimer assay was done in 30 (16.2% of the inpatients with suspected PE and all of them were found to have elevated levels. A lower extremity duplex ultrasound confirmed deep venous thrombosis in 17 (9.1% of the patients with suspected PE, at least 1 week prior to having CTPA. Conclusion: Understanding the recommended guidelines, evidence-based literature, and current concepts in evaluation of patients with suspected acute PE will reduce unnecessary CTPA examinations.

  3. Diagnostic Value of Bronchoalveolar Lavage for Diagnosis of Suspected Peripheral Lung Cancer.

    Science.gov (United States)

    Bezel, Pascal; Tischler, Verena; Robinson, Cecile; Baumueller, Stephan; Bode-Lesniewska, Beata; Kohler, Malcolm; Freitag, Lutz; Franzen, Daniel

    2016-09-01

    There is a paucity of data concerning the benefit of bronchoalveolar lavage (BAL) for the diagnosis of suspected peripheral lung cancer (PLC). The aim of this study was to investigate the diagnostic value of BAL for the diagnosis of suspected PLC. All flexible bronchoscopies that included BAL among other modalities (brush, forceps, washing) for the diagnosis of a suspected PLC performed between 2009 and 2013 were analyzed in this retrospective study. A total of 260 patients were included. Malignancy was present in 61%. BAL's sensitivity for the diagnosis of malignancy was 29%, and overall diagnostic yield of BAL was 46%. However, only 1% of cancer diagnoses would have been missed in the absence of BAL. In the multivariable analysis, the size of lesion (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.02-1.33; P = .023), the presence of bronchus sign (OR, 4.73; 95% CI, 1.06-21.08; P = .042), and the presence of mediastinal/hilar lymphadenopathy (OR, 3.37; 95% CI, 1.53-7.41; P = .002) were associated with improved BAL true-positive ratio relating to diagnosis of malignancy. However, the effect of lesion size on sensitivity was small (area under the curve, 0.31; 95% CI, 0.23-0.40; P diagnosis of malignancy or pulmonary infection was 37. Conventional BAL has a low diagnostic value for the diagnosis of suspected PLC, and the low number needed to test does not qualify BAL as a recommended routine investigation for the diagnosis of suspected PLC for either solid or ground-glass lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Relationship between hemoglobin levels and risk for suspected non-alcoholic fatty liver in Taiwanese adults.

    Science.gov (United States)

    Bai, Chyi-Huey; Wu, Ming-Shun; Owaga, Eddy; Cheng, Shu-Yu; Pan, Wen-Harn; Chang, Jung-Su

    2014-10-31

    Body iron levels have recently been shown to be a strong predictor for non-alcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence of NAFLD in a general adult population, and to investigate the relationship between body iron levels, NAFLD and the metabolic syndrome (MetS). 2186 adults participated in the third National Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008). The participants underwent anthropometry measurements and phlebotomy after an overnight fast, and those with excessive alcohol intake, iron overload of serum ferritin > 600 ng/ml, hepatitis viral infection and hepatocellular carcinoma were excluded. Suspected NAFLD was diagnosed by three alanine transaminase (ALT) cut-points: cut-point 1: serum ALT > 40 U/l; cut-point 2: ALT ≥ 25 U/l for male and ALT ≥ 17 U/l for female; and cut-point 3: ALT ≥ 35 U/l for male and ALT ≥ 26 U/l for female. The prevalence proportion of suspected NAFLD among Taiwanese adults was 6.6% (cut-point 1), 36% (cut-point 2); and 14.3% (cut-point 3). Body iron levels were significantly higher in individuals with suspected NAFLD compared with those without. Distribution of hemoglobin levels, but not serum ferritin levels, by decade of age showed strong correlation with the prevalence of suspected NAFLD in individuals with MetS. Multivariate adjusted odds ratio (OR) showed that the best predictors for suspected NAFLD with the MetS were hemoglobin [OR 1.43 (1.21-1.68); P hemoglobin [OR 1.25 (1.12-1.41); P hemoglobin levels (14.4 μg/dl for male and 13.2 μg/dl for female) are at the greatest risk for developing abnormal liver function. Hemoglobin test should be considered as a part of clinical evaluation for patients with NAFLD.

  5. Facing suspected child abuse – what keeps Swedish general practitioners from reporting to child protective services?

    Science.gov (United States)

    Bengtsson Boström, Kristina; Östberg, Anna-Lena

    2015-01-01

    Abstract Objective. The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS). Design. A cross-sectional questionnaire study. Setting. Primary health care centres in western Sweden. Subjects. 177 GPs and GP trainees. Main outcome measures. Demographic and educational background, education on child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse, and need of support. Results. Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS's methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden. Conclusions. This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse. PMID:25676563

  6. Sensitivity and specificity of narrow-band imaging nasoendoscopy compared to histopathology results in patients with suspected nasopharyngeal carcinoma

    Science.gov (United States)

    Adham, M.; Musa, Z.; Lisnawati; Suryati, I.

    2017-08-01

    Nasopharyngeal carcinoma (NPC) is a disease which is prevalent in developing countries like Indonesia. There were 164 new cases of nasopharyngeal carcinoma in the ear, nose, and throat (ENT) oncology outpatient clinic of the Cipto Mangunkusumo hospital in 2014, and 142 cases in 2015. Unfortunately, almost all of these cases presented at an advanced stage. The success of nasopharyngeal carcinoma treatment is largely determined by the stage when patients are diagnosed; it is critical to diagnose NPC as early as possible. Narrow-band imaging (NBI) is an endoscopic instrument with a light system that can improve the visualization of blood vessels of mucosal epithelial malignant tumors. NBI is expected to help clinicians to assess whether a lesion is malignant or not; to do so, it is important to know the value of sensitivity and specificity. This study is a cross-sectional form of a diagnostic test which was performed in the outpatient clinic of the ENT Head and Neck Surgery Department for the Cipto Mangunkusumo Hospital, from January to June 2016, and involved 56 subjects. Patients with a nasopharyngeal mass discovered by physical examination or imaging, and a suspected nasopharyngeal carcinoma were included as a subject. An NBI examination and biopsy was performed locally. Based on this research, NBI could be used as a screening tool for nasopharyngeal carcinoma with high sensitivity (100%), but with a low specificity result (6.7%).

  7. Critical Mass

    CERN Multimedia

    AUTHOR|(CDS)2070299

    2017-01-01

    Critical Mass is a cycling event typically held on the last Friday of every month; its purpose is not usually formalized beyond the direct action of meeting at a set location and time and traveling as a group through city or town streets on bikes. The event originated in 1992 in San Francisco; by the end of 2003, the event was being held in over 300 cities around the world. At CERN it is held once a year in conjunction with the national Swiss campaing "Bike to work".

  8. 31 CFR 585.215 - Conveyances and cargo suspected of being in violation of United Nations sanctions; detention...

    Science.gov (United States)

    2010-07-01

    ... being in violation of United Nations sanctions; detention; blocking. 585.215 Section 585.215 Money and... and cargo suspected of being in violation of United Nations sanctions; detention; blocking. (a) Except... § 585.201, but which are suspected of a violation of United Nations Security Council Resolutions No. 713...

  9. Magnetic resonance venography in consecutive patients with suspected deep vein thrombosis of the upper extremity: Initial experience

    NARCIS (Netherlands)

    Baarslag, H. J.; van Beek, E. J. R.; Reekers, J. A.

    2004-01-01

    Purpose: To assess the feasibility and accuracy of two magnetic resonance (MR) venography methods in a consecutive series of patients with suspected deep vein thrombosis of the upper extremity (DVTUE). Material and Methods: Consecutive in- and outpatients who were referred for imaging of suspected

  10. Controlled Hypotension in Patients Suspected of a Ruptured Abdominal Aortic Aneurysm: Feasibility during Transport by Ambulance Services and Possible Harm

    NARCIS (Netherlands)

    Reimerink, J. J.; Hoornweg, L. L.; Vahl, A. C.; Wisselink, W.; Balm, R.

    2010-01-01

    Objective: To evaluate a controlled hypotension protocol for patients suspected of a ruptured aneurysm of the abdominal aorta (RAAA) and to identify possible harm to patients with a final diagnosis other than RAAA. Design: Retrospective analysis of patients suspected of RAAA and transported by

  11. Disparities in the Medical Examination of Children in the Home of a Child with Suspected Physical Abuse

    Science.gov (United States)

    Campbell, Kristine A.; Squires, Janet; Cook, Lawrence J.; Berger, Rachel P.

    2009-01-01

    Objective: To identify factors predicting the medical examination of children living in a home with a child referred to child protection services (CPS) for suspected physical abuse. Methods: Medical providers at Children's Hospital of Pittsburgh referred 189 children for suspected physical abuse to CPS between November 1, 2004 and May 1, 2006…

  12. Comparison of planar bone scintigraphy and single photon emission computed tomography in patients suspected of having unilateral condylar hyperactivity

    NARCIS (Netherlands)

    Saridin, C.P.; Raijmakers, P.G.H.M.; Tuinzing, D.B.; Becking, A.G.

    2008-01-01

    Objective A comparison is made of single photon emission computed tomography (SPECT) and planar bone scintigraphy in the diagnosis of patients with suspected unilateral condylar hyperactivity (UCH). Study design The subjects comprised 56 patients with suspected UCH who underwent SPECT and regular

  13. Comparison of planar bone scintigraphy and single photon emission computed tomography in patients suspected of having unilateral condylar hyperactivity

    NARCIS (Netherlands)

    Saridin, Carrol P.; Raijmakers, Pieter G. H. M.; Tuinzing, Dirk B.; Becking, Alfred G.

    2008-01-01

    A comparison is made of single photon emission computed tomography (SPECT) and planar bone scintigraphy in the diagnosis of patients with suspected unilateral condylar hyperactivity (UCH). The subjects comprised 56 patients with suspected UCH who underwent SPECT and regular planar bone scans.

  14. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Myung Ho; Chung, Yung Sun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2010-05-15

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic

  15. The detection of microbial DNA but not cultured bacteria is associated with increased mortality in patients with suspected sepsis-a prospective multi-centre European observational study.

    Science.gov (United States)

    O'Dwyer, M J; Starczewska, M H; Schrenzel, J; Zacharowski, K; Ecker, D J; Sampath, R; Brealey, D; Singer, M; Libert, N; Wilks, M; Vincent, J-L

    2017-03-01

    Blood culture results inadequately stratify the mortality risk in critically ill patients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis. We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications. Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001). Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  16. Influence of the coronary calcium score on the ability to rule out coronary artery stenoses by coronary CT angiography in patients with suspected coronary artery disease.

    Science.gov (United States)

    Schuhbaeck, Annika; Schmid, Jasmin; Zimmer, Thomas; Muschiol, Gerd; Hell, Michaela M; Marwan, Mohamed; Achenbach, Stephan

    2016-01-01

    Recent guidelines for the workup of patients with chest pain and suspected coronary artery disease include coronary computed tomography angiography (CTA). However, its diagnostic value may be limited in patients with severe coronary calcification. We investigated the relationship between the extent of coronary calcium and the ability of coronary CTA to rule out significant stenoses in a series of consecutive patients with suspected coronary artery disease. 2614 consecutive patients with suspected coronary artery disease in whom coronary calcium scoring and coronary CTA had been performed by Dual Source CT were analyzed. The ability of coronary CTA to rule out coronary artery stenoses (fully evaluable coronary arteries and absence of any luminal stenosis >75%) was analyzed relative to the coronary calcium score. The median coronary calcium score was 12, with calcium present in 60.5% of all patients. Coronary CTA ruled out stenoses in 82% of patients, while in 18% of patients at least one stenosis was found or could not be excluded. The threshold above which coronary CTA permitted to rule out stenoses in less than 50% of patients was an "Agatston Score" of 287. This threshold was significantly lower for male patients (213 vs. 330), for patients with a heart rate >65 beats/min (157 vs. 317) and for patients with a body mass index ≥25 kg/m(2) (208 vs. 392). The evaluability of coronary arteries decreased with increasing amounts of calcium and differed significantly between heart rates ≤65 beats/min and >65 beats/min (p coronary CTA permits to rule out coronary artery stenoses in less than 50% of cases. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  17. Developing a visual sensitive image features based CAD scheme to assist classification of mammographic masses

    Science.gov (United States)

    Wang, Yunzhi; Aghaei, Faranak; Tan, Maxine; Qiu, Yuchen; Liu, Hong; Zheng, Bin

    2017-03-01

    Computer-aided diagnosis (CAD) schemes of mammograms have been previously developed and tested. However, due to using "black-box" approaches with a large number of complicated features, radiologists have lower confidence to accept or consider CAD-cued results. In order to help solve this issue, this study aims to develop and evaluate a new CAD scheme that uses visual sensitive image features to classify between malignant and benign mammographic masses. A dataset of 301 masses detected on both craniocaudal (CC) and mediolateraloblique (MLO) view images was retrospectively assembled. Among them, 152 were malignant and 149 were benign. An iterative region-growing algorithm was applied to the special Gaussian-kernel filtered images to segment mass regions. Total 13 Image features were computed to mimic 5 categories of visually sensitive features that are commonly used by radiologists in classifying suspicious mammographic masses namely, mass size, shape factor, contrast, homogeneity and spiculation. We then selected one optimal feature in each of 5 feature categories by using a student t-test, and applied two logistic regression classifiers using either CC or MLO view images to distinguish between malignant and benign masses. Last, a fusion method of combining two classification scores was applied and tested. By applying a 10-fold cross-validation method, the area under receiver operating characteristic curves was 0.806+/-0.025. This study demonstrated a new approach to develop CAD scheme based on 5 visually sensitive image features. Combining with a "visual-aid" interface, CAD results are much more easily explainable to the observers and may increase their confidence to consider CAD-cued results.

  18. Unrecognized non-Q-wave myocardial infarction: prevalence and prognostic significance in patients with suspected coronary disease.

    Directory of Open Access Journals (Sweden)

    Han W Kim

    2009-04-01

    Full Text Available Unrecognized myocardial infarction (UMI is known to constitute a substantial portion of potentially lethal coronary heart disease. However, the diagnosis of UMI is based on the appearance of incidental Q-waves on 12-lead electrocardiography. Thus, the syndrome of non-Q-wave UMI has not been investigated. Delayed-enhancement cardiovascular magnetic resonance (DE-CMR can identify MI, even when small, subendocardial, or without associated Q-waves. The aim of this study was to investigate the prevalence and prognosis associated with non-Q-wave UMI identified by DE-CMR.We conducted a prospective study of 185 patients with suspected coronary disease and without history of clinical myocardial infarction who were scheduled for invasive coronary angiography. Q-wave UMI was determined by electrocardiography (Minnesota Code. Non-Q-wave UMI was identified by DE-CMR in the absence of electrocardiographic Q-waves. Patients were followed to determine the prognostic significance of non-Q-wave UMI. The primary endpoint was all-cause mortality. The prevalence of non-Q-wave UMI was 27% (50/185, compared with 8% (15/185 for Q-wave UMI. Patients with non-Q-wave UMI were older, were more likely to have diabetes, and had higher Framingham risk than those without MI, but were similar to those with Q-wave UMI. Infarct size in non-Q-wave UMI was modest (8%+/-7% of left ventricular mass, and left ventricular ejection fraction (LVEF by cine-CMR was usually preserved (52%+/-18%. The prevalence of non-Q-wave UMI increased with the extent and severity of coronary disease on angiography (p<0.0001 for both. Over 2.2 y (interquartile range 1.8-2.7, 16 deaths occurred: 13 in non-Q-wave UMI patients (26%, one in Q-wave UMI (7%, and two in patients without MI (2%. Multivariable analysis including New York Heart Association class and LVEF demonstrated that non-Q-wave UMI was an independent predictor of all-cause mortality (hazard ratio [HR] 11.4, 95% confidence interval [CI] 2

  19. [Viral load test conducive to excluding negative subjects from suspects in HIV antibody detections].

    Science.gov (United States)

    Hei, Fa-Xin; Zhang, Qi-Yun; Sun, Wei-Dong; Zhang, Qin; Ye, Jing-Rong; Liu, Hai-Lin; Lu, Hong-Yan

    2008-01-01

    To study whether plasma viral load testing is helpful to exclude ones free from Human immunodeficiency virus (HIV) infections from suspects in HIV antibody detections. 19 Specimens, which showed disconcordant results of the two HIV EIA testing (S/CO test, were selected. Viral load of the specimens were detected. A six-month follow up survey in detecting HIV antibody was conducted in these subjects. None of these 19 cases was observed to be positive HIV viral loads and there was no any progress in WB bands development during the follow-up period. The possibility of HIV infection could be excluded. When the specimens react with very low intensity in both EIA and WB, negative viral load result is conducive to exclude negative subjects from suspects in HIV antibody detections.

  20. Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

    DEFF Research Database (Denmark)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens

    2011-01-01

    BACKGROUND:: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment...... is important. METHODS:: A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock......, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). CONCLUSION:: Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence...

  1. Magnetic resonance angiography evidence of vasospasm in children with suspected acute hemiplegic migraine.

    Science.gov (United States)

    Safier, Robert; Cleves-Bayon, Catalina; Vaisleib, Inna; Siddiqui, Ali; Zuccoli, Giulio

    2014-06-01

    Hemiplegic migraine is a rare subtype of migraine that is differentiated by motor weakness in the aura phase. The purpose of this case series was to examine the magnetic resonance angiogram findings of patients suffering from suspected acute hemiplegic migraine. This was a retrospective institutional board review protocol study of 8 patients. All patients received full brain magnetic resonance imaging under a 1.5-T magnet. The scans were subsequently evaluated by a neuroradiologist and 2 neurologists who were blinded to the study. The magnetic resonance angiogram findings of this study showed the presence of vasospasm within the intracranial vasculature during suspected acute hemiplegic migraine. This case series suggests that routine use of magnetic resonance angiography might be beneficial in both managing patients with acute hemiplegic migraine and helping to further understand the pathophysiology of this complicated disease process. © The Author(s) 2013.

  2. Comparison of cortisol and thyroid hormones between tuberculosis-suspect and healthy elephants of Nepal.

    Science.gov (United States)

    Paudel, Sarad; Brown, Janine L; Thapaliya, Sharada; Dhakal, Ishwari P; Mikota, Susan K; Gairhe, Kamal P; Shimozuru, Michito; Tsubota, Toshio

    2016-12-01

    We compared cortisol and thyroid hormone (T3 and T4) concentrations between tuberculosis (TB)-suspected (n=10) and healthy (n=10) elephants of Nepal. Whole blood was collected from captive elephants throughout Nepal, and TB testing was performed using the ElephantTB STAT-PAK® and DPP VetTB® serological assays that detect antibodies against Mycobacterium tuberculosis and M. bovis in elephant serum. Cortisol, T3 and T4 were quantified by competitive enzyme immunoassays, and the results showed no significant differences in hormone concentrations between TB-suspect and healthy elephants. These preliminary data suggest neither adrenal nor thyroid function is altered by TB disease status. However, more elephants, including those positively diagnosed for TB by trunk wash cultures, need to be evaluated over time to confirm results.

  3. The assessment of children with suspected laryngopharyngeal reflux: An Otorhinolaringological perspective.

    Science.gov (United States)

    Galluzzi, Francesca; Schindler, Antonio; Gaini, Renato Maria; Garavello, Werner

    2015-10-01

    The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke

    DEFF Research Database (Denmark)

    Thomsen, Barbara Blicher; Garosi, Laurent; Skerritt, Geoff

    2016-01-01

    Background: In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined...... to the hospitalisation period. A retrospective multicentre study of dogs with suspected cerebellar ischaemic stroke examined from 2010–2015 at five veterinary referral hospitals was performed. Findings from clinical, neurological, and paraclinical investigations including magnetic resonance imaging were assessed....... Results: Twenty-three dogs, 13 females and 10 males with a median age of 8 years and 8 months, were included in the study. The Cavalier King Charles Spaniel (n = 9) was a commonly represented breed. All ischaemic strokes were located to the vascular territory of the rostral cerebellar artery including...

  5. The paramilitary speech Alias '39': suspects, offenders and redeemed in La Mesa, Cesar

    Directory of Open Access Journals (Sweden)

    José Gregorio Pérez V.

    2016-08-01

    Full Text Available The paper aims to characterize the paramilitary speech in the village of La Mesa, Cesar, whose practices of power-knowledge are not registered only in the coercive field, but extend to forms of communication, where the control and subjugation of the population, legitimation and de-legitimation of the main enemy (FARC and ELN, and suspects and the problematic resident (offenders, acquire a particular form of registration in the individualities and the social body, and extends to the soccer field, the school, the streets, the workplaces, the artifacts (stone and soccer arches present in the territory. In addition to suspects and offenders, the paramilitary leader, David Hernández Rojas, alias ‘39’, led to another subject registered in the speech, the redeemed/collaborators.

  6. Aparasitemic serological suspects in Trypanosoma brucei gambiense human African trypanosomiasis : a potential human reservoir of parasites ?

    OpenAIRE

    Koffi, Mathurin; Solano, Philippe; Denizot, M.; Courtin, D.; Garcia, André; Lejon, V.; Buscher, P.; Cuny, Gérard; Jamonneau, Vincent

    2006-01-01

    The serological and parasitological tests used for Trypanosoma brucei gambiense human African trypanosomiasis (HAT) diagnosis have low specificity and sensitivity, respectively, and in the field, control program teams are faced with subjects with positive serology but negative parasitology who remain untreated. The aim of this work was to explore, using PCR tool, the significance of these aparasitemic serological suspects. Since discordant PCR results have been observed earlier with different...

  7. An approach to the patient with a suspected tachycardia in the ...

    African Journals Online (AJOL)

    SVT with a right or left BBB or an intra- ventricular conduction abnormality. This. An approach to the patient with a suspected tachycardia in the emergency department. A Chin,1 MB ChB, MPhil, FHRS; B Vezi,2 MB ChB, FCP (SA), Cert Cardiology (SA); M Namane,3 MB ChB, MPhil;. H Weich,4 MB ChB, MRCP (UK), MMed ...

  8. Performance characteristics of the suspected blood indicator feature in capsule endoscopy according to indication for study.

    Science.gov (United States)

    Buscaglia, Jonathan M; Giday, Samuel A; Kantsevoy, Sergey V; Clarke, John O; Magno, Priscilla; Yong, Elaine; Mullin, Gerard E

    2008-03-01

    The suspected blood indicator (SBI) feature of wireless capsule endoscopy (WCE) was developed for rapid screening of intestinal lesions with bleeding potential. Our aim was to assess the accuracy and performance characteristics of the SBI according to the indications for study in a large cohort of patients. We reviewed collected data on all WCE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. Study indications were as follows: anemia of unknown origin (n = 53), obscure gastrointestinal bleeding (n = 112), suspected Crohn's disease (n = 122), and other (n = 4). Concordant and discordant findings between gastroenterologists' readings and SBI were recorded for each patient. A total of 221 lesions with bleeding potential was detected. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the SBI were 56.4%, 33.5%, 24.0%, and 67.3%, respectively. For actively bleeding lesions, the SBI sensitivity and positive predictive value were only 58.3% and 70%, respectively. The sensitivity was highest (64%) in patients undergoing WCE for suspected Crohn's disease, with a negative predictive value of 80.4%. The sensitivity was only 58.3% and 41.3%, respectively, in studies performed for obscure gastrointestinal bleeding and anemia. Performance characteristics of the currently available SBI feature in WCE are suboptimal and insufficient to screen for lesions with bleeding potential. Even in patients with active intestinal bleeding, the sensitivity of SBI was less than 60%, which is lower than previously reported. However, in patients with suspected Crohn's disease, the high sensitivity and negative predictive value of SBI may make it a useful tool for the detection of large areas of abnormal mucosa.

  9. Extra-appendiceal findings in pediatric abdominal CT for suspected appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Halverson, Mark; Delgado, Jorge; Mahboubi, Soroosh [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-07-15

    Much has been written regarding the incidence, types, importance and management of abdominal CT incidental findings in adults, but there is a paucity of literature on incidental findings in children. We sought to determine the prevalence and characteristics of extra-appendiceal and incidental findings in pediatric abdominal CT performed for suspected appendicitis. A retrospective review was performed of abdominal CT for suspected appendicitis in a pediatric emergency department from July 2010 to June 2012. Extra-appendiceal findings were recorded. Any subsequent imaging was noted. Extra-appendiceal findings were divided into incidental findings of doubtful clinical significance, alternative diagnostic findings potentially providing a diagnosis other than appendicitis explaining the symptoms, and incidental findings that were abnormalities requiring clinical correlation and sometimes requiring further evaluation but not likely related to the patient symptoms. One hundred sixty-five children had abdominal CT for suspected appendicitis. Seventy-seven extra-appendiceal findings were found in 57 (34.5%) patients. Most findings (64 of 77) were discovered in children who did not have appendicitis. Forty-one of these findings (53%) could potentially help explain the patient's symptoms, while 30 of the findings (39%) were abnormalities that were unlikely to be related to the symptoms but required clinical correlation and sometimes further work-up. Six of the findings (8%) had doubtful or no clinical significance. Extra-appendiceal findings are common in children who undergo abdominal CT in the setting of suspected appendicitis. A significant percentage of these patients have findings that help explain their symptoms. Knowledge of the types and prevalence of these findings may help radiologists in the planning and interpretation of CT examinations in this patient population. (orig.)

  10. Suspected Pulmonary Infection with Trichoderma longibrachiatum after Allogeneic Stem Cell Transplantation

    OpenAIRE

    Akagi, Tomoaki; Kawamura, Chizuko; Terasawa, Norio; Yamaguchi, Kohei; Kubo, Kohmei

    2017-01-01

    Aspergillus and Candida species are the main causative agents of invasive fungal infections in immunocompromised human hosts. However, saprophytic fungi are now increasingly being recognized as serious pathogens. Trichoderma longibrachiatum has recently been described as an emerging pathogen in immunocompromised patients. We herein report a case of isolated suspected invasive pulmonary infection with T. longibrachiatum in a 29-year-old man with severe aplastic anemia who underwent allogeneic ...

  11. The yield of high-detail radiographic skeletal surveys in suspected infant abuse.

    Science.gov (United States)

    Barber, Ignasi; Perez-Rossello, Jeannette M; Wilson, Celeste R; Kleinman, Paul K

    2015-01-01

    Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants. To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse. We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture. In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively). Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population.

  12. A Case of Suspected Breast Cancer Metastasis to Brachial Plexus Detected by Magnetic Resonance Neurography

    Directory of Open Access Journals (Sweden)

    Atsushi Mizuma

    2016-07-01

    Full Text Available Metastasis of breast cancer is often detected through a long-term course and difficult to diagnose. We report a case of brachial plexopathy suspected to be the initial lesion of breast cancer metastasis, which was only detected by magnetic resonance (MR neurography. A 61-year-old woman was admitted to our hospital within 2 years after operation for breast cancer because of progressive dysesthesia and motor weakness initially in the upper limb on the affected side and subsequently on the contralateral side. Enhanced computed tomography, axillary lymph node echo, gallium scintigraphy, and short tau inversion recovery MR images showed no abnormalities. MR neurography revealed a swollen region in the left brachial plexus. We suspected neuralgic amyotrophy and initiated treatment with intravenous immunoglobulin therapy and steroid therapy. However, there was no improvement, and the progression of motor weakness in the bilateral lower limbs appeared over 4 years. Concomitant elevation of carbohydrate antigen 15-3 level (58.9 U/ml led us to suspect breast cancer metastasis, which was associated with the worsening of neurological findings, although gallium scintigraphy and bone scintigraphy showed no inflammatory and metastatic lesions. Swelling of the cauda equina in enhanced lumbar MR imaging and abnormal accumulation at the brachial plexus and cervical spinal cord in positron-emission tomography were newly detected contrary to the normal findings on the gallium scintigraphy, which suggested cerebrospinal fluid seeding. We suspected breast cancer metastasis about the initial brachial plexopathy based on the clinical course. MR neurography may be a helpful tool to detect metastatic lesion, especially in nerve roots.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. The yield of high-detail radiographic skeletal surveys in suspected infant abuse

    Energy Technology Data Exchange (ETDEWEB)

    Barber, Ignasi [Hospital Vall d' Hebron, Universitat Autonoma de Barcelona, Pediatric Radiology Department, Barcelona (Spain); Perez-Rossello, Jeannette M.; Kleinman, Paul K. [Boston Children' s Hospital, Radiology Department, Boston, MA (United States); Wilson, Celeste R. [Boston Children' s Hospital, Division of General Pediatrics, Boston, MA (United States)

    2014-07-06

    Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants. To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse. We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture. In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively). Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population. (orig.)

  15. Understanding Gut Fermentation Syndrome in the Psychiatric Evaluation of Patients with Suspected Alcohol Use Disorder

    Science.gov (United States)

    2017-10-18

    Fermentation Syndrome in the Psychiatric Evaluation of Patients with Suspected Alcohol Use Disorder Sb. GRANT NUMBER Sc. PROGRAM ELEMENT NUMBER 6...by ANSI Std. Z39.18 Adobe Professional 7. 0 Introduction Gut Fermentation Syndrome, also known as auto- brewery syndrome, is a phenomenon not well...patient stated abstinence from alcohol use and that Gut Fermentation Syndrome was the cause of continually elevated blood alcohol levels. We will

  16. Terrorism, governmentality and the simulated city: the Boston Marathon bombing and the search for suspect two

    OpenAIRE

    Topinka, Robert

    2016-01-01

    This article examines the online circulation of a photograph of the immediate aftermath of the 2013 Boston Marathon bombings taken by David Green, a Boston Marathon runner. The photograph fortuitously captured an image of Dzhokhar Tsarnaev, the younger Tsarnaev brother, running from the scene. Initially, Tsarnaev went unnoticed by online message board users and FBI investigators – he was just another face in the urban crowd. However, after he was identified as suspect two, he emerged in the p...

  17. [A case of Reye's-like syndrome due to suspected Bordetella pertussis infection in an adult].

    Science.gov (United States)

    Ikeda, Kenichi; Sonoda, Ken

    2009-11-01

    We report a rare case of Reye's-like syndrome associated with suspected pertussis infection. A 26-year-old woman admitted comatose and found in laboratory studies to have acute liver dysfunction, severe hypoglycemia and prolonged prothrombin time, was diagnosed with clinical Reye's-like syndrome due to aspirin use. Her child was probably infected with pertussis, which she contracted and which, in turn, triggered Reye's-like syndrome.

  18. When the Child is Suspected to Have Autism Spectrum Disorder: Recommendation for Parents

    OpenAIRE

    Borodina L.G.; Soldatenkova E.N.

    2015-01-01

    Experts in the area of treatment and intervention for autism spectrum disorders provide parents with recommenda¬tions for situations when their children are suspected to have autism or have been diagnosed. These recommenda¬tions are universal and are appropriate for raising a child with any spectrum disorder. Following these recommenda¬tions will allow parents to comprehend the situation with the child’s development, access approaches, that are used by professionals, and will help them to not...

  19. Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

    Directory of Open Access Journals (Sweden)

    Anil Chander

    2013-09-01

    Full Text Available Objective: There are contradictory reports about the use of adenosine deaminase (ADA as a diagnostic marker intuberculous peritonitis patients. Reports evaluating significance of ADA activity in the diagnosis of tuberculous peritonitisin adults are lacking in Nepal. We thus set out to investigate the ascitic fluid ADA levels in suspected tuberculousperitonitis patients and to determine the diagnostic significance of the test statistically.Methods: This study population comprised of two different adult patients groups. Group I - 35 suspected cases oftuberculous peritonitis and Group II - 35 cases of transudative ascites - the control group (patients with biochemicallyproved transudates or hypoproteinaemia and peritoneal tap was done. ADA estimation was carried out by spectrophotometry.Results: ADA levels (Mean ± SD in suspected tuberculous peritonitis and transudative ascites cases were 48.5±17.9U/L and 19.8±7.7 U/L respectively (P<0.001. In the receiver operating characteristic (ROC curve for ascites, ADA cut-offlevel of 41.5 U/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictivevalue, negative predictive value and accuracy of the test in tuberculous peritonitis cases were 80.0%, 97.2 %, 96.6%,82.9%, 88.6% respectively.Conclusion: ADA levels are elevated in suspected tuberculous peritonitis cases and it is a simple, rapid, inexpensiveand the least invasive test. It is thus a useful biochemical marker for the early diagnosis of tuberculous peritonitis whilewaiting for the results of mycobacterial cultures or biopsies. J Microbiol Infect Dis 2013; 3(3: 104-108Key words: adenosine deaminase, sensitivity, specificity, diagnostic significance, tuberculous peritonitis

  20. Audit of the practice of sputum smear examination for patients with suspected pulmonary tuberculosis in Fiji.

    Science.gov (United States)

    Gounder, Shakti; Tayler-Smith, Katherine; Khogali, Mohammed; Raikabula, Maopa; Harries, Anthony D

    2013-07-01

    In Fiji, patients with suspected pulmonary tuberculosis (PTB) currently submit three sputum specimens for smear microscopy for acid-fast bacilli, but there is little information about how well this practice is carried out. A cross-sectional retrospective review was carried out in all four TB diagnostic laboratories in Fiji to determine among new patients presenting with suspected PTB in 2011: the quality of submitted sputum; the number of sputum samples submitted; the relationship between quality and number of submitted samples to smear-positivity; and positive yield from first, second and third samples. Of 1940 patients with suspected PTB, 3522 sputum samples were submitted: 997 (51.4%) patients submitted one sample, 304 (15.7%) patients submitted two samples and 639 (32.9%) submitted three samples. Sputum quality was recorded in 2528 (71.8%) of samples, of which 1046 (41.4%) were of poor quality. Poor quality sputum was more frequent in females, inpatients and children (0-14 years). Good quality sputum and a higher number of submitted samples positively correlated with smear-positivity for acid-fast bacilli. There were 122 (6.3%) patients with suspected PTB who were sputum smear positive. Of those, 89 had submitted three sputum samples: 79 (89%) were diagnosed based on the first sputum sample, 6 (7%) on the second sample and 4 (4%) on the third sample. This study shows that there are deficiencies in the practice of sputum smear examination in Fiji with respect to sputum quality and recommended number of submitted samples, although the results support the continued use of three sputum samples for TB diagnosis. Ways to improve sputum quality and adherence to recommended guidelines are needed.

  1. Case Report: Clinical Features of a Case of Suspected Borrelia miyamotoi Disease in Hokkaido, Japan.

    Science.gov (United States)

    Yamano, Kimiaki; Ito, Takuya; Kiyanagi, Kaori; Yamazaki, Hirotaka; Sugawara, Mutsubu; Saito, Takashige; Ohashi, Norio; Zamoto-Niikura, Aya; Sato, Kozue; Kawabata, Hiroki

    2017-07-01

    We herein report a case of suspected Borrelia miyamotoi disease in Hokkaido, Japan. The patient complained of lassitude, arthralgia, and high fever after a tick bite. Furthermore, at the time of consultation, the patient exhibited momentary loss of consciousness and low blood pressure. Laboratory tests revealed elevation of liver enzymes, thrombocytopenia, and increased C-reactive protein. Seroconversion to B. miyamotoi glycerophosphoryl diester phosphodiesterase antigen suggested the patient was infected with a relapsing fever group Borrelia species.

  2. Assessment and management of a child with suspected acute neck injury.

    Science.gov (United States)

    Jones, Chris

    2012-04-01

    Any child presenting at an emergency department after trauma, such as road traffic accidents, falls, sports and head injuries, should be assessed for risk of injury to the cervical spine. The aim of this article is to provide an overview of the assessment and nursing management of a child with a suspected cervical spine injury. Basic anatomy is covered along with neck injury assessment, how to measure a cervical collar correctly, safe immobilisation, and communication.

  3. Clinical and laboratorial investigation in patients with suspected drug allergy in a tertiary hospital

    OpenAIRE

    Luciana Mabel Ferreira Vasconcelos

    2012-01-01

    Allergic drug reactions account for 6.5% of hospital admissions, prolonged hospitalization 15.1% of patients and are severe in 6.7% of patients. There are difficulties in understanding the immune mechanisms, diagnosis and treatment of patients. Therefore, such reactions are considered a Public Health problem. The objective of this study was to describe the cases of patients with suspected allergic hypersensitivity to drugs and to evaluate the response of individuals to skin tests. A total of ...

  4. Shortening Isolation of Patients With Suspected Tuberculosis by Using Polymerase Chain Reaction Analysis

    DEFF Research Database (Denmark)

    Fløe, Andreas; Hilberg, Ole; Thomsen, Vibeke Østergaard

    2015-01-01

    Background. Isolation of patients suspected for pulmonary tuberculosis is guided by serial sputum smears. This can result in isolation for days for patients with noncontagious tuberculosis. To determine whether a single sample negative for Mycobacterium tuberculosis complex at polymerase chain re......-positive/PCR-negative cases underlines the importance of increasing the quantity and quality of samples. Moreover, it is important that samples analyzed with PCR are cultured, owing to higher-sensitivity drug susceptibility testing, differential diagnosis, and surveillance....

  5. [Air embolism during lumbar discal hernia repair. Retroperioneal vessels lesions have to be suspected].

    Science.gov (United States)

    Lieutaud, T; Terrier, A; Linne, M; Farhat, F; Tahon, F

    2006-03-01

    Occurrence of deep PETCO(2) drop during surgical lumbar disk repair is rare but dramatic. This case report leads to the diagnosis of retroperitoneal vessels lesions. We review the different diagnosis related to the drop of the PETCO(2) during surgery in the genupectoral position. We recommend that the diagnosis of retroperitoneal vessels lesion have to be suspected early if air embolism occurs during lumbar disk surgery.

  6. Low rate of positive bronchoscopy for suspected foreign body aspiration in infants.

    Science.gov (United States)

    Sheehan, Cameron C; Lopez, Joseph; Elmaraghy, Charles A

    2018-01-01

    To describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body. Retrospective chart review. A retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed. Sixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection. Our institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases. Case Series. Copyright © 2017. Published by Elsevier B.V.

  7. Towards rational use of antibiotics for suspected secondary infections in Buruli ulcer patients.

    Science.gov (United States)

    Barogui, Yves T; Klis, Sandor; Bankolé, Honoré Sourou; Sopoh, Ghislain E; Mamo, Solomon; Baba-Moussa, Lamine; Manson, Willem L; Johnson, Roch Christian; van der Werf, Tjip S; Stienstra, Ymkje

    2013-01-01

    The emerging disease Buruli ulcer is treated with streptomycin and rifampicin and surgery if necessary. Frequently other antibiotics are used during treatment. Information on prescribing behavior of antibiotics for suspected secondary infections and for prophylactic use was collected retrospectively. Of 185 patients that started treatment for Buruli ulcer in different centers in Ghana and Bénin 51 were admitted. Forty of these 51 admitted patients (78%) received at least one course of antibiotics other than streptomycin and rifampicin during their hospital stay. The median number (IQR) of antibiotic courses for admitted patients was 2 (1, 5). Only twelve patients received antibiotics for a suspected secondary infection, all other courses were prescribed as prophylaxis of secondary infections extended till 10 days on average after excision, debridement or skin grafting. Antibiotic regimens varied considerably per indication. In another group of BU patients in two centers in Bénin, superficial wound cultures were performed. These cultures from superficial swabs represented bacteria to be expected from a chronic wound, but 13 of the 34 (38%) S. aureus were MRSA. A guide for rational antibiotic treatment for suspected secondary infections or prophylaxis is needed. Adherence to the guideline proposed in this article may reduce and tailor antibiotic use other than streptomycin and rifampicin in Buruli ulcer patients. It may save costs, reduce toxicity and limit development of further antimicrobial resistance. This topic should be included in general protocols on the management of Buruli ulcer.

  8. Assessment Of Suspected Skin Lesion Depth By Multispectral Digital Dermatoscopy: In-Vivo Tests

    Science.gov (United States)

    Scalise, L.; Munaretto, R.; Serresi, S.; Tomasini, E. P.

    2010-05-01

    The aim of the present study is to demonstrate the possibility to assess the depth of suspected skin lesion in-vivo, using multispectral digital dermatoscopy (MDD); being malignant lesion depth an important factor related to survival rate. The system realised in this work is based on a special multi-wavelength LED illuminator (700 nm, 940 nm and 950 nm) and an high quality CCD camera which allows to acquire a detailed image of the suspected skin lesion. A statistically significant correlation between contrast of the area of the lesion at single wavelength and the depth of the lesions in vivo (as determined by histopathology survey) has been found using 39 samples. Interesting results, have been especially obtained using illuminating wavelength at 940 nm and 950 nm. Using a linear fitting of our data the maximum depth of melanoma has been overestimation of 0.43 ± 0.26 mm. The present study shows a possible use of our MDD system as in the assessment of maximum depth of suspected skin lesions.

  9. Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Wasser, M.N.; Schultze Kool, L.J.; Roos, A. de [Leiden Univ. Hospital (Netherlands)] [and others

    1996-03-01

    Our goal was to assess the value of MRA for detecting stenoses in the celiac (CA) and superior mesenteric (SMA) arteries in patients suspected of having chronic mesenteric ischemia, using an optimized systolically gated 3D phase contrast technique. In an initial study in 24 patients who underwent conventional angiography of the abdominal vessels for different clinical indications, a 3D phase contrast MRA technique (3D-PCA) was evaluated and optimized to image the CAs and SMAs. Subsequently, a prospective study was performed to assess the value of systolically gated 3D-PCA in evaluation of the mesenteric arteries in 10 patients with signs and symptoms of chronic mesenteric ischemia. Intraarterial digital subtraction angiography and surgical findings were used as the reference standard. In the initial study, systolic gating appeared to be essential in imaging the SMA on 3D-PCA. In 10 patients suspected of mesenteric ischemia, systolically gated 3D-PCA identified significant proximal disease in the two mesenteric vessels in 4 patients. These patients underwent successful reconstruction of their stenotic vessels. Cardiac-gated MRA may become a useful tool in selection of patients suspected of having mesenteric ischemia who may benefit from surgery. 16 refs., 6 figs., 4 tabs.

  10. Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review.

    Science.gov (United States)

    Zafrir, Yaron; Trattner, Akiva; Hodak, Emmillia; Eldar, Oren; Lapidoth, Moshe; Ben Amitai, Dan

    2017-11-16

    Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature. The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files. Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively). Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background. © 2017 Wiley Periodicals, Inc.

  11. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer.

    Science.gov (United States)

    Liao, Mei-Nan; Chen, Miin-Fu; Chen, Shin-Cheh; Chen, Ping-Ling

    2008-01-01

    A possible diagnosis of breast cancer imposes a huge psychological impact on most women, but few studies have addressed uncertainty and anxiety changes at different diagnostic stages in women with suspected breast cancer. Thus, this longitudinal study examined uncertainty and anxiety and predictive factors for uncertainty in women with suspected breast cancer. Data were collected on uncertainty (Uncertainty in Illness Scale) and anxiety (State Anxiety Inventory) from 127 women at 3 times: upon notice of a breast biopsy, before biopsy, and after diagnosis. The results showed that uncertainty and anxiety levels were significantly higher before than after diagnosis. At the 3 data collection times, uncertainty and anxiety were significantly lower for participants diagnosed with benign tumors than for those with malignant diagnoses. Uncertainty and anxiety were positively, moderately correlated. Uncertainty was predicted by age, marital status, education level, religious status, family history of benign breast tumor, regular breast self-examination, self-perceived probability of receiving a breast cancer diagnosis, and biopsy result. Therefore, nursing professionals should be aware of the uncertainty and anxiety changes and impact of personal attributes on women with suspected breast cancer during the diagnostic period and provide care programs to alleviate their psychological distress.

  12. Routine deferred computed tomography for patients with suspected urolithiasis is low-value healthcare.

    Science.gov (United States)

    Rosenlund, Ingvild M; Førde, Olav H; Revhaug, Arthur

    2017-02-01

    The aim of this study was to investigate the benefits of deferred routine computed tomography of the kidneys, ureters and bladder (CT KUB) for patients with a self-limiting episode of suspected urolithiasis. The study comprised a case series of consecutive patients examined with deferred routine CT KUB for control of suspected urolithiasis. Patients examined with CT KUB at the University Hospital of North Norway, between 1 January 2010 and 31 December 2013, were included. The final analysis included 189 CT KUBs (response rate 48%). All data were extracted from the patient case files. The primary endpoint was the proportion of asymptomatic patients with a confirmed diagnosis of urolithiasis on CT KUB that led to surgical intervention within 1 year from the initial CT scan. At the time of CT KUB, 171 patients (90%) were asymptomatic, of whom three (1.8%) were treated. Urolithiasis was confirmed on CT KUB in 23% of asymptomatic patients. Deferred CT KUB did not alter the clinical outcome for the great majority of asymptomatic patients. The majority of patients who received adequate pain relief in primary care remained asymptomatic, and did not need specialized healthcare. Refraining from CT KUB involves little risk. Deferred CT KUB for patients with suspected urolithiasis is a low-value healthcare service.

  13. Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Thieme, Mai E.; Valdehueza, Zaldy D.; Wiarda, Bart M. [Medical Centre Alkmaar, Department of Radiology, Alkmaar (Netherlands); Leeuwenburgh, Marjolein M.N. [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam (Netherlands); Academic Medical Centre Amsterdam, Department of Surgery, Amsterdam (Netherlands); Bouman, Donald E. [Medical Spectrum Twente, Department of Radiology, Enschede (Netherlands); Bruin, Ivar G.J.M. de; Schreurs, W.H.; Houdijk, Alexander P.J. [Medical Centre Alkmaar, Department of Surgery, Alkmaar (Netherlands); Stoker, Jaap [Academic Medical Centre Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2014-03-15

    To compare magnetic resonance imaging (MRI) and ultrasound in children with suspected appendicitis. In a single-centre diagnostic accuracy study, children with suspected appendicitis were prospectively identified at the emergency department. All underwent abdominal ultrasound and MRI within 2 h, with the reader blinded to other imaging findings. An expert panel established the final diagnosis after 3 months. We evaluated the diagnostic accuracy of three imaging strategies: ultrasound only, conditional MRI after negative or inconclusive ultrasound, and MRI only. Significance between sensitivity and specificity was calculated using McNemar's test statistic. Between April and December 2009 we included 104 consecutive children (47 male, mean age 12). According to the expert panel, 58 patients had appendicitis. The sensitivity of MRI only and conditional MRI was 100 % (95 % confidence interval 92-100), that of ultrasound was significantly lower (76 %; 63-85, P < 0.001). Specificity was comparable among the three investigated strategies; ultrasound only 89 % (77-95), conditional MRI 80 % (67-89), MRI only 89 % (77-95) (P values 0.13, 0.13 and 1.00). In children with suspected appendicitis, strategies with MRI (MRI only, conditional MRI) had a higher sensitivity for appendicitis compared with a strategy with ultrasound only, while specificity was comparable. (orig.)

  14. Positron emission tomography myocardial perfusion imaging in children with suspected coronary abnormalities.

    Science.gov (United States)

    Singh, T P; Muzik, O; Forbes, T F; Di Carli, M F

    2003-01-01

    Positron emission tomography (PET) myocardial perfusion imaging has higher spatial resolution than conventional single photon emission computed tomography (SPECT) imaging and allows accurate and reproducible quantification of myocardial blood flow (MBF). In this article, we describe the role of PET myocardial perfusion imaging in clinical decision making in children with suspected coronary abnormalities. We performed a PET myocardial perfusion study using N-13 ammonia in 10 children (median age, 14 years; range, 1-17 years). The indications included exercise-induced chest pain and ST segment changes during exercise testing, coronary artery ectasia, hypertrophic cardiomyopathy with myocardial bridging of the left anterior descending coronary artery, and suspected left coronary stenosis in an infant with William's syndrome. MBF was assessed at baseline and during adenosine hyperemia in all 10 patients and postexercise in 8 patients. Myocardial perfusion was homogeneous at baseline in all 10 patients, during adenosine perfusion in 9 of 10 patients, and postexercise in all 8 patients. Three patients with homogeneous rest and stress perfusion had impaired myocardial flow reserve. The infant with William's syndrome developed a large, reversible perfusion defect in the left coronary territory during adenosine stress and underwent surgical repair. Myocardial flow reserve findings were valuable for clinical decision making in individual patients. We conclude that MBF quantification with N-13 ammonia and PET provides supplemental perfusion information and is helpful in clinical decision making in children with suspected coronary abnormalities.

  15. Incidental findings at MRI-enterography in patients with suspected or known Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens

    2010-01-01

    AIM: To determine the frequency and clinical impact of incidental findings detected with magnetic resonance imaging (MRI)-enterography in patients with suspected or known Crohn's disease (CD). METHODS: Incidental findings were defined as unexpected lesions outside the small intestine, not previou......AIM: To determine the frequency and clinical impact of incidental findings detected with magnetic resonance imaging (MRI)-enterography in patients with suspected or known Crohn's disease (CD). METHODS: Incidental findings were defined as unexpected lesions outside the small intestine......, not previously known or suspected at the time of referral, and not related to inflammatory bowel disease. Through a systematic review of medical charts we analyzed the clinical impact of incidental findings, and compared the MRI findings with subsequent diagnostic procedures. RESULTS: A total of 283 patients...... were included in the analysis, and MRI detected active CD in 31%, fistula in 1.4% and abscess in 0.7%. Extra-intestinal findings not related to CD were recorded in 72 patients (25%), of which 58 patients (20%) had 74 previously unknown lesions. Important or incompletely characterized findings were...

  16. Use of /sup 131/I-MIBG scintigraphy in the evaluation of suspected pheochromocytoma

    Energy Technology Data Exchange (ETDEWEB)

    Swensen, S.J.; Brown, M.L.; Sheps, S.G.; Sizemore, G.W.; Gharib, H.; Grant, C.S.; van Heerden, J.A.

    1985-05-01

    Studies at the University of Michigan have shown that /sup 131/I-metaiodobenzylguanidine (/sup 131/I-MIBG) is an effective agent for the diagnosis and localization of pheochromocytomas and paragangliomas. The authors conducted a study that confirmed and expanded that finding. From January 1983 to March 1984, 48 patients at our institution had 51 /sup 131/I-MIBG scans during the workup of suspected sporadic or metastatic pheochromocytoma. Scintigrams were obtained after 500 microCI of /sup 131/I-MIBG had been administered intravenously. The final diagnosis (true-positive, false-negative, or false-positive result) was made at operation and pathologic examination. A true-negative diagnosis was confirmed by normal plasma and fractionated urinary levels of catecholamines and metabolites and, in most patients, computed tomography (CT). The overall sensitivity of /sup 131/I-MIBG scanning was 77%, specificity was 96%, and accuracy was 86%. This test is fairly sensitive in the workup of patients with known or suspected recurrent or metastatic pheochromocytoma. It may also be helpful in the evaluation of suspected sporadic pheochromocytoma when CT findings are normal.

  17. Detection of herpes viruses in the cerebrospinal fluid of adults with suspected viral meningitis in Malawi.

    Science.gov (United States)

    Benjamin, L A; Kelly, M; Cohen, D; Neuhann, F; Galbraith, S; Mallewa, M; Hopkins, M; Hart, I J; Guiver, M; Lalloo, D G; Heyderman, R S; Solomon, T

    2013-02-01

    We looked for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2, respectively), varicella zoster virus (VZV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) DNA in Malawian adults with clinically suspected meningitis. We collected cerebrospinal fluid (CSF) from consecutive adults admitted with clinically suspected meningitis to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, for a period of 3 months. Those with proven bacterial or fungal meningitis were excluded. Real-time polymerase chain reaction (PCR) was performed on the CSF for HSV-1 and HSV-2, VZV, EBV and CMV DNA. A total of 183 patients presented with clinically suspected meningitis. Of these, 59 (32 %) had proven meningitis (bacterial, tuberculous or cryptococcal), 39 (21 %) had normal CSF and 14 (8 %) had aseptic meningitis. For the latter group, a herpes virus was detected in 9 (64 %): 7 (50 %) had EBV and 2 (14 %) had CMV, all were human immunodeficiency virus (HIV)-positive. HSV-2 and VZV were not detected. Amongst those with a normal CSF, 8 (21 %) had a detectable herpes virus, of which 7 (88 %) were HIV-positive. The spectrum of causes of herpes viral meningitis in this African population is different to that in Western industrialised settings, with EBV being frequently detected in the CSF. The significance of this needs further investigation.

  18. An Evaluation of Indian Consumers' Reporting of Suspected Adverse Drug Reactions with a Designated Reporting Form.

    Science.gov (United States)

    Rehan, Harmeet Singh; Sah, Ravinder; Gupta, Anubhuti; Nagar, Parvesh

    2017-01-01

    The Pharmacovigilance Program of India recently initiated a process for direct patient reporting of Adverse Drug Reactions (ADRs) with a designated form. A survey of 200 patients reporting ADRs filling the form. Forms were analysed for patient data, the suspected medication(s), ADRs and possible causality. 54.3% of respondents provided their contact information; the implicated medicine was mentioned in 60% and the description of ADRs in 80% although 46.2% were not interpretable. The severity of ADRs was mentioned in 73.5%. No responder filled the expiry date component of the implicated modification and a causality assessment from most forms was unclassifiable (57%) or unclassified (26%). Details of concomitant drugs were missing. Missing information was a deterrent in analysing the consumer ADR reports for signal detection. It is recommended that the following fields are highlighted in the form: consumer's initials, address, date suspected reaction started, description of event, name, dose, and the reason for the use the medication as well as its expiry date. These should be mandatory in the existing form and new fields added for weight and height, batch number for vaccines and biological products, de challenge and rechallenge results to the suspected medicine and concomitantly used medicines. To improve the quality of information in the consumer reporting form an awareness campaign is also suggested. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. Patient selection for later delivery timing with suspected previa-accreta.

    Science.gov (United States)

    Perlman, Nicola C; Little, Sarah E; Thomas, Ann; Cantonwine, David E; Carusi, Daniela A

    2017-08-01

    We identified patients with previa and suspected accreta who are at lowest risk of unscheduled delivery or major morbidity with planned delivery beyond 34 weeks' gestation. This was a retrospective cohort study of patients who had reached 34.0 weeks' gestational age with a suspected previa-accreta. We evaluated rates of unscheduled and emergent delivery based on known risk factors for premature birth. In a second analysis, we stratified patients based on level of preoperative morbidity concern and evaluated rates of major transfusion and Intensive Care Unit admission by delivery week (34 weeks, 35 weeks or 36 weeks and beyond). Of 84 available patients, we classified 31 patients as low risk for unscheduled delivery and 52 as high risk. The low risk group was scheduled later (36.6 vs. 36.0 weeks; p delivery prior to 36 weeks (3% vs. 19%, p = 0.05). Of the patients with no prior cesarean section, only one (7%) experienced massive blood loss even though 36% had unscheduled deliveries. We observed no significant increase in major transfusion or massive blood loss with advancing gestational age, likely due to selection of the most concerning patients for early, scheduled delivery. Patients with suspected previa-accreta and no risk factors for preterm birth are at low risk for an unscheduled delivery prior to 36 weeks. Those with no concern for percreta or increta or no prior cesarean section may also be candidates for later delivery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  20. Synchronous Low-grade Appendiceal Mucinous Neoplasm and Primary Peritoneal Low-grade Serous Carcinoma: A First Description of These 2 Neoplasms Presenting Together as Suspected Peritoneal Carcinomatosis.

    Science.gov (United States)

    Sekulic, Miroslav; Pichler Sekulic, Simona; Movahedi-Lankarani, Saeid

    2017-09-01

    Low-grade appendiceal mucinous neoplasm is a neoplasm typically of appendiceal origin, which is characterized by diffuse peritoneal involvement by pools of mucin with mucinous epithelium lacking high-grade cytologic atypia, and clinically presents as suspected peritoneal carcinomatosis. A similar clinical presentation can sometimes be seen with disseminated low-grade serous carcinomas of the peritoneum, fallopian tubes, or ovaries; however, this neoplasm is histologically characterized by tubal-type epithelium and invasive or confluent growth. In this case report, we describe a patient presenting with a clinical examination and radiologic features suggestive of peritoneal carcinomatosis and a prominent pelvic mass; however, after pathologic review, the patient was proven to have peritoneal involvement by both low-grade appendiceal mucinous neoplasm of appendiceal origin and a low-grade peritoneal primary serous carcinoma. In short, we present the first description of low-grade appendiceal mucinous neoplasm and serous carcinoma of the peritoneum presenting synchronously, providing morphologic characterization and immunohistochemical studies supporting the diagnosis, and illustrating a rare instance in which 2 neoplastic processes are underlying clinically suspected peritoneal carcinomatosis.

  1. Formula for predicting OSA and the Apnea-Hypopnea Index in Koreans with suspected OSA using clinical, anthropometric, and cephalometric variables.

    Science.gov (United States)

    Kim, Seon Tae; Park, Kee Hyung; Shin, Seung-Heon; Kim, Ji-Eun; Pae, Chi-Un; Ko, Kwang-Pil; Hwang, Hee Young; Kang, Seung-Gul

    2017-12-01

    This study developed formulas to predict obstructive sleep apnea (OSA) and the Apnea-Hypopnea Index (AHI) in Korean patients with suspected OSA using clinical, anthropometric, and cephalometric variables. We evaluated relevant variables in 285 subjects with suspected OSA. These included demographic characteristics, sleep-related symptoms, medical history, clinical scales, anthropometric measurements including facial surface measurements, and cephalometric measurements. All participants underwent full-night laboratory polysomnography. The prediction formula for the probability of OSA was created by logistic regression analysis and confirmed by the bootstrap resampling technique. The formula for predicting the AHI was developed using multiple linear regression analysis. The probability of having OSA was as follows: p = 1 / (1 + exponential (exp)-f ), where f = -16.508 + 1.445 × loudness of snoring 4 + 0.485 × loudness of snoring 3 + 0.078 × waist circumference + 0.209 × subnasale-to-stomion distance + 0.183 × thickness of the uvula (UTH) supine + 0.041 × age. The AHI prediction formula was as follows: -112.606 + 3.516 × body mass index + 0.683 × mandibular plane-hyoid supine + 10.915 × loudness of snoring 4 + 6.933 × loudness of snoring 3 + 1.297 × UTH supine + 0.272 × age. This is the first study to establish formulas to predict OSA and the AHI in Koreans with suspected OSA using cephalometric and other variables. These results will contribute to prioritizing the order in which patients with suspected OSA are referred for polysomnography.

  2. Effectiveness of a fluid chart in outpatient management of suspected dengue fever: A pilot study.

    Science.gov (United States)

    Nasir, Nazrila Hairin; Mohamad, Mohazmi; Lum, Lucy Chai See; Ng, Chirk Jenn

    2017-01-01

    Dengue infection is the fastest spreading mosquito-borne viral disease in the world. One of the complications of dengue is dehydration which, if not carefully monitored and treated, may lead to shock, particularly in those with dengue haemorrhagic fever. WHO has recommended oral fluid intake of five glasses or more for adults who are suspected to have dengue fever. However, there have been no published studies looking at self-care intervention measures to improve oral fluid intake among patients suspected of dengue fever. To assess the feasibility and effectiveness of using a fluid chart to improve oral fluid intake in patients with suspected dengue fever in a primary care setting. This feasibility study used a randomized controlled study design. The data was collected over two months at a primary care clinic in a teaching hospital. The inclusion criteria were: age > 12 years, patients who were suspected to have dengue fever based on the assessment by the primary healthcare clinician, fever for > three days, and thrombocytopenia (platelets chart and a cup (200ml). Baseline clinical and laboratory data, 24-hour fluid recall (control group), and fluid chart were collected. The main outcomes were: hospitalization rates, intravenous fluid requirement and total oral fluid intake. Among the 138 participants who were included in the final analysis, there were fewer hospital admissions in the intervention group (n = 7, 10.0%) than the control group (n = 12, 17.6%) (p = 0.192). Similarly, fewer patients (n = 9, 12.9%) in the intervention group required intravenous fluid compared to the control group (n = 15, 22.1%), (p = 0.154). There was an increase in the amount of daily oral fluid intake in the intervention group (about 3,000 ml) compared to the control group (about 2,500 ml, p = 0.521). However, these differences did not reach statistical significance. This is a feasible and acceptable study to perform in a primary care setting. The fluid chart is a simple, inexpensive

  3. Evolutionary Catastrophes: The Science of Mass Extinction

    Science.gov (United States)

    Hames, Willis

    The stories behind the greatest scientific controversies are more than entertaining. They provide windows into the evolution of scientific thought, scientific method, technological achievements and their research applications, and the influence of individuals and personalities on a community's acceptance of a theory Epic controversies surround the theories for Earth's mass extinction events, and none is more spectacular than the continuing polemic over the Cretaceous-Tertiary (K/T) mass extinctions and ultimate demise of the dinosaurs.In contrast to other great scientific debates, we tend to view the K/T event in the context of a crime scene, where the spectacularly diverse flora and fauna of a primordial Eden were unwittingly slain by one or more ruthless and efficient killers. A “foreign” suspect has been fingered; an intruder that killed suddenly and randomly has become the principal suspect. The main clues uncovered in the case include a global K/T iridium anomaly; shock-deformed minerals in K/T boundary sediments; the ˜6 5 m.y-old Deccan flood-basalt province, which covered an area roughly the size of France; and the ˜6 5 m.y-old Chicxulub impact crater in the Yucatan peninsula, which seems to be among the largest to have formed in the inner solar system over the past billion years.

  4. THE ELITES AND THE MASSES IN 2016

    Directory of Open Access Journals (Sweden)

    Mirela Cristiana NILĂ-STRATONE

    2016-06-01

    Full Text Available The dichotomy elite / non-elite has determined the segmentation of the romanian population in groups centered on competence, talent and excellence - at the qualitatively (positive pole - on the one hand and vanity, fight for power, incompetence - at the opposite pole of the quality - on the other hand. The discrepancy between the two categories has led to the necessity of studying the causes that sustain each cluster. The separation of popular elite mass is an unquestionable cause of a form of aversion from the masses against the elite. Based on this harmful and so-called democratic attitude, the elite has became a suspect notion, with a pronounced negative connotation, marked by doubts. Considering the socio-political events occurring at global level, but especially in Europe in years 2015-2016, feels definitely a need for a ruling class with high moral character, coming from among the meritocratic elite.

  5. Added value of fetal MRI in fetuses with suspected brain abnormalities on neurosonography : a systematic review and meta-analysis

    NARCIS (Netherlands)

    van Doorn, Martine; Oude Rengerink, K|info:eu-repo/dai/nl/375367292; Newsum, Esther A; Reneman, Liesbeth; Majoie, Charles B; Pajkrt, Eva

    PURPOSE: To evaluate the additional diagnostic value of fetal Magnetic Resonance Imaging (MRI) in fetuses with suspected brain abnormalities identified with advanced neurosonography (NS). METHODS: A systematic literature search was performed for studies reporting on a comparison between diagnosis

  6. Study of sonography sensitivity and specificity to the diagnosis of acute appendicitis in suspected patients referred to Khorramabad Ashayer hospital

    Directory of Open Access Journals (Sweden)

    mojtaba Ahmai Nejad

    2012-03-01

    Conclusion: As the study suggests, sonography before sugery can help and leads to definite diagnosis in suspected patients to appendicitis and it can prevent unnecessary surgeries, as well as it can prevent delay in treatment and related complications .

  7. EuroClonality/BIOMED-2 guidelines for interpretation and reporting of Ig/TCR clonality testing in suspected lymphoproliferations

    National Research Council Canada - National Science Library

    Langerak, A.W; Groenen, P.J.T.A; Bruggemann, M; Beldjord, K; Bellan, C; Bonello, L; Boone, E; Carter, G.I; Catherwood, M; Davi, F; Delfau-Larue, M.H; Diss, T; Evans, P.A; Gameiro, P; Garcia Sanz, R; Gonzalez, D; Grand, D; Hakansson, A; Hummel, M; Liu, H; Lombardia, L; Macintyre, E.A; Milner, B.J; Montes-Moreno, S; Schuuring, E; Spaargaren, M; Hodges, E; Dongen, J.J. van

    2012-01-01

    PCR-based immunoglobulin (Ig)/T-cell receptor (TCR) clonality testing in suspected lymphoproliferations has largely been standardized and has consequently become technically feasible in a routine diagnostic setting...

  8. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography

    NARCIS (Netherlands)

    van Belle, Arne; Büller, Harry R.; Huisman, Menno V.; Huisman, Peter M.; Kaasjager, Karin; Kamphuisen, Pieter W.; Kramer, Mark H. H.; Kruip, Marieke J. H. A.; Kwakkel-van Erp, Johanna M.; Leebeek, Frank W. G.; Nijkeuter, Mathilde; Prins, Martin H.; Sohne, Maaike; Tick, Lidwine W.

    2006-01-01

    CONTEXT: Previous studies have evaluated the safety of relatively complex combinations of clinical decision rules and diagnostic tests in patients with suspected pulmonary embolism. OBJECTIVE: To assess the clinical effectiveness of a simplified algorithm using a dichotomized clinical decision rule,

  9. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction

    DEFF Research Database (Denmark)

    Thorup, J; Jokela, R; Cortes, D

    2003-01-01

    OBJECTIVE: To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: The study comprised 100 consecutive children with antenatally detected suspected unilateral PUJ obstruction and a normal contralateral...

  10. Scheduling delay in suspected cases of oral cancer Atraso de agendamento em casos suspeitos de câncer bucal

    National Research Council Canada - National Science Library

    Luciana Meneses Souza; Edgard Michel-Crosato; Maria Gabriela Haye Biazevic; José Leopoldo Ferreira Antunes

    2011-01-01

    ... of São Paulo of patients suspected of having oral cancer. A cross-sectional study was performed in which telephone conversations simulated clinical situations that represented two types of patients...

  11. Retrospective histopathological classification of 1,108 skin biopsies from patients clinically suspected of having leprosy from Bahia, Northeast Brazil

    Directory of Open Access Journals (Sweden)

    Barbosa Júnior Aryon de Almeida

    1998-01-01

    Full Text Available We report a retrospective histopathological classification carried out under laboratory conditions by the method of Ridley & Jopling of 1,108 skin biopsies from patients clinically suspected of having leprosy from Bahia, Northeast Brazil.

  12. Viral etiology of mumps-like illnesses in suspected mumps cases reported in Catalonia, Spain.

    Science.gov (United States)

    Barrabeig, Irene; Costa, Josep; Rovira, Ariadna; Marcos, M Angeles; Isanta, Ricard; López-Adalid, Rubén; Cervilla, Ana; Torner, Nuria; Domínguez, Angela

    2015-01-01

    We investigated the etiology of reported sporadic suspected mumps cases with a negative RT-PCR result for the mumps virus in the Barcelona-South region in 2007-2011. Samples from mumps virus-negative patients presenting unilateral or bilateral parotitis or other salivary gland swelling were tested for Epstein-Barr virus (EBV) by real-time PCR and for respiratory viruses by two multiplex-PCR-based assays to detect parainfluenza virus (PIV) 1-4, influenza virus (InV) A, B and C, respiratory syncytial virus (RSV), enterovirus, coronavirus 229E, coronavirus OC43, and rhinovirus. 101 samples were analyzed in persons aged 8 months to 50 years. Oral samples were collected on the first day of glandular swelling in 53 patients (52.5%), and on the first two days in 74 patients (73.3%). Viruses were detected in 52 (51.5%) of samples: one virus (25 EBV, 8 PIV3, 4 adenovirus, 4 PIV2, 1 PIV1, 1 InVA, and 1 enterovirus) was detected in 44 patients (84.6%), two viruses in 7 patients, and three viruses in one patient. In 58 patients (57.5%) whose sample was collected in the first 2 days after onset of parotitis and had received two doses of MMR vaccine and in 15 patients (14.8%) whose sample was collected on the first day, it is very likely that the cause was not the mumps virus. This would mean that 72.3% (73/101) of the reported sporadic suspected mumps cases were not mumps cases. The timing of oral-sample collection is crucial to correctly interpret the negative results for mumps virus RNA, especially when suspected cases occur in vaccinated persons.

  13. Multivariable prediction model for suspected giant cell arteritis: development and validation

    Science.gov (United States)

    Ing, Edsel B; Lahaie Luna, Gabriela; Toren, Andrew; Ing, Royce; Chen, John J; Arora, Nitika; Torun, Nurhan; Jakpor, Otana A; Fraser, J Alexander; Tyndel, Felix J; Sundaram, Arun NE; Liu, Xinyang; Lam, Cindy TY; Patel, Vivek; Weis, Ezekiel; Jordan, David; Gilberg, Steven; Pagnoux, Christian; ten Hove, Martin

    2017-01-01

    Purpose To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA). Methods A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site. Results There were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75–0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria. Conclusion Our prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern. PMID:29200816

  14. Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement

    Science.gov (United States)

    Jacobson, Jon A.; Benson, Carol B.; Bancroft, Laura W.; Bedi, Asheesh; McShane, John M.; Miller, Theodore T.; Parker, Laurence; Smith, Jay; Steinbach, Lynne S.; Teefey, Sharlene A.; Thiele, Ralf G.; Tuite, Michael J.; Wise, James N.; Yamaguchi, Ken

    2013-01-01

    The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013 PMID:23401583

  15. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

  16. Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients.

    Directory of Open Access Journals (Sweden)

    Dilraj S Grewal

    Full Text Available To identify the risk factors for development of peripapillary retinal splitting (schisis in patients with glaucoma or suspicion of glaucoma.Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL.In this institutional cross-sectional study, 495 patients (990 eyes who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering optic nerve head (ONH imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers.Presence of peripapillary retinal splitting identified on OCT raster scans.Eleven of 990 glaucoma and glaucoma suspect eyes (1.1% of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6% were glaucoma suspects, 3 (42.9% had primary open-angle glaucoma, 1 (14.3% had chronic angle-closure glaucoma and 1 (14.3% had pigmentary glaucoma. 7/11 (63.6% eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5% had beta-zone peripapillary atrophy.We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.

  17. Suspectable Risk Factors of Congenital Anomaly in Dr. Hasan Sadikin General Hospital Bandung, Indonesia

    Directory of Open Access Journals (Sweden)

    Pradistya Syifa Yudiasari

    2017-06-01

    Full Text Available Background: Congenital anomaly is a disease of structural or functional alteration since birth. The cause of congenital anomaly is genetic, environtment, and unknown. The cause of congenital anomaly is unknown, made congenital anomaly is difficult to detect. Therefore, the objective of this study was to identify the suspectable risk factors of congenital anomaly. Methods: This was a descriptive study. About 78 samples were taken by purposive sampling from medical records of patients with congenital anomaly in pediatric surgery ambulatory unit at Dr. Hasan Sadikin General Hospital (RSHS, Bandung from September to November 2014. From the selected medical records, an interview was carried out to the parents’ patient to identify some suspectable risk factors. The collected data were analyzed and presented in tables. Results: From 78 medical records,  hirschprung disease was the highest among all type of congenital anomaly (29%. The characteristic of congenital anomaly was mothers in the age of 20–35 years (65%, fathers’ age was  more than 20 years old, family history of congenital anomaly was 1%, there was no history of previous congenital anomaly in previous pregnancy, infection history was 3%, history of medication was 11.5%, mother’s BMI was in normal term (18.5─24.9 as much as 65%, no history of radiation, there was no history of chronic alcohol. History of smoking/passive smoking was high (65%. Conclusions: Hirschprung disease is the highest rate disease in congenital anomaly and smoking is a highest suspectable risk factor contribute to congenital anomaly.   DOI: 10.15850/amj.v4n2.1095

  18. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study.

    Science.gov (United States)

    Linkins, L A; Warkentin, T E; Pai, M; Shivakumar, S; Manji, R A; Wells, P S; Wu, C; Nazi, I; Crowther, M A

    2016-06-01

    Essentials Heparin-induced thrombocytopenia (HIT) is a thrombogenic condition that is difficult to treat. We evaluated rivaroxaban as a treatment option in patients with suspected or confirmed HIT. One patient had recurrent thrombosis and 9/10 patients with thrombocytopenia had platelet recovery. Rivaroxaban may be an effective and safe treatment option for HIT. Background Rivaroxaban is a direct oral anti-Xa inhibitor that has the potential to greatly simplify treatment of heparin-induced thrombocytopenia (HIT). Objectives To evaluate the efficacy and safety of rivaroxaban in this patient population, we conducted a multicenter, single-arm, prospective cohort study of patients with suspected or confirmed HIT. Patients/Methods Twenty-two consecutive adults with suspected or confirmed HIT received rivaroxaban 15 mg bid until a local HIT assay result was available. Participants with a positive local assay result continued rivaroxaban 15 mg bid until platelet recovery (or until day 21 if they had acute thrombosis at study entry), then stepped down to rivaroxaban 20 mg daily until day 30. Results and Conclusions The primary outcome measure, incidence of new symptomatic, objectively-confirmed venous and arterial thromboembolism at 30 days, occurred in one HIT-positive participant (4.5%; 95% confidence interval [CI], 0-23.5%) and one HIT-positive participant required limb amputation despite platelet recovery. Platelet recovery was achieved in nine out of 10 HIT-positive patients with thrombocytopenia. Rivaroxaban appears to be effective for treating patients with confirmed HIT, although the small number of patients enrolled limits precision. © 2016 International Society on Thrombosis and Haemostasis.

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

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Seligman, Renato; Knorst, Marli Maria, E-mail: mknorst@gmail.com [Hospital de Clinicas de Porto Alegre, Porto Alegre, RS (Brazil); Guerra, Vinicius Andre [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS (Brazil). Faculdade de Medicina. Programa de Pos-Graduacao em Ciencias Pneumologicas; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre (Brazil). Faculdade de Medicina

    2016-01-15

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

  20. PET/MR Outperforms PET/CT in Suspected Occult Tumors.

    Science.gov (United States)

    Sekine, Tetsuro; Barbosa, Felipe de Galiza; Sah, Bert-Ram; Mader, Cäcilia E; Delso, Gaspar; Burger, Irene A; Stolzmann, Paul; Ter Voert, Edwin E; von Schulthess, Gustav K; Veit-Haibach, Patrick; Huellner, Martin W

    2017-02-01

    To compare the diagnostic accuracy of PET/MR and PET/CT in patients with suspected occult primary tumors. This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors. Patients were assessed with PET/CT and PET/MR for the presence of a primary tumor, lymph node metastases, and distant metastases. Wilcoxon signed-rank test was performed to compare the diagnostic accuracy of PET/CT and PET/MR. According to the standard of reference, a primary lesion was found in 14 patients. In 16 patients, the primary lesion remained occult. In the remaining 13 patients, lesions proved to be benign. PET/MR was superior to PET/CT for primary tumor detection (sensitivity/specificity, 0.85/0.97 vs 0.69/0.73; P = 0.020) and comparable to PET/CT for the detection of lymph node metastases (sensitivity/specificity, 0.93/1.00 vs 0.93/0.93; P = 0.157) and distant metastases (sensitivity/specificity, 1.00/0.97 vs 0.82/1.00; P = 0.564). PET/CT tended to misclassify physiologic FDG uptake as malignancy compared with PET/MR (8 patients vs 1 patient). PET/MR outperforms PET/CT in the workup of suspected occult malignancies. PET/MR may replace PET/CT to improve clinical workflow.

  1. MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET?

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, Nathalie L.; Graute, Vera; Cumming, Paul; Bartenstein, Peter; Fougere, Christian la [Ludwig-Maximilians-University Munich, Department of Nuclear Medicine, Munich (Germany); Armbruster, Lena; Suchorska, Bogdana; Tonn, Joerg-Christian; Kreth, Friedrich Wilhelm [Ludwig-Maximilians-University Munich, Department of Neurosurgery, Munich (Germany); Lutz, Juergen [Ludwig-Maximilians-University Munich, Department of Neuroradiology, Munich (Germany); Eigenbrod, Sabina [Ludwig-Maximilians-University Munich, Department of Neuropathology, Munich (Germany)

    2012-06-15

    Since differentiation between low-grade glioma (LGG) and high-grade glioma (HGG) remains challenging according to MRI criteria alone, we investigated the discriminative value of additional dynamic FET PET in patients with MRI-suspected LGG. Included in this retrospective study were 127 patients with newly diagnosed MRI-suspected LGG and dynamic FET PET prior to histopathological assessment. FET PET lesions were visually classified as having reduced, normal, or increased tracer uptake. Maximal tumour uptake scaled to the mean background uptake (SUV{sub max}/BG), mean tumour uptake (SUV{sub mean}/BG), biological tumour volume and kinetics were evaluated and correlated with individual histopathological findings. Histopathological analysis revealed 71 patients with LGG, 47 patients with HGG (including 5 glioblastoma multiforme), 2 patients with low-grade ganglioglioma and 7 patients with non-neoplastic lesions. Of the 127 patients, 97 had lesions with increased FET uptake, of which 93 were neoplastic. Increased uptake was found in 49/71 LGG (69 %) and 42/47 HGG (89 %). None of the conventional uptake parameters differed significantly between the HGG and LGG groups. Kinetic analysis reliably identified HGG (sensitivity 95 %, specificity 72 %, PPV 74 %, NPV 95 %). Normal tracer uptake was observed in 19 patients (15 with LGG, 1 with HGG and 3 with non-neoplastic lesions) and reduced uptake in 11 patients (7 with LGG and 4 with HGG). Among the MRI-suspected LGG, kinetic but not conventional analysis of FET uptake enabled remarkably high sensitivity for detection of HGG. This held true even for lesions with low or diffuse tracer uptake. Lesions with reduced tracer uptake must be interpreted with caution, as they can also harbour HGG tissue. (orig.)

  2. Medical History for Prognostic Risk Assessment and Diagnosis of Stable Patients with Suspected Coronary Artery Disease

    Science.gov (United States)

    Min, James K.; Dunning, Allison; Gransar, Heidi; Achenbach, Stephan; Lin, Fay Y.; Al-Mallah, Mouaz; Budoff, Matthew J.; Callister, Tracy Q.; Chang, Hyuk-Jae; Cademartiri, Filippo; Chinnaiyan, Kavitha; Chow, Benjamin J. W.; D’Agostino, Ralph; DeLago, Augustin; Friedman, John; Hadamitzky, Martin; Hausleiter, Joerg; Hayes, Sean; Kaufmann, Philipp; Raff, Gilbert L.; Shaw, Leslee J.; Thomson, Louise; Villines, Todd; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Berman, Daniel S.; Pencina, Michael

    2014-01-01

    Aims To develop a clinical cardiac risk algorithm for stable patients with suspected CAD based upon angina typicality and CAD risk factors. Methods and Results Between 2004 and 2011, 14,004 adults with suspected CAD referred for cardiac imaging were followed: 1) 9,093 patients for CCTA (CCTA-1) followed for 2.0 years; 2) 2,132 patients for CCTA (CCTA-2) followed for 1·6 years, and 3) 2,779 patients for exercise myocardial perfusion scintigraphy followed for 5.0 years. A best-fit model from CCTA-1 for prediction of death or myocardial infarction (MI) was developed, with integer values proportional to regression coefficients. Discrimination was assessed using C-statistic. The validated model was also tested for estimation of the likelihood of obstructive CAD, defined as ≥50% stenosis, as compared to method of Diamond and Forrester (D-F). Primary outcomes included all-cause mortality and non-fatal MI. Secondary outcomes included prevalence of angiographically obstructive CAD. In CCTA-1, best-fit model discriminated individuals at risk of death or MI (C-statistic 0·76). The integer model ranged from 3-13, and corresponded to 3-year death risk or MI of 0·25% to 53·8%. When applied to the CCTA-2 and MPS, the model demonstrated C-statistics of 0·71 and 0·77. Both best-fit (C=0·76, 95% CI 0·746-0·771) and integer model (C=0·71, 95% CI 0·693-0·719) performed better than D-F (C=0·64; 95% CI, 0·628-0·659) for estimating obstructive CAD. Conclusions For stable symptomatic patients with suspected CAD, we developed a history-based method for prediction of death and obstructive CAD. PMID:25865923

  3. Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis.

    Directory of Open Access Journals (Sweden)

    Yupin Suputtamongkol

    Full Text Available BACKGROUND: Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients. METHODS: The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1 no patients tested or given antibiotic treatment; 2 all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3 lateral flow; 4 MCAT; 5 latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs. FINDINGS: Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment. CONCLUSIONS: Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be

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

    Directory of Open Access Journals (Sweden)

    Eleci Vaz Ferreira

    2016-02-01

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

  5. Relationship between hepcidin and oxidant/antioxidant status in calves with suspected neonatal septicemia

    Directory of Open Access Journals (Sweden)

    E. E. Erkilic

    2016-11-01

    Full Text Available Aim: This study has been conducted for the purpose of determining serum hepcidin, total antioxidant status (TAS, total oxidant status (TOS, and Fe levels in calves with suspected neonatal septicemia before and after treatment and the clinical significance of hepcidin in calves with suspected neonatal septicemia. Materials and Methods: The study material consisted of 15 calves of different ages and sexes brought to the Training, Research and Application Center at the Kafkas University Faculty of Veterinary Medicine with suspected neonatal septicemia. 8.5 mL of blood was drawn from the jugular vein of each animal into coagulant tubes before and after treatment for one-off biochemical analyses and centrifuged. After this, the serum was separated. Hepcidin, TAS, TOS, and Fe levels in the serum were measured. Results: While pre-treatment hepcidin levels were 58.42±3.46 ng/mL, post-treatment levels were 46.87±2.98 ng/mL (p<0.05. Pre-treatment Fe levels were 60.13±7.27 μg/dl, while post-treatment levels were 83.1±8.09 μg/dl (p<0.05. The changes in the TAS and TOS levels were also found to be statistically significant. Conclusion: In light of the fact that hepcidin plays a role function in the regulation of Fe as well as the fact that Fe is a significant nutritional source for many microorganisms, it was concluded that hepcidin may play a significant role in nutritional immunity and the pathogenesis of diseases.

  6. Pressure Pain Sensitivity in Patients With Suspected Opioid-Induced Hyperalgesia.

    Science.gov (United States)

    Wasserman, Ronald A; Hassett, Afton L; Harte, Steven E; Goesling, Jenna; Malinoff, Herbert L; Berland, Daniel W; Zollars, Jennifer; Moser, Stephanie E; Brummett, Chad M

    2015-01-01

    This study was designed to test whether a brief quantitative sensory testing assessment could be used to detect hyperalgesia in patients with suspected opioid-induced hyperalgesia (OIH). Twenty patients on long-term opioid therapy with suspected OIH were recruited along with 20 healthy controls. Pressure pain threshold, Pain50, a measure of intermediate suprathreshold pressure pain sensitivity, and tolerance levels were evaluated. As a secondary outcome, changes in pressure pain sensitivity after intravenous administration of placebo (saline) and fentanyl (1.5 μg/kg) were assessed. There were no significant differences in pain measures between healthy controls and patients. However, there was an association between higher doses of opioids and having a lower pain tolerance (r = -0.46, P = 0.041) and lower Pain50 (r = -0.46, P = 0.044), which was consistent with the hypothesis. Patients on more than 100 mg oral morphine equivalents displayed decreased pressure pain tolerance compared with patients taking less than 100 mg oral morphine equivalents (P = 0.042). In addition, male patients showed a hyperalgesic response to fentanyl administration, which was significant for the Pain50 measure (P = 0.002). Whereas there were no differences between patients suspected of having OIH and the healthy controls, the finding that higher doses of opioids were associated with more sensitivity suggests that dose might be an important factor in the development of hyperalgesia. In addition, male patients demonstrated a hyperalgesic response after a bolus of fentanyl. Future studies are needed to develop better diagnostics for detecting hyperalgesia in the clinical setting.

  7. Association of naso-Oro-pharyngeal structures with the sleep architecture in suspected obstructive sleep apnea.

    Science.gov (United States)

    Singhal, Pawan; Gupta, Ravi; Sharma, Rajanish; Mishra, Prakash

    2014-01-01

    The study was conducted to find out the association of various naso-oro-pharyngeal structures with sleep macro-architecture in suspected obstructive sleep apnea subjects. Study included 51 subjects with suspected obstructive sleep apnea. Subjects with possible central apnea and those consuming any substance that can affect sleep architecture were excluded. Level I polysomnography was performed after thorough physical examination. Overnight study was scored in 30 s epochs to find out the polysomnographic variables. Surgical treatment was offered wherever indicated. Subjects with moderate to severe obstructive sleep apnea were manually titrated on CPAP with the polysomnogram. SPSS v 17.0 was used for statistical analysis. We did not find any difference in the sleep architecture between genders. Sleep Efficiency was better in subjects with dental overjet, dental attrition, high tongue base, macroglossia, lesser oral cavity volume, edematous uvula, increased submental fat, hypertrophied facial muscles and Mallampatti grade III-IV. Shorter Sleep Latency was seen in subjects with tender TMJ and Mallampatti Gr III-IV. REM latency was shorter in subjects with high tongue base, macroglossia and hypertrophied muscles of mastication. Increased REM was observed in subjects with high tongue base, edematous uvula and tender TMJ. Enlarged tonsils had reversed effect with poor sleep efficiency, increased REM latency and decreased REM. CPAP therapy (N = 20) lessened awake time, decreased N2 and increased REM. Oro-pharyngeal structures affect the sleep architecture in suspected OSA subjects. Nasal structures do not affect the sleep architecture in these subjects and enlarged tonsils have opposite effect. Sleep architecture changes on the titration night with CPAP.

  8. Ultrasonography for suspected deep vein thrombosis: how useful is single-point augmentation?

    Energy Technology Data Exchange (ETDEWEB)

    McQueen, A.S. [Department of Radiology, Freeman Hospital, Newcastle upon Tyne (United Kingdom)], E-mail: andrewmcqueen7@hotmail.com; Elliott, S.T. [Department of Radiology, Freeman Hospital, Newcastle upon Tyne (United Kingdom); Keir, M.J. [Department of Medical Physics, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)

    2009-02-15

    Aims: To assess the role of single-point augmentation of spectral Doppler flow in the diagnosis of acute deep vein thrombosis (DVT). Secondary objectives included identifying the augmentation response in non-DVT diagnoses. Methods: Patients attending the ultrasound departments of two hospitals for investigation of suspected acute DVT during an 8-month period were recruited to the study group. Spectral Doppler assessment of the superficial femoral vein was recorded during Valsalva and calf compression manoeuvres in the asymptomatic and symptomatic legs. The Doppler waveforms from the symptomatic limb were characterized as 'normal' or 'abnormal' by the operator. Standard compression ultrasonography of the symptomatic leg was then performed with the presence of DVT or an alternative diagnosis documented. Results: One hundred and sixty-seven patients underwent ultrasound examinations using the study methodology. Nine patients were subsequently excluded due to bilateral DVT or inability to tolerate calf compression. The mean age of the remaining 158 patients was 65.4 years with 28 DVTs identified (18% of patients). Calf compression elicited a normal response in 118/130 of non-DVT examinations (specificity 91%) and an abnormal response in 18/28 DVT examinations (sensitivity 64%). Diminished or absent augmentation was identified in alternative diagnoses that included haematoma and Baker's cyst. Conclusions: This study demonstrates that single-point augmentation has a low sensitivity in suspected lower-limb DVT, and that the majority of undetected DVTs are isolated to the calf veins. An abnormal augmentation response is a poor predictor of lower-limb DVT as alternative diagnoses can produce diminished or reduced augmentation. Therefore, single-point augmentation does not add to the standard compression ultrasound examination for suspected DVT and should not be routinely performed.

  9. Dutch Suspects of Terrorist Activity: A Study of Their Biographical Backgrounds Based on Primary Sources.

    Directory of Open Access Journals (Sweden)

    Maarten van Leyenhorst

    2017-09-01

    Full Text Available With the impending defeat of ISIS in Syria and Iraq, supporters of terrorist groups, among them home-grown supporters and returning foreign fighters, have become a huge security threat to their country of return. Some have committed attacks in western countries, even while under the surveillance of authorities. Counter-terrorism is confronted with enormous challenges. One of the most prominent issues is the absence of evidence based knowledge on early warning signs. Experts on radicalization and terrorism have emphasized that neither typologies of terrorists nor accurate descriptions of generalizable risks can be made. This leads to opportunities for those who are willing to prepare and commit acts of terrorism to do so, without the agencies in charge of monitoring such individuals being able to accurately identify relevant threats. An additional deficiency in counter-terrorism research, is its dependency on historic and secondary source material. One of various actors in the Netherlands tasked to evaluate and mitigate relevant risks of terrorist suspects and offenders, is the Dutch Probation Service (DPS. In response to today’s prevailing terrorist threat, a specialized section of the DPS is set up to identify and supervise potential problem behaviour of those who are suspected or convicted of terrorism. The authors have been involved in this Unit Terrorism, Extremism and Radicalization (TER for years. As professionals of TER, the authors have had unique access to both judicial data, such as police files and prosecutor’s data, as to experts in the Dutch field of counter-terrorism. The authors have analysed the pre-sentencing advices of twenty-six clients of the DPS. These files are comprised of several socio-economic, historical, psychopathological and behavioural indicators. The goals are to learn from the analysis of the biographical backgrounds of the suspects and to stimulate the debate on management and supervision of terrorist

  10. Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography.

    Science.gov (United States)

    Chen, Chien-Hua; Yang, Chi-Chieh; Yeh, Yung-Hsiang; Yang, Tsang; Chung, Tieh-Chi

    2015-09-01

    Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies. We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US. The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p > 0.05). Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice. Copyright © 2013. Published by Elsevier B.V.

  11. V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bajc, Marika; Olsson, Berit; Joegi, Jonas [Skaane University Hospital and Lund University, Clinical Physiology and Nuclear Medicine, Lund (Sweden); Gottsaeter, Anders [Skaane University Hospital, Vascular Diseases, Malmoe (Sweden); Hindorf, Cecilia [Skaane University Hospital, Radiation Physics, Lund (Sweden)

    2015-07-15

    The purpose of the study was to assess the prevalence of pulmonary embolism (PE) and other lung diseases among pregnant women with suspected PE and to calculate the radiation exposure to patient and fetus in this population. As a secondary aim, we evaluated the negative predictive value of a normal ventilation/perfusion single photon emission computed tomography (V/P SPECT) examination in pregnancy. We studied all 127 pregnant women who had suspected PE and had undergone V/P SPECT at our institution in the course of a 5-year period. Radiation exposure to patient and fetus and the negative predictive value of a normal V/P SPECT examination were also measured. V/P SPECT identified PE in 11 women (9 %). Moreover, in 15 women (12 %) the examination revealed pneumonia (in 2 cases in addition to PE) and in 1 woman signs of airway obstruction were revealed. Among the 116/127 women (91 %) where PE was ruled out by V/P SPECT, none was diagnosed subsequently with PE or deep venous thrombosis (DVT) during the same pregnancy or puerperal period. For P SPECT, the calculated fetal absorbed dose was < 0.6 mGy,and the calculated breast absorbed dose 0.6 mGy. For V SPECT, the calculated fetal absorbed dose was < 0.014 mGy and the breast absorbed dose 0.25 mGy. The prevalence of PE was low (9 %) among pregnant women with suspected disease. Pneumonia was diagnosed in 12 % of patients. The negative predictive value of V/P SPECT was high, and the radiation exposure from V/P SPECT was low both for fetus and patient. (orig.)

  12. Isolation & characterization of Brucella melitensis isolated from patients suspected for human brucellosis in India.

    Science.gov (United States)

    Barua, Anita; Kumar, Ashu; Thavaselvam, Duraipandian; Mangalgi, Smita; Prakash, Archana; Tiwari, Sapana; Arora, Sonia; Sathyaseelan, Kannusamy

    2016-05-01

    Brucellosis is endemic in the southern part of India. A combination of biochemical, serological and molecular methods is required for identification and biotyping of Brucella. The present study describes the isolation and biochemical, molecular characterization of Brucella melitensis from patients suspected for human brucellosis. The blood samples were collected from febrile patients suspected to have brucellosis. A total of 18 isolates were obtained from 102 blood samples subjected to culture. The characterization of these 18 isolates was done by growth on Brucella specific medium, biochemical reactions, CO2 requirement, H2S production, agglutination with A and M mono-specific antiserum, dye sensitivity to basic fuchsin and thionin. Further, molecular characterization of the isolates was done by amplification of B. melitensis species specific IS 711 repetitive DNA fragment and 16S (rRNA) sequence analysis. PCR-restriction fragment length polymorphism (RFLP) analysis of omp2 locus and IS711 gene was also done for molecular characterization. All 102 suspected samples were subjected to bacteria isolation and of these, 18 isolates could be recovered on blood culture. The biochemical, PCR and PCR-RFLP and 16s rRNA sequencing revealed that all isolates were of B. melitensis and matched exactly with reference strain B. melitensis 16M. The present study showed an overall isolation rate of 17.64 per cent for B. melitensis. There is a need to establish facilities for isolation and characterization of Brucella species for effective clinical management of the disease among patients as well as surveillance and control of infection in domestic animals. Further studies are needed from different geographical areas of the country with different level of endemicity to plan and execute control strategies against human brucellosis.

  13. Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients.

    Science.gov (United States)

    Grewal, Dilraj S; Merlau, Daniel J; Giri, Pushpanjali; Munk, Marion R; Fawzi, Amani A; Jampol, Lee M; Tanna, Angelo P

    2017-01-01

    To identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucoma. Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL. In this institutional cross-sectional study, 495 patients (990 eyes) who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering) optic nerve head (ONH) imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers. Presence of peripapillary retinal splitting identified on OCT raster scans. Eleven of 990 glaucoma and glaucoma suspect eyes (1.1%) of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years) had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6%) were glaucoma suspects, 3 (42.9%) had primary open-angle glaucoma, 1 (14.3%) had chronic angle-closure glaucoma and 1 (14.3%) had pigmentary glaucoma. 7/11 (63.6%) eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy. We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.

  14. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department.

    Science.gov (United States)

    Ham, H W Wietske; Schoonhoven, L Lisette; Schuurmans, M Marieke J; Leenen, L Luke P H

    2017-01-01

    To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries. Prospective cohort study setting level one trauma center in the Netherlands participants adult trauma patients transported to the Emergency Department on a backboard, with extrication collar and headblocks and admitted to the hospital for treatment or evaluation of their injuries. Between January and December 2013, 254 trauma patients were included. The following dependent variables were collected: Age, Skin color and Body Mass Index, and Time in Emergency Department, Injury Severity Score, Mean Arterial Pressure, hemoglobin level, Glasgow Coma Score, and admission ward after Emergency Department. Pressure ulcer development during admission was associated with a higher age (p 0.00, OR 1.05) and a lower Glasgow Coma Scale score (p 0.00, OR 1.21) and higher Injury Severity Scores (p 0.03, OR 1.05). Extra nutrition decreases the probability of PU development during admission (p 0.04, OR 0.20). Pressure ulcer development within the first 48h of admission was positively associated with a higher age (p 0.01, OR 1.03) and a lower Glasgow Coma Scale score (p 0.01, OR 1.16). The proportion of patients admitted to the Intensive Care Unit and Medium Care Unit was higher in patients with pressure ulcers. The pressure ulcer risk during admission is high in patients with an increased age, lower Glasgow Coma Scale and higher Injury Severity Score in the Emergency Department. Pressure ulcer risk should be assessed in the Emergency Department to apply preventive interventions in time. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Suspected herniated lumbar disc - computed tomography in differential diagnosis of non-disc-related sciatica

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, T.; Koehler, D.; Treisch, J.; Claussen, C.; Felix, R.

    1984-07-01

    The most common reason a patient is referred for spinal CT examination is to exclude a ruptured intervertebral disc. Besides nerve root entrapment due to herniated disc, a number of unusual or unexpected conditions have been encountered in the course of CT lumbar spine studies. These include spondylolisthesis, spinal dysraphism, Paget's disease, and inflammatory, neoplastic, or metastatic lesions. The application of spinal (small-circle) target imaging includes the risk of overlooking soft tissue lesions that extend beyond the reconstruction circle. Therefore, complete (large-circle) circumferential abdominal scanning is recommended in case of a suspected extraspinal cause of sciatica.

  16. ANAMNESIS AND CLINIC FINDINGS OF THE PATIENTS SUSPECTED OF HAVING ECTOPIC PREGNANCY

    Directory of Open Access Journals (Sweden)

    Stanoje Pesic

    2000-09-01

    Full Text Available An analysis has been done of a series of 573 patients suffering from extrauterinepregnancy, namely those found suspect upon entering the hospital. Thediagnosis of extra-uterine pregnancy was confirmed in 322 (56% patients. Theleading symptom of extra-uterine pregnancy is metrorrhagia (63,41%. As for theoperation time, 3 1% of them were immediately operated. The ultrasound techniqueadds to the diagnostic certainty. Our results show that carefully taken anamnesis inaddition to symptom recording and a careful clinic examination can make possiblethe extra-uterine pregnancy diagnosis.

  17. Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Danielle I. Miano

    2015-12-01

    Full Text Available Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US or computed tomography (CT studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods: We conducted a retrospective chart review including emergency department (ED and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4] compared to those without (57%, 95% CI [52.9,61.0]. Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7] and those without (13%, 95% CI [10.3,15.7]. The proportion of

  18. Ultrasound findings of teres minor denervation in suspected quadrilateral space syndrome.

    Science.gov (United States)

    Brestas, Paraskevas S; Tsouroulas, Marinos; Nikolakopoulou, Zoi; Malagari, Katerina; Drossos, Charalampos

    2006-09-01

    Isolated teres minor denervation is an uncommon finding on sonographic examination. We present a case of a 64-year-old man with increased echogenity of the teres minor muscle and a slight reduction in muscle bulk. Investigation of a suspected axillary nerve lesion included a detailed sonographic examination of the posterior shoulder and the axillary space, followed by MR imaging and electrophysiologic testing. This case demonstrates the potential importance of examining rotator cuff muscles when performing sonographic examination of the shoulder in patients with persistent symptoms, no history of trauma, and absence of tendon tears.

  19. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  20. Suspected Pulmonary Infection with Trichoderma longibrachiatum after Allogeneic Stem Cell Transplantation.

    Science.gov (United States)

    Akagi, Tomoaki; Kawamura, Chizuko; Terasawa, Norio; Yamaguchi, Kohei; Kubo, Kohmei

    2017-01-01

    Aspergillus and Candida species are the main causative agents of invasive fungal infections in immunocompromised human hosts. However, saprophytic fungi are now increasingly being recognized as serious pathogens. Trichoderma longibrachiatum has recently been described as an emerging pathogen in immunocompromised patients. We herein report a case of isolated suspected invasive pulmonary infection with T. longibrachiatum in a 29-year-old man with severe aplastic anemia who underwent allogeneic stem cell transplantation. A direct microscopic examination of sputum, bronchoaspiration, and bronchoalveolar lavage fluid samples revealed the presence of fungal septate hyphae. The infection was successfully treated with 1 mg/kg/day liposomal amphotericin B.

  1. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Sejersten, Maria Sejersten; Baber, Usman

    2015-01-01

    Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials.......4%, respectively. Stroke, acute heart failure, and ST-segment elevation myocardial infarction (STEMI) carried a 25- to 50-fold adjusted mortality hazard during the first 4 days. In patients with suspected STEMI, 90.5% had an acute angiography performed. Nontransferred, nonreperfused patients with STEMI (9...

  2. [Suspected tuberculosis at a refugee center: 79 referred cases in 2 years at St. Loup Hospital].

    Science.gov (United States)

    Rieder, Philippe; Zwahlen, André

    2003-02-01

    The recent opening, close to the hospital of Saint-Loup, of an application centre for foreigners who ask for a status of refugee in Switzerland gave us the opportunity, over the last two years, to evaluate 79 patients with suspected tuberculosis. Of them 67% came from sub-Saharan Africa and 25% from Eastern Europe. A bacillary tuberculosis was found in 19 cases (24%), requiring immediate treatment and a respiratory isolation of a mean duration of 18 days. In addition, 11 cases (14%) had non-bacillary tuberculosis with negative sputum smear but positive culture. This new situation led us to implement a specific strategy of hospital hygiene.

  3. [The forensic expertise of cadavers of females suspected to be victims of sexually motivated homicide].

    Science.gov (United States)

    Dmitrieva, O A

    2004-01-01

    According to the author's independent observations, the criminal, as a rule, strangles his victim in sex-related murders. In cases of suspected sex-related murders of women, the female urogenital system needs to be examined as an anatomically whole preparation. It was proven that the spermatozoid structure (in the cadaveric vagina, whose condition was optimal) began to change from week 2 with almost all their heads being destroyed by the end of week 6. When cadavers are found in 1.5-2 months after the event, there is no reason to give up examinations of the sperm from cadaver.

  4. The utility of cardiac CT beyond the assessment of suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kakouros, N. [Johns Hopkins Hospital, Baltimore, MD (United States); Giles, J.; Crundwell, N.B. [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom); McWilliams, E.T.M., E-mail: eric.mcwilliams@esht.nhs.uk [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom)

    2012-07-15

    Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

  5. Induction of labour at or near term for suspected fetal macrosomia.

    Science.gov (United States)

    Boulvain, Michel; Irion, Olivier; Dowswell, Therese; Thornton, Jim G

    2016-05-22

    Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section. To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies. Randomised trials of induction of labour for suspected fetal macrosomia. Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach. We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias.Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences

  6. When the Child is Suspected to Have Autism Spectrum Disorder: Recommendation for Parents

    Directory of Open Access Journals (Sweden)

    Borodina L.G.

    2015-12-01

    Full Text Available Experts in the area of treatment and intervention for autism spectrum disorders provide parents with recommenda¬tions for situations when their children are suspected to have autism or have been diagnosed. These recommenda¬tions are universal and are appropriate for raising a child with any spectrum disorder. Following these recommenda¬tions will allow parents to comprehend the situation with the child’s development, access approaches, that are used by professionals, and will help them to not waste precious time on finding primary information after the diagnosis.

  7. Lyme disease: a selective medium for isolation of the suspected etiological agent, a spirochete.

    Science.gov (United States)

    Johnson, S E; Klein, G C; Schmid, G P; Bowen, G S; Feeley, J C; Schulze, T

    1984-01-01

    A simple procedure with a new selective culture medium for the isolation of the suspected etiological agent of Lyme disease from ticks is described. Live ticks (Ixodes dammini) were ground with a mortar and pestle, and the suspensions were inoculated into a selective and nonselective medium. The selective medium, which contained kanamycin and 5-fluorouracil, yielded positive spirochete cultures from 100% of the pooled ticks and from 79% of the single tick specimens. The isolation rate for the nonselective medium was 0% from the tick pools and 58% from the single tick specimens. PMID:6361065

  8. Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever.

    Science.gov (United States)

    Estofolete, Cássia Fernanda; Mota, Mânlio Tasso Oliveira; Vedovello, Danila; Góngora, Delzi Vinha Nunes de; Maia, Irineu Luiz; Nogueira, Maurício Lacerda

    2016-01-01

    Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.

  9. Nasogastric tube feeding in cats with suspected acute pancreatitis: 55 cases (2001-2006).

    Science.gov (United States)

    Klaus, Jennifer A; Rudloff, Elke; Kirby, Rebecca

    2009-08-01

    To evaluate the complications and outcome associated with different nasogastric tube (NGT) feeding techniques in cats with suspected acute pancreatitis. Descriptive retrospective case series. Small animal emergency and referral hospital. The patient database (2001-2006) was searched for cats with suspected acute pancreatitis that received NGT liquid enteral feeding within 72 hours of admission and ≥12 hours during hospitalization. Signalment, history, clinical signs, laboratory data and abdominal ultrasonographic examinations were used for suspected diagnosis. Cats were grouped based upon whether they received bolus feeding or continuous rate infusion (CRI) of a liquid diet via the NGT, and whether or not administration of an intravenous amino acid and carbohydrate solution occurred prior to NGT feeding (AAS and non-AAS group, respectively). Fifty-five cats were included. For all cats, NGT feeding was initiated at a mean of 33.5 ± 15.0 hours and the target caloric intake (1.2 X {(30 X BW [kg]) +70}) was reached at 58.0 ± 28.4 hours from presentation. There was a significantly longer time from admission to the initiation of NGT feeding in the 34/55 cats in the AAS group vs. the 21/55 cats in the non-AAS group (P = 0.009). The 8 bolus-fed cats took longer to reach target caloric intake vs. the 47 CRI-fed cats (P = 0.002). Complications associated with NGT feeding for all cats included: mechanical problems (13%), diarrhea (25%), vomiting following NGT placement (20%) and vomiting following NGT feeding (13%). Mean time to discharge for all cats occurred after 78.6 ± 29.5 hours with an overall weight gain of 0.08 ± 0.52 kg. Fifty cats survived 28 days post-discharge. NGT feeding in this group of cats with suspected acute pancreatitis was well tolerated, and associated with a low incidence of diarrhea, vomiting, and mechanical complications. © Veterinary Emergency and Critical Care Society 2009.

  10. A Non-Invasive Method to Assess Cerebral Perfusion Pressure in Geriatric Patients with Suspected Cerebrovascular Disease

    OpenAIRE

    Bo Liu; Qi Li; Kewei Li; Nan Deng; Peng He; Chunchang Qin; Deyu Yang; Zhiwei Li; Peng Xie

    2015-01-01

    Background Cerebral perfusion pressure (CPP) can adversely impact cerebrovascular hemodynamics but cannot be practically measured in most clinical settings. Here, we aimed to establish a representative mathematical model for CPP in geriatric patients with suspected cerebrovascular disease. Methods A total of 100 patients (54 males and 46 females between 60?80 years of age) with suspected cerebrovascular disease and no obvious cerebrovascular stenosis were selected for invasive CPP monitoring ...

  11. Characterisation of leather candidate certified reference materials for their mass fractions of aromatic amines

    NARCIS (Netherlands)

    Wegener, J.W.M.; Schulz, H.

    2007-01-01

    Three batches of leather samples were coloured with nine azo dyes that can yield eight proven or suspected carcinogenic aromatic amines under reduction conditions. The samples were milled to grains and bottled in jars. A group of five laboratories has established the mass fraction of the amines in a

  12. Contribution of creatine kinase MB mass concentration at admission to early diagnosis of acute myocardial infarction

    NARCIS (Netherlands)

    Bakker, A. J.; Gorgels, J. P.; van Vlies, B.; Koelemay, M. J.; Smits, R.; Tijssen, J. G.; Haagen, F. D.

    1994-01-01

    OBJECTIVE: To assess the diagnostic value at admission of creatine kinase MB mass concentration, alone or in combination with electrocardiographic changes, in suspected myocardial infarction. DESIGN: Prospective study of all consecutive patients admitted within 12 hours after onset of chest pain to

  13. Added value of interpreter experience in occult and suspect hip fractures: a retrospective analysis of 254 patients.

    Science.gov (United States)

    Collin, David; Göthlin, Jan H; Nilsson, Martin; Hellström, Mikael; Geijer, Mats

    2016-06-01

    The influence of experience in categorizing suspect and occult fractures on radiography compared to MRI and clinical outcome has not been studied. The aim of this study is to evaluate the importance of experience in diagnosing normal or suspect hip radiographs compared to MRI. Primarily reported normal or suspect radiography in 254 patients with low-energy hip trauma and subsequent MRI was re-evaluated by two experienced reviewers. Primary readings and review were compared. The prevalence of fractures among normal and suspect radiographic studies was assessed. Clinical outcome was used as reference. At review of radiography, 44 fractures (17 %) were found. Significantly more fractures were found among suspect cases than among normal cases. At MRI, all 44 fractures were confirmed, and further 64 fractures were detected (25 %). MRI detected all fractures with no missed fractures revealed at follow-up. There were a significantly higher proportion of fractures at MRI among the suspect radiographic diagnoses for both the primary report and at review than among occult cases. The more experienced reviewers classified radiography examinations with higher accuracy than primary reporting general radiologists. There was almost complete agreement on MRI diagnoses.

  14. Independent oversight review of the Department of Energy Quality Assurance Program for suspect/counterfeit parts. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    To address the potential threat that suspect/counterfeit parts could pose to DOE workers and the public, the Office of the Deputy Assistant Secretary for Oversight initiated a number of activities beginning in mid-1995. Oversight placed increased emphasis on the field`s quality assurance-suspect/counterfeit parts programs during safety management evaluations, in keeping with the Office of Environment, Safety and Health (EH) oversight responsibilities, which include oversight of the Department`s quality assurance (QA) programs. In addition, Oversight reviewed relevant policy documents and occurrence reports to determine the nature and magnitude of the problem within the Department. The results of that review, contained in an Office of Oversight report, Independent Oversight Analysis of Suspect/Counterfeit Parts Within the Department of Energy (November 1995), indicate a lack of consistency and comprehensiveness in the Department`s QA-suspect/counterfeit parts program. A detailed analysis of the causes and impacts of the problem was recommended. In response, this review was initiated to determine the effectiveness of the Department`s QA program for suspect/counterfeit parts. This study goes beyond merely assessing and reporting the status of the program, however. It is the authors intention to highlight the complex issues associated with suspect/counterfeit parts in the Department today and to present approaches that DOE managers might consider to address these issues.

  15. Awareness of Memory Abilities in Community-Dwelling Older Adults with Suspected Dementia and Mild Cognitive Impairment

    Science.gov (United States)

    Lin, Feng; Wharton, Whitney; Dowling, N. Maritza; Ries, Michele L.; Johnson, Sterling C.; Carlsson, Cynthia M.; Asthana, Sanjay; Gleason, Carey E.

    2010-01-01

    Aims To examine awareness of memory abilities by groups (healthy control, suspected dementia/mild cognitive impairment, MCI, and diagnosed dementia/MCI), and to describe group differences in the relationship between awareness and cognitive performance in a community sample. Methods In a cross-sectional design, 183 subjects were evaluated in a community setting and categorized into 3 groups based on their cognitive performance and reported medical history. Awareness of memory abilities was quantified using a published anosognosia ratio (AR) comparing the estimated to the objective memory performance by subjects. Each group was further categorized into ‘overestimators’, ‘accurate estimators’, and ‘underestimators’ based on their AR scores. Results The suspected and diagnosed dementia/MCI groups had significantly higher AR scores than the controls. The suspected group also had a significantly larger proportion (96.2%) of overestimators than the diagnosed (73.3%) and control groups (26.1%). Impaired awareness in overestimators of the suspected and diagnosed groups was correlated with deficits in executive function, language or global cognition. Conclusion Impaired awareness of memory abilities was prevalent in community-dwelling older adults with suspected and diagnosed dementia or MCI. Those with suspected dementia or MCI were more likely to overestimate their memory abilities than their diagnosed counterparts, suggesting that limited awareness of deficits may hinder utilization of dementia diagnostic services. PMID:20714155

  16. Ticking Stellar Time Bomb Identified - Astronomers find prime suspect for a Type Ia supernova

    Science.gov (United States)

    2009-11-01

    it will eventually become heavy enough to explode as a supernova. Combining the NACO images with data obtained with several other telescopes [5] the astronomers could determine the distance of the system - about 25 000 light-years from the Sun - and its intrinsic brightness - over 10 000 times brighter than the Sun. This implies that the vampire white dwarf in this system has a high mass that is near its fatal limit and is still simultaneously being fed by its companion at a high rate. "Whether V445 Puppis will eventually explode as a supernova, or if the current nova outburst has pre-empted that pathway by ejecting too much matter back into space is still unclear," says Woudt. "But we have here a pretty good suspect for a future Type Ia supernova!" Notes [1] White dwarfs represent the evolutionary end product of stars with initial masses up to a few solar masses. A white dwarf is the burnt-out stellar core that is left behind when a star like the Sun sheds its outer layers towards the end of its active life. It is composed essentially of carbon and oxygen. This process normally also leads to the formation of a surrounding planetary nebula. [2] Adaptive optics is a technique that allows astronomers to obtain an image of an object free from the blurring effect of the atmosphere. See the adaptive optics page at ESO: http://www.eso.org/public/astronomy/technology/adaptive_optics.html [3] See for example http://www.eso.org/~bleibund/papers/EPN/epn.html [4] This Chandrasekhar limit, named after the Indian physicist Subrahmanyan Chandrasekhar, is nearly 1.4 times the mass of the Sun. When a white dwarf reaches a mass above this limit, either by sucking matter from a companion or merging with another white dwarf, it will turn itself into a thermonuclear bomb that will burn carbon and oxygen explosively. [5] The team also used the SOFI instrument on ESO's New Technology Telescope, the IMACS spectrograph on the 6.5-metre Magellan Baade telescope, and the Infrared Survey

  17. Evaluation of a simulation procedure designed to recognize shape and contour of suspicious masses in mammography

    Science.gov (United States)

    Sousa, Maria A. Z.; Siqueira, Paula N.; Schiabel, Homero

    2015-03-01

    A large number of breast phantoms have been developed for conducting quality tests, characterization of imaging systems and computer aided diagnosis schemes, dosimetry and image perception. The realism of these phantoms is important for ensuring the accuracy of results and a greater range of applications. In this work, a developed phantom is considered proposing the use of PVC films for simulation of nodules inserted in the breast parenchyma designed for classification between malignant and benign signals according to the BI-RADS® standard. The investigation includes analysis of radiographic density, mass shape and its corresponding contour outlined by experienced radiologists. The material was cut based on lesions margins found in 44 clinical cases, which were divided between circumscribed and spiculated structures. Tests were performed to check the ability of the specialists in distinguishing the contour compared to actual cases while the shapes accuracy was determined quantitatively by evaluation metrics. Results showed the applicability of the chosen material creating image radiological patterns very similar to the actual ones.

  18. Power Doppler Ultrasonography and Shear Wave Elastography as Complementary Imaging Methods for Suspected Local Breast Cancer Recurrence.

    Science.gov (United States)

    Jales, Rodrigo Menezes; Dória, Maira Teixeira; Serra, Kátia Piton; Miranda, Mila Meneguelli; Menossi, Carlos Alberto; Schumacher, Klaus; Sarian, Luis Otávio

    2017-12-04

    To prospectively investigate the diagnostic accuracy and clinical consequences of power Doppler morphologic criteria and shear wave elastography (SWE) as complementary imaging methods for evaluation of suspected local breast cancer recurrence in the ipsilateral breast or chest wall. Thirty-two breast masses with a suspicion of local breast cancer recurrence on B-mode ultrasonography underwent complementary power Doppler and SWE evaluations. Power Doppler morphologic criteria were classified as avascular, hypovascular, or hypervascular. Shear wave elastography was classified according to a 5-point scale (SWE score) and SWE maximum elasticity. Diagnostic accuracy was assessed by the sensitivity, specificity, and area under the curve. A decision curve analysis assessed clinical consequences of each method. The reference standard for diagnosis was defined as core needle or excisional biopsy. Histopathologic examinations revealed 9 (28.2%) benign and 23 (71.8%) malignant cases. Power Doppler ultrasonography (US) had sensitivity of 34.8% (95% confidence interval [CI], 6.6%-62.9%) and specificity of 45.4% (95% CI, 19.3%-71.5%). The SWE score (≥3) had sensitivity of 87.0% (95% CI, 66.4%-97.2%) and specificity of 44.4% (95% CI, 13.7%-78.8%). The SWE maximum elasticity (velocity > 6.5cm/s) had sensitivity of 87% (95% CI, 66.4%-97.2%) and specificity of 77.8% (95% CI, 40.0% to 97.2%). The areas under the curves for the SWE score and SWE maximum elasticity were 0.71 (95% CI, 0.53-0.87) and 0.82 (95% CI, 0.64-0.93), respectively (P = .32). Power Doppler US is unsuitable for discrimination between local breast cancer recurrence and fibrosis. Although the SWE score and SWE maximum elasticity can make this discrimination, the use of these methods to determine biopsy may lead to poorer clinical outcomes than the current practice of performing biopsies of all suspicious masses. © 2017 by the American Institute of Ultrasound in Medicine.

  19. Herbs and herbal combinations used to treat suspected malaria in Bo, Sierra Leone.

    Science.gov (United States)

    Ranasinghe, Shamika; Ansumana, Rashid; Lamin, Joseph M; Bockarie, Alfred S; Bangura, Umaru; Buanie, Jacob A G; Stenger, David A; Jacobsen, Kathryn H

    2015-05-26

    Most adults in West Africa treat acute febrile illnesses with local herbs, but the patterns of herbs used for malaria have not been recently described in Sierra Leone. We used a population-based cross-sectional approach to interview 810 randomly-sampled rural and urban adult residents of Bo, Sierra Leone, in December 2013 and January 2014 about their use of herbal remedies when they suspect they have malaria. In total, 55% of the participants reported taking one or more of seven herbs to treat symptoms of malaria. Among herb users, the most commonly used anti-malarial herbs were Moringa oleifera (moringa, 52%) and Sarcocephalus latifolius (yumbuyambay, 50%). The other herbs used included Senna siamea (shekutoure, 18%), Cassia sieberiana (gbangba, 18%), Uvaria afzelii (gone-botai, 14%), Morinda chrysorhiza (njasui, 14%), and Craterispermum laurinum (nyelleh, 7%). Combination herbal therapy was common, with 37% of herb users taking two or more herbs together when ill with suspected malaria. Indigenous medical knowledge about herbal remedies and combinations of local herbs remains an integral part of malaria case management in Sierra Leone. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics

    Directory of Open Access Journals (Sweden)

    Nerissa S. Bauer

    2017-10-01

    Full Text Available PurposePediatric providers are increasingly screening for postpartum depression (PD, yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior.Design and methodsMothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource.Results73 of 133 eligible mothers participated (55% response rate. Fifty women recalled a recommendation to seek help. Only 43.8% (32/73 made a follow-up appointment with an adult provider and even fewer kept the appointment.ConclusionA majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.

  1. Prevalence of Clostridium perfringens toxin in patients suspected of having antibiotic-associated diarrhea.

    Science.gov (United States)

    Kim, Young Jin; Kim, Si Hyun; Ahn, Junggu; Cho, Soongmoon; Kim, Dongchun; Kim, Kwanghyun; Lee, Heegun; Son, Hyunwoo; Lee, Hee Joo; Yong, Dongeun; Choi, Jun Yong; Kim, Hye Ran; Shin, Jeong Hwan

    2017-12-01

    Although Clostridium perfringens has been reported as a cause of antibiotic-associated diarrhea (AAD), it is uncommon to detect this pathogen in clinical microbiology laboratories in Korea. The aim of this study was to investigate the prevalence of C. perfringens toxin in patients suspected of having AAD. A total of 135 stool specimens submitted to a clinical microbiology laboratory for C. difficile toxin assay were tested. We tried to detect both C. difficile and C. perfringens toxins using the Seeplex Diarrhea ACE Detection kit (Seegene, Seoul, Korea). We evaluated the prevalence of 10 bacteria and 5 viruses. A total of 40 Clostridium spp. were detected in 34 specimens (29.6%). The C. perfringens toxin was detected in 14 of 135 specimens (10.4%), while C. difficile toxin was detected in 26 specimens (19.3%). Other bacteria and viruses, including 8 Aeromonas spp., were detected in 15 specimens. All tests were negative in 92 of the 135 specimens (68.1%). Clostridium perfringens toxin is relatively common, and we should consider the possibility of its presence in patients suspected of having AAD, especially if C. difficile tests are negative. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. ABO genotyping of suspects from sperm DNA isolated from postcoital samples in sex crimes.

    Science.gov (United States)

    Sasaki, M; Shiono, H

    1996-03-01

    In sexual assaults against women, one key to identifying the suspect is ABO phenotyping or the typing of other polymorphic markers of the seminal fluid in the victim's vagina. However, ABO phenotyping is frequently unsuccessful, since mixtures of fluids cannot be separated to be subjected to conventional methods for the detection of antibody or antigen material. We therefore studied ABO blood group genotyping of sperm DNA isolated from contaminating vaginal fluid by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Seminal samples of genotypes OO, AO, BO and AB were experimentally mixed with vaginal fluid (OO, AO, BO and AB), and were successfully separated and genotyped by this method. In practice, we also separated and genotyped the seminal DNA of suspects from contaminated postcoital vaginal fluid obtained in 4 sexual assaults. These forensic samples were easily separated and completely genotyped. This reliable ABO genotyping method by PCR-RFLP, using separated sperm DNA, should be of value in forensic identification in sexual assaults.

  3. Is extended biopsy protocol justified in all patients with suspected prostate cancer?

    Science.gov (United States)

    Ojewola, R W; Tijani, K H; Jeje, E A; Anunobi, C C; Ogunjimi, M A; Ezenwa, E V; Ogundiniyi, O S

    2012-01-01

    To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.

  4. Suspected cold agglutination during mild hypothermic pediatric open heart surgery: a report of two cases.

    Science.gov (United States)

    Hoashi, Takaya; Kagisaki, Koji; Moon, Jiyong; Takahashi, Yuzo; Hayashi, Teruyuki; Ichikawa, Hajime

    2015-12-01

    Cold agglutination was suspected in 2 pediatric open heart surgery cases during mild hypothermic cardiopulmonary bypass. The first patient was a 2-year-old boy with secundum atrial septal defect. Fifteen minutes after the initiation of mild hypothermic cardiopulmonary bypass, the inlet pressure of oxygenator suddenly elevated from 250 to over 500 mmHg, whereas outlet pressure was maintained. The blood flow rate decreased from 140 to 85 ml/kg/min. At that time, the arterial blood temperature was less than 32°C. Cold agglutinin was highly suspected, so patient was immediately warmed, and the inlet pressure of oxygenator decreased to 250 mmHg when the arterial blood temperature reached to 36°C. Second patient was a 3-year-old boy with secondary developed subvalvular pulmonary stenosis after the repair of double chambered right ventricle at 10 months of his age. Eighteen minutes after the initiation of mild hypothermic cardiopulmonary bypass, the inflow pressure suddenly elevated to 500 mmHg and transmission flow decreased to 55 ml/kg/min. Twenty-three minutes after warming, the pressure fell to a normal level and transmission flow was recovered. The operation continued with normo-thermic cardiopulmonary bypass and crystalloid cardioplegia. Both cases had no postoperative complications related to cold agglutinin such as myocardial infarction, cerebral infarction, or renal insufficiency.

  5. Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Dudau, Cristina [King' s College Hospital NHS Foundation Trust, Department of Neuroradiology, London (United Kingdom); Salim, Fakhruddin; Jiang, Dan [Department of Otolaryngology, Head and Neck Surgery, Auditory Implantation Centre, London (United Kingdom); Connor, Steve E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom)

    2017-03-15

    To assess the diagnostic efficacy and therapeutic impact of CT in evaluating patients with clinically suspected otosclerosis. CT scans performed over a 5-year period for clinically suspected otosclerosis were retrospectively reviewed. CT diagnoses were correlated with subsequent surgical management. For otosclerosis positive cases, clinically significant extensions of otosclerosis were correlated with audiometry and the diagnosis was correlated with surgical findings. Of 259 CT studies, 46 % of patients were positive, 49 % negative and 5 % equivocal for otosclerosis. A relevant alternative CT diagnosis was evident in 33 % of the negative studies. One targeted surgery was performed for every four CT studies. CT outcome influenced the decision to perform stapedectomy in 41 % CT-positive versus 4 % CT-negative patients. CT-positive ears for otosclerosis could not be predicted from baseline clinical or audiometric criteria. Those with endosteal extension demonstrated lower bone conduction thresholds presurgically. The positive predictive value of CT diagnosis of otosclerosis was 100 %. CT demonstrated a high rate of clinically relevant diagnoses in both CT-positive and -negative for otosclerosis patients, and this frequently influenced surgical management. CT also added value by demonstrating relevant extensions of the otosclerotic foci, some of which were predictive of audiometric parameters. (orig.)

  6. Spatial distance regulates sex-specific feelings to suspected sexual and emotional infidelity.

    Science.gov (United States)

    Schützwohl, Achim; Morjaria, Sheena; Alvis, Shahin

    2011-09-15

    The present study investigates the hitherto neglected influence of the spatial distance between the jealous person, the partner, and a potential rival as a proximate contextual factor regulating emotion intensity. The study tested four predictions. (1) The jealousy mechanism responds with mild negative feelings at most as long as the partner is close to the jealous person. (2) The negative feelings increase when the partner is far from the jealous person but the rival is close. (3) The most uncomfortable feelings result when the partner and the rival are close together and both far from the jealous person. (4) Based on the evolutionary psychological considerations, men report stronger negative feelings than women when suspecting sexual infidelity. Conversely, women report stronger negative feelings than men when suspecting emotional infidelity. The results confirmed predictions 1 and 4. Reversing predictions 2 and 3, the close rival consistently elicited the most uncomfortable feelings. Implications and limitations of the present study are discussed and suggestions for future research are provided.

  7. Magnetic resonance urography in children: evaluation of suspected ureteral ectopia in duplex systems.

    Science.gov (United States)

    Staatz, G; Rohrmann, D; Nolte-Ernsting, C C; Stollbrink, C; Haage, P; Schmidt, T; Günther, R W

    2001-12-01

    We evaluate the diagnostic accuracy of magnetic resonance urography in children with suspected ectopic ureters and ureteroceles in duplex systems. A total of 14 children 4 weeks to 8 years old with a total of 18 duplex systems underwent magnetic resonance urography using a 1.5 tesla scanner. After injection of low dose furosemide, half-Fourier rapid acquisition with relaxation enhancement images were obtained for T2-weighted static fluid magnetic resonance urography. Respiratory gated 3-dimensional gradient echo images were acquired for T1-weighted excretory magnetic resonance urography 5 to 30 minutes after intravenously administered gadolinium. All magnetic resonance examinations were successfully performed without sedation. The diagnostic accuracy of T1-weighted excretory magnetic resonance urography depended on the renal function. Twelve duplex systems with a normal excretory function, including 6 bifid ureters and 6 upper moieties with inferomedial ectopic ureters, were analyzed correctly with the exception of a 6 mm. ureterocele in 1 case. In 6 duplex systems with poor or nonfunctioning upper moieties ectopic ureters were only demonstrated on T2-weighted magnetic resonance urograms. Respiratory gated excretory and static fluid magnetic resonance urography complement each other in the evaluation of duplex systems in children and provide high accuracy in the evaluation of suspected ectopic ureters and ureteroceles.

  8. Longitudinal growth assessment for the prediction of adverse perinatal outcome in SGA-suspected fetuses.

    Science.gov (United States)

    Caradeux, Javier; Eixarch, Elisenda; Mazarico, Edurne; Basuki, Tri Rahmat; Gratacos, Eduard; Figueras, Francesc

    2017-08-07

    Fetal growth restriction (FGR) is associated with an increased risk of adverse perinatal outcome (APO). However, distinguishing this condition from smallness-for-gestational age remains elusive. A set of criteria has recently been proposed for such purpose, including the severity of smallness, Doppler parameters and growth velocity. To establish whether the use of growth velocity adds to Doppler evaluation in predicting APO among SGA-suspected fetuses. A prospective cohort of consecutive singleton pregnancies with late (diagnosis > 32.0 weeks) SGA (estimated fetal weight [EFW] SGA. Of them, 231 (48.9%) qualified as late FGR. Univariate analysis showed a significant trend towards higher frequency of EFW z-velocity in the lowest decile in pregnancies with APO (14.5% vs. 8.2%; p = 0.041). Nonetheless, the addition of z-velocity neither improved the association nor the prediction performance of standard criteria of FGR for the occurrence of APO. Longitudinal assessment of fetal growth by means of z-velocity did not have any independent predictive value for adverse perinatal outcome when used in combination with Doppler in SGA-suspected fetuses. This article is protected by copyright. All rights reserved.

  9. Neonatal BCG has no effect on allergic sensitization and suspected food allergy until 13 months

    DEFF Research Database (Denmark)

    Thøstesen, Lisbeth Marianne; Kjaer, Henrik Fomsgaard; Pihl, Gitte Thybo

    2017-01-01

    BACKGROUND: Vaccination with Bacillus Calmette-Guérin (BCG) is used in many countries as protection against tuberculosis. Studies have suggested that BCG may also have non-specific effects, reducing non-tuberculosis mortality, morbidity, and atopic manifestations. In this study we evaluated...... the effect of neonatal BCG vaccination on allergic sensitization and suspected food allergy at 13 months of age. METHODS: The Danish Calmette Study was conducted from 2012-2015 at three Danish hospitals. Within 7 days of birth, the 4262 newborns of 4184 included mothers were randomized 1:1 to BCG or to a no...... of age. RESULTS: By 13 months of age the parents and/or general practitioners of 5.6% (117/2089) of the children in the BCG group and 6.1% (126/2061) of the control group suspected food allergy, resulting in a risk ratio comparing BCG-vaccinated children with control children of 0.91 (95% CI 0.71 to 1...

  10. Bacterial colonization of the ovarian bursa in dogs with clinically suspected pyometra and in controls.

    Science.gov (United States)

    Rubio, Alejandro; Boyen, Filip; Tas, Olaf; Kitshoff, Adriaan; Polis, Ingeborgh; Van Goethem, Bart; de Rooster, Hilde

    2014-10-15

    Septic peritonitis occurs relatively commonly in dogs. Secondary septic peritonitis is usually associated with perforation of intestines or infected viscera, such as the uterus in pyometra cases. The aim of this study was to evaluate the bacterial flora in the ovarian bursae of intact bitches as a potential source of contamination. One hundred forty dogs, clinically suspected of pyometra, were prospectively enrolled. The control group consisted of 26 dogs that underwent elective ovariohysterectomies and 18 dogs with mammary gland tumors that were neutered at the time of mastectomy. Bacteriology samples were taken aseptically at the time of surgery from the bursae and the uterus in all dogs. Twenty-two dogs that were clinically suspected of pyometra had sterile uterine content ("mucometra" cases); the remaining 118 had positive uterine cultures ("pyometra" cases) and septic peritoneal fluid was present in 10% of these cases. Of the 118 pyometra cases, 9 had unilateral and 15 had bilateral bacterial colonization of their ovarian bursae. However, the bacteria from the ovarian bursa were similar to those recovered from the uterine pus in only half of the cases. Furthermore, positive bursae were also seen in one mucometra dog (unilateral) and in four control dogs (two unilateral and two bilateral). The data illustrate that the canine ovarian bursa can harbor bacteria. The biological importance of these isolations remains unclear. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. INVESTIGATION OF SUSPECTED PERIPHERAL NEUROPATHY OUTBREAK IN DECHENTSEMO CENTRAL SCHOOL, THINLEYGANG, PUNAKHA

    Directory of Open Access Journals (Sweden)

    Tsheten

    2016-09-01

    Full Text Available Background: A suspected peripheral neuropathy outbreak was reported from Dechentsemo Central School, Thinleygang, Punakha, following which the investigation team was immediately dispatched in the field. Objective: The aim of investigation was to ascertain the cause and risk factor for the outbreak in order to implement control measures. Methods: A case control study was devised for the investigation to study about the past exposure or deficiencies in order to find out the suspected cause and risk factors. A semi-quantitative food frequency questionnaire was administered to both cases and controls to collect information on the type of food they have consumed. The information garnered was analyzed using Chi-Square or Fischer Exact test for categorical variables and Man-Whitney U-test for quantitative variables. Results: All 17 cases were females with mean age of 13 years (SD 2.7 years. The average daily amount of thiamine intake was 0.6 mg/day for case and 0.8 mg/day for controls against the recommended daily allowance (RDA of 1.2 mg/day. Case and control patients differed significantly with respect to fat intake (p-value = 0.02, more strongly with folate and iron intake (p-value < 0.01. Conclusion: The outbreak of peripheral neuropathy in Dechentsemo Central School appears to be linked to reduced dietary intake rich in vitamin B1 coupled with low intake of folate and iron in their diet.

  12. Dark-lumen magnetic resonance colonography in patients with suspected sigmoid diverticulitis: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Ajaj, Waleed; Lauenstein, Thomas; Goehde, Susanne; Kuehle, Christiane; Herborn, Christoph U. [University Hospital, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Ruehm, Stefan G. [University of California, Department of Radiology, David Geffen School of Medicine, Los Angeles, CA (United States); Langhorst, Jost; Zoepf, Thomas; Gerken, Guido [University Hospital, Department of Gastroenterology and Hepatology, Essen (Germany); Goyen, Mathias [Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2005-11-01

    To assess dark-lumen magnetic resonance colonography (MRC) for the evaluation of patients with suspected sigmoid diverticulitis. Forty patients with suspected sigmoid diverticulitis underwent MRC within 72 h prior to conventional colonoscopy (CC). A three-dimensional T1-weighted volumetric interpolated breath-hold examination sequence was acquired after an aqueous enema and intravenous administration of gadolinium-based contrast agents. All MRC data were evaluated by two radiologists. Based on wall thickness and focal uptake of contrast material and pericolic reaction including mesenteric infiltration on T1-weighted sequence the sigmoid colon was assessed for the presence of diverticulitis. MRC classified 17 of the 40 patients as normal with regard to sigmoid diverticulitis. However, CC confirmed the presence of light inflammatory signs in four patients which were missed in MRC. MRC correctly identified wall thickness and contrast uptake of the sigmoid colon in the other 23 patients. In three of these patients false-positive findings were observed, and MRC classified the inflammation of the sigmoid colon as diverticulitis whereas CC and histopathology confirmed invasive carcinoma. MRC detected additionally relevant pathologies of the entire colon and could be performed in cases where CC was incomplete. MRC may be considered a promising alternative to CC for the detection of sigmoid diverticulitis. (orig.)

  13. Fetal MRI improves diagnostic accuracy in patients referred to a fetal center for suspected esophageal atresia.

    Science.gov (United States)

    Ethun, Cecilia G; Fallon, Sara C; Cassady, Christopher I; Mehollin-Ray, Amy R; Olutoye, Oluyinka O; Zamora, Irving J; Lee, Timothy C; Welty, Stephen E; Cass, Darrell L

    2014-05-01

    The purpose of this study was to describe prenatal imaging characteristics and outcomes of fetuses with suspected esophageal atresia (EA) in order to improve prenatal diagnosis, counseling, and management. The medical records of all patients referred to our multidisciplinary fetal center for suspected EA from January 2003 to April 2013 were reviewed retrospectively. Thirty-three patients were referred with a prenatal diagnosis of possible EA. Following fetal center evaluation with MRI, EA was deemed unlikely in 6 (18%) fetuses. Of 27 fetuses in whom EA could not be excluded, EA was confirmed postnatally in 15 (56%), excluded in 7 (26%), and unconfirmed in 5 (3 fetal losses; 2 lost to follow-up). Imaging characteristics on fetal MRI associated with the highest positive predictive values (PPV) were an esophageal pouch (100%) and a small stomach (75%). The finding of polyhydramnios had high sensitivity (93%) but low specificity (31%) and PPV (61%) for a diagnosis of EA. Prenatal imaging and fetal center evaluation correctly identify the presence or absence of esophageal atresia in 78% of patients referred on suspicion of this condition. The presence of an esophageal pouch on fetal MRI has significant predictive value for EA. These data may assist with evidence-based prenatal family counseling. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. A management programme for suspected heart failure in primary care in cooperation with specialists in cardiology.

    Science.gov (United States)

    Mejhert, Märit; Kahan, Thomas

    2015-03-01

    The diagnosis of new onset congestive heart failure (CHF) is often difficult as symptoms and signs are non-specific. Proper diagnostic investigations and treatments are underused in primary care. To describe a management programme for patients with suspected CHF in primary care in cooperation with specialists in cardiology. Prospective study of 102 consecutive primary care patients with suspected new onset CHF referred to an easily accessible hospital-based cardiology outpatient clinic management programme. Following clinical examination, ECG, echocardiography, blood chemistry including NT-proBNP, and assessment of NYHA class and quality of life (EQ5D), patients with a confirmed diagnosis of CHF were prescribed medication with advice on titration and target doses. Trained CHF nurses gave Information on CHF and provided follow up. Half (47%) of the referred patients had the diagnosis of CHF confirmed. Low NT-proBNP values (CHF group was 86% ACE-inhibitors/angiotensin receptor blockers, 61% ß-blocking agents, and 81% diuretics (P CHF in primary care, with referral to a hospital-based specialist team, can be applied successfully.

  15. Evolving considerations in the management of patients with left bundle branch block and suspected myocardial infarction

    Science.gov (United States)

    Neeland, Ian J.; Kontos, Michael C.; de Lemos, James A.

    2012-01-01

    Patients with a suspected acute coronary syndrome (ACS) and left bundle branch block (LBBB) present a unique diagnostic and therapeutic challenge to the clinician. Although current guidelines recommend that patients with new or presumed new LBBB undergo early reperfusion therapy, data suggest that only a minority of patients with LBBB are ultimately diagnosed with acute myocardial infarction regardless of LBBB chronicity and that a significant proportion of patients will not have an occluded culprit artery at cardiac catheterization. The current treatment approach exposes a significant proportion of patients to the risks of fibrinolytic therapy without the likelihood of significant benefit, and leads to increased rates of false-positive cardiac catheterization laboratory activation, unnecessary risks, and costs. Therefore, alternative strategies to those for patients with ST-elevation myocardial infarction (STEMI) are needed to guide selection of appropriate patients with suspected ACS and LBBB for urgent reperfusion therapy. In this article, we describe the evolving epidemiology of LBBB in ACS and discuss controversies related to current clinical practice. We propose a more judicious diagnostic approach among clinically stable patients with LBBB who do not have electrocardiographic findings highly specific for STEMI. PMID:22766335

  16. Adherence to standard of care in the diagnosis and treatment of suspected bacterial meningitis.

    Science.gov (United States)

    Chia, David; Yavari, Youness; Kirsanov, Eugeny; Aronin, Steven I; Sadigh, Majid

    2015-01-01

    Acute bacterial meningitis (ABM) is a rare but deadly neurological emergency. Accordingly, Infectious Diseases Society of America (IDSA) guidelines summarize current evidence into a straightforward algorithm for its management. The goal of this study is to evaluate the overall compliance with these guidelines in patients with suspected ABM. A retrospective cross-sectional study was conducted of adult patients who underwent lumbar puncture for suspected ABM to ascertain local adherence patterns to IDSA guidelines for bacterial meningitis. Primary outcomes included appropriate utilization of neuroimaging, blood cultures, antibiotics, corticosteroids, and lumbar puncture. In all, 160 patients were included in the study. Overall IDSA compliance was only 0.6%. Neuroimaging and blood cultures were appropriately utilized in 54.3% and 47.5% of patients, respectively. Steroids and antibiotics were appropriately administered in only 7.5% and 5.6% of patients, respectively. Adherence to IDSA guidelines is poor. Antibiotic choice is often incorrect, corticosteroids are rarely administered, and there is an overutilization of neuroimaging. © The Author(s) 2014.

  17. The Role of 16S rRNA Gene Sequencing in Confirmation of Suspected Neonatal Sepsis.

    Science.gov (United States)

    El Gawhary, Somaia; El-Anany, Mervat; Hassan, Reem; Ali, Doaa; El Gameel, El Qassem

    2016-02-01

    Different molecular assays for the detection of bacterial DNA in the peripheral blood represented a diagnostic tool for neonatal sepsis. We targeted to evaluate the role of 16S rRNA gene sequencing to screen for bacteremia to confirm suspected neonatal sepsis (NS) and compare with risk factors and septic screen testing. Sixty-two neonates with suspected NS were enrolled. White blood cells count, I/T ratio, C-reactive protein, blood culture and 16S rRNA sequencing were performed. Blood culture was positive in 26% of cases, and PCR was positive in 26% of cases. Evaluation of PCR for the diagnosis of NS showed sensitivity 62.5%, specificity 86.9%, PPV 62.5%, NPV 86.9% and accuracy of 79.7%. 16S rRNA PCR increased the sensitivity of detecting bacterial DNA in newborns with signs of sepsis from 26 to 35.4%, and its use can be limited to cases with the most significant risk factors and positive septic screen. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A. [Heidelberg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Akbar, M. [Heidelberg Univ. (Germany). Dept. of Orthopaedic Surgery and Rehabilitation Medicine

    2016-12-15

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  19. Importance of Wells score and Geneva score for the evaluation of patients suspected of pulmonary embolism.

    Science.gov (United States)

    Gruettner, Joachim; Walter, Thomas; Lang, Siegfried; Meyer, Michael; Apfaltrer, Paul; Henzler, Thomas; Viergutz, Tim

    2015-01-01

    The European Society of Cardiology guidelines for pulmonary embolism (PE) published in 2008 and updated in 2014 recommend a risk stratification including risk scores like Wells and the Geneva score. The utility and practicability of these scores are controversially discussed. Recently, in a trauma cohort and in spinal surgery patients, no correlation between Wells Score and PE diagnosis was found. The aim of the study was the evaluation of Wells and Geneva scores in patients presenting with chest pain, dyspnoea or syncope in an emergency department. We retrospectively examined 326 patients suspected of PE, including assessment, according to Wells and Geneva scores. PE was detected in 13.5 %. The average Wells score was 1.0, the average Geneva score 3.9. The receiver operating characteristic (ROC) curve analyses showed for both scores a high significant area under the curve (Wells score 0.68; Geneva score 0.64). The association between the scores and the diagnosis of PE was calculated with logistic regression analysis and showed high significant odds ratios (OR) for both scores (Wells score 1.38; Geneva score 1.24). There was no significant difference between the area under the curve (AUC) of Wells score and Geneva score. The utility of Wells and Geneva scores for the evaluation of patients suspected of PE in an emergency patient cohort. Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  20. Suspected Lynch syndrome associated MSH6 variants: A functional assay to determine their pathogenicity.

    Directory of Open Access Journals (Sweden)

    Hellen Houlleberghs

    2017-05-01

    Full Text Available Lynch syndrome (LS is a hereditary cancer predisposition caused by inactivating mutations in DNA mismatch repair (MMR genes. Mutations in the MSH6 DNA MMR gene account for approximately 18% of LS cases. Many LS-associated sequence variants are nonsense and frameshift mutations that clearly abrogate MMR activity. However, missense mutations whose functional implications are unclear are also frequently seen in suspected-LS patients. To conclusively diagnose LS and enroll patients in appropriate surveillance programs to reduce morbidity as well as mortality, the functional consequences of these variants of uncertain clinical significance (VUS must be defined. We present an oligonucleotide-directed mutagenesis screen for the identification of pathogenic MSH6 VUS. In the screen, the MSH6 variant of interest is introduced into mouse embryonic stem cells by site-directed mutagenesis. Subsequent selection for MMR-deficient cells using the DNA damaging agent 6-thioguanine (6TG allows the identification of MMR abrogating VUS because solely MMR-deficient cells survive 6TG exposure. We demonstrate the efficacy of the genetic screen, investigate the phenotype of 26 MSH6 VUS and compare our screening results to clinical data from suspected-LS patients carrying these variant alleles.

  1. The utility and yield of endoscopic ultrasonography for suspected choledocholithiasis in common gastroenterology practice.

    Science.gov (United States)

    Quispel, Rutger; van Driel, Lydi M W J; Veldt, Bart J; van Haard, Paul M M; Bruno, Marco J

    2016-12-01

    Endoscopic ultrasonography (EUS) is an established diagnostic modality for diagnosing common bile duct (CBD) stones. Its use has led to a reduction in the number of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed for suspected choledocholithiasis. We aimed to explore the role of EUS in detecting CBD stones and/or sludge in common gastroenterology practice. We reviewed case records of 268 consecutive patients who underwent (EUS) procedures performed to confirm or rule out the presence of CBD stones and/or sludge between November 2006 and January 2011 in the Reinier de Graaf Hospital, Delft, The Netherlands, which is a nonacademic community hospital. On the basis of EUS findings, 169 of 268 (63%) patients did not undergo ERCP and were therefore not exposed to its risk of complications. Patients with positive findings on EUS (n=99) all underwent ERCP and endoscopic sphincterotomy. Only 57 of 99 (58%) had positive findings at ERCP. The main contributing factors to this finding seem to be time interval between EUS and ERCP and the type of CBD content (i.e. sludge, one CBD stone or more than one CBD stone) described. In our common gastroenterology practice, EUS plays an important role in selecting patients suspected to have CBD stones or sludge for ERCP. Much is to be learned about the probability of spontaneous passage of CBD stones and sludge into the duodenum.

  2. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever.

    Science.gov (United States)

    Todd, Suzanne R; Dahlgren, F Scott; Traeger, Marc S; Beltrán-Aguilar, Eugenio D; Marianos, Donald W; Hamilton, Charlene; McQuiston, Jennifer H; Regan, Joanna J

    2015-05-01

    To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P=.20) or hypoplasia (P=1.0) was found between the 2 groups. This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label. Published by Elsevier Inc.

  3. The diagnostic yield of skin biopsy in patients with leukemia and suspected infection.

    Science.gov (United States)

    Farmakiotis, Dimitrios; Ciurea, Ana Mercedes; Cahuayme-Zuniga, Lizbeth; Kontoyiannis, Dimitrios P

    2013-10-01

    To determine the diagnostic yield of skin biopsy in patients with leukemia, new skin lesions, and suspected infection. We reviewed the medical records of all patients with leukemia who underwent skin biopsy for new lesions and clinical suspicion of infection over 4 years. Biopsy was considered to have changed the diagnosis, if the results differed from the prior leading clinical impression. Seventy-six (39%) of 195 patients had infections identified via skin biopsy. Among the remaining patients, the most common diagnoses were leukemia cutis, drug reactions and Sweet's syndrome. Ulcerated or necrotic lesions and bacteremia or fungemia were the only independent predictors of infection. 55% of patients with severe neutropenia had biopsy-proven infectious causes of their skin lesions. One third of all afebrile patients had skin manifestations owing to infection. Skin biopsy results differed from the initial clinical impression in 34% of all patients. In 45% of infected patients, pathogens were identified by skin biopsy alone. Noninfectious causes accounted for a large proportion of new skin lesions in leukemia patients with suspected infections. Absence of neutropenia or fever did not rule out infection. Ulcerated or necrotic lesions and bacteremia or fungemia were independent predictors of infection. In the evaluation of patients with leukemia and new skin lesions, skin biopsy remains an important procedure to rule out infection, and is particularly useful for pathogen identification. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  4. Suspect Height Estimation Using the Faro Focus(3D) Laser Scanner.

    Science.gov (United States)

    Johnson, Monique; Liscio, Eugene

    2015-11-01

    At present, very little research has been devoted to investigating the ability of laser scanning technology to accurately measure height from surveillance video. The goal of this study was to test the accuracy of one particular laser scanner to estimate suspect height from video footage. The known heights of 10 individuals were measured using an anthropometer. The individuals were then recorded on video walking along a predetermined path in a simulated crime scene environment both with and without headwear. The difference between the known heights and the estimated heights obtained from the laser scanner software were compared using a one-way t-test. The height estimates obtained from the software were not significantly different from the known heights whether individuals were wearing headwear (p = 0.186) or not (p = 0.707). Thus, laser scanning is one technique that could potentially be used by investigators to determine suspect height from video footage. © 2015 American Academy of Forensic Sciences.

  5. Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

    Directory of Open Access Journals (Sweden)

    Daniella Matos da Silva

    Full Text Available ABSTRACT: Intraoperative ultrasonography (IOUS is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.

  6. Spatial Distance Regulates Sex-Specific Feelings to Suspected Sexual and Emotional Infidelity

    Directory of Open Access Journals (Sweden)

    Achim Schützwohl

    2011-07-01

    Full Text Available The present study investigates the hitherto neglected influence of the spatial distance between the jealous person, the partner, and a potential rival as a proximate contextual factor regulating emotion intensity. The study tested four predictions. (1 The jealousy mechanism responds with mild negative feelings at most as long as the partner is close to the jealous person. (2 The negative feelings increase when the partner is far from the jealous person but the rival is close. (3 The most uncomfortable feelings result when the partner and the rival are close together and both far from the jealous person. (4 Based on the evolutionary psychological considerations, men report stronger negative feelings than women when suspecting sexual infidelity. Conversely, women report stronger negative feelings than men when suspecting emotional infidelity. The results confirmed predictions 1 and 4. Reversing predictions 2 and 3, the close rival consistently elicited the most uncomfortable feelings. Implications and limitations of the present study are discussed and suggestions for future research are provided.

  7. Comprehensive training in suspected child abuse and neglect for dental students: a hybrid curriculum.

    Science.gov (United States)

    Ivanoff, Chris S; Hottel, Timothy L

    2013-06-01

    Child abuse and neglect are tragic realities of American society. However, most U.S. dental schools do not provide students with adequate training to deal with the problem. This article proposes expanding the predoctoral dental curriculum with a problem-based learning model that can effectively stimulate critical thinking skills to assist graduates in screening and reporting suspected child abuse and neglect throughout their careers. The unique multicultural environment of dental school offers students an unprecedented opportunity to develop awareness about child abuse and domestic violence, while increased vigilance can potentially save innocent young lives. Educating students about proper protocol when they suspect child abuse or neglect is imperative, particularly for dental schools involving students in community sealant and other preventive programs in public schools. By expanding their curriculum to include recognition and intervention, dental schools can help break the cycle of violence and transform attitudes towards taking decisive action. Clinical curricula that have moved to private practice preceptor models are well suited to screen for child abuse. The goal is to motivate dental schools to deal with this critical issue, develop reporting protocols and procedures for appropriate response, and provide their students with consummate training.

  8. Feasibility of abdominal plain film images in evaluation suspected drug smuggler

    Energy Technology Data Exchange (ETDEWEB)

    Sormaala, Markus J., E-mail: markus.sormaala@welho.com [Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Salonen, Hanna-Mari, E-mail: hanna-mari.salonen@hus.fi [Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Mattila, Ville M., E-mail: ville.mattila@uta.fi [Department of Orthopedic Surgery and Trauma, Tampere University Hospital, Tampere (Finland); Kivisaari, Arto, E-mail: arto.kivisaari@hus.fi [Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Autti, Taina, E-mail: taina.autti@hus.fi [Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland)

    2012-09-15

    Objective: Drug smuggling in the gastrointestinal tract has soared within the last 20 years. Though illegal substances in the gastrointestinal tract can be visualized with ultrasound, MRI and CT, the abdominal radiograph has by far remained the most frequently used way of detecting smuggled drugs. The purpose of the study was to evaluate the inter-radiologist interpretation error and the reliability of the abdominal radiograph in detecting smuggled drugs. Materials and methods: A total of 279 abdominal radiographs of suspected smugglers were classified by three radiologists as clearly positive or negative for drug smuggling. All available information about the cases was collected from the customs officers and police. Results: Out of these cases 203 (73%) were interpreted as negative and 35 (13%) as positive by all three radiologists. In 86% of the cases there was, therefore, an inter-radiological agreement in interpreting the images. In 41 (14%) cases, however, there was an inter-radiologist disagreement. Kappa-value for inter-observer variability was 0.70. Conclusions: In up to a seventh of the abdominal radiographs the interpretation can be challenging even for an experienced radiologist. False positive interpretation can lead to innocent passengers being detained in vain. As negatively interpreted images usually result in releasing of the suspect, there is no way of knowing how many false negative occur. This makes the abdominal radiograph a suboptimal examination, and low dose CT should be considered as the screening modality for gastrointestinal drug smugglers.

  9. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Sylvia Marie Biso

    2017-01-01

    Full Text Available Background. Acute coronary syndrome (ACS can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods. This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results. Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p<0.05, lower mean peak troponin levels (12 versus 49, p<0.05, and lower mean length of stay (12 versus 25 days, p<0.05 compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion. Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG.

  10. Cardiac magnetic resonance imaging in suspected blunt cardiac injury: A prospective, pilot, cohort study.

    Science.gov (United States)

    Burrell, Aidan Jc; Kaye, David M; Fitzgerald, Mark C; Cooper, David J; Hare, James L; Costello, Benedict T; Taylor, Andrew J

    2017-05-01

    The aim of this study was to evaluate the incidence and severity of blunt cardiac injury (BCI) as determined by cardiac magnetic resonance imaging (CMR), and to compare this to currently used diagnostic methods in severely injured patients. We conducted a prospective, pilot cohort study of 42 major trauma patients from July 2013 to Jan 2015. The cohort underwent CMR within 7 days, enrolling 21 patients with evidence of chest injury and an elevated Troponin I compared to 21 patients without chest injury who acted as controls. Major adverse cardiac events (MACE) including ventricular arrhythmia, unexplained hypotension requiring inotropes, or a requirement for cardiac surgery were recorded. 6/21 (28%) patients with chest injuries had abnormal CMR scans, while all 21 control patients had normal scans. CMR abnormalities included myocardial oedema, regional wall motion abnormalities, and myocardial haemorrhage. The left ventricle was the commonest site of injury (5/6), followed by the right ventricle (2/6) and tricuspid valve (1/6). MACE occurred in 5 patients. Sensitivity and specificity values for CMR at predicting MACE were 60% (15-95) and 81% (54-96), which compared favourably with other tests. In this pilot trial, CMR was found to give detailed anatomic information of myocardial injury in patients with suspected BCI, and may have a role in the diagnosis and management of patients with suspected BCI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Alcohol and drug intoxication during police interrogation and the reasons why suspects confess to the police.

    Science.gov (United States)

    Sigurdsson, J F; Gudjonsson, G H

    1994-08-01

    This study investigates the effects of alcohol, drug intoxication and withdrawal symptoms on the mental state of criminal suspects and the nature of their confession. A total of 359 sentenced prisoners were approached on admission and 96% agreed to participate in the study. They completed a specially designed Confession Questionnaire, which asked them questions about their reasons for confessing to the police, their attitude towards their confession, their mental state at the time of the confession and the extent to which they had been under the influence of alcohol and drug intoxication at the time of crime and police interview. The confession rate for the sample was very high (92%), with serious traffic violators having the highest confession rate (95%) and sex offenders the lowest (83%). The findings illustrate that the "perception of proof", "internal need to confess" and "external pressure" are the main reasons why suspects confess. However, subjects were identified who had experienced a typical "prisoner's dilemma" phenomenon during the police interview because of a co-defendant. Alcohol and drug intoxication was very commonly reported both at the time of the offence and the police interview, but these were related to the nature of their offence. Although intoxication and withdrawal symptoms did not appear to seriously impair their coping during the police interview it was consistently reported as having made them confused.

  12. The Knowledge of Lung Tuberculosis Suspects for Sputum Examination Attitude In The Kamoning Primary Health Care

    Directory of Open Access Journals (Sweden)

    Puteri Febriana Arivany

    2017-04-01

    Full Text Available Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis. Tuberculosis (TB is an infectious disease mostly attacks the lungs TB disease is transmitted by smear positive TB patients through the air when an infected person coughs or sneezes in the form of droplets. Sputum examination is an effort to enforce TB diagnose and to determine the potential of this transmission. The aims was conducted to determine the relationship between the respondents’ knowledge andthe sputum examination in the health center Kamoning Sampang. This research used analytic observational study with survey method using cross sectional. The research performed in 60 patients and sampling method used is imple random sampling. The independent variabel consist of education, occupation, income respondents, education and attitude of the respondent in conducting sputum examination. The strength of correlation was measured by Contingency Coefficient and Odd Ratio (OR were analyzed using chi-square test. Contingency Coefficient of respondents knowledge knowledge suspected pulmonary tuberculosis in sputum examination is 0,253 and OR = 3,600. The conclusion is there was a weak correlation between the respondents knowledge and sputum examination. Symptoms and treatment of pulmonary TB can be identified if the health workers in collaboration with religious leaders and community leaders to provide the Information according to age and education of the respondents. Keywords: knowledge, attitude, TB suspect, sputum examination

  13. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study.

    Science.gov (United States)

    van der Hulle, Tom; Cheung, Whitney Y; Kooij, Stephanie; Beenen, Ludo F M; van Bemmel, Thomas; van Es, Josien; Faber, Laura M; Hazelaar, Germa M; Heringhaus, Christian; Hofstee, Herman; Hovens, Marcel M C; Kaasjager, Karin A H; van Klink, Rick C J; Kruip, Marieke J H A; Loeffen, Rinske F; Mairuhu, Albert T A; Middeldorp, Saskia; Nijkeuter, Mathilde; van der Pol, Liselotte M; Schol-Gelok, Suzanne; Ten Wolde, Marije; Klok, Frederikus A; Huisman, Menno V

    2017-07-15

    Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism. We did a prospective, multicentre, cohort study in 12 hospitals in the Netherlands, including consecutive patients with suspected pulmonary embolism between Oct 5, 2013, to July 9, 2015. Patients were managed by simultaneous assessment of the YEARS clinical decision rule, consisting of three items (clinical signs of deep vein thrombosis, haemoptysis, and whether pulmonary embolism is the most likely diagnosis), and D-dimer concentrations. In patients without YEARS items and D-dimer less than 1000 ng/mL, or in patients with one or more YEARS items and D-dimer less than 500 ng/mL, pulmonary embolism was considered excluded. All other patients had CTPA. The primary outcome was the number of independently adjudicated events of venous thromboembolism during 3 months of follow-up after pulmonary embolism was excluded, and the secondary outcome was the number of required CTPA compared with the Wells' diagnostic algorithm. For the primary outcome regarding the safety of the diagnostic strategy, we used a per-protocol approach. For the secondary outcome regarding the efficiency of the diagnostic strategy, we used an intention-to-diagnose approach. This trial is registered with the Netherlands Trial Registry, number NTR4193. 3616 consecutive patients with clinically suspected pulmonary embolism were screened, of whom 151 (4%) were excluded. The remaining 3465 patients were assessed of whom 456 (13%) were

  14. Mass Customization Services

    DEFF Research Database (Denmark)

    Friedrich, Gerhard

    Topics of the IMCM’08 & PETO’08 and this book are: Mass customization in service, mass customizing financial services, mass customization in supply networks, implementation issues in logistics, product life cycle and mass customization. The research field of mass customization is more than 15 years...

  15. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases.

    Science.gov (United States)

    Farsi, Davood; Hajsadeghi, Skokoufeh; Hajighanbari, Mohammad Javad; Mofidi, Mani; Hafezimoghadam, Peyman; Rezai, Mahdi; Mahshidfar, Babak; Abiri, Samaneh; Abbasi, Saeed

    2017-06-01

    Few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by emergency physicians. The aim of the present study was to evaluate the diagnostic accuracy of FOCUS performed by emergency medicine residents compared to echocardiography performed by a cardiologist in emergency department (ED) patients suspected of cardiovascular disease. The research involved a prospective observational cross-sectional study enrolling patients over 18-years old suspected of having cardiovascular disease who required an echocardiograph. For each patient, a FOCUS test was conducted by a trained emergency medicine resident. The diagnostic accuracy of ED performed FOCUS was compared to echocardiography performed by a cardiologist (gold standard) in the ED. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for FOCUS. The agreement of EM residents and cardiologists on each finding was evaluated using Cohen's kappa coefficient with 95% CI. Two hundred and five patients, with a mean age of 61.0 ± 17 years (50% male), were included in this study. Agreement between FOCUS performed by an emergency medicine resident and echocardiography performed by a cardiologist in measuring ejection fraction of the left ventricle was 91% (κ = 0.85; 95% CI = 0.79-0.91). Reports of the two groups for identifying right ventricular enlargement showed 96% agreement (κ = 0.86; 95% CI = 0.82-0.90). The agreements for right ventricular pressure overload, wall motion abnormality and pericardial effusion were 100% (κ = 0.83; 95% CI = 0.77-0.89), 92% (κ = 0.83; 95% CI = 0.76-0.90), and 96% (κ = 0.83; 95% CI = 0.77-0.89), respectively. FOCUS performed by emergency medicine residents is comparable to echocardiography performed by cardiologists. Therefore, it could be a reliable tool and screening test for initial testing of patients suspected of cardiac abnormalities.

  16. Double-read of skeletal surveys in suspected non-accidental trauma: what we learned

    Energy Technology Data Exchange (ETDEWEB)

    Karmazyn, Boaz; Wanner, Matthew R.; Marine, Megan B. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indianapolis, IN (United States); Miller, Elise M.; Jennings, S.G. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Lay, Sara E. [Indiana University School of Medicine, Methodist Hospital, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Massey, James M. [The Children' s Hospital at TriStar Centennial, Department of Imaging, Nashville, TN (United States); Ouyang, Fangqian [Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN (United States); Hibbard, Roberta A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Riley Hospital for Children, Indianapolis, IN (United States)

    2017-05-15

    Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown. To determine the advantage of double-read versus single-read of radiographic skeletal surveys for suspected non-accidental trauma. The study was performed in two phases. In the first phase (April 2013 to September 2013), double-read was performed for all skeletal surveys obtained during weekday working hours. Because we had no new double-read findings in studies initially read as negative, we conducted a second phase (January 2014 to March 2014). In the second phase we limited double-reads to skeletal surveys found positive on the first read. At the end of this period, we retrospectively performed double-read for all initially negative skeletal surveys. We excluded follow-up skeletal surveys. The difference in discrepancy (new fracture or false diagnosis of a fracture) ratio between negative and positive skeletal surveys was evaluated using the Fisher exact test, and change in discrepancy ratio between the first and second study phases was evaluated using the stratified Cochran-Mantel-Haenszel test. Overall in the two phases, 178 skeletal surveys were performed in 178 children (67 girls) with mean age of 9 months (range 3 days to 3.7 years). Double-read found 16 discrepancies in 8/178 (4.5%) skeletal surveys. Seven of these studies showed additional fractures (n=15). In one study, an initial read of a skull fracture was read as a variant on the second read. There was a significant (P=0.01) difference between rate of disagreement in negative skeletal surveys (1/104, 1.0%) and positive skeletal surveys (7/74, 9.5%). No significant change in disagreement rate was demonstrated between the two phases of the study (P=0.59). Double-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found

  17. Anterior segment morphology after laser iridotomy in primary angle closure suspects.

    Science.gov (United States)

    Mansoori, Tarannum; Balakrishna, Nagalla

    2017-11-12

    To evaluate and compare the changes in anterior segment parameters in primary angle closure suspects before and after laser peripheral iridotomy and intrasession repeatability of measurements before laser iridotomy as assessed by Scheimpflug-Placido disc topographer. Before laser iridotomy, 56 eyes of 56 primary angle closure suspect patients underwent anterior segment analysis with the Sirius Scheimpflug-Placido disc topographer system using glaucoma analysis mode, which was repeated a week after iridotomy. Anterior segment parameters such as central anterior chamber depth, central corneal thickness, anterior chamber volume and iridocorneal angle were analysed before and after laser iridotomy and compared with paired t-test. Three consecutive scans were obtained to assess the intrasession repeatability of measurements before iridotomy by a single examiner and intraclass correlation co-efficient was calculated. Multivariate regression analysis was performed to evaluate the predictors associated with iridocorneal angle narrowing. Intraclass correlation co-efficient values ranged from 0.982 for anterior chamber volume to 0.998 for the iridocorneal angle. After laser iridotomy, mean central anterior chamber depth increased from 2.14 ± 0.29 mm to 2.21 ± 0.28 mm (p = 0.04), mean anterior chamber volume increased from 96.2 ± 16.98 mm 3 to 98.14 ± 15.87 mm 3 (p angle widened from 33.38 ± 3.96° to 34.82 ± 4.27° (p = 0.01), compared with pre-iridotomy status. There was no change in central corneal thickness, intraocular pressure or pupil diameter. Multivariate regression analysis model showed that at one week after iridotomy, iridocorneal angle opening was positively correlated with age (β = 0.773, p = 0.005) and anterior chamber volume (β = 1.308, p angle closure suspect patients. The Scheimpflug-Placido disc topographer provides reproducible measurements of the iridocorneal angle and other parameters

  18. Comparative study of Widal test against stool culture for typhoid fever suspected cases in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Ameya G

    2017-01-01

    Full Text Available Gemechu Ameya,1 Edemew Atalel,2 Berhanu Kebede,3 Bethel Yohannes4 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, 2Department of Medical Laboratory Science, Durbetie Primary Hospital, Amahara, 3Department of Medical Laboratory Science, Dalifage Primary Hospital, Afar, 4Department of Medical Laboratory Science, Hayilemariyam Hospital, Adama, Ethiopia Introduction: Infection caused by Salmonella enterica subsp. serotype Typhi remains an important public health problem in developing countries. Culture is an effective diagnostic method of confirming this infection. Diagnosis in developing countries is mostly done by Widal test, which is nonreliable. The aim of this study was to compare the Widal test against stool culture in typhoid-suspected cases and to evaluate the agreement between test methods.Methodology: A cross-sectional study design was conducted on typhoid-suspected cases in southern Ethiopia. Collected data were entered into Epi-Info version 3.5.1 and exported to SPSS version 20.0 for further analysis. Kappa test was used to assess the agreement between the tests. Sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV were calculated to compare the Widal test against stool culture.Results: A total of 95 patients participated in the study, of whom 49 (51.6% were females and 46 (48.4% were males. The age range of the suspected cases were between 10 and 62 years, with mean age of 27.9 years. Of the examined cases, 65 (68.4% were positive for slide agglutination Widal test, whereas only 19 (20.0% were positive for S. enterica serotype Typhi by stool culture. The sensitivity, specificity, PPV, and NPV of slide agglutination test against stool culture were 84.2%, 35.5%, 24.6%, and 90.0%, respectively. Slide agglutination test has a poor agreement with the stool culture (kappa = 0.103, but tube titration test has a fair agreement with the

  19. Progressive lesions of central nervous system in microcephalic fetuses with suspected congenital Zika virus syndrome.

    Science.gov (United States)

    Sarno, M; Aquino, M; Pimentel, K; Cabral, R; Costa, G; Bastos, F; Brites, C

    2017-12-01

    To describe the pattern and progression of central nervous system (CNS) lesions in microcephalic fetuses with suspected Zika virus (ZIKV) infection. In this prospective study in Salvador, Brazil, we analyzed fetuses diagnosed with microcephaly and suspected ZIKV infection after a routine primary care ultrasound scan between July 2015 and February 2016 raised suspicion of fetal microcephaly. The pregnancies were followed with serial ultrasound scans until delivery at one of the three main referral centers for fetal abnormalities in Salvador, Brazil. Microcephaly was diagnosed when the head circumference was two or more SDs below the mean for gestational age and its relationship with ZIKV infection was defined according to the World Health Organization's criteria. All women were interviewed, to assess potential factors associated with fetal microcephaly. Serology test results for toxoplasmosis, cytomegalovirus, rubella, syphilis and human immunodeficiency virus (HIV) were recorded, as were previous routine ultrasound results. Signs/symptoms of infection during the pregnancy were noted. Of 60 cases of suspected ZIKV-related fetal microcephaly seen during the study period, eight were excluded due to serological evidence of other congenital infections or major ultrasound chromosomal markers. In the remaining 52 fetuses, microcephaly was diagnosed between 19 and 40 (median, 27.7; interquartile range, 23.4-32.0) weeks of gestation. The main ultrasound findings were: ventriculomegaly (65.4% of cases), cerebral calcifications (44.2%) and posterior fossa abnormalities (32.7%). 9.6% presented with arthrogryposis as an associated finding. Microcephaly was an isolated finding in four cases (7.7%). While ventriculomegaly was progressive in 41.2% of cases with this finding, the velocity of head circumference increase decreased progressively in almost all cases. Exanthematic disease was present in the majority (86.5%) of the women, 67.3% presenting in the first trimester of

  20. Genotype MTBDR plus (Hain) test in suspected MDR-TB patients.

    Science.gov (United States)

    Sangsayunh, Piamlarp; Chuchothawon, Chareon

    2014-10-01

    Incidence ofMDR-TB in Thailand is higher Diagnosis ofmulti-drug resistance (MDR-TB) is often delayed because of insufficient investigations. Therefore, there is a need to introduce an efficient testing method. Genotype MTBDR plus (Hain test) is a new technology of line probe assay (LPAs) In general practice, it had questionable benefit on negative and positive direct smear specimens. Evaluate the accuracy of the Hain test as compared to the conventional culture and drug susceptibility test (DST), and evaluate the judgment of the physician on starting MDR-TB treatment after receiving the result of the Hain test. An observational prospective study was done of 100 suspected MDR-TB patients who visited the Central Chest Institute of Thailand between September and December 2012. Ninety-four patients were included in the present study. They were assessed by direct sputum smear test, Hain test, sputum conventional culture, and drug-susceptibility test (DST) in the first visit. Followed-up treatment until cure/definite treatment were observed for definite diagnosis. Hain tests identified 65 (69%) MTB positives, 25 (26%) MTB negatives, andfour (4%) Non-tuberculous Mycobacteria (NTM), respectively. Fourteen of 17 negative direct smear but positive Hain test samples were culture negative. We followed these 14 patients. Four patients with TB treatment were cured. Six patients received MDR treatment and improved. Two patients were misdiagnosed CA. Two patients had old scar TB lesion. Sensitivity, specificity, and accuracy ofHain test for MDR-TB detection compared to standard conventional culture were 95%, 86%, and 88%, respectively. Twelve patients were NTMculture positive. Most of them (75%) were M abscessus. Sixty-three percent of chest physicians used the result of the Hain testfor extended treatment ofstandard regimen in non-IR resistance or changing ofTB regimen. There was correlation between judgments of starting MDR-TB treatment and results of Hain test (p = 0.001), no

  1. Prevalence and risk factors of suspected elder abuse subtypes in people aged 75 and older.

    Science.gov (United States)

    Garre-Olmo, Josep; Planas-Pujol, Xènia; López-Pousa, Secundino; Juvinya, Dolors; Vilà, Antoni; Vilalta-Franch, Joan

    2009-05-01

    To assess the prevalence of suspected elder abuse subtypes and to identify related factors. Cross-sectional, population-based, descriptive study. Eight rural villages in Girona, Spain. Six hundred seventy-six inhabitants aged 75 and older. All participants were interviewed in their homes using the study protocol, which includes an abuse screen used in previous elder abuse studies and questions about demographic, social, physical, psychiatric, cognitive, and social services variables. The mean age of the participants was 81.7 +/- 4.8; 58.2% were female. Prevalence of suspected neglect abuse was 16.0% (95% confidence interval (CI)=13.2-18.9), prevalence of psychosocial abuse was 15.2% (95% CI=12.8-18.2), prevalence of financial abuse was 4.7% (95% CI=3.0-6.4) and prevalence of physical abuse was 0.1% (95% CI=0.004-0.8). Psychosocial abuse was positively associated with depressive symptoms (odds ratio (OR)=1.65, 95% CI=1.01-2.72), social isolation (OR=0.35, 95% CI=0.18-0.69), and frequent bladder incontinence (OR=2.44, 95% CI=1.23-4.86). Neglect abuse was positively associated with social isolation (OR=0.52, 95% CI=0.27-0.99), use of social services (OR=1.83, 95% CI=1.05-3.20), and living arrangements (OR=5.29, 95% CI=2.65-10.56). Financial abuse was associated with marital status (OR=0.15, 95% CI=0.04-0.59), age 85 and older, (OR=3.84, 95% CI=1.70-8.68), and Mini-Mental State Examination score (OR=0.85, 95% CI=0.78-0.94). After adjustment for confounding factors, each subtype of suspected elder abuse was associated with different variables. The results of this study suggest that elder abuse cannot be analyzed as a unitary concept and that risk factors must be assessed for each abuse subtype.

  2. Comparison of 2- and 3-Dimensional Sonography for Estimation of Birth Weight and Neonatal Adiposity in the Setting of Suspected Fetal Macrosomia.

    Science.gov (United States)

    Gibson, Kelly S; Stetzer, Bradley; Catalano, Patrick M; Myers, Stephen A

    2016-06-01

    To compare the accuracy of 2-dimensional (2D) and 3-dimensional (3D) fetal measurements for prediction of birth weight Z score and neonatal adiposity (percent body fat) in the setting of suspected fetal macrosomia. We conducted a prospective observational study of term singleton pregnancies with suspected macrosomia. Patients were enrolled on admission to labor and delivery and underwent sonographic examinations. Within 48 hours of delivery, neonatal anthropometric measurements were obtained. Thirty-four neonates were included in the analysis. Mothers were very obese (mean body mass index ± SD, 39.1 ± 7.8 kg/m(2)); 56.5% were white; and 39.1% had diabetes. Neonates were 38% female and had a mean birth weight of 3940.0 ± 496.8 g, percent body fat of 18.5% ± 4.0%, and Ponderal index of 2.8 ± 0.3 g/cm(3). Mean 2D estimated fetal weight was 3973 ± 443 g; mean 3D estimated fetal weight was 3803 ± 528 g; and mean thigh volume was 102.5 ± 19.6 cm(3). Both 2D and 3D measurements accounted for about half the variance in predicted birth weight (R(2) for 2D = 0.53, 71% within 10% of birth weight; R(2) for 3D = 0.47, 65% within 10% of birth weight). Thigh volume Z score was the prenatal parameter most highly correlated with both birth weight Z score (R(2) = 0.52; r = 0.72; 95% confidence interval, 0.54-0.84; P macrosomia, fractional thigh volume was the best sonographic estimate of neonatal percent body fat and birth weight Z score. Future research on prediction of neonatal weight and adiposity in macrosomic fetuses should include an estimate of fetal soft tissue given the generalized increase in body fat of these fetuses. © 2016 by the American Institute of Ultrasound in Medicine.

  3. Virtual patients: an effective educational intervention to improve paediatric basic specialist trainee education in the management of suspected child abuse?

    LENUS (Irish Health Repository)

    McEvoy, M M

    2011-09-01

    Child abuse is a particularly difficult subject to teach at both undergraduate and postgraduate level. Most doctors are dissatisfied with their training in child abuse recognition and management. We developed an interactive video based Virtual Patient to provide formal training for paediatric Basic Specialist Trainees in the recognition of suspected child abuse. The Virtual Patient case revolves around the management of suspected physical abuse in a seven month old child, who initially presents to the Emergency Department with viral upper respiratory tract symptoms. This Virtual Patient was used to facilitate a case discussion with Basic Specialist Trainees. A questionnaire was developed to determine their perception of the value of the Virtual Patient as an educational tool. Twenty five Basic Specialist Trainees completed the questionnaire. Upon completion of the case, 23\\/25 (92%) participants reported greater self confidence in their ability to recognize cases of suspected child abuse and 24\\/25 (96%) of participants reported greater self confidence in their ability to report cases of suspected child abuse. Basic Specialist Trainees perceived the Virtual Patient to be a useful educational tool. Virtual Patients may have a role to play in enhancing postgraduate training in the recognition of suspected child abuse.

  4. First Trimester Abortion: A Rare Cause of Intrauterine Bony Spicules

    Directory of Open Access Journals (Sweden)

    Anshuja Singla

    2012-01-01

    Full Text Available Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following first trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal.

  5. Spicules Intensity Oscillations in SOT/HINODE Observations E ...

    Indian Academy of Sciences (India)

    2015-04-01

    Apr 1, 2015 ... Phys., 283, 187T. Tavabi, E. 2014, Astrophys. Space Sci., 352, 43T. Tavabi, E., Koutchmy, S., Ajabshirizadeh, A., Ahangarzadeh Maralani, A. R., Zeighami, S. 2014, Astron. Astrophys., arXiv:1409.7654v2[astro-ph.SR] 30 Sep 2014. Trauth, M. H., MATLAB Recipes for Earth Sciences, Second Edition, Chapter ...

  6. Siliceous spicules in marine demosponges (example Suberites domuncula)

    NARCIS (Netherlands)

    Muller, WEG; Belikov, SI; Tremel, W; Perry, CC; Gieskes, WWC; Boreiko, A; Schroder, HC; Mueller, W.E.G.; Schroeder, H.C.

    2006-01-01

    All metazoan animals comprise a body plan of different complexity. Since-especially based on molecular and cell biological data-it is well established that all metazoan phyla, including the Porifera (sponges), evolved from a common ancestor the search for common, basic principles of pattern

  7. Transcranial color-coded duplex sonography in suspected acute basilar artery occlusion.

    Science.gov (United States)

    Kermer, Pawel; Wellmer, Andreas; Crome, Olaf; Mohr, Alexander; Knauth, Michael; Bähr, Mathias

    2006-03-01

    Transcranial color-coded duplex sonography (TCDS) is a noninvasive, quick and inexpensive diagnostic tool used routinely to assess vascular abnormalities in cerebral ischemia. The value of TCDS for diagnosis and follow-up of acute basilar artery (BA) ischemia in comparison/combination with spiral CT angiography (CTA) and/or digital subtraction angiography (DSA) has not yet been studied. We prospectively studied 15 consecutive patients with clinically suspected acute BA occlusion (BAO) by TCDS as well as 3 to 5 d later in those with proven BAO. BA ischemia was verified in 11 patients. During follow-up, all BAO patients showed recanalization of the BA independent of thrombolytic treatment. In conclusion, TCDS appears to be an efficient method for BAO diagnosis when immediate angiography is not available. Together with CTA it increases diagnostic safety before performing an invasive and cost-intensive DSA.

  8. Cognitive-linguistic performances of multilingual university students suspected of dyslexia.

    Science.gov (United States)

    Lindgrén, Signe-Anita; Laine, Matti

    2011-05-01

    High-performing adults with compensated dyslexia pose particular challenges to dyslexia diagnostics. We compared the performance of 20 multilingual Finnish university students with suspected dyslexia with 20 age-matched and education-matched controls on an extensive test battery. The battery tapped various aspects of reading, writing, word retrieval, phonological processing and other cognitive functions relevant for dyslexia. Reading and writing were examined in the two domestic languages, Swedish and Finnish. The most prominent group differences in reading and writing emerged on accuracy measures in both languages (reading text aloud, proofreading, writing to dictation, free writing). The dyslexia group also performed less well on speeded segmentation of written input, complex speeded naming and complex phoneme manipulation. The pattern of results fits the phonological deficit hypothesis of dyslexia and indicates the presence of pervasive underlying defects in compensated dyslexia. Copyright © 2010 John Wiley & Sons, Ltd.

  9. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus Wejnold; Dippmann, Christian; Dahl, L

    2016-01-01

    BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option...... for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment...... arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. CONCLUSION: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic...

  10. Suspected neurotoxicity due to Clostridium perfringens type B in a tiger (Panthera tigris).

    Science.gov (United States)

    Zeira, Offer; Briola, Chiara; Konar, Martin; Dumas, Maria Pia; Wrzosek, Marcin Adam; Papa, Valentina

    2012-09-01

    A 4-yr-old tiger (Panthera tigris) was referred with acute onset of severe abnormal consciousness. Neurological evaluation showed normal palpebral and corneal reflexes, normal pupil diameter with normal direct and consensual papillary light reflex, and absent menace response bilaterally. Diffuse forebrain lesion or focal lesion affecting the ascending reticular activating system was suspected. Complete blood examination and cerebrospinal fluid analysis were normal. Magnetic resonance imaging of the brain showed an empty sella as the only result. Clostridium perfringens 10(4) to 10(7) colony-forming units/g were detected in fecal flora samples. Multiplex polymerase chain reaction assay identified serotype B counts with production of epsilon toxin. This toxin specifically accumulates in the central nervous system, where it causes acute neurological signs in humans, domestic animals, and wildlife. In this communication, the acute onset of neurological signs without evidence of trauma, vascular, metabolic, or inflammatory diseases may be caused by neurotoxicity due to C. perfringens.

  11. Utility of testing for monoclonal bands in serum of patients with suspected osteoporosis

    DEFF Research Database (Denmark)

    Abrahamsen, B.; Andersen, Ivan; Christensen, Susanne S.

    2005-01-01

    , Denmark. PARTICIPANTS: 799 people (685 women) aged 19 to 94 years newly referred with suspected osteoporosis. MAIN OUTCOME MEASURES: Proportion of patients fulfilling the Nordic Myeloma Study Group definition for target condition and proportion of patients with other important haematological conditions......OBJECTIVE: To determine whether measuring monoclonal bands (M component) in serum should be part of the investigation of patients referred to osteoporosis clinics. DESIGN: Retrospective, cross sectional, observational study. SETTING: Referral centre for osteoporosis in a university hospital....... RESULTS: 4.9% (18 of 366) of patients with osteoporosis and 2.2% (9 of 408) of patients without osteoporosis had M component in serum (chi2 = 3.66, P = 0.04). Multiple myeloma was diagnosed in three patients with osteoporosis (absolute risk 0.8%, 95% confidence interval 0.11% to 1.7%). The relative risk...

  12. Ultrasonography, computed tomography, and cholescintigraphy in suspected obstructive jaundice--a prospective comparative study

    DEFF Research Database (Denmark)

    Matzen, P; Malchow-Møller, A; Brun, B

    1983-01-01

    In order to compare their capacity to visualize the bile ducts, ultrasonography, computed tomography, and cholescintigraphy were performed in 56 consecutive jaundiced patients in whom extrahepatic cholestasis was clinically suspected. The predictions as to the patency of the large bill ducts were...... compared with the final diagnoses made on the basis of direct cholangiography together with autopsy, biopsy, operative findings, and the clinical course. Thirty-nine patients (70%) had obstructed bile ducts, and 17 (30%) had patent large bile ducts. Using a simple scoring scale with 112 points...... as the maximum, ultrasonography obtained 72 points, computed tomography received 56 points, and cholescintigraphy totalled 37 points. Nonsignificant trends were found in favor of ultrasonography as compared with computed tomography and of computed tomography as compared with cholescintigraphy (p greater than 0...

  13. PATIENTS WITH SUSPECTED METAL IMPLANT ALLERGY: POTENTIAL CLINICAL PICTURES AND ALLERGOLOGICAL DIAGNOSTIC APPROACH (REVIEW

    Directory of Open Access Journals (Sweden)

    P. Thomas

    2014-01-01

    Full Text Available The focus of this review are allergic complications following insertion of metallic orthopedic implants. Such potential allergic reactions encompass eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Allergy might be considered prior to planned orthopaedic surgery or in patients with complications following arthroplasty We recommend, that differential diagnoses - in particular infection -should always be excluded in cooperation with surgery collegues. The clinical work up of a patient suspected of suffering from metal implant allergy should include a combined evaluation of medical history, clinical findings, patch testing and histology In vitro testing, namely the lymphocyte transformation test (LTT, can indicate metal sensitization, but needs careful interpretation.

  14. Prediction of the academic success of children with suspected neurological impairments.

    Science.gov (United States)

    Gold, P; Berk, R A

    1979-07-01

    Explored a multivariate approach to the prediction of 8-year academic achievement. Ss were black, of low socioeconomic status, and had been diagnosed as suspect neurologically impaired at age 7. A serial array of early predictors that included maternal education, sex, birth weight, 8-month and 4-year intelligence, and 3-year speech, hearing, and language were entered into multiple regression analyses to determine their value in predicting 8-year academic achievement in word recognition, arithmetic, spelling, and oral reading. The 4-year intelligence measure was the best overall predictor, although maternal education, sex, and birth weight contributed slightly to the predictions. The resulting equations, however, could not be used to predict accurately 8-year academic achievement.

  15. Donepezil decreases annual rate of hippocampal atrophy in suspected prodromal Alzheimer's disease.

    Science.gov (United States)

    Dubois, Bruno; Chupin, Marie; Hampel, Harald; Lista, Simone; Cavedo, Enrica; Croisile, Bernard; Louis Tisserand, Guy; Touchon, Jacques; Bonafe, Alain; Ousset, Pierre Jean; Ait Ameur, Amir; Rouaud, Olivier; Ricolfi, Fréderic; Vighetto, Alain; Pasquier, Florence; Delmaire, Christine; Ceccaldi, Mathieu; Girard, Nadine; Dufouil, Carole; Lehericy, Stéphane; Tonelli, Isabelle; Duveau, Françoise; Colliot, Olivier; Garnero, Line; Sarazin, Marie; Dormont, Didier

    2015-09-01

    The purpose of this study was to study the effect of donepezil on the rate of hippocampal atrophy in prodromal Alzheimer's disease (AD). A double-blind, randomized, placebo-controlled parallel group design using donepezil (10 mg/day) in subjects with suspected prodromal AD. Subjects underwent two brain magnetic resonance imaging scans (baseline and final visit). The primary efficacy outcome was the annualized percentage change (APC) of total hippocampal volume (left + right) measured by an automated segmentation method. Two-hundred and sixteen only subjects were randomized across 28 French expert clinical sites. In the per protocol population (placebo = 92 and donepezil = 82), the donepezil group exhibited a significant reduced rate of hippocampal atrophy (APC = -1.89%) compared with the placebo group (APC = -3.47%), P donepezil compared with placebo. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  16. Sporotrichosis in Iran: A mini review of reported cases in patients suspected to cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    shahram mahmoudi

    2015-03-01

    Full Text Available Sporotrichosis is a chronic subcutaneous fungal infection with global distribution. It is a rare fungal infection with nine reported cases in Iran, including eight humans and one animal, within the past 30 years. Among the human cases, seven were of the fixed cutaneous type of sporotrichosis and one had sporotrichoid lymphocutaneous. The reported patients were within the age range of 23-60 years, and six of them were female. The most frequent sites of infection were forearms and hands, as well as the face and legs. In addition, the majority of the cases had previously been suspected of leishmaniasis and received treatment. Sporotrichosis is not a well-known condition in Iran and is often misdiagnosed and erroneously treated for other cutaneous parasitic or bacterial infections with similar clinical manifestations. Therefore, sporotrichosis should be taken into account in the differential diagnosis of nodular-ulcerative skin lesions.

  17. Emphysematous Cystitis During Treatment of Suspected Nonconvulsive Status Epilepticus in Type 2 Diabetic Patient

    Directory of Open Access Journals (Sweden)

    Chung-Jung Wu

    2011-06-01

    Full Text Available Emphysematous cystitis is a rare disorder and complication of urinary tract infection (UTI, characterized by spontaneous gas formation in the urinary bladder because of bacterial fermentation. We present a case of emphysematous cystitis during treatment of suspected nonconvulsive status epilepticus in a patient with Type 2 diabetes mellitus. The patient recovered satisfactorily after 27 days of hospitalization. Treatment of emphysematous cystitis consisted of adequate urinary drainage, empirical antibiotic therapy, and strict blood glucose control. Diabetic patients are susceptible to an increased incidence of UTI and its complications. An early and correct diagnosis of UTI in diabetic patients followed by adequate treatment will prevent the disease from developing into a serious or life-threatening condition, such as emphysematous cystitis, or progressing to septic shock.

  18. A suspected case of intermediate syndrome in a dog with carbamate toxicosis.

    Science.gov (United States)

    Tinson, E; Boller, E; Davis, M

    2017-06-01

    A 7-year-old female spayed Labrador Retriever was managed for suspected carbamate toxicosis after confirmed ingestion of a large amount of methiocarb. Therapy included decontamination, supportive care and management for aspiration pneumonia. On the third day of hospitalisation, after an initial clinical improvement, the dog developed respiratory muscle weakness, inspiratory dyspnoea and pronounced cervical muscle weakness. These delayed clinical signs were consistent with the 'intermediate syndrome' described in some cases of organophosphate and carbamate toxicoses in humans and also described in one case of organophosphate toxicosis in the dog. Intermediate syndrome has not been reported in carbamate toxicosis in the dog. This case report highlights the necessity for veterinarians to monitor for additional complications not commonly considered in acute carbamate toxicoses. © 2017 Australian Veterinary Association.

  19. [Iliac artery occlusion balloons for suspected placenta accreta during cesarean section].

    Science.gov (United States)

    Burgos Frías, N; Gredilla, E; Guasch, E; Gilsanz, F

    2014-02-01

    Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

    DEFF Research Database (Denmark)

    Brinth, Louise; Latif, Tabassam; Pors, Kirsten

    2014-01-01

    Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflex control - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorly understood. Methods: We studied the hemodynamic response to carotid sinus massage (CSM......) and compared this to other measurements of autonomic cardiovascular control in patients suspected of syncope-related falls. One hundred patients (≥80 years-old) referred to our syncope unit due to recurrent falls or possible syncope participated. CSM was performed in the supine and head-up tilted (HUT......Hg, respectively. Changes in SBP were greater in the head-up tilted position (right side; p=0.029, left side; p=0.007). Hypersensitive responses were elicited in 45 patients. We found orthostatic hypotension (OH) (r=-0.275, p=0.015), not CSS, to be inversely correlated to low frequency HR variability during HUT...

  1. A case suspected for yellow fever vaccine-associated viscerotropic disease in the Netherlands.

    Science.gov (United States)

    van de Pol, Eva M; Gisolf, Elizabeth H; Richter, Clemens

    2014-01-01

    Yellow fever (YF) 17D vaccine is one of the most successful vaccines ever developed. Since 2001, 56 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been published in the peer-reviewed literature. Here, we report a new case suspected for YEL-AVD in the Netherlands. Further research is needed to determine the true incidence of YEL-AVD and to clarify host and vaccine-associated factors in the pathogenesis of YEL-AVD. Because of the potential adverse events, healthcare providers should carefully consider vaccination only in people who are truly at risk for YF infection, especially in primary vaccine recipients. © 2014 International Society of Travel Medicine.

  2. [Two Cases of Urethral Clear Cell Adenocarcinoma with Suspected Recurrence of Uterine Cancer].

    Science.gov (United States)

    Okuno, Masato; Kusuda, Yuji; Taguchi, Isao; Kawabata, Gaku

    2017-08-01

    Herein, we report two cases of urethral clear cell carcinoma in two patients who had previously undergone radical hysterectomyfor utetine cancer. Case 1 presented with bloodyvaginal discharge and case 2 presented with acute urinaryretention. Magnetic resonance imaging revealed a periurethral tumor in both cases. Both cases were suspected to be recurrence at first. However, pathological findings of the transurethral resection-biopsyshowed clear cell adenocarcinoma in both cases. Subsequentlyradical cystourethrectomy and pelvic lymphadenectomy were performed in both cases. Surgical findings showed tumor invasion of the vaginal muscularis in case 1 and invasion of the anterior wall of the vagina and bladder neck in case 2. Although adjuvant postoperative therapywas not performed, there has been no evidence of recurrence to date.

  3. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic.

    Science.gov (United States)

    Hsu, Christopher H; Champaloux, Steven W; Keïta, Sakoba; Martel, Lise; Bilivogui, Pepe; Knust, Barbara; McCollum, Andrea M

    2018-01-01

    Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (pdefinition used in Guinea contributed to improved overall sensitivity and specificity.

  4. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts

    Energy Technology Data Exchange (ETDEWEB)

    Sivit, Carlos J. [Departments of Radiology and Pediatrics, Rainbow Babies and Childrens Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, Euclid Avenue, 11100, 44106-5056, Cleveland, OH (United States)

    2004-06-01

    Acute appendicitis is the most common condition presenting with right lower quadrant pain requiring acute surgical intervention in childhood. The clinical diagnosis of acute appendicitis is often not straightforward and can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed non-operatively. Complications usually result from perforation and include abscess formation, peritonitis, sepsis, bowel obstruction and death. Cross-sectional imaging with sonography and computed tomography (CT) have proven useful for the evaluation of suspected acute appendicitis in children. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to precisely delineate gynecologic disease. The principal advantages of CT are its operator independency with resultant higher diagnostic accuracy, enhanced delineation of disease extent in perforated appendicitis, and improved patient outcomes including decreased negative laparotomy and perforation rates. (orig.)

  5. [Asynchronous Bilateral Testicular Infarction with Suspected Polyarteritis Nodosa : A Case Report].

    Science.gov (United States)

    Kurokawa, Masayuki; Naito, Sei; Ichiyanagi, Osamu; Suto, Aya; Kurota, Yuta; Sakurai, Toshihiko; Nishida, Hayato; Kawazoe, Hisashi; Kato, Tomoyuki; Nagaoka, Akira; Ito, Hiromi; Yamakawa, Mitsunori; Tsuchiya, Norihiko

    2016-12-01

    This report documents a case of asynchronous bilateral testicular infarction. The patient was a 42- year-old man who presented with left testicular pain and swelling. He had a past history of right idiopathic testicular infarction and underwent a right orchiectomy 6 years ago. He also had received treatment for 5 years for suspected polyarteritis nodosa (PAN). The left scrotal pain persisted for a week and left orchiectomy was performed. Pathological evaluations demonstrated a benign testis with testicular hemorrhage and chronic vasculopathy. There was no fibrinoid necrosis of medium-size vessel walls which characterizes PAN. In this report, we review the pathogenesis, risk of contralateral testicular infarction, and management of testicular infarction.

  6. Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis

    Science.gov (United States)

    Katz Sand, Ilana B.; Honce, Justin M.; Lublin, Fred D.

    2015-01-01

    Several single gene disorders share clinical and radiologic characteristics with multiple sclerosis and have the potential to be overlooked in the differential diagnostic evaluation of both adult and paediatric patients with multiple sclerosis. This group includes lysosomal storage disorders, various mitochondrial diseases, other neurometabolic disorders, and several other miscellaneous disorders. Recognition of a single-gene disorder as causal for a patient’s ‘multiple sclerosis-like’ phenotype is critically important for accurate direction of patient management, and evokes broader genetic counselling implications for affected families. Here we review single gene disorders that have the potential to mimic multiple sclerosis, provide an overview of clinical and investigational characteristics of each disorder, and present guidelines for when clinicians should suspect an underlying heritable disorder that requires diagnostic confirmation in a patient with a definite or probable diagnosis of multiple sclerosis. PMID:25636970

  7. The use of the isotopic composition of individual compounds for correlating spilled oils and refined products in the environment with suspected sources

    Energy Technology Data Exchange (ETDEWEB)

    Philp, R.P.; Allen, J.; Kuder, T. [Oklahoma Univ., Norman, OK (United States). School of Geology and Geophysics

    2002-07-01

    Gas chromatography (GC) and gas chromatography/mass spectrometry (CGMS) are two methods generally used to correlate crude oils and refined products found in the environment with their suspected pollution sources. In certain cases, this can be done with bulk carbon isotope compositions, but with crude condensates, or refined products, the lack of biomarkers prohibits the successful use for making unique correlations. Such products can be correlated using an alternative method which makes use of combined gas chromatography-isotope ratio and mass spectrometry (GCIRMS). This method makes it possible to determine the carbon and hydrogen isotopic composition of individual compounds in crude oil, thus producing isotopic fingerprints that could be used in correlation studies. The feasibility of using of GCIRMS to correlate various spilled products in different environments was the main focus of this study. The authors are not proposing that this method will replace GC or GCMS, but are suggesting that it is a powerful tool that could be used in conjunction with the early methods. Carbon and hydrogen isotopic fractionation has been reported for light components such as benzene and toluene. Higher carbon numbered compounds do not seem to undergo major carbon isotopic fractionation as a result of weathering. Hydrogen variations are currently undergoing investigation for compounds with a carbon number greater than C10. Also, isotopic fractionation for refined products has the potential to attenuate naturally. 33 refs., 6 figs.

  8. Herbal medicine use and linked suspected adverse drug reactions in a prospective cohort of Ugandan inpatients.

    Science.gov (United States)

    Kiguba, Ronald; Ononge, Sam; Karamagi, Charles; Bird, Sheila M

    2016-05-26

    Clinical history-taking can be employed as a standardized approach to elucidate the use of herbal medicines and their linked suspected adverse drug reactions (ADRs) among hospitalized patients. We sought to identify herbal medicines nominated by Ugandan inpatients; compare nomination rates by ward and gender; confirm the herbs' known pharmacological properties from published literature; and identify ADRs linked to pre-admission use of herbal medicines. Prospective cohort of consented adult inpatients designed to assess medication use and ADRs on one gynaecological and three medical wards of 1790-bed Mulago National Referral Hospital. Baseline and follow-up data were obtained on patients' characteristics, including pre-admission use of herbal medicines. Fourteen percent (26/191) of females in Gynaecology nominated at least one specific herbal medicine compared with 20 % (114/571) of inpatients on medical wards [20 % (69/343) of females; 20 % (45/228) of males]. Frequent nominations were Persea americana (30), Mumbwa/multiple-herb clay rods (23), Aloe barbadensis (22), Beta vulgaris (12), Vernonia amygdalina (11), Commelina africana (7), Bidens pilosa (7), Hoslundia opposita (6), Mangifera indica (4), and Dicliptera laxata (4). Four inpatients experienced 10 suspected ADRs linked to pre-admission herbal medicine use including Commelina africana (4), multiple-herb-mumbwa (1), or unspecified local-herbs (5): three ADR-cases were abortion-related and one kidney-related. The named herbal medicines and their nomination rates generally differed by specialized ward, probably guided by local folklore knowledge of their use. Clinical elicitation from inpatients can generate valuable safety data on herbal medicine use. However, larger routine studies might increase the utility of our method to assess herbal medicine use and detect herb-linked ADRs. Future studies should take testable samples of ADR-implicated herbal medicines for further analysis.

  9. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  10. Identification and speciation of Malassezia in patients clinically suspected of having pityriasis versicolor

    Directory of Open Access Journals (Sweden)

    Avani Shah

    2013-01-01

    Full Text Available Background: Malassezia is a lipid-dependent yeast known to cause Pityriasis versicolor, a chronic, recurrent superficial infection of skin and present as hypopigmented or hyperpigmented lesions on areas of skin. If not diagnosed and treated, it may lead to disfigurement of the areas involved and also result in deep invasive infections. Aim: The aim of the present study was to identify and speciate Malassezia in patients clinically suspected of having Pityriasis versicolor. Materials and Methods: Total 139 patients suspected of having Pityriasis versicolor were evaluated clinically and diagnosis was done by Wood′s lamp examination, confirmed mycologically by using KOH, cultivation on Sabouraud′s dextrose agar and modified Dixon agar at a tertiary care hospital in Mumbai. The total duration of study was 12 months. Results: Majority of the patients were males (59.71% in the age group of 21-30 years (33.81% who were students (30.21% by profession. The incidence of Malassezia in Pityriasis versicolor was 50.35%. The most common isolate was M. globosa (48.57%, followed by M. furfur (34.28%. Majority of the patients had hypopigmented lesions, with M. globosa as the predominant isolate. Neck was the most common site affected; 88.48% were Wood′s lamp positive of which 56.91% of Malassezia isolates grew on culture. KOH mount was positive in 82.01% of which 61.40% Malassezia isolates grew on culture. Conclusions: The procedure of culture and antifungal testing is required to be performed as different species of Malassezia are involved in Pityriasis versicolor and susceptibility is different among different species. Thus, it would help to prevent recurrences and any systemic complications.

  11. Lack of uniformity in the investigation and management of suspected β-lactam allergy in children.

    Science.gov (United States)

    Foong, Ru-Xin Melanie; Logan, Kirsty; Perkin, Michael Richard; du Toit, George

    2016-08-01

    Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests (IDT) and drug provocation challenges (DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy. Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children. Eighty-one clinicians, practising in 16 countries, completed the questionnaire. There is variability in the selection of diagnostic tests used by clinicians around the world and poor agreement on positive cut-off values (sp-IgE, SPT and IDT) and practical techniques used to measure SPT or IDT wheal diameters. DPC were considered the gold standard investigation with 94% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe - only 3% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care. There is lack of consistency amongst clinicians in different countries in the diagnosis and management of suspected beta-lactam allergy. The development of a standardized approach is a priority. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Salivary levels of suspected periodontal pathogens in relation to periodontal status and treatment.

    Science.gov (United States)

    von Troil-Lindén, B; Torkko, H; Alaluusua, S; Jousimies-Somer, H; Asikainen, S

    1995-11-01

    The primary ecological niche for suspected periodontal pathogens seems to be the subgingival area, even though periodontal pathogens are also frequently recovered from saliva. The interrelationship of different periodontal conditions and the salivary levels of suspected periodontal pathogens is not known. In the present study, salivary levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus, and Peptostreptococcus micros were determined by bacterial culture and related to clinical periodontal status in 40 subjects with either advanced, moderate, or initial/no periodontitis. Culture-positive subjects harbored the 5 bacterial species in mean numbers ranging from 2 x 10(5) to 6 x 10(7) colony-forming units (CFU)/mL saliva. A. actinomycetemcomitans was found in none and P. gingivalis in one of the subjects with initial periodontitis, whereas both species were found in 33% and 44%, respectively, of the subjects with moderate periodontitis and in 60% and 40%, respectively, of the subjects with advanced periodontitis. The mean numbers of CFU/mL of P. intermedia, C. rectus and P. micros were significantly higher in subjects with advanced periodontitis than in subjects with initial/no periodontitis. Ten patients with advanced periodontitis were treated mechanically and with adjunctive systemic metronidazole, and were re-examined 1 and 6 months after treatment. Periodontal treatment eradicated or significantly reduced the levels of salivary periodontal pathogens for half a year, whereas in untreated subjects, the levels and the detection frequencies generally remained fairly stable. In conclusion, the results showed that the salivary levels of periodontal pathogens reflect the periodontal status of the patient.

  13. Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis: The MyoRacer-Trial.

    Science.gov (United States)

    Lurz, Philipp; Luecke, Christian; Eitel, Ingo; Föhrenbach, Felix; Frank, Clara; Grothoff, Matthias; de Waha, Suzanne; Rommel, Karl-Philipp; Lurz, Julia Anna; Klingel, Karin; Kandolf, Reinhard; Schuler, Gerhard; Thiele, Holger; Gutberlet, Matthias

    2016-04-19

    Data suggest that T1 and T2 mapping have excellent diagnostic accuracy in patients with suspected myocarditis. However, the true diagnostic performance of comprehensive cardiac magnetic resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been determined. This study assessed the performance of CMR imaging, including T1 and T2 mapping, compared with EMB in an unselected, consecutive patient cohort with suspected myocarditis. It also examined the potential role of CMR field strength by comparing 1.5-T versus 3.0-T imaging. Patients underwent biventricular EMB, cardiac catheterization (for exclusion of coronary artery disease), and CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis as well as native T1, calculation of extracellular volume fraction (ECV), and T2 mapping (only on 1.5-T). Patients were divided into 2 groups according to symptom duration (acute: ≤14 days vs. chronic: >14 days). A total of 129 patients underwent 1.5-T imaging. In patients with acute symptoms, native T1 yielded the best diagnostic performance as defined by the area under the curve (AUC) of receiver-operating curves (0.82) followed by T2 (0.81), ECV (0.75), and LLC (0.56). In patients with chronic symptoms, only T2 mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of native T1, ECV, and LLC were comparable to 1.5-T with no significant differences. In patients with acute symptoms, mapping techniques provide a useful tool for confirming or rejecting the diagnosis of myocarditis and are superior to the LLC. However, only T2 mapping has acceptable diagnostic performance in patients with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis [MyoRacer]; NCT02177630). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Detection of suspected placental invasion by MRI: Do the results depend on observer’ experience?

    Energy Technology Data Exchange (ETDEWEB)

    Alamo, Leonor, E-mail: leonor.alamo@chuv.ch [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Anaye, Anass; Rey, Jannick; Denys, Alban [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Bongartz, Georg [Universitätsspital Basel (Switzerland); Terraz, Sylvain [Hôpitaux Universitaires Genève (Switzerland); Artemisia, Simona; Meuli, Reto; Schmidt, Sabine [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland)

    2013-02-15

    Purpose: To evaluate the diagnostic value of previously described MR features used for detecting suspected placental invasion according to observers’ experience. Materials and methods: Our population included 25 pregnant women (mean age 35.16) investigated by prenatal MRI (1.5 T, T1- and T2-weighted MR-sequences without i.v. contrast), among them 12 with histopathologically proven placental invasion and 13 women (52%) without placental invasion used as control group. Two senior and two junior radiologists blindly and independently reviewed MR-examinations in view of 6 previously defined MR-features indicating presence and degree of placental invasion (placenta increta, accreta or percreta). For each reader the sensibility, specificity, and receiver operating curve (ROC) were calculated. Interobserver agreements between senior and junior readers were determined. Stepwise logistic regression was performed including the 6 MR-features predictive of placental invasion. Results: Demographics between both groups were statistically equivalent. Overall sensitivity and specificity for placental invasion was 90.9% and 75.0% for seniors and 81.8% and 61.8% for juniors, respectively. The best single MR-feature indicating placental invasion was T2-hypointense placental bands (r{sup 2} = 0.28), followed by focally interrupted myometrial border, infiltration of pelvic organs and tenting of the bladder (r{sup 2} = 0.36). Interobserver agreement for detecting placental invasion was 0.64 for seniors and 0.41 for juniors, thus substantial and moderate, respectively. Seniors detected placental invasion and depth of infiltration with significantly higher diagnostic certitude than juniors (p = 0.0002 and p = 0.0282, respectively). Conclusion: MRI can be a reliable and reproducible tool for the detection of suspected placental invasion, but the diagnostic value significantly depends on observers’ experience.

  15. Controlled attenuation parameter for diagnosing steatosis in bariatric surgery candidates with suspected nonalcoholic fatty liver disease.

    Science.gov (United States)

    Naveau, Sylvie; Voican, Cosmin S; Lebrun, Amandine; Gaillard, Martin; Lamouri, Karima; Njiké-Nakseu, Micheline; Courie, Rodi; Tranchart, Hadrien; Balian, Axel; Prévot, Sophie; Dagher, Ibrahim; Perlemuter, Gabriel

    2017-09-01

    Steatosis in patients with nonalcoholic fatty liver disease (NAFLD) is often benign, but may progress to fibrosis. The accurate diagnosis of hepatic steatosis is therefore important for clinical decision-making and prognostic assessments. The controlled attenuation parameter (CAP), a noninvasive measurement obtained with Fibro-Scan, has been developed for liver steatosis assessment. CAP performs poorly in patients with high BMI. The XL probe was initially developed for measuring liver stiffness in overweight patients. We assessed the diagnostic value of CAP in candidates for bariatric surgery with suspected NAFLD examined with the XL probe. For the retrospective group, raw ultrasonic radiofrequency signals were stored prospectively in the Fibro-Scan examination file for offline CAP calculation in 194 consecutive obese patients undergoing liver stiffness measurement in the 15 days before liver biopsy. For the prospective group, CAP was calculated automatically and prospectively from the XL probe in 123 obese patients. In the retrospective group, the diagnostic accuracy of CAP was satisfactory for differentiating S3 from S0-S1-S2 (0.79±0.03; 95% confidence interval: 0.71-0.84) and S3 from S0 (0.85±0.05; 95% confidence interval: 0.73-0.92). The Obuchowski measure demonstrated a very good discriminatory performance: 0.87±0.02 in the retrospective group and 0.91±0.02 in the prospective group. CAP calculations from XL probe measurements efficiently detected severe steatosis in morbidly obese patients with suspected NAFLD. However, the cutoff values should now be confirmed in a larger prospective cohort.

  16. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke.

    Science.gov (United States)

    Thomsen, Barbara; Garosi, Laurent; Skerritt, Geoff; Rusbridge, Clare; Sparrow, Tim; Berendt, Mette; Gredal, Hanne

    2016-06-07

    In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospitalisation period. A retrospective multicentre study of dogs with suspected cerebellar ischaemic stroke examined from 2010-2015 at five veterinary referral hospitals was performed. Findings from clinical, neurological, and paraclinical investigations including magnetic resonance imaging were assessed. Twenty-three dogs, 13 females and 10 males with a median age of 8 years and 8 months, were included in the study. The Cavalier King Charles Spaniel (n = 9) was a commonly represented breed. All ischaemic strokes were located to the vascular territory of the rostral cerebellar artery including four extensive and 19 limited occlusions. The most prominent neurological deficits were gait abnormalities (ataxia with hypermetria n = 11, ataxia without hypermetria n = 4, non-ambulatory n = 6), head tilt (n = 13), nystagmus (n = 8), decreased menace response (n = 7), postural reaction deficits (n = 7), and proprioceptive deficits (n = 5). Neurological signs appeared irrespective of the infarct being classified as extensive or limited. All dogs survived and were discharged within 1-10 days of hospitalisation. Dogs affected by rostral cerebellar ischaemic stroke typically present with a collection of neurological deficits characterised by ataxia, head tilt, and nystagmus irrespective of the specific cerebellar infarct topography. In dogs with peracute to acute onset of these neurological deficits, cerebellar ischaemic stroke should be considered an important differential diagnosis, and neuroimaging investigations are indicated. Although dogs are often severely compromised at presentation, short-term prognosis is excellent and rapid clinical improvement may be observed within the

  17. Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome.

    Science.gov (United States)

    Xu, Hong; Evans, Marie; Gasparini, Alessandro; Szummer, Karolina; Spaak, Jonas; Ärnlöv, Johan; Lindholm, Bengt; Jernberg, Tomas; Carrero, Juan Jesús

    2017-10-15

    We investigated the association between phosphate and the risk of adverse clinical outcomes in patients with manifest cardiovascular disease (CVD). Observational study of patients hospitalized during 2006-2011 in Stockholm, Sweden, because of suspected acute coronary syndrome (ACS). The exposure was serum phosphate during the hospitalization. We modeled the association between phosphate and in-hospital death or in-hospital events (composite of myocardial infarction, cardiogenic shock, resuscitated cardiac arrest, atrial fibrillation, or atrioventricular block) as well as the one-year post-discharge risk of death or cardiovascular event (composite of myocardial re-infarction, heart failure and stroke). Confounders included demographics, comorbidities, kidney function, diagnoses, in-hospital procedures and therapies. Included were 2547 patients (68% men, mean age 67±14years) with median phosphate of 1.10 (range 0.14-4.20) mmol/L. During hospitalization, 198 patients died and 328 suffered an adverse event. Within one year post-discharge, further 381 deaths and 632 CVD events occurred. The associations of phosphate with mortality and CVD were J-shaped, with highest risk magnitudes at higher phosphate levels. For instance, compared to patients in the 50th percentile of phosphate distribution, those above the 75th percentile (1.3mmol/L, normal range) had significantly higher odds for in-hospital death [odds ratio 1.36, 95% confidence interval (CI) (1.08-1.71)] and of CVD post-discharge [sub-hazard ratios 1.17 (1.03-1.33)]. In patients with suspected ACS, both higher and lower phosphate levels associated with increased risk of adverse outcomes during the index hospitalization and within one year post-discharge. The risk association was present already within normal-range serum phosphate values. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  18. Etiology of maculopapular rash in measles and rubella suspected patients from Belarus.

    Directory of Open Access Journals (Sweden)

    Marina A Yermalovich

    Full Text Available As a result of successful implementation of the measles/rubella elimination program, the etiology of more and more double negative cases remains elusive. The present study determined the role of different viruses as causative agents in measles or rubella suspected cases in Belarus. A total of 856 sera sent to the WHO National Laboratory between 2009 and 2011 were tested for specific IgM antibodies to measles virus (MV, rubella virus (RV and human parvovirus B19 (B19V. The negatives were further investigated for antibodies to enterovirus (EV and adenovirus (AdV. Children of up to 3 years were tested for IgM antibodies to human herpesvirus 6 (HHV6. A viral etiology was identified in 451 (52.7% cases, with 6.1% of the samples being positive for MV; 2.6% for RV; 26.2% for B19V; 9.7% for EV; 4.6% for AdV; and 3.6% for HHV6. Almost all measles and rubella cases occurred during limited outbreaks in 2011 and nearly all patients were at least 15 years old. B19V, EV and AdV infections were prevalent both in children and adults and were found throughout the 3 years. B19V occurred mainly in 3-10 years old children and 20-29 years old adults. EV infection was most common in children up to 6 years of age and AdV was confirmed mainly in 3-6 years old children. HHV6 infection was mostly detected in 6-11 months old infants. Laboratory investigation of measles/rubella suspected cases also for B19V, EV, AdV and HHV6 allows diagnosing more than half of all cases, thus strengthening rash/fever disease surveillance in Belarus.

  19. Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?

    Directory of Open Access Journals (Sweden)

    Jovan Lovrenski

    2016-05-01

    Full Text Available Objective. To compare lung ultrasound (LUS with auscultation findings in children with clinical suspicion of pneumonia. Patients and methods. A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patient’s clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial. For LUS examinations a combined transthoracic – transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC diameter was measured, and 95% confidence intervals (CI of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemar’s test. Results. LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemar’s test showed a statistically significant difference between LUS and auscultation. Conclusions. LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.

  20. Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Matthias; Dietlein, Markus; Weber, Kerstin; Moka, Detlef; Schicha, Harald [Klinik und Poliklinik fuer Nuklearmedizin, Universitaet zu Koeln, Joseph-Stelzmann-Strasse 9, 50924 Koeln (Germany); Fischer, Eva; Michel, Olaf; Stennert, Eberhard [Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenheilkunde, Universitaet zu Koeln, Koeln (Germany)

    2002-12-01

    Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [{sup 111}In-DTPA-D-Phe{sup 1}]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq {sup 111}In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further

  1. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism. Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Michaely, H.J. [Inst. fuer Klinische Radiologie und Nuklearmedizin, Universitaetsklinikum Mannheim, Univ. Heidelberg (Germany); Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany); Johnson, T.R.; Morhard, D.; Becker, C.; Reiser, M.; Nikolaou, K. [Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany)

    2008-10-15

    To evaluate the feasibility of dual-energy CT angiography (CTA) of the lung in patients with suspected pulmonary embolism (PE). 24 patients with suspected PE were examined with a single-acquisition, dual-energy CTA protocol (A-system: 140 kV/65 mAsref, B-system: 80 kV/190 mAsref) on a dual-source CT system. Lung perfusion was visualized by color-coding voxels containing iodine and air using dedicated dual-energy post-processing software. Perfusion defects were classified by two blinded radiologists as being consistent or non-consistent with PE. Subjective image quality of perfusion maps and CTA was rated using a 5-point scale (1: excellent, 5: poor). The reading of a third independent radiologist served as the standard of reference for the diagnosis of PE. In all patients with PE (n = 4), perfusion defects classified as being consistent with PE were identified in lung areas affected by PE. Both readers did not record perfusion defects classified as being consistent with PE in any of the patients without PE. Thus, on a per patient basis the sensitivity and specificity for the assessment of PE was 100% for both readers. On a per segment basis the sensitivity and specificity ranged between 60 - 66.7% and 99.5 - 99.8%. The interobserver agreement was good (k = 0.81). Perfusion defects rated as non-consistent with PE were most frequently caused by streak artifacts from dense contrast material in the great thoracic vessels. The median score of the image quality of both the perfusion maps and CTA was 2. In conclusion, dual-energy CTA of pulmonary embolism is feasible and allows the assessment of perfusion defects caused by pulmonary embolism. Further optimization of the injection protocol is required to reduce artifacts from dense contrast material. (orig.)

  2. Emergency Department Management of Suspected Calf-Vein Deep Venous Thrombosis: A Diagnostic Algorithm

    Directory of Open Access Journals (Sweden)

    Levi Kitchen

    2016-06-01

    Full Text Available Introduction: Unilateral leg swelling with suspicion of deep venous thrombosis (DVT is a common emergency department (ED presentation. Proximal DVT (thrombus in the popliteal or femoral veins can usually be diagnosed and treated at the initial ED encounter. When proximal DVT has been ruled out, isolated calf-vein deep venous thrombosis (IC-DVT often remains a consideration. The current standard for the diagnosis of IC-DVT is whole-leg vascular duplex ultrasonography (WLUS, a test that is unavailable in many hospitals outside normal business hours. When WLUS is not available from the ED, recommendations for managing suspected IC-DVT vary. The objectives of the study is to use current evidence and recommendations to (1 propose a diagnostic algorithm for IC-DVT when definitive testing (WLUS is unavailable; and (2 summarize the controversy surrounding IC-DVT treatment. Discussion: The Figure combines D-dimer testing with serial CUS or a single deferred FLUS for the diagnosis of IC-DVT. Such an algorithm has the potential to safely direct the management of suspected IC-DVT when definitive testing is unavailable. Whether or not to treat diagnosed IC-DVT remains widely debated and awaiting further evidence. Conclusion: When IC-DVT is not ruled out in the ED, the suggested algorithm, although not prospectively validated by a controlled study, offers an approach to diagnosis that is consistent with current data and recommendations. When IC-DVT is diagnosed, current references suggest that a decision between anticoagulation and continued follow-up outpatient testing can be based on shared decision-making. The risks of proximal progression and life-threatening embolization should be balanced against the generally more benign natural history of such thrombi, and an individual patient’s risk factors for both thrombus propagation and complications of anticoagulation. [West J Emerg Med. 2016;17(4384-390.

  3. Patient delay determinants for patients with suspected tuberculosis in Yogyakarta province, Indonesia.

    Science.gov (United States)

    Lock, Willem A; Ahmad, Riris A; Ruiter, Robert A C; van der Werf, Marieke J; Bos, Arjan E R; Mahendradhata, Yodi; de Vlas, Sake J

    2011-12-01

    Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks). Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed. The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance/travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time. Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector. © 2011 Blackwell Publishing Ltd.

  4. MR findings in cases of suspected impacted fracture of the femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Stiris, M.G.; Lilleaas, F.G. [Aker Hospital, Oslo (Norway). Dept. of Diagnostic Radiology

    1997-09-01

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.).

  5. [CT strategy for patients with suspected acute appendicitis; comparison of conditional and immediate CT].

    Science.gov (United States)

    Atema, Jasper J; Gans, Sarah L; van Randen, Adrienne; Laméris, Wytze; van Es, H W Wouter; van Heesewijk, Johannes P M; van Ramshorst, Bert; Bouma, Wim H; ten Hove, Wim; van Keulen, Esteban M; Dijkgraaf, Marcel G W; Bossuyt, Patrick M M; Stoker, Jaap; Boermeester, Marja A

    2015-01-01

    To compare the diagnostic accuracy of conditional CT strategy, i.e. CT if ultrasound findings are negative or inconclusive, with immediate CT strategy for patients with suspected appendicitis. Subanalysis of a prospective multicenter diagnostic accuracy study. Only data of patients with signs of appendicitis based on medical history, physical examination, and laboratory tests were analyzed. All patients underwent both ultrasound and CT. Images of each were read by different observers who were blinded to the results of the other imaging modality. The observer then selected the most likely diagnosis. These diagnoses were compared with the reference standard, i.e. final diagnoses as assigned by an expert panel based on all available data and at least 6 months of follow-up. A total of 422 patients with suspected appendicitis were included. In 251 patients the final diagnosis was acute appendicitis (59%). In 199 patients (47%), ultrasound findings were inconclusive or negative. Use of conditional CT strategy resulted in correctly identified number of correctly identified patients with appendicitis, i.e. 96% (95% CI 93-98), versus 95% identified by immediate CT (95% CI 91-97). However, conditional CT strategy resulted in more false positive diagnoses compared with immediate CT (39 versus 22), had an accompanying lower specificity of 77% (95% CI 70-83) versus 87% (95% CI 81-91), and a lower positive predictive value of 86% (95% CI 81-90) versus 92% (95% CI 87-95). Use of a conditional CT strategy results in exactly the same number of patients with correctly identified acute appendicitis while halving the number of CTs needed. However, conditional strategy results in more false positive diagnoses.

  6. Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection

    Directory of Open Access Journals (Sweden)

    Diogo Diniz Gomes Bugano

    2011-09-01

    Full Text Available Objective: To compare efficacy and safety of vancomycin versusteicoplanin in patients with proven or suspected infection.Methods: Data Sources: Cochrane Renal Group’s SpecializedRegister, CENTRAL, MEDLINE, EMBASE, nephrology textbooksand review articles. Inclusion criteria: Randomized controlled trialsin any language comparing teicoplanin to vancomycin for patientswith proven or suspected infection. Data extraction: Two authorsindependently evaluated methodological quality and extracted data.Study investigators were contacted for unpublished information. Arandom effect model was used to estimate the pooled risk ratio (RRwith 95% confidence interval (CI. Results: A total of 24 studies (2,610patients were included. The drugs had similar rates of clinical cure(RR: 1.03; 95%CI: 0.98-1.08, microbiological cure (RR: 0.98; 95%CI:0.93-1.03 and mortality (RR: 1.02; 95%CI: 0.79-1.30. Teicoplaninhad lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92, red mansyndrome (RR: 0.21; 95%CI: 0.08-0.59 and total adverse events (RR:0.73; 95%CI: 0.53-1.00. Teicoplanin reduced the risk of nephrotoxicity(RR: 0.66; 95%CI: 0.48-0.90. This effect was consistent for patientsreceiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88 or havingvancomycin doses corrected by serum levels (RR: 0.22; 95%CI:0.10-0.52. There were no cases of acute kidney injury needingdialysis. Limitations: Studies lacked a standardized definition fornephrotoxicity. Conclusions: Teicoplanin and vancomycin are equallyeffective; however the incidence of nephrotoxicity and other adverseevents was lower with teicoplanin. It may be reasonable to considerteicoplanin for patients at higher risk for acute kidney injury.

  7. Treatment with epinephrine (adrenaline) in suspected anaphylaxis during anesthesia in Denmark.

    Science.gov (United States)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens; Husum, Bent; Malling, Hans-Jørgen; Mosbech, Holger

    2011-07-01

    Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.

  8. Emergency physician performed tricuspid annular plane systolic excursion in the evaluation of suspected pulmonary embolism.

    Science.gov (United States)

    Daley, James; Grotberg, John; Pare, Joseph; Medoro, Amanda; Liu, Rachel; Hall, Michael Kennedy; Taylor, Andrew; Moore, Christopher L

    2017-01-01

    The primary objectives were to describe the diagnostic characteristics tricuspid annular plane systolic excursion (TAPSE) for pulmonary embolism (PE) and to optimize the measurement cutoff of TAPSE for the diagnosis of PE. Secondary objectives included assessment of interrater reliability and the quantitative visual estimation of TAPSE. This is a prospective observational cohort study involving a convenience sample of patients at an urban academic emergency department. Patients underwent focused right heart echocardiogram (FOCUS) before computed tomographic angiography (CTA) for suspected PE. A total of 150 patients were enrolled, 32 of whom (21.3%) were diagnosed as having a PE. A receiver operating characteristic curve analysis yielded 2.0 cm as the optimal cutoff for TAPSE in the diagnosis of PE, with a sensitivity of 72% (95% confidence interval [CI], 53-86), a specificity of 66% (95% CI, 57-75), and an area under the curve of 0.73 (95% CI, 0.65-0.83). In patients with tachycardia or hypotension, post hoc analysis demonstrated that FOCUS is 100% (95% CI, 80-100) sensitive for PE, whereas TAPSE is 94% (95% CI, 71-99) sensitive for PE. The intraclass correlation coefficient was 0.87 (95% CI, 0.79-0.93). Emergency physicians with training in echocardiography accurately visually estimated TAPSE, with a κ statistic of 0.94 (95% CI, 0.87-0.98). Emergency physicians with training in echocardiography can reliably measure TAPSE and are able to accurately visually estimate TAPSE as either normal or abnormal. When using an abnormal cutoff of less than 2.0 cm, TAPSE has moderate diagnostic value in patients with suspected PE. On post hoc analysis, TAPSE and FOCUS appear to be highly sensitive for PE in patients with tachycardia or hypotension. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Short and long-term outcomes in children with suspected acute encephalopathy.

    Science.gov (United States)

    Nishiyama, Masahiro; Nagase, Hiroaki; Tanaka, Tsukasa; Fujita, Kyoko; Kusumoto, Mayumi; Kajihara, Shinsuke; Yamaguchi, Yoshimichi; Maruyama, Azusa; Takeda, Hiroki; Uetani, Yoshiyuki; Tomioka, Kazumi; Toyoshima, Daisaku; Taniguchi-Ikeda, Mariko; Morioka, Ichiro; Takada, Satoshi; Iijima, Kazumoto

    2016-09-01

    The time-dependent changes that occur in children after acute encephalopathy are not clearly understood. Therefore, we assessed changes in brain function after suspected acute encephalopathy over time. We created a database of children admitted to the pediatric intensive care unit at Kobe Children's Hospital because of convulsions or impaired consciousness with fever between 2002 and 2013. Clinical courses and outcomes were reviewed and patients who met the following criteria were included in the study: (1) 6months to 15years of age, (2) no neurological abnormality before onset, (3) treated for suspected acute encephalopathy, and (4) followed after 1 (0-2) month and 12 (10-17) months of onset. Outcomes were assessed using the Pediatric Cerebral Performance Category (PCPC) scale, with a score of 1 representing normal performance; 2, mild disability; 3, moderate disability; 4, severe disability; 5, vegetative state; and 6, brain death. A total of 78 children (32 male) with a median (range) age at onset of 20 (6-172) months were enrolled. Fifty-one cases scored 1 on the PCPC, 13 scored 2, three scored 3, five scored 4, one scored 5, and five cases scored 6 at discharge. Whereas seven of the 13 cases that scored a 2 on the PCPC recovered normal brain function after 12months, none of the nine cases that scored a 3-5 on the PCPC recovered normal function. Our findings suggest moderate to severe disability caused by acute encephalopathy had lasting consequences on brain function, whereas mild disability might result in improved function. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  10. Exogenous pigment in Peyer patches of children suspected of having IBD.

    Science.gov (United States)

    Hummel, Thalia Z; Kindermann, Angelika; Stokkers, Pieter C F; Benninga, Marc A; ten Kate, Fiebo J W

    2014-04-01

    The base of human Peyer patches of the terminal ileum has been noted to contain black granular pigment deposits, composed of titanium dioxide and aluminosilicate, which are food additives typically present in a Western diet, and pharmaceuticals. In the present study, we investigated the distribution of exogenous pigment throughout the gastrointestinal tract of children suspected of having inflammatory bowel disease (IBD), the correlation between their age and the presence and amount of pigment in Peyer patches, and its relation to pediatric IBD. Biopsies (upper and lower gastrointestinal tract) from children suspected of having IBD who underwent endoscopy, were reassessed by a blinded, expert pathologist. The amount of pigment in biopsies was scored using a semiquantitative scale (range 0 to +++). A total of 151 children were included: 62 with Crohn disease (CD), 26 with ulcerative colitis, and 63 with non-IBD. In 63 children (42%), deposits of black pigment were found only in biopsies from the terminal ileum, located in Peyer patches. A significant correlation was found between increasing age and the amount of pigment (P = 0.004). Pigment deposits were found significantly less in the patients with CD compared with those in patients with ulcerative colitis and those with non-IBD (26% vs 62% and 49%, P = 0.002). These results provide support for the hypothesis that the amount of pigment, only present in Peyer patches in the terminal ileum, becomes denser with increasing age. Absence of pigment in Peyer patches in a higher number of patients with CD suggests that microparticles may have become involved in the inflammatory process, possibly because of disrupted autophagy.

  11. The prevalence of marijuana in suspected impaired driving cases in Washington state.

    Science.gov (United States)

    Couper, Fiona J; Peterson, Brianna L

    2014-10-01

    In December 2012, the possession and private use of limited quantities of marijuana and marijuana products became legal in the state of Washington. At the same time, the state's driving under the influence statutes were amended to include a per se level of 5 ng/mL delta(9)-tetrahydrocannabinol (THC) in whole blood for drivers aged 21 years and older. The aim of this study was to assess the effect of marijuana legalization on the prevalence of marijuana in suspected impaired driving cases. The prevalence of both active THC and its metabolite carboxy-THC detected in such cases pre-legalization was compared with the prevalence post-legalization. In 2009-2012, the average yearly percentage of cases positive for THC and carboxy-THC was 19.1% (range: 18.2-20.2%) and 27.9% (range: 26.3-28.6%), respectively. In 2013, the percentages had significantly increased to 24.9 and 40.0%, respectively (P 5 ng/mL over the 5-year period. The prevalence of alcohol and the majority of other drugs in this same population of suspected impaired drivers submitted for testing did not change during this same 5-year period-marijuana was the only drug to show such an increase in frequency. Further, this observed increase remained after the data had been normalized to account for changes in laboratory testing procedures that occurred during this time period. Future studies need be conducted to ascertain whether the observed increase has had any effect on the incidence of crashes, serious injuries and/or traffic fatalities. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Characterization of Mammographic Masses Based on Level Set Segmentation with New Image Features and Patient Information

    Science.gov (United States)

    Shi, Jiazheng; Sahiner, Berkman; Chan, Heang-Ping; Ge, Jun; Hadjiiski, Lubomir; Helvie, Mark A.; Nees, Alexis; Wu, Yi-Ta; Wei, Jun; Zhou, Chuan; Zhang, Yiheng; Cui, Jing

    2009-01-01

    Computer-aided diagnosis (CAD) for characterization of mammographic masses as malignant or benign has the potential to assist radiologists in reducing the biopsy rate without increasing false negatives. The purpose of this study was to develop an automated method for mammographic mass segmentation and explore new image based features in combination with patient information in order to improve the performance of mass characterization. Our previous CAD system, which used the active contour segmentation, and morphological, textural, and spiculation features, has achieved promising results in mass characterization. The new CAD system is based on the level set method, and includes two new types of image features related to the presence of microcalcifications with the mass and abruptness of the mass margin, and patient age. A linear discriminant analysis (LDA) classifier with stepwise feature selection was used to merge the extracted features into a classification score. The classification accuracy was evaluated using the area under the receiver operating characteristic curve. Our primary data set consisted of 427 biopsy-proven masses (200 malignant and 227 benign) in 909 regions of interest (ROIs) (451 malignant and 458 benign) from multiple mammographic views. Leave-one-case-out resampling was used for training and testing. The new CAD system based on the level set segmentation and the new mammographic feature space achieved a view-based Az value of 0.83±0.01. The improvement compared to the previous CAD system was statistically significant (p=0.02). When patient age was included in the new CAD system, view-based and case-based Az values were 0.85±0.01 and 0.87±0.02, respectively. The performance of the new CAD system was also compared to an experienced radiologist’s likelihood of malignancy rating. When patient age was used in classification, the accuracy of the new CAD system was comparable to that of the radiologist (p=0.34). The study also demonstrated the

  13. The Sexual Stratification Hypothesis: Is the Decision to Arrest Influenced by the Victim/Suspect Racial/Ethnic Dyad?

    Science.gov (United States)

    O'Neal, Eryn Nicole; Beckman, Laura O; Spohn, Cassia

    2016-05-24

    The sexual stratification hypothesis suggests that criminal justice responses to sexual victimization will differ depending on the victim/suspect racial/ethnic dyad. Previous research examining the sexual stratification hypothesis has primarily focused on court processes, and the small body of literature examining arrest decisions is dated. There remains substantial opportunity for testing the sexual stratification hypothesis at response stages apart from the court level (i.e., arrest). Using quantitative data on 655 sexual assault complaints that were reported to the Los Angeles County Sherriff's Department (LASD) and the Los Angeles Police Department (LAPD) in 2008, this study examines the effect of the victim/suspect racial/ethnic dyad on the decision to arrest. Findings suggest that police consider the victim/suspect racial/ethnic dyad when making arrest decisions. In addition, victim characteristics, strength of evidence indicators, and measures of case factors predict the police decision to make an arrest. © The Author(s) 2016.

  14. Influence on intraocular pressure of the postural change and daily activities in the early morning in suspected glaucoma patients

    Directory of Open Access Journals (Sweden)

    Ting Chen

    2014-05-01

    Full Text Available AIM:To evaluate the influence on intraocular pressure(IOPof the postural change and daily activities in the early morning in suspected glaucoma patients.METHODS:The supine and sitting IOP were measured and analyzed on 51 suspected glaucoma patients(100 eyeswith Icare rebound tonometer before and after getting up and daily activities in the early morning. RESULTS: The mean of sitting IOP of 51 patients was 17.12±4.53mmHg, which was significantly lower than the mean of supine IOP(19.14±5.51mmHg. The mean of IOP before and after daily activity of 51 patients were 17.12±4.53mmHg and 14.44±3.90mmHg respectively, which showed significantly difference. CONCLUSION:Postural change and daily activities can result in significant changes of IOP in suspected glaucoma patients.

  15. Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study.

    Science.gov (United States)

    Hsu, Sheng-Der; Chen, Cheng-Jueng; Chou, Yu-Ching; Wang, Sheng-Hao; Chan, De-Chuan

    2017-10-12

    We aimed to evaluate the effect of early pelvic binder use in the emergency management of suspected pelvic trauma, compared with the conventional stepwise approach. We enrolled trauma patients with initial stabilization using a pelvic binder when suspecting pelvic injury. The inclusion criteria were traumatic injury requiring a trauma team and at least one of the following: a loss of consciousness or a Glasgow coma score (GCS) of binder had shorter hospital and intensive care unit (ICU) stays. The study group achieved statistically significantly improved survival and lower mean blood transfusion volume and mortality rate, although they were more severe in the trauma score. We recommend prompt pelvic binder use for suspected pelvic injury before definitive imaging is available, as a cervical spine collar is used to protect the cervical spine from further injury prior to definitive identification and characterization of an injury.

  16. Audit of aspects of practice in relation to patients with suspected community-onset blood stream infection.

    Science.gov (United States)

    Reza, M A; Cormican, M

    2017-11-01

    Community-onset blood stream infection (C-BSI) is an important cause of sepsis. The urinary tract is an important source for C-BSI. Urinary catheters are a recognized risk factor. Blood culture is the critical diagnostic test. Prompt effective antimicrobial therapy is a key intervention. We reviewed practice in relation to patients presenting with suspected C-BSI. To review practice in relation to patients presenting with suspected C-BSI. Patients were those with blood cultures (BC) submitted from the emergency department over 4 weeks. Details were recorded from laboratory and patient records. Data were analysed in SPSS. BC were taken from 201 patients. Suspected source was respiratory (32.8%), urine (14.9%) or other (52.3%). 9 (4.5%) patients had urine catheters. Urine was the suspected source of infection in five of these. Bacteriuria was present in seven of these nine from whom urine samples were submitted though it was polymicrobial in all but 2. Median time from registration to first administration of an antimicrobial was 226 min and was broadly guideline compliant in 121 (80.7%) of 151 patients who received treatment. BC were positive in 17 (8.5%) of which 10 (5.0%) were significant (mainly Escherichia coli). Suspected C-BSI is common. E. coli is the leading pathogen. Urine is a common suspect source. Urinary catheters are present in 4.5%. Median time to first dose of antimicrobial treatment is almost 4 h suggesting scope to expedite patients transition from presentation to intervention.

  17. Predictors of increasing injury severity across suspected recurrent episodes of non-accidental trauma: a retrospective cohort study.

    Science.gov (United States)

    Thackeray, Jonathan; Minneci, Peter C; Cooper, Jennifer N; Groner, Jonathan I; Deans, Katherine J

    2016-01-16

    Little is known about how the severity of injury changes with recurrent events of suspected non-accidental trauma (NAT). Our objective was to determine risk factors for escalating severity of injury in children with multiple events of suspected NAT. This retrospective longitudinal cohort study included children from a pediatric Medicaid accountable care organization with ≥ 1 non-birth related episode containing an International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology code for NAT or a skeletal survey between 2007 and 2011. Subsequent potential NAT events were defined as independent episodes with codes for either NAT, a skeletal survey, or injuries suspicious for abuse. Severity of injury was calculated using the New Injury Severity Score (NISS). Multivariable Cox proportional hazards regression modeling was used with results expressed as hazard ratios and 95 % confidence intervals. Of the 914 children with at least one suspected NAT event, 39 % had at least one suspected recurrent NAT event; 12 % had 2 events and 5 % had ≥ 3 events during follow-up. Factors associated with an increased risk for a recurrent episode of suspected NAT with higher NISS were living in a rural area (1.69, 1.02-2.78, p = 0.04) and having an open wound (2.12, 1.24-3.62, p = 0.006), or superficial injury (2.28, 1.31-3.98, p = 0.004). In contrast, a greater number of injuries was associated with a decreased risk for a recurrent episode of suspected NAT with higher NISS (p injuries are either not reported to child protective services or not removed from the unsafe environment with either situation leading to subsequent events. The medical and child welfare systems need to better identify these potential victims of recurrent events..

  18. Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: Survey of patients seen in general practice

    Directory of Open Access Journals (Sweden)

    Skarphedinsson Sigurdur

    2010-11-01

    Full Text Available Abstract Background Serological testing for Lyme borreliosis (LB is frequently requested by general practitioners for patients with a wide variety of symptoms. Methods A survey was performed in order to characterize test utilization and clinical features of patients investigated for serum antibodies to Borrelia burgdorferi sensu lato. During one calendar year a questionnaire was sent to the general practitioners who had ordered LB serology from patients in three Danish counties (population 1.5 million inhabitants. Testing was done with a commercial ELISA assay with purified flagella antigen from a Danish strain of B. afzelii. Results A total of 4,664 patients were tested. The IgM and IgG seropositivity rates were 9.2% and 3.3%, respectively. Questionnaires from 2,643 (57% patients were available for analysis. Erythema migrans (EM was suspected in 38% of patients, Lyme arthritis/disseminated disease in 23% and early neuroborreliosis in 13%. Age 0-15 years and suspected EM were significant predictors of IgM seropositivity, whereas suspected acrodermatitis was a predictor of IgG seropositivity. LB was suspected in 646 patients with arthritis, but only 2.3% were IgG seropositive. This is comparable to the level of seropositivity in the background population indicating that Lyme arthritis is a rare entity in Denmark, and the low pretest probability should alert general practitioners to the possibility of false positive LB serology. Significant predictors for treating the patient were a reported tick bite and suspected EM. Conclusions A detailed description of the utilization of serology for Lyme borreliosis with rates of seropositivity according to clinical symptoms is presented. Low rates of seropositivity in certain patient groups indicate a low pretest probability and there is a notable risk of false positive results. 38% of all patients tested were suspected of EM, although this is not a recommended indication due to a low sensitivity of

  19. Survey of laboratory findings in suspected cases of bovine spongiform encephalopathy in Denmark from 1990 to 2000

    DEFF Research Database (Denmark)

    Agerholm, J.S.; Tegtmeier, C.L.; Nielsen, T.K.

    2002-01-01

    . A total of 176 submissions were made, mostly from bovines with neurological disorders and mainly during the last 3 years of this period. Lesions or other laboratory findings consistent with severe neurological disorders were found in 115 cases. The most frequent diagnosis was encephalic 41 p listeriosis......A survey of the laboratory findings in suspected cases of bovine spongiform encephalopathy (BSE) in Denmark from I June 1990 to '31 December 2000 is presented. During this period BSE was a notifiable disease, and the heads of suspected cases were submitted according to the legislation on BSE...

  20. Overview of suspected adverse reactions to veterinary medicinal products reported in South Africa (March 2002 – February 2003

    Directory of Open Access Journals (Sweden)

    V. Naidoo

    2003-07-01

    Full Text Available The Veterinary Pharmacovigilance and Medicines Information Centre is responsible for the monitoring of veterinary adverse drug reactions in South Africa. An overview of reports of suspected adverse drug reactions received by the centre during the period March 2002 to February 2003 is given. In total, 40 reports were received. This had declined from the previous year. Most reports involved suspected adverse reactions that occurred in dogs and cats. Most of the products implicated were Stock Remedies. The animal owner predominantly administered these products. Only 1 report was received from a veterinary pharmaceutical company. Increasing numbers of reports are being received from veterinarians.