Sample records for factors clinical presentation

  1. Recurrent erysipelas - risk factors and clinical presentation

    PubMed Central

    2014-01-01

    Background Erysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. In the present study we aimed at clarifying predisposing conditions for reoccurrence. Methods Medical records were reviewed from all patients ?18 years of age diagnosed with erysipelas at the Department of Infectious Diseases at Skåne University Hospital, Sweden, from January 2007 to February 2011. 502 patients were included, of which 357 were single episode erysipelas and 145 had recurrent erysipelas. These two groups were compared regarding underlying conditions and clinical presentation. Results Erysipelas in the lower limbs had the greatest propensity of recurrence. The associations between underlying conditions and recurrence were largely depending on the site of erysipelas. Overall, the most prominent risk factor for recurrence was lymphedema and other conditions causing a chronic impairment of the defence against microbes. Conditions temporarily disrupting the skin barrier (e.g. a local wound or toe web intertrigo), although likely being risk factors for erysipelas per se, did not seem to predispose to repeated episodes. Individuals with recurrent erysipelas tended to seek medical attention earlier, and were less likely to be hospitalized or receive intravenous antibiotics, but there was no evidence of any difference in inflammatory reaction when taking confounding factors into account. Conclusions In this large cross-sectional study of over 500 patients with erysipelas, lymphedema was the most prominent risk factors for recurrence although the distribution of predisposing conditions varies depending on the site of erysipelas. PMID:24884840

  2. Peritoneal Perforation of Liver Hydatid Cysts: Clinical Presentation, Predisposing Factors, and Surgical Outcome

    Microsoft Academic Search

    Alper Akcan; Hizir Akyildiz; Tarik Artis; Ahmet Ozturk; Mehmet Ali Deneme; Engin Ok; Erdogan Sozuer

    2007-01-01

    The aim of this study was to evaluate the clinical presentation of, predisposing factors in, and early and long-term outcome\\u000a of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. Medical records of 27 patients with traumatic\\u000a rupture of hydatid cysts were evaluated retrospectively, as were records of 347 patients with nonperforated hydatid cysts.\\u000a The ratio of perforation cases to

  3. Impact of atherosclerosis risk factors on the clinical presentation of arterial occlusive disease in Arabic patients

    PubMed Central

    Elsharawy, Mohamed A; Alkhadra, Akram H; Ibrahim, Mohammed Fakhary A; Selim, Fathi; Hassan, Khairy; Elsaid, Aymen S; Bahnassy, Ahmed

    2008-01-01

    BACKGROUND: Although the risk factors for atherosclerosis have been identified, their impact on the presentation of arterial occlusive disease has not been studied among Arabs. OBJECTIVE: To determine the correlation between atherosclerotic risk factors and the extent and presentation of atherosclerotic disease in different arterial systems. METHODS: The present case-control study was performed on a consecutive series of Arabic patients over one year. There were two groups – an atherosclerotic group, which included patients with peripheral arterial disease, extracranial cerebrovascular disease or coronary artery disease (CAD), and the control group, which included patients admitted to one of the general surgical units who were free from atherosclerotic disease. All patients underwent evaluation of risk factors (diabetes mellitus [DM], smoking, dyslipidemia and hypertension) for atherosclerosis and systemic assessment of the vascular tree. RESULTS: Two hundred fifteen patients in the atherosclerotic group and 191 patients in the control group were included in the study. There were positive correlations between the prevalence of DM, smoking, dyslipidemia and the severity of presentation of peripheral arterial disease, and the extent of CAD. The correlation between the incidence of DM and the severity of presentation of CAD was also significant. The correlation was also positive between the incidence of ex-smoking and hypertension, and the severity of presentation of extracranial cerebrovascular disease. CONCLUSION: Different risk factors may interact in different ways in the clinical presentation of atherosclerotic disease in different arterial systems. PMID:22477450

  4. Peritoneal perforation of liver hydatid cysts: clinical presentation, predisposing factors, and surgical outcome.

    PubMed

    Akcan, Alper; Akyildiz, Hizir; Artis, Tarik; Ozturk, Ahmet; Deneme, Mehmet Ali; Ok, Engin; Sozuer, Erdogan

    2007-06-01

    The aim of this study was to evaluate the clinical presentation of, predisposing factors in, and early and long-term outcome of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. Medical records of 27 patients with traumatic rupture of hydatid cysts were evaluated retrospectively, as were records of 347 patients with nonperforated hydatid cysts. The ratio of perforation cases to nonperforation cases was 7.8%. Traffic accidents were the most common cause of perforation (n = 16). All patients had abdominal findings, and two patients (7%) had anaphylactic findings. The sensitivities of computed tomography and ultrasonography were 100% and 93%, respectively. Conservative surgical procedures were used for 80.5% of cysts and radical procedures for 19.5%. Associated organ injuries were determined in 10 patients. No significant difference was found between patients with peritoneal perforation and those without perforation in terms of sex (p = 0.403), previous hydatid disease surgery (p = 0.565), localization (p = 0.241), number of cysts (p = 0.537), presence of cystic content infection (p = 0.65), or presence of bile duct communication (p = 0.37). However, there were significant differences in age (p = 0.004), cyst diameter ( > 10 cm) (p = 0.03), and presence of superficially localized cysts (p = 0.011). Three patients developed recurrence. In the group of patients with perforation, the complication and recurrence rates were not statistically different in a comparison of surgical techniques (p = 0.37). No postoperative deaths occurred. The main predisposing factors for cyst perforation are young age and superficial localization. Peritoneal rupture increases the rates of postoperative morbidity and recurrence; in contrast, there was no significant relation between the operative procedure and the morbidity and recurrence rates. PMID:17464537

  5. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation.

    PubMed

    Lemaignen, A; Birgand, G; Ghodhbane, W; Alkhoder, S; Lolom, I; Belorgey, S; Lescure, F-X; Armand-Lefevre, L; Raffoul, R; Dilly, M-P; Nataf, P; Lucet, J C

    2015-07-01

    The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC-positive SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC-negative SSI, 2.1%). Median time to reoperation for CDC-negative SSI was 18 days (interquartile range, 14-26) and 16 (interquartile range, 11-24) for CDC-positive SSI (p 0.02). Microorganisms associated with CDC-negative SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%); only six were due to Staphylococcus aureus (4%), while CDC-positive SSI were mostly due to S. aureus (52/145, 36%) and germs from the digestive tract (52/145, 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical preoperative state, postoperative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries in female patients. The number of internal thoracic arteries used and factors affecting wound healing were primarily associated with CDC-negative SSI, whereas comorbidities and perioperative complications were mainly associated with CDC-positive SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. PMID:25882356

  6. Lacaziosis - unusual clinical presentation.

    PubMed

    Sousa, Pétra Pereira de; Schettini, Antonio Pedro Mendes; Rodrigues, Carlos Alberto Chirano; Westphal, Danielle Cristine

    2015-01-01

    Lacaziosis or Jorge Lobo's disease is a fungal, granulomatous, chronic infectious disease caused by Lacazia loboi, which usually affects the skin and subcutaneous tissue. It is characterized by slow evolution and a variety of cutaneous manifestations with the most common clinical expression being nodular keloid lesions that predominate in exposed areas. We report the case of a patient who had an unusual clinical presentation, with a single-plated lesion on the back. Histopathological examination confirmed the diagnosis of Lacaziosis. PMID:25831004

  7. Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases.

    PubMed

    Rahman, K M; Sarker, C B; Mohammad, Q D; Dhar, D K; Hossain, M S; Siddiqui, M N I; Alam, K S

    2002-07-01

    Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases. PMID:12395682

  8. Is Diabetes a Risk Factor for a Severe Clinical Presentation of Dengue? - Review and Meta-analysis

    PubMed Central

    Htun, Nan Shwe Nwe; Odermatt, Peter; Eze, Ikenna C.; Boillat-Blanco, Noémie; D’Acremont, Valérie; Probst-Hensch, Nicole

    2015-01-01

    Background The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue. Methodology/Findings A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08–2.84, p = 0.022). Conclusions/Significance Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. PMID:25909658

  9. Risk Factors and Clinical Presentation of Cervical Arterial Dissection: Preliminary Results of a Prospective Case-Control Study.

    PubMed

    Thomas, Lucy C; Rivett, Darren A; Attia, John R; Levi, Christopher

    2015-07-01

    Study Design Cross-sectional case-control study. Objectives To identify risk factors and clinical presentation of individuals with cervical arterial dissection. Background Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment. Methods Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken. Results Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection. Conclusion Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2015;45(7):503-511. Epub 21 May 2015. doi:10.2519/jospt.2015.5877. PMID:25996363

  10. Meningitis, clinical presentation of tetanus.

    PubMed

    Moniuszko, Anna; Zajkowska, Agata; Tumiel, Ewa; Rutkowski, Krzysztof; Czupryna, Piotr; Pancewicz, S?awomir; Rutkowski, Ryszard; Zdrodowska, Agnieszka; Zajkowska, Joanna

    2015-01-01

    Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease. PMID:25789186

  11. Meningitis, Clinical Presentation of Tetanus

    PubMed Central

    Moniuszko, Anna; Zajkowska, Agata; Tumiel, Ewa; Rutkowski, Krzysztof; Pancewicz, S?awomir; Rutkowski, Ryszard; Zdrodowska, Agnieszka; Zajkowska, Joanna

    2015-01-01

    Background. Tetanus is an acute disease caused by a neurotoxin produced by Clostridium tetani. Tetanus immunization has been available since the late 1930s but sporadic cases still occur, usually in incompletely vaccinated or unvaccinated individuals. Case Report. An elderly previously vaccinated female contracted tetanus following foot injury. Clinically she presented with meningitis causing diagnostic and therapeutic delays. Why Should Physician Be Aware of This? Even in developed countries the differential diagnosis of meningitis, especially in the elderly, should include tetanus. Treatment in intensive care unit is required. General population might benefit from vaccine boosters and education on this potentially fatal disease. PMID:25789186

  12. Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

    PubMed Central

    Beidas, Rinad S.; Suarez, Liza; Simpson, David; Read, Kendra; Wei, Chiaying; Connolly, Sucheta; Kendall, Philip

    2012-01-01

    The current study compared ethnic minority and European Americanclinically-referred anxious youth (N = 686; 2–19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed. PMID:22410093

  13. The clinical presentation of chronic traumatic encephalopathy.

    PubMed

    Lenihan, Michael W; Jordan, Barry D

    2015-05-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder attributed to repetitive mild traumatic brain injury. The diagnosis in a living individual can be challenging and can be made definitively only at autopsy. The symptoms are often nonspecific and overlap with neurodegenerative disorders such as Alzheimer's disease (AD) and frontotemporal dementia (FTD). Higher exposure to repetitive head trauma increases the risk of CTE. Genetic risk factors such as presence of an apolipoprotein E ?4 allele may be important. Individuals have varying degrees of cognitive, behavioral, and motor decline. Limitations in the manner in which data have been obtained over the years have led to different clinical descriptions of CTE. At present, there are no biomarkers to assist in the diagnosis. Standard neuroimaging may show nonspecific atrophic changes; however, newer imaging modalities such as positron emission tomography (PET) and diffusion tensor imaging (DTI) show promise. Neuropsychological testing may be helpful in determining the pattern of cognitive or behavioral decline. PMID:25772999

  14. Juvenile Idiopathic Arthritis: Classification, Clinical Presentation and Current Treatments

    Microsoft Academic Search

    Günther E. Dannecker; Pierre Quartier

    2009-01-01

    Background: The term juvenile idiopathic arthritis (JIA) describes a clinically heterogeneous group of arthritides. The onset in all subgroups is before 16 years of age, but each group presents with different clinical signs and symptoms. The cause of the disease is unknown, but both genetic and environmental factors are believed to be involved. Management of the disease has greatly improved

  15. The different clinical presentations of vasovagal syncope.

    PubMed

    Alboni, Paolo

    2015-05-01

    For some decades, after the introduction of the head-up tilt test into clinical practice, the clinical presentation of vasovagal syncope (VVS) has been classified as typical (or classical) and atypical (or non-classical). Some clinical features and recent data suggest that even unexplained falls and syncope during sleeping hours may be possible clinical presentations of VVS. In recent studies, tilt testing and carotid sinus massage by means of the 'method of symptoms' were performed in one group of patients with unexplained falls and in another group with unexplained syncope (presence of prodromal symptoms). Overall, tilt testing and carotid sinus massage displayed a high positivity rate in the group of patients with unexplained falls (about 60%), which was similar to that of the unexplained syncope group. These new data seem to indicate that some unexplained falls could be cases of atypical VVS/carotid sinus syncope with retrograde amnesia. Some clinical features suggest that syncope during sleeping hours is a form of VVS with a different clinical presentation: high prevalence of autonomic prodromes, of diurnal episodes of typical VVS and specific phobias, and of positive tilt testing with severe cardioinhibition. PMID:25792719

  16. [Lumbar spinal stenosis. Classification and clinical presentation].

    PubMed

    van Akkerveeken, P F

    1993-08-01

    A review is presented of the nomenclature, taxonomy and clinical presentation of the lumbar canal and lateral stenosis. A historical review of the literature illustrates the growing importance of this clinical entity in the narrow spinal canal. The definition of Verbiest is introduced and explained. It distinguishes two main groups of spinal stenosis: congenital and developmental stenosis. Developmental stenosis contains several subgroups. Special attention is paid to "central" lumbar canal stenosis and lateral spinal stenosis. Both entities are discussed with a description of the etiology, anatomy, and symptomatology. The importance of nerve root infiltration as a diagnostic tool in asymptomatic radiculopathy is emphasized. PMID:8414475

  17. Clinical presentation of chronic traumatic encephalopathy

    PubMed Central

    Daneshvar, Daniel H.; Baugh, Christine M.; Seichepine, Daniel R.; Montenigro, Philip H.; Riley, David O.; Fritts, Nathan G.; Stamm, Julie M.; Robbins, Clifford A.; McHale, Lisa; Simkin, Irene; Stein, Thor D.; Alvarez, Victor E.; Goldstein, Lee E.; Budson, Andrew E.; Kowall, Neil W.; Nowinski, Christopher J.; Cantu, Robert C.; McKee, Ann C.

    2013-01-01

    Objective: The goal of this study was to examine the clinical presentation of chronic traumatic encephalopathy (CTE) in neuropathologically confirmed cases. Methods: Thirty-six adult male subjects were selected from all cases of neuropathologically confirmed CTE at the Boston University Center for the Study of Traumatic Encephalopathy brain bank. Subjects were all athletes, had no comorbid neurodegenerative or motor neuron disease, and had next-of-kin informants to provide retrospective reports of the subjects' histories and clinical presentations. These interviews were conducted blind to the subjects' neuropathologic findings. Results: A triad of cognitive, behavioral, and mood impairments was common overall, with cognitive deficits reported for almost all subjects. Three subjects were asymptomatic at the time of death. Consistent with earlier case reports of boxers, 2 relatively distinct clinical presentations emerged, with one group whose initial features developed at a younger age and involved behavioral and/or mood disturbance (n = 22), and another group whose initial presentation developed at an older age and involved cognitive impairment (n = 11). Conclusions: This suggests there are 2 major clinical presentations of CTE, one a behavior/mood variant and the other a cognitive variant. PMID:23966253

  18. Clinical Linguistics: Its Past, Present and Future

    ERIC Educational Resources Information Center

    Perkins, Michael R.

    2011-01-01

    Historiography is a growing area of research within the discipline of linguistics, but so far the subfield of clinical linguistics has received virtually no systematic attention. This article attempts to rectify this by tracing the development of the discipline from its pre-scientific days up to the present time. As part of this, I include the…

  19. Growth factors from genes to clinical application

    SciTech Connect

    Sara, V.R. (Dept. of Pathology, Karolinska Hospital, Stockholm (SE)); Hall, K.; Low, H. (Dept. of Endocrinology, Karolinska Hospital, Stockholm (SE))

    1990-01-01

    The last decade has witnessed an explosion in the identification of growth factors and their receptors. This has been greatly facilitated by recombinant DNA technology, which has provided the tools not only to identify these proteins at the gene level but also to produce recombinant proteins for evaluating their biological activities. With the help of such techniques, we are moving toward an understanding of the biosynthesis of growth factors and their receptors, structure-function relationships, as well as mechanisms for intracellular signal transmission. The possibility of modifying these factors has opened new fields of clinical application. In this paper, four major areas of growth factor research are presented: the characterization of growth factor genes and their protein products, growth factor receptors and signal transduction by the receptors to mediate biological action, the biological actions of the various growth factors, and the role of growth factors in health and disease and their possible clinical application. Some of the topics covered include: structure of the IGFs and their variants; isoforms of PDGF receptor types; tyrosine kinase activation; structure of G-proteins in biological membranes; possible therapeutic application of NGF in the treatment of Parkinson's and Alzheimer's diseases; PDGF's possible role in the development of several fibroproliferative diseases and its therapeutic application in wound healing; and the possible use of angiogenic inhibitors in tumor treatment.

  20. Diagnosis and clinical presentation of osteoarthritis.

    PubMed

    Abhishek, A; Doherty, Michael

    2013-02-01

    Osteoarthritis (OA), the commonest arthropathy, targets the knees, hips, finger interphalangeal joints, thumb bases, first metatarsophalangeal joints, and spinal facet joints, and displays marked heterogeneity of clinical presentation. Signs of OA include coarse crepitus, bony enlargement, reduced range of movement, and joint-line tenderness. Muscle wasting and joint deformity occur with severe OA. Painful periarticular disorders often coexist with OA. Inflammation is absent or only modest, although mild-moderate effusions are common at the knee. The diagnosis of OA may be made without recourse to radiographic or laboratory investigations in the at-risk age group with typical symptoms and signs. PMID:23312410

  1. Pituitary autoimmune disease: nuances in clinical presentation.

    PubMed

    Glezer, A; Bronstein, M D

    2012-08-01

    Pituitary autoimmune disease is considered an autoimmune organ-specific disorder, characterized by a pituitary infiltration of lymphocytes, macrophages, and plasma cells that could lead to loss of pituitary function. Hypophysitis may be secondary to systemic diseases or infections. Primary pituitary hypophysitis is classified into lymphocytic, granulomatous, xanthomatous, mixed forms (lymphogranulomatous, xanthogranulomatous), necrotizing and IgG4 plasmacytic, according to the histological findings. Concerning lymphocytic hypophysitis (LH), it is characterized by lymphocytic infiltration and can be subclassified according to the affected area on: lymphocytic adenohypophysitis, lymphocytic infundibulo-neurohypophysitis and lymphocytic panhypophysitis. LH had always been considered a rare disease. Nevertheless, with improved imaging techniques, especially magnetic resonance imaging (MRI), LH diagnosis has been increased. This disease usually affects young women during pregnancy or postpartum period with headache, visual impairment, ACTH deficiency and a homogenous sellar mass with thickening of pituitary stalk in MRI. Definitive diagnosis depends on histopathological evaluation; nevertheless, a presumptive diagnosis could be done in a typical case. As no specific autoantigen was identified in LH, there is no antipituitary antibody (APA) method available for helping diagnosis. However, APA used in some centers for research could support an autoimmune origin for some hypopituitarism previously named as idiopathic, confirming nuances in clinical presentation of pituitary autoimmune disease. Therapeutic approach should be based on the grade of suspicious and clinical manifestations of LH. PMID:22426958

  2. Clinical presentation of meningococcal disease in childhood.

    PubMed

    Sabatini, C; Bosis, S; Semino, M; Senatore, L; Principi, N; Esposito, S

    2012-06-01

    Although relatively rare, meningococcal disease represents a global health problem being still the leading infectious cause of death in childhood with an overall mortality around 8%. Meningococcal meningitis is the most commonly recognized presentation, accounting for 80% to 85% of all reported cases of meningococcal disease (in half of these cases sepsis is also present concomitantly). The remaining 15-20% of cases are most commonly bloodstream infections only. Meningococcal serogroups A, B, and C account for most cases of meningococcal disease throughout the world. Recently, serogroups W-135 and X (predominantly in Africa) and group Y (in the United States and European countries) have emerged as important disease-causing isolates. Despite recent advances in medical management, the mortality rate of fulminant meningococcemia ranges from 15% to 30%. However, among survivors, 10-30% could have long term sequelae (i.e. sensoneural hearing loss, seizure, motor problems, hydrocephalus, mental retardation, and cognitive and behavioral problems). Considering the clinical severity of meningococcal disease, prevention represents the first approach for avoiding serious complications and possible deaths. The availability of new vaccines able to cover the emerging serotypes including A and Y as well as the availability on the market of new products that could prevent meningococcal B infection represent a great opportunity for the decrease of the burden of this complicated disease. PMID:23240173

  3. Papillon–Lefèvre syndrome: clinical presentation and management options

    PubMed Central

    Sreeramulu, Basapogu; Shyam, Naragani DVN; Ajay, Pilla; Suman, Pathipaka

    2015-01-01

    Papillon–Lefèvre syndrome (PLS) is a rare autosomal recessive disorder, characterized by diffuse palmoplantar keratoderma and precocious aggressive periodontitis, leading to premature loss of deciduous and permanent dentition at a very young age. Various etiopathogenic factors are associated with the syndrome, like immunologic alterations, genetic mutations, and the role of bacteria. Dentists play a significant role in the diagnosis and management of PLS as there are characteristic manifestations like periodontal destruction at an early age and an early eruption of permanent teeth. Here, we are presenting an elaborate review of PLS, its etiopathogenesis, clinical presentation, and management options.

  4. Sheehan's syndrome presenting as psychosis: a rare clinical presentation

    PubMed Central

    Dar, Mohamand Maqbool; Arif, Tasleem; Bashir, Haamid; Bhat, Mohammad Hayat; Ahmed, Javid

    2013-01-01

    Sheehan's syndrome (SS) refers to the occurrence of varying degree of hypopituitarism after parturition (1). It is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care and its frequency is decreasing worldwide. However, it is still frequent in underdeveloped and developing countries. Sheehan's syndrome is often diagnosed late as it evolves slowly (2,3). Reports of psychoses in patients with Sheehan's syndrome are rare. Herein, a case report of psychosis in a 31 year old woman who developed Sheehan's syndrome preceded by postpartum haemorrhage is presented. Treatment with thyroxine and glucocorticoids resulted in complete remission after attaining euthyroid and eucortisolemic state. PMID:23483784

  5. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives

    PubMed Central

    Kernt, M; Kampik, A

    2010-01-01

    Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis. PMID:20390032

  6. Clinical presentation of abdominal tuberculosis in HIV seronegative adults

    Microsoft Academic Search

    Cengiz Bolukbas; Fusun F Bolukbas; Tulin Kendir; Remzi A Dalay; Nihat Akbayir; Mehmet H Sokmen; Ali T Ince; Mithat Guran; Erkan Ceylan; Guray Kilic; Oya Ovunc

    2005-01-01

    BACKGROUND: The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. METHODS: Based upon the clinical presentation, the patients

  7. Uterine sarcomas: clinical presentation and MRI features

    PubMed Central

    Santos, Pedro; Cunha, Teresa Margarida

    2015-01-01

    Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI. PMID:25347940

  8. Comedone formation: etiology, clinical presentation, and treatment.

    PubMed

    Cunliffe, William J; Holland, D B; Jeremy, A

    2004-01-01

    An important feature in the etiology of acne is the presence of pilosebaceous ductal hypercornification, which can be seen histologically as microcomedones (Fig 1) and clinically as blackheads, whiteheads, and other forms of comedones, such as macrocomedones. There is a significant correlation between the severity of acne and the number and size of microcomedones (follicular casts), the presence of which is a measure of comedogenesis. This correlation can be demonstrated by skin surface biopsy using cyanoacrylate gel. In this procedure, microcomedones are sampled by applying cyanoacrylate gel to the skin surface. A glass microscopic slide is then applied on top of the gel and pressed firmly onto the skin for 1 minute(1-3). The glass slide is gently removed, taking with it the upper part of the stratum corneum and microcomedones, which are then analyzed by low-power microscopy or digital image analysis.(1-3) PMID:15556720

  9. Clinical oncology in Malaysia: 1914 to present

    PubMed Central

    2006-01-01

    A narration of the development of staff, infrastructure and buildings in the various parts of the country is given in this paper. The role of universities and other institutions of learning, public health, palliative care, nuclear medicine and cancer registries is described together with the networking that has been developed between the government, non-governmental organisations and private hospitals. The training of skilled manpower and the commencement of the Master of Clinical Oncology in the University of Malaya is highlighted. Efforts taken to improve the various aspects of cancer control which includes prevention of cancer, early detection, treatment and palliative care are covered. It is vital to ensure that cancer care services must be accessible and affordable throughout the entire health system, from the primary care level up to the centres for tertiary care, throughout the whole country. PMID:21614216

  10. Clinical oncology in Malaysia: 1914 to present.

    PubMed

    Lim, Gcc

    2006-01-01

    A narration of the development of staff, infrastructure and buildings in the various parts of the country is given in this paper. The role of universities and other institutions of learning, public health, palliative care, nuclear medicine and cancer registries is described together with the networking that has been developed between the government, non-governmental organisations and private hospitals. The training of skilled manpower and the commencement of the Master of Clinical Oncology in the University of Malaya is highlighted. Efforts taken to improve the various aspects of cancer control which includes prevention of cancer, early detection, treatment and palliative care are covered. It is vital to ensure that cancer care services must be accessible and affordable throughout the entire health system, from the primary care level up to the centres for tertiary care, throughout the whole country. PMID:21614216

  11. [Clinical presentation of cutaneous adnexal tumors].

    PubMed

    Zelger, B; Kazakov, D V; Zelger, B G

    2014-09-01

    Cutaneous adnexal lesions can sometimes be clinically diagnosed even by an experienced clinician or a differential diagnosis can at least be narrowed down. However, clinical findings alone cannot replace histological investigations and diagnosis or make them superfluous. This expertise is based on an algorithm which first differentiates inflammatory pseudo-tumors, such as ruptured infundibular cysts (atheroma) from authentic neoplastic adnexal lesions. In a second step criteria of regularity and/or chaos, such as asymmetry, irregular border, color variation and/or destruction with exulceration help to evaluate the dignity. In a third step criteria of differentiation allow the characterization of lesions varying in size from macules to papules, plaques, nodules and tumors to the subgroups of adnexal differentiation. Infundibular differentiation is characterized by comedones and is skin-colored, yellow or white and hard. Follicular differentiation notifies hair and is skin-colored, pearl-like to occasionally brown-black and variably hard. Sebaceous differentiation signifies lobulation and is yellow to skin-colored or red and soft. Apocrine lesions are reddish and fleshy. Eccrine differentiation shows either papillary reddish-brown (differential diagnosis viral warts) or skin-colored hard lesions. Multiple, monomorphous lesions are characteristic of syndromes, such as Spiegler-Brooke-Fend, Birt-Hogg-Dubé, Muir-Torre, and Gorlin-Goltz.One peculiarity of adnexal lesions is their potential to form cysts. Cysts with horny or hairy material are skin-colored to yellow, with glandular fluid fluctuation, a bluish character, and with illumination a Tyndall phenomenon becomes obvious, while ruptured cysts reveal an erythematous-reddish, ill-defined foreign body reaction. Brown to bluish-gray and black color is seen by the presence of melanocytes with melanin in lesions with mostly follicular differentiation. Strong vascularization and bleeding are reddish, soft, spongy and compressible and in due course variably dark due to the presence of hemosiderin. PMID:25154603

  12. Lobomycosis: epidemiology, clinical presentation, and management options

    PubMed Central

    Francesconi, Valeska Albuquerque; Klein, Ana Paula; Santos, Ana Paula Botelho Gualda; Ramasawmy, Rajendranath; Francesconi, Fábio

    2014-01-01

    Lobomycosis is a subcutaneous mycosis of chronic evolution caused by the Lacazia loboi fungus. Its distribution is almost exclusive in the Americas, and it has a particularly high prevalence in the Amazon basin. Cases of lobomycosis have been reported only in dolphins and humans. Its prevalence is higher among men who are active in the forest, such as rubber tappers, bushmen, miners, and Indian men. It is recognized that the traumatic implantation of the fungus on the skin is the route by which humans acquire this infection. The lesions affect mainly exposed areas such as the auricles and upper and lower limbs and are typically presented as keloid-like lesions. Currently, surgical removal is the therapeutic procedure of choice in initial cases. Despite the existing data and studies to date, the active immune mechanisms in this infection and its involvement in the control or development of lacaziosis have not been fully clarified. In recent years, little progress has been made in the appraisal of the epidemiologic aspects of the disease. So far, we have neither a population-based study nor any evaluation directed to the forest workers. PMID:25328400

  13. Benign paroxysmal positional vertigo Part I: Background and clinical presentation

    PubMed Central

    van der Velde, Gabrielle M

    1999-01-01

    Purpose: To review recent theories regarding the aetiology and pathophysiology of benign paroxysmal positional vertigo (BPPV), including its epidemiology, clinical presentation, diagnosis, and differential diagnosis. Data sources: Relevant studies were identified by searching MEDLINE from 1966 - March, 1997. Study selection: A total of 35 studies were selected on the basis of their relevance to Part I of this review. Data extraction: The findings and results of relevant studies and their subsequent theories and conclusions are discussed and compiled into a general overview of BPPV. Results of data synthesis: BPPV is considered the most common cause of vertigo of peripheral origin. A potential causal association has been observed with numerous apparent aetiological factors, all of which may lead to peripheral vestibular trauma. Findings of densities within the posterior semi-circular canal have given rise to the most recent theories regarding the pathophysiology for BPPV, canalithiasis and cupulolithiasis. Conclusions: BPPV is a multiaetiological peripheral vestibular disease whose underlying cause remains an enigma. The existing evidence supports two recent pathophysiological theories, cupulolithiasis and canalithiasis. Two conditions of special concern to the chiropractor, vertebrobasilar insufficiency and cervicogenic vertigo, closely ressemble BPPV, and can be differentiated by certain identifying features. BPPV may be diagnosed clinically, after ruling out conditions in which vertigo is a central feature. A review of the treatment for BPPV, focusing on recent physical treatments will be discussed in Part II of this paper.

  14. Senile Systemic Amyloidosis: Clinical Features at Presentation and Outcome

    PubMed Central

    Pinney, Jennifer H.; Whelan, Carol J.; Petrie, Aviva; Dungu, Jason; Banypersad, Sanjay M.; Sattianayagam, Prayman; Wechalekar, Ashutosh; Gibbs, Simon D. J.; Venner, Christopher P.; Wassef, Nancy; McCarthy, Carolyn A.; Gilbertson, Janet A.; Rowczenio, Dorota; Hawkins, Philip N.; Gillmore, Julian D.; Lachmann, Helen J.

    2013-01-01

    Background Cardiac amyloidosis is a fatal disease whose prognosis and treatment rely on identification of the amyloid type. In our aging population transthyretin amyloidosis (ATTRwt) is common and must be differentiated from other amyloid types. We report the clinical presentation, natural history, and prognostic features of ATTRwt compared with cardiac?isolated AL amyloidosis and calculate the probability of disease diagnosis of ATTRwt from baseline factors. Methods and Results All patients with biopsy?proven ATTRwt (102 cases) and isolated cardiac AL (36 cases) seen from 2002 to 2011 at the UK National Amyloidosis Center were included. Median survival from the onset of symptoms was 6.07 years in the ATTRwt group and 1.7 years in the AL group. Positive troponin, a pacemaker, and increasing New York Heart Association (NYHA) class were associated with worse survival in ATTRwt patients on univariate analysis. All patients with isolated cardiac AL and 24.1% of patients with ATTRwt had evidence of a plasma cell dyscrasia. Older age and lower N?terminal pro?B?type natriuretic peptide (NT pro?BNP) were factors significantly associated with ATTRwt. Patients aged 70 years and younger with an NT pro?BNP <183 pmol/L were more likely to have ATTRwt, as were patients older than 70 years with an NT pro?BNP <1420 pmol/L. Conclusions Factors at baseline associated with a worse outcome in ATTRwt are positive troponin T, a pacemaker, and NYHA class IV symptoms. The age of the patient at diagnosis and NT pro?BNP level can aid in distinguishing ATTRwt from AL amyloidosis. PMID:23608605

  15. Esophageal perforation. An unusual presentation with a benign clinical course.

    PubMed

    DeLuca, R F; Tedesco, F J; Ballan, K; Wortzel, E; Rogers, A I

    1977-04-01

    A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation. PMID:879153

  16. Clinical Presentation of Acute Abdomen: Study of 600 Patients

    Microsoft Academic Search

    J. R. Staniland; Janet Ditchburn; F. T. de Dombal

    1972-01-01

    This paper presents the clinical features of 600 patients suffering from abdominal pain of acute onset and admitted to either the General Infirmary or St. James's Hospital, Leeds. The survey was initially retrospective, but later put on a prospective basis. Roughly two-thirds of these 600 patients presented a “typical” picture of the disease with which they presented, while the remaining

  17. Clinical presentation of abdominal tuberculosis in HIV seronegative adults

    PubMed Central

    Bolukbas, Cengiz; Bolukbas, Fusun F; Kendir, Tulin; Dalay, Remzi A; Akbayir, Nihat; Sokmen, Mehmet H; Ince, Ali T; Guran, Mithat; Ceylan, Erkan; Kilic, Guray; Ovunc, Oya

    2005-01-01

    Background The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. Methods Based upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group. Results According to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003). Conclusion Gastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change. PMID:15969744

  18. Hyperinsulinaemia: A prospective risk factor for lethal clinical prostate cancer

    Microsoft Academic Search

    Jan Hammarsten; Benkt Högstedt

    2005-01-01

    Previous studies have suggested that hyperinsulinaemia and other components of metabolic syndrome are risk factors for clinical prostate cancer. This prospective study tested the hypothesis that hyperinsulinaemia and other components of metabolic syndrome are risk factors for lethal clinical prostate cancer. The clinical, haemodynamic, anthropometric, metabolic and insulin profile at baseline in men who had died from clinical prostate cancer

  19. What type of different clinical manifestations can cardiac sarcoidosis present?

    PubMed

    ?entürk, Ay?egül; Mara?, Yüksel; Argüder, Emine; Karalezli, Ay?egül; Hasano?lu, H Canan; Ö?üt, Tuba; Ba?tu?, Serdal; Karabekir, Ercan

    2015-06-01

    Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45 %. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement. PMID:25429793

  20. Correlation of Angiographic Morphology and Clinical Presentation in Unstable Angina

    Microsoft Academic Search

    George Dangas; Roxana Mehran; Sylvan Wallenstein; Nikolaos A Courcoutsakis; Venu Kakarala; Jacqueline Hollywood; John A Ambrose

    1997-01-01

    Objectives. This study sought to correlate angiographically detected complex lesions and intracoronary thrombus with the severity of clinical presentation in unstable angina (UA).Background. Unstable angina is usually related to acute thrombosis superimposed on a disrupted plaque. Complex and thrombotic lesions are more prevalent in UA and have been associated with a worse prognosis. The highest levels of the Braunwald classification

  1. Student Research Day Award Winners, 2012 Clinical Research Oral Presentations

    E-print Network

    Thompson, Michael

    -Low Breast Cancer: A molecular subtype associated with poor prognosis". 2nd Place Dr. Kara Schnarr, Radiation of androgen-deprivation-therapy induced osteoporosis in patients with prostate cancer". Basic Science Research presentation entitled "The effects of fractionated radiotherapy on lymphocyte radiation response". Clinical

  2. Inflammation and clinical presentation in neurodegenerative disease: a volatile relationship

    Microsoft Academic Search

    Brianne Magouirk Bettcher; Joel H. Kramer

    2012-01-01

    A proposed immune mechanism that potentially modifies or exacerbates neurodegenerative disease presentation in older adults has received considerable attention in the past decade, with recent studies demonstrating a strong link between pro-inflammatory markers and neurodegeneration. The overarching aim of the following review is to synthesize recent research that supports a possible relationship between inflammation and clinical features of neurodegenerative diseases,

  3. Inflammation and clinical presentation in neurodegenerative disease: a volatile relationship

    PubMed Central

    Bettcher, Brianne Magouirk; Kramer, Joel H.

    2013-01-01

    A proposed immune mechanism that potentially modifies or exacerbates neurodegenerative disease presentation in older adults has received considerable attention in the past decade, with recent studies demonstrating a strong link between pro-inflammatory markers and neurodegeneration. The overarching aim of the following review is to synthesize recent research that supports a possible relationship between inflammation and clinical features of neurodegenerative diseases, including risk of development, cognitive and clinical correlates, and progression of the specified diseases. Specific emphasis is placed on providing a temporal context for the association between inflammation and neurodegeneration. PMID:22515699

  4. Inflammation and clinical presentation in neurodegenerative disease: a volatile relationship.

    PubMed

    Bettcher, Brianne Magouirk; Kramer, Joel H

    2013-04-01

    A proposed immune mechanism that potentially modifies or exacerbates neurodegenerative disease presentation in older adults has received considerable attention in the past decade, with recent studies demonstrating a strong link between pro-inflammatory markers and neurodegeneration. The overarching aim of the following review is to synthesize recent research that supports a possible relationship between inflammation and clinical features of neurodegenerative diseases, including risk of development, cognitive and clinical correlates, and progression of the specified diseases. Specific emphasis is placed on providing a temporal context for the association between inflammation and neurodegeneration. PMID:22515699

  5. Multibacillary leprosy: erythema as the only clinical presentation.

    PubMed

    Wen, Peng-Fei; Wang, Lin

    2012-02-01

    Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. In this article, we present a 45-year-old man and a 39-year-old women who suffered from asymptomatic irregular erythemas on their trunk and extremities. Since both patients denied the history of exposure to leprosy patients and were absent clinical signs of superficial sensation dysfunction and enlarged peripheral nerves, they were diagnosed of mycosis fungoides and livedo reticularis clinically. Nevertheless the biopsies of erythemas showed perineural and periadnexal foamy-cell granulomas in the dermis and Fite staining revealed a large number of acid-fast bacilli. A diagnosis of multibacillary leprosy was made finally. These cases revealed that since leprosy is still epidemic in some remote area in China and in other developing countries and its clinical manifestations may be very weird sometimes, the dermatologists should be alert of it and skin biopsy could confirm the diagnosis. PMID:22490424

  6. 5 CFR 847.904 - What are Present Value Factors?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false What are Present Value Factors? 847.904 Section 847.904...CSRS or FERS Retirement § 847.904 What are Present Value Factors? Present value factors have the same meaning in this...

  7. 5 CFR 847.904 - What are Present Value Factors

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false What are Present Value Factors 847.904 Section 847.904 ...CSRS or FERS Retirement § 847.904 What are Present Value Factors Present value factors have the same meaning in this...

  8. 5 CFR 847.904 - What are Present Value Factors?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false What are Present Value Factors? 847.904 Section 847.904...CSRS or FERS Retirement § 847.904 What are Present Value Factors? Present value factors have the same meaning in this...

  9. 5 CFR 847.904 - What are Present Value Factors?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false What are Present Value Factors? 847.904 Section 847.904...CSRS or FERS Retirement § 847.904 What are Present Value Factors? Present value factors have the same meaning in this...

  10. 5 CFR 847.904 - What are Present Value Factors

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false What are Present Value Factors 847.904 Section 847.904 ...CSRS or FERS Retirement § 847.904 What are Present Value Factors Present value factors have the same meaning in this...

  11. 5 CFR 847.602 - Present value factors.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Present value factors. 847.602 Section...Retroactive Provisions § 847.602 Present value factors. (a) OPM publishes...payroll offices): (1) One table of present value factors for all CSRS...

  12. 5 CFR 847.602 - Present value factors.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Present value factors. 847.602 Section...Retroactive Provisions § 847.602 Present value factors. (a) OPM publishes...payroll offices): (1) One table of present value factors for all CSRS...

  13. 5 CFR 847.602 - Present value factors.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Present value factors. 847.602 Section...Retroactive Provisions § 847.602 Present value factors. (a) OPM publishes...payroll offices): (1) One table of present value factors for all CSRS...

  14. 5 CFR 847.602 - Present value factors.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Present value factors. 847.602 Section...Retroactive Provisions § 847.602 Present value factors. (a) OPM publishes...payroll offices): (1) One table of present value factors for all CSRS...

  15. 5 CFR 847.602 - Present value factors.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Present value factors. 847.602 Section...Retroactive Provisions § 847.602 Present value factors. (a) OPM publishes...payroll offices): (1) One table of present value factors for all CSRS...

  16. Hypophosphatemic osteomalacia: an unusual clinical presentation of multiple myeloma.

    PubMed

    Reyskens, M; Sleurs, K; Verresen, L; Janssen, M; van den Berg, J; Geusens, P

    2015-07-01

    An unusual case of a 75-year-old man is presented who had multiple stress fractures due to adult onset hypophosphatemic osteomalacia, which was the result of Fanconi syndrome, with light chain cast proximal tubulopathy due to multiple myeloma. A 75-year-old man presented with diffuse pain and muscle weakness. He had multiple stress fractures, low serum phosphate, decreased renal tubular reabsorption of phosphate, and normal PTH and FGF23, indicating adult onset hypophosphatemic osteomalacia. Phosphate supplements with calcitriol resulted in clinical recovery and healing of stress fractures. Because of proteinuria, a renal biopsy was performed that revealed Fanconi syndrome with light chain cast proximal tubulopathy and light kappa chains were found in serum and urine. A bone biopsy confirmed the diagnosis of multiple myeloma, and treatment with chemotherapy resulted in cytological and clinical recovery. PMID:25906239

  17. Fascioliasis: 3 cases with three different clinical presentations.

    PubMed

    Arslan, Ferhat; Batirel, Ay?e; Samasti, Mustafa; Tabak, Fehmi; Mert, Ali; Özer, Serdar

    2012-06-01

    Fascioliasis, which is a zoonotic infestation caused by the trematode Fasciola hepatica (liver fluke), is primarily a disease of herbivorous animals such as sheep and cattle. Humans become accidental hosts through ingesting uncooked aquatic plants such as watercress. It presents a wide spectrum of clinical pictures ranging from fever, eosinophilia and vague gastrointestinal symptoms in the acute phase to cholangitis, cholecystitis, biliary obstruction, extrahepatic infestation, or asymptomatic eosinophilia in the chronic phase. However, it may often be overlooked, especially in the acute phase, because of vague symptoms. As a result of newly introduced serological assays facilitating the diagnosis, there has been an increase in the number of reported cases. Here, we report the clinical and laboratory assessment and therapeutic approach of a series of three cases diagnosed (in order of) one week, three months and one and a half years after presentation of the first symptoms of the disease. PMID:22798118

  18. Factors motivating dyspepsia patients to enter clinical research

    Microsoft Academic Search

    Mikhail A. Rojavin; Pamela Downs; Michael A. Shetzline; Raffy Chilingerian; Marielle Cohard-Radice

    2006-01-01

    One of the most influential factors in science and medicine has been the development of placebo-controlled clinical trials. However, recruitment of patients for clinical trials is sometimes a major problem in clinical research. Successful patient recruitment may be enhanced with a clear understanding of the motivating factors that determine a patient's decision to enter a study. We have developed the

  19. Stenotrophomonas maltophilia endogenous endophthalmitis: clinical presentation, antibiotic susceptibility, and outcomes

    PubMed Central

    Chhablani, Jay; Sudhalkar, Aditya; Jindal, Animesh; Das, Taraprasad; Motukupally, Swapna R; Sharma, Savitri; Pathengay, Avinash; Flynn, Harry W

    2014-01-01

    Objective To describe clinical presentation, antibiotic susceptibility, and outcomes in patients with Stenotrophomonas maltophilia endogenous endophthalmitis. Design Retrospective case series. Participants Four eyes of four patients with S. maltophilia endogenous endophthalmitis. Methods Retrospective chart review of culture-positive S. maltophilia endogenous endophthalmitis treated at L V Prasad Eye Institute, Hyderabad, India, between January 2007 and December 2012, was done. Collected information included demographic, clinical, and microbiology data. Results These four patients with S. maltophilia endogenous endophthalmitis cases accounted for 0.47% (4/836) of total bacterial endophthalmitis cases treated in this period. All patients were from a rural setting and younger than 40 years. Two of the four patients had a history of immune compromise or hospitalization. The visual acuity at presentation was less than 20/320 in all patients. Common presenting features were severe anterior and posterior segment inflammation and hypopyon. All patients underwent vitrectomy with injection of intravitreal antibiotics and dexamethasone. Direct microscopy of the vitreous sample was positive in all cases. All isolates were sensitive to fluoroquinolones and chloramphenicol; sensitivity to aminoglycosides and third-generation cephalosporins was highly variable. The final visual acuity was 20/80 or more in three patients. The time to presentation did not seem to influence the visual or anatomical outcome. Conclusion S. maltophilia is a rare cause of endogenous endophthalmitis and usually occurs in young and apparently healthy individuals. Clinical presentation is moderate to severe, and recovery is variable. Fourth-generation fluoroquinolones and chloramphenicol were the most sensitive antibiotics against S. maltophilia in this series of patients. PMID:25170244

  20. [Urticaria pigmentosa: two different clinical presentations in pediatric patients].

    PubMed

    Spada, Julieta; Lequio, Mariana; Pyke, María de los Ángeles; Hernández, Marisa; Chouela, Edgardo

    2011-08-01

    Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity. PMID:21829861

  1. Macular lymphocytic arteritis: first clinical presentation with ulcers.

    PubMed

    Llamas-Velasco, M; García-Martín, P; Sánchez-Pérez, J; Sotomayor, E; Fraga, J; García-Diez, A

    2013-04-01

    Macular lymphocytic arteritis describes a recently reported entity, clinically characterized by asymptomatic hyperpigmented macules on the lower limbs, without association of systemic diseases. Histopathologically it is characterized by a lymphocytic arteritis with a hyalinized fibrin ring. We report a new case presenting with ulceration, a finding not previously described. A 25-year-old Hispanic woman was evaluated for a 1-year history of a gradually progressive, asymptomatic eruption that begins at level of both knees and progressively affects both legs and feet. She also referred recently appeared ulcers on inner right ankle without previous traumatism. Physical examination revealed multiple fairly well-defined light brown and faint pink patches with petechiae on as well as retiform crusts and livedoid lesions on inner right ankle. Both types of lesions were biopsied showing lymphocytic arteritis with fibrinoid necrosis and thrombus. There were no relevant laboratory alterations. The clinical peculiarity of our case is the clinical image of the lesions mimicking a pigmented purpuric dermatosis and the presence of a non-traumatic ulcer which could be explained because chronic lymphocytic damage may cause ischemic damage. Ulceration in our case supports consideration of macular arteritis as a latent form of cutaneous polyarteritis nodosa. PMID:23384039

  2. Systemic Lupus Erythematosus Presenting as Acute Adrenal Insufficiency: A Rare Clinical Presentation

    PubMed Central

    Bhat, RA; Khan, I; Mir, T; Khan, I; Wani, M

    2014-01-01

    Systemic lupus erythematosus is a complex autoimmune disease with multisystem involvement with varied presentation. Autoimmune adrenal disease, on the other hand, can be associated with other autoimmune diseases. Adrenal insufficiency as a presenting feature of Systemic lupus erythematosus is a rare occurrence. We hereby report a case of a 20 year-old female who presented to us in an acute hypoadrenal state and was found to have Systemic lupus erythematosus with renal involvement. Patient was successfully managed with steroids and improved clinically. PMID:24669348

  3. Clinical Presentation of Prostate Cancer in Black South Africans

    PubMed Central

    Tindall, Elizabeth A; Monare, L Richard; Petersen, Desiree C; van Zyl, Smit; Hardie, Rae-Anne; Segone, Alpheus M; Venter, Philip A; Bornman, MS Riana; Hayes, Vanessa M

    2014-01-01

    Background Compared with White Americans, Black American men are at a significant increased risk of presenting with prostate cancer (PCa) and associated mortality, suggesting a link to African-ancestry. However, PCa status within Africa is largely unknown. We address the clinical presentation of PCa within Black South African men. Methods Over 1,000 participants with or without PCa have enrolled in the Southern African Prostate Cancer Study (SAPCS). Using genome-wide profiling we establish a unique within Africa population substructure. Adjusting for age, clinical variables were assessed, compared against Black Americans and between rural and urban localities while addressing potential socio-demographic confounders. Results We report a significant difference in the distribution of prostate specific antigen (PSA) levels skewed towards higher PSA levels in the PCa cases (83.0% present with a PSA???20?µg/L; median PSA?=?98.8?µg/L) relative to men with no detectable PCa (18.5% present with a PSA???20?µg/L; median PSA?=?9.1?µg/L). Compared with Black Americans, Black South Africans presented with significantly more aggressive disease defined by Gleason score >7 (17% and 36%, respectively) and PSA???20?µg/L (17.2% and 83.2%, respectively). We report exasperated disease aggression defined by Gleason score >7 (P?=?0.0042) and poorly differentiated tumor grade (P?present with higher PSA levels and histopathological tumor grade compared with Black Americans, which is further escalated in men from rural localities. Our data suggests that lack of PSA testing may be contributing to an aggressive PCa disease phenotype within South African men. PMID:24723425

  4. The Clinical Presentation of Celiac Disease: Experiences from Northeastern Iran

    PubMed Central

    Ganji, Azita; Esmaielzadeh, Abbas; Aafzal Aghayee, Mehdi; Goshayeshi, Ladan; Ghaffarzadegan, Kamran

    2014-01-01

    BACKGROUND This study aimed to explore demographic characteristics and clinical presentations of celiac disease (CD) in Northeastern Iran. METHODS This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase (anti-tTG) were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification. RESULTS Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 ± 13.2 years were included. The patient’s chief complaints in order of decreasing frequency were dyspepsia (24.6%), diarrhea (20%), anemia (12.8%), and flatulence (7.2%). Bone disease was seen (osteopenia, osteoporosis) in 30% of patients. A positive family history of CD was found in 17.9% of cases. There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy. The histology grade (Marsh) did not show any correlation with anti-tTG serum levels, age, body mass index (BMI) or hemoglobin levels. CONCLUSION In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels. We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia. PMID:24872868

  5. [The historical background and present development of evidence-based healthcare and clinical nursing].

    PubMed

    Tsai, Jung-Mei

    2014-12-01

    Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application. PMID:25464952

  6. Clinical Symptoms and Risk Factors in Cerebral Microangiopathy Patients

    PubMed Central

    Okroglic, Sandra; Widmann, Catherine N.; Urbach, Horst; Scheltens, Philip; Heneka, Michael T.

    2013-01-01

    Objective Although the clinical manifestation and risk factors of cerebral microangiopathy (CM) remain unclear, the number of diagnoses is increasing. Hence, patterns of association among lesion topography and severity, clinical symptoms and demographic and disease risk factors were investigated retrospectively in a cohort of CM patients. Methods Patients treated at the Department of Neurology, University of Bonn for CM (n?=?223; 98m, 125f; aged 77.32±9.09) from 2005 to 2010 were retrospectively enrolled. Clinical symptoms, blood chemistry, potential risk factors, demographic data and ratings of vascular pathology in the brain based on the Wahlund scale were analyzed using Pearson's chi square test and one-way ANOVA. Results Progressive cognitive decline (38.1%), gait apraxia (27.8%), stroke-related symptoms and seizures (24.2%), TIA-symptoms (22%) and vertigo (17%) were frequent symptoms within the study population. Frontal lobe WMLs/lacunar infarcts led to more frequent presentation of progressive cognitive decline, seizures, gait apraxia, stroke-related symptoms, TIA, vertigo and incontinence. Parietooccipital WMLs/lacunar infarcts were related to higher frequencies of TIA, seizures and incontinence. Basal ganglia WMLs/lacunar infarcts were seen in patients with more complaints of gait apraxia, vertigo and incontinence. Age (p?=?.012), arterial hypertension (p<.000), obesity (p<.000) and cerebral macroangiopathy (p?=?.018) were positively related to cerebral lesion load. For increased glucose level, homocysteine, CRP and D-Dimers there was no association. Conclusion This underlines the association of CM with neurological symptoms upon admission in a topographical manner. Seizures and vertigo are symptoms of CM which may have been missed in previous studies. In addition to confirming known risk factors such as aging and arterial hypertension, obesity appears to increase the risk as well. Since the incidence of CM is increasing, future studies should focus on the importance of prevention of vascular risk factors on its pathogenesis. PMID:23393549

  7. Clinical presentation of anorexia nervosa in males: 24 new cases.

    PubMed

    Sharp, C W; Clark, S A; Dunan, J R; Blackwood, D H; Shapiro, C M

    1994-03-01

    As part of a larger prognostic study of anorexia nervosa, clinical features at presentation of 24 males with anorexia are described, and compared with a female group matched for date of admission. Data were extracted from the original case records and follow-up interview. The study confirms the view that males display the classical syndrome of anorexia nervosa, but differs from previous studies in several respects. Age at onset (mean 18.6 years) and at presentation (mean 20.2 years) is later, with a mean duration of illness at presentation of only 1.6 years. A premorbid tendency to obesity is confirmed; maximum weight loss during the illness amounted to 42% matched population mean weight (MPMW), and weight at presentation was 78.5% MPMW, somewhat higher than the female group. In keeping with earlier studies, binging and vomiting were noted commonly, in around half of sufferers, but laxative abuse was less frequent and excessive exercising more frequent in males. Depressive and obsessional symptoms are common in both groups, and a strong family history of affective disorders and alcohol abuse was noted in over one third. PMID:8173558

  8. Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic

    PubMed Central

    Gay, Charles W.; Bishop, Mark D.; Beres, Jacqueline L.

    2012-01-01

    Introduction The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic. Case Report/Methods After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult. Results Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement. Conclusion It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment. PMID:23204955

  9. [Retroperitoneal Castleman's disease. Presentation of a clinical case].

    PubMed

    Guglielmi, A; Boni, M; Pelosi, G; De Manzoni, G; Frameglia, M; Girlanda, R

    1996-01-01

    Castelman disease (CD) is a rare lymphadenopathy that usually presents as a solitary, slow growing mass; its etiology is still unknown. The authors described a case of CD localized in the retro-pancreatic space. A 33-year old patient, female, underwent abdominal ultrasonography because of upper right abdominal pain. The ultrasound showed gallbladder stones and a mass of 4 cm in diameter behind the pancreatic head, modifying the shape of the inferior vena cava. The patient underwent surgical excision and histological examination showed a hyaline type of CD. In the 70% of the cases, the disease is located in the mediastinum, only in 14% of the cases in the retroperitoneal space. The case we report is a hyaline type of CD that is the most frequent histological type, constitutes 90% of the cases, occurs usually in the young population and after surgical excision has a very good prognosis. Different is the clinical behaviour of the plasma cell type of CD that has an aggressive and often fatal clinical outcome. The patient we treated is still free of any symptoms one year after the operation. PMID:9005777

  10. Thymic neoplasm: a rare disease with a complex clinical presentation

    PubMed Central

    Rashid, Omar M.; Cassano, Anthony D.

    2013-01-01

    Thymic neoplasms constitute a broad category of rare lesions with a wide spectrum of pathologic characteristics and clinical presentations which therefore require a high index of suspicion to diagnose. The natural history of the disease is seldom predictable, anywhere from an indolent to an aggressively malignant course. Although the classification and staging of these lesions are complex and controversial, complete radical surgical resection remains the gold standard of therapy. Radiation and chemotherapy are important elements of the multimodality approach to treating these patients and it is important for thoracic surgeons to work closely with their colleagues in other disciplines in the management of and future research endeavors in thymic neoplasm. In this review, we discuss the evaluation of the patient with an anterior mediastinal mass, the classification and staging of thymic neoplasms, the role of surgery, radiation and chemotherapy in treating this disease, as well as future directions in research for novel targeted therapies. PMID:23585946

  11. [Women's clinic in Japan at present and in the future].

    PubMed

    Matsuda, Masako

    2015-04-01

    Innovative women's clinic was first established in Kagoshima University Hospital in 2001, dedicated to offer gender-based evaluation and treatment of numerous medical problems of concern to women by female physicians. The clinic was welcomed enthusiastically by Japanese women, followed by new openings of clinics specifically for women with similar concepts throughout the country. However, two major problems have emerged later. One is the shortage of female doctors, and another is financial difficulty. We need to formulate and implement new strategies for further development of women's clinics in Japan. Among of all, establishment of educational and training programs would be the most important task. PMID:25936141

  12. Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

    Microsoft Academic Search

    Ganapathy A. Prasad; Nicholas J. Talley; Yvonne Romero; Amindra S. Arora; Lori A. Kryzer; Thomas C. Smyrk; Jeffery A. Alexander

    2007-01-01

    OBJECTIVES:Eosinophilic esophagitis (EE) is an increasingly recognized cause of dysphagia. We prospectively assessed the prevalence of EE using midesophageal biopsies in patients presenting with no endoscopically evident cause of dysphagia. We also aimed to determine the clinical and endoscopic factors predictive of EE in outpatients undergoing endoscopy for dysphagia.METHODS:Outpatients (18–60 yr of age) undergoing endoscopy for dysphagia at Mayo Clinic,

  13. 21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...not otherwise approvable that present an opportunity to understand...not otherwise approvable that present an opportunity to understand...the clinical investigation presents a reasonable opportunity...The clinical investigation presents a reasonable...

  14. 21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...not otherwise approvable that present an opportunity to understand...not otherwise approvable that present an opportunity to understand...the clinical investigation presents a reasonable opportunity...The clinical investigation presents a reasonable...

  15. 21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...not otherwise approvable that present an opportunity to understand...not otherwise approvable that present an opportunity to understand...the clinical investigation presents a reasonable opportunity...The clinical investigation presents a reasonable...

  16. 21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...not otherwise approvable that present an opportunity to understand...not otherwise approvable that present an opportunity to understand...the clinical investigation presents a reasonable opportunity...The clinical investigation presents a reasonable...

  17. Clinical Presentation, Pathogenesis, Diagnosis, and Treatment of Epidermolysis Bullosa Acquisita

    PubMed Central

    Ludwig, Ralf J.

    2013-01-01

    Epidermolysis bullosa acquisita (EBA) is a chronic mucocutaneous autoimmune skin blistering disease. The pathogenic relevance of autoantibodies targeting type VII collagen (COL7) has been well-documented. Therefore, EBA is a prototypical autoimmune disease with a well-characterized pathogenic relevance of autoantibody binding to the target antigen. EBA is a rare disease with an incidence of 0.2 new cases per million and per year. The current treatment of EBA relies on general immunosuppressive therapy, which does not lead to remission in all cases. Therefore, there is a high, so far unmet medical need for the development of novel therapeutic options. During the last 10 years, several novel in vitro and in vivo models of EBA have been established. These models demonstrated a critical role of the genetic background, T cells, and cytokines for mediating the loss of tolerance towards COL7. Neutrophils, complement activation, Fc gamma receptor engagement, cytokines, several molecules involved in cell signaling, release of reactive oxygen species, and matrix metalloproteinases are crucial for autoantibody-induced tissue injury in EBA. Based on this growing understanding of the diseases' pathogenesis, several potential novel therapeutic targets have emerged. In this review, the clinical presentation, pathogenesis, diagnosis, and current treatment options for EBA are discussed in detail. PMID:23956869

  18. Present situation of the clinical utilization of radioactive tracers

    NASA Astrophysics Data System (ADS)

    Masi, R.

    1983-10-01

    The utilization of radioactive tracers in Italy with a clinical scope is examined. Geographic distribution of clinical centers, legislation, disposal of radioactive wastes, personnel, equipment available, operation mode and prospectives are discussed. Deficiencies in equipment, personnel and choice of diagnosis methods are shown.

  19. Down syndrome and moyamoya: clinical presentation and surgical management.

    PubMed

    See, Alfred P; Ropper, Alexander E; Underberg, Daniel L; Robertson, Richard L; Scott, R Michael; Smith, Edward R

    2015-07-01

    OBJECT Moyamoya can cause cerebral ischemia and stroke in Down syndrome (DS) patients. In this study, the authors defined a surgically treated population of patients with DS and moyamoya and compared their clinical presentation, response to surgical treatment, and long-term prognosis with those of the general population of patients with moyamoya but without DS. METHODS This study was a retrospective review of a consecutive operative series of moyamoya patients with DS treated at Boston Children's Hospital from 1985 through 2012. RESULTS Thirty-two patients, average age 9.7 years (range 1.8-29.3 years), underwent surgery for moyamoya in association with DS. The majority presented with ischemic symptoms (87% stroke, 42% transient ischemic attacks). Twenty-four patients (75%) had congenital heart disease. Nineteen patients (59%) had bilateral moyamoya on presentation, and 13 presented with unilateral disease, of which 2 progressed to surgery on the opposite side at a later date. Patients were followed for a median of 7.5 years (1-20.2 years) after surgery, with no patients lost to follow-up. Follow-up arteriography demonstrated Matsushima Grade A collaterals in 29 of 39 (74%) hemispheres, Grade B in 5 (13%), and Grade C in 5 (13%). Complications included postoperative strokes in 2 patients, which occurred within 48 hours of surgery in both; one of these patients had arm weakness and the other confusion (both had recovered completely at follow-up). Seizures occurred in 5 patients perioperatively, including one who had a new seizure disorder related to hypocalcemia. CONCLUSIONS Moyamoya disease is a cause of stroke in patients with DS. Both the incidence of preoperative stroke (87% vs 67%) and the average age at diagnosis for children under age 21 (8.4 vs 6.5 years) were greater in patients with DS and moyamoya than in the general moyamoya surgical population, suggesting a possible delay in reaching a correct diagnosis of the cause of cerebral ischemia in the DS patient population. Pial synangiosis provided long-term protection from stroke in all patients treated. PMID:25837890

  20. Factors associated with clinical inertia: an integrative review

    PubMed Central

    Aujoulat, Isabelle; Jacquemin, Patricia; Rietzschel, Ernst; Scheen, André; Tréfois, Patrick; Wens, Johan; Darras, Elisabeth; Hermans, Michel P

    2014-01-01

    Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia. PMID:24868181

  1. Water temperature-influential factors, field measurement, and data presentation

    USGS Publications Warehouse

    Stevens, Herbert H.; Ficke, John F.; Smoot, George F.

    1975-01-01

    This manual contains suggested procedures for collecting and reporting of water-temperature data on streams, lakes and reservoirs, estuaries, and ground water. Among the topics discussed are the selection of equipment and measuring sites, objectives and accuracy of measurements, and data processing and presentation. Background information on the influence of temperature on water quality and the factors influencing water temperature are also presented.

  2. Social and Demographic Factors Affecting Psychopathology and Substance Abuse in a Spanish Family Clinic Population.

    ERIC Educational Resources Information Center

    Ladner, Robert A.

    This report presents findings on the social and demographic factors associated with drug abuse, alcoholism, and major psychological impairment in a population of Cuban American patients presenting at the Spanish Family Guidance Clinic (Miami, Florida) in 1974-75. The analysis indicates a number of factors operating to increase the likelihood of…

  3. Coronary artery disease: arterial remodelling and clinical presentation

    PubMed Central

    Smits, P; Pasterkamp, G; van Ufford, M A Q.; Eefting, F; Stella, P; de Jaegere, P P T; Borst, C

    1999-01-01

    OBJECTIVE—To investigate the hypothesis that in coronary artery disease large plaques in compensatorily enlarged segments are associated with acute coronary syndromes, whereas smaller plaques in shrunken segments are associated with stable angina pectoris.?METHODS—Patients selected for percutaneous transluminal coronary angioplasty (PTCA) were divided into two groups, one with stable angina pectoris (stable group, n = 37) and one with unstable angina or postmyocardial infarction angina of the infarct related artery (unstable group, n = 32). In both groups, remodelling at the culprit lesion site was determined by intravascular ultrasound before the intervention. Remodelling was calculated as relative vessel area: [vessel area culprit lesion site ÷ mean vessel area of both proximal and distal reference sites] × 100%. Compensatory enlargement was defined as remodelling of ? 105%, whereas shrinkage was defined as remodelling of ? 95%.?RESULTS—In the unstable group, the vessel area at the culprit lesion site was larger than in the stable group, at mean (SD) 18.1 (5.3) v 14.6 (5.4) mm2 (p = 0.008). Lumen areas were similar. Consequently, plaque area and percentage remodelling were larger in the unstable group than in the stable group: mean (SD) 14.8 (4.8) v 11.6 (4.9) mm2 (p = 0.009) and 112 (31)% v 95 (17)% (p = 0.005), respectively. Significantly more culprit lesion sites were classified as shrunken in the stable group (21/37) than in the unstable group (8/32; p = 0.014). On the other hand, more lesion sites were classified as enlarged in the unstable group (16/23) than in the stable group (8/37; p = 0.022).?CONCLUSIONS—In patients selected for PTCA, the mode of remodelling is related to clinical presentation.???Keywords: atherosclerosis; coronary disease; remodelling; intravascular ultrasound PMID:10490561

  4. Clinical presentation of coeliac disease in adult gastroenterological practice

    PubMed Central

    Boyd, S; Collins, B J; Bell, P M; Love, A H G

    1985-01-01

    Clinical features, complications and results of investigations are analysed in 50 patients diagnosed by jejunal biopsy as having coeliac disease at the Adult Gastroenterology Unit, Royal Victoria Hospital, Belfast, between 1969 and 1983. Only one patient was entirely asymptomatic, but 22% had no disturbance of bowel habit, and 50% had not lost weight. There were relatively few physical abnormalities on clinical examination. Screening tests using standard haematological and biochemical methods were positive only in between 8% and 52% of patients. More specific tests for malabsorption were positive in between 54% and 84% of patients. Jejunal biopsy remains the definitive procedure to identify patients with coeliac disease. PMID:4095802

  5. Malaria real-time PCR: correlation with clinical presentation.

    PubMed

    Dormond, L; Jaton, K; de Vallière, S; Genton, B; Greub, G

    2015-05-01

    Among 112 patients infected only by Plasmodium falciparum, WHO criteria of severity were compared with parasite load assessed by microscopy and quantitative PCR. Clinical severity was significantly correlated with higher parasite load as determined by microscopy (p < 0.001) and by PCR (p < 0.001). Hence, quantitative PCR might be useful to predict outcome. PMID:25905022

  6. Necrotizing Fasciitis: Clinical Presentation, Microbiology, and Determinants of Mortality

    Microsoft Academic Search

    CHIN-HO WONG; HAW-CHONG CHANG; SHANKER PASUPATHY; LAY-WAI KHIN; JEE-LIM TAN; CHENG-OOI LOW

    Results: The paucity of cutaneous findings early in the course of the disease makes the diagnosis difficult, and only thirteen of the eighty-nine patients had a diagnosis of necrotizing fasciitis at the time of admission. Preadmission treatment with antibiotics modified the initial clinical picture and often masked the severity of the underlying infec- tion. Polymicrobial synergistic infection was the most

  7. [Clinical presentations and a classification of oligophrenia psychoses in children.

    PubMed

    Makarov, I V

    2014-01-01

    The article discusses the clinical variants of psychosis in children with mental retardation. A particular group of psychotic disorders - oligophrenia psychosis, is described. A total of 28 children (19 boys) who were hospitalized in a psychiatric hospital or treated as outpatients from 1992 to 2012 were examined. The average age of the patients was 12±1.3 years. The duration of follow-up (analysis of medical records or direct clinical observation) was up to 18 years. Almost all children had mild mental retardation (only one patient had moderate mental retardation). Diagnosis corresponded to ICD-10 codes F06.07, F06.27, F06.29, F06.817 or F06.819. Mental retardation corresponded to the second code section F70 (F71 in one case). Clinical and psychopathological methods, follow-up study, statistical analysis of the data were used. Four clinical variants of oligophrenia psychoses in children were identified: 1) psychosis with amentive confusion, 2) schizophreniform psychosis, 3) verbal hallucinosis, 4) psychosis with a predominance of psychomotor agitation. PMID:24637824

  8. Applications of PET CT in clinical practice: Present and future

    NASA Astrophysics Data System (ADS)

    Costa, Durval Campos

    2007-02-01

    Radionuclide imaging and specially positron emission tomography (PET) has already demonstrated its benefits in three major medical subjects, i.e. neurology, cardiology and particularly clinical oncology. More recently the combination of PET and X-ray computed tomography (CT) as PET-CT led to a significant increment of the already large number of clinical applications of this imaging modality. This "anatomy-metabolic fusion" also known as Metabolic Imaging has its future assured if we can: (1) improve resolution reducing partial volume effect, (2) achieve very fast whole body imaging, (3) obtain accurate quantification of specific functions with higher contrast resolution and, if possible, (4) reduce exposure rates due to the unavoidable use of ionizing radiation.

  9. Clinical trials in "emerging markets": regulatory considerations and other factors.

    PubMed

    Singh, Romi; Wang, Ouhong

    2013-11-01

    Clinical studies are being placed in emerging markets as part of global drug development programs to access large pool of eligible patients and to benefit from a cost effective structure. However, over the last few years, the definition of "emerging markets" is being revisited, especially from a regulatory perspective. For purposes of this article, countries outside US, EU and the traditional "western countries" are discussed. Multiple factors are considered for placement of clinical studies such as adherence to Good Clinical Practice (GCP), medical infrastructure & standard of care, number of eligible patients, etc. This article also discusses other quantitative factors such as country's GDP, patent applications, healthcare expenditure, healthcare infrastructure, corruption, innovation, etc. These different factors and indexes are correlated to the number of clinical studies ongoing in the "emerging markets". R&D, healthcare expenditure, technology infrastructure, transparency, and level of innovation, show a significant correlation with the number of clinical trials being conducted in these countries. This is the first analysis of its kind to evaluate and correlate the various other factors to the number of clinical studies in a country. PMID:24070788

  10. Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement

    PubMed Central

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

    2009-01-01

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

  11. Clinical presentation of patients with symptomatic anterior hip impingement.

    PubMed

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

    2009-03-01

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

  12. Diagnosis and clinical presentation of premalignant lesions of the penis.

    PubMed

    von Krogh, G; Horenblas, S

    2000-01-01

    Although a considerable number of penile cancers may arise de novo, certain potentially premalignant conditions do exist. We account in some detail for precancerous growths, which may initially be misclassified and not submitted to proper therapy and follow-up. At one end of the spectrum disorders exist that are generally considered as medically benign, such as warty tumors; at the other end growths occur that are highly indicative of being potentially invasive, i.e. giant condylomas, bowenoid papulosis, eythroplasia of Queyrat and Bowen's disease. We also focus on elucidating the clinical behavior of some inflammatory conditions, which may either be of pathogenic significance for squamous cell carcinoma development or give rise to differential diagnostic problems, most importantly lichen sclerosus et atrophicus (balanitis xerotica obliterans). We advocate a vigilant approach for histopathological evaluation whenever any clinical diagnostic uncertainty or therapeutic recalcitrance exists. We also favor the administration of highly active topical therapy against penile chronic inflammatory conditions such as lichen sclerosus et atrophicus, careful clinical follow-up of these cases and surgical treatment of phimosis. PMID:11144899

  13. Invasive pneumococcal disease: association between serotype, clinical presentation and lethality.

    PubMed

    Rodríguez, M Angeles Gutiérrez; González, Amai Varela; Gavín, María Ascensión Ordobás; Martínez, Fernando Martín; Marín, Natividad García; Blázquez, Belén Ramos; Moreno, Juan Carlos Sanz

    2011-08-01

    To ascertain the factors linked to invasive pneumococcal disease (IPD) caused by the different serotypes in the period 2007-2009, following the conjugate vaccine's inclusion in the childhood vaccination schedule, a total of 2013 IPD cases were reviewed. The mean annual incidence in this period was 10.74 cases per 100,000 inhabitans and the lethality was 8.8%. Overall serotype distribution displayed certain peculiarities, such as the high frequency of serotype 5. Serotype 3, male gender, sepsis and presence of risk factors were significantly associated with lethality. Vaccinated children under 5 years of age had a higher risk of disease due to serotype 19A. Serotype 8 was associated with the presence of underlying risk factors. PMID:21683112

  14. Bluish vomiting: a rare clinical presentation of poisoning.

    PubMed

    Higny, J; Vanpee, D; Boulouffe, C

    2014-08-01

    Bluish vomiting is a symptom of poisoning that is rarely seen in Western emergency departments. Consequently, physicians are not aware of the diagnosis, complications, and treatment of this unusual form of intoxication. In this article, we report a case of bluish vomiting that occurred after an accidental ingestion of copper sulphate. In the discussion, we review three life-threatening causes of bluish vomiting (copper sulphate, boric acid, and paraquat ingestion), and we discuss their respective clinical manifestations, specificities, complications, and management therapies. PMID:24846181

  15. Factors affecting the implementation of clinical pharmacy services in China.

    PubMed

    Penm, Jonathan; Moles, Rebekah; Wang, Holly; Li, Yan; Chaar, Betty

    2014-03-01

    New policies in China have recently led to the implementation of clinical pharmacy services in hospitals. We explored the views of hospital administrators, pharmacy directors, clinical pharmacists, and dispensing pharmacists about the factors affecting clinical pharmacy services in China, using the framework approach and organizational theory. We conducted 30 interviews with 130 participants at 29 hospitals (both secondary and tertiary) in Beijing, Zhengzhou, Luoyang, and Shanghai. We found that the barriers to and facilitators of implementation of clinical pharmacy services slotted into the environment and participant dimensions of Scott's adapted version of Leavitt's organizational model. External support from government was perceived as crucial to promoting pharmacy services. It is proposed that the internationally recognized Basel Statements of the International Pharmaceutical Federation also provide a strong foundation for guiding China in implementing clinical pharmacy services. PMID:24562375

  16. [Iron deficiency in elderly people: clinical presentation and management].

    PubMed

    Chassagne, Philippe; Bahri, Oarda; Roca, Frédéric

    2014-06-01

    Iron deficiency (absolute or functional) is commonly observed (frequently without associated anemia) in up to one third of old people. Iron deficiency is the most cause of anemia in adults. Many non hematological consequences of iron deficiency are described like: cardiac failure, mood or cognitive disorders, chronic fatigue or restless leg syndrome. Iron deficiency can be orally or with intravenous iron replacement treates if necessary. Long term compliance of patients orally treated for iron deficiency is poor mainly because of fair tolerability of drugs. New regimen of intravenous iron replacement are now available when orally iron administration can not be achieved. In functional iron deficiency iron intravenous replacement seems especially relevant. However further controlled studies are necessary to assess their clinical benefits. PMID:25031217

  17. Clinical presentation and surgical outcomes of intramedullary neurenteric cysts.

    PubMed

    Yang, Tao; Wu, Liang; Fang, Jingyi; Yang, Chenlong; Deng, Xiaofeng; Xu, Yulun

    2015-07-01

    OBJECT Intramedullary neurenteric cysts (NECs) are exceedingly rare lesions and have been previously reported in case reports. The aim of this study was to determine the clinical manifestations, radiological features, and long-term prognosis of patients with such lesions. METHODS The authors retrospectively reviewed the records of 13 patients with an intramedullary NEC. Each patient underwent MRI, laminotomy, and microsurgery. The accurate diagnosis was based on imaging and pathology findings. Each patient's follow-up status was determined through individual office visits and a structured telephone interview. RESULTS The series included 7 male and 6 female patients. Progressive or intermittent motor deficit was the main symptom associated with or without pain or sensory disturbance. Five cysts were located in the cervical cord, 1 in the cervicothoracic cord, 3 in the thoracic cord, and 4 in the conus medullaris. Concurrent malformations included scoliosis (3 cases), fusion of rib (1 case), enlarged spinal canal (1 case), tethered spinal cord (1 case), and ectocardia (1 case). Gross-total resection of the cyst was achieved in 8 cases, and subtotal resection (STR) was achieved in 5 cases. All patients were followed up, with a mean duration of 66.5 months. Cyst recurrence was observed in 4 cases after STR. In 2 cases the patients underwent reoperation; the other 2 patients remained clinically stable and did not undergo reoperation. At the last evaluation, neurological function was improved in 11 patients and remained stable in 2 patients. CONCLUSIONS Intramedullary NECs should be considered in the differential diagnosis of a middle-aged patient with intermittent neurological symptoms and concurrent malformations. Early surgery is advocated to prevent permanent neurological deficits. When gross-total resection cannot be achieved, maximally safe removal under the protection of intraoperative neuromonitoring is advised. Because of the high risk of cyst recurrence, routine follow-up MRI is needed. If a residual cyst shows obvious regrowth and results in neurological deficits, timely reoperation with a goal of STR should be performed. PMID:25909275

  18. [Sclerosing mesenteritis. Report of two cases with different clinical presentation].

    PubMed

    Martínez Odriozola, P; García Jiménez, N; Cabeza García, S; Oceja Barrutieta, E

    2003-05-01

    Sclerosing mesenteritis is a rare disease of the mesenterium of unknown cause and chronic evolution. Two presentations have been reported: mesenteric panniculitis and retractile mesenteritis; inflammation of mesenteric fat predominates in one of them, while fibrotic thickening and shortening of the mesenterium is characteristic of the other. We report two cases of sclerosing mesenteritis which presented in very different ways. One patient suffered an episode of intestinal obstruction, and the second one was admitted for evaluation of fever of unknown origin (FUO). While intestinal obstruction is a relatively common complication of sclerosing mesenteritis, its presentation as a FUO is exceptional. PMID:12831301

  19. Present status of clinical deployment of glucokinase activators.

    PubMed

    Nakamura, Akinobu; Terauchi, Yasuo

    2015-03-01

    Glucokinase is one of four members of the hexokinase family of enzymes. Its expression is limited to the major organs (such as the pancreas, liver, brain and the gastrointestinal tract) that are thought to have an integrated role in glucose sensing. In the liver, phosphorylation of glucose by glucokinase promotes glycogen synthesis, whereas in the ?-cells, it results in insulin release. Studies of glucokinase-linked genetically-modified mice and mutations in humans have illustrated the important roles played by glucokinase in whole-body glucose homeostasis, and suggest that the use of pharmacological agents that augment glucokinase activity could represent a viable treatment strategy in patients with type 2 diabetes. Since 2003, many glucokinase activators (GKAs) have been developed, and their ability to lower the blood glucose has been shown in several animal models of type 2 diabetes. Also, we and others have shown in mouse models that GKAs also have the effect of stimulating the proliferation of ?-cells. However, the results of recent phase II trials have shown that GKAs lose their efficacy within several months of use, and that their use is associated with a high incidence of hypoglycemia; furthermore, patients treated with GKAs frequently developed dyslipidemia. A better understanding of the role of glucokinase in metabolic effects is required to resolve several issues identified in clinical trials. PMID:25802718

  20. Parotid lymphoma: a review of clinical presentation and management.

    PubMed

    Shum, Jonathan W; Emmerling, Max; Lubek, Joshua E; Ord, Robert A

    2014-07-01

    Lymphoma of the parotid gland is a relatively rare occurrence among head and neck tumors. Presentation is indistinguishable from other swellings of the parotid gland; therefore, it is important to consider lymphoma in the differential diagnosis when examining parotid swellings. Parotid lymphomas are most likely to be B-cell non-Hodgkin lymphoma of 1 of 3 types, which include follicular, marginal zone, and diffuse large B cell, although other histologic patterns have been described. We present a review of 3 patients with parotid lymphoma who presented to the University of Maryland Medical Center's Department of Oral and Maxillofacial Surgery with facial swelling. Two patients were diagnosed with follicular lymphoma, whereas the third was diagnosed with marginal zone lymphoma. PMID:24405648

  1. Clinical presentation and operative repair of hernia of Morgagni

    PubMed Central

    Loong, T; Kocher, H

    2005-01-01

    A 77 year old woman who presented with an incarcerated hernia of Morgagni was successfully treated without complications. A Medline search (1996 to date) along with cross referencing was done to quantify the number of acute presentations in adults compared to children. Different investigating modalities—for example, lateral chest and abdominal radiography, contrast studies or, in difficult cases, computed tomography or magnetic resonance imaging—can be used to diagnose hernia of Morgagni. The favoured method of repair—laparotomy or laparoscopy—is also discussed. A total of 47 case reports on children and 93 case reports on adults were found. Fourteen percent of children (seven out of 47) presented acutely compared with 12% of adults (12 out of 93). Repair at laparotomy was the method of choice but if uncertain, laparoscopy would be a useful diagnostic tool before attempted repair. Laparoscopic repair was favoured in adults especially in non-acute cases. PMID:15640427

  2. The Present and Future of Appointment, Tenure, and Compensation Policies for Medical School Clinical Faculty

    Microsoft Academic Search

    Robert F. Jones; Jennifer S. Gold

    2001-01-01

    The authors present data and information about appoint- ment, tenure, and compensation policies to describe how medical schools are redefining the terms under which they relate to their full-time clinical faculties. First, the authors note the increasing differentiation of clinical fac- ulty members into two groups, researchers and clinicians. The present-day competitive realities of both research and clinical enterprises have

  3. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy

    PubMed Central

    Purohit, Treta; Cappell, Mitchell S

    2015-01-01

    Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren’s syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva substitutes, cholinergic agents, and scrupulous oral and dental care. Complications of cirrhosis from advanced PBC include esophageal varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatoma formation. PMID:25954476

  4. Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome

    PubMed Central

    Kim, Shin Jae; Ko, Myeong Jin; Lee, Young Seok; Kim, Young Baeg; Chung, Chan

    2014-01-01

    Objective Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. Methods This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy. Results The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment. Conclusion It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS. PMID:25110484

  5. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy.

    PubMed

    Purohit, Treta; Cappell, Mitchell S

    2015-05-01

    Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren's syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva substitutes, cholinergic agents, and scrupulous oral and dental care. Complications of cirrhosis from advanced PBC include esophageal varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatoma formation. PMID:25954476

  6. Clinical presentations of Ehlers Danlos syndrome type IV

    Microsoft Academic Search

    F M Pope; P Narcisi; A C Nicholls; M Liberman; J W Oorthuys

    1988-01-01

    Ehlers Danlos syndrome type IV is an often lethal disease caused by various mutations of type III collagen genes. It presents in infancy and childhood in several ways, and the symptoms and signs include low birth weight, prematurity, congenital dislocation of the hips, easy inappropriate bruising (sometimes suspected as child battering), and a diagnostic facial phenotype. These features predict a

  7. An unusual clinical presentation of subacute granulomatous thyroiditis.

    PubMed

    Peros, Kristijan; Bozek, Tomislav; Prkacin, Ingrid; Stakor, Mia Sunji?; Zmire, Josip

    2013-09-01

    Subacute granulomatous thyroiditis is an inflammatory thyroid condition that is presumed to be caused by a viral infection or postviral inflammatory process. It is characterized by neck pain, usually a tender diffuse goiter, and thyrotoxicosis. A case is presented of subacute granulomatous thyroiditis in an adult woman who had no neck pain but presented with morning stiffness in the small joints of the right hand, intermittent abdominal pain, malaise, fever, and myalgia. After the diagnosis had been established, she was treated with propranolol and acetylsalicylic acid, and has fully recovered. In conclusion, this disease may be difficult to diagnose, especially if there is a combination of fever and increased aminotransferases, which can lead to a wrong diagnostic approach. PMID:24558772

  8. Cowden Syndrome Presenting as Breast Cancer: Imaging and Clinical Features

    PubMed Central

    Seo, Mirinae; Ahn, Hye Shin; Moon, Hyeong-Gon

    2014-01-01

    Cowden syndrome is an uncommon, autosomal dominant disease which is characterized by multiple hamartomas of the skin, mucous membrane, brain, breast, thyroid, and gastrointestinal tract. The diagnosis of Cowden syndrome implicates an increased risk of developing breast cancer. We report a case of a 22-year-old woman with Cowden syndrome that presented as breast cancer with concomitant bilateral exuberant benign masses in both breasts. PMID:25246819

  9. Clinical presentation, assessment and management of pre-eclampsia.

    PubMed

    Lavallee, Layla

    2015-07-01

    Pre-eclampsia is a complex and unpredictable disorder that may occur during pregnancy. Its presentation ranges from mild to severe, and the condition may lead to the death of the mother and/or the baby in extreme cases. The earlier the disorder is detected and managed, the better the outcome. This article provides an outline of the disorder and its management, within the framework of UK and international guidelines. A series of suggested activities encourages the reader to reflect on the information provided within the context of their practice. PMID:26153971

  10. Association between DNA Methylation of the BDNF Promoter Region and Clinical Presentation in Alzheimer's Disease

    PubMed Central

    Nagata, Tomoyuki; Kobayashi, Nobuyuki; Ishii, Jumpei; Shinagawa, Shunichiro; Nakayama, Ritsuko; Shibata, Nobuto; Kuerban, Bolati; Ohnuma, Tohru; Kondo, Kazuhiro; Arai, Heii; Yamada, Hisashi; Nakayama, Kazuhiko

    2015-01-01

    Background/Aims In the present study, we examined whether DNA methylation of the brain-derived neurotrophic factor (BDNF) promoter is associated with the manifestation and clinical presentation of Alzheimer's disease (AD). Methods Of 20 patients with AD and 20 age-matched normal controls (NCs), the DNA methylation of the BDNF promoter (measured using peripheral blood samples) was completely analyzed in 12 patients with AD and 6 NCs. The resulting methylation levels were compared statistically. Next, we investigated the correlation between the DNA methylation levels and the clinical presentation of AD. Results The total methylation ratio (in %) of the 20 CpG sites was significantly higher in the AD patients (5.08 ± 5.52%) than in the NCs (2.09 ± 0.81%; p < 0.05). Of the 20 CpG sites, the methylation level at the CpG4 site was significantly higher in the AD subjects than in the NCs (p < 0.05). Moreover, the methylation level was significantly and negatively correlated with some neuropsychological test subscores (registration, recall, and prehension behavior scores; p < 0.05). Conclusion These results suggest that the DNA methylation of the BDNF promoter may significantly influence the manifestation of AD and might be associated with its neurocognitive presentation. PMID:25873928

  11. Löeffler endomyocarditis: a clinical presentation as right ventricular tumor.

    PubMed

    De Cock, C; Lemaitre, J; Deuvaert, F E

    1998-11-01

    A four-year-old girl presented with an apical mass of the right ventricle, pulmonary embolism and hypereosinophilia, and was shown to be infected with Toxocara canis. Cardiac involvement was represented by endomyocardial fibrosis, mainly at the apex of the right ventricle, mural thrombi and tricuspid regurgitation. Hypereosinophilia appears to be the head point at the basis of multiple organ damage in Löeffler endomyocarditis. The disease mechanism proposed is the eosinophilic production of peroxidases, which are cytotoxic when released in large amounts into the blood flow. Treatment is based on etiologic and corticosteroid therapy (prednisolone 1-2 mg/kg/day); surgical therapy is indicated in the end stages of the pathologic process. PMID:9870201

  12. Solitary schwannoma of the sural nerve: An unusual clinical presentation

    PubMed Central

    YAMAMOTO, KOSUKE; NISHIO, JUN; YANO, SHINTARO; NAITO, MASATOSHI

    2014-01-01

    Schwannomas may arise from any peripheral nerve containing Schwann cells. However, sural nerve schwannoma is extremely rare. In this study, a case of solitary schwannoma originating from the sural nerve in a 42-year-old male is presented. Physical examination revealed a 3-cm, elastic-hard, mobile, non-tender mass, while neurovascular examinations, including Tinel’s sign, were normal. Magnetic resonance imaging revealed an oval-shaped subcutaneous mass with iso-signal intensity relative to skeletal muscle on T1-weighted sequences. T2-weighted spectral presaturation with inversion recovery sequences showed higher signal intensity peripherally and lower signal intensity centrally, representing a target sign. Contrast-enhanced T1-weighted sequences demonstrated a marked central enhancement of the mass. The tumor was completely enucleated using an intracapsular technique. Histological examination confirmed the diagnosis of a schwannoma, consisting mainly of Antoni A tissue. The patient had no evidence of local recurrence and no neurological deficit at the final follow-up. Although rare, schwannoma should be considered in the differential diagnosis of a well-defined, oval, subcutaneous mass in the posterior aspect of the lower leg. PMID:24348770

  13. Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

    PubMed

    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2014-08-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 217 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (4.9 vs. 1.5 per month and 1.2 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95% confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20% and was associated with urinary catheter (OR 34.7, 95 % CI 1.89-63.6) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs. PMID:24584718

  14. Factors influencing inclusion of patients with malignancies in clinical trials.

    PubMed

    Tournoux, Caroline; Katsahian, Sandrine; Chevret, Sylvie; Levy, Vincent

    2006-01-15

    Participation in clinical trials remains low and is a central issue in oncology. The authors identified, through a systematic review, 75 papers published up to August 2004 that report barriers to recruitment of patients in clinical trials. These barriers range from patient preference and concern about information/consent to clinical problems with protocols. Strategies to overcome barriers on the part of patients and clinicians are needed and should be carefully evaluated. Thirty-three (44%) papers reported factors related to patients as influencing the inclusion of patients, 28 (37%) reported clinician's related factors, and 37 (49%) other factors from either specific groups of patients (30 papers, 40%) and/or other scopes (13 papers, 17%). No differences in prevalence were found between papers dedicated to hematologic malignancies and solid tumors. Factors related to clinicians as influential were more frequently reported before 1995 (70%) than thereafter (25%; P = 0.0009). Reporting specific groups of patients as influential was more frequent in North American articles (50%) than in others (14%, P = 0.008). Patients' barriers included mostly patient preference (12 papers), concern about information and/or consent (11 papers), worry about uncertainty (7 papers), and/or relationship with medical team (7 papers). Concerning clinicians, incompatibility of protocol with normal practice (nine papers), problems in complying with the protocol (eight papers), and/or consent procedure (eight papers) were the most reported factors. The remaining factors mostly relied on specific groups of patients (30 papers), notably age of patients (18 papers) and/or minority population (11 papers, all from the USA). Strategies to overcome these barriers are needed and should be carefully evaluated. PMID:16397866

  15. Non-alcoholic fatty liver disease and obesity: Biochemical, metabolic and clinical presentations

    PubMed Central

    Mili?, Sandra; Luli?, Davorka; Štimac, Davor

    2014-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. Presentation of the disease ranges from simple steatosis to non-alcoholic steatohepatitis (NASH). NAFLD is a hepatic manifestation of metabolic syndrome that includes central abdominal obesity along with other components. Up to 80% of patients with NAFLD are obese, defined as a body mass index (BMI) > 30 kg/m2. However, the distribution of fat tissue plays a greater role in insulin resistance than the BMI. The large amount of visceral adipose tissue (VAT) in morbidly obese (BMI > 40 kg/m2) individuals contributes to a high prevalence of NAFLD. Free fatty acids derived from VAT tissue, as well as from dietary sources and de novo lipogenesis, are released to the portal venous system. Excess free fatty acids and chronic low-grade inflammation from VAT are considered to be two of the most important factors contributing to liver injury progression in NAFLD. In addition, secretion of adipokines from VAT as well as lipid accumulation in the liver further promotes inflammation through nuclear factor kappa B signaling pathways, which are also activated by free fatty acids, and contribute to insulin resistance. Most NAFLD patients are asymptomatic on clinical presentation, even though some may present with fatigue, dyspepsia, dull pain in the liver and hepatosplenomegaly. Treatment for NAFLD and NASH involves weight reduction through lifestyle modifications, anti-obesity medication and bariatric surgery. This article reviews the available information on the biochemical and metabolic phenotypes associated with obesity and fatty liver disease. The relative contribution of visceral and liver fat to insulin resistance is discussed, and recommendations for clinical evaluation of affected individuals is provided. PMID:25071327

  16. Clinical and Socioeconomic Factors influence treatment decisions in Graves' Disease

    PubMed Central

    Elfenbein, Dawn M.; Schneider, David F.; Havlena, Jeffrey; Chen, Herbert; Sippel, Rebecca S.

    2014-01-01

    Background Definitive treatment of Graves' disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI. Methods Patients treated for Graves' disease between 8/2007 and 9/2013 at our university hospital were included. A comparative analysis of clinical and socioeconomic factors was completed. Results Of 427 patients, 300 (70%) underwent RAI while 127 (30%) underwent surgery. Multiple factors were associated with surgery: younger age (mean 36 vs. 41 years old, p<0.01), female gender (33% vs. 19% males, p=0.01), black race (56% vs. 28% non-black, p<0.01), Medicaid or uninsured (43% vs. 27% private insurance or Medicare, p<0.01), ophthalmopathy (38% vs. 26%, p< 0.01), goiter (35% vs. 23%, p<0.01), lowest quartile of median household income (38% vs. 27% upper three quartiles, p=0.03). Thyroidectomy increased annually, with 52% undergoing surgery during the final year (p<0.01). Adjusting for confounding, younger age (OR 1.04; 95% CI 1.02, 1.05), female gender (OR 2.06; 95% CI 1.06, 4.01), ophthalmopathy (OR 2.35; 95% CI 1.40, 3.96), and later year of treatment (OR 1.66; 95% CI 1.41, 1.95) remained significantly associated with surgery. Conclusions Surgery has now become the primary treatment modality of choice for Graves' disease at our institution. Clinical factors are the main drivers behind treatment choice, but patients with lower SES are more likely to have clinical features best treated with surgery, underlying the importance of improving access to quality surgical care for all patients. PMID:25245130

  17. Factor analysis in experimental designs in clinical and social psychology

    Microsoft Academic Search

    E. S. Bordin

    1943-01-01

    The author presents an extension of the method of factor analysis which offers an analytical structure for the design of experiments that will avoid distortion of original data and yet permit rigorous and systematic tests of hypotheses. In this method, persons become the variables and behavior items become the population. The persons are correlated, and this is followed by factor

  18. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management

    PubMed Central

    Nouh, Amre; Remke, Jessica; Ruland, Sean

    2014-01-01

    Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens. PMID:24778625

  19. Tumor necrosis factor inhibitors: clinical utility in autoimmune diseases.

    PubMed

    Willrich, Maria A V; Murray, David L; Snyder, Melissa R

    2015-02-01

    Tumor necrosis factor (TNF) production is amplified in several autoimmune disorders. In the 1990s, it became a validated therapeutic target used for the treatment of conditions such as rheumatoid arthritis and inflammatory bowel disease. Biologic drugs targeting TNF include engineered monoclonal antibodies and fusion proteins. Currently, there are 5 Food and Drug Administration-approved TNF inhibitors (infliximab, etanercept, adalimumab, certolizumab, and golimumab), representing close to $20 billion in sales. Clinical trials remain open to test their efficacy and safety compared with one another, as well as to measure clinical outcomes in different conditions and patient populations. The industry is also eager to develop biotherapeutics that are similar but cheaper than the currently existing biologics or are safer with higher efficacy; these are the so-called "biosimilars." Clinical utility of TNF inhibitors and indications of mono- or combined therapy with immunomodulators are reviewed here. Pharmacokinetics of the TNF inhibitors is affected by routes of administration, clearance mechanisms of immunoglobulins, and immunogenicity. Finally, strategies for management of treatment efficacy and increasing evidence for monitoring of serum concentration of TNF inhibitors are discussed, assessing for the presence of the antidrug antibodies and the different analytical methods available for laboratory testing. As clinical applications of the TNF inhibitors expand, and other classes join the revolution in the treatment of chronic inflammatory disorders, therapeutic drug monitoring of biologics will become increasingly important, with the potential to dramatically improve patient care and management. PMID:25305470

  20. Urinary Diversions after Cystectomy: The Association of Clinical Factors, Complications and Functional Results of Four Different Diversions

    Microsoft Academic Search

    Jakko A. Nieuwenhuijzen; Remco R. de Vries; Alex Bex; Henk G. van der Poel; Wim Meinhardt; Ninja Antonini; Simon Horenblas

    2008-01-01

    PurposeWe present a single institute experience of the four most widely used diversions after cystectomy in 281 patients, with an evaluation of the association between clinical factors, complication rates, functional results, and metabolic complications.

  1. Clinical presentation and patterns of care for short-term survivors of malignant glioma.

    PubMed

    Collins, Anna; Sundararajan, Vijaya; Brand, Caroline A; Moore, Gaye; Lethborg, Carrie; Gold, Michelle; Murphy, Michael A; Bohensky, Megan A; Philip, Jennifer

    2014-09-01

    Palliative care provision for patients with high-grade malignant glioma is often under-utilised. Difficulties in prognostication and inter-patient variability in survival may limit timely referral. This study sought to (1) describe the clinical presentation of short-term survivors of malignant glioma (survival time <120 days); (2) map their hospital utilisation, including palliative and supportive care service use, and place of death; (3) identify factors which may be important to serve as a prompt for palliative care referral. A retrospective cohort study of incident malignant glioma cases between 2003-2009 surviving <120 days in Victoria, Australia was undertaken (n = 482). Cases were stratified according to the patient's survival status (dead vs. alive) at the end of the diagnosis admission, and at 120 days from diagnosis. Palliative care was received by 78 % of patients who died during the diagnosis admission. Only 12 % of patients who survived the admission and then deteriorated rapidly dying in the following 120 days were referred to palliative care in their hospital admission, suggesting an important clinical subgroup that may miss out on being linked into palliative care services. The strongest predictor of death during the diagnosis admission was the presence of cognitive or behavioural symptoms, which may be an important prompt for early palliative care referral. PMID:24889839

  2. A new recombinant factor VIII: from genetics to clinical use

    PubMed Central

    Santagostino, Elena

    2014-01-01

    Advances in recombinant technology and knowledge about coagulation factor VIII (FVIII) are building a platform for new therapeutic options in patients with hemophilia A. The development of turoctocog alfa, a novel, high-purity, third-generation, B-domain truncated recombinant FVIII, has been produced and formulated without the use of animal-derived or human serum-derived components, in the wake of understanding of the new biochemical characteristics of FVIII, namely its protein structure, and glycosylation and sulfating patterns. Culture conditions and a five-step purification process have been developed to optimize the safety of turoctocog alfa. The results of two pilot clinical trials using turoctocog alfa confirmed high safety levels, with no patient developing inhibitors during the period of observation. The purpose of this review is to describe briefly the molecular and biological properties of turoctocog alfa, together with details of its clinical development, with emphasis on the needs of patients with hemophilia A. PMID:25548513

  3. [Esophageal toxicity of radiation therapy: clinical risk factors and management].

    PubMed

    Challand, T; Thureau, S; Dubray, B; Giraud, P

    2012-09-01

    Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionned radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V(20Gy), V(30Gy), V(40Gy), V(45Gy) and V(50Gy). Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and denutrition by enteral feeding. PMID:22925486

  4. Recruitment in AIDS Clinical Trials: Investigation of Sociodemographic and Psychosocial Factors Affecting Participation in Clinical Research

    Microsoft Academic Search

    Kathleen A. Ethier; Michael R. Rodriguez; Rachel A. Fox-Tierney; Chloe Martin; Gerald Friedland; Jeannette R. Ickovics

    1999-01-01

    The primary objective of this study was to identify the social, psychological, and behavioral factors that influenced recruitment in AIDS clinical trials. The study compared HIV-infected individuals participating in a trial (n = 113) and a group of HIV-infected patients not currently participating in a trial (n = 103). Trial participants were more likely to be White (61.5% vs. 38.8%,

  5. Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance

    PubMed Central

    Nahm, Moon H.; Moseley, M. Allen

    2013-01-01

    Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country. PMID:23341706

  6. Design of documentation for handheld ergonomics: presenting clinical evidence at the point of care

    Microsoft Academic Search

    Michelle Graham; Mark H. Chignell; Harumi Takeshita

    2002-01-01

    Medical doctors require high quality clinical evidence at the point of care in order to support their decision-making. Presentation of clinical evidence on handheld devices, and in a timely fashion, requires an integrated approach to documentation and ergonomic design. This paper reports on results from The Bringing Evidence to the Point of Care Project at the University of Toronto, concerning

  7. Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department

    Microsoft Academic Search

    Rico Fiumefreddo; Roya Zaborsky; Jeannine Haeuptle; Mirjam Christ-Crain; Andrej Trampuz; Ingrid Steffen; Reno Frei; Beat Müller; Philipp Schuetz

    2009-01-01

    BACKGROUND: Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP) in patients presenting to the emergency department are lacking. METHODS: We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two

  8. "Keeping up with Research in Clinical Presented by Jess Tyndall, Medical Librarian and Leila Mohammadi,

    E-print Network

    "Keeping up with Research in Clinical Education" Presented by Jess Tyndall; clinical education, simulation and rural and community-based education. It will build capacity for research to "search smart" and set up eAlerts in key areas of research interest, something which saves them doing

  9. Investigating common clinical presentations in first opinion small animal consultations using direct observation

    PubMed Central

    Robinson, N. J.; Dean, R. S.; Cobb, M.; Brennan, M. L.

    2015-01-01

    Understanding more about the clinical presentations encountered in veterinary practice is vital in directing research towards areas relevant to practitioners. The aim of this study was to describe all problems discussed during a convenience sample of consultations using a direct observation method. A data collection tool was used to gather data by direct observation during small animal consultations at eight sentinel practices. Data were recorded for all presenting and non-presenting specific health problems discussed. A total of 1901 patients were presented with 3206 specific health problems discussed. Clinical presentation varied widely between species and between presenting and non-presenting problems. Skin lump, vomiting and inappetence were the most common clinical signs reported by the owner while overweight/obese, dental tartar and skin lump were the most common clinical examination findings. Skin was the most frequently affected body system overall followed by non-specific problems then the gastrointestinal system. Consultations are complex, with a diverse range of different clinical presentations seen. Considering the presenting problem only may give an inaccurate view of the veterinary caseload, as some common problems are rarely the reason for presentation. Understanding the common diagnoses made is the next step and will help to further focus questions for future research. PMID:25564472

  10. RNAi Factors are Present and Active in Human Cell Nuclei

    PubMed Central

    Gagnon, Keith T.; Li, Liande; Chu, Yongjun; Janowski, Bethany A.; Corey, David R.

    2014-01-01

    Summary RNAi is widely appreciated as a powerful regulator of mRNA translation in the cytoplasm of mammalian cells. However, the presence and activity of RNAi factors in the mammalian nucleus has been the subject of considerable debate. Here we show that Argonaute-2 (Ago2) and RNAi factors Dicer, TRBP and TRNC6A/GW182 are in the human nucleus and associate together in multi-protein complexes. Small RNAs can silence nuclear RNA and guide site-specific cleavage of the targeted RNA, demonstrating that RNAi can function in the human nucleus. Nuclear Dicer is active and miRNAs are bound to nuclear Ago2, consistent with the existence of nuclear miRNA pathways. Notably, we do not detect loading of duplex small RNAs in nuclear extracts and known loading factors are absent. These results extend RNAi into the mammalian nucleus and suggest that regulation of RNAi via small RNA loading of Ago2 differs between the cytoplasm and the nucleus. PMID:24388755

  11. Age and clinical outcomes in patients presenting with acute coronary syndromes?

    PubMed Central

    Ahmed, Emad; AlHabib, Khalid F.; El-Menyar, Ayman; Asaad, Nidal; Sulaiman, Kadhim; Hersi, Ahmad; Almahmeed, Wael; Alsheikh-Ali, Alawi A.; Amin, Haitham; Al-Motarreb, Ahmed; Al Saif, Shukri; Singh, Rajvir; Al-Lawati, Jawad; Al Suwaidi, Jassim

    2013-01-01

    Context Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. Aims To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). Methods and material Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: ?50 years, 51–70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. Statistical analysis used One-way ANOVA test for continuous variables, Pearson chi-square (X2) test for categorical variables and multivariate logistic regression analysis for predictors were performed. Results Among 7930 consecutive ACS patients; 2755 (35%) were ?50 years, 4110 (52%) were 51–70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients ?50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03–1.60), heart failure (OR 2.8; 95% CI 2.17–3.52) and major bleeding (OR 4.02; 95% CI 1.37–11.77) and in-hospital mortality (age 51–70: OR 2.67; 95% CI 1.86–3.85, and age >70: OR 4.71; 95% CI 3.11–7.14). Conclusion Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly. PMID:24027372

  12. Significant clinical worsening after natalizumab withdrawal: Predictive factors.

    PubMed

    Vidal-Jordana, A; Tintoré, M; Tur, C; Pérez-Miralles, F; Auger, C; Río, J; Nos, C; Arrambide, G; Comabella, M; Galán, I; Castilló, J; Sastre-Garriga, J; Rovira, A; Montalban, X

    2015-05-01

    We aimed to single out multiple sclerosis (MS) cases with poor outcome after natalizumab withdrawal and to identify predictive variables. We ascertained 47 withdrawals, and compared their pre- and post-natalizumab periods. We objectively defined significant clinical worsening after natalizumab withdrawal as a 2-step increase in Expanded Disability Status Scale (EDSS). We performed regression models. As a group, post-natalizumab annualized relapse rate (ARR) was lower in the post-natalizumab period, and there were no differences in the mean number of gadolinium (Gd)-enhancing lesions between pre- and post-natalizumab magnetic resonance imaging (MRI). Corticosteroid treatment did not change the outcomes. Eight patients (19%) presented significant clinical worsening after natalizumab withdrawal, which was predicted by a higher baseline EDSS and a 1-step EDSS increase while on natalizumab. PMID:25392320

  13. Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms.

    PubMed

    Jordan, Amy S; McEvoy, R Doug

    2003-10-01

    Sleep apnea syndromes are a common cause of sleepiness and neurocognitive impairment and have been implicated as an independent risk factor for cardiovascular disease. While both epidemiological and sleep clinic-based studies indicate that sleep apnea syndromes are more common in men than in women, the gender difference in prevalence is more marked within the sleep clinic. Reasons for the relative failure of women to attend sleep clinics and the pathophysiologic differences that give rise to the male predominance of sleep apnea syndromes are unknown. The purpose of this review was to examine the literature with regard to these aspects, to provide clinical guidance to improve the reduced attendance of women to sleep laboratories and to stimulate research interest into the causes of these differences. PMID:14573374

  14. Clinical significance of growth differentiation factor 11 in colorectal cancer.

    PubMed

    Yokoe, Takeshi; Ohmachi, Takahiro; Inoue, Hiroshi; Mimori, Koshi; Tanaka, Fumiaki; Kusunoki, Masato; Mori, Masaki

    2007-11-01

    Growth differentiation factor 11 (GDF11), a member of the transforming growth factor-beta superfamily and bone morphogenetic protein (BMP) subfamily, plays a role in regulation of development and differentiation. Although some members of BMP subfamily have been reported to correlate with cancer, the significance of GDF11 has not been studied in a clinical oncology setting. The current study explored the clinicopathological significance of GDF11 expression in colorectal cancer. Quantitative real-time reverse transcription-PCR in colorectal cancer specimens obtained from 130 patients showed that GDF11 mRNA expression in cancer tissue was significantly higher than in normal tissue (p=0.001). Tumors were classified as high GDF11 expression (n=65) or low GDF11 expression (n=65). Patients whose tumors had high GDF11 expression showed a high frequency of lymph node metastasis (p=0.049) and had more cancer-related deaths (p=0.040). Furthermore, the patients with high GDF11 expression had significantly poorer overall survival than those with low expression (p=0.0334). Although multivariate analysis showed that GDF11 was not an independent prognostic factor, these findings suggest that GDF11 may be a novel diagnostic and prognostic biomarker in patients with colorectal cancer. PMID:17912435

  15. [Bone substitute with growth factor. Preliminary clinical cases for cranio- and maxillo-facial indications].

    PubMed

    Arnaud, E; Molina, F; Mendoza, M; Fuente del Campo, A; Ortiz-Monasterio, F

    1998-02-01

    Several biological materials have been analyzed in combination with osteo-inductive growths factors to determine whether such a system can replace bone grafting in surgical practice. Efforts have been aimed at the discovery of the best carriers and delivery systems. We present the results of the surgical treatment of 11 cranio-maxillo-facial defects in 9 patients using a combination of natural coral skeleton (NCS in blocks or granules), human fibrin glue and transforming growth factor beta-1 (TGF-beta 1) as a composite bone substitute. Three patients were initially excluded because of early extrusion of the materials due to a technical error. Clinical and radiological evaluation was performed in all cases, with the patient acting as his own control. Clinical firmness and radiological mineralization occurred in three quarters of cases. New bone formation was confirmed histologically in two of these patients. Clinically the initial results remained stable over a three years follow-up with staged surgical procedures performed on a number of patients. None of the patients suffered any detrimental effect from implantation of the bone substitute. Although the numbers in these series are limited, the association of TGF-beta 1, human fibrin glue and NCS represented an interesting step, although the clinical results could be improved. Important factors in the success of this technique appeared to be stabilisation of the biological materials, quality and asepsis of the surrounding tissue and the dose of growth factor. PMID:9768091

  16. Clinical presentations and imaging findings of neuroblastoma beyond abdominal mass and a review of imaging algorithm

    PubMed Central

    Chu, C M; Rasalkar, D D; Hu, Y J; Cheng, F W T; Li, C K; Chu, W C W

    2011-01-01

    Neuroblastoma is one of the most common malignant neoplasms in childhood. The most common clinical presentation of this tumour is abdominal mass. However, affected children may have various clinical presentations as a result of disseminated metastatic disease or associated paraneoplastic syndromes at the time of diagnosis. In this article we have outlined the imaging findings in seven patients with “extra-abdominal” presentation of neuroblastoma and the pitfalls in making the correct diagnosis. The purpose of this pictorial review is to alert the general radiologist to the possible presentations of this common childhood malignancy to derive early detection and diagnosis. PMID:21172969

  17. Malignant mesothelioma of tunica vaginalis: an extremely rare case presenting without risk factors

    PubMed Central

    Akin, Yigit; Bassorgun, Ibrahim; Basara, Isil; Yucel, Selcuk

    2015-01-01

    Testicular tumours have many different manifestations, including hydrocele formation. Herein, we present an extremely rare case of testicular mesothelioma presenting with left hydrocele, but without risk factors. Left radical inguinal orchidectomy was performed, and pathological examination revealed a malignant mesothelioma of the tunica vaginalis of the testis. No infiltration of the spermatic cord was evident, and upon advanced radiological evaluation, no sign of metastasis was detected. Follow-up was still ongoing in our urology outpatient clinic at the time of this report. Although hydrocele is a simple and common condition that is easy to diagnose, a detailed investigation should be performed. Thus, when encountering a patient with hydrocele, the clinician should evaluate the possibility of the presence of an underlying testicular/paratesticular tumour, including a rare one such as mesothelioma of the tunica vaginalis. PMID:25820862

  18. Malignant mesothelioma of tunica vaginalis: an extremely rare case presenting without risk factors.

    PubMed

    Akin, Y; Bassorgun, I; Basara, I; Yucel, S

    2015-03-01

    Testicular tumours have many different manifestations, including hydrocele formation. Herein, we present an extremely rare case of testicular mesothelioma presenting with left hydrocele, but without risk factors. Left radical inguinal orchidectomy was performed, and pathological examination revealed a malignant mesothelioma of the tunica vaginalis of the testis. No infiltration of the spermatic cord was evident, and upon advanced radiological evaluation, no sign of metastasis was detected. Follow-up was still ongoing in our urology outpatient clinic at the time of this report. Although hydrocele is a simple and common condition that is easy to diagnose, a detailed investigation should be performed. Thus, when encountering a patient with hydrocele, the clinician should evaluate the possibility of the presence of an underlying testicular/paratesticular tumour, including a rare one such as mesothelioma of the tunica vaginalis. PMID:25820862

  19. The cultural formulation: a method for assessing cultural factors affecting the clinical encounter.

    PubMed

    Lewis-Fernández, Roberto; Díaz, Naelys

    2002-01-01

    The growing cultural pluralism of US society requires clinicians to examine the impact of cultural factors on psychiatric illness, including on symptom presentation and help-seeking behavior. In order to render an accurate diagnosis across cultural boundaries and formulate treatment plans acceptable to the patient, clinicians need a systematic method for eliciting and evaluating cultural information in the clinical encounter. This article describes one such method, the Cultural Formulation model, expanding on the guidelines published in DSM-IV. It consists of five components, assessing cultural identity, cultural explanations of the illness, cultural factors related to the psychosocial environment and levels of functioning, cultural elements of the clinician-patient relationship, and the overall impact of culture on diagnosis and care. We present a brief historical overview of the model and use a case scenario to illustrate each of its components and the substantial effect on illness course and treatment outcome of implementing the model in clinical practice. PMID:12418357

  20. Macrophage response in patients diagnosed with aseptic necrosis of the femoral head presenting different risk factors.

    PubMed

    Kamal, Diana; Tr?istaru, Rodica; Kamal, Constantin Kamal; Alexandru, Drago? Ovidiu; Ion, Daniela Adriana; Grecu, Dan Cristian

    2015-01-01

    Aseptic necrosis of the femoral head is a condition caused by partial or total interruption of blood supply to the femoral head. The diminished blood supply causes necrosis of the cellular elements and of the bone marrow, followed by the collapse of the bone structure, events that ultimately lead to the destruction of the bone tissue, the appearance of local pain and loss of function in the affected coxofemoral joint. The importance of this condition is that it mainly affects young adults aged 30-50 years, active from a socio-professional standpoint, and increased life expectancy. The material studied to achieve CD68 immunostaining was represented by bone fragments from the area of necrosis and from the adjacent areas of the femoral heads, harvested from 39 patients when performing hip arthroplasty surgery. The patients were diagnosed with aseptic necrosis of the femoral head and hospitalized in the Clinic of Orthopedics and Traumatology, Emergency County Hospital of Craiova, Romania, from June 2014 to January 2015. The 39 patients included in the study were divided into four categories according to presented risk factors (alcohol, alcohol and smoking, trauma, corticosteroids). All the 39 cases had positive immunostaining for CD68, macrophage being highlighted both in the area of necrosis and in the adjacent areas. We noted significant differences in the number and arrangement of macrophages in patients presenting different risk factors. The highest number of macrophages was present in patients presenting a risk factor corticosteroids, and the lowest number of macrophages was found in patients who had trauma as the main risk factor. PMID:25826501

  1. Age modifies the immunologic response and clinical presentation of american tegumentary leishmaniasis.

    PubMed

    Carvalho, Augusto M; Amorim, Camila F; Barbosa, Juliana L S; Lago, Alexsandro S; Carvalho, Edgar M

    2015-06-01

    Leishmania (Viannia) braziliensis is the main causal agent of American tegumentary leishmaniasis (ATL) that may present as cutaneous, mucosal, or disseminated cutaneous leishmaniasis. The disease is highly prevalent in young males and there is a lack of studies of ATL in the elderly. Herein, we compared clinical manifestations, immunologic response, and response to antimony therapy between patients > 60 years of age (N = 58) and patients who were 21-30 years of age (N = 187). The study was performed in Corte de Pedra, Bahia, Brazil, a well-known area of L. braziliensis transmission. Cytokine production by cultured peripheral blood mononuclear cells stimulated with soluble Leishmania antigen was performed. Elderly subjects more frequently had a previous history of cutaneous leishmaniasis, large lesions, or mucosal leishmaniasis, and they were less likely to have lymphadenopathy. There was no difference regarding gender and response to therapy. Peripheral blood mononuclear cells from elderly subjects produced a similar amount of tumor necrosis factor than young patients but they produced less interferon-gamma and more interleukin-10 than young subjects. We concluded that elderly patients with cutaneous leishmaniasis should be searched for mucosal or disseminated leishmaniasis. The decreased interferon-gamma production and increase in interleukin-10 observed in elderly patients may contribute to parasite persistence and L. braziliensis infection dissemination. PMID:25918209

  2. Intragenic deletion of RBFOX1 associated with neurodevelopmental/neuropsychiatric disorders and possibly other clinical presentations

    PubMed Central

    2013-01-01

    Background RBFOX1 is an important splicing factor regulating developmental and tissue-specific alternative splicing in heart, muscle, and neuronal tissues. Constitutional genetic defects in RBFOX1 are implicated in multiple medical conditions. Results We identified 14 copy number variants (CNV) involving RBFOX1 from 2,124 consecutive pediatric patients referred for chromosomal microarray analysis (CMA), including 13 intragenic deletions and a single intragenic duplication. The clinical significances of the intragenic deletions of RBFOX1 were evaluated. Conclusions Our data strongly supports the associations of intragenic deletions of RBFOX1 with a diversity of neurodevelopmental and neuropsychiatric disorders, and possibly other clinical features. PMID:23822903

  3. Risk factors for and sequelae of headaches in schoolchildren with clinical implications from a psychosocial perspective.

    PubMed

    Rhee, H

    2001-12-01

    Functional headache, by definition, is a headache not associated with organic diseases. It is a common symptom in school children and can cause potentially serious health problems, affecting their growth and development. Therefore, this report synthesizes the literature about functional headaches in schoolchildren from a psychosocial perspective. This report examines the research on risk factors and sequelae of headaches in children, presents a framework to guide the conceptualization of this phenomenon, and suggests an application of this framework for clinical practice. PMID:11740786

  4. Clinical presentation of hypernatremic dehydration in exclusively breast-fed neonates

    Microsoft Academic Search

    Hakam Yaseen; Moza Salem; Maha Darwich

    2004-01-01

    Objective: To identify the clinical presentation of dehydration related to failure of lactation in exclusively breastfed term infants.Method: A prospective study was performed between January 2000 and June 2003 in AI Qassimi Hospital in the Emirate of Sharjah. Enrollment\\u000a criteria included term neonates whose birth weight of >2000g with no underlying organic illness causing poor feeding admitted\\u000a for clinical manifestations

  5. Is Leptin the Parabiotic “Satiety” Factor ? Past and Present Interpretations

    PubMed Central

    Harris, Ruth B.S.

    2012-01-01

    In 1959 Hervey hypothesized that a circulating feedback signal informed the hypothalamus of the size of fat stores and initiated appropriate corrections to energy balance. The hypothesis resulted from a parabiosis study in which one animal became obese following lesioning of the ventromedial hypothalamus. The partner of the lesioned rat was hypophagic and lost a large amount of body fat. Similar results came from parabiosis studies with obese Zucker rats and rats that overate due to stimulation of the lateral hypothalamus. In studies in which one parabiont was made obese by overfeeding the non-overfed partners lost substantial amounts of fat with a minimal reduction in food intake and no loss of lean tissue. The loss of fat was due to inhibition of adipose lipogenesis and other metabolic adjustments typical of food restriction. Parabiosis with genetically obese mice implied that ob/ob mice did not produce the feedback signal and subsequently the mutant ob protein, leptin, was identified. This paper provides a review and interpretation of parabiosis work that preceded the discovery of leptin, an evaluation of leptin in relation to its function as the circulating feedback signal and evidence for additional circulating factors involved in the control of adipose tissue mass. PMID:22889986

  6. Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria

    Microsoft Academic Search

    L. A. Adebusoye; I. O. Ajayi; M. D. Dairo; A. O. Ogunniyi

    2012-01-01

    The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional

  7. Threadworm: an infrequent clinical finding in a genitourinary medicine clinic attendee presenting with ano-genital irritation.

    PubMed

    Day, S

    2009-05-01

    A 24-year-old lady presented to an evening genitourinary (GU) clinic with a short history of vulval and anal irritation. On perianal examination, several threadworms were visible. Symptoms resolved with oral mebendazole and strict personal and environmental hygiene. Threadworm is a common and easily treatable cause of pruritus ani, yet is underreported in GU literature. If the history is suggestive, consider performing the diagnostic cellophane test and/or prescribing empirical treatment. PMID:19386978

  8. Lichen sclerosus: a potpourri of misdiagnosed cases based on atypical clinical presentations

    PubMed Central

    Ventolini, Gary; Patel, Ravi; Vasquez, Robert

    2015-01-01

    Objective Lichen sclerosus (LS) is a chronic progressive inflammatory autoimmune-induced disease that primarily affects the epidermis and dermis of the external genital-anal region. Intense and recalcitrant pruritus is the hallmark of LS. Physical exam reveals thinning, hyperkeratosis, and parchment-like appearance. However, the classic symptom and signs of LS may not always be present and patients may be asymptomatic for pruritus. Hence, we describe 15 misdiagnosed cases with atypical clinical presentations. We believe that the absence of pruritus contributed to their initial misdiagnosis. The purpose of this paper is to increase awareness of atypical presentations of LS. Methods Data base review of de-identified clinical case pictures was performed. All patients had histopathology-confirmed diagnoses of LS. The data base file contains 800 cases of vulvovaginal disorders. The Institutional Review Board (IRB) considered that searching a de-identified data base of pictures did not require IRB approval. Results We identified 15 different atypical clinical cases. Patient ages were 18–75 years old. These patients were asymptomatic for pruritus and were misdiagnosed before they presented to the vulvovaginal specialized clinic. Conclusion Fifteen patients asymptomatic for pruritus with histopathology-confirmed diagnosis of LS were identified. They illustrate atypical clinical presentations that LS may have. PMID:26056492

  9. Clinical Study on Causative Factors and Recurrence of Choledocholithiasis

    PubMed Central

    Sakai, Yoshihiro

    1996-01-01

    To identify factors involved in choledocholithiasis, clinical characteristics were studied using univariate and multivariate analyses. Factors involved in recurrence were also investigated. The subjects consisted of 51 patients with calcium bilirubinate stones (B group) and 52 patients with cholesterol stones (C group). All patients had choledocholithiasis and underwent lithotripsy by endoscopic sphincterotomy (EST) during the past 9 years. Twenty variables, including clinical symptoms and endoscopic retrograde cholangiopancreatography (ERCP) findings, were analyzed using a Statistical Analysis System (SAS) software package. Univariate analysis were done using Student's t-test and the chi-square test. Multivariate analyses were done by stepwise logistic regression analysis. In univariate analyses, there were significant differences between the B group and C group in nine variables: age, common bile duct diameter, common hepatic duct diameter, common bile duct stone diameter, cystic duct diameter, and the presence of gallbladder stones, atypical arrangement of the hepatic duct, parapapillary diverticulum, and large parapapillary diverticulum. In multivariate analysis, the four variables of no gallbladder stone, large parapapillary diverticulum, cystic duct less than 8 mm, and atypical arrangement of the hepatic duct were significant independent factors for the development of stones in the B group, with relative risks of 37.75, 16.73, 5.56, and 5.49, respectively. The results indicated that calcium bilirubinate stones were frequently associated with parapapillary diverticulum and abnormal arrangement of the bile duct. The formation of these stones was attributed to chronic biliary stasis caused by dysfunction of the biliary tract, including the papilla. In contrast, most cholesterol stones found in the common bile duct had apparently descended from the gallbladder. Common bile duct stones recurred after EST in 9 patients, all of whom had calcium bilirubinate stones. On ERCP, recurrence was found to be frequently associated with gallbladder stones, large parapapillary diverticula, and atypical arrangement of the hepatic duct. Patients with these characteristics on initial ERCP should therefore receive appropriate treatment and undergo strict follow-up observations owing to the increased risk of recurrence caused by dysfunction of the biliary tract. PMID:18493421

  10. Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

    PubMed Central

    Lee, James C.; Kawut, Steven M.; Shah, Rupal J.; Localio, A. Russell; Bellamy, Scarlett L.; Lederer, David J.; Cantu, Edward; Kohl, Benjamin A.; Lama, Vibha N.; Bhorade, Sangeeta M.; Crespo, Maria; Demissie, Ejigayehu; Sonett, Joshua; Wille, Keith; Orens, Jonathan; Shah, Ashish S.; Weinacker, Ann; Arcasoy, Selim; Shah, Pali D.; Wilkes, David S.; Ware, Lorraine B.; Palmer, Scott M.; Christie, Jason D.

    2013-01-01

    Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2–2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0–1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2–3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2–5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2–2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3–3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1–5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6–7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1–1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357). PMID:23306540

  11. Modifiable Risk Factors for Attempted Suicide in Australian Clinical and Community Samples

    ERIC Educational Resources Information Center

    Carter, Gregory L.; Page, Andrew; Clover, Kerrie; Taylor, Richard

    2007-01-01

    Modifiable risk factors for suicide attempt require identification in clinical and community samples. The aim of this study was to determine if similar social and psychiatric factors are associated with suicide attempts in community and clinical settings and whether the magnitude of effect is greater in clinical populations. Two case-control…

  12. Androgen-producing adrenocortical carcinoma: report of 3 cases with different clinical presentations.

    PubMed

    Jaruratanasirikul, Somchit; Patarapinyokul, Sakda; Mitranun, Winyou

    2012-06-01

    Adrenocortical carcinoma is extremely rare in children. The majority of cases presented with a combination of clinical features of Cushing syndrome and hyperandrogenism. The authors report three cases of isolated androgen-producing adrenocortical carcinoma with different clinical presentations. The two cases had clinical manifestations of hyperandrogenism: one boy with isosexual pseudoprecocity and one girl with heterosexual pseudoprecocity, both of whom underwent complete tumor removal and were well after surgery. The third patient presented with a huge abdominal mass and weight loss. Local and distant metastases (both lungs) were detected at the time of diagnosis. The patient expired after 36 days of hospitalization. The pathological section in all three patients demonstrated highly pleomorphism, increased mitoses, and scattered areas of necrosis. All cases had high levels of 1 7-hydroxyprogesterone, dehydroepiandrosterone-sulphate, and testosterone. PMID:22774627

  13. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    PubMed Central

    Lottridge, Danielle M; Chignell, Mark; Danicic-Mizdrak, Romana; Pavlovic, Nada J; Kushniruk, Andre; Straus, Sharon E

    2007-01-01

    Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012). Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization. PMID:17655759

  14. Immune status at presentation for human immunodeficiency virus clinical care in Rio de Janeiro and Baltimore

    PubMed Central

    Moreira, Ronaldo I.; Luz, Paula M.; Struchiner, Claudio J.; Morgado, Mariza; Veloso, Valdilea G.; Keruly, Jeanne C.; Grinsztejn, Beatriz; Moore, Richard D.

    2011-01-01

    Introduction Late presentation to HIV clinical care increases individual risk of (multiple) clinical events and death, and decreases successful response to highly active antiretroviral therapy (HAART). In Brazil, provision of HAART free of charge to all HIV-infected individuals could lead to increased testing and linkage to care. Methods We assessed the immune status of 2,555 patients who newly presented for HIV clinical care between 1997 and 2009 at the Johns Hopkins Clinical Cohort, in Baltimore, USA and at the Instituto de Pesquisa Clinica Evandro Chagas Clinical Cohort, in Rio de Janeiro, Brazil. The mean change in the CD4 cell count per year was estimated using multivariate linear regression models. Results Overall, from 1997 to 2009, 56% and 54% of the patients presented for HIV clinical care with CD4 count ? 350 cells/mm3 in Baltimore and Rio de Janeiro, respectively. On average, 75% of the patients presented with viral load > 10,000 copies/mL. In Rio de Janeiro only, the overall adjusted per year increase in the mean CD4 cell count was statistically significant [5 cells/mm3 (95% CI 1, 10 cells/mm3)]. Discussion We found that, over years, the majority of patients presented late, that is, with a CD4 count < 350 cells/mm3. Our findings indicate that, despite the availability of HAART for more than a decade, and mass media campaigns stimulating HIV testing in both countries, the proportion of patients who start therapy at an advanced stage of the disease is still high. PMID:21857314

  15. Clinical Prognostic Factors for Radical Cystectomy in Bladder Cancer

    PubMed Central

    Jeon, Seung Hyun; Jeon, Sung-Hyun

    2005-01-01

    Purpose We investigated the effects of radical cystectomy and the prognostic factors that affect the survival of bladder cancer patients. Materials and Methods From 1979 to 2002, 59 patients with long-term follow up results of at least 2 years were enrolled in this study. Indications for surgery included muscle invasive bladder cancer and high-risk superficial bladder cancer. The cancer specific and recurrence free survival rates with respect to the possible prognostic factors were determined using Kaplan-Meier statistics. Results The mean patient age was 62.8 years (M: 48, F: 11), and the estimated 5- and 10-year survival rates were 62% and 39.4%, respectively. The median time to local or systemic recurrence was 16 months (range: 5~100), and the average survival durations after local and systemic recurrence were 14.4 months and 12.7 months, respectively. Pathologic stage, tumor grade, mean nuclear area, sex and lymphatic invasion were significant factors by univariate analysis (p<0.05). The disease related survival rate in patients having progression from an initial superficial tumor was lower than for those patients who displayed muscle invasive disease at the initial treatment. Multivariate analysis identified pathologic stage and lymphatic invasion as independent prognostic factors. Conclusions Radical cystectomy for organ-confined cancer showed favorable 5- and 10-year survival rates. The survival rate for patients with progression from an initial superficial tumor was worse than for those patients with invasive tumor at the initial presentation. The most significant independent prognostic factors were the pathologic stage and the presence of lymphatic invasion, which were highly correlated with all the investigated disease endpoints. PMID:19956510

  16. Giardia intestinalis genotypes: Risk factors and correlation with clinical symptoms.

    PubMed

    Mohammed Mahdy, A K; Surin, Johari; Wan, K L; Mohd-Adnan, A; Al-Mekhlafi, M S Hesham; Lim, Y A L

    2009-10-01

    This study was conducted to identify genotypes related risk factors of Giardia intestinalis in an Orang Asli (aboriginal) community in Pahang, Malaysia. Stool samples were collected from 321 individuals aged between 2 and 76 years old, of whom 160 were males and 161 were females. Faecal samples were processed with trichrome staining technique for the primary identification of G. intestinalis. Molecular identification was carried out by the amplification of a partial SSU rRNA gene using nested PCR. PCR products were purified and genotyped. 42 samples successfully amplified from the 76 positive faecal samples, only 1 was Assemblage A, the rest were Assemblage B. Risk analysis based on the detected genotypes of Giardia using univariate analysis and logistic regression identified three significant risk factors of giardiasis caused by assemblage B which included children clinical symptoms of giardiasis (OR=2.4, 95% CI=1.13-5.12, p=0.019). Females infected with Assemblage B were at higher risk of manifesting gastroenteritis signs and symptoms (OR=3.9, 95% CI=1.50-10.31, p=0.004). It has been concluded that giardiasis is still a public health problem in Orang Asli community and most commonly caused by assemblage B. The dynamic of transmission is most probably anthroponotic which is human to human either directly or indirectly through contaminated food. This route of transmission should be considered in the control strategy of the disease. Mass treatment together with health education could be the most practical intervention for reducing the infection. Those at high risk should receive more attention from public health authorities. PMID:19560431

  17. Combined methylmalonic acidemia and homocystinuria, cblC type. I. Clinical presentations, diagnosis and management

    PubMed Central

    Carrillo-Carrasco, Nuria; Chandler, Randy J.

    2014-01-01

    Combined methylmalonic acidemia and homocystinuria, cblC type, is an inborn error of intracellular cobalamin metabolism with a wide spectrum of clinical manifestations that is stated to be the most common inherited disorder of cobalamin metabolism. This metabolic disease is caused by mutations in the MMACHC gene and results in impaired intracellular synthesis of adenosylcobalamin and methylcobalamin, cofactors for the methylmalonyl-CoA mutase and methionine synthase enzymes. Elevated methylmalonic acid and homocysteine with decreased methionine production are the biochemical hallmarks of this disorder. Awareness of the diverse clinical presentations associated with cblC disease is necessary to provide a timely diagnosis, to guide management of affected individuals and to establish a framework for the future treatment of individuals detected through expanded newborn screening. This article reviews the biochemistry, clinical presentations, genotype-phenotype correlations, diagnosis and management of cblC disease. PMID:21748409

  18. Assessing the clinical impact of prognostic factors: When is \\

    Microsoft Academic Search

    Daniel F. Hayes; Bruce Trock; Adrian L. Harris

    1998-01-01

    Very few tumor markers have been recommended for routine clinical care of patients with breast cancer [1]. A framework to determine the clinical utility of tumor markers is required. In a previous publication, a \\

  19. Factors related to medication adherence in memory disorder clinic patients

    PubMed Central

    OWNBY, R. L.; HERTZOG, C.; CROCCO, E.; DUARA, R.

    2012-01-01

    Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers’ reports of patients’ medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients’ mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers’ reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients’ relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients’ beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence. PMID:16798630

  20. The influence of cow factors on the incidence of clinical mastitis in dairy cows

    Microsoft Academic Search

    W. Steeneveld; H. Hogeveen; H. W. Barkema; J. van den Broek; R. B. M. Huirne

    2008-01-01

    Many cow-specific risk factors for clinical mastitis (CM) are known. Other studies have analyzed these risk factors separately or only analyzed a limited number of risk factors simultaneously. The goal of this study was to determine the influence of cow factors on the incidence rate of CM (IRCM) with all cow factors in one multivariate model. Also, using a similar

  1. Impact of HFE genetic testing on clinical presentation of hereditary hemochromatosis: new epidemiological data

    Microsoft Academic Search

    Virginie Scotet; Gérald Le Gac; Marie-Christine Mérour; Anne-Yvonne Mercier; Brigitte Chanu; Chandran Ka; Catherine Mura; Jean-Baptiste Nousbaum; Claude Férec

    2005-01-01

    BACKGROUND: Hereditary hemochromatosis (HH) is a common inherited disorder of iron metabolism in Northern European populations. The discovery of a candidate gene in 1996 (HFE), and of its main mutation (C282Y), has radically altered the way to diagnose this disease. The aim of this study was to assess the impact of the HFE gene discovery on the clinical presentation and

  2. Acute lymphoblastic leukaemia in adults: Immunological subtypes and clinical features at presentation

    Microsoft Academic Search

    M. B. van't Veer; W. L. J. van Putten; L. F. Verdonck; G. J. Ossenkoppele; B. Löwenberg; J. C. Kluin-Nelemans; P. W. Wijermans; H. C. Schouten; W. Sizoo; A. W. Dekker

    1993-01-01

    Summary In 91 of 106 adult patients with acute lymphoblastic leukemia (ALL) enrolled in the treatment protocol ALL HOVON-5 between May 1988 and October 1991, the immunophenotype of the leukemia was determined and correlated with clinical characteristics at presentation. The immunological marker analysis was performed in ten laboratories, all members of the Dutch Study Group on Immunophenotyping of Leukemias and

  3. The Vulnerabilities of Re-presenting Practtice: From Clinical Gaze to Narrative Frames of Acceptance

    Microsoft Academic Search

    Melissa Park

    2005-01-01

    Ethnography often entails being a vulnerable observer (Behar, 1996). There is nothing more heartbreaking than the tasks of analysis and re-presentation when attempting to do justice to troubled yet hopeful transactions in “clinical borderlands” where the stakes are high for everyone involved (Mattingly, 2003; Mattingly & Lawlor, 2001). When data foregrounds potentially conflictive moral issues and dilemmas, representation itself is

  4. Clinical hyperthermia of prostate cancer using magnetic nanoparticles: Presentation of a new interstitial technique

    Microsoft Academic Search

    M. Johannsen; U. Gneveckow; L. Eckelt; A. Feussner; N. WaldÖFner; R. Scholz; S. Deger; P. Wust; S. A. Loening; A. Jordan

    2005-01-01

    The aim of this pilot study was to evaluate whether the technique of magnetic fluid hyperthermia can be used for minimally invasive treatment of prostate cancer. This paper presents the first clinical appli- cation of interstitial hyperthermia using magnetic nanoparticles in locally recurrent prostate cancer. Treatment planning was carried out using computerized tomography (CT) of the prostate. Based on the

  5. Livedoid vasculopathy: review of pathogenesis, clinical presentation, diagnostic workup, and treatment.

    PubMed

    Haunson, G Trey; Judy, David W; Prall, Nicole C; Miller, Richard A

    2012-12-01

    We report the case of a patient with livedoid vasculopathy that had been undiagnosed and inadequately treated for more than 10 years. To improve disease recognition and management, we review the pathogenesis, typical clinical presentation, diagnostic workup, and treatment options for livedoid vasculopathy. PMID:23409480

  6. Extracorporeal Ultrasound-Guided High Intensity Focused Ultrasound: Implications from the Present Clinical Trials

    PubMed Central

    Yu, Tinghe; Fu, Xiao

    2014-01-01

    Extracorporeal ultrasound-guided high intensity focused ultrasound (HIFU) has been clinically used for 15 years, and over 36000 cases have been reported. However, there yet lacked a consensus in the clinical values, suggesting the necessity of checking clinical findings. Clinical trials were searched and data reevaluated. HIFU was hardly performed alone; almost all present anticancer means have been applied during an HIFU treatment, and a specific regimen varied between trials; there were heterogeneity and disagreement between trials. The complexity made it difficult to distinguish the effect of HIFU. Based upon evaluable data, the efficacy of HIFU was similar to that of radio frequency, chemoembolization, chemotherapy, radiotherapy, or hormone therapy; a combined therapy did not improve the efficacy. The survival rate of HIFU plus radiotherapy was lower than that of radical surgery in liver cancers. Adverse events had no downtrend in the past years. HIFU was not a standardized procedure where the intensity and insonation mode were modified constantly throughout a treatment, limiting an evaluation from the perspective of ultrasonics. These implied that HIFU should be applied as an alternative at most occasions. The present clinical trials had defects making against the understating of HIFU. PMID:24982965

  7. Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases

    Microsoft Academic Search

    Latika Sibal; Steve G. Ball; Vincent Connolly; Robert A. James; Philip Kane; William F. Kelly; Pat Kendall-Taylor; David Mathias; Petros Perros; Richard Quinton; Bijay Vaidya

    2004-01-01

    Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy.\\u000a Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983–2004.\\u000a Results: Forty-five patients (28 men; mean age 49 years, range 16–72 years) were identified. Only 8 (18%) were known to have pituitary\\u000a adenomas at presentation. Thirty-four (81%)

  8. Presentation and Treatment of Subfertile Men with Balanced Translocations: The Cleveland Clinic Experience

    Microsoft Academic Search

    Christina B. Ching; Edmund Ko; Bryan Hecht; Marissa Smith; Edmund Sabanegh

    2012-01-01

    Introduction: Balanced chromosomal translocations are a relatively common (2–7%) finding among infertile couples. We report clinical features of males with translocations at our institution. Materials and Methods: Data was collected on men presenting for infertility evaluation between July 2006 March 2010, including presentation, medical history, and infertility treatments. Criteria for genetic evaluation, consisting of karyotype and Y-linked microdeletion assay, included

  9. [A clinical presentation of a very rare infection: parenchymal Fasciola hepatica].

    PubMed

    Sapmaz, Ferdane; Kalkan, Ismail Hakk?; Guliter, Sefa; Nazl?o?lu, Adem

    2013-01-01

    Fascioliasis is primarily an infection of livestock such as cattle and sheep, caused by the flat, brown liver fluke Fasciola hepatica. Humans are accidental hosts. The diagnosis of infection depends on suspicion. Radiologic findings are specific. Usually, Computed Tomography (CT) and other imaging studies show hypodense migratory lesions of the liver. The development of a chronic liver abscess appears to be extremely rare. Here we present our case with hepatic abscess due to F. hepatica, which is a rare clinical presentation. PMID:24412878

  10. Contribution of Transjugular Liver Biopsy in Patients with the Clinical Presentation of Acute Liver Failure

    SciTech Connect

    Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Luca, Angelo; Gruttadauria, Salvatore; Minervini, Marta Ida; Vizzini, Giovanni; Arcadipane, Antonio; Gridelli, Bruno [Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT) (Italy)

    2006-12-15

    Purpose. Acute liver failure (ALF) treated with conservative therapy has a poor prognosis, although individual survival varies greatly. In these patients, the eligibility for liver transplantation must be quickly decided. The aim of this study was to assess the role of transjugular liver biopsy (TJLB) in the management of patients with the clinical presentation of ALF. Methods. Seventeen patients with the clinical presentation of ALF were referred to our institution during a 52 month period. A TJLB was performed using the Cook Quick-Core needle biopsy. Clinical data, procedural complications, and histologic findings were evaluated. Results. Causes of ALF were virus hepatitis B infection in 7 patients, drug toxicity in 4, mushroom in 1, Wilson's disease in 1, and unknown origin in 4. TJLB was technically successful in all patients without procedure-related complications. Tissue specimens were satisfactory for diagnosis in all cases. In 14 of 17 patients the initial clinical diagnosis was confirmed by TJLB; in 3 patients the initial diagnosis was altered by the presence of unknown cirrhosis. Seven patients with necrosis <60% were successfully treated with medical therapy; 6 patients with submassive or massive necrosis ({>=}85%) were treated with liver transplantation. Four patients died, 3 had cirrhosis, and 1 had submassive necrosis. There was a strict statistical correlation (r = 0.972, p < 0.0001) between the amount of necrosis at the frozen section examination and the necrosis found at routine histologic examination. The average time for TJLB and frozen section examination was 80 min. Conclusion. In patients with the clinical presentation of ALF, submassive or massive liver necrosis and cirrhosis are predictors of poor prognosis. TLJB using an automated device and frozen section examination can be a quick and effective tool in clinical decision-making, especially in deciding patient selection and the best timing for liver transplantation.

  11. Model-based clinical drug development in the past, present and future: a commentary.

    PubMed

    Kimko, Holly; Pinheiro, José

    2015-01-01

    Clinical drug development remains a mostly empirical, costly enterprise, in which decision-making is often based on qualitative assessment of risk, without properly leveraging all the relevant data collected throughout the development programme. Model-based drug development (MBDD) has been proposed by regulatory agencies, academia and pharmaceutical companies as a paradigm to modernize drug research through the quantification of risk and combination of information from different sources across time. We present here a historical account of the use of MBDD in clinical drug development, the current challenges and further opportunities for its application in the pharmaceutical industry. PMID:24527997

  12. Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment

    PubMed Central

    Gurion, R.; Lehman, T. J. A.; Moorthy, L. N.

    2012-01-01

    Systemic juvenile idiopathic arthritis (sJIA) constitutes a small part of juvenile idiopathic arthritis (JIA), yet has a disproportionally higher rate of mortality. Despite being grouped under JIA, it is considered to be a multifactorial autoinflammatory disease. The objective of this paper is to review the epidemiology, pathogenesis, genetics, clinical manifestations, complications, therapy, prognosis, and outcome of sJIA. The presentation and clinical manifestations of sJIA have not changed much in the past several decades, but the collective understanding of the pathogenesis and the development of new targeted therapies (particularly the biologic agents) have transformed and improved the disease outcome for children with sJIA. PMID:22235382

  13. Clinical Presentation Resembling Mucosal Disease Associated with 'HoBi'-like Pestivirus in a Field Outbreak.

    PubMed

    Weber, M N; Mósena, A C S; Simões, S V D; Almeida, L L; Pessoa, C R M; Budaszewski, R F; Silva, T R; Ridpath, J F; Riet-Correa, F; Driemeier, D; Canal, C W

    2014-04-16

    The genus Pestivirus of the family Flaviviridae consists of four recognized species: Bovine viral diarrhoea virus 1 (BVDV-1), Bovine viral diarrhoea virus 2 (BVDV-2), Classical swine fever virus (CSFV) and Border disease virus (BDV). Recently, atypical pestiviruses ('HoBi'-like pestiviruses) were identified in batches of contaminated foetal calf serum and in naturally infected cattle with and without clinical symptoms. Here, we describe the first report of a mucosal disease-like clinical presentation (MD) associated with a 'HoBi'-like pestivirus occurring in a cattle herd. The outbreak was investigated using immunohistochemistry, antibody detection, viral isolation and RT-PCR. The sequence and phylogenetic analysis of 5'NCR, N(pro) and E2 regions of the RT-PCR positive samples showed that four different 'HoBi'-like strains were circulating in the herd. The main clinical signs and lesions were observed in the respiratory and digestive systems, but skin lesions and corneal opacity were also observed. MD characteristic lesions and a pestivirus with cytopathic biotype were detected in one calf. The present study is the first report of a MD like presentation associated with natural infection with 'HoBi'-like pestivirus. This report describes the clinical signs and provides a pathologic framework of an outbreak associated with at least two different 'HoBi'-like strains. Based on these observations, it appears that these atypical pestiviruses are most likely underdiagnosed in Brazilian cattle. PMID:24735072

  14. Effectiveness of Physical Exercise to Reduce Cardiovascular Risk Factors in Youths: A Randomized Clinical Trial

    PubMed Central

    Cesa, Claudia Ciceri; Barbiero, Sandra Mari; Petkowicz, Rosemary de Oliveira; Martins, Carla Correa; Marques, Renata das Virgens; Andreolla, Allana Abreu Martins; Pellanda, Lucia Campos

    2015-01-01

    Background The aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents. Methods A randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home. Results A total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14. Conclusion A low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors. PMID:25780484

  15. GDNF: A Potent Survival Factor for Motoneurons Present in Peripheral Nerve and Muscle

    Microsoft Academic Search

    Christopher E. Henderson; Heidi S. Phillips; Richard A. Pollock; Alun M. Davies; Corinne Lemeulle; Mark Armanini; Barbara Moffet; Richard A. Vandlen; Vassilis E. Koliatsos; Arnon Rosenthal; Ve Koliatsor

    1994-01-01

    For survival, embryonic motoneurons in vertebrates depend on as yet undefined neurotrophic factors present in the limb bud. Members of the neurotrophin family are currently the best candidates for such neurotrophic factors, but inactivation of their receptor genes leads to only partial loss of motoneurons, which suggests that other factors are involved. Glial cell line-derived neurotrophic factor (GDNF), originally identified

  16. Acute subarachnoid hemorrhage. An unusual clinical presentation of cerebral venous sinus thrombosis.

    PubMed

    Hassan, Ali; Ahmad, Bakhtiar; Ahmed, Zahoor; Al-Quliti, Khalid W

    2015-01-01

    Ruptured cerebral aneurysm is the most common cause of spontaneous subarachnoid hemorrhage (SAH). Rarely cerebral venous sinus thrombosis (CVST) may present initially as acute SAH, and clinically mimics aneurysmal bleed. We report 2 cases of CVST who presented with severe headache associated with neck pain and focal seizures. Non-contrast brain CT showed SAH, involving the sulci of the convexity of hemisphere (cSAH) without involving the basal cisterns. Both patients received treatment with anticoagulants and improved. Awareness of this unusual presentation of CVST is important for early diagnosis and treatment. The purpose of this paper is to emphasize the inclusion of vascular neuroimaging like MRI with venography or CT venography in the diagnostic workup of SAH, especially in a patient with strong clinical suspicion of CVST or in a patient where neuroimaging showed cSAH. PMID:25630784

  17. PNH is a debilitating, fatal but treatable disease: same disease, different clinical presentations

    PubMed Central

    Sahin, Fahri; Yilmaz, Asu F; Ozkan, Melda Comert; Gokmen, Nihal Mete; Saydam, Guray

    2015-01-01

    Paroxysmal nocturnal hemoglobinuria (PNH) is a disease characterized by chronic persistent hemolysis, multi-organ damage and eventually multiple organ failure. PNH develops as a result of increased sensitivity to complement due to an acquired deficiency of certain glycosylphosphatidylinositol (GPI)-linked proteins. The clinical presentation of PNH varies greatly from one patient to another. We present three cases of PNH with different clinical presentations to illustrate the debilitating nature of the disease, possible fatal outcomes, and the need to timely diagnosis and targeted therapy. These cases also underline the need for increased awareness of PNH among relevant healthcare specialties. PNH should be considered as a differential diagnosis in patients with unexplained abdominal pain, dyspnea, renal failure, thrombosis and non-immune hemolytic anemia. PMID:26171282

  18. Clinical presentations of critical cardiac defects in the newborn: Decision making and initial management

    PubMed Central

    2010-01-01

    The risk of mortality and morbidity of patients with congenital heart defects (CHDs) is highest during neonatal period and increases when diagnosis and proper management are delayed. Neonates with critical CHDs may present with severe cyanosis, respiratory distress, shock, or collapse, all of which are also frequent clinical presentations of various respiratory problems or sepsis in the newborn. Early diagnosis and stabilization and timely referral to a tertiary cardiac center are crucial to improve the outcomes in neonates with CHDs. In this review, the clinical presentation of critical and potentially life-threatening CHDs is discussed along with brief case reviews to help understand the hemodynamics of these defects and ensure proper decision-making in critically ill patients. PMID:21189937

  19. Genetic and Clinical Factors Affecting Plasma Clozapine Concentration

    PubMed Central

    Edman, Gunnar; Bertilsson, Leif; Hukic, Dzana Sudic; Lavebratt, Catharina; Eriksson, Sven V.; Ösby, Urban

    2015-01-01

    Objective: To assess (1) the variance of plasma clozapine levels; (2) the relative importance of sex, smoking habits, weight, age, and specific genetic variants of cytochrome P450 1A2 (CYP1A2), uridine diphosphate glucuronosyltransferase 1A4 (UGT1A4), and multidrug resistance protein 1 (MDR1) on plasma levels of clozapine; and (3) the relation between plasma clozapine levels, fasting glucose levels, and waist circumference. Method: There were 113 patients on clozapine treatment recruited from psychosis outpatient clinics in Stockholm County, Sweden. Patients had genotype testing for single nucleotide polymorphisms: 2 in MDR1, 3 in CYP1A2, and 1 in UGT1A4. Multiple and logistic regression were used to analyze the relations. Results: There was a wide variation in plasma concentrations of clozapine (mean = 1,615 nmol/L, SD = 1,354 nmol/L), with 37% of the samples within therapeutic range (1,100–2,100 nmol/L). Smokers had significantly lower plasma clozapine concentrations than nonsmokers (P ? .03). There was a significant association between the rs762551 A allele of CYP1A2 and lower plasma clozapine concentration (P ? .05). Increased fasting glucose level was 3.7-fold more frequent in CC and CA genotypes than AA genotype (odds ratio = 0.27; 95% confidence interval, 0.10–0.72). There was no significant relation between higher fasting glucose levels, larger waist circumference, and higher clozapine levels. Conclusions: It is difficult to predict plasma clozapine concentration, even when known individual and genetic factors are considered. Therefore, therapeutic drug monitoring is recommended in patients who are treated with clozapine.

  20. Cervical intervertebral foraminal disc extrusion in dogs: clinical presentation, MRI characteristics and outcome after medical management.

    PubMed

    Bersan, E; McConnell, F; Trevail, R; Behr, S; De Decker, S; Volk, H A; Smith, P M; Gonçalves, R

    2015-06-01

    The aim of the present study was to retrospectively evaluate the clinical signs, MRI characteristics, interobserver agreement and outcome after medical treatment in dogs affected by cervical intervertebral foraminal disc extrusion (CIFDE). The medical records of three referral institutions were searched for dogs diagnosed with CIFDE between 2010 and 2012. Thirteen dogs were identified with CIFDE; affected dogs often had a normal neurological examination, with cervical hyperaesthesia and lameness as the most common clinical signs. On MRI, sagittal images showed no evidence of compression of the spinal cord; CIFDE could be identified only on transverse sections in all cases. An excellent interobserver agreement was found in the localisation of the affected intervertebral disc space, and a substantial agreement was found on the detection of CIFDE versus foraminal stenosis caused by overgrowing articular processes. All but two dogs recovered completely, and they were considered free of clinical signs without analgesia within a median of 7.5?weeks (range: 2-20) after medical management was started. The remaining two dogs were surgically treated followed by complete recovery. In view of our findings, the importance of a thorough MRI investigation in dogs presenting with cervical hyperaesthesia as the sole clinical sign should be highlighted. PMID:25745084

  1. Severe Rift Valley Fever May Present with a Characteristic Clinical Syndrome

    PubMed Central

    Kahlon, Summerpal S.; Peters, Clarence J.; LeDuc, James; Muchiri, Eric M.; Muiruri, Samuel; Njenga, M. Kariuki; Breiman, Robert F.; Clinton White, A.; King, Charles H.

    2010-01-01

    Rift Valley fever (RVF) virus is an emerging pathogen that is transmitted in many regions of sub-Saharan Africa, parts of Egypt, and the Arabian peninsula. Outbreaks of RVF, like other diseases caused by hemorrhagic fever viruses, typically present in locations with very limited health resources, where initial diagnosis must be based only on history and physical examination. Although general signs and symptoms of human RVF have been documented, a specific clinical syndrome has not been described. In 2007, a Kenyan outbreak of RVF provided opportunity to assess acutely ill RVF patients and better delineate its presentation and clinical course. Our data reveal an identifiable clinical syndrome suggestive of severe RVF, characterized by fever, large-joint arthralgia, and gastrointestinal complaints and later followed by jaundice, right upper-quadrant pain, and delirium, often coinciding with hemorrhagic manifestations. Further characterization of a distinct RVF clinical syndrome will aid earlier detection of RVF outbreaks and should allow more rapid implementation of control. PMID:20207858

  2. Clinical presentations of X-linked retinoschisis in Taiwanese patients confirmed with genetic sequencing

    PubMed Central

    Liu, Laura; Chen, Ho-Min; Tsai, Shawn; Chang, Tsong-Chi; Tsai, Tzu-Hsun; Yang, Chung-May; Chao, An-Ning; Chen, Kuan-Jen; Kao, Ling-Yuh; Yeung, Ling; Yeh, Lung-Kun; Hwang, Yih-Shiou; Wu, Wei-Chi; Lai, Chi-Chun

    2015-01-01

    Purpose To investigate the clinical characteristics of X-linked retinoschisis (XLRS) and identify genetic mutations in Taiwanese patients with XLRS. Methods This study included 23 affected males from 16 families with XLRS. Fundus photography, spectral domain optical coherent tomography (SD-OCT), fundus autofluorescence (FAF), and full-field electroretinograms (ERGs) were performed. The coding regions of the RS1 gene that encodes retinoschisin were sequenced. Results The median age at diagnosis was 18 years (range 4–58 years). The best-corrected visual acuity ranged from no light perception to 20/25. The typical spoke-wheel pattern in the macula was present in 61% of the patients (14/23) while peripheral retinoschisis was present in 43% of the patients (10/23). Four eyes presented with vitreous hemorrhage, and two eyes presented with leukocoria that mimics Coats’ disease. Macular schisis was identified with SD-OCT in 82% of the eyes (31/38) while foveal atrophy was present in 18% of the eyes (7/38). Concentric area of high intensity was the most common FAF abnormality observed. Seven out of 12 patients (58%) showed electronegative ERG findings. Sequencing of the RS1 gene identified nine mutations, six of which were novel. The mutations are all located in exons 4–6, including six missense mutations, two nonsense mutations, and one deletion-caused frameshift mutation. Conclusions XLRS is a clinically heterogeneous disease with profound phenotypic inter- and intrafamiliar variability. Genetic sequencing is valuable as it allows a definite diagnosis of XLRS to be made without the classical clinical features and ERG findings. This study showed the variety of clinical features of XLRS and reported novel mutations. PMID:25999676

  3. Genotypic Analysis of Meningococcal Factor H-Binding Protein from Non-Culture Clinical Specimens

    PubMed Central

    Clark, Stephen A.; Lucidarme, Jay; Newbold, Lynne S.; Borrow, Ray

    2014-01-01

    Factor H-Binding Protein (fHbp) is an outer membrane protein antigen included in two novel meningococcal group B vaccines and, as such, is an important typing target. Approximately 50% of meningococcal disease cases in England and Wales are confirmed using real-time PCR on non-culture clinical specimens only. Protocols for typing fHbp from this subset of cases have not yet been established. Here we present a nested PCR-based assay designed to amplify and sequence fHbp from non-culture clinical specimens. From analytical sensitivity experiments carried out using diluted DNA extracts, an estimated analytical sensitivity limit of 6 fg/µL of DNA (<3 genome copies/µL) was calculated. The sensitivity of the assay was shown to be comparable to the ctrA-directed real-time PCR assay currently used to confirm invasive disease diagnoses from submitted clinical specimens. A panel of 96 diverse, patient-matched clinical specimen/isolate pairs from invasive disease cases was used to illustrate the breadth of strain coverage for the assay. All fHbp alleles sequenced from the isolates matched those derived from previous whole genome analyses. The first-round PCR primer binding sites are highly conserved, however an exceptional second-round PCR primer site mismatch in one validation isolate prevented amplification. In this case, amplification from the corresponding clinical specimen was achieved, suggesting that the use of a nested PCR procedure may compensate for any minor mismatches in round-two primer sites. The assay was successful at typing 91/96 (94.8%) of the non-culture clinical specimens in this study and exhibits sufficient sensitivity to type fHbp from the vast majority of non-culture clinical specimens received by the Meningococcal Reference Unit, Public Health England. PMID:24587125

  4. Left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement

    SciTech Connect

    Por?ba, Rafa?, E-mail: sogood@poczta.onet.pl; Skoczy?ska, Anna; Ga?, Pawe?; Turczyn, Barbara; Wojakowska, Anna

    2012-09-15

    The aim of the study was to evaluate left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement. The studies included 115 workers (92 men and 23 women) occupationally exposed to mercury vapour without clinical presentation of cardiac involvement (mean age: 47.83 ± 8.29). Blood samples were taken to determine blood lipid profile, urine was collected to estimate mercury concentration (Hg-U) and echocardiographic examination was performed to evaluate diastolic function of the left ventricle. In the entire group of workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement, Spearman correlations analysis demonstrated the following significant linear relationships: between body mass index (BMI) and ratio of maximal early diastolic mitral flow velocity/early diastolic mitral annular velocity (E/E') (r = 0.32, p < 0.05), between serum HDL concentration and E/E' (r = ? 0.22, p < 0.05), between Hg-U and E/E' (r = 0.35, p < 0.05), between Hg-U and isovolumetric relaxation time (IVRT') (r = 0.41, p < 0.05), between Hg-U and ratio of maximal early diastolic mitral flow velocity/maximal late diastolic mitral flow velocity (E/A) (r = ? 0.31, p < 0.05) and between serum HDL concentration and E/A (r = 0.43, p < 0,05). In logistic regression analysis it as shown that independent factors of left ventricular diastolic dysfunction risk in the study group included a higher urine mercury concentration, a higher value of BMI and a lower serum HDL concentration (OR{sub Hg}-{sub U} = 1.071, OR{sub BMI} = 1.200, OR{sub HDL} = 0.896, p < 0.05). Summing up, occupational exposure to mercury vapour may be linked to impaired left ventricular diastolic function in workers without clinical presentation of cardiac involvement. -- Highlights: ? Study aimed at evaluation of LVDD in workers occupationally exposed to Hg. ? There was significant linear relationships between Hg-U and E/E'. ? Independent risk factor of LVDD in study group included higher Hg-U. ? Independent risk factor of LVDD in study group included higher BMI and lower HDL. ? Occupational exposure to Hg may be linked to LVDD.

  5. Clinical factors affecting pathological fracture and healing of unicameral bone cysts

    PubMed Central

    2014-01-01

    Background Unicameral bone cyst (UBC) is the most common benign lytic bone lesion seen in children. The aim of this study is to investigate clinical factors affecting pathological fracture and healing of UBC. Methods We retrospectively reviewed 155 UBC patients who consulted Nagoya musculoskeletal oncology group hospitals in Japan. Sixty of the 155 patients had pathological fracture at presentation. Of 141 patients with follow-up periods exceeding 6 months, 77 were followed conservatively and 64 treated by surgery. Results The fracture risk was significantly higher in the humerus than other bones. In multivariate analysis, ballooning of bone, cyst in long bone, male sex, thin cortical thickness and multilocular cyst were significant adverse prognostic factors for pathological fractures at presentation. The healing rates were 30% and 83% with observation and surgery, respectively. Multivariate analysis revealed that fracture at presentation and history of biopsy were good prognostic factors for healing of UBC in patients under observation. Conclusion The present results suggest that mechanical disruption of UBC such as fracture and biopsy promotes healing, and thus watchful waiting is indicated in these patients, whereas patients with poor prognostic factors for fractures should be considered for surgery. PMID:24884661

  6. Ovarian Granulosa Cell Tumor: Clinical Features, Treatment, Outcome, and Prognostic Factors

    PubMed Central

    Khosla, Divya; Dimri, Kislay; Pandey, Awadhesh K.; Mahajan, Rohit; Trehan, Romeeta

    2014-01-01

    Background: Granulosa cell tumors are rare neoplasms characterized by long natural history and favorable prognosis. Aims: The objective of this study was to determine the clinical presentation, treatment, outcome, and prognostic factors for patients of granulosa cell tumors. Materials and Methods: A retrospective analysis of 26 patients of granulosa cell tumor of ovary from 2002 to 2011 was carried out. The records of all patients were analyzed to determine clinical presentation, treatment, survival, and prognostic factors. Results: The median age of the patients was 50 years (range, 17-71 years). Abdominal pain was the most common presenting symptom. The median follow-up was 71.4 months (range, 21.6-149.9 months). The estimated 5 and 10 year overall survival (OS) was 84.6 and 72.5%, respectively. Event-free survival (EFS) was 76.5 and 52.9% at 5 and 10 years, respectively. Advanced stage was significant independent poor prognostic indicator for both OS and EFS. Conclusion: Majority of the patients with granulosa cell tumors of the ovary present in early stage. Surgery is the primary treatment modality for granulosa cell tumors. Advanced stage and presence of residual disease were associated with inferior survival, but only prospective studies can ascertain their definite role. PMID:24741552

  7. Multiple Clinical Presentations of Lymphoproliferative Disorders in Pediatric Liver Transplant Recipients: A Single-Center Experience

    Microsoft Academic Search

    M. L. Pinho-Apezzato; U. Tannuri; A. C. A. Tannuri; E. S. Mello; F. Lima; N. E. Gibelli; M. M. Santos; A. A. Ayoub; J. G. Maksoud-Filho; M. C. Velhote; M. M. Silva; W. C. Andrade; H. T. Miyatani

    2010-01-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation that has been linked to Epstein-Barr virus (EBV) infection. The aim of this article was to describe a single-center experience with the multiplicity of clinical presentations of PTLD. Among 350 liver transplantations performed in 303 children, 13 survivor children displayed a histological diagnosis of PTLD (13\\/242 survivors; 5.4%).

  8. An unusual presentation of Kabuki syndrome: clinical overlap with CHARGE syndrome.

    PubMed

    Verhagen, Judith M A; Oostdijk, Wilma; Terwisscha van Scheltinga, Cecilia E J; Schalij-Delfos, Nicoline E; van Bever, Yolande

    2014-09-01

    Kabuki syndrome is a rare genetic disorder characterized by intellectual disability and multiple congenital anomalies, including short stature, peculiar facial appearance, skeletal anomalies, a variety of visceral malformations and abnormal dermatoglyphic patterns. We describe a case of Kabuki syndrome presenting with atypical features, consisting of bilateral microphthalmia, coloboma, anal atresia and panhypopituitarism, showing considerable phenotypic overlap with CHARGE syndrome. This report demonstrates that clinical follow-up and molecular genetic testing can be useful for establishing the correct diagnosis. PMID:24862881

  9. Glucose transporter 1 deficiency syndrome and hemiplegic migraines as a dominant presenting clinical feature.

    PubMed

    Mohammad, Shekeeb S; Coman, David; Calvert, Sophie

    2014-12-01

    Glucose transporter 1 deficiency syndrome (OMIM 606777) is a treatable epileptic encephalopathy caused by mutations in the SLC2A1 gene (OMIM 138140) causing impaired glucose transport into the brain. The classical phenotype is associated with seizures, developmental delay, ataxia and spasticity; however, milder phenotypes are emerging. We describe an 8-year-old boy with glucose transporter 1 deficiency syndrome whose clinical presentation was dominated by hemiplegic migraines that resolved with institution of a modified Atkins diet. PMID:25440161

  10. When a man encounters a woman, Satan is also present: clinical relationships in Bedouin society.

    PubMed

    Mass, M; al-Krenawi, A

    1994-07-01

    Professional encounters in Bedouin society between male therapists and their female clients are discussed in terms of the conflict between clinical precepts and Bedouin codes of social conduct. The effects of the conflict on the transference relationship are examined by means of case presentations, and rules of conduct acceptable in both the professional realm and Bedouin society are proposed as an avenue toward resolution. PMID:7977659

  11. Combination of Clinical Factors Predictive of Growth of Small Choroidal Melanocytic Tumors

    Microsoft Academic Search

    Carol L. Shields; Jacqueline Cater; Jerry A. Shields; Arun D. Singh; Maria Carmen; M. Santos; Cynthia Carvalho

    2000-01-01

    Objective: To better define the effect of individual risk factors and combinations thereof on the growth of small choroidal melanocytic tumors. Design: Retrospective analysis. Setting: Clinical practice of ocular oncology. Patients: The study included 1287 patients with small suspicious choroidal melanocytic tumors, measuring 3 mm or less in thickness, managed with observation. Results: On multivariate analysis, the clinical risk factors

  12. WISC-IV and Clinical Validation of the Four- and Five-Factor Interpretative Approaches

    ERIC Educational Resources Information Center

    Weiss, Lawrence G.; Keith, Timothy Z.; Zhu, Jianjun; Chen, Hsinyi

    2013-01-01

    The purpose of this study was to determine the constructs measured by the WISC-IV and the consistency of measurement across large normative and clinical samples. Competing higher order four- and five-factor models were analyzed using the WISC-IV normative sample and clinical subjects. The four-factor solution is the model published with the test…

  13. Stem Cell Factor: Biology and Relevance to Clinical Practice

    Microsoft Academic Search

    M. A. Smith; C. J. Pallister; J. G. Smith

    2001-01-01

    The type III tyrosine kinase receptor c-KIT and its ligand stem cell factor (SCF; also known as KIT ligand, mast cell growth factor and steel factor) are closely involved in the regulation of a wide range of tissues at different stages of life. This review provides an outline of the discovery, structure and expression of SCF and c-KIT but concentrates

  14. Factors associated with poor asthma control in the outpatient clinic setting

    PubMed Central

    Al-Zahrani, Jamaan M.; Ahmad, Anwar; AL-Harbi, Abdullah; Khan, Ayaz M; Al-Bader, Bader; Baharoon, Salim; Shememeri, Abdullah AL; AL-Jahdali, Hamdan

    2015-01-01

    BACKGROUND/OBJECTIVES: The goal of the study was to assess asthma control using asthma control test (ACT) and to explore the factors that effects asthma control among participants with bronchial asthma in the outpatient clinic setting. METHODS: This cross-sectional descriptive study was conducted in the outpatient primary care clinic at King Abdulaziz Medical City in Riyadh. Adult patients who were diagnosed with bronchial asthma by their primary treating physician were recruited over a 6-month period. Patients completed the ACT and questionnaires, which identified factors that affect asthma control. RESULTS: Four hundred asthmatic patients (n = 400) were enrolled, and 70% of these patients were women. Fifty-four percent of patients inappropriately used the inhaler device. The estimated prevalence of uncontrolled asthma at the time of the study was 39.8%. Inappropriate device use by the patient was more frequently associated with uncontrolled asthma (P—value = 0.001). Active smoking (P—value = 0.007), passive smoking (P—value = 0.019), unsealed mattress (P—value = 0.030), and workplace triggers (P—value = 0.036) were also associated with uncontrolled asthma. However, the extent of asthma control did not appear to be related to the existence of regular follow-ups, bedroom carpets, outpatient clinic visits, age, body mass index (BMI), or duration of asthma. CONCLUSIONS: The present study identified a high prevalence of uncontrolled asthma in the primary outpatient clinic setting and common risk factors that may contribute to poor asthma control. PMID:25829960

  15. Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases

    PubMed Central

    Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.

    2012-01-01

    Objective The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. Clinical Features Two patients presented with a vascular and muscular findings suggesting activity-related upper extremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a “pinched nerve sensation” in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. Intervention and Outcome The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. Conclusion Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain. PMID:23843762

  16. Genomic imbalances in patients with a clinical presentation in the spectrum of Cornelia de Lange syndrome

    PubMed Central

    2013-01-01

    Background Cornelia de Lange syndrome (CdLS) is a rare autosomal-dominant disorder characterised by facial dysmorphism, growth and psychomotor developmental delay and skeletal defects. To date, causative mutations in the NIPBL (cohesin regulator) and SMC1A (cohesin structural subunit) genes account for > 50% and 6% of cases, respectively. Methods We recruited 50 patients with a CdLS clinical diagnosis or with features that overlap with CdLS, who were negative for mutations at NIPBL and SMC1A at molecular screening. Chromosomal rearrangements accounting for the clinical diagnosis were screened for using array Comparative Genomic Hybridisation (aCGH). Results Four patients were shown to carry imbalances considered to be candidates for having pathogenic roles in their clinical phenotypes: patient 1 had a 4.2 Mb de novo deletion at chromosome 20q11.2-q12; patient 2 had a 4.8 Mb deletion at chromosome 1p36.23-36.22; patient 3 carried an unbalanced translocation, t(7;17), with a 14 Mb duplication of chromosome 17q24.2-25.3 and a 769 Kb deletion at chromosome 7p22.3; patient 4 had an 880 Kb duplication of chromosome 19p13.3, for which his mother, who had a mild phenotype, was also shown to be a mosaic. Conclusions Notwithstanding the variability in size and gene content of the rearrangements comprising the four different imbalances, they all map to regions containing genes encoding factors involved in cell cycle progression or genome stability. These functional similarities, also exhibited by the known CdLS genes, may explain the phenotypic overlap between the patients included in this study and CdLS. Our findings point to the complexity of the clinical diagnosis of CdLS and confirm the existence of phenocopies, caused by imbalances affecting multiple genomic regions, comprising 8% of patients included in this study, who did not have mutations at NIPBL and SMC1A. Our results suggests that analysis by aCGH should be recommended for CdLS spectrum cases with an unexplained clinical phenotype and included in the flow chart for diagnosis of cases with a clinical evaluation in the CdLS spectrum. PMID:23551878

  17. Risk factors for cardiovascular disease and death: a clinical perspective.

    PubMed

    McIntosh, H D

    1989-07-01

    Coronary artery disease has been demonstrated to conform to the principles of an epidemic disease. Therefore, the incidence of the occurrence of the disease is dependent in large part on "disturbances of human culture." These primarily include a cholesterol-rich diet, obesity, cigarette smoking, elevated blood pressure and sedentary life-style. It is gratifying that during the last quarter of a century, large segments of society in the United States have modified many of their adverse patterns of living. As a result, there has been a striking decline in both the incidence of the diagnosis of coronary artery disease and the frequency of premature death due to the disease process. Sudden cardiac death is frequently an unexpected first clinical manifestation of coronary artery disease and, despite heroic efforts, treatment of sudden death victims is frequently unsuccessful. Furthermore, progression of coronary artery disease, even in patients who present with angina pectoris or acute myocardial infarction, is unpredictable. Coronary arteriography, the "gold standard" used for evaluation, gives insight primarily into anatomy and ventricular function (under experimental conditions) existing at a given instant in time. Which lesions are serious and likely to progress are usually unknown, even to the most experienced angiographer. Therefore, surgical and catheter-directed therapeutic approaches are at best only "shotgun" or partial techniques. For these reasons, the principal and continuing therapeutic efforts to reduce the occurrence and control the ravages of coronary artery disease should be directed toward prevention. Such efforts should begin in early childhood and become a lifelong practice, one that all physicians, including the most procedure-dominated specialists, should personally adopt and teach.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2661627

  18. Clinical presentation of retinoblastoma in Malaysia: a review of 64 patients

    PubMed Central

    Reddy, S C; Anusya, S

    2010-01-01

    AIM To analyze the demography, presenting clinical features, spread of the disease of retinoblastoma in patients who were treated in two tertiary hospitals in Malaysia. METHODS In this retrospective study, information of gender, age, race, presenting clinical features, findings of CT scan orbits and brain, lumbar puncture and bone marrow aspiration results were collected from the medical records of retinoblastoma patients diagnosed in Hospital of Universiti Sains Malaysia and General Hospital of Kuala Lumpur over a period of ten years. The data were collected in the same type of proforma from both hospitals. RESULTS A total of 64 patients were treated in both hospitals together, of whom boys and girls were almost equally affected. The mean age of children at presentation was 24.2 (range 3-84) months, 53 (82.8%) children were under 36 months old. The disease was unilateral in 39 (60.9%) patients. The most common presenting signs were leukocoria in 46 (71.8%), followed by proptosis in 21 (32.8%) patients. Routine screening of the siblings of affected children revealed retinoblastoma in 2 patients. There was intracranial extension in 8 (12.5%) and metastasis in bone marrow in 6 (9.3%) patients. CONCLUSION Leukocoria is the most common presentation of retinoblastoma in Malaysia. However, the disease was intraocular in 40 (62.5%) and extraocular (orbital involvement, intracranial and distant metastasis) in 24 (37.5%) patients. PMID:22553520

  19. Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department

    Microsoft Academic Search

    Mustafa Serinken; Ozgur Karcioglu; Ibrahim Turkcuer; Halis Ilke Ozkan; Mustafa Kemal Keysan; Aytaç Bukiran

    2008-01-01

    BACKGROUND: Renal colic (RC), is one of the most severe pain patterns which is most commonly diagnosed and managed in the emergency department (ED). This study is designed to evaluate the characteristics of adult patients presenting with pain and diagnosed with RC in the ED, length of stay in the ED and hospital and factors affecting these variables. METHODS: All

  20. Clinical Features and Risk Factors for Atazanavir (ATV)-Associated Urolithiasis: A Case-Control Study

    PubMed Central

    Lafaurie, Matthieu; De Sousa, Barbara; Ponscarme, Diane; Lapidus, Nathanael; Daudon, Michel; Weiss, Laurence; Rioux, Christophe; Fourn, Erwan; Katlama, Christine; Molina, Jean-Michel

    2014-01-01

    Objectives Clinical features and risk factors for atazanavir (ATV)-associated urolithiasis have not been fully investigated. Methods We reviewed all cases of ATV-containing urolithiasis identified by infrared spectrophotometry among HIV-infected patients over a 5-year period to describe their clinical features and outcome. A case-control study was performed to identify risk factors associated with ATV-associated urolithiasis using univariate and multivariate logistic regression analyses. Results 30 cases of ATV-associated urolithiasis were analyzed. Patients were mostly men (87%), median age: 45.5 years, median CD4 cell count: 443 cells/µL and 97% had plasma HIV RNA level <50 cp/mL. Median time between the initiation of ATV-containing regimen and the diagnosis of urolithiasis was 3.1 years. Patients presented with flank pain in 90% and macroscopic hematuria in 82.6%, 34% had renal dysfunction and 44.8% needed ureteroscopic treatment. In univariate analysis, chronic hepatitis C, a history of urolithiasis, prior use of indinavir, ATV duration, undetectable plasma HIV RNA, use of ritonavir as a booster and serum free bilirubin level were associated with ATV-urolithiasis. Multivariate models retained serum free bilirubin level (OR: 2.31, p<0.02) and either ATV duration (OR: ?=?1.42, p?=?<0.03) or a history of urolithiasis (OR?=?4.79, p<0.02) when adjusting on serum free bilirubin level as risk factors associated with urolithiasis. Conclusions ATV-containing urolithiasis are associated with frank clinical symptoms and may require surgical intervention. A high serum bilirubin level, a long exposure to ATV and a history of urolithiasis are risk factors for this rare adverse event. PMID:25409506

  1. Idiopathic Retroperitoneal Fibrosis: A Retrospective Review of Clinical Presentation, Treatment, and Outcomes

    PubMed Central

    Kermani, Tanaz A.; Crowson, Cynthia S.; Achenbach, Sara J.; Luthra, Harvinder S.

    2011-01-01

    OBJECTIVE: To describe the clinical manifestations, laboratory results, imaging findings, and treatments in patients with idiopathic retroperitoneal fibrosis (IRF) seen at Mayo Clinic in Rochester, MN. PATIENTS AND METHODS: In this retrospective study, we used International Classification of Diseases, Ninth Revision codes to identify all patients evaluated for IRF between January 1, 1996, and December 31, 2006, at Mayo Clinic in Rochester, MN. Medical records were reviewed, and clinical information was abstracted. Idiopathic retroperitoneal fibrosis was diagnosed on the basis of compatible imaging findings. Patients were followed up until their last visit at Mayo Clinic, death, or December 31, 2008, whichever came first. RESULTS: Of the 185 patients identified as having IRF, 113 (61%) were men and 72 (39%) were women. Mean ± SD age at diagnosis was 57.6±11.8 years. Biopsy specimens were obtained in 142 cases (77%). The most common presenting symptoms were back pain (38%) and abdominal pain (40%). Baseline erythrocyte sedimentation rate and/or C-reactive protein levels were elevated in 88 (58%) of the 151 patients tested. The median creatinine level at diagnosis was 1.3 mg/dL (interquartile range, 1.1-2.1 mg/dL). Fifteen patients (8%) were treated with ureteral procedures only, 58 patients (31%) with medications only, and 105 patients (57%) with a combination of medical and surgical therapies. Seven patients (4%) were not treated. Corticosteroids were initiated in 116 patients (63%), and tamoxifen was used in 120 patients (65%). Follow-up was available for 151 patients (82%). Creatinine levels were normal at last visit in 102 (68%) of the 151 patients with follow-up. No patient developed end-stage renal disease. Relapses occurred in 18 (12%) of the 151 patients. Eleven patients died. CONCLUSION: In this cohort, outcomes such as end-stage renal disease or death from renal failure were not observed. Relapses may occur, and patients with IRF warrant long-term follow-up. PMID:21454732

  2. Mucocutaneous warts in Middle Anatolia, Turkey: clinical presentations and therapeutic approaches

    PubMed Central

    Gönül, Müzeyyen; Iyidal, Ay?egül Yalç?nkaya; Çakmak, Seray; K?l?ç, Arzu; Gul, Ulker; Doner, Pinar

    2015-01-01

    Introduction Viral warts are common skin condition caused by the human papilloma virus. Aim To determine the clinical features of warts and therapeutic approaches to warts and compare them with the literature. Material and methods A cross-sectional survey was conducted on 362 consecutive patients presenting to a dermatology clinic in Ankara, Middle Anatolia, Turkey. Age, gender, anatomic localization, clinical types, number of warts, and medical therapy histories were recorded. Results In our study 139 (38.4%) children and 223 (61.6%) adults had warts. Warts were seen in 191 men, and 171 women. The mean age was 24.7 ±13.5. In all groups the incidence and the number of warts were higher in men. Clinical types of warts were vulgar, anogenital, plantar, verruca plana, filiform, and mosaic. Thirty-six (9.9%) of 362 cases had more than one type. The locations of warts were as follows extremities (n = 233, 64.4%), anogenital (n = 86, 23.7%) and head and neck (n = 73, 20.2%). The incidence of anogenital warts was statistically higher in men than women (p < 0.05). Topical medical treatment was the first choice (n = 60, 57.1%). Conclusions In our study, the incidence and the number of warts were higher in men, which is different than in previous reports. The anogenital wart (AW) was ranked second in all types of warts. According to this finding, we can say that the frequency of AW has been increased in Turkey. To our knowledge recently there have been no studies investigating the clinical features of viral warts in all ages in the literature.

  3. Granulocyte colony-stimulating factor: biology and clinical potential

    Microsoft Academic Search

    MaryAnn Foote; George Morstyn

    \\u000a The study of hematopoiesis was greatly facilitated in the mid-1960s when techniques for studying hematopoietic cells in clonal\\u000a culture were developed. Initially, serum or conditioned medium was added to cultures as a source of growth factors, i.e.,\\u000a the colony-stimulating factors (CSFs) [56, 57, 85]. One of the factors that was isolated, purified, cloned, and produced in\\u000a commercial quantities was granulocyte

  4. Tuberculous Otitis with Proteus mirabilis Co-Infection: An Unsuspected Presentation Encountered in Clinical Practice

    PubMed Central

    Sardar, Moumita; Jadhav, Savita Vivek; Vyawahare, Chanda; Misra, Rabindranath

    2014-01-01

    Tuberculosis, a contagious bacterial disease which is caused by Mycobacterium tuberculosis, primarily involves the lungs.Though Pulmonary tuberculosis (PTB) is the commonest clinical presentation, there is a need for alertness towards uncommon presentations which involve other organs. Tuberculous otitis media (TOM) is one such rare presentation seen in paediatric practice. It is characterized by painless otorrhoea which fails to respond to the routine antibacterial treatment. TOM usually occurs secondary to PTB. Here is a case of tuberculous otitis media with Proteus mirabilis co-infection, with no evidence of PTB. In the sample of ear discharge obtained from the patient, acid fast bacilli were demonstrated on direct microscopy after Ziehl-Neelsen staining. Culture done on Lowenstein-Jensen medium demonstrated slow-growing Mycobacterium. Bacteriological culture and identification helped in isolating Proteus mirabilis. PCR, followed by Line- Probe Assay for early identification and susceptibility testing to primary drugs, was done. Further, patient tested negative for the Mantoux test. Patient was enrolled in National Tuberculosis programme- RNTCP. This case emphasizes on one of the less common presentations of a common disease. A high clinical suspicion and laboratory confirmation are required for appropriate patient management. PMID:24995225

  5. Late clinical presentation of congenital adrenal hyperplasia in older children: findings from national paediatric surveillance

    PubMed Central

    Knowles, Rachel L; Khalid, Javaria M; Oerton, Juliet M; Hindmarsh, Peter C; Kelnar, Christopher J; Dezateux, Carol

    2014-01-01

    Objectives To describe the clinical presentation and sequelae, including salt-wasting crises of newly-diagnosed congenital adrenal hyperplasia (CAH) in children aged over 1?year in a contemporary population without screening. To appraise the potential benefit of newborn screening for late-presenting CAH. Design Active national surveillance undertaken in Great Britain prospectively from 2007–2009 through the British Paediatric Surveillance Unit. Setting England, Wales and Scotland. Patients Children first presenting aged 1–15?years with clinical features of CAH and elevated 17-hydroxyprogesterone. Results Fifty-eight children (26 [45%] boys) aged 1–15?years were reported; 50 (86%) had 21-hydroxylase deficiency. Diagnosis was precipitated by secondary sexual characteristics (n=38 [66%]; median age 5.8 [IQR] 4.8, 7.6) years, genital virilisation (8 girls; 3.2 [IQR 1.3, 7.3] years) or an affected sibling (n=8; 10.0 [IQR 7.4, 13.3] years). At least 33 (57%) children had advanced bone age and 13 (30%) were obese (body mass index ?95th centile). No child had experienced a salt-wasting crisis. Conclusions In Great Britain, 30 children aged 1–15?years present annually for the first time with CAH. Older children frequently manifest prematurely advanced epiphyseal and pubertal maturation and genital virilisation, which are often irreversible and likely to have long-lasting consequences for adult health and wellbeing. Almost one-third of affected children are obese before commencing steroid therapy. Newborn screening offers the potential to avoid serious clinical manifestations in older children with unrecognised CAH; however, it may also detect some children who would otherwise remain asymptomatic and for whom the benefit from treatment is uncertain. PMID:24043550

  6. Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke1

    PubMed Central

    Oliveira, Ana Railka de Souza; Costa, Alice Gabrielle de Sousa; Morais, Huana Carolina Cândido; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; de Araujo, Thelma Leite

    2015-01-01

    Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration. PMID:26039291

  7. Congenital Aniridia: Long-term Clinical Course, Visual Outcome, and Prognostic Factors

    PubMed Central

    Chang, Ji Woong; Kim, Jeong Hun; Kim, Seong-Joon

    2014-01-01

    Purpose To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up. Methods The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. Results Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. Conclusions Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed. PMID:25435751

  8. Clinical Experience with Recombinant Factor VIla in Patients with Thrombocytopenia

    Microsoft Academic Search

    Jörgen Kristensen; Andreas Killander; Erik Hippe; Carsten Helleberg; Jörgen Ellegård; Mette Holm; Jack Kutti; Ulf-Henrik Mellqvist; Jan Erik Johansson; Steven Glazer; Ulla Hedner

    1996-01-01

    Platelets play a central role in primary hemostasis. The role of the coagulation mechanism during early stages of hemostasis is less clear, although increasing evidence is emerging indicating the ultimate importance of the factor VII (FVII)-tissue factor-dependent coagulation system in providing the first thrombin molecules necessary for the platelet activation to occur. Supporting this, early fibrin formation has been reported

  9. Infections caused by carbapenemase-producing Enterobacteriaceae: risk factors, clinical features and prognosis.

    PubMed

    Paño Pardo, José Ramón; Serrano Villar, Sergio; Ramos Ramos, Juan Carlos; Pintado, Vicente

    2014-12-01

    Infections caused by carbapenem-producing Enterobacteriaceae (CPE) can present as several infectious syndromes, but they primarily present as respiratory, urinary and blood stream infections (primary or catheter-related) that are usually found as nosocomial or healthcare-associated infections. The risk of CPE infection is influenced by individual factors, such as the length of the hospital stay and their exposure to invasive procedures and/or to antimicrobials. Of note, exposure to several antimicrobials, not only carbapenems, has been linked to CPE colonization; the duration of antibiotic exposure is one of the primary drivers of CPE acquisition. Individual risk factors must be considered jointly with the local epidemiology of these microorganisms in healthcare institutions. Overall, these infections have a high associated mortality. Mortality is influenced by host factors (e.g., age, comorbidity and immune deficiency), infection-related variables (e.g., type and severity of the infection) and treatment-related factors such as the delay in the initiation of appropriate antimicrobial therapy and the use or monotherapy or combined antimicrobial therapy. Gaining knowledge concerning the epidemiology, clinical features and prognostic features of CPE infection could be useful for improving infection prevention and for the management of patients with infections caused by these microorganisms. PMID:25542051

  10. Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment.

    PubMed

    Hankin, Cheryl S; Bronstone, Amy; Koran, Lorrin M

    2011-05-01

    Agitation among psychiatric inpatients (particularly those diagnosed with schizophrenia or bipolar disorder) is common and, unless recognized early and managed effectively, can rapidly escalate to potentially dangerous behaviors, including physical violence. Inpatient aggression and violence have substantial adverse psychological and physical consequences for both patients and providers, and they are costly to the healthcare system. In contrast to the commonly held view that inpatient violence occurs without warning or can be predicted by "static" risk factors, such as patient demographics or clinical characteristics, research indicates that violence is usually preceded by observable behaviors, especially non-violent agitation. When agitation is recognized, staff should employ nonpharmacological de-escalation strategies and, if the behavior continues, offer pharmacological treatment to calm patients rapidly. Given the poor therapeutic efficacy and potential for adverse events associated with physical restraint and seclusion, and the potential adverse sequelae of involuntary drug treatment, these interventions should be considered last resorts. Pharmacological agents used to treat agitation include benzodiazepines and first- and second-generation antipsychotic drugs. Although no currently available agent is ideal, recommendations for selecting among them are provided. There remains an unmet need for a non-invasive and rapidly acting agent that effectively calms without excessively sedating patients, addresses the patient's underlying psychiatric symptoms, and is reasonably safe and tolerable. A treatment with these characteristics could substantially reduce the clinical and economic burden of agitation in the inpatient psychiatric setting. PMID:21586995

  11. A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation

    PubMed Central

    2009-01-01

    Background Shigellosis remains considerable public health problem in some developing countries. The nature of Shigellae suggests that they are highly adaptable when placed under selective pressure in a human population. This is demonstrated by variation and fluctuations in serotypes and antimicrobial resistance profile of organisms circulating in differing setting in endemic locations. Antimicrobial resistance in the genus Shigella is a constant threat, with reports of organisms in Asia being resistant to multiple antimicrobials and new generation therapies. Methods Here we compare microbiological, clinical and epidemiological data from patients with shigellosis over three different periods in southern Vietnam spanning14 years. Results Our data demonstrates a shift in dominant infecting species (S. flexneri to S. sonnei) and resistance profile of the organisms circulating in southern Vietnam. We find that there was no significant variation in the syndromes associated with either S. sonnei or S. flexneri, yet the clinical features of the disease are more severe in later observations. Conclusions Our findings show a change in clinical presentation of shigellosis in this setting, as the disease may be now more pronounced, this is concurrent with a change in antimicrobial resistance profile. These data highlight the socio-economic development of southern Vietnam and should guide future vaccine development and deployment strategies. Trial Registration Current Controlled Trials ISRCTN55945881 PMID:20003464

  12. Terrestrial Snakebites in the South East of the Arabian Peninsula: Patient Characteristics, Clinical Presentations, and Management

    PubMed Central

    Alkaabi, Juma M.; Al Neyadi, Mariam; Al Darei, Fakhra; Al Mazrooei, Mariam; Al Yazedi, Jawaher; Abdulle, Abdishakur M.

    2011-01-01

    Background To describe the characteristics, clinical presentations, management and complications of snakebites in the border region between Al-Ain, United Arab Emirates (UAE) and Buraimi, Sultanate of Oman. Methodology/Principal Findings We carried out a retrospective review of medical records to study snakebite cases over four-year duration at three tertiary hospitals. Overall, 64 snakebite cases were studied with median hospitalization of 2 (interquartile range [IQR] 1–4) days. The majority of cases were male (87.5%), and most (61%) of the incidents occurred during summer months. The bite sites were predominantly (95%) to the feet and hands. Main clinical features included pain, local swelling, and coagulopathy, blistering and skin peeling. Overall, there were no deaths, but few major complications occurred; extensive skin peeling (n?=?5, 8%), multi-organ failure (n?=?1, 1.5%), and compartment syndrome (n?=?1, 1.5%). Polyvalent anti snake venom (ASV), analgesia, tetanus toxoid, intravenous fluids, and antibiotics such as ampicillin, cloxacillin, and cephalosporins were commonly instituted as part of treatment protocols in the three hospitals. Conclusion The overwhelming majority of bites occurred during summer months, and envenomations were more common in, relatively, young male farmers, but with no serious clinical complications. Prevention and treatment strategies should include increasing public awareness, developing management guidelines, and manufacturing specific ASV for a wide spectrum of the local venomous snakes. PMID:21931788

  13. Unusual Clinical Presentation of Thoracic Tuberculosis: The Need for a Better Knowledge of Illness

    PubMed Central

    Manca, Sandra; Fois, Alessandro Giuseppe; Santoru, Luigi; Trisolini, Rocco; Polo, Maria Francesca; Ostera, Salvatore; Patelli, Marco; Pirina, Pietro

    2015-01-01

    Patient: Male, 73 Final Diagnosis: Bronchoesophageal fistula in endobronchial tuberculosis and mediastinal lymphadenopathy Symptoms: Nonproductive cough • weight loss Medication: Isoniazid • rifampin • pyrazinamide • ethambutol Clinical Procedure: Laser treatment Specialty: Pulmonology Objective: Unusual clinical course Background: Pulmonary tuberculosis (TB), a highly contagious infectious disease, is a significant public health problem all over the world and remains an important cause of preventable death in the adult population. Endobronchial TB is an unusual form of thoracic TB that may be complicated by tracheobronchial stenosis, and bronchoesophageal fistula formation is a very rare complication. Tubercular lymphadenitis can also lead to fistula formation through a process of caseum necrosis and opening of a fistula between the bronchus and oesophagus. Case Report: We report an uncommon case of thoracic TB in an immunocompetent 73-year-old Caucasian man who presented several problems: bronchoesophageal fistula, endobronchial TB, and mediastinal lymphadenopathy in the absence of contemporary parenchymal consolidation. Furthermore, he presented a normal chest radiograph and mostly unclear and non-specific symptoms at onset. Conclusions: We emphasize the need for a better knowledge of this illness and awareness that it may have an unusual presentation. In these cases, diagnosis and proper treatment can be delayed, with severe complications for the patient. Pulmonary TB remains a real diagnostic challenge: a normal chest radiograph and nonspecific symptoms do not allow us to exclude this persistent infectious disease. PMID:25907152

  14. Poland’s Syndrome: Different Clinical Presentations and Surgical Reconstructions in 18 Cases

    Microsoft Academic Search

    Renato da Silva Freitas; André Ricardo Dall’Oglio Tolazzi; Vanessa Dello Mônaco Martins; Breno Albuquerque Knop; Ruth Maria Graf; Gilvani Azor de Oliveira e Cruz

    2007-01-01

    Background  The literature reports many variations of Poland’s syndrome. This article describes 18 cases of Poland’s syndrome in different\\u000a stages of treatment, with variable clinical presentations and reconstructive techniques.\\u000a \\u000a \\u000a \\u000a Methods  This study evaluated 15 females and 3 males, ages 2 to 43 years, for breast deformity, nipple–areolar complex position, pectoralis\\u000a muscle malformation, thoracic deformities, and the presence of brachysyndactyly. Surgical treatment was

  15. Single center experience of five diffuse panbronchiolitis patients clinically presenting as severe asthma.

    PubMed

    Park, Kyung Hee; Park, Hye Jung; Lee, Jae-Hyun; Park, Jung-Won

    2015-06-01

    Diffuse panbronchiolitis (DPB) is a bronchiolitis affecting the whole lung fields which can be treated by macrolide. Especially East Asian patients are more susceptible to diffuse panbronchiolitis. As asthma and DPB both can cause airway obstruction, differential diagnosis is important for the 2 diseases. Here we report 5 patients with DPB clinically presenting as severe asthma in Korea, who were well treated by macrolide. Among the 5 patients, 2 could stop their asthma inhalers and the other 3 could reduce asthma medications after diagnosis and treatment of DPB. In conclusion, considering DPB as differential diagnosis for asthmatics in Asian ethnic groups is important. PMID:26028938

  16. Present status of PACS at Kyoto University Hospital: image workstation for clinical education

    NASA Astrophysics Data System (ADS)

    Minato, Kotaro; Komori, Masaru; Nakano, Yoshihisa; Okajima, Kaoru; Kimura, Ishu; Takahashi, Takashi; Konishi, Junji; Abe, Mituyuki; Gotoh, Yoshihiro; Sato, Kazuhiro

    1990-08-01

    The PAC system: KIDS (Kyoto University Hospital Image Database and Communication System) has been expanded to include several major digital imaging modalities such as X-ray CT, MRI, DSA and CR. The fiber optic high-speed local area network and the workstation with quick image handling are newly designed. The system (new KIDS) is intended to achieve a film-less environment in the department of radiology and to evaluate the feasibility of a hospital-wide PAC system. The present status of the system at the end of 1989 including a image workstation installed in a lecture hall for clinical education is described.

  17. Factor Analysis in the Development and Refinement of Clinical Assessment Instruments.

    ERIC Educational Resources Information Center

    Floyd, Frank J.; Widaman, Keith F.

    1995-01-01

    The goals of exploratory and confirmatory factor analysis are described, and procedural guidelines for each approach are summarized, emphasizing the use of factor analysis in developing and refining clinical measures. Recent examples of the use of factor analysis are reviewed and used to highlight controversies that can emerge. (SLD)

  18. Low somatic cell count : a risk factor for subsequent clinical mastitis in a dairy herd

    Microsoft Academic Search

    W. Suriyasathaporn; Y.H. Schukken; M. Nielen; A. Brand

    2000-01-01

    A case-control study was conducted to evaluate factors measured at the udder inflammation-free state as risk factors for subsequent clinical mastitis. The factors including somatic cell count (SCC), body condition score, milk yield, percentages of milk fat and milk protein, and diseases were evaluated for their association with the results of udder inflammatory response. The results of the response were

  19. Frequency, Clinical Presentation, and Outcomes of Drug-Induced Liver Injury after Liver Transplantation

    PubMed Central

    Sembera, Stepan; Lammert, Craig; Talwalkar, Jayant A.; Sanderson, Schuyler O.; Poterucha, John J.; Hay, J. Eileen; Wiesner, Russell H.; Gores, Gregory J.; Rosen, Charles B.; Heimbach, Julie K.; Charlton, Michael R.

    2012-01-01

    Background Drug-induced liver injury (DILI) is increasingly recognized as a common cause of acute hepatitis. The clinical impact of DILI following liver transplantation (LT) is not known. Aims To describe the frequency, clinical presentation, and outcomes of DILI among LT recipients. Methods LT recipients with possible DILI were identified using electronic pathology and clinical note database retrieval tools. Diagnostic criteria were applied to identify cases of DILI. Results Among 1689 LT recipients, 29 individuals with DILI (1.7%) were identified. Mean age was 52 years with 52 % women. Major indications for LT were primary sclerosing cholangitis (28%), cholangiocarcinoma (14%), and hepatocellular carcinoma (14%). Severity of DILI was mild or moderate in 92% of cases. Nausea or diarrhea (31%), jaundice (24%), and pruritus (10%) were the most common symptoms at diagnosis. Mean ALT was 204±263 U/L, AST 108 ± 237 U/L, ALP 469 ± 689 U/L, and TB 1.9±10.3 mg/dL. Median duration of medication use until DILI diagnosis was 57 days, and major classes of agents were antibiotics (48%), immunosuppressive agents (14%), and antihyperlipidemic drugs (7%), Trimethoprim-sulfamethoxazole was the most common single implicated agent (n=11). Serum liver enzymes improved within a median time of 34 days (range, 5-246 days) after drug withdrawal. Hepatic re-transplantation or death did not occur. Among 50 cases with possible DILI explained by other causes, 13 (26%) individuals had no alternate diagnosis despite histology compatible with DILI. Conclusions DILI is a rare yet under-recognized event among LT recipients. The majority of cases are not clinically severe, and resolve following drug cessation without hepatic retransplantation or death. PMID:22389256

  20. Presentations from the SNM NCI Workshop: Use of PET CT in the Clinic and Clinical Trials: Quantitation for Change Analysis

    Cancer.gov

    The session was aimed at physicians and physicists with an interest in the use of PET CT and other imaging modalities in clinical trials and clinical medicine. A basic understanding of PET imaging principles is useful as a background for viewing this material.

  1. Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease

    PubMed Central

    Tanpowpong, Pornthep; Broder-Fingert, Sarabeth; Katz, Aubrey J; Camargo, Carlos A

    2012-01-01

    OBJECTIVES: Celiac disease (CD) is common and often cited as an “iceberg” phenomenon (i.e., an assumed large number of undiagnosed cases). Recently, atypical or asymptomatic manifestations are becoming more commonly described in older children and adolescents. Moreover, CD diagnosis in children can be complicated by several factors, including its diverse clinical presentations, delay in recognizing CD signs and symptoms, and premature dietary gluten avoidance before the formal diagnosis of CD. To date, few studies have directly examined age-related differences in clinical characteristics and gluten-related issues among children with CD. The aim of this study was to determine age-related patterns in clinical characteristics and gluten-related issues among children with confirmed CD. METHODS: We performed a structured medical record review of biopsy-proven CD patients, aged 0–19 years, between 2000 and 2010 at a large Boston teaching hospital. Data collection included demographics, medical history, gluten-related issues, and diagnostic investigations (CD-specific serology, upper gastrointestinal endoscopy, and small intestinal biopsy). The first positive duodenal biopsy with Marsh III classification defined age of diagnosis. Patients were divided into three age groups for comparisons of the aforementioned characteristics: infant-preschool group (0–5 years), school-aged group (6–11 years), and adolescence group (12–19 years). RESULTS: Among 411 children with biopsy-proven CD, the mean age was 9.5 (s.d. 5.1) years. Most were female (63%) and white (96%). All children had positive CD-specific serology. Most children presented with either abdominal complaints or bowel movement changes. Overall, boys were more common among infant-preschool group compared with the other age groups. More distinct clinical manifestations (vomiting, bowel movement changes, and weight issues) were apparent in the youngest group, whereas school-aged children had more subjective abdominal complaints at the initial presentation. Conversely, the adolescents were most likely to present without any gastrointestinal (GI) symptoms, but not when this was combined with absence of weight issues. Age of diagnosis was not associated with atypical extraintestinal CD presentations. Regarding the gluten-related issues, 10% of school-aged children avoided dietary gluten before the formal CD diagnosis, and 27% of the adolescents reported dietary gluten transgression within the first 12 months of diagnosis, significantly higher than the other age groups. Age differences in histopathology were also found. Whereas the infant-preschool group had a higher proportion of total villous atrophy, the older children were more likely to have gross duodenal abnormalities and chronic duodenitis suggestive of CD at the time of diagnosis. CONCLUSIONS: Children and adolescents with CD have age-related patterns in both the clinical presentations and gluten-related issues. More pronounced clinical and histological features were determined in younger children, whereas older children more commonly presented with solely subjective abdominal complaints or even without any GI symptoms. However, silent and atypical extraintestinal CD presentations were comparable between age groups. In addition to the aforementioned presentations, the higher rates of dietary gluten avoidance and transgression in older children make CD diagnosis and management particularly challenging. These age-related patterns may further increase awareness, facilitate early diagnosis, and improve patient care of pediatric CD. PMID:23238134

  2. Clinical presentation and pharmacotherapy response in social anxiety disorder: The effect of etiological beliefs.

    PubMed

    Cohen, Jonah N; Potter, Carrie M; Drabick, Deborah A G; Blanco, Carlos; Schneier, Franklin R; Liebowitz, Michael R; Heimberg, Richard G

    2015-07-30

    Therapies for social anxiety disorder (SAD) leave many patients symptomatic at the end of treatment and little is known about predictors of treatment response. This study investigated the predictive relationship of patients? etiological attributions to initial clinical features and response to pharmacotherapy. One hundred thirty-seven individuals seeking treatment for SAD received 12 weeks of open treatment with paroxetine. Participants completed the Attributions for the Etiology of Social Anxiety Scale at baseline in addition to measures of social anxiety and depression at baseline and over the course of treatment. A latent class analysis suggested four profiles of etiological beliefs about one?s SAD that may be characterized as: Familial Factors, Need to be Liked, Bad Social Experiences, and Diffuse Beliefs. Patients in the more psychosocially-driven classes, Need to be Liked and Bad Social Experiences, had the most severe social anxiety and depression at baseline. Patients in the Familial Factors class, who attributed their SAD to genetic, biological, and early life experiences, had the most rapid response to paroxetine.These results highlight the effect of biological and genetically-oriented etiological beliefs on pharmacological intervention, have implications for person-specific treatment selection, and identify potential points of intervention to augment treatment response. PMID:25920804

  3. Clinical Presentation of Staphylococcus epidermidis Septic Arthritis Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Young Mo

    2012-01-01

    Purpose This study evaluated the clinical presentations of Staphylococcus epidermidis (S. epidermidis) septic arthritis after arthroscopic anterior cruciate ligament reconstruction (ACLR). Materials and Methods Between September 2006 and February 2008, S. epidermidis septic arthritis developed in six patients following arthroscopic ACLR. We reviewed the medical records retrospectively and interviewed the patients. Results The average interval between ACLR and symptom onset was 4.7 days (range, 2 to 8 days). Local warmth, swelling limited knee motion and general malaise were observed in varying degrees in all the patients. The fever was generally slight with an intermittent spiking pattern. Postoperative erythrocyte sedimentation rate and C-reactive protein were elevated. After the development of infection, the joint was aspirated in all cases. The white blood cell count was at least 22,400, with the presence of 80 to 90% of polymorphonuclear cells. All the patients had a few Gram-positive cocci and positive cultures for S. epidermidis. Conclusions The symptoms, signs and laboratory findings of S. epidermidis septic arthritis following ACLR are nonspecific with various clinical presentations. So the diagnosis is often delayed. Positive gram staining can be used to confirm septic arthritis. Careful observation for septic arthritis is advised in case of presence of any abnormality after ACLR. PMID:22570852

  4. Primary Drug-Resistant Tuberculosis in Hanoi, Viet Nam: Present Status and Risk Factors

    PubMed Central

    Hang, Nguyen Thi Le; Maeda, Shinji; Lien, Luu Thi; Thuong, Pham Huu; Hung, Nguyen Van; Thuy, Tran Bich; Nanri, Akiko; Mizoue, Tetsuya; Hoang, Nguyen Phuong; Cuong, Vu Cao; Ngoc, Khieu Thi Thuy; Sakurada, Shinsaku; Endo, Hiroyoshi; Keicho, Naoto

    2013-01-01

    Introduction Resistance of Mycobacterium tuberculosis (MTB) to anti-tuberculosis (TB) drugs presents a serious challenge to TB control worldwide. We investigated the status of drug resistance, including multidrug-resistant (MDR) TB, and possible risk factors among newly diagnosed TB patients in Hanoi, the capital of Viet Nam. Methods Clinical and epidemiological information was collected from 506 newly diagnosed patients with sputum smear- and culture-positive TB, and 489 (96.6%) MTB isolates were subjected to conventional drug susceptibility testing, spoligotyping, and 15-locus variable numbers of tandem repeats typing. Adjusted odds ratios (aORs) were calculated to analyze the risk factors for primary drug resistance. Results Of 489 isolates, 298 (60.9%) were sensitive to all drugs tested. Resistance to isoniazid, rifampicin, streptomycin, ethambutol, and MDR accounted for 28.2%, 4.9%, 28.2%, 2.9%, and 4.5%, respectively. Of 24 isolates with rifampicin resistance, 22 (91.7%) were MDR and also resistant to streptomycin, except one case. Factors associated with isoniazid resistance included living in old urban areas, presence of the Beijing genotype, and clustered strains [aOR = 2.23, 95% confidence interval (CI) 1.15–4.35; 1.91, 1.18–3.10; and 1.69, 1.06–2.69, respectively). The Beijing genotype was also associated with streptomycin resistance (aOR = 2.10, 95% CI 1.29–3.40). Human immunodeficiency virus (HIV) coinfection was associated with rifampicin resistance and MDR (aOR = 5.42, 95% CI 2.07–14.14; 6.23, 2.34–16.58, respectively). Conclusion Isoniazid and streptomycin resistance was observed in more than a quarter of TB patients without treatment history in Hanoi. Transmission of isoniazid-resistant TB among younger people should be carefully monitored in urban areas, where Beijing strains and HIV coinfection are prevalent. Choosing an optimal treatment regimen on the basis of the results of drug susceptibility tests and monitoring of treatment adherence would minimize further development of drug resistance strains. PMID:23967255

  5. Vascular endothelial growth factor receptor tyrosine kinase inhibitors in metastatic renal cell cancer: latest results and clinical implications

    PubMed Central

    Aslam, Shahzeena

    2013-01-01

    Metastatic renal cell cancer (mRCC) accounts for 25–30% of patients with renal cell cancer at presentation. In addition to this, a significant proportion of patients with localized disease at presentation will develop metastatic disease. With the introduction of tyrosine kinase inhibitors (TKIs), the treatment of mRCC has been radically altered. Several newer generation vascular endothelial growth factor receptor TKIs have been tested in the clinical setting over recent years, resulting in the availability of more drugs. We review the latest results from clinical trials and the implications these have on the management of patients with mRCC. PMID:24179487

  6. Pathological gambling, co-occurring disorders, clinical presentation, and treatment outcomes at a university-based counseling clinic.

    PubMed

    Soberay, Adam; Faragher, J Michael; Barbash, Melissa; Brookover, Amanda; Grimsley, Paul

    2014-03-01

    It is the intent of this study to examine the relationship between the number of co-occurring disorders in a sample of pathological gamblers and variables associated with clinical presentation and treatment outcomes. Participants were given screening tools for four common psychological disorders: the hands depression screen, the Mood Disorder Questionnaire, the Carroll-Davidson generalized anxiety disorder screen, and the Sprint-4 PTSD Screen. The number of co-occurring disorders, as indicated by the results of these screening instruments, was compared to severity of gambling problems at outset of treatment, as measured by the NORC diagnostic screen for gambling problems-self administered. The number of co-occurring disorders was also compared to psychosocial functioning at the outset of treatment, as well as level of improvement in psychosocial functioning through treatment. Psychosocial functioning was measured using the Outcome Questionnaire 45 (OQ-45). The number of co-occurring disorders was compared to participant satisfaction with the therapeutic relationship as measured by the working alliance inventory-short form. Results suggest that co-occurring disorders are commonplace among treatment seeking pathological gamblers. Over 86 % of the sample screened positively for at least one of the four targeted psychological disorders. Furthermore, the number of co-occurring disorders was found to be positively related to severity of gambling problems at outset of treatment and negatively related to level of psychosocial functioning at outset of treatment. However, the number of co-occurring disorders was not found to be significantly related to level of improvement in psychosocial functioning through treatment. Overall, those that attended at least six sessions reported significantly improved psychosocial functioning by the end of their sixth session. Finally, the number of co-occurring disorders was not found to be significantly related to participants' reported level of satisfaction with the therapeutic relationship. PMID:23297170

  7. Clinical Management of Patients Presenting with Non-Adjustable Gastric Band (NAGB) Complications

    PubMed Central

    Balogh, Julius; Vizhul, Andrey; Dunkin, Brian J.; Tariq, Nabil; Sherman, Vadim

    2014-01-01

    Background: A number of bariatric surgical procedures have been developed to manage morbid obesity and related co-morbidities. The non-adjustable gastric band (NAGB) was one such procedure that created restriction to food intake by gastric segmentation. Benefits of the procedure included a low risk of perioperative complications and substantial early weight loss. Unfortunately, the long term results of NAGB include a high incidence of complications and failure to maintain weight loss. The purpose of this study was to examine the presentation, workup, and treatment of patients presenting with complications following NAGB placement. Methods: A retrospective review of the diagnosis and management of 11 patients who presented with complications related to NAGB placement. Results: All patients presented with some degree of proximal gastric outlet obstruction. The majority of patients (8/11) presented with vomiting as the main complaint. Other complaints included intolerance to solids, liquids, and reflux. Only 2/11 patients presented with weight loss since undergoing NAGB placement, while the remainder had weight regain to their pre-NAGB level and above. Depending on clinical presentation, desire for additional weight loss and co-morbid conditions, patients underwent a variety of treatments. This included NAGB removal (endoscopic, laparo-endoscopic, and laparoscopic) as well as conversion to another bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass). Conclusion: Patients with NAGB complications present with symptoms related to a proximal gastric outlet obstruction, related to constriction imposed by the band. This may result in severe food and liquid intolerance and subsequent weight loss, but more likely results in maladaptive eating and subsequent weight gain. Optimal therapy involves removal of the NAGB. Laparoscopic conversion to another bariatric procedure, optimally a Roux-en-Y gastric bypass, is warranted to treat morbid obesity and associated co-morbidities. PMID:24910561

  8. Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

    PubMed Central

    2013-01-01

    Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. Results The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Conclusion Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse. PMID:24321441

  9. Variable Clinical Presentation of an MUC1 Mutation Causing Medullary Cystic Kidney Disease Type 1

    PubMed Central

    Kmoch, Stanislav; Antignac, Corinne; Robins, Vicki; Kidd, Kendrah; Kelsoe, John R.; Hladik, Gerald; Klemmer, Philip; Knohl, Stephen J.; Scheinman, Steven J.; Vo, Nam; Santi, Ann; Harris, Alese; Canaday, Omar; Weller, Nelson; Hulick, Peter J.; Vogel, Kristen; Rahbari-Oskoui, Frederick F.; Tuazon, Jennifer; Deltas, Constantinos; Somers, Douglas; Megarbane, Andre; Kimmel, Paul L.; Sperati, C. John; Orr-Urtreger, Avi; Ben-Shachar, Shay; Waugh, David A.; McGinn, Stella; Hoda?ová, Kate?ina; Vylet'al, Petr; Živná, Martina; Hart, Thomas C.; Hart, P. Suzanne

    2014-01-01

    Background and objectives The genetic cause of medullary cystic kidney disease type 1 was recently identified as a cytosine insertion in the variable number of tandem repeat region of MUC1 encoding mucoprotein-1 (MUC1), a protein that is present in skin, breast, and lung tissue, the gastrointestinal tract, and the distal tubules of the kidney. The purpose of this investigation was to analyze the clinical characteristics of families and individuals with this mutation. Design, setting, participants, & measurements Families with autosomal dominant interstitial kidney disease were referred for genetic analysis over a 14-year period. Families without UMOD or REN mutations prospectively underwent genotyping for the presence of the MUC1 mutation. Clinical characteristics were retrospectively evaluated in individuals with the MUC1 mutation and historically affected individuals (persons who were both related to genetically affected individuals in such a way that ensured that they could be genetically affected and had a history of CKD stage IV or kidney failure resulting in death, dialysis, or transplantation). Results Twenty-four families were identified with the MUC1 mutation. Of 186 family members undergoing MUC1 mutational analysis, the mutation was identified in 95 individuals, 91 individuals did not have the mutation, and111 individuals were identified as historically affected. Individuals with the MUC1 mutation suffered from chronic kidney failure with a widely variable age of onset of end stage kidney disease ranging from 16 to >80 years. Urinalyses revealed minimal protein and no blood. Ultrasounds of 35 individuals showed no medullary cysts. There were no clinical manifestations of the MUC1 mutation detected in the breasts, skin, respiratory system, or gastrointestinal tract. Conclusion MUC1 mutation results in progressive chronic kidney failure with a bland urinary sediment. The age of onset of end stage kidney disease is highly variable, suggesting that gene–gene or gene–environment interactions contribute to phenotypic variability. PMID:24509297

  10. High prevalence of cerebral venous sinus thrombosis (CVST) as presentation of cystathionine beta-synthase deficiency in childhood: molecular and clinical findings of Turkish probands.

    PubMed

    Karaca, Mehmet; Hismi, Burcu; Ozgul, Riza Koksal; Karaca, Sefayet; Yilmaz, Didem Yucel; Coskun, Turgay; Sivri, Hatice Serap; Tokatli, Aysegul; Dursun, Ali

    2014-01-25

    Classical homocystinuria is the most commonly inherited disorder of sulfur metabolism, caused by the genetic alterations in human cystathionine beta-synthase (CBS) gene. In this study, we present comprehensive clinical findings and the genetic basis of homocystinuria in a cohort of Turkish patients. Excluding some CBS mutations, detailed genotype-phenotype correlation for different CBS mutations has not been established in literature. We aimed to make clinical subgroups according to main clinical symptoms and discussed these data together with mutational analysis results from our patients. Totally, 16 different mutations were identified; twelve of which had already been reported, and four are novel (p.N93Y, p.L251P, p.D281V and c.829-2A>T). The probands were classified into three major groups according to the clinical symptoms caused by these mutations. A psychomotor delay was the most common diagnostic symptom (n=12, 46.2% neurological presentation), followed by thromboembolic events (n=6, 23.1% vascular presentation) and lens ectopia, myopia or marfanoid features (n=5, 19.2% connective tissue presentation). Pyridoxine responsiveness was 7.7%; however, with partial responsive probands, the ratio was 53.9%. In addition, five thrombophilic nucleotide changes including MTHFR c.677 C>T and c.1298 A>C, Factor V c.1691 G>A, Factor II c.20210 G>A, and SERPINE1 4G/5G were investigated to assess their contributions to the clinical spectrum. We suggest that the effect of these polymorphisms on clinical phenotype of CBS is not very clear since the distribution of thrombophilic polymorphisms does not differ among specific groups. This study provides molecular findings of 26 Turkish probands with homocystinuria and discusses the clinical presentations and putative effects of the CBS mutations. PMID:24211323

  11. Factors Influencing Changes in the Clinical Immunology Laboratory

    Microsoft Academic Search

    Robert M. Nakamura; David J. Bylund

    1994-01-01

    anisms. In the future, the immunology laboratory will pro- vide test services on a disease-oriented basis and will utilize assays of humoral and cellular immunity, as well as other assays based on molecular techniques. The labo- ratory scientist will work closely with clinicians and provide interactive consultation. The major factors that will influ- ence future laboratory tests are: (a) governmental

  12. Vascular endothelial growth factor - basic science and its clinical implications

    Microsoft Academic Search

    Peter Celec; Yoshikazu Yonemitsu

    2004-01-01

    Vascular endothelial growth factor (VEGF) is the most important signaling molecule involved in the regulation of the formation of new vessels. Results of recent studies have provided new insights into the molecular mechanisms of the VEGF signaling pathways. VEGF local or systemic application represents a new approach in the therapy of ischemic diseases, especially of the coronary artery disease. Inhibition

  13. Type 2 Diabetes in Children: Clinical Aspects and Risk Factors

    Microsoft Academic Search

    Silva Arslanian

    2002-01-01

    In the past, type 2 diabetes mellitus was considered a disease of adults and older individuals, not a paediatric condition. Over the last decade, however, in the USA and the rest of the world there has been a disturbing trend of increasing cases of type 2 diabetes in children, mirroring increasing rates of obesity. The risk factors for paediatric type

  14. Clinical presentation of intracranial epidermoids: a surgical series of 20 initial and four recurred cases

    PubMed Central

    Kato, Koichi; Ujiie, Hiroshi; Higa, Takashi; Hayashi, Masataka; Kubo, Osami; Okada, Yoshikazu; Hori, Tomokatsu

    2010-01-01

    Epidermoids are generally recognized as benign tumors; however, total resection is often difficult. The recurrence from the residual capsule, dissemination of the tumor, and aseptic meningitis are common problems. The aim of the present study was to analyze and report on the clinical characteristics of intracranial epidermoids, particularly complications and cases with a poor clinical outcome. 24 patients with intracranial epidermoids who were treated surgically at Tokyo Women's Medical University Hospital between 1997 and 2007 were examined. The location and size of the tumor, pre-and postoperative symptoms, adherence of the tumor to cranial nerves, and proliferative capacity were determined. The most frequent site of the tumor was the cerebello-pontine (C-P) angle (16/24); eight of these patients presented with hearing loss and six presented with trigeminal neuralgia. In many cases, hearing loss and diplopia persisted after surgery. All epidermoids located in the C-P angle were attached to and/or compressed the trigeminal nerves, therefore, the origin is suggested to be the dura mafer of petrous bone around the trigeminal nerve. Of all 24 patients, the tumor recurred in four (after 3, 5, 10 and 20 years). One patient had a poor prognosis, with dissemination and brain stem infarction. Epidermoids can recur from residual capsule adhering to the brain stem or cranial nerves up to 10-20 years after the initial surgery. Long-term follow-up imaging studies are required when complete resection of the tumor capsule is not possible. In rare cases, spontaneous cyst rupture, dissemination, and brain stem infarction result in a poor prognosis. PMID:22028741

  15. Retained Fetal Membranes in C57BL/6NCrl Mice: Description of Clinical Case Presentations and Related Epidemiologic Findings

    PubMed Central

    Johnson, Jenelle K; Vemulapalli, Tracy H; Van Alstine, William G; Roberts, Christopher S; Garner, Joseph P; Hickman, Debra L

    2011-01-01

    During a triinstitutional study to test whether individually ventilated caging systems impaired welfare and reproduction relative to static housing systems, varying numbers (2 to 7) of discoid-shaped, fleshy structures were found in utero of 17 postpartum female mice on study. Further investigation revealed these structures to be retained fetal membranes (RFM). A point prevalence of 24.3% was calculated based on a total population of 70 postpartum female mice on study. This finding was preceded by 3 typical clinical presentations, which are described here. We designed a case-control matched cross-sectional epidemiologic study to identify associated risk factors and antemortem indicators of RFM. Housing on the bottom shelves and attachment to the rack systems were factors associated with a diagnosis of the condition. In addition, neutrophilia, monocytosis, lymphopenia, and decreasing hematocrit values were associated with the diagnosis of RFM. These results confirmed that a CBC can be a useful antemortem screening test for the identification of affected mice. We conclude that RFM are likely an incidental finding although they may present concurrent with other pregnancy complications. PMID:22330577

  16. A Four- and Five-Factor Structural Model for Wechsler Tests: Does It Really Matter Clinically?

    ERIC Educational Resources Information Center

    Schwartz, David M.

    2013-01-01

    The purpose of this commentary is to focus on the clinical utility of the four- and five-factor structural models for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). It provides a discussion of important considerations when evaluating the clinical utility of the…

  17. Factors Associated With Clinically Significant Head Injury in Children Involved in Motor Vehicle Crashes

    Microsoft Academic Search

    Michael L. Nance; Michael J. Kallan; Kristy B. Arbogast; Myung S. Park; Dennis R. Durbin; Flaura K. Winston

    2010-01-01

    Objective: Head injury is the most common cause of death for child occupants in motor vehicle crashes (MVCs). The morbidity associated with nonlethal MVC-related head injuries is of great clinical consequence as well. The purpose of this study was to identify the frequency of, and risk factors for, clinically significant head injury (CSHI) in child occupants in MVCs.Methods: A large,

  18. Psychometric Structure of a Comprehensive Objective Structured Clinical Examination: A Factor Analytic Approach

    ERIC Educational Resources Information Center

    Volkan, Kevin; Simon, Steven R.; Baker, Harley; Todres, I. David

    2004-01-01

    Problem Statement and Background: While the psychometric properties of Objective Structured Clinical Examinations (OSCEs) have been studied, their latent structures have not been well characterized. This study examines a factor analytic model of a comprehensive OSCE and addresses implications for measurement of clinical performance. Methods: An…

  19. Novel Mutation of the GNE Gene Presenting Atypical Mild Clinical Feature: A Korean Case Report

    PubMed Central

    Choi, Young-Ah; Park, Sung-Hye; Yi, Youbin

    2015-01-01

    Glucosamine (UDP-N-acetyl)-2-epimerase/N-acetylmannosamine kinase (GNE) myopathy is caused by mutations in GNE, a key enzyme in sialic acid biosynthesis. Here, we reported a case of GNE that presented with atypical mild clinical feature and slow progression. A 48-year-old female had a complaint of left foot drop since the age of 46 years. Electromyography (EMG) and muscle biopsy from left tibialis anterior muscle were compatible with myopathy. Genetic analysis led to the identification of c.1714G>C/c.527A>T compound heterozygous mutation, which is the second most frequent mutation in Japan as far as we know. Previous research has revealed that c.1714G>C/c.527A>T compound heterozygous mutation is a mild mutation as the onset of the disease is much later than the usual age of onset of GNE myopathy and the clinical course is slowly progressive. This was the first case report in Korea of the clinicopathological characteristics of GNE myopathy with GNE (c.1714G>C/c.527A>T compound heterozygous) mutation.

  20. Clinical picture of primary HIV infection presenting as a glandular-fever-like illness.

    PubMed Central

    Gaines, H.; von Sydow, M.; Pehrson, P. O.; Lundbegh, P.

    1988-01-01

    The clinical symptoms and signs were assessed in 20 consecutive patients developing infection with the human immunodeficiency virus (HIV). All were male homosexuals and all presented with a glandular-fever-like illness. Changes in laboratory values were compared with findings in 40 HIV negative male homosexual controls. In the 10 patients for whom date of exposure to the virus could be established the incubation period was 11-28 days (median 14). One or two days after the sudden onset of fever patients developed sore throat, lymphadenopathy, rash, lethargy, coated tongue, tonsillar hypertrophy, dry cough, headache, myalgia, conjunctivitis, vomiting, night sweats, nausea, diarrhoea, and palatal enanthema. Twelve patients had painful, shallow ulcers in the mouth or on the genitals or anus or as manifested by oesophageal symptoms; these ulcers may have been the site of entry of the virus. During the first week after the onset of symptoms mild leucopenia, thrombocytopenia, and increased numbers of banded neutrophils were detected (p less than 0.0005). The mean duration of acute illness was 12.7 days (range 5-44). All patients remained healthy during a mean follow up period of 2.5 years. Heightened awareness of the typical clinical picture in patients developing primary HIV infection will alert the physician at an early stage and so aid prompt diagnosis and help contain the epidemic spread of AIDS. PMID:3146367

  1. Correlation between Clinical Diagnosis and Colonoscopic Findings of Patients Presented with Lower Gastrointestinal Bleeding.

    PubMed

    Rahman, M M; Bhuiyan, M H; Ferdaus, A M; Mahmud, R

    2015-04-01

    Lower gastrointestinal bleeding is a frequently encountered problem in general medical practice. This bleeding comes from a site distal to ligament of Treitz. But it may also come from upper gastrointestinal tract when it is massive and pass through the stool. This study was intended to explore the causes of lower gastrointestinal bleeding and correlating them with their colonoscopic findings. This study was cross-sectional prospective. Sample was taken purposively. Out of 200 patients which were selected for the study, 122(61%) were male and 78(39%) were female with a male to female ratio of 5:3. The ages of the patients were ranging from 5 to 80 years with the mean age of 41.9±15.0 years; maximum 38(19%) patients were in 51 to 60 years. All patients were presented with per rectal bleeding & underwent colonoscopy & maximum 57(28.5%) patients were diagnosed as hemorrhoids, followed by colorectal cancer in 55(27.5%) cases. In 10(5%) cases of haemorrhoids 2nd pathology was found associated with it. In 32(16%) cases colonoscopic findings were normal. It was concluded that the most common cause of lower gastrointestinal bleeding was hemorrhoids followed by colorectal cancer. But several cases of colon cancer were misdiagnosed clinically as colitis. So clinical diagnosis should be correlated & confirmed by colonoscopy and biopsy. PMID:26007248

  2. Canadian Thoracic Society: Presenting a new process for clinical practice guideline production

    PubMed Central

    Gupta, Samir; Bhattacharyya, Onil K; Brouwers, Melissa C; Estey, Elizabeth A; Harrison, Margaret B; Hernandez, Paul; Palda, Valerie A; Boulet, Louis-Philippe

    2009-01-01

    A key mandate of the Canadian Thoracic Society (CTS) is to promote evidence-based respiratory care through clinical practice guidelines (CPGs). To improve the quality and validity of the production, dissemination and implementation of its CPGs, the CTS has revised its guideline process and has created the Canadian Respiratory Guidelines Committee to oversee this process. The present document outlines the basic methodological tools and principles of the new CTS guideline production process. Important features include standard methods for choosing and formulating optimal questions and for finding, appraising, and summarizing the evidence; use of the Grading of Recommendations Assessment, Development and Evaluation system for rating the quality of evidence and strength of recommendations; use of the Appraisal of Guidelines for Research and Evaluation instrument for quality control during and after guideline development and for appraisal of other guidelines; use of the ADAPTE process for adaptation of existing guidelines to the local context; and use of the GuideLine Implementability Appraisal tool to augment implementability of guidelines. The CTS has also committed to develop guidelines in new areas, an annual guideline review cycle, and a new formal process for dissemination and implementation. Ultimately, it is anticipated that these changes will have a significant impact on the quality of care and clinical outcomes of individuals suffering from respiratory diseases across Canada. PMID:20011719

  3. Oral Lichen Planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management.

    PubMed

    Gupta, Sonia; Jawanda, Manveen Kaur

    2015-01-01

    The mouth is a mirror of health or disease, a sentinel or early warning system. The oral cavity might well be thought as a window to the body because oral manifestations accompany many systemic diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. Oral lichen planus (OLP) is a chronic mucocutaneous disorder of stratified squamous epithelium of uncertain etiology that affects oral and genital mucous membranes, skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. This disease has most often been reported in middle-aged patients with 30-60 years of age and is more common in females than in males. The disease seems to be mediated by an antigen-specific mechanism, activating cytotoxic T cells, and non-specific mechanisms like mast cell degranulation and matrix metalloproteinase activation. A proper understanding of the pathogenesis, clinical presentation, diagnosis of the disease becomes important for providing the right treatment. This article discusses the prevalence, etiology, clinical features, oral manifestations, diagnosis, complications and treatment of oral LP. PMID:26120146

  4. Oral Lichen Planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management

    PubMed Central

    Gupta, Sonia; Jawanda, Manveen Kaur

    2015-01-01

    The mouth is a mirror of health or disease, a sentinel or early warning system. The oral cavity might well be thought as a window to the body because oral manifestations accompany many systemic diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. Oral lichen planus (OLP) is a chronic mucocutaneous disorder of stratified squamous epithelium of uncertain etiology that affects oral and genital mucous membranes, skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. This disease has most often been reported in middle-aged patients with 30-60 years of age and is more common in females than in males. The disease seems to be mediated by an antigen-specific mechanism, activating cytotoxic T cells, and non-specific mechanisms like mast cell degranulation and matrix metalloproteinase activation. A proper understanding of the pathogenesis, clinical presentation, diagnosis of the disease becomes important for providing the right treatment. This article discusses the prevalence, etiology, clinical features, oral manifestations, diagnosis, complications and treatment of oral LP.

  5. Factors affecting clinical assessment of insulin sensitivity in horses.

    PubMed

    Firshman, A M; Valberg, S J

    2007-11-01

    Insulin resistance is thought to be involved in the pathogenesis of many equine conditions such as pars intermedia dysfunction, equine metabolic syndrome, diabetes mellitus, hyperlipaemia, laminitis, endotoxaemia and osteochondrosis dissecans (OCD); whereas polysaccharide storage myopathy in Quarter Horses and equine motor neuron disease (EMD) have been associated with increased insulin sensitivity. However, it is clear that there is not one ideal test, in terms of both practicality and accuracy, for evaluating insulin sensitivity in horses and improved diagnostic techniques are required. This review sets out the background to the subject and identifies current knowledge regarding the measurement of insulin sensitivity by tolerance testing and clamping techniques. Factors affecting insulin sensitivity, such as breed, pregnancy, lactation, obesity and nutritional factors are discussed. In addition, the relationship with training, nutritional supplementation and drug administration are considered. PMID:18065318

  6. The ESPEN clinical practice Guidelines on Parenteral Nutrition: present status and perspectives for future research.

    PubMed

    Bozzetti, Federico; Forbes, Alastair

    2009-08-01

    The ESPEN Guidelines on Parenteral Nutrition (PN) reflect current scientific knowledge in the field of clinical nutrition in adults. They summarize the indications for PN and its anticipated outcomes in respect of the underlying disease, nutritional status and quality of life. They are companion documents to the ESPEN Guidelines on Enteral Nutrition and follow the same general format. They address the influence of the underlying disease on the patient's nutritional status, and that of malnutrition on the outcome of the disease. Contraindications to and complications of PN are considered, together with comparative analyses of the roles of the parenteral and enteral routes in different illness states. The quality and strength of the supporting literature has been graded according to the criteria of the Scottish Intercollegiate Guidelines Network (SIGN) and the Agency for Health Care Policy and Research. Hence, meta-analysis of randomised clinical trials (level of evidence Ia) or at least one randomised clinical trial (level of evidence Ib) translate to a Grade A recommendation. Levels of evidence IIa, IIb and III are attributed respectively to: at least one well-designed controlled trial without randomisation; at least one other type of well-designed, quasi-experimental study; or well-designed non-experimental descriptive studies such as comparative studies, correlation studies, case-control studies; each of these sustains a Grade B recommendation. Grade C recommendations reflect expert opinion and/or the clinical experience of respected authorities (level of evidence IV). Each of the 11 sets of PN Guidelines was devised by an international working group, the total faculty comprising no fewer than 87 experts from 16 European/Mediterranean countries, each group's contributions being co-ordinated by a designated chairman. Once each guideline had been approved by all the members of the relevant working group, this version was reviewed by at least two independent external reviewers (one selected from ESPEN's Education and Clinical Practice Committee, and at least one from outside the ESPEN committee structure). Following this review each guideline was hosted in draft form on the public pages of the ESPEN website for at least one month to permit the receipt of comments or suggestions from any interested party. At this point the Guidelines were reviewed and revised again by the original working group chairman and submitted to the Clinical Nutrition editorial process. At least 3 further reviewers were selected by the Journal's editorial office for each guideline, in line with the normal selection process. Final revisions were performed by the Chairmen of the working groups, and by ourselves as commissioning editors of the whole project. More than 300 evidence-based recommendations are now presented. Fewer than one sixth of the recommendations are Grade A, and disappointingly, but unsurprisingly, more than 50% are Grade C. The need for more and better controlled trials in the field remains apparent. PMID:19523723

  7. Vascular Endothelial Growth Factor: Basic Science and Clinical Progress

    Microsoft Academic Search

    NAPOLEONE FERRARA

    2004-01-01

    Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen in vitro and an angiogenic inducer in a variety of in vivo models. Hypoxia has been shown to be a major inducer of VEGF gene transcription. The tyrosine ki- nases Flt-1 (VEGFR-1) and Flk-1\\/KDR (VEGFR-2) are high- affinity VEGF receptors. The role of VEGF in developmental angiogenesis is emphasized by

  8. [Clinical presentation and etiology of ichthyoses. Overview of the new nomenclature and classification].

    PubMed

    Oji, V

    2010-10-01

    Ichthyoses comprise a heterogeneous group of Mendelian disorders of cornification (MEDOC) affecting the entire skin and characterized by hyperkeratosis and/or scaling. The genetic basis of almost all ichthyosis forms has been elucidated. In 2009, the worldwide first Ichthyosis Consensus Classification was approved. Its nosology is based on the clinical presentation and reflects recent pathogenic aspects. It distinguishes basically between non-syndromic and syndromic ichthyoses. The term ARCI/autosomal recessive congenital ichthyosis represents the umbrella for harlequin ichthyosis, lamellar ichthyosis and congenital ichthyosiform erythroderma. Ichthyoses due to keratin mutations are referred to as KPI/keratinopathic ichthyosis and include epidermolytic ichthyosis (EI) and superficial epidermolytic ichthyosis (SEI). In Germany the Network for Ichthyoses and Related Keratinization Disorders (NIRK) and the patient organization Selbsthilfe Ichthyose e.V. provide contact points for diagnostic and therapeutic questions. PMID:20827455

  9. The pathogenesis and clinical presentation of macular edema in inflammatory diseases.

    PubMed

    Guex-Crosier, Y

    1999-01-01

    Cystoid macular edema (CME) is a classical complication of ocular inflammation. This syndrome was already described by Irvine in 1953 but the pathogenesis of this condition remains unclear. Cystoid macular edema can result either from a rupture of the inner or from the outer blood ocular barrier. Clinical CME that is responsible for a low visual acuity must be differentiated from angiographic CME that can be present even without any decrease in visual acuity. Fluid progressively accumulates into the outer plexiform layer of the retina and pools into cystic spaces. Fluid accumulation can now be better seen with optical coherence tomography (OCT). In chronic CME fluid accumulation is associated with thinning of the retina and fibrosis. At this stage irreversible lesions are present and CME does not respond to medical therapies. Inflammatory CME must be differentiated from CME resulting from irreversible vascular damage such as in diabetic CME or due to vein occlusions. Experimental research on cystoid macular edema has been hampered by the lack of animal model: most of laboratory animals have no macula, monkeys appear to be highly resistant to macular edema. Five major causes have been suspected to be at the origin of CME: (1) photic retinopathy, (2) trauma of ocular tissue, (3) secondary irritation of the ciliary body, (4) vitreous traction and (5) pharmaceutically induced CME. Clinical experience has shown that pseudophakic CME usually responds well to local therapy of steroids and non-steroidal antiinflammatory drugs (NSAIDs) and/or in association with systemic acetazolamide. Acetazolamide is increasing fluid resorption through the retinal pigment epithelium. Postoperative CME rarely needs additional posterior subtenon's injections to resolve. But in CME occurring secondary to uveitis additional posterior sub-Tenon's steroid injections or systemic steroids may be necessary to decrease the constant release of inflammatory mediators. PMID:10896343

  10. A General Factor of Death Distress in Seven Clinical and Non-Clinical Groups

    ERIC Educational Resources Information Center

    Abdel-Khalek, Ahmed M.

    2004-01-01

    The Arabic Scale of Death anxiety (ASDA), the Death Depression Scale (DDS), and the Death Obsession Scale (DOS) were administered, individually, to 7 groups (n = 765) of Egyptian normal participants (non-clinical), anxiety disorder patients, patients suffering from schizophrenia (males and females), and addicts (males only). They were generally…

  11. Pseudozoster clinical presentation of Demodex infestation after prolonged topical steroid use.

    PubMed

    Karincaoglu, Y; Tepe, B; Kalayci, B; Seyhan, M

    2008-11-01

    A 60-year-old man presented with a plaque lesion on the upper right half of the face, which had developed after ophthalmic varicella zoster infection about 2 years previously. The lesion, which was burning and itchy, included a few tiny erythematous pustules, and was slightly squamous and infiltrated. The lesion covered the upper two-thirds of the right trigeminal nerve dermatome, involving half of the face with the forehead, the periorbital area, upper part of the cheek and the nose. The lesion became more marked after continuous topical anaesthetic and corticosteroid use. A standardized skin-surface biopsy was taken, and revealed a large number of Demodex folliculorum (38/cm(2)) in the lesion area. The lesions completely abated after topical 5% permethrin treatment, and no recurrence was observed during follow-up. Demodicosis may have atypical clinical presentations, other than the well-known classic forms. To our knowledge, this is the first unilateral trigeminal, pseudozoster presentation in the literature. PMID:18684117

  12. A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain

    PubMed Central

    Roux, C; Priol, G; Fechtenbaum, J; Cortet, B; Liu?Léage, S; Audran, M

    2007-01-01

    Background Vertebral fractures are underdiagnosed, although the resulting mortality and morbidity in postmenopausal women with osteoporosis is now recognised. In a population of postmenopausal women with osteoporosis and back pain, symptoms may be related to vertebral fractures or degenerative changes of the spine. Aim To evaluate a population of postmenopausal women presenting with back pain and factors associated with vertebral fractures which were assessable in a clinical setting in order to determine the necessity for spine radiography. Methods Patient questioning and physical examination were carried out and spinal radiographic data collected from 410 postmenopausal women with osteoporosis, with an average age of 74?years, who consulted a rheumatologist for back pain. Of these, 215 (52.4%) patients were diagnosed with at least one vertebral fracture. Logistic regression was used to identify the most relevant clinical features associated with existing vertebral fractures, and to derive a quantitative index of risk. Results The model included six parameters: age, back pain intensity, height loss, history of low trauma non?vertebral fractures, thoracic localisation of back pain and sudden occurrence of back pain. The scoring system, or the quantitative index, had a maximal score of 16. For a score ?7, the probability of existing vertebral fracture was ?43%. The correlation between this quantitative index and the logistic model probability was 0.98, suggesting an excellent and highly significant approximation of the original prediction equation. Conclusions : From six clinical items, an index was built to identify women with osteoporosis and back pain who should have spine radiography. This simple tool may help clinicians to optimise vertebral fracture diagnosis and to make a proper therapeutic decision. PMID:16793842

  13. Clinical Presentation of Obstructive Sleep Apnea in Patients with End-stage Renal Disease

    PubMed Central

    Beecroft, Jaime M.; Pierratos, Andreas; Hanly, Patrick J.

    2009-01-01

    Study Objectives: Obstructive sleep apnea (OSA) is common in patients with end-stage renal disease (ESRD) and is largely underrecognized. Our objective was to determine whether the presentation of OSA in patients with ESRD differs from the stereotypical presentation in the general population (loud snoring, witnessed apnea, and daytime sleepiness in overweight, middle-aged men). Methods: Seventy-six chronic dialysis patients with OSA were compared to 380 OSA patients with normal renal function who were matched for apnea severity (apnea-hypopnea index). All patients underwent overnight polysomnography and completed the Epworth Sleepiness Scale and a questionnaire to assess symptoms of OSA. Results: Age and gender distribution were similar between groups, however, body mass index was lower in the ESRD group (28 ± 5 vs. 33 ± 14 kg/m2). Patients with ESRD were less likely to report snoring (80% vs. 98%), witnessed apnea during sleep (32% vs. 58%), unrefreshing sleep (55% vs. 73%), and morning headaches (15% vs. 27%). Overnight polysomnography revealed less intense snoring and more sleep disturbance in patients with ESRD. The prevalence and severity of self-reported daytime sleepiness was similar between groups. Conclusions: The presenting symptoms of patients with ESRD and documented OSA differed from a control group of OSA patients matched for AHI. This suggests that the presentation of ESRD patients with OSA may differ from the general population, and this should be appreciated to avoid underdiagnosis of this important comorbidity. Citation: Beecroft JM; Pierratos A; Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med 2009;5(2):115-121. PMID:19968043

  14. An Update on the Epidemiology of Schizophrenia with a Special Reference to Clinically Important Risk Factors

    ERIC Educational Resources Information Center

    El-Missiry, Ahmed; Aboraya, Ahmed Sayed; Manseur, Hader; Manchester, Johnna; France, Cheryl; Border, Katherine

    2011-01-01

    Schizophrenia is a chronic mental illness which poses a tremendous burden on the families, caregivers and the society. The purpose of this paper is to provide an updated review of the epidemiology of schizophrenia with a special attention to the clinically important risk factors such as drug abuse, hormonal factors and the new advances in genetic…

  15. Clinical, Demographic, and Situational Factors Linked to Distress Associated with Benign Breast Biopsy

    Microsoft Academic Search

    Rachel F. Steffens; Heather R. Wright; Molly Y. Hester; Michael A. Andrykowski

    2010-01-01

    Benign breast biopsy (BBB) can be distressing for many women. Few studies have examined specific aspects of the BBB more or less distressing or risk factors for distress. Women (N = 51) who had a recent BBB reported the magnitude of distress associated with specific aspects of their experience. Clinical and demographic variables were also examined as risk factors for

  16. Risk Factors for Clinically Significant Intimate Partner Violence among Active-Duty Members

    ERIC Educational Resources Information Center

    Smith Slep, Amy M.; Foran, Heather M.; Heyman, Richard E.; Snarr, Jeffery D.

    2011-01-01

    Hypothesized risk factors for men's and women's clinically significant intimate partner violence (CS-IPV) from four ecological levels (i.e., individual, family, workplace, community) were tested in a representative sample of active-duty U.S. Air Force members (N = 42,744). When considered together, we expected only individual and family factors to…

  17. Factors influencing wound complications: a clinical and experimental study.

    PubMed Central

    Bucknall, T. E.

    1983-01-01

    Burst abdomen, incisional herniation, sinus formation and post-operative wound infection continue to bedevil the surgeon. A prospective study of 1129 laparotomy wounds defined the extent of the problem; 1.7% incidence of dehiscence, 7.4% herniation and 6.7% sinus formation, all significantly associated with wound infection. Mass closure reduced the dehiscence rate from 3.8% to 0.76%. Infection reduced wound strength in a rat laparotomy model due to a decrease in fibroblast concentration and activity. A monofilament non-absorbable suture was shown experimentally to be the most suitable suture for closing infected abdominal wounds. Electron microscopy demonstrated bacteria in the interstices of infected multifilament sutures. A randomised clinical trial comparing polyglycolic acid and monofilament nylon in the closure of abdominal wounds confirmed the experimental findings; polyglycolic acid resulted in a significantly higher wound failure rate with no decrease in sinus formation. A mass closure technique using monofilament nylon is recommended for laparatomy closure and efforts should continue to reduce wound sepsis. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 Fig. 11 Fig. 12 PMID:6299161

  18. A comparative study of pre- and post-menopausal breast cancer: Risk factors, presentation, characteristics and management

    PubMed Central

    Surakasula, Aruna; Nagarjunapu, Govardhana Chary; Raghavaiah, K. V.

    2014-01-01

    Objective: Breast cancer is the most common female cancer worldwide and is the second most commonly diagnosed cancer in Indian women. This study evaluates the differences between pre- and post-menopausal breast cancer women regarding risk factors, nature of disease presentation, tumor characteristics, and management. Methods: This is a prospective observational study, conducted in the Oncology Department of St. Ann's Cancer Hospital, for a period of 6 months from January to August 2012. Data on basic demography, clinical and pathological tumor profile, and treatment details were collected prospectively for each patient based on patient interviews and medical records. Findings: Among 100 female patients taken up for the study, 48 were premenopausal and 52 had reached menopause. The mean age of presentation for breast carcinoma was a decade earlier in these patients compared with western patients. The risk factors for both pre-and post-menopausal breast cancer were found similar other than late menopause in postmenopausal patients. Having dense breast tissue was a predominant risk factor among all women. Late presentation was the common phenomenon in almost all patients. The treatment given was not based on any standard guidelines due to inadequate public health policies. Conclusion: Late stage at presentation of breast cancer is the main problem and possesses a challenge to the health care community. In order to reduce the burden of breast cancer, a multi-sectorial approach and evidence-based strategies aiming at early detection and effective management of the disease are required. PMID:24991630

  19. Angioedema: the role of ACE inhibitors and factors associated with poor clinical outcome

    Microsoft Academic Search

    R. Agah; V. Bandi; K. K. Guntupalli

    1997-01-01

    Objective: We sought to study the prevalence of angiotensin-converting enzyme (ACE) inhibitors, a cause of angioedema, and investigate\\u000a any association between clinical findings at the time of presentation and clinical outcome. Design and setting: Retrospective review of the charts of all patients presenting with angioedema to the emergency department at our tertiary\\u000a referral teaching hospital or clinics over a 4-year

  20. Referral and use of heart failure clinics: What factors are related to utilization?

    PubMed Central

    Gravely, Shannon; Ginsburg, Liane; Stewart, Donna E.; Mak, Susanna; Grace, Sherry L.

    2015-01-01

    Background Due to its growing prevalence, heart failure (HF) has become a major burden worldwide. HF clinics have been shown to reduce hospital readmissions, and generally have favorable effects on quality of life, survival and care costs. This study investigated the rates of referral and utilization of HF clinics, and examined factors related to program use. Methods This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling and need factors affecting HF clinic use. Clinical and demographic data were extracted from medical charts. One-year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. Data were collected between the years 2006–2008 and analyses ensued in 2010. Results Forty-one patients(15.1%) self-reported referral, and 35(12.9%) reported attending a HF clinic (85% of those referred) at 1 of 16 sites. Generalized estimating equations showed that factors related to greater program use were: having a HF clinic at the site of hospital recruitment(Odds Ratio[OR]=8.40, p=0.04), referral to other disease management programs(OR= 4.87, p=0.04), higher education(OR=4.61, p=0.02), lower stress(OR=0.93, p=0.03) and lower functional status(OR=0.97, p=0.03). Conclusion Similar to previous research, only one-seventh of HF patients were referred and used a HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated. PMID:22366509

  1. A Review of Body Dysmorphic Disorder and Its Presentation in Different Clinical Settings

    PubMed Central

    Mufaddel, Amir; Osman, Ossama T.; Almugaddam, Fadwa

    2013-01-01

    Objective: Body dysmorphic disorder (BDD) is a relatively common psychiatric disorder characterized by preoccupations with perceived defects in physical appearance. This review aimed to explore epidemiology, clinical features, comorbidities, and treatment options for BDD in different clinical settings. Data Source and Study Selection: A search of the literature from 1970 to 2011 was performed using the MEDLINE search engine. English-language articles, with no restriction regarding the type of articles, were identified using the search terms body dysmorphic disorder, body dysmorphic disorder clinical settings, body dysmorphic disorder treatment, and body dysmorphic disorder & psychodermatology. Results: BDD occurs in 0.7% to 2.4% of community samples and 13% of psychiatric inpatients. Etiology is multifactorial, with recent findings indicating deficits in visual information processing. There is considerable overlap between BDD and obsessive-compulsive disorder (OCD) in symptom etiology and response to treatment, which has led to suggestions that BDD can be classified with anxiety disorders and OCD. A recent finding indicated genetic overlap between BDD and OCD. Over 60% of patients with BDD had a lifetime anxiety disorder, and 38% had social phobia, which tends to predate the onset of BDD. Studies reported a high level of comorbidity with depression and social phobia occurring in > 70% of patients with BDD. Individuals with BDD present frequently to dermatologists (about 9%–14% of dermatologic patients have BDD). BDD co-occurs with pathological skin picking in 26%–45% of cases. BDD currently has 2 variants: delusional and nondelusional, and both variants respond similarly to serotonin reuptake inhibitors (SRIs), which may have effect on obsessive thoughts and rituals. Cognitive-behavioral therapy has the best established treatment results. Conclusions: A considerable overlap exists between BDD and other psychiatric disorders such as OCD, anxiety, and delusional disorder, and this comorbidity should be considered in evaluation, management, and long-term follow-up of the disorder. Individuals with BDD usually consult dermatologists and cosmetic surgeons rather than psychiatrists. Collaboration between different specialties (such as primary care, dermatology, cosmetic surgery, and psychiatry) is required for better treatment outcome. PMID:24392251

  2. Profile of the patients who present to immunology outpatient clinics because of frequent infections

    PubMed Central

    Ald?rmaz, Sonay; Yücel, Esra; K?yk?m, Ayça; Çoku?ra?, Haluk; Akçakaya, Necla; Camc?o?lu, Y?ld?z

    2014-01-01

    Aim: We aimed to determine the rate of primary immune deficiency (PID) among children presenting to our immunology outpatient clinic with a history of frequent infections and with warning signs of primary immune deficiency. Material and Methods: The files of 232 children aged between 1 and 18 years with warning signs of primary immune deficiency who were referred to our pediatric immunology outpatient clinic with a complaint of frequent infections were selected and evaluated retrospectively. Results: Thirty-six percent of the subjects were female (n=84) and 64% were male (n=148). PID was found in 72.4% (n=164). The most common diagnosis was selective IgA deficiency (26.3%, n=61). The most common diseases other than primary immune deficiency included reactive airway disease and/or atopy (34.4%, n=22), adenoid vegetation (12.3%, n=8), chronic disease (6.3%, n=4) and periodic fever, aphtous stomatitis and adenopathy (4.6%, n=3). The majortiy of the subjects (90.5%, n=210) presented with a complaint of recurrent upper respiratory tract infection. PID was found in all subjects who had bronchiectasis. The rates of the diagnoses of variable immune deficiency and Bruton agammaglubulinemia (XLA) were found to be significantly higher in the subjects who had lower respiratory tract infection, who were hospitalized because of infection and who had a history of severe infection compared to the subjects who did not have these properties (p<0.05 and p<0.01, respectively). Growth and developmental failure was found with a significantly higher rate in the patients who had a diagnosis of severe combined immune deficiency or hyper IgM compared to the other subjects (p<0.01). No difference was found in the rates of PID between the age groups, but the diagnosis of XLA increased as the age of presentation increased and this was considered an indicator which showed that patients with XLA were being diagnosed in a late period. Conclusions: It was found that the rate of diagnosis was considerably high (72.4%), when the subjects who had frequent infections were selected by the warning signs of PID.

  3. Risks, precipitants and clinical presentation of gastro-oesophageal reflux disease at the Kilimanjaro Christian Medical Centre in Tanzania

    PubMed Central

    Mwandri, Michael Bartholomew; Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Kilonzo, Kajiru Gad; Urasa, Sarah Japhet

    2014-01-01

    Introduction Risk factors and precipitants of gastro-oesophageal disease (GERD) differ widely in communities. We conducted an observational study to describe these risks, precipitants and clinical presentation of GERD patients at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. Methods We consecutively recruited 92 GERD patients who were referred for endoscopy at KCMC from March to November 2008. By using structured questionnaire we enquired: risk factors, precipitants and symptoms of GERD and upper gastrointestinal endoscopic findings. Their upper gastrointestinal endoscopic findings were as well documented. Results The mean (± SD) age of the study population was 47.32 (±17) years. Reported symptoms included water brash (37%), dyspepsia (6%), chronic cough (11%) and hemoptysis (5%). More than half (56%) of the patients surveyed identified food precipitants for their GERD symptoms. Triggers of GERD symptoms were boiled beans 19%, spicy food 11%, sour/fermented meals 10%, roasted tomato 9%, silver cyprinid fish (dagaa) 5%, beans with cooked green banana (matoke) 2% and fermented milk 1%. Most of the studied patients had normal body mass index (52%), and 25% admitted to be consuming alcohol though they didn't associate it with their GERD symptoms. The most common endoscopy finding was “loose lower oesophageal sphincter” (85%). Conclusion Most GERD patients referred for endoscopy at KCMC were found to have water brash and “loose lower oesophageal sphincters” as described by endoscopists to denote mechanical abnormality of the lower oesophageal sphincter. GERD symptoms were precipitated by common locally available food and spices. PMID:25745527

  4. [Osteoradionecrosis. I. Etiology, pathogenesis, clinical aspects and risk factors].

    PubMed

    Thiel, H J

    1989-01-01

    In curative therapy of mouth-cavity and oropharyngeal carcinomas the osteoradionecrosis has to be accepted as a calculated risk with an incidence of 4-35%. It is the question of a radio-caused bone death that comes about by progressive and irreversible morphological alterations at bones and at vessels: Loss of osteocytes, active osteoblasts and osteoclasts (hypocellularity), injury of normal bone metabolism, slackening of regeneration process, extreme susceptibility to infections of the devitalized bone, radio-induced obliterating endarteritis with hyalinization, thrombosis and fibrosing of vessels, obliteration of the lumen and gradual reduction of blood-supply at the level of tissue (hypovascularity and hypoxemia: Aseptic osteoradionecrosis, radio-osteonecrosis). If there is a secondary infection of dental, periodontal or traumatic origin additionally, the condition explodes as septic osteoradionecrosis with the symptoms and findings of radio-osteomyelitis. The osteoradionecrosis begins more frequently in the mandibula than in the maxilla. The cumulative incidence is 30% after 6, 60% after 12, and more than 80% after 24 months. The duration of osteoradionecrosis follows an exponential curve with constant probability of necrosis termination at any moment after necrosis event in which the monthly probability of necrosis healing is nearly 0.06. Risk factors for formation of an osteoradionecrosis are tumor neighbourhood to bones and teeth, tumor and mandibula dosis, tumor stage, irradiation technique, status of teeth as well as moment and carrying out of tooth extractions. Tumors in neighbourhood of mandibula have a fivefold higher risk, with 80 Gy irradiated patients a 2.9-fold and toothed patients a 2.6-fold, altogether high-risk patients have a 17.7-fold higher necrosis risk than low-risk patients. Promoting factors are caries, parodontosis, a periapical pathology, a trauma, irritation by artificial teeth, elective tooth extraction before irradiation, tooth extraction after irradiation as well as jaw operations because of remains or recurrence of the tumor. PMID:2685871

  5. Comparisons of the mortality and clinical presentations of status epilepticus in private practice community and university hospital settings in Richmond, Virginia

    PubMed Central

    DeLorenzo, Robert J.; Kirmani, Batool; Deshpande, Laxmikant S.; Jakkampudi, Vamsy; Towne, Alan R.; Waterhouse, Elizabeth; Garnett, Linda; Ramakrisnan, Ramesh

    2010-01-01

    We prospectively compared the clinical course of 119 patients treated for status epilepticus (SE) in private practice community hospitals and 344 SE patients treated in the VCU university hospitals in Richmond, Virginia USA over a two-year period to test the hypothesis that SE presents with the same mortality and clinical patterns in both clinical settings. Of the patients reviewed, the major etiologies for SE were cerebrovascular disease, decreased anti-epileptic drug levels in epileptic patients, anoxia-hypoxia, and remote symptomatic. The other etiologies included were alcohol related, trauma, central nervous system infections, tumors, systemic infection, metabolic disorders, idiopathic, and hemorrhage. These observations provide the first direct prospective comparison of SE presenting in university and private practice community hospital settings in the same geographic area. Mortality was the highest in the elderly population while the pediatric population had low mortality in both clinical settings. Etiology risk factors for outcome were similar for both the populations. The data also suggest that the higher degree of illness severity in university hospitals may be associated with a higher incidence of SE, but not with mortality or a different clinical presentation of the condition. The results of this study demonstrate that SE has the same mortality and presents in an essentially identical manner in university and private practice community hospitals and underscores the fact that mortality in SE is not just associated with tertiary care hospitals and the importance of recognizing the severity of SE in the private practice setting. PMID:19324574

  6. Placental morphometrical and histopathology changes in the different clinical presentations of Hypertensive Syndromes in Pregnancy

    Microsoft Academic Search

    Rosana R. M. Corrêa; Daniel B. Gilio; Camila L. Cavellani; Marina C. Paschoini; Flávia A. Oliveira; Luís C. Peres; Marlene A. Reis; Vicente P. A. Teixeira; Eumenia C. C. Castro

    2008-01-01

    Objective  Even though there are clinical studies emphasizing the diagnosis and the perinatal intercurrent diseases of the Hypertensive\\u000a Syndromes in Pregnancy, few of these studies establish the clinical forms of the specific hypertensive syndromes with the\\u000a associated morphological placental alterations. The lack of studies on placental morphology and the etiopathogenesis of the\\u000a different clinical standards for HSP, together with the need

  7. Clinical and hematological presentation of children and adolescents with polycythemia vera

    Microsoft Academic Search

    Holger Cario; Mary Frances McMullin; Heike L. Pahl

    2009-01-01

    Polycythemia vera (PV) in children and adolescents is very rare. Data on clinical and laboratory evaluations as well as on\\u000a treatment modalities are sparse. Here, we report the long-term clinical course of a PV patient first diagnosed more than 40 years\\u000a ago at age 12. In addition, after a systematic review of the scientific medical literature, clinical and hematological data\\u000a of

  8. Economic analysis of the clinical uses of the colony-stimulating factors.

    PubMed

    Smith, T J

    1996-05-01

    Colony-stimulating factors can reduce the morbidity and possibly the mortality from some types of cancer treatment. Reductions in hospitalization and supportive care, eg, transfusion requirements and antibiotics, have been documented in several clinical trials and can lead to lower total care costs. However, the high cost of colony-stimulating factors and the necessity to treat large numbers of patients who do not benefit can offset the economic gains, unless the savings in hospitalization and supportive care are substantial. Primary prophylaxis with colony-stimulating factors is cost-saving only if the rate of hospitalization for febrile neutropenia is 40% or more; no current standard regimens are near that figure. In general, the American Society of Clinical Oncology clinical practice guide-lines for the use of colony-stimulating factors lead to effective and cost-conscious use of these expensive growth factors. Colony-stimulating factors are not recommended for primary prophylaxis of febrile neutropenia, are recommended for secondary prophylaxis if dose-reduction is not appropriate, and are recommended for stimulation of hematopoietic progenitor cells and reconstitution after high-dose chemotherapy. Further expansion of use based on economic factors will depend on documented survival benefit, major improvements in supportive care due to colony-stimulating factors, or markedly lower costs of colony-stimulating factors. PMID:9372072

  9. [Clinical study on papillary thyroid carcinoma presenting with lymph node metastasi].

    PubMed

    Mizumachi, Takatsugu; Oridate, Nobuhiko; Homma, Akihiro; Nagahashi, Tatsumi; Furuta, Yasushi; Fukuda, Satoshi

    2004-08-01

    Papillary thyroid carcinoma (PTC) may metastasize to cervical lymph nodes. It is, however, uncommon for a palpable neck node alone to lead to the diagnosis of this disease when it is not apparent at presentation. Standard treatment for such cases has not yet been established. We retrospectively analyzed clinical courses in 8 patients with thyroid papillary carcinoma presenting with palpable lymph node metastasis at Hokkaido University Hospital between 1990 and 2003. Three had high thyrogloblin in cervical cystic lesions, leading to the diagnosis of PTC with lymph node metastasis. In 4, PTC was diagnosed by pathological examination of cervical lymph nodes initially diagnosed as lateral cervical cysts. Preoperative examination did not indicate PTC within the gland in any case. All 8 were alive at the last visit after follow-up from 23 to 150 months (mean: 78 months). Total thyroidectomy was done on 4 and thyroid lobectomy on 3. Pathological examination of resected thyroid glands confirmed multifocal papillary carcinoma from 4 mm to 15 mm in diameter. Six underwent unilateral neck dissection and 1 chose bilateral dissection. The other patient received no additional surgery on either the thyroid or neck after the single enlarged lymph node initially diagnosed as a lateral cervical cyst was resected. Postoperative radioiodine treatment was done in 2 undergoing total thyroidectomy. Recurrence in the cervical area were observed in 1 whose neck dissection was insufficient. Based on these observations, we concluded that patients who undergo thyroid lobectomy and adequate neck dissection may enjoy longer survival than those treated with total thyroidectomy without sacrificing thyroid and parathyroid function. We therefore propose a prospective study on the effectiveness of thyroid lobectomy with neck dissection including positive nodes in patients with occult PTC presenting with lymph node metastasis. PMID:15457986

  10. Late presentation of hyperandrogenism in pregnancy: clinical features and differential diagnosis

    PubMed Central

    Das, Gautam; Eligar, Vinay S; Govindan, Jyothish; Rees, D Aled

    2013-01-01

    Summary Background Hyperandrogenic states in pregnancy are rare but arise most commonly due to new-onset ovarian pathology in pregnancy. We describe the case of a young woman who presented in the latter half of her pregnancy with features of hyperandrogenism. We review the biochemical and imaging findings and discuss the differential diagnosis. Case presentation A 26-year-old woman presented in the later part of her pregnancy with widespread hirsutism. Biochemical testing confirmed hyperandrogenism (testosterone, 13.7?nmol/l and second-trimester pregnancy range, 0.9–4.9?nmol/l), although she had no history of menstrual disturbance, hirsutism or acne prior to conception. Radiological evaluation (ultrasound and magnetic resonance imaging) revealed multiple cystic lesions in both ovaries, leading to a presumptive diagnosis of hyperreactio luteinalis (HL). The implications of maternal hyperandrogenism on foetal virilisation were considered and the patient was counselled appropriately. She delivered a healthy baby boy uneventfully. Androgen levels, hirsutism and acne normalised within a few weeks of delivery. Conclusion HL can occur at any stage of pregnancy and is an important differential diagnosis in pregnant patients with features of androgen excess. Most cases regress spontaneously after delivery and major interventions are usually not needed. Learning points Hyperandrogenism in pregnancy is rare.Clinical features are similar to the non-pregnant state in the mother but virilisation in the foetus can have profound consequences.HL and pregnancy luteoma are the most common ovarian pathologies leading to hyperandrogenism in pregnancy.Spontaneous regression occurs in the post-partum period in the vast majority of cases and surgery is only required for local complications. PMID:24616776

  11. Radionuclide ventriculography (equilibrium gated blood pool scanning)--its present clinical position and recent developments.

    PubMed

    Adam, W E; Clausen, M; Hellwig, D; Henze, E; Bitter, F

    1988-01-01

    Myocardial scanning (MS) and radionuclide ventriculography (RNV) are the foundation of nuclear cardiology. These procedures aim in two completely different directions: RNV tries to image heart motion, that is, mechanical (pump) function, and therefore belongs to the group of first-order functional imaging (FI, imaging mechanical function), whereas MS is based on myocardial metabolism, and therefore can be attributed to third-order functional imaging (metabolism). This statement is relevant for the assessment of the clinical position of RNV: Third-order (metabolism) functional imaging is the domain of nuclear medicine (NM), whereas first-order FI has to face the competition of alternative noninvasive procedures such as ultrasound (US), digital subtraction angiography (DSA), computer tomography (CT), and nuclear magnetic resonance (NMR). The domain of RNV includes stages two (acute infarction) and three (postinfarction period) of coronary arterial disease (CAD). The advantageous combination of quantitative data on global, left ventricular (LV) function and imaging of regional motion ensures the superiority of RNV over US. However, RNV is inferior to MS in physical examinations in the preinfarction stage of CAD, whereas US is clearly inferior to both NM procedures. Recent progress could be attained by gated SPECT (GASPECT). A proposal is presented for simplification of this time-consuming procedure. Technetium-labeled isonitriles offer the chance for the combination of "perfusion-motion" imaging of the myocardium. However, even standard RNV offers new possibilities. The multitude of parameters produced by quantitation has not yet been exploited completely. This can be done by discriminant analysis. The computer finds out an optimal subset from the whole set of parameters for the solution of a significant clinical problem. The software "learns" to find the "label" of a special pathognomonic entity. This computer work is supported by a relational data bank (Oracle) and an optical disk. Two examples for the effectiveness of the computer in problem solving are presented. It is concluded that RNV, even in the very competitive class of first-order functional imaging, enjoys a preferred position. The future indeed seems brighter because labeled isonitriles offer the chance for the combination of perfusion-motion imaging of the myocardium. PMID:3282886

  12. Safety, efficacy and indications of prescription of maraviroc in clinical practice: Factors associated with clinical outcomes.

    PubMed

    Llibre, Josep M; Rivero, Antonio; Rojas, Jhon F; Garcia Del Toro, Miguel; Herrero, Cristina; Arroyo, David; Pineda, Juan A; Pasquau, Juan; Masiá, Mar; Crespo, Manel; Blanco, José R; Moreno, Santiago

    2015-08-01

    Maraviroc is approved for treatment-experienced HIV+ adults in twice-daily administration. Limited data are available on safety, efficacy and use in routine clinical practice, outside of restrictive clinical trials. This retrospective multicenter (27 centers) study included 667 subjects starting a regimen with maraviroc. The primary endpoint was plasma HIV-RNA <50copies/mL and CD4(+) cell count change at 48 and 96weeks (FDA snapshot analysis). 94.4% had CCR5 tropism (58.3% Trofile™, 29.2% population genotype, and 12% genotyping proviral DNA). Half of the subjects received the drug in scenarios or dosages outside the initial approval. Maraviroc was prescribed for salvage in 346 (51.9%) individuals, as a switch strategy due to toxicity in 135 (38.7%), for immune discordance in 75 (11.2%), and for simplification in 48 (7.2%). After salvage therapy, 223 (64.5%) subjects had HIV-RNA <50copies/mL at 48weeks, and 178 (51.4%) at 96weeks. Darunavir/r was included in 224 (64.7%) subjects and associated with higher rates of virological and immunologic efficacy (p<0.001). In multivariate analysis MSM (OR 2.25; 95%CI 1.29-3.94) and baseline HIV-RNA <100,000copies/mL (OR 1.96; 1.06-3.70) were associated with virological suppression. An increase in CD4(+) counts was seen at 48 and 96weeks in subjects with immune discordance (p<0.001). Maraviroc was used once-daily in 142 (21.3%) subjects overall, and 68 (57.4%) in switch/simplification. No new safety signals were identified. Besides in salvage regimens, maraviroc was frequently used in switch due to toxicity, simplification, and immune discordance. The efficacy in salvage in clinical practice was higher than in phase III clinical trials, likely due to availability of new active drugs in the regimen. These results increase our understanding of the efficacy, safety, and conditions of prescription of maraviroc beyond the initial registrational trials and the early manufacturer pharmacovigilance programs. PMID:25977241

  13. The transforming growth factor-?\\/SMAD signaling pathway is present and functional in human mesangial cells

    Microsoft Academic Search

    Anne-Christine Poncelet; Mark P. De Caestecker; H. William Schnaper

    1999-01-01

    The transforming growth factor-?\\/SMAD signaling pathway is present and functional in human mesangial cells.BackgroundTransforming growth factor-? (TGF-?) signals through a unique set of intracellular proteins, called SMADs, that have been characterized mainly in transient overexpression systems. Because several models of glomerulosclerosis suggest a role for TGF-? in the extracellular matrix accumulation, we sought to characterize the role of SMAD proteins

  14. Factors associated with utilization of a free HIV VCT clinic by female sex workers in Jinan City, Northern China.

    PubMed

    Wang, Ying; Li, Bing; Pan, Jingbin; Sengupta, Sohini; Emrick, Catherine Boland; Cohen, Myron S; Henderson, Gail E

    2011-05-01

    Based on our previous qualitative exploration, this research presents the second phase in our study of factors associated with utilization of a free HIV VCT clinic in Jinan City, Northern China, by female sex workers (FSWs). A total of 970 FSWs from entertainment venues were interviewed and prospectively followed to determine who ultimately sought and received VCT at the clinic, compared to those who did not. Simple and multiple logistic regressions were performed on factors drawn from the Ecological Perspective, hypothesized to be associated with utilization of testing at the VCT clinic. Despite 69% of FSWs expressing willingness to attend the VCT clinic, only 11% were actually tested. The multiple logistic regression model that provided best goodness of fit included the covariates of willingness to attend the VCT clinic (Adjusted OR 3.13, 95% CI: 1.62-6.59), low perceived HIV infection risk (Adjusted OR 0.64, 95% CI: 0.35-1.11), low fear of FSWs status disclosure in the clinic (Adjusted OR 0.55, 95% CI: 0.31-0.94) and influence of acquaintances (Adjusted OR 0.52, 95% CI: 0.29-0.89) and peers (Adjusted OR 2.45, 95% CI: 1.40-4.50). This is the first study in China to follow FSWs longitudinally to measure factors related to VCT utilization. The low utilization of VCT services by participants in our study is similar to prior reports throughout China. FSWs' access to VCT service is associated with intrapersonal, institutional, and particularly, interpersonal factors. Based on these findings, we recommend emphasis on confidentiality of services, VCT education for influential peers, and introduction of HIV rapid testing on site. PMID:20458528

  15. Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

    PubMed Central

    Whitman, Cynthia B.; Shreay, Sanatan; Gitlin, Matthew; van Oijen, Martijn G. H.

    2013-01-01

    Summary Background and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD. Design, setting, participants, & measurements A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed. Results A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to11.1). Conclusions Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups. PMID:23929931

  16. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

    PubMed Central

    2011-01-01

    Background Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Methods We collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ?6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing. Results Of the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003. Conclusion A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups. PMID:21226905

  17. Differences between membranoproliferative glomerulonephritis types I and III in clinical presentation, glomerular morphology, and complement perturbation.

    PubMed

    Jackson, E C; McAdams, A J; Strife, C F; Forristal, J; Welch, T R; West, C D

    1987-02-01

    Data for 26 patients with membranoproliferative glomerulonephritis, type I (MPGN I) and 22 with membranoproliferative glomerulonephritis, type III (MPGN III), as distinguished by glomerular ultrastructure, were analyzed to determine differences in presentation, complement perturbation, and glomerular morphology by light microscopy. MPGN III was detected with greater frequency by the chance discovery of hematuria and proteinuria in the otherwise healthy individual (MPGN III, 63%; MPGN I, 30%; P = .01) and never, in the absence of renal failure, presented with systemic symptoms such as ease of fatigue, weight loss, and pallor, as may patients with MPGN I. The more frequent detection of MPGN III by chance is evidence that its onset is insidious and that for long periods it produces no symptoms or signs. Glomerular proliferation is also less than in MPGN I. Further, in MPGN III, the complement perturbation and glomerular immunofluorescence give no evidence of classical pathway activation, for which there is abundant evidence in MPGN I. Even with severe hypocomplementemia in MPGN III, C3 nephritic factor, another cause of hypocomplementemia, is rarely detectable and then in very low concentration. The cause of the complement perturbation in MPGN III has so far escaped identification. Although these observations give evidence that MPGN III is distinct from MPGN I, there is compelling evidence from other studies that a predisposition to both types is inherited and that similar genetic factors are operative in the two types. Because their genetic basis appears to be the same, it must be concluded that despite their differences, types I and III are variants of the same disease. PMID:3826060

  18. PTA of Infrapopliteal Arteries: Long-term Clinical Follow-up and Analysis of Factors Influencing Clinical Outcome

    SciTech Connect

    Peregrin, Jan H., E-mail: jape@medicon.cz; Koznar, Boris; Kovac, Josef; Lastovickova, Jarmila; Novotny, Jiri; Vedlich, Daniel [Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology (Czech Republic); Skibova, Jelena [Institute for Clinical and Experimental Medicine, Department of Statistics (Czech Republic)

    2010-08-15

    This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.

  19. [Human plague and pneumonic plague : Pathogenicity, epidemiology, clinical presentations and therapy].

    PubMed

    Riehm, Julia M; Löscher, Thomas

    2015-07-01

    Yersinia pestis is a highly pathogenic gram-negative bacterium and the causative agent of human plague. In the last 1500 years and during three dreaded pandemics, millions of people became victims of Justinian's plague, the Black Death, or modern plague. Today, Y. pestis is endemic in natural foci of Asian, African and American countries. Due to its broad dissemination in mammal species and fleas, eradication of the pathogen will not be possible in the near future. In fact, plague is currently classified as a "re-emerging disease". Infection may occur after the bite of an infected flea, but also after oral ingestion or inhalation of the pathogen. The clinical presentations comprise the bubonic and pneumonic form, septicemia, rarely pharyngitis, and meningitis. Most human cases can successfully be treated with antibiotics. However, the high transmission rate and lethality of pneumonic plague require international and mandatory case notification and quarantine of patients. Rapid diagnosis, therapy and barrier nursing are not only crucial for the individual patient but also for the prevention of further spread of the pathogen or of epidemics. Therefore, WHO emergency schedules demand the isolation of cases, identification and surveillance of contacts as well as control of zoonotic reservoir animals and vectors. These sanctions and effective antibiotic treatment usually allow a rapid containment of outbreaks. However, multiple antibiotic resistant strains of Y. pestis have been isolated from patients in the past. So far, no outbreaks with such strains have been reported. PMID:25963643

  20. Giardia duodenalis assemblage, clinical presentation and markers of intestinal inflammation in Brazilian children

    PubMed Central

    Kohli, Anita; Bushen, Oluma Y.; Pinkerton, Relana C.; Houpt, Eric; Newman, Robert D.; Sears, Cynthia L.; Lima, Aldo A. M.; Guerrant, Richard L.

    2008-01-01

    Summary Data on the relationship between the two genotypes of Giardia duodenalis that infect humans, assemblages A and B, their clinical presentation and intestinal inflammation are limited. We analyzed 108 stool samples previously collected for a diarrhoeal study among Brazilian children, representing 71 infections in 47 children. Assemblage B was most prevalent, accounting for 43/58 (74.1%) infections, while assemblage A accounted for 9/58 (15.5%) infections and 6/58 (10.3%) infections were mixed (contained both assemblage A and B). There was no significant difference in diarrhoeal symptoms experienced during assemblage A, B or mixed infections. Children with assemblage B demonstrated greater variability in G. duodenalis cyst shedding but at an overall greater level (n = 43, mean 3.6 × 105, range 5.3 × 102–2.5 × 106 cysts/ml) than children infected with assemblage A (n = 9, mean 1.4 × 105, range 1.5 × 104–4.6 × 105 cysts/ml; P = 0.009). Children with mixed infections shed more cysts (mean 8.3 × 105, range 3.1 × 104–2.8 × 106 cysts/ml) than children with assemblage A or B alone (P = 0.069 and P = 0.046 respectively). This higher rate of cyst shedding in children with assemblage B may propagate its spread, accounting for its increased incidence. Additionally, second and third infections had decreasing faecal lactoferrin, suggesting some protection against severity, albeit not against infection, by prior infection. PMID:18485429

  1. Clinical presentation and treatment of Wilson's disease: a single-centre experience.

    PubMed

    Pellecchia, M T; Criscuolo, C; Longo, K; Campanella, G; Filla, A; Barone, P

    2003-01-01

    Thirty patients with Wilson's disease (WD) were observed at a movement disorder clinic between 1970 and 2000. Disease onset was at the mean age (SD) of 14.5 (+/-5.9) years. Presentation with hepatic disease occurred in 12 of 30 patients and with neurologic disease in 15. Three patients were asymptomatic at the time of diagnosis. The mean (SD) delay to diagnosis was 5.9 (+/-5.7) years. Five patients diagnosed in an advanced stage of disease died before initiating treatment. Eighteen patients were followed and treated with D-penicillamine alone or in combination with zinc sulphate. Treatment improved most of neurological symptoms. Dystonic postures, behavioural disturbances and dysarthria were the most resistant neurological signs. 'Pseudo-sclerotic' neurologic involvement predicted a good outcome, whereas hepatic onset and 'classic' neurologic involvement were associated with a poorer prognosis. Two of the 18 treated patients died of hepatic failure due to voluntary discontinuation of therapy. Both D-penicillamine and zinc sulphate were well tolerated. No teratogenic effect of D-penicillamine was observed throughout 5 pregnancies. Our results suggest that D-penicillamine or a combination of D-penicillamine and zinc sulphate is a safe and effective long-term treatment in patients with WD. PMID:12824712

  2. Chronic hepatitis in the English springer spaniel: clinical presentation, histological description and outcome

    PubMed Central

    Bexfield, N. H.; Andres-Abdo, C.; Scase, T. J.; Constantino-Casas, F.; Watson, P. J.

    2011-01-01

    Medical records and liver histology of 68 English springer spaniels (ESS) with a histological diagnosis of CH were reviewed retrospectively. PCR was performed on liver tissue for canine adenovirus-1 (CAV-1), canine parvovirus, canine herpesvirus and pathogenic Leptospira species. Follow-up information was obtained to calculate survival times. Median age at presentation was three years seven months (range, seven months to eight years five months) and there were 48 female and 20 male dogs. Clinical signs were non-specific and five dogs were asymptomatic. All dogs had an increase in serum activity of one or more hepatobiliary enzymes. Histopathology demonstrated hepatocyte necrosis and apoptosis with varying amounts of fibrosis. A predominantly lymphoplasmacytic infiltrate throughout the hepatic parenchyma was found in all 68 dogs, but 45 of these dogs also had a neutrophilic component to the inflammatory infiltrate. There was no significant copper accumulation and no aetiological agent was identified by PCR. The median survival time was 189 days (range, 1 to 1211 days), 38 dogs died within three months and 12 dogs survived more than a year following diagnosis. PMID:21852307

  3. Understanding pathogenetic aspects and clinical presentation of primary effusion lymphoma (PEL) through its derived cell lines

    PubMed Central

    Carbone, Antonino; Cesarman, Ethel; Gloghini, Annunziata; Drexler, Hans G.

    2013-01-01

    Primary effusion lymphoma (PEL) is a very rare subgroup of B-cell lymphomas presenting as pleural, peritoneal and pericardial neoplastic effusions in the absence of a solid tumor mass or recognizable nodal involvement. There is strong evidence that Kaposi’s sarcoma associated herpesvirus (KSHV) is a causal agent of PEL. PEL tumor cells are latently infected by KSHV with consistent expression of several viral proteins and microRNAs that can affect cellular proliferation, differentiation and survival. The most relevant data on pathogenesis and biology of KSHV have been provided by studies on PEL derived cell lines. Fourteen continuous cell lines have been established from the malignant effusions of patients with AIDS-and non-AIDS-associated PEL. These KSHV+ EBV+/? cell lines are wellcharacterized, authenticated and mostly available from public biological ressource centers. The PEL cell lines display unique features and are clearly distinct from other lymphoma cell lines. PEL cell lines represent an indispensable tool for the understanding of KSHV biology and its impact on the clinical manifestation of PEL. Studies on PEL cell lines have shown that a number of viral genes, expressed during latency or lytic life cycle, have effects on cell binding, proliferation, angiogenesis and inflammation. Also PEL cell lines are important model systems for the study of the pathology of PEL including the lack of invasive or destructive growth patterns and the peculiar propensity of PEL to involve body cavity surfaces. PMID:20051807

  4. Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and management.

    PubMed

    Caforio, Alida L P; Marcolongo, Renzo; Jahns, Roland; Fu, Michael; Felix, Stephan B; Iliceto, S

    2013-11-01

    According to the current WHO classification of cardiomyopathies, myocarditis is an inflammatory disease of the myocardium and is diagnosed by endomyocardial biopsy using established histological, immunological and immunohistochemical criteria; it may be idiopathic, infectious or autoimmune and may heal or lead to dilated cardiomyopathy (DCM). DCM is characterized by dilatation and impaired contraction of the left or both ventricles; it may be idiopathic, familial/genetic, viral and/or immune. The diagnosis of DCM requires exclusion of known, specific causes of heart failure, including coronary artery disease. On endomyocardial biopsy, there is myocyte loss, compensatory hypertrophy, fibrous tissue and immunohistochemical findings consistent with chronic inflammation (myocarditis) in 30-40 % of cases. In a patient subset, myocarditis and DCM represent the acute and chronic stages of an inflammatory disease of the myocardium, which can be viral, post-infectious immune or primarily organ-specific autoimmune. Here, we review the clinical presentation, etiopathogenetic diagnostic criteria, and management of immune-mediated and autoimmune myocarditis. PMID:23114995

  5. Clinical Presentation and Microarray Analysis of Peruvian Children with Atypical Development and/or Aberrant Behavior

    PubMed Central

    Butler, Merlin G.; Usrey, Kelly; Roberts, Jennifer L.; Schroeder, Stephen R.

    2014-01-01

    We report our experience with high resolution microarray analysis in infants and young children with developmental disability and/or aberrant behavior enrolled at the Centro Ann Sullivan del Peru in Lima, Peru, a low income country. Buccal cells were collected with cotton swabs from 233 participants for later DNA isolation and identification of copy number variation (deletions/duplications) and regions of homozygosity (ROH) for estimating consanguinity status in 15 infants and young children (12 males, 3 females; mean age ± SD = 28.1?m ± ?7.9?m; age range 14?m–41?m) randomly selected for microarray analysis. An adequate DNA yield was found in about one-half of the enrolled participants. Ten participants showed deletions or duplications containing candidate genes reported to impact behavior or cognitive development. Five children had ROHs which could have harbored recessive gene alleles contributing to their clinical presentation. The coefficient of inbreeding was calculated and three participants showed first-second cousin relationships, indicating consanguinity. Our preliminary study showed that DNA isolated from buccal cells using cotton swabs was suboptimal, but yet in a subset of participants the yield was adequate for high resolution microarray analysis and several genes were found that impact development and behavior and ROHs identified to determine consanguinity status. PMID:25400949

  6. A molecular diagnostic approach able to detect the recurrent genetic prognostic factors typical of presenting myeloma

    PubMed Central

    Boyle, Eileen M; Proszek, Paula Z; Kaiser, Martin F; Begum, Dil; Dahir, Nasrin; Savola, Suvi; Wardell, Christopher P; Leleu, Xavier; Ross, Fiona M; Chiecchio, Laura; Cook, Gordon; Drayson, Mark T; Owen, Richard G; Ashcroft, John M; Jackson, Graham H; Anthony Child, James; Davies, Faith E; Walker, Brian A; Morgan, Gareth J

    2015-01-01

    Risk stratification in myeloma requires an accurate assessment of the presence of a range of molecular abnormalities including the differing IGH translocations and the recurrent copy number abnormalities that can impact clinical behavior. Currently, interphase fluorescence in situ hybridization is used to detect these abnormalities. High failure rates, slow turnaround, cost, and labor intensiveness make it difficult and expensive to use in routine clinical practice. Multiplex ligation-dependent probe amplification (MLPA), a molecular approach based on a multiplex polymerase chain reaction method, offers an alternative for the assessment of copy number changes present in the myeloma genome. Here, we provide evidence showing that MLPA is a powerful tool for the efficient detection of copy number abnormalities and when combined with expression assays, MLPA can detect all of the prognostically relevant molecular events which characterize presenting myeloma. This approach opens the way for a molecular diagnostic strategy that is efficient, high throughput, and cost effective. PMID:25287954

  7. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis

    Microsoft Academic Search

    Frederik Barkhof; Massimo Filippi; L. H. Miller; Philip Scheltens; Adriana Campi; Chris H. Polman; Giancarlo Comi; H. J. Adhr; Nick Losseff; Jacob Valk

    1997-01-01

    Summary We compared MRI criteria used to predict conversion of suspected multiple sclerosis to clinically definte multiple sclerosis. Seventy-four patients with clinically isolated neurological symptoms suggestive of multiple sclerosis were studied with MRI. Logistic regression analysis was used to remove redundant information, and a diagnostic model was built after each MRI parameter was dichotomized according to maximum accuracy using receiver

  8. Cheek and Periorbital Peculiar Discoid Lupus Erythematosus: Rare Clinical Presentation Mimicking Tinea Faciei, Cutaneous Granulomatous Disease or Blepharitis

    PubMed Central

    Nakamura, Satoshi; Yamada, Tomoko; Umemoto, Naoka; Nakamura, Toshinobu; Wakatabi, Koji; Iida, Eri; Masaki, Masumi; Kakurai, Maki; Demitsu, Toshio

    2015-01-01

    We present clinically peculiar facial discoid lupus erythematosus (DLE) that mimicked tinea faciei. Although DLE is a chronic autoimmune dermatosis, it has a variety of rare clinical presentations, including periorbital DLE, comedonic DLE and hypertrophic DLE recently. In this case, a scaly, erythematous lesion on the eyelid and the central healed, mildly elevated, annularly distributed facial DLE mimicked tinea faciei, complicating our diagnosis. PMID:25969679

  9. Desmoplastic infantile ganglioglioma with late presentation. A clinical, radiological and histopathological analysis.

    PubMed

    Romero-Rojas, Alfredo E; Diaz-Perez, Julio A; Lozano-Castillo, Alfonso

    2013-12-01

    Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial tumor in the central nervous system. Definitive diagnosis of this neoplasm is based on histopathologic analysis evaluating distinctive findings such as the fibroblastic differentiation. Here we present a clinical case of DIG with a long follow-up in an eight-year-old boy with a six-month history of recurrent emesis, psychomotor hyperactivity and generalized tonic-clonic seizures. Computed tomography scan and magnetic resonance imaging (MRI) showed a cystic, heterogeneous, mass on the right temporal uncus. A histopathological diagnosis of late presentation DIG was made. We documented the immunohistochemical expression of a molecular soft tissue / muscle differentiation marker (h-CaD) in addition to a low proliferative index (Ki-67) in this case. After surgical intervention, a control MRI showed changes of right frontal-temporal craniotomy and a persistent mass in the anterior and medial temporal lobe with basal extension. Further surgical intervention was performed, completely removing the tumor, which had the same characteristics. The patient is asymptomatic while receiving anticonvulsant therapy (phenytoin) with no evidence of tumor recurrence on MRI after a follow-up of five years. The low grade and soft tissue appearance in images are correlated with the histopathologic and immunohistochemical profile of this tumor, but the rarity of this tumor makes a presumptive diagnosis by images a challenge. The above-mentioned molecular markers or new ones could be used as molecular targets for molecular imaging studies to increase the probability of a pre-operative diagnosis based on molecular features through images. PMID:24355183

  10. Gender-related variation in the clinical presentation and outcomes of critical limb ischemia

    PubMed Central

    McCoach, Caroline E; Armstrong, Ehrin J; Singh, Satinder; Javed, Usman; Anderson, David; Yeo, Khung Keong; Westin, Gregory G; Hedayati, Nasim; Amsterdam, Ezra A; Laird, John R

    2013-01-01

    Critical limb ischemia (CLI) is a major cause of limb loss and mortality among patients with advanced peripheral artery disease. Our objective was to evaluate the gender-specific differences in patient characteristics and clinical outcomes among patients with CLI. We performed a retrospective analysis of 97 women and 122 men presenting with CLI who underwent angiography from 2006 to 2010. Baseline demographics, procedural details, and lesion characteristics were assessed for each patient. Kaplan–Meier analysis was used to assess long-term patient and lesion-level outcomes. Cox proportional hazard modeling was used to evaluate the relationship between gender and major adverse cardiovascular events (MACE). Compared to men, women were less likely to have a history of coronary artery disease (39% vs 54%, p = 0.02) or diabetes (57% vs 70%, p = 0.05) but had similar baseline medical therapy. At angiography, women were more likely to have significant femoropopliteal (77% vs 67%, p = 0.02) and multi-level infrainguinal disease (63% vs 51%, p = 0.02). Women were also more likely to undergo multi-vessel percutaneous intervention (69% vs 55%, p = 0.05), but had similar rates of limb salvage after percutaneous intervention or surgical bypass (HR 0.94 [95% CI 0.45–1.94], p = 0.9). During follow-up, women had higher rates of subsequent major adverse cardiovascular events (HR 1.63 [95% CI 1.01–2.63], p = 0.04). In conclusion, women with CLI are more likely to present with femoropopliteal and multi-level infrainguinal disease. Despite similar rates of limb salvage, women with CLI have an increased rate of subsequent major adverse cardiovascular events. PMID:23439776

  11. Moxibustion and other acupuncture point stimulation methods to treat breech presentation: a systematic review of clinical trials

    Microsoft Academic Search

    Xun Li; Jun Hu; Xiaoyi Wang; Huirui Zhang; Jianping Liu

    2009-01-01

    BACKGROUND: Moxibustion, acupuncture and other acupoint stimulations are commonly used for the correction of breech presentation. This systematic review aims to evaluate the efficacy and safety of moxibustion and other acupoint stimulations to treat breech presentation. METHODS: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on moxibustion, acupuncture or any other acupoint stimulating methods for breech presentation

  12. Evaluation of clinical, laboratory and morphologic prognostic factors in colon cancer

    PubMed Central

    Grande, Michele; Milito, Giovanni; Attinà, Grazia Maria; Cadeddu, Federica; Muzi, Marco Gallinella; Nigro, Casimiro; Rulli, Francesco; Farinon, Attilio Maria

    2008-01-01

    Background The long-term prognosis of patients with colon cancer is dependent on many factors. To investigate the influence of a series of clinical, laboratory and morphological variables on prognosis of colon carcinoma we conducted a retrospective analysis of our data. Methods Ninety-two patients with colon cancer, who underwent surgical resection between January 1999 and December 2001, were analyzed. On survival analysis, demographics, clinical, laboratory and pathomorphological parameters were tested for their potential prognostic value. Furthermore, univariate and multivariate analysis of the above mentioned data were performed considering the depth of tumour invasion into the bowel wall as independent variable. Results On survival analysis we found that depth of tumour invasion (P < 0.001; F-ratio 2.11), type of operation (P < 0.001; F-ratio 3.51) and CT scanning (P < 0.001; F-ratio 5.21) were predictors of survival. Considering the degree of mural invasion as independent variable, on univariate analysis, we observed that mucorrhea, anismus, hematocrit, WBC count, fibrinogen value and CT scanning were significantly related to the degree of mural invasion of the cancer. On the multivariate analysis, fibrinogen value was the most statistically significant variable (P < 0.001) with the highest F-ratio (F-ratio 5.86). Finally, in the present study, the tumour site was significantly related neither to the survival nor to the mural invasion of the tumour. Conclusion The various clinical, laboratory and patho-morphological parameters showed different prognostic value for colon carcinoma. In the future, preoperative prognostic markers will probably gain relevance in order to make a proper choice between surgery, chemotherapy and radiotherapy. Nevertheless, current data do not provide sufficient evidence for preoperative stratification of high and low risk patients. Further assessments in prospective large studies are warranted. PMID:18778464

  13. Factors influencing polymerase chain reaction outcomes in patients with clinically suspected ocular tuberculosis

    PubMed Central

    2014-01-01

    Background Polymerase chain reaction (PCR) assay can be a useful method for definitive diagnosis in paucibacillary infections such as ocular tuberculosis (TB). In this study, we have evaluated factors affecting PCR outcomes in patients with clinically suspected ocular TB. Patients with clinically suspected ocular TB were investigated by PCR of aqueous or vitreous samples. Three control groups were also tested: group 1 included culture-proven non-tuberculous endophthalmitis, group 2 culture-negative non-tuberculous endophthalmitis, and group 3 patients undergoing surgery for uncomplicated cataract. PCR targeted one or more of following targets: IS6110, MPB64, and protein b genes of Mycobacterium tuberculosis complex. Multiple regression analysis (5% level of significance) was done to evaluate the associations between positive PCR outcome and laterality of disease, tuberculin skin test (TST)/interferon-gamma release assay (IGRA), chest radiography, and type of sample (aqueous or vitreous). The main outcome measures were positive PCR by one or more gene targets, and factors influencing positive PCR outcomes. Results All 114 samples were tested for MPB64, 110 for protein b, and 88 for IS6110. MPB64 was positive in 70.2% (n?=?80) of tested samples, protein b in 40.0% (n?=?44), and IS6110 in only 9.1% (n?=?8). DNA sequencing of amplicons from four randomly chosen PCR reactions showed homology for M. tuberculosis complex. Of the 80 PCR-positive patients, 71 completed a full course of antitubercular therapy, of which 65 patients (91.5%) had complete resolution of inflammation at final follow-up. Among controls, 12.5% (3 out of 24) in group 1 and 18.7% (6 out of 32) in group 2 also tested positive by PCR. No PCR-positive outcome was observed in control group 3 (n?=?25). Multiple regression analysis revealed significant association of positive PCR outcome with bilateral presentation, but not with a positive TST/IGRA, chest radiography, or type of sample (aqueous/vitreous) used. Conclusions Careful selection of gene targets can yield high PCR positivity in clinically suspected ocular TB. Bilateral disease presentation but not any evidence of latent systemic TB influences PCR outcomes. False-positive results may be seen in ocular inflammation unrelated to ocular TB. PMID:24661354

  14. Metabolomic Analysis of Clinical Plasma from Cerebral Infarction Patients Presenting with Blood Stasis

    PubMed Central

    Kim, Min Jung; Jung, Jeeyoun; Kim, Jin Hee; Lee, Myeong Soo; Kim, Myung-Sunny

    2015-01-01

    Blood stasis (BS) is characterized as a disorder of blood circulation. In traditional Korean medicine (TKM), it is viewed as a cause factor of diseases such as multiple sclerosis and stroke. This study investigated differences in the plasma metabolites profiles of subjects displaying BS or non-BS patterns. Thirty-one patients with cerebral infarction diagnosed with BS and an equal number of sex- and age-matched non-BS patients were enrolled. Metabolic profiling was performed using UPLC-MS. The ratio of subjects with a rough pulse and purple coloration of the tongue was higher in patients presenting with BS pattern. Through metabolomics analysis, 82 metabolites that differed significantly between the BS and non-BS pattern were identified, and the two groups were significantly separated using an orthogonal partial least square-discriminant analysis model (P < 0.001). Of these 82 metabolites, acetyl carnitine, leucine, kynurenine, phosphocholine, hexanoyl carnitine, and decanoyl carnitine were present in significantly higher levels in patients with a BS pattern than those with a non-BS pattern. Our results also demonstrated that seven plasma metabolites, including acyl-carnitines and kynurenine, were associated with a BS pattern, suggesting that variant plasma metabolic profiles may serve as a biomarker for diagnosis of BS in patients with cerebral infarction. PMID:25834622

  15. Risk Factors and Clinical Outcomes of Bacterial and Fungal Scleritis at a Tertiary Eye Care Hospital

    PubMed Central

    Reddy, Jagadesh C.; Murthy, Somasheila I.; Reddy, Ashok K.; Garg, Prashant

    2015-01-01

    Purpose: The aim was to analyze demographics, risk factors, pathogenic organisms, and clinical outcome in cases with microbiologically proven bacterial or fungal scleritis. Materials and Methods: Retrospective review of all the medical records of patients with microbiologically proven infectious scleritis examined from March 2005 to December 2009 in the cornea services of L. V. Prasad Eye Institute, Hyderabad, India was done. Results: Forty-two eyes of 42 patients were included in this study. The mean age at presentation was 48.52 ± 14.10 years (range: 12-70). Surgery was the major risk factor seen in 24 eyes (58.5%). Scleral infection was noted after vitreoretinal surgery (with scleral buckle) in 15 eyes, cataract surgery in 3 eyes, pterygium surgery in 3 eyes, corneoscleral tear repair and scleral buckle surgery in 3 eyes. Sixteen eyes (39%) were on systemic or topical steroids at the time of presentation. History of injury was noted in 9 eyes (22%) and diabetes mellitus in 7 patients (17%). Associated keratitis was noted in 9 eyes (21.4%). The scleral abscess was unifocal in 33 eyes (78.5%), multifocal in 6 eyes (14.2%) and diffuse in 3 eyes (7.14%). The final follow-up ranged from 24 days to 37 months. The final visual acuity was better in 18 eyes (42.8%), stable in 13 (30.9%), and deteriorated in 7 eyes (16.6%). Recurrence was seen in 4 eyes (9.5%). Conclusions: Surgery is a major risk factor for infectious scleritis in our series. Fungus was the most common organism isolated. Thorough debridement and intensive use of medications have improved the outcome. PMID:25949079

  16. Risk Factors Associated with Clinical Mastitis in Low Somatic Cell Count British Dairy Herds

    Microsoft Academic Search

    E. J. Peeler; M. J. Green; J. L. Fitzpatrick; K. L. Morgan; L. E. Green

    2000-01-01

    A cross-sectional survey of dairy farms with low bulk milk somatic cell counts was carried out to assess the level of clinical mastitis and to quantify risk factors associated with the incidence rate of clinical mastitis. Questionnaires were sent to 3009 milk operations with an annual mean bulk milk somatic cell count of less than 100,000 cells\\/ml during 1997. A

  17. Relationship between quality of life and clinical status in asthma: a factor analysis

    Microsoft Academic Search

    E. F. Juniper; M. E. Wisniewski; F. M. Cox; A. H. Emmett; K. E. Nielsen; P. M. O'Byrne

    2004-01-01

    Relationship between quality of life and clinical status in asthma: a factor analysis. E.F. Juniper, M.E. Wisniewski, F.M. Cox, A.H. Emmett, K.E. Nielsen, P.M. O9Byrne. #ERS Journals Ltd 2004. ABSTRACT: Many studies have shown that correlation between clinical asthma status and asthma-specific quality of life is only weak to moderate. However, this relationship has never been explored to determine whether

  18. Type 2 diabetes in children: Clinical aspects and risk factors.

    PubMed

    Rao, P V

    2015-04-01

    A strong link between obesity, insulin resistance, and metabolic syndrome has been reported with development of a new paradigm to type 2 diabetes mellitus (T2DM), with some evidence suggesting that beta-cell dysfunction is present before the onset of impaired glucose tolerance. Differentiating type 1 diabetes mellitus (T1DM) from T2DM is actually not very easy and there exists a number of overlapping characteristics. The autoantibody frequencies of seven antigens in T1DM patients may turn out to be actually having T2DM patients (pre-T2DM). T2DM patients generally have increased C-peptide levels (may be normal at time of diagnosis), usually no auto-antibodies, strong family history of diabetes, obese and show signs of insulin resistance (hypertension, acanthosis, PCOS). The American Academy of Paediatrics recommends lifestyle modifications ± metformin when blood glucose is 126-200 mg/dL and hemoglobin A1c (HbA1c) <8.5. Insulin is recommended when blood glucose is >200 mg/dL and HbA1c >8.5, with or without ketosis. Metformin is not recommended if the patient is ketotic, because this increases the risk of lactic acidosis. Metformin is currently the only oral hypoglycemic that has been approved for use in children. Knowing these subtle differences in mechanism, and knowing how to test patients for which mechanism (s) are causing their diabetes mellitus, may help us eventually tailor treatment programs on an individual basis. PMID:25941651

  19. A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

    PubMed Central

    Heinerichs, Scott; Vela, Luzita I.; Drouin, Joshua M.

    2013-01-01

    Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for self-directed study (SNAPPS) is used in medicine to express clinical reasoning. Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students. Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age = 21.53 ± 1.18 years, grade point average = 3.25 ± 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme. Intervention(s): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period. Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning. Results: Case presentations were longer (t18.806 = ?5.862, P < .001) but were more concise (t32 = 11.297, P < .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t32 = 2.857, P = .007) and the clinical reasoning subscale (t25.773 = ?14.162, P < .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F1,34 = 6.230, P = .02) but observed no group effects (F1,34 = 0.698, P = .41) or time-by-group interaction (F1,34 = 1.050, P = .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F1,34 = 1.470, P = .23) and no group (F1,34 = 3.751, P = .06) or time (F1,34 = 0.835, P = .37) effects. Conclusions: The SNAPPS is an effective and feasible clinical education technique for case presentations. This learner-centered technique provides the opportunity for the expression of clinical reasoning skills. PMID:23675796

  20. Factors Influencing the Clinical Stratification of Suitability to Drive after Stroke: A Qualitative Study.

    PubMed

    Stapleton, Tadhg; Connolly, Deirdre; O'Neill, Desmond

    2015-07-01

    While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum. PMID:26020451

  1. The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital- a prospective study

    PubMed Central

    2014-01-01

    Background Necrotizing fasciitis is an infectious process characterized by rapidly progressing necrosis of superficial fascia and subcutaneous tissue with subsequent necrosis of overlying skin. Necrotizing fasciitis is a rare but fatal infection. The worldwide incidence is at 0.4 per 100,000. Mortality is up to 80% with no intervention, and 30-50% with intervention. Delay in intervention is associated with poor outcome. The risk factors for necrotizing fasciitis are diabetes mellitus, HIV, malignancy, illicit drug use, malnutrition among others. The aim of this study was to describe the clinical presentation and early outcomes of necrotizing fasciitis amongst Ugandan patients. Methods A prospective descriptive case series study conducted at Mulago National Referral and Teaching hospital from 5th January to 30th April 2011. Patients with necrotizing fasciitis were consecutively recruited after clinical evaluation, laboratory and microbiological tests were performed. Aggressive debridement was done and broad-spectrum antibiotics administered. Patients were followed up on surgical wards. Ethical approval was obtained. Results Thirty five patients were recruited over a 4 months period. More males were affected with, M: F 3:1. The 20-40 years age group was most affected. Attainment of healthy granulation tissue took 19 days on average. Mortality rate was 14% (5/35). Limbs were the most affected body parts 20/35 (57%), the scrotum and perineum (23%). Among infants the scalp was the most affected. Co-morbidities included HIV 8/35 (17%), and DM (5%) among others. The commonest organisms were gram negative. Split skin grafting was necessary in 74% (26/35) of patients. Conclusion There were a high number of patients with necrotizing fasciitis; it was associated with low mortality but high morbidity (long hospital stay). There was a high preponderance to males and limbs were the more affected body parts. PMID:25069415

  2. Recruiting faculty with clinical responsibilities: factors that influence a decision to accept an academic position.

    PubMed

    Grauer, Gregory F

    2005-01-01

    The current opportunities for veterinary clinical specialists in private practice and industry have made recruiting and retaining faculty a major focus for most clinical academic departments. To gain a better understanding of the importance of the various factors considered in accepting an academic position, an electronic survey was distributed to newly hired veterinary faculty with clinical responsibilities. The results suggest that the perceived climate and collegiality within the prospective hiring department is the most important factor influencing the decision to accept an academic position. Salary is the second most important factor. Institutional support for the newly hired faculty member and the reputation and quality of the prospective institution rank as more important than the perceived quality of the local community and the geographic location of the institution. The search process and administrative support are the least important factors. There were no differences between the responses of faculty hired into tenure-track positions and those of faculty hired into clinical-track positions. Focusing on the advantages of a collegial environment, enhancing compensation packages, and using creative and flexible appointments may improve faculty recruitment and retention in clinical academic departments. PMID:16261500

  3. Educating the ambulance technician, paramedic, and clinical supervisor: using factor analysis to inform the curriculum

    PubMed Central

    Kilner, T

    2004-01-01

    Methods: Data generated by a Delphi study investigating the desirable attributes of ambulance technician, paramedic, and clinical supervisor were subject to factor analysis to explore inter-relations between the variables or desirable attributes. Variables that loaded onto any factor at a correlation level of >0.3 were included in the analysis. Results: Three factors emerged in each of the occupational groups. In respect of the ambulance technician these factors may be described as; core professional skills, individual and collaborative approaches to health and safety, and the management of self and clinical situations. For the paramedic the themes are; core professional skills, management of self and clinical situations, and approaches to health and safety. For the clinical supervisor there is again a theme described as core professional skills, with a further two themes described as role model and lifelong learning. Conclusions: The profile of desirable attributes emerging from this study are remarkably similar to the generic benchmark statements for health care programmes outlined by the Quality Assurance Agency for Higher Education. It seems that a case is emerging for a revision of the curriculum currently used for the education and training of ambulance staff, which is more suited to a consumer led health service and which reflects the broader professional base seen in programmes associated with other healthcare professions. This study has suggested outline content, and module structure for the education of the technician, paramedic, and clinical supervisor, based on empirical evidence. PMID:15107389

  4. Exploring self-criticism: confirmatory factor analysis of the FSCRS in clinical and nonclinical samples.

    PubMed

    Castilho, Paula; Pinto-Gouveia, José; Duarte, Joana

    2015-01-01

    The Forms of Self-criticizing/Attacking and Self-reassuring Scale (FSCRS) is a self-report questionnaire that assesses the forms of self-criticism and self-reassurance. The aim of this study was to explore the latent structure of the FSCRS in nonclinical and clinical samples. Data from 381 participants from the general population and from 304 participants from clinical settings were subjected to confirmatory factor analyses to explore several structural models reflecting alternative representations of the FSCRS dimensionality. Overall, the model with the best fit to the data, in both samples, was the three-factor model (inadequate self, hated self and reassured self subscales) replicating the FSCRS original structure. The scale showed good psychometric characteristics, and the three factors discriminated between the clinical and nonclinical samples. To our knowledge, this is the first study to confirm the factor structure of the FSCRS in a purely clinical sample, and to test alternative models. This study adds to the existent literature that has been supporting the conceptualization of self-criticism as a multidimensional construct. Given the good psychometric properties of the Portuguese version of the FSCRS, its use is encouraged and recommended for the assessment of self-criticism in both clinical and research settings. PMID:24307461

  5. Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer

    Microsoft Academic Search

    James L. Klosky; Darlene K. Cash; Joanna Buscemi; Shelly Lensing; Danette M. Garces-Webb; Wenyan Zhao; Sally Wiard; Melissa M. Hudson

    2008-01-01

    Introduction  Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related\\u000a health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite\\u000a the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the\\u000a demographic, medical, and logistic factors impacting clinic attendance and long-term

  6. Host Factors and HIV-1 Replication: Clinical Evidence and Potential Therapeutic Approaches

    PubMed Central

    Santa-Marta, Mariana; de Brito, Paula Matos; Godinho-Santos, Ana; Goncalves, Joao

    2013-01-01

    HIV and human defense mechanisms have co-evolved to counteract each other. In the process of infection, HIV takes advantage of cellular machinery and blocks the action of the host restriction factors (RF). A small subset of HIV+ individuals control HIV infection and progression to AIDS in the absence of treatment. These individuals known as long-term non-progressors (LNTPs) exhibit genetic and immunological characteristics that confer upon them an efficient resistance to infection and/or disease progression. The identification of some of these host factors led to the development of therapeutic approaches that attempted to mimic the natural control of HIV infection. Some of these approaches are currently being tested in clinical trials. While there are many genes which carry mutations and polymorphisms associated with non-progression, this review will be specifically focused on HIV host RF including both the main chemokine receptors and chemokines as well as intracellular RF including, APOBEC, TRIM, tetherin, and SAMHD1. The understanding of molecular profiles and mechanisms present in LTNPs should provide new insights to control HIV infection and contribute to the development of novel therapies against AIDS. PMID:24167505

  7. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers

    Microsoft Academic Search

    U Macleod; E D Mitchell; C Burgess; S Macdonald; A J Ramirez

    2009-01-01

    Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of

  8. Alveolar Soft Part Sarcoma: Clinical Presentation, Treatment and Outcome in a Series of 19 Patients

    PubMed Central

    Kim, Jun Young

    2014-01-01

    Background Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor that usually affects young patients. Because of the rarity of the disease, most reports relating to ASPS are in the form of case reports or small series. Methods We performed a retrospective study to evaluate the clinicopathologic features, treatment, outcome and pattern of treatment failure in a consecutive series of patients with localized or metastatic ASPS between 1996 and 2011. Demographics, tumor sizes, sites and extent of disease, treatments provided, progression-free survival, and overall survival were evaluated. Results A total of 19 patients were identified. The clinical assumptive diagnosis of the first medical examination doctor was benign soft tissue tumor in 5 cases (26%) and benign hemangioma in 4 cases (21%), delaying treatment. The most common location of primary tumor was the thigh. The median diameter of the mass was 55 mm (range, 10 to 130 mm). An R0 resection was obtained in 11 cases. Adjuvant radiotherapy was delivered in 8 cases; postoperative systemic chemotherapy was delivered in 10 cases. Eight out of 15 patients (53%) exhibited metastases either at presentation or later. Median overall follow-up was 54 months. Conclusions The treatment principle for alveolar soft tissue sarcoma is massive resection, and when the surgical margin is questionable, radiation treatment can be added for prevention of local recurrence. Also, due to discovery of metastases and local recurrence, even after 5 years of general treatment, outpatient department follow-up is needed, and we need to keep in mind that lung, intracranial, and bone metastases are common. PMID:24605193

  9. Follow up of patients presenting with fatigue to an infectious diseases clinic

    Microsoft Academic Search

    M. Sharpe; K. Hawton; V. Seagroatt; G. Pasvol

    1992-01-01

    OBJECTIVES--To determine the symptomatic and functional status during follow up of patients referred to hospital with unexplained fatigue and to identify patient variables associated with persistent functional impairment. DESIGN--Follow up by postal questionnaire six weeks to four years (median 1 year) after initial clinical assessment of patients referred to hospital during 1984-8. SETTING--Infectious diseases outpatient clinic in a teaching hospital.

  10. Human Factors Principles Applied to CAD/CAM Presentation by Eric N. Wiebe

    E-print Network

    Human Factors Principles Applied to CAD/CAM Presentation by Eric N. Wiebe NC State University Meeting, San Diego, CA. Abstract CAD/CAM technology has advanced rapidly in the last few years but only. The geometric model generated by CAD tools has been underutilized as a means of increasing the efficiency

  11. Clinical Analysis of Etiology, Risk Factors and Outcome in Patients with Acute Kidney Injury

    PubMed Central

    Hamzic-Mehmedbasic, Aida; Rebic, Damir; Balavac, Merima; Muslimovic, Alma; Dzemidzic, Jasminka

    2015-01-01

    Introduction: Acute kidney injury is characterized by a rapid loss of renal excretory function with the increase of nitrogen compounds in the blood and with different outcome. Objective: Since descriptions of the risk factors and sequelae of acute kidney injury (AKI) remain relatively limited, the objective of this study was to determine etiology and clinical characteristics of AKI, as well as risk factors for adverse outcome of renal function and death in AKI patients. Methods: We retrospectively studied a cohort of 84 adult AKI patients admitted to Nephrology Clinic in University Clinical Centre Sarajevo during period 2012-2014. Demographic, laboratory and clinical parameters were retrieved. The in-hospital and 6 months mortality were recorded. Renal function outcome was defined 3 months following discharge. Results: Majority of patients were older (median age 73.5 years) with great severity of AKI (Stage III in 78.5% of cases) and high burden of comorbidities (mean Charlson comorbidity index, CCI score 6.4±3.05). The most common causes of AKI were acute interstitial nephritis (16.7%), heart failure (15.5%), gastroenterocolitis (13.1%), and sepsis (12%). Renal function recovery was recorded in 48.8% of patients, with prevalence of 10.7% of intrahospital mortality and 37.3% of 6 months mortality. Risk factors for poor outcome of renal function and mortality in AKI patients were increasing age and higher CCI score, while protective factor was higher diuresis. Sepsis proved to be risk factor for death. PMID:26005378

  12. Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time-Series Analysis

    PubMed Central

    Pulido, Jose E.; Gasparrini, Antonio; Saigal, Christopher S.; Horton, Benjamin P.; Landis, J. Richard; Madison, Rodger; Keren, Ron

    2014-01-01

    Background: High ambient temperatures are a risk factor for nephrolithiasis, but the precise relationship between temperature and kidney stone presentation is unknown. Objectives: Our objective was to estimate associations between mean daily temperature and kidney stone presentation according to lag time and temperatures. Methods: Using a time-series design and distributed lag nonlinear models, we estimated the relative risk (RR) of kidney stone presentation associated with mean daily temperatures, including cumulative RR for a 20-day period, and RR for individual daily lags through 20 days. Our analysis used data from the MarketScan Commercial Claims database for 60,433 patients who sought medical evaluation or treatment of kidney stones from 2005–2011 in the U.S. cities of Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Los Angeles, California; and Philadelphia, Pennsylvania. Results: Associations between mean daily temperature and kidney stone presentation were not monotonic, and there was variation in the exposure–response curve shapes and the strength of associations at different temperatures. However, in most cases RRs increased for temperatures above the reference value of 10°C. The cumulative RR for a daily mean temperature of 30°C versus 10°C was 1.38 in Atlanta (95% CI: 1.07, 1.79), 1.37 in Chicago (95% CI: 1.07, 1.76), 1.36 in Dallas (95% CI: 1.10, 1.69), 1.11 in Los Angeles (95% CI: 0.73, 1.68), and 1.47 in Philadelphia (95% CI: 1.00, 2.17). Kidney stone presentations also were positively associated with temperatures < 2°C in Atlanta, and < 10°C in Chicago and Philadelphia. In four cities, the strongest association between kidney stone presentation and a daily mean temperature of 30°C versus 10°C was estimated for lags of ? 3 days. Conclusions: In general, kidney stone presentations increased with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days. These findings further support an adverse effect of high temperatures on nephrolithiasis. Citation: Tasian GE, Pulido JE, Gasparrini A, Saigal CS, Horton BP, Landis JR, Madison R, Keren R, for the Urologic Diseases in America Project. 2014. Daily mean temperature and clinical kidney stone presentation in five U.S. metropolitan areas: a time-series analysis. Environ Health Perspect 122:1081–1087;?http://dx.doi.org/10.1289/ehp.1307703 PMID:25009122

  13. Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery?

    PubMed

    Wickwar, S; McBain, H B; Ezra, D G; Hirani, S P; Rose, G E; Newman, S P

    2015-07-01

    PurposeGraves' orbitopathy (GO) is associated with changes in the appearance of the eyes and visual dysfunction. Patients report feeling socially isolated and unable to continue with day-to-day activities. This study aimed at investigating the demographic, clinical, and psychosocial factors associated with quality of life in patients presenting for orbital decompression surgery.MethodsOne-hundred and twenty-three adults with GO due for orbital decompression at Moorfields Eye Hospital London were recruited prospectively. Clinical measures including treatment history, exophthalmos, optic neuropathy, and diplopia were taken by an ophthalmologist. Participants completed psychosocial questionnaires, including the Graves' Ophthalmopathy Quality of Life Scale (GO-QOL), the Hospital Anxiety and Depression Scale, and the Derriford Appearance Scale. Hierarchical multiple regression analyses were used to identify predictors of quality of life.ResultsHigher levels of potential cases of clinical anxiety (37%) and depression (26%) were found in this study sample than in patients with other chronic diseases or facial disfigurements. A total of 55% of the variance in GO-QOL visual function scores was explained by the regression model; age, asymmetrical GO and depressed mood were significant unique contributors. In all, 75% of the variance in GO-QOL appearance scores was explained by the regression model; gender, appearance-related cognitions and depressed mood were significant unique contributors.ConclusionAppearance-related quality of life and mood were particularly affected in this sample. Predominantly psychosocial characteristics were associated with quality of life. It is important when planning surgery for patients that clinicians be aware of factors that could potentially influence outcomes. PMID:25998940

  14. Factors associated with cure after therapy of clinical mastitis caused by Staphylococcus aureus.

    PubMed

    Sol, J; Sampimon, O C; Barkema, H W; Schukken, Y H

    2000-02-01

    One hundred and fifty-nine cases of clinical Staphylococcus aureus mastitis were analyzed to detect factors associated with bacteriological cure after therapy. On 100 Dutch dairy farms, data were collected from four clinical trials with five intramammary treatment regimes designed to treat beta-lactamase-positive pathogens. Infected quarters were treated three times, with a 12-h interval between treatments. Treatment was extended for 2 d if results of the trial treatment were, according to the owner, not satisfactory. The overall bacteriological cure rate was 52%. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was significantly higher than that of clinical beta-lactamase-positive S. aureus mastitis. Bacteriological cure was also significantly higher if somatic cell count of the cow was low at the milk recording prior to the onset of the clinical mastitis. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was also significantly higher after an extended treatment compared with no extended treatment. The seriousness of the various clinical symptoms and the bacteriological cure rate of clinical S. aureus mastitis were not associated. PMID:10714861

  15. Clinical and Angioarchitectural Risk Factors Associated with Intracranial Hemorrhage in Dural Arteriovenous Fistulas: A Single-Center Retrospective Study

    PubMed Central

    Li, Chuanhui; Wang, Yang; Li, Youxiang; Jiang, Chuhan; Yang, Xinjian; Wu, Zhongxue

    2015-01-01

    Purpose To investigate which clinical and angioarchitectural features were associated with the occurrence of intracranial hemorrhage in patients with intracranial dural arteriovenous fistulas (DAVFs). Materials and Methods We retrospectively reviewed the clinical and angioarchitectural features of 236 consecutive patients diagnosed with DAVF in our department from April 2009 to November 2013. Two groups of patients, with or without intracranial hemorrhage as clinical presentation at the initial diagnosis, were analysed to identify the differences in clinical and angioarchitectural features in univariate analysis. A multivariate logistic regression model was also developed to assess the independent contribution of the potential risk factors. Associations were considered significant for p<0.05. Results Fifty-six patients (23.7%) presented with intracranial hemorrhage at the initial diagnosis of DAVF. In univariate analysis, male patients (p = 0.002), patients with medical history of smoking (p<0.001) or alcohol consumption (p = 0.022), and DAVFs located at the tentorium (p = 0.010), frontalbasal (p = 0.007), foramen magnum (p = 0.043) or cerebral convexity (p<0.001) were associated with an increased risk of intracranial hemorrhage. A higher risk of hemorrhagic occurrence was also observed in DAVFs with superficial cortical venous drainage (p<0.001), deep venous drainage (p = 0.003), occluded venous sinus (p<0.032), or higher Borden type (p<0.001). A multivariate logistic regression model showed that intracranial hemorrhage in patients with DAVFs was correlated with higher Borden classification (OR 5.880; 95% CI, 3.370–10.257; p<0.001). Conclusion Venous drainage pattern was the only independent risk factor of intracranial hemorrhage in our patients with intracranial DAVF. The other potential risk factors may be confounding factors in predicting intracranial hemorrhage. PMID:26120845

  16. Garlic powder intake and cardiovascular risk factors: a meta-analysis of randomized controlled clinical trials

    PubMed Central

    Kwak, Jin Sook; Kim, Ji Yeon; Paek, Ju Eun; Lee, You Jin; Kim, Haeng-Ran; Park, Dong-Sik

    2014-01-01

    BACKGROUND/OBJECTIVES Although preclinical studies suggest that garlic has potential preventive effects on cardiovascular disease (CVD) risk factors, clinical trials and reports from systematic reviews or meta-analyses present inconsistent results. The contradiction might be attributed to variations in the manufacturing process that can markedly influence the composition of garlic products. To investigate this issue further, we performed a meta-analysis of the effects of garlic powder on CVD risk factors. MATERIALS/METHODS We searched PubMed, Cochrane, Science Direct and EMBASE through May 2014. A random-effects meta-analysis was performed on 22 trials reporting total cholesterol (TC), 17 trials reporting LDL cholesterol (LDL-C), 18 trials reporting HDL cholesterol (HDL-C), 4 trials reporting fasting blood glucose (FBG), 9 trials reporting systolic blood pressure (SBP) and 10 trials reporting diastolic blood pressure (DBP). RESULTS The overall garlic powder intake significantly reduced blood TC and LDL-C by -0.41 mmol/L (95% confidence interval [CI], -0.69, -0.12) (-15.83 mg/dL [95% CI, -26.64, -4.63]) and -0.21 mmol/L (95% CI, -0.40, -0.03) (-8.11 mg/dL [95% CI, -15.44, -1.16]), respectively. The mean difference in the reduction of FBG levels was -0.96 mmol/L (95% CI, -1.91, -0.01) (-17.30 mg/dL [95% CI, -34.41, -0.18]). Evidence for SBP and DBP reduction in the garlic supplementation group was also demonstrated by decreases of -4.34 mmHg (95% CI, -8.38, -0.29) and -2.36 mmHg (95% CI, -4.56, -0.15), respectively. CONCLUSIONS This meta-analysis provides consistent evidence that garlic powder intake reduces the CVD risk factors of TC, LDL-C, FBG and BP. PMID:25489404

  17. Prognostic factors for clinical failure of exacerbations in elderly outpatients with moderate-to-severe COPD

    PubMed Central

    Wilson, Robert; Anzueto, Antonio; Miravitlles, Marc; Arvis, Pierre; Haverstock, Daniel; Trajanovic, Mila; Sethi, Sanjay

    2015-01-01

    Background Acute exacerbations represent a significant burden for patients with moderate-to-severe chronic obstructive pulmonary disease. Each exacerbation episode is frequently associated with a lengthy recovery and impaired quality of life. Prognostic factors for outpatients that may predict poor outcome after treatment with antibiotics recommended in the guidelines, are not fully understood. We aimed to identify pretherapy factors predictive of clinical failure in elderly (?60 years old) outpatients with acute Anthonisen type 1 exacerbations. Trial registration NCT00656747. Methods Based on the moxifloxacin in AECOPDs (acute exacerbations of chronic obstructive pulmonary disease) trial (MAESTRAL) database, this study evaluated pretherapy demographic, clinical, sputum bacteriological factors using multivariate logistic regression analysis, with internal validation by bootstrap replicates, to investigate their possible association with clinical failure at end of therapy (EOT) and 8 weeks posttherapy. Results The analyses found that the independent factors predicting clinical failure at EOT were more frequent exacerbations, increased respiratory rate and lower body temperature at exacerbation, treatment with long-acting anticholinergic drugs, and in vitro bacterial resistance to study drug. The independent factors predicting poor outcome at 8 weeks posttherapy included wheezing at preexacerbation, mild or moderate (vs extreme) sleep disturbances, lower body temperature at exacerbation, forced expiratory volume in 1 second <30%, lower body mass index, concomitant systemic corticosteroids for the current exacerbation, maintenance long-acting ?2-agonist and long-acting anticholinergic treatments, and positive sputum culture at EOT. Conclusion Several bacteriological, historical, treatment-related factors were identified as predictors of early (EOT) and later (8 weeks posttherapy) clinical failure in this older outpatient population with moderate-to-severe chronic obstructive pulmonary disease. These patients should be closely monitored and sputum cultures considered before and after treatment.

  18. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    Microsoft Academic Search

    Peter N. Ruygrok; Mark W. I. Webster; Vincent de Valk; Gerrit-Anne van Es; John A. Ormiston; Marie-Angèle M. Morel; Patrick W. Serruys

    Background—Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. Methods and Results—All patients with angiographic restenosis from the BENESTENT I, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, FLARE, SOPHOS, and ROSE studies were analyzed. Multivariate analysis

  19. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    Microsoft Academic Search

    P. N. Ruygrok; M. W. I. Webster; Valk de V; Es van G. A; J. A. Ormiston; M.-A. M. Morel; P. W. J. C. Serruys

    2001-01-01

    BACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND RESULTS: All patients with angiographic restenosis from the BENESTENT I, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, FLARE, SOPHOS, and ROSE studies were analyzed.

  20. The role of intrinsic factors in the implementation of psychosocial interventions into routine clinical practice

    Microsoft Academic Search

    M Fleming; A Savage-Grainge; C Martin; C Hill; S Brown; J Buckle; J Miles

    2008-01-01

    Despite the efficacy, political will and numbers of mental health practitioners trained in psychosocial interventions, they remain scarcely available in routine clinical practice. External factors such as the inability of mental health organisations to develop strategies to support the use of psychosocial interventions have been implicated. This study compares data from two groups, one that had completed psychosocial intervention training

  1. Patient and Clinical Site Factors Associated with Rescreening Behavior Among Older Multiethnic, Low-Income Women

    ERIC Educational Resources Information Center

    Fox, Patrick; Arnsberger, Pamela; Owens, Desi; Nussey, Brenda; Zhang, Xiluan; Golding, Jacqueline M.; Tabnak, Farzaneh; Otero-Sabogal, Regina

    2004-01-01

    Purpose: Our goal was to identify factors predictive of mammography rescreening within 18 months of baseline screening in multiethnic, low-income older women. Design and Methods: We interviewed a cross-sectional survey of staff of 102 randomly selected clinics that provided screening and diagnostic services. We also surveyed a random sample of 391…

  2. Megakaryocyte Growth and Development Factor: A Review of Early Clinical Studies

    Microsoft Academic Search

    RICK ABRAHAM; RUSSELL L. BASSER

    Megakaryocyte growth and development factor (MGDF), a Mpl ligand, recently entered clinical trials worldwide and has been demonstrated to have potent bio- logical activity. MGDF administration causes a dose- dependent increase in platelet count but no effect on white cell count or hematocrit. These platelets are morphologi- cally and functionally normal. When administered follow- ing moderately myelosuppressive chemotherapy, MGDF significantly

  3. The Diagnostic Value of Clinical Symptoms in Women and Men Presenting with Chest Pain at the Emergency Department, a Prospective Cohort Study

    PubMed Central

    van der Meer, Manon G.; Backus, Barbra E.; van der Graaf, Yolanda; Cramer, Maarten J.; Appelman, Yolande; Doevendans, Pieter A.; Six, A. Jacob; Nathoe, Hendrik M.

    2015-01-01

    Background Previous studies suggested that diagnosing coronary artery disease (CAD) is more difficult in women than in men. Studies investigating the predictive value of clinical signs and symptoms and compare its combined diagnostic value between women and men are lacking. Methodology Data from a large multicenter prospective study was used. Patients admitted to the emergency department (ED) with chest pain but without ST-elevation were eligible. The endpoint was proven CAD, defined as a significant stenosis at angiography or the diagnosis of a non-ST-elevation myocardial infarction or cardiovascular death within six weeks after presentation at the ED. Twelve clinical symptoms and seven cardiovascular risk factors were collected. Potential predictors of CAD with a p-value <0.15 in the univariable analysis were included in a multivariable model. The diagnostic value of clinical symptoms and cardiovascular risk factors was quantified in women and men separately and areas under the curve (AUC) were compared between sexes. Results A total of 2433 patients were included. We excluded 102 patients (4%) with either an incomplete follow up or ST-elevation. Of the remaining 2331 patients 43% (1003) were women. CAD was present in 111 (11%) women and 278 (21%) men. In women 11 out of 12 and in men 10 out of 12 clinical symptoms were univariably associated with CAD. The AUC of symptoms alone was 0.74 (95%CI: 0.69-0.79) in women and 0.71 (95%CI: 0.68-0.75) in men and increased to respectively 0.79 (95%CI: 0.74-0.83) in women versus 0.75 (95%CI: 0.72-0.78) in men after adding cardiovascular risk factors. The AUCs of women and men were not significantly different (p-value symptoms alone: 0.45, after adding cardiovascular risk factors: 0.11). Conclusion The diagnostic value of clinical symptoms and cardiovascular risk factors for the diagnosis of CAD in chest pain patients presenting on the ED was high in women and men. No significant differences were found between sexes. PMID:25590466

  4. Perspectives in Diabetes Clinical Trials of Diabetic Neuropathy: Past, Present, and Future

    Microsoft Academic Search

    Michael A. Pfeifer; Mary P. Schumer

    This article reviews current knowledge of the etiology of diabetic neuropathy and the outcomes and limitations of previous trials and discusses future directions for the investigation of its prevention and treatment. Proposed mechanisms for the development of diabetic neuropathy have been widely studied. It has been shown that there is improvement of nerve function associated with some short-term clinical trials

  5. Stiff Person Syndrome: A Rare Neurological Disorder, Heterogeneous in Clinical Presentation and Not Easy to Treat

    PubMed Central

    Buechner, Susanne; Florio, Igor

    2015-01-01

    Background. Stiff person syndrome (SPS) is a rare neurological disorder characterized by progressive rigidity of axial and limb muscles associated with painful spasms. SPS can be classified into classic SPS, paraneoplastic SPS, and SPS variants. Its underlying pathogenesis is probably autoimmune, as in most cases antibodies against glutamic acid decarboxylase (GAD) are observed. Similarly, paraneoplastic SPS is usually linked to anti-amphiphysin antibodies. Treatment is based on drugs enhancing gamma-aminobutyric acid (GABA) transmission and immunomodulatory agents. Case Series. Patient 1 is a 45-year-old male affected by the classic SPS, Patient 2 is a 73-year-old male affected by paraneoplastic SPS, and Patient 3 is a 68-year-old male affected by the stiff limb syndrome, a SPS variant where symptoms are confined to the limbs. Symptoms, diagnostic findings, and clinical course were extremely variable in the three patients, and treatment was often unsatisfactory and not well tolerated, thus reducing patient compliance. Clinical manifestations also included some unusual features such as recurrent vomiting and progressive dysarthria. Conclusions. SPS is a rare disorder that causes significant disability. Because of its extensive clinical variability, a multitask and personalized treatment is indicated. A clearer understanding of uncommon clinical features and better-tolerated therapeutic strategies are still needed. PMID:26106494

  6. Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients

    Microsoft Academic Search

    J Bohr; C Tysk; S Eriksson; H Abrahamsson; G Järnerot

    1996-01-01

    BACKGROUND: Data on collagenous colitis have been based on a limited number of patients. AIMS: To obtain more information on this disease from a register set up at Orebro Medical Center Hospital. PATIENTS AND METHODS: Twenty five Swedish hospitals have contributed to this patient register, which comprises 163 histopathologically verified cases. Clinical data were retrospectively analysed. RESULTS: Collagenous colitis followed

  7. Clinical Presentation of Inhalational Anthrax Following Bioterrorism Exposure Report of 2 Surviving Patients

    Microsoft Academic Search

    Thom A. Mayer; Susan Bersoff-Matcha; Cecele Murphy; James Earls; Scott Harper; Denis Pauze; Michael Nguyen; Jonathan Rosenthal; Donald Cerva; Glenn Druckenbrod; Dan Hanfling; Naaz Fatteh; Anthony Napoli; Ashna Nayyar; Elise L. Berman

    The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Wash- ington, DC. This report details the clinical

  8. POSTER PRESENTATION Open Access Genetic markers in clinical subtypes of juvenile

    E-print Network

    Paris-Sud XI, Université de

    , France. 23-25 November 2011 Introduction Juvenile idiopathic arthritis (JIA) is the most common children cri- teria as antinuclear antibodies (ANA), age of beginning or uveitis. Our objective was to look and the different clinical sub types of JIA. Results 101 children with JIA were included. Oligoarticular form

  9. Annual Research Review: Attachment Disorders in Early Childhood--Clinical Presentation, Causes, Correlates, and Treatment

    ERIC Educational Resources Information Center

    Zeanah, Charles H.; Gleason, Mary Margaret

    2015-01-01

    Background: Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In…

  10. Clinical Profile of Childhood Onset Depression Presenting to Child Adolescent and Family Services in Northampton

    ERIC Educational Resources Information Center

    Majumder, Pallab; Hammad, Hala

    2006-01-01

    Background: The clinical profile of depressive disorder in children and young people in Child Adolescent and Family Services (CAFS), Northampton was studied. Methods: Twenty-five patients who had attended the CAFS over a period of 2 years were analysed retrospectively. Results: The age range of subjects was 8 to 19 years. Majority of patients were…

  11. Platelets accelerate gastric ulcer healing through presentation of vascular endothelial growth factor

    PubMed Central

    Wallace, John L; Dicay, Michael; McKnight, Webb; Dudar, Genevieve K

    2006-01-01

    Platelets contain an array of growth factors that can modulate healing processes, including both pro- (e.g., vascular endothelial growth factor (VEGF)) and antiangiogenic (e.g., endostatin) factors. Previous studies have shown that circulating platelets contribute significantly to gastric ulcer healing, acting as a delivery system for these growth factors to the site of injury. In this study, we examined the effects of orally administered human platelets on the healing of gastric ulcers in rats, and determined the contribution of VEGF and endostatin to healing in this model. Twice-daily administration of human platelets significantly accelerated ulcer healing, but platelet-poor plasma (PPP), lysed platelets and serum failed to produce this effect. There was no correlation between ulcer healing and the levels of VEGF or endostatin in serum, PPP or platelet-rich plasma (PRP). Accelerated ulcer healing could not be produced by oral administration of the angiogenic factors themselves, at concentrations matching those in PRP. The accelerated healing induced by platelets could be reversed by immuno-neutralization of VEGF. In contrast, immuno-neutralization of endostatin did not affect PRP-induced ulcer healing. These studies indicate that VEGF released from platelets accounts for the accelerated healing of gastric ulcers. However, as intact (rather than lysed) platelets were required for the accelerated healing, the presentation of VEGF by the platelet at the site of injury appears to be crucial for enhancement of the healing process. PMID:16565732

  12. Risk factors for renal disease in systemic lupus erythematosus and their clinical implications.

    PubMed

    Ntatsaki, Eleana; Isenberg, David

    2015-07-01

    Lupus nephritis is one of the most common severe manifestations of systemic lupus erythematosus and is associated with significant morbidity and mortality. Genetic, ethnic and hormonal factors may influence the presence and severity of renal involvement and therefore affect the outcome and overall prognosis of patients. In this review, we will discuss the association of known lupus risk factors in developing renal disease and explore the recent literature to identify potential risk factors and their clinical implications in terms of diagnostic vigilance, management and prognosis. PMID:25973642

  13. Regional differences in incidence and clinical presentation of type 1 diabetes in children aged under 15 years in Croatia

    PubMed Central

    Stipan?i?, Gordana; La Grasta Saboli?, Lavinia; Požgaj Šepec, Marija; Radica, Ana; Skrabi?, Veselin; Severinski, Sre?ko; Kujundži? Tiljak, Mirjana

    2012-01-01

    Aim To determine regional differences in the incidence, incidence trends, and clinical presentation of type 1 diabetes in children under the age of 15 years in Croatia in a 9-year period (1995-2003). Methods We included the patients who had been diagnosed with the disease and had started the insulin treatment before they were 15 years old. Regional differences between eastern, central, and southern Croatia were observed. The gross incidence was expressed by the number of newly diagnosed type 1 diabetes patients in 100?000 children of the same age and sex per year, ie, for the 0-14 age group, and for the 0-4, 5-9, and 10-14 subgroups. Results The highest incidence was observed in southern Croatia (10.91 per 100?000/y) and the lowest in central Croatia (8.64 per 100?000/y), and in eastern Croatia the incidence was 8.93 per 100?000/y. All three regions showed a growing incidence trend, which was significant only in eastern and southern Croatia. There was 35.9% of patients with diabetic ketoacidosis in eastern Croatia, 41.7% in central Croatia, and 31.3% in southern Croatia. Conclusion Croatian regions show differences in the incidence, incidence trends, and disease presentation of type 1 diabetes. A further follow-up is needed to establish whether the regional differences are a consequence of the population dynamics in the observed period or they will continue to exist, pointing to differences in environmental risk factors. PMID:22522992

  14. [Oral glucocorticoid-induced psychiatric side-effects: focus on clinical specificities, incidence, risk factors and treatment].

    PubMed

    Ricoux, A; Guitteny-Collas, M; Sauvaget, A; Delvot, P; Pottier, P; Hamidou, M; Vanelle, J-M

    2013-05-01

    Oral glucocorticoids have been used for several decades and psychiatric side-effects may occur. This review will discuss relevant data of the clinical specificities, the incidence, the risk factors for the occurrence of these episodes and the preventive and curative medications of these episodes. We performed a literature review by using PubMed database. We selected and discussed articles and studies with high standard of evidence. The occurrence of psychiatric symptoms is quite frequent. The varying intensity of clinical features ranges from minor signs (impregnation) to acute psychotic episodes which may occur from 5 to 30% of patients. Affective symptoms or disorders are the most prominent clinical features. Delirium may occur and suicidal risk could be increased. The significant predictive factors are prednisone dosage more than 40 mg/day, particularly weight-based dosage, and a history of psychiatric disorders. When a reduced dosage of glucocorticoids is not sufficient to control the symptomatology, curative medication is mainly based on atypical antipsychotics such as olanzapine. Studies about neuropsychiatric complications of glucocorticoids present various and heterogeneous results. Further prospective clinical studies should be based on a close cooperation between physicians and consultation liaison psychiatrists. This collaboration is required for an optimized management of the patient who receive glucocorticoids. PMID:23374903

  15. Difference Between Present and Future of Spatial and Seasonal Carbon Budget Control Factor in Eastern Asia

    NASA Astrophysics Data System (ADS)

    Obikawa, H.; Sasai, T.

    2014-12-01

    IPCC reported that warming over the 21st century in Eastern Asia was grater than the global mean and precipitation seasonal variability likely intensified along with extent of warming. Flux tower measurements showed that photosynthesis and ecosystem respiration in the region were easily influenced by air temperature and/or precipitation generally than in the other regions. Therefore, the future energy and water condition probably alter the present relationship between vegetation and soil activities and meteorological phenomena. However, there are few quantitative analysis which demonstrates terrestrial ecosystem response to future climate change in Eastern Asia. For this research, we estimated present (2001 - 2010) and future (2091 - 2100) seasonal NEP control factor with 10km-grid in Eastern Asia. We created future 10km-grid climate data by combining present satellite and climate datasets with CMIP5 GCM outputs and vegetation data by using empirical method considering extension of growing length. The terrestrial biosphere model BEAMS was used for NEP control factor analysis. As a result, difference of primary NEP control factor between present and future was characteristic by seasons. In spring and autumn, temperature precedence area in the high latitudes decreased in future. While in summer, most of the area showed radiation precedence except water precedence in arid area in both periods, but radiation contribution for NEP in the middle latitudes decreased. We found that primary NEP control factor changed by terrestrial sensitivity to climate change and a capacity of climate to drive carbon cycle. Future warming mitigated the photosynthetic activity restriction which caused by cold stress. Terrestrial carbon cycle demand for radiation in summer might be approaching satisfaction in future. Our simulation provided quantitative evidence that unique climate feedback via terrestrial ecosystem activity will behave variedly in each region and season.

  16. Factors related to child maltreatment in children presenting with burn injuries.

    PubMed

    Wibbenmeyer, Lucy; Liao, Junlin; Heard, Jason; Kealey, Lyn; Kealey, Gerald; Oral, Resmiye

    2014-01-01

    The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment. All consenting children admitted with burn injuries were surveyed regarding their injury mechanism and current sociodemographic status. Suspicious injuries were referred by the burn team to the multidisciplinary review team (MRT). The MRT reported injuries with signs of physical abuse, supervision neglect, neglect of other basic needs, or sexual abuse. These children constituted the cases in our study. Variables related to maltreatment were entered into stepwise logistic regression to identify independent predicting variables. P< .05 was considered significant. MRT identified 16 children (24%) admitted with burn injuries with suspicions of maltreatment. Risk factors related to suspicions of maltreatment included: young age, large burns, tap water injury, immersion lines, delay in care, absence of a two-parent family (unconventional family structure), young parents, inconsistent history, and injury pattern. In this single-center prospective study, the authors identified several factors that, when present in injuries with initial suspicion of maltreatment, should trigger a child maltreatment workup. Burn clinicians have an important role as advocates for children and their families. It is important to continue to further the knowledge of maltreatment detection and prevention among children presenting with burn injuries. PMID:24823333

  17. Analysis of clinical characteristics and prognostic factors for angioimmunoblastic T-cell lymphoma.

    PubMed

    Kameoka, Yoshihiro; Takahashi, Naoto; Itou, Shigeki; Kume, Masaaki; Noji, Hideyoshi; Kato, Yuichi; Ichikawa, Yoshikazu; Sasaki, Osamu; Motegi, Mutsuhito; Ishiguro, Atsushi; Tagawa, Hiroyuki; Ishizawa, Kenichi; Ishida, Yoji; Ichinohasama, Ryo; Harigae, Hideo; Sawada, Kenichi

    2015-06-01

    Angioimmunoblastic T-cell lymphoma (AITL) is a distinct peripheral T-cell lymphoma entity exhibiting peculiar clinical features and poor prognosis. Its clinical characteristics and prognostic factors are not well established. To clarify the clinical characteristics and prognostic features of AITL, we conducted a multicenter, retrospective study. Fifty-six patients were enrolled. The median patient age was 68 years. Immunohistochemical examinations of tumor cells showed positivity for CD10 and T-cell markers, and chromosomal examination detected several types of abnormalities. More than 80 % of patients show advanced disease at diagnosis and poor prognostic scores. A high proportion of patients showed accompanying B symptoms, splenomegaly, and hepatomegaly at diagnosis. The 5-year overall survival (OS) rate was 48 % and progression-free survival was 25 %. Univariate analysis revealed higher age, fever, poor performance status, anemia, and low albumin level to be poor prognostic factors for OS. In addition to these factors, both IPI and PIT were also predictive of OS. Multivariate analysis indicated only a low level of serum albumin to be a significant prognostic factor for OS. Serum albumin may be one of the important prognostic factors for AITL. Further investigation is needed to confirm these results. PMID:25739382

  18. Common neuropathological features underlie distinct clinical presentations in three siblings with hereditary diffuse leukoencephalopathy with spheroids caused by CSF1R p.Arg782His.

    PubMed

    Robinson, John L; Suh, EunRan; Wood, Elisabeth M; Lee, Edward B; Coslett, H Branch; Raible, Kevin; Lee, Virginia M-Y; Trojanowski, John Q; Van Deerlin, Vivianna M

    2015-01-01

    Hereditary diffuse leukoencephalopathy with spheroids (HDLS) presents with a variety of clinical phenotypes including motor impairments such as gait dysfunction, rigidity, tremor and bradykinesia as well as cognitive deficits including personality changes and dementia. In recent years, colony stimulating factor 1 receptor gene (CSF1R) has been identified as the primary genetic cause of HDLS. We describe the clinical and neuropathological features in three siblings with HDLS and the CSF1R p.Arg782His (c.2345G?>?A) pathogenic mutation. Each case had varied motor symptoms and clinical features, but all included slowed movements, poor balance, memory impairment and frontal deficits. Neuroimaging with magnetic resonance imaging revealed atrophy and increased signal in the deep white matter. Abundant white matter spheroids and CD68-positive macrophages were the predominant pathologies in these cases. Similar to other cases reported in the literature, the three cases described here had varied clinical phenotypes with a pronounced, but heterogeneous distribution of axonal spheroids and distinct microglia morphology. Our findings underscore the critical importance of genetic testing for establishing a clinical and pathological diagnosis of HDLS. PMID:26141825

  19. The transcription factor TFEB acts as a molecular switch that regulates exogenous antigen-presentation pathways.

    PubMed

    Samie, Mohammad; Cresswell, Peter

    2015-07-01

    Dendritic cells (DCs) can initiate immune responses by presenting exogenous antigens to T cells via both major histocompatibility complex (MHC) class I pathways and MHC class II pathways. Lysosomal activity has an important role in modulating the balance between these two pathways. The transcription factor TFEB regulates lysosomal function by inducing lysosomal activation. Here we report that TFEB expression inhibited the presentation of exogenous antigen by MHC class I while enhancing presentation via MHC class II. TFEB promoted phagosomal acidification and protein degradation. Furthermore, we found that the activation of TFEB was regulated during DC maturation and that phagosomal acidification was impaired in DCs in which the gene encoding TFEB was silenced. Our data indicate that TFEB is a key participant in the differential regulation of the presentation of exogenous antigens by DCs. PMID:26030023

  20. How clinically effective is intravascular ultrasound in interventional cardiology? Present and future perspectives.

    PubMed

    Nakatani, Shimpei; Proniewska, Klaudia; Pociask, El?bieta; Paoletti, Giulia; de Winter, Sebastiaan; Muramatsu, Takashi; Bruining, Nico

    2013-11-01

    Intravascular ultrasound (IVUS) has been clinically available for almost 25 years now and showed us valuable information regarding the coronary vessel lumen, its dimensions, the plaque burden and plaque characteristics that we were not able to assess by angiography alone. Using these abilities, IVUS has helped us to start, understand the atherosclerotic process in the coronary vessels. Further technical innovations partially overcame the somewhat limited image resolution of IVUS allowing more in-depth characterization and quantification of coronary plaque components. In addition, IVUS has been shown to be helpful to guide interventional procedures including optimal stent deployment in many clinical situations. In this review, we focus on the potential role of IVUS technology in interventional cardiology and on the valuable role of IVUS usage in percutaneous coronary interventions. PMID:24195458

  1. Cancer immunotherapy in clinical practice—the past, present, and future

    PubMed Central

    Goel, Gaurav; Sun, Weijing

    2014-01-01

    Considerable progress has been made in the field of cancer immunotherapy in recent years. This has been made possible in large part by the identification of new immune-based cellular targets and the development of novel approaches aimed at stimulating the immune system. The role played by the immunosuppressive microenvironment in the development of tumors has been established. The success of checkpoint-inhibiting antibodies and cancer vaccines has marked the beginning of a new era in cancer treatment. This review highlights the clinically relevant principles of cancer immunology and various immunotherapeutic approaches that have either already entered mainstream oncologic practice or are currently in the process of being evaluated in clinical trials. Furthermore, the current barriers to the development of effective immunotherapies and the potential strategies of overcoming them are also discussed. PMID:25189717

  2. Patients with Multiple Chemical Sensitivities in an Occupational Health Clinic: Presentation and Follow-Up

    Microsoft Academic Search

    Michael B. Lax; Paul K. Henneberger

    1995-01-01

    Thirty-five people with work-related Multiple Chemical Sensitivities were studied to learn about the onset and progression of illness. The subjects were selected from patients at an occupational health clinic. Individuals were identified as subjects if they fulfilled a seven-point case definition for Multiple Chemical Sensitivities and if onset of symptoms was related to workplace exposures. Three occupational exposures to solvents,

  3. Cutaneous and Skeletal Simultaneous Locations as a Rare Clinical Presentation of Tuberculosis

    PubMed Central

    Pereira, Aida; Miranda, Ana; Santo, Frederico E.; Fernandes, Pedro

    2015-01-01

    Tuberculosis is a resurgent disease in most regions of the world, infecting one-third of the world's population and having a multisystemic involvement. Incidence of extra-pulmonary tuberculosis has increased in the last few decades as a result of the Human Immunodeficiency Virus (HIV) infection. The authors report a clinical case of the rare concomitant cutaneous and skeletal tuberculosis in an immunocompetent patient transferred from endemic area.

  4. Combined methylmalonic acidemia and homocystinuria, cblC type. I. Clinical presentations, diagnosis and management

    Microsoft Academic Search

    Nuria Carrillo-Carrasco; Randy J. Chandler; Charles P. Venditti

    Combined methylmalonic acidemia and homocystinuria, cblC type, is an inborn error of intracellular cobalamin metabolism with\\u000a a wide spectrum of clinical manifestations that is stated to be the most common inherited disorder of cobalamin metabolism.\\u000a This metabolic disease is caused by mutations in the MMACHC gene and results in impaired intracellular synthesis of adenosylcobalamin and methylcobalamin, cofactors for the methylmalonyl-CoA

  5. Clinical presentation of congenital sialidosis in a patient with a neuraminidase gene frameshift mutation

    Microsoft Academic Search

    Tina Buchholz; Guy Molitor; Kiven E. Lukong; Manfred Praun; Orsolya Genzel-Boroviczény; Matthias Freund; Alexey V. Pshezhetsky; Andreas Schulze

    2001-01-01

    Congenital sialidosis is a rare lysosomal storage disease caused by a primary neuraminidase deficiency which results from\\u000a defects in the neuraminidase gene on chromosome 6p. The inheritance is autosomal recessive. Patients exhibit excessive urinary\\u000a excretion of bound sialic acid and decreased or undetectable amounts of neuraminidase activity in various tissues. The clinical\\u000a expression is variable, but ascites and hepatosplenomegaly are

  6. Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

    PubMed

    Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

    2014-09-01

    This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ?6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient. PMID:25179920

  7. A New Special-Purpose Factorization Algorithm In this paper, a new factorization algorithm is presented, which finds a prime

    E-print Network

    Cheng, Qi

    where D and b are integers. Hence this algorithm will factor a number efficiently, if it has a prime factorization is a classical problem in computer science and number theory. It has been studied for centuriesA New Special-Purpose Factorization Algorithm Qi Cheng Abstract In this paper, a new factorization

  8. Risk factors and clinical features of ovarian pregnancy: a case–control study

    PubMed Central

    Zhu, Qian; Li, Cheng; Zhao, Wei-Hong; Yuan, Jiang-Jing; Yan, Ming-Xing; Qin, Guo-Juan; Zhang, Jian

    2014-01-01

    Objective To identify risk factors for ovarian pregnancy (OP) and compare clinical features between OP and tubal pregnancy (TP) patients. Design Case–control study. Setting University hospital. Participants A case–control study was conducted from January 2005 to May 2014. Women diagnosed with OP were recruited as the case group (n=71), 145 women with TP and 146 with intrauterine pregnancy (IUP) were matched as controls at a ratio of 1:2:2. Women who refused interviews or provided incomplete information were excluded. Results OP risk was lower than TP risk in women with serological evidence of Chlamydia trachomatis infection (adjusted OR1 0.17, 95% CI 0.06 to 0.52), previous adnexal surgery (adjusted OR1 0.25, 95% CI 0.07 to 0.95), and current levonorgestrel emergency contraceptive use (adjusted OR1 0.24, 95% CI 0.07 to 0.78). In vitro fertilisation-embryo transfer (IVF-ET) carried a higher risk of OP (adjusted OR1 12.18, 95% CI 2.23 to 66.58) than natural conception. When Controlled by IUP women, current users of intrauterine devices (IUDs) carried a higher risk of OP than non-users of any contraceptives (adjusted OR2 9.60, 95% CI 1.76 to 42.20). ?-Human chorionic gonadotropin (hCG) levels on the day of surgery were higher in OP patients than in TP patients (p<0.01). Women with OP were less likely to initially present with vaginal bleeding than those with TP (p=0.02). Moreover, shock (p=0.02), rupture (p<0.01), haemoperitoneum (p<0.01) and emergency laparotomy (p<0.01) were more common in the OP group than in the TP group. Conclusions IVF-ET and IUD use may be risk factors for OP, and OP patients tend to have high ?-hCG levels and a poor clinical outcome (shock, rupture, haemoperitoneum and need for emergency laparotomy). Our findings may contribute to the prevention and early diagnosis of OP. PMID:25472658

  9. Clinical factors correlated with the success rate of miniscrews in orthodontic treatment

    PubMed Central

    Topouzelis, Nikolaos; Tsaousoglou, Phoebus

    2012-01-01

    Miniscrews offer a reliable alternative for anchorage during orthodontic treatment, particularly for non-cooperative patients or periodontal patients with alveolar bone loss. The study aims at assessing the correlation of various clinical indicators with the success or failure of miniscrews used for anchorage during orthodontic treatment. Thirty-four consecutive patients with a cumulative total of 82 miniscrews implanted participated in the study. Generalized Estimating Equations were used to assess the correlation of various factors with success rates. The miniscrew was considered the unit of analysis clustered within site and within patient. The overall success rate of miniscrews was 90.2%. For every additional miniscrew used in a patient's oral cavity, the success rate was reduced by 67%. Retromandibular triangle and palatal placement and in movable mucosa resulted in lower success rate. The miniscrew length and diameter were found to correlate with success rates. Orthodontic force applied on miniscrews for uprighting purposes showed a lower success rate than that used for retraction. This study revealed that miniscrews present high success rates. The number of miniscrews used per patient, the miniscrew site placement, the soft tissue type of placement, the miniscrew length and diameter as well as the orthodontic force applied on the miniscrew showed significant correlation with success rates. PMID:22241373

  10. LUNG CANCER IN NEVER SMOKERS: CLINICAL EPIDEMIOLOGY AND ENVIRONMENTAL RISK FACTORS

    PubMed Central

    Samet, Jonathan M.; Avila-Tang, Erika; Boffetta, Paolo; Hannan, Lindsay M.; Olivo-Marston, Susan; Thun, Michael J.; Rudin, Charles M.

    2011-01-01

    More than 161,000 lung cancer deaths are projected to occur in the U.S. in 2008. Of these, an estimated 10–15% will be caused by factors other than active smoking, corresponding to 16,000–24,000 deaths annually. Thus lung cancer in never smokers would rank among the most common causes of cancer mortality in the U.S. if considered to be a separate category. Slightly more than half of the lung cancers caused by factors other than active smoking occur in never smokers. As summarized in the accompanying article, lung cancers that occur in never smokers differ from those that occur in smokers in their molecular profile and response to targeted therapy. These recent laboratory and clinical observations highlight the importance of defining the genetic and environmental factors responsible for the development of lung cancer in never-smokers. This article summarizes available data on the clinical epidemiology of lung cancer in never smokers, and the several environmental risk factors that population-based research has implicated in the etiology of these cancers. Primary factors closely tied to lung cancer in never smokers include exposure to known and suspected carcinogens including radon, second-hand tobacco smoke, and other indoor air pollutants. Several other exposures have been implicated. However, a large fraction of lung cancers occurring in never-smokers cannot be definitively associated with established environmental risk factors, highlighting the need for additional epidemiologic research in this area. PMID:19755391

  11. Genetic and environmental factors determining clinical outcomes and cost of warfarin therapy: a prospective study

    PubMed Central

    Jorgensen, Andrea L.; Al-Zubiedi, Sameh; Zhang, Jieying Eunice; Keniry, Andrew; Hanson, Anita; Hughes, Dyfrig A.; van Eker, Diane; Stevens, Lisa; Hawkins, Karen; Toh, Cheng H.; Kamali, Farhad; Daly, Ann K.; Fitzmaurice, David; Coffey, Alison; Williamson, Paula R.; Park, Brian Kevin; Deloukas, Panos; Pirmohamed, Munir

    2012-01-01

    Background In this prospective cohort study, we have undertaken a comprehensive evaluation of clinical parameters along with variation in 29 genes (including CYP2C9 and VKORC1) to identify factors determining interindividual variability in warfarin response. Methods Consecutive patients (n = 311) were followed up prospectively for 26 weeks. Several outcomes chosen to capture both warfarin efficacy and toxicity were assessed. Univariate and multiple regression analyses were undertaken to assess the combined effect of clinical and genetic factors. Results CYP2C9 was the most important gene determining initial anticoagulant control, whereas VKORC1 was more important for stable anticoagulation. Novel associations with some clinical outcomes were found with single nucleotide polymorphisms in the cytochrome 450 genes CYP2C18 and CYP2C19, which were independent of the associations observed with CYP2C9 and in genes encoding CYP3A5, protein S and clotting factor V, although the variability explained by these genes was small. On the basis of the results of microcosting, adverse events were shown to be a significant predictor of total cost. Conclusion Accurate prediction of warfarin dose requirement needs to take into account multiple genetic and environmental factors, the contributions of which vary in the induction and maintenance phases of treatment. PMID:19752777

  12. The prediction of output factors for spread-out proton Bragg peak fields in clinical practice.

    PubMed

    Kooy, Hanne M; Rosenthal, Stanley J; Engelsman, Martijn; Mazal, Alejandro; Slopsema, Roelf L; Paganetti, Harald; Flanz, Jacob B

    2005-12-21

    The reliable prediction of output factors for spread-out proton Bragg peak (SOBP) fields in clinical practice remained unrealized due to a lack of a consistent theoretical framework and the great number of variables introduced by the mechanical devices necessary for the production of such fields. These limitations necessitated an almost exclusive reliance on manual calibration for individual fields and empirical, ad hoc, models. We recently reported on a theoretical framework for the prediction of output factors for such fields. In this work, we describe the implementation of this framework in our clinical practice. In our practice, we use a treatment delivery nozzle that uses a limited, and constant, set of mechanical devices to produce SOBP fields over the full extent of clinical penetration depths, or ranges, and modulation widths. This use of a limited set of mechanical devices allows us to unfold the physical effects that affect the output factor. We describe these effects and their incorporation into the theoretical framework. We describe the calibration and protocol for SOBP fields, the effects of apertures and range-compensators and the use of output factors in the treatment planning process. PMID:16333159

  13. [The development of clinical reasoning skills and leadership: personal factors and organizational factors].

    PubMed

    Larue, Caroline; Dubois, Sylvie; Girard, Francine; Goudreau, Johanne; Dumont, Katia

    2013-03-01

    Continuing education of newly graduated nurses (NGN) depends on several factors related to the characteristics of skills to be developed, the target population and the organizational context. Few studies describe both how nurses develop their skills and how institutions promote this development. The objectives of this manuscript are to (1) describe the behaviors that the NGN use to develop their reasoning skills and leadership and (2) document the organizational elements that facilitate this development. Method. Individual interviews were conducted with nurses (n = 34) using a grid of semistructured interviews and two group interviews were conducted with nurses (n = 7) and managers (n = 19) in two teaching hospitals in eastern Canada. The results show that nurses develop mainly by reflecting on their professional practice in their workplace. However, the lack of time for reflection in the workspace is a considerable obstacle while managerial leadership is an important asset. PMID:23671988

  14. Clinical Factors and Viral Load Influencing Severity of Acute Hepatitis A

    PubMed Central

    Lee, Hyun Woong; Chang, Dong-Yeop; Moon, Hong Ju; Chang, Hye Young; Shin, Eui-Cheol; Lee, June Sung; Kim, Kyung-Ah; Kim, Hyung Joon

    2015-01-01

    Background and Aims Clinical manifestations of hepatitis A virus (HAV) infection vary from mild to fulminant hepatic failure (FHF) in adults. We investigated the relationship between laboratory findings, including viral load, and clinical outcomes in patients with acute hepatitis A (AHA) and evaluated predictive factors for severe acute hepatitis (s-AH). Methods We analyzed the clinical manifestations of AHA in 770 patients. Patients with a prothrombin time (PT) of less than 40% of normal were classified as s-AH and included 4 patients with FHF, 11 patients with acute renal failure, and 3 patients with prolonged jaundice (n = 128). Other patients were defined as mild acute hepatitis (m-AH) (n = 642). Serum samples were obtained from 48 patients with acute hepatitis A. Among them, 20 with s-AH, and 28 with m-AH, were tested for HAV RNA titer. Results In a multivariate analysis, age (HR = 1.042, P = 0.041), peak creatinine (HR = 4.014, P = 0.001), bilirubin (HR = 1.153, P = 0.003), alanine aminotransferase (ALT) (HR = 1.001, P<0.001), initial lactate dehydrogenase (LDH) (HR = 1.000, P = 0.045) and total cholesterol (HR = 0.978, P<0.001) were independent factors for s-AH. Serum HAV RNA was detected in 20/20 (100%) patients with s-AH and 22/28 (78.6%) patients with m-AH. In a multivariate analysis of the 48 patients who were tested for HAV RNA, peak ALT (HR = 1.001, P = 0.004) and HAV RNA titer (HR = 2.076, P = 0.012) were independent factors for s-AH. Conclusions Clinical factors including age, peak creatinine, bilirubin, ALT, initial LDH and total cholesterol were independent factors for s-AH in a multivariate analysis. In particular, HAV load strongly correlated with the severity of hepatitis A. PMID:26090677

  15. Effect of Interval to Definitive Breast Surgery on Clinical Presentation and Survival in Early-Stage Invasive Breast Cancer

    SciTech Connect

    Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.c [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Cherian, Anil [Department of Medical Oncology, London Regional Cancer Program, London, ON (Canada); Perera, Francisco; Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, ON (Canada); Hammond, A. [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada)

    2009-11-01

    Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and Materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.

  16. Clinical Significance of Conditions Presenting with ECG Changes Mimicking Acute Myocardial Infarction

    PubMed Central

    Yahalom, Malka; Roguin, Nathan; Suleiman, Khaled; Turgeman, Yoav

    2013-01-01

    The electrocardiogram (ECG) is the primary tool in the diagnosis of acute myocardial infarction (AMI). However, other clinical conditions, both cardiac and noncardiac originated pathologies, may result in ECG tracing of AMI. This may lead to an incorrect diagnosis, exposing the patients to unnecessary tests and potentially harmful therapeutic procedures. The aim of this report is to increase the still insufficient awareness of clinicians from multiple disciplines, regarding the different clinical syndromes, both cardiac and noncardiac, associated with ECG abnormalities mimicking AMI, to avoid unjustified thrombolytic therapy or intervention procedures. During a 9-year period, the data from six patients (five females, one male; mean age, 50 years [range, 18 to 78 years]) who were admitted to cardiac care unit (CCU) with transient ECG changes resembling AMI were recorded retrospectively. During this 9-year period, 5,400 patients were hospitalized in CCU: 1,350 patients were diagnosed as ST-elevation myocardial infarction (STEMI) and 4,050 patients were diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Only two out of six patients had chest pain with ECG changes criteria suspicious of AMI. STEMI was suspected in four out of six patients. All patients, but one, had normal left ventricular (LV) function. One patient had transient LV dysfunction. All patients, but one, with perimyocarditis, had normal serum cardiac markers. In four out of six patients, who underwent coronary arteries imaging during hospitalization (by angiography or by CT scan), normal coronary arteries were documented. Two patients who underwent ambulatory cardiac CT scan imaging after being discharged from hospital documented patent coronary arteries (case no. 3), or some insignificant irregularities (case no. 4). The discharge diagnoses from CCU were as follows: postictal syndrome, pericarditis, hypothermia, stress-induced (“tako-tsubo”) cardiomyopathy, anaphylactic reaction, and status of postchemotherapy. All patients experienced full recovery with normal ECG tracing. During the 5-year follow-up, all patients were alive, and cardiac morbidity was not reported. We conclude that both cardiac and noncardiac clinical syndromes may mimic AMI. Comprehensive clinical examination and profound medical history are crucial for making the correct diagnosis in conditions with ECG changes mimicking AMI. PMID:24436595

  17. Exuberant clinical presentation of probable Malassezia folliculitis in a young nonimmunosuppressed patient.

    PubMed

    Marques, Silvio Alencar; Silva, Sabrina Bortoletto Gomes da; Camargo, Rosangela Maria Pires de; Stolf, Hamilton Ometto; Marques, Mariangela Esther Alencar

    2012-01-01

    Malassezia folliculitis is an inflammatory disorder observed in both immunocompetent and immunosuppressed patients. The authors describe an unusual and exuberant presumed case affecting the face, trunk and upper limbs of a 12-year-old nonimmunosuppressed patient. Although the agent was not identified by culture, the clinical and histopathological aspects plus the response to specific treatment support the diagnosis of Malassezia folliculitis. The only possible predisponent cause observed on the patient was greasy skin. Repetitive cultures were negative. Treatment with itraconazol promoted apparent cure, however, the patient relapsed twelve months later. PMID:22714763

  18. Contribution of Gender to Pathophysiology and Clinical Presentation of IBS: Should Management Be Different in Women?

    Microsoft Academic Search

    Ann Ouyang; Helena F. Wrzos

    2006-01-01

    The irritable bowel syndrome (IBS) is found more commonly in women than men. It is more prevalent in patients with chronic fatigue syndrome, fibromyalgia, and chronic pelvic pain, all syndromes characterized by pain and found predominantly in women. This article reviews evidence for a role of biological sex factors and gender on the pathways mediating visceral pain. The effect of

  19. Influence of site of origin of lung carcinomas on clinical presentation and central nervous system metastases

    Microsoft Academic Search

    B E Tomlinson; R H Perry; E G Stewart-Wynne

    1979-01-01

    A retrospective survey of 100 patients dying from carcinoma of the lung showed that neurological presentation and central nervous system metastases are more frequently present when the primary carcinoma is situated in the peripheral lung tissue (including lung apex). The high incidence of cases presenting neurologically and the high incidence of single secondary deposits involving the central nervous system from

  20. Clinical and electrophysiological features in a French family presenting with seipinopathy.

    PubMed

    Ollivier, Yolaine; Magot, Armelle; Latour, Philippe; Perrier, Julie; Mercier, Sandra; Maisonobe, Thierry; Péréon, Yann

    2015-02-01

    Seipinopathies are a group of inherited diseases affecting upper and lower motor neurons due to mutations in the Berardinelli-Seip congenital lipodystrophy 2 gene (BSCL2). We report a French family carrying the N88S mutation in the BSCL2 gene. A 12-yr-old girl complained of bilateral asymmetrical pes cavus with right hand motor deficit and amyotrophy, asymmetrical leg amyotrophy and pyramidal signs. Electrophysiological examination showed axonal asymmetrical motor neuropathy with distal predominance. Her father complained of right hand rest tremor with bilateral hand weakness. Physical examination revealed left leg, hand and forearm amyotrophy, akinesia and right arm rigidity, brisk reflexes in the lower limbs and bilateral Babinski sign. Nerve conduction studies showed distal asymmetrical axonal neuropathy with slight sensitive impairment with moderate decrease of nerve conduction velocity in some nerves. DNA sequencing revealed the presence of the known N88S mutation in the BSCL2 gene (dideoxy-nucleotide method on a 3730 DNA Analyzer, Life Technologies). BSCL2 gene mutations are associated with a wide spectrum of clinical and electrophysiological phenotypes and should be suspected in cases of distal hereditary motor neuropathy with pyramidal signs or early hand involvement. There may also be associated mild demyelination which may vary in severity within the same family. Clinical diagnosis was more difficult in this particular case due to the association with Parkinson symptoms. PMID:25454168

  1. Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology

    Microsoft Academic Search

    Jody Stähelin-Massik; Mihael Podvinec; Jens Jakscha; Othmar N. Rüst; Johannes Greisser; Michael Moschopulos; Hanspeter E. Gnehm

    2008-01-01

    The aim of this study was to obtain comprehensive data on clinical presentation, microbiology, computed tomography, surgical\\u000a findings and histology in acute, sub-acute and chronic mastoiditis. We performed a prospective, observational study in children\\u000a under 16 years of age presenting to our institution during the 2-year period beginning in April 2000. The children were examined\\u000a and their condition treated in accordance

  2. Clinical presentation and outcome of mesenteric vein thrombosis: a single-center experience.

    PubMed

    Al-Thani, Hassan; El-Mabrok, Jamela; El-Menyar, Ayman; Al-Sulaiti, Marym; Tabeb, Abdel Hakem; Hajaji, Khairi; Elgohary, Hesham; Asim, Mohammad; Latifi, Rifat

    2015-03-01

    Mesenteric venous thrombosis (MVT) is an uncommon event. We retrospectively analyzed data for patients who were admitted with MVT between June 2005 and May 2012 in Qatar. The study included 35 patients with a mean age of 45 ± 11 years. The risk of MVT was significantly high among males who smoked and females of Arab ethnicity. The main manifestations of MVT were abdominal distension and vomiting. The major etiological factors included deficiency in protein C and S, homocysteinemia, and prior abdominal surgery. Computed tomography (CT) findings were helpful in 80% of the patients. Bowel resection with primary anastomosis was performed in 25 (71%) patients. The overall mortality rate was 17%. High index of suspicion, detection of risk factors, CT imaging, and timely intervention are essential for better prognosis. PMID:24755695

  3. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders.

    PubMed

    Taylor, Jenny C; Martin, Hilary C; Lise, Stefano; Broxholme, John; Cazier, Jean-Baptiste; Rimmer, Andy; Kanapin, Alexander; Lunter, Gerton; Fiddy, Simon; Allan, Chris; Aricescu, A Radu; Attar, Moustafa; Babbs, Christian; Becq, Jennifer; Beeson, David; Bento, Celeste; Bignell, Patricia; Blair, Edward; Buckle, Veronica J; Bull, Katherine; Cais, Ondrej; Cario, Holger; Chapel, Helen; Copley, Richard R; Cornall, Richard; Craft, Jude; Dahan, Karin; Davenport, Emma E; Dendrou, Calliope; Devuyst, Olivier; Fenwick, Aimée L; Flint, Jonathan; Fugger, Lars; Gilbert, Rodney D; Goriely, Anne; Green, Angie; Greger, Ingo H; Grocock, Russell; Gruszczyk, Anja V; Hastings, Robert; Hatton, Edouard; Higgs, Doug; Hill, Adrian; Holmes, Chris; Howard, Malcolm; Hughes, Linda; Humburg, Peter; Johnson, David; Karpe, Fredrik; Kingsbury, Zoya; Kini, Usha; Knight, Julian C; Krohn, Jonathan; Lamble, Sarah; Langman, Craig; Lonie, Lorne; Luck, Joshua; McCarthy, Davis; McGowan, Simon J; McMullin, Mary Frances; Miller, Kerry A; Murray, Lisa; Németh, Andrea H; Nesbit, M Andrew; Nutt, David; Ormondroyd, Elizabeth; Oturai, Annette Bang; Pagnamenta, Alistair; Patel, Smita Y; Percy, Melanie; Petousi, Nayia; Piazza, Paolo; Piret, Sian E; Polanco-Echeverry, Guadalupe; Popitsch, Niko; Powrie, Fiona; Pugh, Chris; Quek, Lynn; Robbins, Peter A; Robson, Kathryn; Russo, Alexandra; Sahgal, Natasha; van Schouwenburg, Pauline A; Schuh, Anna; Silverman, Earl; Simmons, Alison; Sørensen, Per Soelberg; Sweeney, Elizabeth; Taylor, John; Thakker, Rajesh V; Tomlinson, Ian; Trebes, Amy; Twigg, Stephen R F; Uhlig, Holm H; Vyas, Paresh; Vyse, Tim; Wall, Steven A; Watkins, Hugh; Whyte, Michael P; Witty, Lorna; Wright, Ben; Yau, Chris; Buck, David; Humphray, Sean; Ratcliffe, Peter J; Bell, John I; Wilkie, Andrew O M; Bentley, David; Donnelly, Peter; McVean, Gilean

    2015-07-01

    To assess factors influencing the success of whole-genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases or families across a broad spectrum of disorders in whom previous screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritization. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission above biological plausibility contributed to accuracy. Overall, we identified disease-causing variants in 21% of cases, with the proportion increasing to 34% (23/68) for mendelian disorders and 57% (8/14) in family trios. We also discovered 32 potentially clinically actionable variants in 18 genes unrelated to the referral disorder, although only 4 were ultimately considered reportable. Our results demonstrate the value of genome sequencing for routine clinical diagnosis but also highlight many outstanding challenges. PMID:25985138

  4. Clinical picture, outcome and predictive factors of lymphoma in Sj?gren syndrome.

    PubMed

    Papageorgiou, Aristea; Voulgarelis, Michael; Tzioufas, Athanasios G

    2015-07-01

    The intrinsic and complex nature of primary Sj?gren's syndrome (pSS) makes it difficult to identify risk factors that can predict the development and outcome of non-Hodgkin's lymphoma (NHL), yet patients at high risk for such complication seem to bear certain clinic-serological characteristics that render them a unique profile. In the last decade, research focusing on B-cell hyperactivity as the hallmark of pSS-related lymphoproliferation has shed light on certain biological and molecular factors that participate in disease evolution and lymphoma development, thus indicating possible predictors of lymphoma development and outcome. In this review, we explore all the available data concerning the clinical picture, risk prognostication and outcome of pSS-associated NHLs. PMID:25808075

  5. Effect of Obesity and Clinical Factors on Pre-Incision Time: Study of Operating Room Workflow

    PubMed Central

    Hosseini, Narges; Hallbeck, M. Susan; Jankowski, Christopher J.; Huddleston, Jeanne M.; Kanwar, Amrit; Pasupathy, Kalyan S.

    2014-01-01

    As the obese population is increasing rapidly worldwide, there is more interest to study the different aspects of obesity and its impact especially on healthcare outcomes and health related issues. Targeting non-surgical times in the operating room (OR), this study focuses on the effect of obesity along with clinical factors on pre-incision times in OR. Specifically, both the individual and combined effect of clinical factors with obesity on pre-incision times is studied. Results show that with the confidence of 95%, pre-incision time in the OR of obese patients is significantly higher than those for non-obese patients by approximately five percent. Findings also show that more complex cases do not exhibit significant differences between these patient subgroups. PMID:25954375

  6. Active duty military personnel presenting for care at a Gay Men's Health Clinic.

    PubMed

    Smith, Davey M

    2008-01-01

    Under the "Don't Ask, Don't Tell, Don't Pursue, Don't Harass" Department of Defense policy, gay men and women are allowed to serve in the military, but they are not allowed to disclose their sexual orientation. This study was performed to determine the incidence of active duty military personnel seeking care at a Gay Men's Health Clinic. Nine percent of the clients, who had served between June and August 2002, were active duty U.S. Navy sailors. They all expressed fears of being discharged from the military when asked why they did not access military healthcare. The "DADTDPDH" policy breeds distrust between men who have sex with men (MSM) service-members and their healthcare provider and this ensures inadequate healthcare. PMID:18825864

  7. "Addicted to Euphoria": The History, Clinical Presentation, and Management of Party Drug Misuse.

    PubMed

    Bearn, Jenny; O'Brien, Matthew

    2015-01-01

    Eating, drinking, sexual activity, and parenting invoke pleasure, an emotion that promotes repetition of these behaviors, are essential for survival. Euphoria, a feeling or state of intense excitement and happiness, is an amplification of pleasure, aspired to one's essential biological needs that are satisfied. People use party drugs as a shortcut to euphoria. Ecstasy (3,4-methylenedioxymethamphetamine), ?-hydroxybutyric acid, and ketamine fall under the umbrella of the term "party drugs," each with differing neuropharmacological and physiological actions. This chapter seeks to survey the history and epidemiology of party drug use; we will then discuss the pharmacological characteristics of each drug to provide a platform for understanding the difficulties that party drug users encounter through intoxication, harmful use, dependence, and withdrawal and how these should be clinically managed. PMID:26070759

  8. Intimate Partner and General Aggression Perpetration among Combat Veterans Presenting to a Posttraumatic Stress Disorder Clinic

    PubMed Central

    Taft, Casey T.; Weatherill, Robin P.; Woodward, Halley E.; Pinto, Lavinia A.; Watkins, Laura E.; Miller, Mark W.; Dekel, Rachel

    2013-01-01

    This study examined rates and correlates of intimate partner and general aggression perpetration among 236 male combat veterans seeking services in a VA PTSD clinic. Approximately 33% of those in an intimate relationship reported perpetrating partner physical aggression in the previous year, and 91% reported partner psychological aggression. Comparable rates were found for general aggression perpetration among partnered and non-partnered veterans. PTSD symptoms as well as symptoms of depression were associated with aggression across subgroups and forms of aggression, and PTSD symptoms reflecting arousal and lack of control were generally the strongest predictor of aggression. Findings indicate a need for additional aggression screening and intervention development for this population, and highlight the targeting of heightened arousal and lack of behavioral control in aggression interventions. PMID:20099937

  9. Non-syndromic congenital hypogonadotropic hypogonadism: clinical presentation and genotype-phenotype relationships.

    PubMed

    Brioude, Frédéric; Bouligand, Jérôme; Trabado, Séverine; Francou, Bruno; Salenave, Sylvie; Kamenicky, Peter; Brailly-Tabard, Sylvie; Chanson, Philippe; Guiochon-Mantel, Anne; Young, Jacques

    2010-05-01

    Congenital hypogonadotropic hypogonadism (CHH) results from abnormal gonadotropin secretion, and it is characterized by impaired pubertal development. CHH is caused by defective GNRH release, or by a gonadotrope cell dysfunction in the pituitary. Identification of genetic abnormalities related to CHH has provided major insights into the pathways critical for the development, maturation, and function of the reproductive axis. Mutations in five genes have been found specifically in Kallmann's syndrome, a disorder in which CHH is related to abnormal GNRH neuron ontogenesis and is associated with anosmia or hyposmia. In combined pituitary hormone deficiency or in complex syndromic CHH in which gonadotropin deficiency is either incidental or only one aspect of a more complex endocrine disorder or a non-endocrine disorder, other mutations affecting GNRH and/or gonadotropin secretion have been reported. Often, the CHH phenotype is tightly linked to an isolated deficiency of gonadotropin secretion. These patients, who have no associated signs or hormone deficiencies independent of the deficiency in gonadotropin and sex steroids, have isolated CHH. In some familial cases, they are due to genetic alterations affecting GNRH secretion (mutations in GNRH1, GPR54/KISS1R and TAC3 and TACR3) or the GNRH sensitivity of the gonadotropic cells (GNRHR). A minority of patients with Kallmann's syndrome or a syndromic form of CHH may also appear to have isolated CHH, but close clinical, familial, and genetic studies can reorient the diagnosis, which is important for genetic counseling in the context of assisted reproductive medicine. This review focuses on published cases of isolated CHH, its clinical and endocrine features, genetic causes, and genotype-phenotype relationships. PMID:20207726

  10. Ataxia-telangiectasia-like disorder (ATLD)-its clinical presentation and molecular basis.

    PubMed

    Taylor, A M R; Groom, A; Byrd, P J

    2004-01-01

    Comparison of the clinical and cellular phenotypes of different genomic instability syndromes provides new insights into functional links in the complex network of the DNA damage response. A prominent example of this principle is provided by examination of three such disorders: ataxia-telangiectasia (A-T) caused by lack or inactivation of the ATM protein kinase, which mobilises the cellular response to double strand breaks in the DNA; ataxia-telangiectasia-like disease (ATLD), a result of deficiency of the human Mre11 protein; and the Nijmegen breakage syndrome (NBS), which represents defective Nbs1 protein. Mre11 and Nbs1 are members of the Mre11/Rad50/Nbs1 (MRN) protein complex. MRN and its individual components are involved in different responses to cellular damage induced by ionising radiation and radiomimetic chemicals, including complexing with chromatin and with other damage response proteins, formation of radiation-induced foci, and the induction of different cell cycle checkpoints. The phosphorylation of Nbs1 by ATM would indicate that ATM acts upstream of the MRN complex. Consistent with this were the suggestions that ATM could be activated in the absence of fully functional Nbs1 protein. In contrast, the regulation of some ATM target proteins, e.g. Smc1 requires the MRN complex as well as ATM. Nbs1 may, therefore, be both a substrate for ATM and a mediator of ATM function. Recent studies that indicate a requirement of the MRN complex for proper ATM activation suggest that the relationship between ATM and the MRN complex in the DNA damage response is yet to be fully determined. Despite the fact that both Mre11 and Nbs1 are part of the same MRN complex, deficiency in either protein in humans does not lead to the same clinical picture. This suggests that components of the complex may also act separately. PMID:15279810

  11. Reward-Related Decision Making in Older Adults: Relationship to Clinical Presentation of Depression

    PubMed Central

    McGovern, Amanda R.; Alexopoulos, George S.; Yuen, Genevieve S.; Morimoto, Sarah Shizuko; Gunning, Faith M.

    2015-01-01

    Objective Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: 1. To use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression. 2. To examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to elderly, healthy subjects, depressed, elderly patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. Methods We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, elderly patients with non-psychotic major depression and 36 elderly, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy whereas 42 participants did not have apathy. Results Older adults with depression and healthy comparison participants did not differ in their performance on the IGT. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared to non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. Conclusions This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals. PMID:25306937

  12. Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response

    Microsoft Academic Search

    K Gaffney; J Ledingham; J D Perry

    1995-01-01

    OBJECTIVE--To assess the efficacy of a single intra-articular injection of triamcinolone hexacetonide (THA) in knee osteoarthritis (OA) and examine factors which may relate to treatment efficacy. METHODS--Eighty four patients with clinical and radiographic evidence of knee OA were recruited and randomly allocated to receive either THA (20 mg in 1 ml) or placebo (0.9% normal saline, 1 ml). Follow up

  13. Clinical Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of the Novel Factor Xa Inhibitor Edoxaban in Healthy Volunteers

    Microsoft Academic Search

    Koichiro Ogata; Jeanne Mendell-Harary; Masaya Tachibana; Hiroshi Masumoto; Toshihiro Oguma; Masazumi Kojima; Satoshi Kunitada

    2010-01-01

    This is a clinical safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) study of a single ascending dose (SAD) and a multiple ascending dose (MAD) of the oral direct factor Xa inhibitor edoxaban in healthy males. The placebo-controlled, single-blind, randomized, 2-part study consists of a SAD arm with 85 subjects (10, 30, 60, 90, 120, 150 mg) and a MAD arm

  14. Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

    Microsoft Academic Search

    L Brabin; S A Roberts; E Fairbrother; D Mandal; S P Higgins; S Chandiok; P Wood; G Barnard; H C Kitchener

    2005-01-01

    Objectives: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics.Methods: In a cross sectional study adolescents within 5 years of menarche, ?17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were

  15. The Many Faces of Celiac Disease: Clinical Presentation of Celiac Disease in the Adult Population

    Microsoft Academic Search

    PETER H. R. GREEN

    2005-01-01

    The major modes of presentation of patients with celiac disease are the classic diarrhea-predominant form and silent celiac disease. Those with silent celiac disease lack diarrhea, although they may present with manifestations of celiac disease that include an irritable bowel syndrome, anemia, osteoporosis, neurologic diseases, or malignancy. A significant proportion of patients are diagnosed through screening at-risk groups including relatives

  16. Clinical presentation as a guide to the identification of GERD in children

    Microsoft Academic Search

    M. M. Carr; A. Nguyen; M. Nagy; C. Poje; M. Pizzuto; L. Brodsky

    2000-01-01

    Objective: to determine if there is a correlation between common otolaryngologic symptoms and presence of gastroesophageal reflux disease (GERD) in children. Methods: charts of 295 children presenting with suspicion of GERD were reviewed for presenting symptoms including: (1) airway symptoms: stertor, stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, blue spells, hoarseness, throat clearing; (2) feeding symptoms: wet

  17. Cerebral neuroschistosomiasis: a rare clinical presentation and review of the literature

    PubMed Central

    Llenas-García, Jara; Guerra-Vales, Juan-Manuel; Alcalá-Galiano, Andrea; Domínguez, Cristina; Pérez-Nuñez, Angel; Lizasoaín, Manuel; Díaz-Pedroche, Carmen; Montes, Santiago; Martínez, Josefina; Sierra, Fernando; Salto, Efren

    2009-01-01

    The symptomatic presentation of cerebral schistosomiasis is uncommon. The case of a 25-year-old woman from Equatorial Guinea with headache and seizures secondary to cerebral neuroschistosomiasis, as confirmed by histopathological examination and microbiological study, is presented. A review of the literature on this subject is also provided. PMID:21852999

  18. Cerebral neuroschistosomiasis: a rare clinical presentation and review of the literature.

    PubMed

    Llenas-García, Jara; Guerra-Vales, Juan-Manuel; Alcalá-Galiano, Andrea; Domínguez, Cristina; Pérez-Nuñez, Angel; Lizasoaín, Manuel; Díaz-Pedroche, Carmen; Montes, Santiago; Martínez, Josefina; Sierra, Fernando; Salto, Efren

    2009-01-01

    The symptomatic presentation of cerebral schistosomiasis is uncommon. The case of a 25-year-old woman from Equatorial Guinea with headache and seizures secondary to cerebral neuroschistosomiasis, as confirmed by histopathological examination and microbiological study, is presented. A review of the literature on this subject is also provided. PMID:21852999

  19. Clinical and Genetic Characteristics of Mexican Patients with Juvenile Presentation of Niemann-Pick Type C Disease

    PubMed Central

    Piña-Aguilar, Raul E.; Vera-Loaiza, Aurea; Chacón-Camacho, Oscar F.; Zenteno, Juan Carlos; Nuñez-Orozco, Lilia; Santillán-Hernández, Yuritzi

    2014-01-01

    Niemann-Pick type C disease (NPC) is a rare lysosomal disease with a protean presentation, ranging from a fatal neonatal course with visceromegaly to an adult presentation with only neurological or psychiatric symptomatology. In this report we describe the genetic and clinical characteristics of 3 Mexican patients from different families with juvenile presentation of NPC. Clinical examination, imaging of central nervous and gastrointestinal system, and EEG were performed. Genetic studies include sequencing and deletion/duplication analysis of NPC1 and NPC2 genes. All patients presented with cognitive impairment, ataxia, and supranuclear vertical gaze palsy; one case had gelastic cataplexy. Also they developed epilepsy and cortical atrophy and two patients had thinning of corpus callosum. The 3 patients were compound heterozygotes for NPC1 sequence variants, including 5 missense and 1 nonsense mutations: p.P1007A and p.F1087L in Case 1; p.Q921P and p.G992R in Case 2; and p.R348? and p.V1165M in case 3. Mexican patients with juvenile NPC presented with a variable clinical phenotype and compound heterozygosity. This suggests a relative high frequency of mutation carriers as it is reported for European population. Consequently, clinicians should consider NPC as a diagnosis possibility in any adolescent or young adult patient with juvenile dementia and/or ataxia, even in absence of gelastic cataplexy and supranuclear vertical gaze palsy. PMID:25349751

  20. Causative anti-diabetic drugs and the underlying clinical factors for hypoglycemia in patients with diabetes

    PubMed Central

    Yanai, Hidekatsu; Adachi, Hiroki; Katsuyama, Hisayuki; Moriyama, Sumie; Hamasaki, Hidetaka; Sako, Akahito

    2015-01-01

    Recent clinical trials indicated that the intensive glycemic control do not reduce cardiovascular disease mortality among diabetic patients, challenging a significance of the strict glycemic control in diabetes management. Furthermore, retrospective analysis of the Action to Control Cardiovascular Risk in Diabetes study demonstrated a significant association between hypoglycemia and mortality. Here, we systematically reviewed the drug-induced hypoglycemia, and also the underlying clinical factors for hypoglycemia in patients with diabetes. The sulfonylurea use is significantly associated with severe hypoglycemia in patients with type 2 diabetes. The use of biguanide (approximately 45%-76%) and thiazolidinediones (approximately 15%-34%) are also highly associated with the development of severe hypoglycemia. In patients treated with insulin, the intensified insulin therapy is more frequently associated with severe hypoglycemia than the conventional insulin therapy and continuous subcutaneous insulin infusion. Among the underlying clinical factors for development of severe hypoglycemia, low socioeconomic status, aging, longer duration of diabetes, high HbA1c and low body mass index, comorbidities are precipitating factors for severe hypoglycemia. Poor cognitive and mental functions are also associated with severe hypoglycemia. PMID:25685276

  1. Clinical presentation, etiology, and survival in adult acute encephalitis syndrome in rural Central India

    PubMed Central

    Joshi, Rajnish; Mishra, Pradyumna Kumar; Joshi, Deepti; Santhosh, SR; Parida, M.M.; Desikan, Prabha; Gangane, Nitin; Kalantri, S.P.; Reingold, Arthur; Colford, John M.

    2013-01-01

    Background Acute encephalitis syndrome (AES) is a constellation of symptoms that includes fever and altered mental status. Most cases are attributed to viral encephalitis (VE), occurring either in outbreaks or sporadically. We conducted hospital-based surveillance for sporadic adult-AES in rural Central India in order to describe its incidence, spatial and temporal distribution, clinical profile, etiology and predictors of mortality. Methods All consecutive hospital admissions during the study period were screened to identify adult-AES cases and were followed until 30-days of hospitalization. We estimated incidence by administrative sub-division of residence and described the temporal distribution of cases. We performed viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. The diagnostic tests included RT-PCR (for enteroviruses, HSV 1 and 2), conventional PCR (for flaviviruses), CSF IgM capture ELISA (for Japanese encephalitis virus, dengue, West Nile virus, Varicella zoster virus, measles, and mumps). We compared demographic and clinical variables across etiologic subtypes and estimated predictors of 30-day mortality. Results A total of 183 AES cases were identified between January and October 2007, representing 2.38% of all admissions. The incidence of adult AES in the administrative subdivisions closest to the hospital was 16 per 100,000. Of the 183 cases, a non-viral etiology was confirmed in 31 (16.9%) and the remaining 152 were considered as VE suspects. Of the VE suspects, we could confirm a viral etiology in 31 cases: 17 (11.2%) enterovirus; 8 (5.2%) flavivirus; 3 (1.9%) Varicella zoster; 1 (0.6%) herpesvirus; and 2 (1.3%) mixed etiology); the etiology remained unknown in remaining 121 (79.6%) cases. 53 (36%) of the AES patients died; the case fatality proportion was similar in patients with a confirmed and unknown viral etiology (45.1 and 33.6% respectively). A requirement for assisted ventilation significantly increased mortality (HR 2.14 (95% CI 1.0–4.77)), while a high Glasgow coma score (HR 0.76 (95% CI 0.69–0.83)), and longer duration of hospitalization (HR 0.88 (95% CI 0.83–0.94)) were protective. Conclusion This study is the first description of the etiology of adult-AES in India, and provides a framework for future surveillance programs in India. PMID:23643180

  2. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain

    Microsoft Academic Search

    John G. Canto; Michael G. Shlipak; William J. Rogers; Judith A. Malmgren; Paul D. Frederick; Costas T. Lambrew; Joseph P. Ornato; Hal V. Barron; Catarina I. Kiefe

    2000-01-01

    CONTEXT: Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown.\\u000aOBJECTIVES: To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome.\\u000aDESIGN: Prospective

  3. Stromal prostatic sarcoma: a rare tumor with rare clinical and imaging presentation

    PubMed Central

    Rojas-Jiménez, Anamaría; Otero-Garcia, Milagros; Mateos-Martin, Alejandro

    2013-01-01

    Adult prostatic stromal sarcoma is a rare malignant tumor. The main presenting symptom is urinary retention secondary to bladder outlet obstruction. Prostatic Specific Antigen level can be normal. Imaging features show a prostate mass with or without pelvic organ invasion depending on the aggressiveness of the tumor. We present a patient with prostatic stromal sarcoma who debuted with urinary obstruction, leukocytosis and neutrophilia, prostate enlargement, and hypodense prostate areas on CT images, simulating prostatitis with abscess formation. PMID:24421945

  4. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.

    PubMed

    Pasquel, Francisco J; Umpierrez, Guillermo E

    2014-11-01

    The hyperosmolar hyperglycemic state (HHS) is the most serious acute hyperglycemic emergency in patients with type 2 diabetes. von Frerichs and Dreschfeld described the first cases of HHS in the 1880s in patients with an "unusual diabetic coma" characterized by severe hyperglycemia and glycosuria in the absence of Kussmaul breathing, with a fruity breath odor or positive acetone test in the urine. Current diagnostic HHS criteria include a plasma glucose level >600 mg/dL and increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis. The incidence of HHS is estimated to be <1% of hospital admissions of patients with diabetes. The reported mortality is between 10 and 20%, which is about 10 times higher than the mortality rate in patients with diabetic ketoacidosis (DKA). Despite the severity of this condition, no prospective, randomized studies have determined best treatment strategies in patients with HHS, and its management has largely been extrapolated from studies of patients with DKA. There are many unresolved questions that need to be addressed in prospective clinical trials regarding the pathogenesis and treatment of pediatric and adult patients with HHS. PMID:25342831

  5. Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections.

    PubMed

    Crump, John A; Sjölund-Karlsson, Maria; Gordon, Melita A; Parry, Christopher M

    2015-10-01

    Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica, initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015. PMID:26180063

  6. Clinical and research measurement techniques of the pulmonary circulation: the present and the future.

    PubMed

    Naeije, Robert; D'Alto, Michele; Forfia, Paul R

    2015-01-01

    There has been a lot of progress in measurement techniques of the pulmonary circulation in recent years, and this has required updating of basic physiological knowledge. Pulmonary artery pressures (PAP) are normally low and dependent on left atrial pressure (LAP) and cardiac output (CO). Therefore, defining the functional state of the pulmonary circulation for the detection of pulmonary vascular disease or evaluation of disease progression requires measurements of PAP, LAP and CO. Invasive measurements have lately improved by a better definition of zero leveling and of the effects of intrathoracic pressure changes, and understanding of the inherent limitations of fluid-filled thermodilution catheters. The effects of LAP and pulmonary flow on PAP in health and disease are now integrated in the hemodynamic diagnosis of pulmonary hypertension. Development of alternative noninvasive approaches is critically dependent on their potential to quantify pulmonary vascular pressures and CO. Doppler echocardiography and magnetic resonance imaging are coming close. Both approaches are performant for flow measurements, but pressures remain indirectly assessed from flow velocities and/or structural changes. Doppler echocardiography or magnetic resonance imaging has been shown to be accurate, allowing for valid population studies, but with insufficient precision for single number-derived clinical decision making. PMID:25534670

  7. Clinical application of Electrical Impedance Tomography in the Present Health Scenario of India

    NASA Astrophysics Data System (ADS)

    Chakraborti, K. L., Dr; Selvamurthy, W., Dr

    2010-04-01

    Early detection of Breast Cancer is currently emerging as a big clinical entity requiring a non invasive, radiation less, harmless, cost effective diagnostic technique. Survival is improved if detected early. Breast Cancer is the second most common cancer in India. Health corporate system of India is urgently requiring a cost effective, noninvasive novel technique like "Electrical Impedance Tomography (EIT)" for screening large poor rural population of India for early diagnosis of Breast Cancer. EIT is the technique to visualize spatial distribution of Electro-impedance (or conductivity) inside the object, such as human body. A medical device which allows imaging of the distribution of conductivity in 3D in regions below the skin surface has been developed and tested. Its purpose is to enable early detection and preliminary diagnosis of breast tumors. The system uses a planar array consisting of 256 electrodes and enables obtaining images of the three-dimensional conductivity distribution in regions below the skin's surface up to several centimeters deep. The developed measuring system and image reconstruction algorithm can be used for breast tissue imaging and diagnostic, in particular for malignant tumor detection. Initially ten patients as control and ten patients with breast lesions have been studied with this new technique. It was found that electrical impedance mammograms from different groups has clear visual distinctions and statistically significant difference in breast glands conductivity. The results are quiet encouraging. EIT may emerge as the first line noninvasive imaging method of choice for screening large population for early detection of breast cancer.

  8. Factors Influencing Long-Term Follow-Up Clinic Attendance Among Survivors of Childhood Cancer

    PubMed Central

    Klosky, James L.; Cash, Darlene K.; Buscemi, Joanna; Lensing, Shelly; Garces-Webb, Danette M.; Zhao, Wenyan; Wiard, Sally; Hudson, Melissa M.

    2009-01-01

    Introduction Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the demographic, medical, and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer. Methods Adherence to clinic attendance was monitored among 941 long-term childhood cancer survivors scheduled for evaluation at our institution. Patients were classified as “attenders” or “non-attenders” based on the outcome of their first scheduled clinic appointment over a one year period. Social work staff contacted non-attenders by telephone to determine reasons for missed appointments. Results Nearly 15% of survivors were classified as non-attenders. Univariate findings revealed that older age, lower SES, being non-white, less medically insured, traveling by car, living shorter distance from clinic, having a scheduled social work consultation, and entering or exiting survivorship clinic were associated with clinic non-attendance (all p values <.05). The final multivariate model indicated that non-whites (OR=1.88, 95% CI=1.19–2.97), patients without insurance (OR=2.36,95% CI=1.98 – 3.79), those traveling by car (OR=12.74, 95% CI=3.97 – 40.86), and those who have not experienced secondary cancer events (OR=1.76, 95% CI=0.94–3.28) were more likely to be non-attenders. Work or school conflicts were the primary reasons cited for missed appointments. Discussion/Conclusions Despite mechanisms designed to reduce financial burdens associated with attending survivorship clinic at our institution, demographic, medical, and logistic barriers exist which impact participation in long-term follow-up. Implications for Cancer Survivors and Providers These results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic nonattendance, particularly among underserved populations. PMID:18787958

  9. Poor-prognosis estrogen receptor- positive disease: present and future clinical solutions

    PubMed Central

    2012-01-01

    Use of chemotherapy for patients with estrogen receptor (ER)-positive breast cancer has been a conflicting issue. Recent studies have identified predictive markers allowing identification of poor-prognosis ER-positive breast cancers in need of more aggressive therapy. In general, tumours belonging to the so-called luminal B class, tumours expressing a high Ki67, human epidermal growth factor receptor 2 (HER-2) overexpression or a high score on the Oncotype DX gene expression profile reveal a poor prognosis compared with ER-rich tumours of the luminal A class. In contrast, recent studies have shown these tumours, contrasting tumours of the luminal A class, to benefit from more aggressive anthracycline-containing chemotherapy including a taxane. In the case of metastatic disease, patients with HER-2-positive, ER-positive tumours may benefit from having endocrine therapy and an anti-HER-2 agent administered in combination. PMID:22590486

  10. Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer

    Microsoft Academic Search

    Patrick Kupelian; Jerald Katcher; Howard Levin; Craig Zippe; Eric Klein

    1996-01-01

    ObjectivesTo better identify factors affecting prostate-specific antigen (PSA) level elevation after radical prostatectomy alone in men with clinical Stage T1–2 prostate cancer, we have reviewed our experience in the PSA era with 337 cases. The identification of these factors permits better understanding of the impact of case selection on treatment outcome in prostate cancer.

  11. Clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma

    PubMed Central

    Jia, Bo; Shi, Yuankai; Dong, Mei; Feng, Fengyi; Yang, Sheng; Lin, Hua; Zhou, Liqiang; Zhou, Shengyu; Chen, Shanshan; Yang, Jianliang; Liu, Peng; Qin, Yan; Zhang, Changgong; Gui, Lin; Wang, Lin; Wang, Xue

    2014-01-01

    Objective To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma (DLBCL). Methods A retrospective study of 37 patients with primary testicular DLBCL was carried out from November 2003 to May 2012. Their clinical features, survival and prognostic factors were analyzed. Results During a median follow-up period of 39.8 months (5.4-93.0 months), the median progression-free survival (PFS) was 26.2 months (95% CI: 0-65 months) and the 3-year overall survival (OS) rate was 78.4%. Within the whole cohort, the factors significantly associated with a superior PFS were limited stage (stage I/II), lactate dehydrogenase (LDH) ?245 U/L, international prognostic index (IPI) ?1, primary tumor diameter <7.5 cm, and patients who had complete response (CR) and received doxorubicin-contained chemotherapy (P<0.05). There was a trend toward superior outcome for patients who received combined therapy (surgery/chemotherapy/radiotherapy) (P=0.055). Patients who had CR, primary tumor diameter <7.5 cm and IPI score ?1 were significantly associated with longer PFS at multivariate analysis. Conclusions Primary testicular DLBCL had poorer survival. CR, primary tumor diameter and IPI were independent prognostic factors. The combined therapy of orchectomy, doxorubicin-contained chemotherapy and contralateral testicular radiotherapy (RT) seemed to improve survival. PMID:25232220

  12. Oral malignant melanoma: A case report of an unusual clinical and histologic presentation.

    PubMed

    Belgaumi, Uzma Iqbal; Shetty, Pushparaja; Shirlal, Shilpa

    2013-05-01

    Malignant melanoma is a potentially aggressive tumor of melanocytic origin. Primary oral malignant melanoma is a rare neoplasm, accounting for 0.5% of all oral malignancies. The present case occurred in a 60-year-old female patient, as a pedunculated growth involving the palate and alveolar ridge and histologically showing a desmoplastic differentiation. The article discusses the distinct clinico-pathologic presentation of this case and emphasizes on the need to identify and report such cases for further understanding of their biologic behavior. PMID:24019813

  13. Ectopic pinealoma: an unusual clinical presentation and a histochemical comparison with a seminoma of the testis

    PubMed Central

    Beeley, J. M.; Daly, J. J.; Timperley, W. R.; Warner, J.

    1973-01-01

    A patient with ectopic pinealoma first presented with apparent anorexia nervosa and hypernatraemic coma. A history of diabetes insipidus two months previously was not known on admission to hospital. The diabetes insipidus was unmasked by the administration of steroids. Neuroendocrinal and neuropathological aspects of the case are discussed with reference to the march of symptoms due to the growth of the tumour. Histochemical evidence is presented supporting the similarity between ectopic pinealoma and seminoma which suggests that they may more properly be referred to as atypical teratomas. Images PMID:4356733

  14. Incidence and predictive factors for malignancies in 136 Japanese patients with dermatomyositis, polymyositis and clinically amyopathic dermatomyositis.

    PubMed

    Azuma, Kohei; Yamada, Hidehiro; Ohkubo, Michiko; Yamasaki, Yoshioki; Yamasaki, Masaomi; Mizushima, Machiko; Ozaki, Shoichi

    2011-04-01

    The aim of this study was to define the standardized incidence ratio (SIR) of malignancy and the potential risk factors of concomitant malignancies in patients with inflammatory myopathies, including clinically amyopathic dermatomyositis (CADM). A total of 145 patients diagnosed with either dermatomyositis/polymyositis (DM/PM) or CADM at our institute between 1984 and 2002 were enrolled in the study. The demographic, clinical and laboratory features of the patients at the time of DM/PM or CADM diagnosis were compared between patients with and without malignancies, respectively. Multivariate analysis by logistic regression was used to determine the independent risk factors for the development of malignancies in DM/PM patients. Malignancy was found in 17 of 70 patients with DM (24%), three of 15 patients with CADM (20%), and three of 51 patients with PM (6%). Gastric cancer (8/23) was the most common malignancy. Compared with general population, the SIR of malignancies was 13.8 (range 9.0-21.1). The patients who developed malignancies were older (61.5 vs. 51.1 years; P < 0.005), presented more often with dysphagia (61 vs. 15%; P < 0.0001) and were less likely to have the complication of interstitial lung disease (30 vs. 60%; P < 0.05). These features were independent predictive factors for developing malignancies in multiple logistic regression analysis. The results of our study confirm that CADM in addition to DM was associated with high rates of malignancy among our patient cohort. PMID:20922453

  15. Clinical Heterogeneity in Patients With FOXP3 Mutations Presenting With Permanent Neonatal Diabetes

    PubMed Central

    Rubio-Cabezas, Oscar; Minton, Jayne A.L.; Caswell, Richard; Shield, Julian P.; Deiss, Dorothee; Sumnik, Zdenek; Cayssials, Amely; Herr, Mathias; Loew, Anja; Lewis, Vaughan; Ellard, Sian; Hattersley, Andrew T.

    2009-01-01

    OBJECTIVE—Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is caused by FOXP3 mutations. We aimed to determine the prevalence, genetics, and clinical phenotype of FOXP3 mutations in a large cohort with permanent neonatal diabetes (PNDM). RESEARCH DESIGN AND METHODS—The 11 coding exons and the polyadenylation region of FOXP3 were sequenced in 26 male subjects with diabetes diagnosed before 6 months of age in whom common genetic causes of PNDM had been excluded. Ten subjects had at least one additional immune-related disorder, and the remaining 16 had isolated diabetes. RESULTS—We identified four hemizygous FOXP3 mutations in 6 of 10 patients with associated immune-related disorders and in 0 of 16 patients with isolated diabetes (P = 0.002). Three patients with two novel mutations (R337Q and P339A) and the previously reported L76QfsX53 developed classic IPEX syndrome and died within the first 13 months. The novel mutation V408M was found in three patients from two unrelated families and had a mild phenotype with hypothyroidism and autoimmune enteropathy (n = 2) or nephrotic syndrome (n = 1) and survival to 12–15 years. CONCLUSIONS—FOXP3 mutations result in ?4% of cases of male patients with permanent diabetes diagnosed before 6 months. Patients not only have classic IPEX syndrome but, unexpectedly, may have a more benign phenotype. FOXP3 sequencing should be performed in any male patient with the diagnosis of diabetes in the first 6 months who develops other possible autoimmune-associated conditions, even in the absence of full IPEX syndrome. PMID:18931102

  16. Factors influencing the approaches to studying of preclinical and clinical students and postgraduate trainees

    PubMed Central

    2011-01-01

    Background Students can be classified into three categories depending on their approaches to studying; namely, deep approach (DA), strategic approach (SA) and surface apathetic or superficial approach (SAA). The aim of this study was to identify factors affecting the approaches to studying among Sri Lankan medical undergraduates and post graduate trainees and to analyze the change in the pattern of study skills with time and experience. Method Pre-clinical and clinical students of the Faculty of Medicine, University of Colombo and postgraduate trainees in Surgery at the National Hospital of Sri Lanka were invited to complete the Approaches and Study Skills Inventory for Students (ASSIST) questionnaire. Results A total of 187 pre clinical (M: F = 96:91), 124 clinical (M: F = 61:63) and 53 post graduate trainees (M: F = 50:3) participated in the study. Approaches of male and female students were similar. SA was significantly affected by age among the preclinical students (p = 0.01), but not in other groups. Among pre-clinical students, males preferred a teacher who supported understanding (p = 0.04) but females preferred a passive transmission of information (p < 0.001). This, too, was not visible among other groups. A linear regression performed on group (batch), gender, island rank at GCE Advance Level (AL) examination, self appraisal score and the preference scores of type of teacher only managed to explain 35% or less of variance observed for each approach in individual groups. Conclusion Different factors affect the approach to studying in different groups but these explain only a small fraction of the variance observed. PMID:21599886

  17. Intuitive presentation of clinical forensic data using anonymous and person-specific 3D reference manikins.

    PubMed

    Urschler, Martin; Höller, Johannes; Bornik, Alexander; Paul, Tobias; Giretzlehner, Michael; Bischof, Horst; Yen, Kathrin; Scheurer, Eva

    2014-08-01

    The increasing use of CT/MR devices in forensic analysis motivates the need to present forensic findings from different sources in an intuitive reference visualization, with the aim of combining 3D volumetric images along with digital photographs of external findings into a 3D computer graphics model. This model allows a comprehensive presentation of forensic findings in court and enables comparative evaluation studies correlating data sources. The goal of this work was to investigate different methods to generate anonymous and patient-specific 3D models which may be used as reference visualizations. The issue of registering 3D volumetric as well as 2D photographic data to such 3D models is addressed to provide an intuitive context for injury documentation from arbitrary modalities. We present an image processing and visualization work-flow, discuss the major parts of this work-flow, compare the different investigated reference models, and show a number of cases studies that underline the suitability of the proposed work-flow for presenting forensically relevant information in 3D visualizations. PMID:24952238

  18. Increased pre-therapeutic serum vascular endothelial growth factor in patients with early clinical relapse of osteosarcoma

    Microsoft Academic Search

    M Kaya; T Wada; S Kawaguchi; S Nagoya; T Yamashita; Y Abe; H Hiraga; K Isu; M Shindoh; F Higashino; F Okada; M Tada; S Yamawaki; S Ishii

    2002-01-01

    To investigate the clinical significance of circulating angiogenic factors, especially in association with early relapse of osteosarcoma, we quantified pre-therapeutic levels of vascular endothelial growth factor, basic fibroblast growth factor and placenta growth factor in the sera of 16 patients with osteosarcoma using an enzyme-linked immunosorbent assay. After a 1-year follow-up, the serum level of angiogenic factors was analysed with

  19. Proton electromagnetic form factors: Basic notions, present achievements and future perspectives

    NASA Astrophysics Data System (ADS)

    Pacetti, Simone; Baldini Ferroli, Rinaldo; Tomasi-Gustafsson, Egle

    2015-01-01

    The aim of this report is to give basic notions on electromagnetic hadron form factors (FFs), as they are understood at the present time, to summarize and analyze the present experimental results and available theoretical models and to open a view on future perspectives. FFs are fundamental quantities, which describe the internal, dynamical structure of hadrons. Although the theoretical formalism was settled in the middle of last century, as well as the first experiments in electron-proton elastic scattering for which R. Hofstadter got the Nobel prize in 1961, a renewed activity is due to recent, surprising results and to the opening of new experimental possibilities. An elegant formalism was built on the assumption of a hadron electromagnetic interaction based on the exchange of a virtual photon of four-momentum q2. In this case FFs are analytic functions of only one variable, q2, and the electromagnetic vertex ?? hh (h is any hadron) is defined by two structure functions, which, in turn, are expressed in terms of (2 S + 1) FFs, S being the hadron spin, assuming parity and time-invariance. Our aim is to anticipate the potentiality contained in the future data, combined with the present knowledge, to point out the relevant observables and the most significative measurements, and to give predictions to be compared to the data when they will be available.

  20. How do socio-demographic and clinical factors interact with adherence attitude profiles in schizophrenia? A cluster-analytical approach.

    PubMed

    Beck, Eva-Marina; Cavelti, Marialuisa; Wirtz, Markus; Kossowsky, Joe; Vauth, Roland

    2011-05-15

    Knowledge regarding socio-demographic and clinical risk factors of medication nonadherence does not always help in addressing adherence in individual patients. Classifying patients according to subjective adherence influencing factors may aid practitioners in choosing adequate strategies for improving medication adherence. A total of 171 outpatients with schizophrenia and schizoaffective disorder were classified according to factors influencing their medication adherence assessed using the Rating of Medication Influences Scale. Additionally, psychotic symptoms, depression, and insight, also known to influence pharmacological treatment motivation, were assessed. A cluster analysis yielded 3 groups that were distinguished both by the relative ranking of adherence influences and by specific associations with risk factors of nonadherence. For the "Interpersonal, Future-oriented Group" (n=59, 35% of the sample), interpersonal factors (positive therapeutic relationship, positive attitudes of significant others towards medication), immediate positive consequences of the medication intake (daily benefits, no perceived pressure to take medication), and avoiding future negative consequences of non-compliance, such as relapse and re-hospitalization, were essential for adherence. The "Autonomous, Future-oriented Group" (n=69, 40% of the sample) appraised interpersonal factors as being less important as compared to the other groups. This group exhibited significantly fewer depressive symptoms than the first group and had significantly more stable partnerships as compared to the other groups. The "Autonomous, Present-oriented Group" (n=43, 25% of the sample) was mainly motivated by immediate positive consequences and displayed higher levels of cognitive disorganization and negative symptoms than the second group, as well as the lowest level of insight of all groups. Treatment strategies addressing adherence enhancement in schizophrenia may profit by considering both the patient's subjective adherence attitude profile as well as the specific pattern of risk factors for nonadherence including depression, lack of insight, negative syndrome, cognitive disorganization and socio-demographic factors, which are differentially associated with each adherence attitude profile. PMID:21074860

  1. Clinical prognostic factors for disabling Crohn's disease: A systematic review and meta-analysis

    PubMed Central

    Dias, Cláudia Camila; Rodrigues, Pedro Pereira; da Costa-Pereira, Altamiro; Magro, Fernando

    2013-01-01

    AIM: To identify demographic and clinical factors associated with disabling Crohn’s disease (CD). METHODS: A systematic review and meta-analysis of observational studies, focusing on the factors that can predict the prognosis of different outcomes of CD was undertaken. PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigating the above mentioned factors in adult patients with CD. Studies were eligible for inclusion if they describe prognostic factors in CD, with inclusion and exclusion criteria defined as follows. Studies with adult patients and CD, written in English and studying association between clinical factors and at least one prognosis outcome were included. Meta-analysis of effects was undertaken for the disabling disease outcome, using odds ratio (OR) to assess the effect of the different factors in the outcome. The statistical method used was Mantel-Haenszel for fixed effects. The 16-item quality assessment tool (QATSDD) was used to assess the quality of the studies (range: 0-42). RESULTS: Of the 913 papers initially selected, sixty studies were reviewed and three were included in the systematic review and meta-analysis. The global QATSDD scores of papers were 18, 21 and 22. Of a total of 1961 patients enrolled, 1332 (78%) were classified with disabling disease five years after diagnosis. In two studies, age at diagnosis was a factor associated with disabling disease five years after diagnosis. Individuals under 40 years old had a higher risk of developing disabling disease. In two studies, patients who were treated with corticosteroids on the first flare developed disabling disease five years after diagnosis. Further, perianal disease was found to be relevant in all of the studies at two and five years after diagnosis. Finally, one study showed localization as a factor associated with disabling disease five years after diagnosis, with L3 being a higher risk factor. This meta-analysis showed a significantly higher risk of developing disabling disease at five years after initial diagnosis among patients younger than 40 years of age (OR = 2.47, 95%CI: 1.74-3.51), with initial steroid treatment for first flare (OR = 2.42, 95%CI: 1.87-3.11) and with perianal disease (OR = 2.00, 95%CI: 1.41-2.85). CONCLUSION: Age at diagnosis, perianal disease, initial use of steroids and localization seem to be independent prognostic factors of disabling disease. PMID:23840127

  2. Envelope specific T cell responses & cytokine profiles in chikungunya patients hospitalized with different clinical presentations

    PubMed Central

    Tripathy, Anuradha S.; Tandale, Babasaheb V.; Balaji, Saravana S.; Hundekar, Supriya L.; Ramdasi, Ashwini Y.; Arankalle, Vidya A.

    2015-01-01

    Background & objectives: Since the 2006 massive outbreaks, chikungunya (CHIK) is a major public health concern in India. The aim of this study was to assess envelope specific immune responses in patients with chikungunya infection. Methods: This study included 46 hospitalized patients with chikungunya virus infection (encephalitis, n=22, other systemic involvement, OSI, n=12, classical, n=12) and six controls from Ahmedabad city, Gujarat, India. T cell responses and the levels of Th1, pro/ anti-inflammatory cytokines against the CHIK virus envelope antigens were assessed by lymphocyte proliferation assay and by cytometric bead array in flow cytometry, respectively. Results: Lymphoproliferative response was uniform among the patients. Comparisons of cytokines revealed significantly higher levels of interleukin (IL)-4 and IL-5 in encephalitis, OSI and classical patients versus controls. The levels of tumour necrosis factor (TNF)-? were higher in classical patients categories compared to the controls. Interferon (IFN)-? levels were lower in encephalitis patients versus control. Interpretation & conclusions: Our findings showed recognition of T cell epitopes on the envelope region of chikungunya virus by all patient categories. Lower level of IFN-? may be associated with the severity of disease in these patients. PMID:25900956

  3. A case of severe heatstroke and review of pathophysiology, clinical presentation, and treatment.

    PubMed

    Horseman, Michael A; Rather-Conally, Jacquelyn; Saavedra, Crystal; Surani, Salim

    2013-01-01

    Heatstroke is life-threatening condition characterized by hyperthermia and central nervous system disturbances. It can also be classified as a form of systemic inflammatory response syndrome with multiple organ dysfunction and in many ways resembles sepsis. Like sepsis, most patients with heatstroke demonstrate a hyperdynamic hemodynamic response. In contrast to sepsis, rhabdomyolysis may complicate management and initial fluid resuscitation is not well defined. We present an illustrative case report and review of literature. PMID:22232203

  4. Hypophyseal Non-Hodgkin's Lymphoma presenting with clinical panhypopituitarism successfully treated with chemotherapy

    Microsoft Academic Search

    Andries R. Jonkhoff; Peter C. Huijgens; Willem O. Schreuder; Gerrit J. J. Teule; Jan J. Heimans

    1993-01-01

    Summary A patient is described with a testicular Non-Hodgkin's Lymphoma (NHL) presenting with panhypopituitarism caused by a hypophyseal localization. A67Gallium scintigraphy showed avid uptake in the hypophyseal region. Obviously67Gallium could reach the tumor, by the intravenous route, which was the reason to treat the patient with intravenous chemotherapy. A complete remission was induced, which seems to be lasting (+ 25

  5. Acquired Factor XI Inhibitor Presenting as Spontaneous Bilateral Subdural Hematoma in an Elderly Patient

    PubMed Central

    Scarti, Luca; Beltrame, Chiara; Picchi, Antonella; Taccetti, Gianni; Fortini, Alberto

    2014-01-01

    Development of autoantibodies against coagulation factors is an uncommon bleeding disorder associated with cancer, autoimmune conditions, pregnancy, or no apparent disease. Spontaneous FVIII inhibitors are the most frequently encountered; those against FXI have been only anecdotally reported. We report a case of acquired FXI inhibitor presenting as fatal intracranial spontaneous bleeding in an elderly patient with history of cancer and previous transfusions. Few cases of acquired FXI inhibitor have been reported in association with connective tissue disease, cancer, or surgery. Bleeding includes mucocutaneous bleeding, postsurgical hemorrhage, or life-threatening events. Treatment consists of arresting the bleeding and inhibitor eradication. High degree of suspicion is essential to promptly diagnose and treat this uncommon condition. PMID:25431698

  6. Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature

    PubMed Central

    2011-01-01

    Sclerosing mesenteritis (SM) is a rare pathological condition affecting the mesentery. It is a benign, non-specific inflammation of the adipose tissue of the mesentery of the small intestine and colon. It is characterized by a variable amount of chronic fibrosis. Its etiology is unknown, the pathogenesis is obscure, while the pathological characteristics of the disease are unspecific. The initial clinical presentation varies from typically asymptomatic to that of an acute abdomen. The diagnosis is suggested by computed tomography but is usually confirmed by surgical biopsies. Treatment is largely empirical; it is decided upon on the basis of the clinical condition of the patient, and usually a few specific drugs are used. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. We will present five cases of SM as well as a review of the available literature in order to state and compare a variety of clinical presentations, diverse possible etiologies and dissimilar treatment options. PMID:21635777

  7. Sclerosing Mesenteritis: Diverse clinical presentations and dissimilar treatment options. A case series and review of the literature.

    PubMed

    Vlachos, Konstantinos; Archontovasilis, Fotis; Falidas, Evangelos; Mathioulakis, Stavros; Konstandoudakis, Stefanos; Villias, Constantinos

    2011-01-01

    Sclerosing mesenteritis (SM) is a rare pathological condition affecting the mesentery. It is a benign, non-specific inflammation of the adipose tissue of the mesentery of the small intestine and colon. It is characterized by a variable amount of chronic fibrosis. Its etiology is unknown, the pathogenesis is obscure, while the pathological characteristics of the disease are unspecific. The initial clinical presentation varies from typically asymptomatic to that of an acute abdomen. The diagnosis is suggested by computed tomography but is usually confirmed by surgical biopsies. Treatment is largely empirical; it is decided upon on the basis of the clinical condition of the patient, and usually a few specific drugs are used. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. We will present five cases of SM as well as a review of the available literature in order to state and compare a variety of clinical presentations, diverse possible etiologies and dissimilar treatment options. PMID:21635777

  8. Clinical signs indicative of temporomandibular disorders in adults: time trends and associated factors.

    PubMed

    Köhler, Alkisti Anastassaki; Hugoson, Anders; Magnusson, Tomas

    2013-01-01

    The study aimed to examine possible time trends in the prevalence of clinical signs indicative of temporomandibular disorder (TMD) in an adult population, to analyse possible associations between TMD signs and associated factors and to estimate the need for TMD treatment. Three independent, stratified and randomly selected samples of around 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years participated in the Jönköping studies in 1983,1993 and 2003. The study material consisted of 1,693 subjects who, after answering a questionnaire and being interviewed about the presence of TMD symptoms, were clinically examined in terms of the presence of TMD signs according to the Clinical Dysfunction Index (Di) by Helkimo. Associations between clinical signs and the Di as dependent variables and each of the independent variables of age group, gender, reported bruxism, trauma, self-perceived healthiness and the year of investigation were analysed in binary logistic regression models. Estimates of the need for TMD treatment were based on the presence of a combination of severe symptoms and clinical signs. The prevalence of severely impaired jaw movement capacity, relating to horizontal movements, had increased in 2003. The prevalence of muscle pain and temporomandibular joint pain upon posterior palpation was found to vary statistically significantly between 1993 and 2003. Gender differences were noted in these changes overtime. Female gender, advancing age, awareness of bruxism, self-perceived health impairment and the wearing of complete dentures were associated with TMD signs and a higher degree of clinical dysfunction. The estimated need for TMD treatment increased from 5% in 1983 to 8% in 2003 and was higher in women than in men. In conclusion, the results indicate that the prevalence of some TMD signs and of estimated treatment need increased during the period 1983-2003. PMID:23721032

  9. Factors shaping effective utilization of health information technology in urban safety-net clinics.

    PubMed

    George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

    2013-09-01

    Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings. PMID:23981394

  10. Factors associated with nurses’ self-efficacy in clinical setting in Iran, 2013

    PubMed Central

    Soudagar, Simin; Rambod, Masoume; Beheshtipour, Noushin

    2015-01-01

    Background: In nursing, self-efficacy is quite critical for skill performance. Some factors might influence and predict self-efficacy in nurses. Thus, the present study aimed to investigate self-efficacy and the factors predicting nurses’ self-efficacy in clinical setting. Materials and Methods: In this cross-sectional study, 264 nurses were selected from five hospitals affiliated to Shiraz University of Medical Sciences by stratified random sampling. General Self-efficacy Scale (GSE) was used to assess a general sense of perceived self-efficacy. The data were analyzed using one-way analysis of variance (ANOVA) and multiple regression analysis. Results: The mean of self-efficacy in all the nurses was 29.78 [Standard Deviation (SD) = 5.82]. Moreover, the self-efficacy of the nurses with diploma, bachelor's, and master's degrees was 32.22 (SD = 6.21), 29.33 (SD = 5.68), and 32.00 (SD = 6.00), respectively. In addition, a significant difference was found between the nurses with bachelor's and diploma degrees regarding their self-efficacy (P = 0.01). Also, a significant relationship was found between self-efficacy and willingness to work in the nursing unit (F = 3.31, P = 0.01) and interest in the nursing field (F = 2.43, P = 0.04). The nurses who had more than 16 years of working experience in the field of nursing reported a better self-efficacy score. Overall, self-efficacy was predicted by the years of experience in the field of nursing (? =0.25, P = 0.009) and the interest in the nursing field (? = ?0.15, P = 0.02). Conclusions: This study indicated that the nurses with diploma degrees gained higher self-efficacy scores compared to those with bachelor's degrees. Changing the nursing curriculum and increasing the motivation in the nursing context might enhance the interest in the nursing field as well as the nurses’ self-efficacy. Of course, other studies are recommended to be conducted to improve the nurses’ self-efficacy. PMID:25878701

  11. Clinical Presentation, Convalescence, and Relapse of Rocky Mountain Spotted Fever in Dogs Experimentally Infected via Tick Bite

    PubMed Central

    Levin, Michael L.; Killmaster, Lindsay F.; Zemtsova, Galina E.; Ritter, Jana M.; Langham, Gregory

    2014-01-01

    Rocky Mountain spotted fever (RMSF) is a tick-borne disease caused by R. rickettsii in North and South America. Domestic dogs are susceptible to infection and canine RMSF can be fatal without appropriate treatment. Although clinical signs of R. rickettsii infection in dogs have been described, published reports usually include descriptions of either advanced clinical cases or experimental infections caused by needle-inoculation of cultured pathogen rather than by tick bite. The natural progression of a tick-borne R. rickettsii infection has not been studied in sufficient detail. Here, we provide a detailed description of clinical, hematological, molecular, and serological dynamics of RMSF in domestic dogs from the day of experimental exposure to infected ticks through recovery. Presented data indicate that neither the height/duration of fever nor detection of rickettsial DNA in dogs' blood by PCR are good indicators for clinical prognosis. Only the apex and subsequent subsidence of neutrophilia seem to mark the beginning of recovery and allow predicting a favorable outcome in Rickettsia-infected dogs, even despite the continuing persistence of mucosal petechiae and skin rash. On the other hand the appropriate (doxycycline) antibiotic therapy of sufficient duration is crucial in prevention of RMSF relapses in dogs. PMID:25542001

  12. Plasmodium knowlesi: clinical presentation and laboratory diagnosis of the first human case in a Scottish traveler.

    PubMed

    Cordina, Claire J; Culleton, Richard; Jones, Brian L; Smith, Catherine C; MacConnachie, Alisdair A; Coyne, Michael J; Alexander, Claire L

    2014-01-01

    The first imported case of Plasmodium knowlesi in Scotland is described in a 33-year-old female with a travel history to Borneo. The patient ceased to take antimalarial prophylaxis after 4 days of her 10-day visit and presented with a history of fever, rigor, vomiting, and diarrhea after 13 days on her return to the UK. Malaria antigen detection using the Optimal-IT and Binax-NOW kits was negative. Unusual trophozoite-like structures were observed under microscopic examination and the identification of P. knowlesi performed by a nested polymerase chain reaction (PCR) gel-based approach was confirmed by using a PCR-sequencing assay. PMID:24861374

  13. A Case of Palmar Lichen Nitidus Presenting as a Clinical Feature of Pompholyx

    PubMed Central

    Park, Sang Hoon; Kim, Sung Woo; Noh, Tae Woo; Hong, Kwang Cheol; Kang, Yoo Seok; Lee, Un Ha; Jang, Sang Jai

    2010-01-01

    Lichen nitidus (LN) is an uncommon chronic eruption of an unknown cause, and it is characterized by tiny, discrete, flesh-colored papules. The sites of predilection are the genitalia, trunk and extremities. Unilateral palmar involvement with pruritus is infrequent. We report here on a case of LN confined to the right palm, and the patient presented with multiple, pruritic, erythematous to flesh-colored, tiny papules and vesicles that mimicked pompholyx. The histopathological examination of a skin biopsy specimen showed the typical findings of LN. PMID:20548925

  14. Unusual extensive physiologic melanin pigmentation of the oral cavity: a clinical presentation.

    PubMed

    Mallikarjuna, K; Gupta, S; Shukla, S; Chaurasia, S

    2013-01-01

    Pigmented lesions are commonly found in the oral cavity. Oral pigmentations may be physiological or pathological in nature. It may represent as a localized anomaly of limited significance or the presentation of potentially life threatening multisystem disease. Oral pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic. Evaluation of a patient with pigmented lesions should include a full medical and dental history, extraoral and intraoral examinations. In this article, we report a case of extensive physiologic pigmentation of the oral cavity in a 12 year old female patient, posing a diagnostic challenge. PMID:23886725

  15. [Clinical presentation of attention deficit/hyperactivity disorder as a function of the gender].

    PubMed

    Montiel-Nava, Cecilia; Montiel-Barbero, Isabel; Peña, Joaquín A

    2007-12-01

    Results from studies comparing boys and girls diagnosed as having Attention Deficit-Hyperactivity Disorder (ADHD) have been non conclusive. In general, the results of such studies report boys as being more hyperactive and presenting more conduct problems, and girls as having more cognitive and learning problems. The aim of this study was to collect information about the characterization of the disorder depending on the gender. 169 children (123 males, 46 females), between 4 and 13 years of age with ADHD were studied. The assessment battery included Conners' rating scales-Revised for parents and teachers, short forms of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) and Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), academic achievement measures, developmental history and the Diagnostic Interview Schedule for Children-IV Version-Parents (DISC-IV). The results indicated the lack of significant differences between genders for the studied variables, ADHD boys and girls scored alike in the various behavioral and cognitive measures. The results presented describe homogeneity in the symptoms, demographic characteristics and neuropsychological functioning for children of both genders; suggesting a syndrome with the same criteria and independent of the gender. PMID:18271391

  16. CD44 isoforms containing exon V3 are responsible for the presentation of heparin-binding growth factor

    Microsoft Academic Search

    Kelly L. Bennett; David G. Jackson; Jan C. Simon; Ezster Tanczos; Robert Peach; Brett Modrell; Ivan Stamenkovic; Gregory Plowman; Alejandro Aruffo

    1995-01-01

    Glycosaminoglycan-modified isoforms of CD44 have been implicated in growth factor presenta- tion at sites of inflammation. In the present study we show that COS cell transfectants expressing CD44 iso- forms containing the alternatively spliced exon V3 are modified with heparan sulfate (HS). Binding studies with three HS-binding growth factors, basic-fibroblast growth factor (b-FGF), heparin binding-epidermal growth factor (HB-EGF), and amphiregulin,

  17. The influence of cow factors on the incidence of clinical mastitis in dairy cows.

    PubMed

    Steeneveld, W; Hogeveen, H; Barkema, H W; van den Broek, J; Huirne, R B M

    2008-04-01

    Many cow-specific risk factors for clinical mastitis (CM) are known. Other studies have analyzed these risk factors separately or only analyzed a limited number of risk factors simultaneously. The goal of this study was to determine the influence of cow factors on the incidence rate of CM (IRCM) with all cow factors in one multivariate model. Also, using a similar approach, the probability of whether a CM case is caused by gram-positive or gram-negative pathogens was calculated. Data were used from 274 Dutch dairy herds that recorded CM over an 18-mo period. The final dataset contained information on 28,137 lactations of 22,860 cows of different parities. In total 5,363 CM cases were recorded, but only 2,525 CM cases could be classified as gram-positive or gram-negative. The cow factors parity, lactation stage, season of the year, information on SCC from monthly test-day records, and CM history were included in the logistic regression analysis. Separate analyses were performed for heifers and multiparous cows in both the first month of lactation and from the second month of lactation onward. For investigating whether CM was caused by gram-positive or gram-negative pathogens, quarter position was included in the logistic regression analysis as well. The IRCM differed considerably among cows, ranging between 0.0002 and 0.0074 per cow-day at risk for specific cows depending on cow factors. In particular, previous CM cases, SCC in the previous month, and mean SCC in the previous lactation increased the IRCM in the current month of lactation. Results indicate that it is difficult to distinguish between gram-positive and gram-negative CM cases based on cow factors alone. PMID:18349231

  18. Medulloepithelioma with peculiar clinical presentation, stem cell phenotype and aberrant DNA-methylation profile.

    PubMed

    Ozolek, John A; Cohen, Debra E; Kool, Marcel; Pfister, Stefan M; Korshunov, Andrey; Bukowinski, Andrew J; Davis, Amy W

    2015-07-01

    SUMMARY? We present a 21-year-old male with a neck mass diagnosed as medulloepithelioma. Despite aggressive chemo- and radio-therapy, the tumor metastasized and proved fatal after seventeen months. The tumor demonstrated robust immunohistochemical expression of multiple markers of embryonic/neural stem cells and embryogenesis from the paraffin embedded tissue. The tumor, expressing LIN28A but negative for the 19q13.42 amplicon, also lacked the characteristic methylation profile for medulloepithelioma and other tumors with similar morphology. The expression of embryonic markers may explain its unresponsiveness to therapy and poor prognosis. Therapies targeted at embryonic cell phenotypes may hold the key for successfully treating cancers with embryonal phenotypes or tumors harboring cells with embryonal phenotypes. PMID:26118758

  19. Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective†

    PubMed Central

    Corrigan, Frank M.; Hull, Alastair M.

    2015-01-01

    Evidence of efficacy in studies of post-traumatic conditions is largely derived from studies in which variables are kept to a minimum. Extrapolation of treatments from uncomplicated disorders to complex conditions may therefore be called evidence-based without being evidenced. Complex conditions with polysymptomatic presentations and extensive comorbidity are being denied proper evaluation, and patients most severely traumatised from the early stages of their development are not provided with rigorously evaluated psychotherapies because they are more difficult to study in the manner approved by research protocols. Such evidence as there is suggests that the simple extension of treatments for uncomplicated disorders is seriously inadequate. This has significant implications for health services responsible for the provision of the most efficacious treatments to those whose disorders arise from severe trauma, often very early in their life. PMID:26191439

  20. Ruptured heterotopic pregnancy: an unusual presentation of an uncommon clinical problem

    PubMed Central

    Gibson, Kyle R; Horne, Andrew W

    2012-01-01

    A 30-year-old nulliparous lady presented to our Emergency Gynaecology Service with a 3-day history of epigastric pain and vomiting at 7?weeks of gestation. An intrauterine pregnancy had been confirmed 3?days earlier when she had attended with an episode of left-iliac fossa pain. Unfortunately, she became more unwell within 1?h of admission and as the cause of her symptoms was unclear, she was taken to the theatre for a joint gynaecology and general surgical diagnostic laparoscopy. This revealed a haemoperitoneum of 2?litres and a ruptured ectopic pregnancy in her left fallopian tube. A left salpingectomy was undertaken to remove the ectopic pregnancy. The patient made an excellent recovery and delivered a healthy baby at 39?weeks of gestation without further complication. PMID:23192579

  1. Nontuberculous mycobacterial infection in a clinical presentation of Fitz-Hugh-Curtis syndrome: a case report with multigene diagnostic approach

    PubMed Central

    2014-01-01

    Background Fitz-Hugh-Curtis syndrome (FHCS) is caused by inflammation of perihepatic capsules associated with pelvic inflammatory disease. In recent years, infections with nontuberculous mycobacteria (NTM) have been increasingly occurring in immunocompromised and immunocompetent patients. However, NTM has never been reported in patients with FHCS. We present the first case of a patient with extrapulmonary NTM infection in a clinical presentation of FHCS. Case presentation A 26-year-old Korean woman presented with right upper quadrant and suprapubic pain. She was initially suspected to have FHCS. However, she was refractory to conventional antibiotic therapy. Laparoscopy revealed multiple violin-string adhesions of the parietal peritoneum to the liver and miliary-like nodules on the peritoneal surfaces. Diagnosis of NTM was confirmed by the polymerase chain reaction analysis results of biopsy specimens that showed caseating granulomas with positive acid-fast bacilli. Treatment with anti-NTM medications was initiated, and the patient’s symptoms were considerably ameliorated. Conclusions An awareness of NTM as potential pathogens, even in previously healthy adults, and efforts to exclude other confounding diseases are important to establish the diagnosis of NTM disease. NTM infection can cause various clinical manifestations, which in the present case, overlapped with the symptoms of perihepatic inflammation seen in FHCS. PMID:25115526

  2. Clinical Risk Factors Affecting Procedure-Related Major Neurological Complications in Unruptured Intracranial Aneurysms

    PubMed Central

    Jang, E-Wook; Kim, Yong Bae; Chung, Joonho; Suh, Sang Hyun; Hong, Chang-Ki

    2015-01-01

    Purpose The operative risk and natural history rupture risk for the treatment of unruptured intracranial aneurysms (UIAs) should be evaluated. The purpose of this study was to report our experience with treating UIAs and to outline clinical risk factors associated with procedure-related major neurological complications. Materials and Methods We treated 1158 UIAs in 998 patients over the last 14 years. All patients underwent operation performed by a single microvascular surgeon and two interventionists at a single institution. Patient factors, aneurysm factors, and clinical outcomes were analyzed in relation to procedure-related complications. Results The total complication rate was 22 (2.2%) out of 998 patients. Among them, complications developed in 14 (2.3%) out of 612 patients who underwent microsurgery and in 8 (2.1%) out of 386 patients who underwent endovascular procedures. One patient died due to intraoperative rupture during an endovascular procedure. The procedure-related complication was highly correlated with age (p=0.004), hypertension (p=0.002), and history of ischemic stroke (p<0.001) in univariate analysis. The multivariate analysis revealed previous history of ischemic stroke (p=0.001) to be strongly correlated with procedure-related complications. Conclusion A history of ischemic stroke was strongly correlated with procedure-related major neurological complications when treating UIAs. Accordingly, patients with UIAs who have a previous history of ischemic stroke might be at risk of procedure-related major neurological complications. PMID:26069121

  3. Expression and clinical significance of fibroblast growth factor 1 in gastric adenocarcinoma

    PubMed Central

    Liu, Naiqing; Zhang, Jingyu; Sun, Shuxiang; Yang, Liguang; Zhou, Zhongjin; Sun, Qinli; Niu, Jun

    2015-01-01

    Background The clinical significance of fibroblast growth factor 1 (FGF1) has been revealed in several cancers, including ovarian cancer, breast cancer, and bladder cancer. However, the clinical significance of FGF1 in gastric adenocarcinoma has not been explored. Patients and methods In our experiments, we systematically evaluated FGF1 expression in 178 cases of gastric adenocarcinoma with immunohistochemistry, and subsequently analyzed the correlation between FGF1 expression and clinicopathologic features. Moreover, FGF1 expression in tumor tissue and corresponding adjacent tissue was detected and compared by real-time polymerase chain reaction. The Kaplan–Meier method and the Cox-regression model were used with univariate and multivariate analysis, respectively, to evaluate the prognostic value of FGF1 in gastric adenocarcinoma. Results Higher FGF1 expression rate is 56.7% (101/178) in gastric adenocarcinoma. FGF1 expression in gastric adenocarcinoma was significantly higher than adjacent tissue (P<0.0001). Expression of FGF1 is significantly associated with lymph node invasion (P<0.001), distant metastasis (P=0.013), and differentiation (P=0.015). Moreover, FGF1 overexpression was closely related to unfavorable overall survival rate (P=0.021), and can be identified to be an independent unfavorable prognostic factor (P=0.004). Conclusion FGF1 is an independent prognostic factor, indicating that FGF1 could be a potential molecular drug target in gastric adenocarcinoma. PMID:25792845

  4. Behavioural and clinical factors associated with depression among individuals with diabetes.

    PubMed

    Yekta, Z; Pourali, R; Yavarian, R

    2010-03-01

    Depression has been linked to greater mortality and morbidity in diabetic patients, but this issue has not been adequately studied in the Islamic Republic of Iran. This cross-sectional study described the prevalence of depression in patients attending a diabetes clinic in Urmia and determined the associated sociodemographic, behavioural and clinical factors. Of 295 patients, 128 (43.4%) had depression scores (> or = 15) on the Beck Depression Inventory. The mean score for all patients was 15.4 (SD 9.5). Those with depression were significantly older and less educated than those without depression, had a longer duration of diabetes and were more likely to suffer complications. On logistic regression analysis, older age was the only variable significantly associated with depression. PMID:20795442

  5. Clinical observations and risk factors for tinnitus in a Sicilian cohort.

    PubMed

    Martines, Francesco; Sireci, Federico; Cannizzaro, Emanuele; Costanzo, Roberta; Martines, Enrico; Mucia, Mariana; Plescia, Fulvio; Salvago, Pietro

    2014-09-01

    The aims of this study were to determine the distribution of risk factors associated with tinnitus analysing their role in the development of tinnitus and the effects of their interaction; to evidence the importance of a suitable and adequate clinical and audiologic assessment to avoid those modifiable risk factors responsible for cochlear dysfunction and tinnitus onset. 46 subjects with tinnitus and 74 controls were studied according to: age, sex, Body Mass Index (BMI), neck circumference, tobacco smoking, feeling fatigue or headache, self reporting snoring, hypertension, diabetes, coronary heart disease, and/or hyperlipidemia, and laboratory finding as lipid profile and levels of reactive oxygen metabolites (d-ROM). Audiological assessment was performed by multi-frequency audiometry (PTA0.5-16 kHz) and transient-evoked otoacoustic emissions (TEOAE diagnostic). Univariate analysis was performed to examine the association between determinants and occurrence of tinnitus; Mantel-Haenszel test (G.or) was used to investigate the joint effect of determinants on tinnitus. Tinnitus was more frequent among males with age >50 years; BMI >30 kg/m(2), neck circumference >40 cm, headache, hypertension, hypercholesterolemia resulted significant risk factors for tinnitus (P < 0.0001). Tinnitus group had more comorbidity (P < 0.0001) and worse audiometric thresholds (60.87 Vs 21.62 % hearing loss; P < 0.0001) with respect to control group. The interaction between hypertension-BMI ? 30 kg/m(2) (G.or = 8.45) and smoking-hypercholesterolemia (G.or = 5.08) increases the risk of tinnitus (P < 0.0001). Our results underline that several factors either individually or jointly contribute to tinnitus onset; a comprehensive knowledge about tinnitus risk factors and associated clinical conditions could contribute to minimizing this disorder. PMID:25190254

  6. Progressive outer retinal necrosis syndrome: a comprehensive review of its clinical presentation, relationship to immune system status, and management.

    PubMed

    Austin

    2000-12-01

    Progressive outer retinal necrosis (PORN) syndrome is a form of the Varicella zoster virus (VZV) chorioretinitis found almost exclusively in people with the acquired immunodeficiency syndrome (AIDS). This destructive infection has an extremely rapid course that may lead to no light perception in affected eyes within days or weeks. Attempts at its treatment have had limited success. Rhegmatogenous retinal detachments often occur after the development of atrophic retinal holes, and silicone oil temponade has been found to be the most successful reattachment procedure. Unfortunately, cataract formation is common after such surgery. PORN needs to be differentiated from acute retinal necrosis (ARN) syndrome, a necrotizing retinitis that can also be caused by VZV. PORN and ARN are found at opposite ends of the spectrum of necrotizing herpetic retinopathies (NHR), where its clinical presentation depends upon immune system status. After a brief case presentation, the distinguishing clinical characteristics of PORN, its differentiation from ARN, attempts at its treatment, the role of the immune system status on its clinical appearance and treatment, and management of complications such as retinal detachment and subsequent cataracts are discussed. PMID:11137426

  7. 76 FR 52539 - Federal Employees' Retirement System; Present Value Conversion Factors for Spouses of Deceased...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ...conform to the economic, demographic and mortality assumptions adopted by the Board of Actuaries...assumptions, new demographic factors and mortality assumptions adopted by the Board of Actuaries...the demographic factors, economic and mortality assumptions require corresponding...

  8. Korean Anxiety Sensitivity Index-3: Its Factor Structure, Reliability, and Validity in Non-Clinical Samples

    PubMed Central

    Lim, Young-Jin

    2012-01-01

    Objective The aim here is to examine the factorial structure, internal consistency, and concurrent validity of the Korean version of the Anxiety Sensitivity Index-3 (K-ASI-3) in student samples in Korea. Also, we investigated the cross-cultural differences in the Social Concerns factor. Methods K-ASI-3 was administered to non clinical samples in Korea. Internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-ASI-3. Results Results from CFA comparing our data to factor solutions commonly reported as representative of European-American samples indicated an adequate fit. The K-ASI-3 showed good performance on the indices of internal consistency and concurrent validity. In addition, using regression analyses, we found the Social Concerns factor is most strongly related to life satisfaction and worry. However, we found no evidence that Korean college students express more Social Concerns than their European Caucasian counterparts. Conclusion The authors demonstrate that the K-ASI-3 has highly internally consistent and psychometrically sound items, and that it reliably measures three lower-order domains assessing Physical, Social, and Cognitive Concerns. PMID:22396684

  9. Myogenic Growth Factor Present in Skeletal Muscle is Purified by Heparin-Affinity Chromatography

    NASA Astrophysics Data System (ADS)

    Kardami, Elissavet; Spector, Dennis; Strohman, Richard C.

    1985-12-01

    A myogenic growth factor has been purified from a skeletal muscle, the anterior latissimus dorsi, of adult chickens. In the range of 1-10 ng, this factor stimulates DNA synthesis as well as protein and muscle-specific myosin accumulation in myogenic cell cultures. Purification is achieved through binding of the factor to heparin. The factor is distinct from transferrin and works synergistically with transferrin in stimulating myogenesis in vitro.

  10. [Update in arrhythmogenic right ventricular cardiomyopathy: genetic, clinical presentation and risk stratification].

    PubMed

    Tomé Esteban, María T; García-Pinilla, José M; McKenna, William J

    2004-08-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC), or dysplasia, is a genetic heart muscle disease whose diagnosis is often a challenge for the clinician. It is one of the commonest causes of sudden cardiac death in the young. The classic description of the disease describes the end stage of a process where the myocardium, mainly of the right ventricle, has been substituted by fibrofatty tissue. Thus the early stages of the disease with subtle symptomatology are often missed. Unfortunately the risk of a fatal outcome is no less severe. The genetic basis is under investigations. Disease causing mutations in important cell adhesion genes (plakoglobin, desmoplakin) provide the basis for improved diagnosis and understanding of the pathogenesis. Animal models support the pathogenic theory that alterations on the integrity of the adhesion junction is followed by a cellular death and progressive fibrofatty replacement, the substrate for ventricular arrhythmias. Due the growing complexity and numerous phenotypic variations reported, sometimes in the same family, international registries have been created. The present review aims to summarise the current concepts on ARVC emphasising the genetic studies, the diagnosis, new diagnostic techniques and prognosis. PMID:15282065

  11. Interferon regulatory factor 8 regulates pathways for antigen presentation in myeloid cells and during tuberculosis.

    PubMed

    Marquis, Jean-François; Kapoustina, Oxana; Langlais, David; Ruddy, Rebecca; Dufour, Catherine Rosa; Kim, Bae-Hoon; MacMicking, John D; Giguère, Vincent; Gros, Philippe

    2011-06-01

    IRF8 (Interferon Regulatory Factor 8) plays an important role in defenses against intracellular pathogens, including several aspects of myeloid cells function. It is required for ontogeny and maturation of macrophages and dendritic cells, for activation of anti-microbial defenses, and for production of the Th1-polarizing cytokine interleukin-12 (IL-12) in response to interferon gamma (IFN?) and protection against infection with Mycobacterium tuberculosis. The transcriptional programs and cellular pathways that are regulated by IRF8 in response to IFN? and that are important for defenses against M. tuberculosis are poorly understood. These were investigated by transcript profiling and chromatin immunoprecipitation on microarrays (ChIP-chip). Studies in primary macrophages identified 368 genes that are regulated by IRF8 in response to IFN?/CpG and that behave as stably segregating expression signatures (eQTLs) in F2 mice fixed for a wild-type or mutant allele at IRF8. A total of 319 IRF8 binding sites were identified on promoters genome-wide (ChIP-chip) in macrophages treated with IFN?/CpG, defining a functional G/AGAAnTGAAA motif. An analysis of the genes bearing a functional IRF8 binding site, and showing regulation by IFN?/CpG in macrophages and/or in M. tuberculosis-infected lungs, revealed a striking enrichment for the pathways of antigen processing and presentation, including multiple structural and enzymatic components of the Class I and Class II MHC (major histocompatibility complex) antigen presentation machinery. Also significantly enriched as IRF8 targets are the group of endomembrane- and phagosome-associated small GTPases of the IRG (immunity-related GTPases) and GBP (guanylate binding proteins) families. These results identify IRF8 as a key regulator of early response pathways in myeloid cells, including phagosome maturation, antigen processing, and antigen presentation by myeloid cells. PMID:21731497

  12. [Investigation of acid proteinase and phospholipase activity as virulence factors in clinical Aspergillus spp. isolates].

    PubMed

    B?r?nci, Asuman; B?lg?n, Kemal; Tanriverd? Çayci, Yeliz

    2014-07-01

    Aspergillus spp. are widespread in nature and cause severe infections especially in immunocompromised patients. Aspergillus fumigatus complex is the most common species that causes infections in humans; however Aspergillus niger complex and Aspergillus flavus complex are the emerging agents that are isolated frequently from clinical specimens more recently. Besides the host factors such as immunosuppression, hematologic malignancy and corticosteroid use, fungal virulence factors such as elastase, acid protease and phospholipase enzymes are considered among the factors that affect the development of invasive aspergillosis. The aim of this study was to detect the acid proteinase and phospholipase enzyme activities in 30 A.fumigatus complex, nine A.flavus complex and four A.niger complex strains isolated from clinical specimens. Acid proteinase and phospholipase activities of the isolates were investigated by using bovine serum albumin agar (BSA), and egg yolk agar plates, respectively. Acid proteinase and phospholipase activity was detected in 76.7% (23/30) and 93.3% (28/30) of A.fumigatus complex isolates, respectively. None of the nine A.flavus complex isolates exhibited acid proteinase or phospholipase activity. Acid proteinase activity was not detected in any of the A.niger complex isolates (n= 4), however phospholipase activity was detected in one (25%) isolate. All of the acid proteinase positive A.fumigatus complex strains (n= 23) were also positive for phospholipase activity. In conclusion, further larger scale multicenter studies supported by clinical data, are needed to enlighten the roles of acid proteinase and phospholipase in the pathogenesis of infections due to Aspergillus spp. PMID:25052116

  13. An Acquired Factor VIII Inhibitor in a Patient with HIV and HCV: A Case Presentation and Literature Review

    PubMed Central

    Zeichner, S. B.; Harris, A.; Turner, G.; Francavilla, M.; Lutzky, J.

    2013-01-01

    Introduction. Despite its low incidence, acquired factor VIII inhibitor is the most common autoantibody affecting the clotting cascade. The exact mechanism of acquisition remains unclear, but postpartum patients, those with autoimmune conditions or malignancies, and those with exposure to particular drugs appear most susceptible. There have been several case reports describing acquired FVIII inhibitors in patients receiving interferon alpha for HCV treatment and in patients being treated for HIV. To our knowledge, this is the first case of a patient with HCV and HIV who was not actively receiving treatment for either condition. Case Presentation. A 57-year-old Caucasian male with a history of HIV and HCV was admitted to our hospital for a several day history of progressively worsening right thigh bruising and generalized weakness. CTA of the abdominal arteries revealed large bilateral retroperitoneal hematomas. Laboratory studies revealed the presence of a high titer FVIII inhibitor. Conclusion. Our case of a very rare condition highlights the importance of recognizing and understanding the diagnosis of acquired FVIII inhibitor. Laboratory research and clinical data on the role of newer agents are needed in order to better characterize disease pathogenesis, disease associations, genetic markers, and optimal disease management. PMID:24198984

  14. Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

    PubMed Central

    Nojkov, Borko; Cappell, Mitchell S

    2015-01-01

    Although relatively uncommon, Dieulafoy’s lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy’s lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy’s lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration (visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970’s to 9%-13% currently with the advent of aggressive endoscopic therapy. PMID:25901208

  15. Mycobacterial disease in cats in Great Britain: I. Culture results, geographical distribution and clinical presentation of 339 cases.

    PubMed

    Gunn-Moore, Danièlle A; McFarland, Sarah E; Brewer, Jacqueline I; Crawshaw, Timothy R; Clifton-Hadley, Richard S; Kovalik, Marcel; Shaw, Darren J

    2011-12-01

    This study investigated 339 cases of feline mycobacterial disease from cats with cutaneous lesions or masses found at exploratory laparotomy. Tissue samples were submitted to the Veterinary Laboratories Agency for mycobacterial culture over a 4-year period to December 2008. The study assessed which species of culturable mycobacteria were involved, where the cats lived, and their clinical presentation (physical findings, serum biochemistry, radiography, feline leukaemia virus and feline immunodeficiency virus status). Mycobacterium microti was cultured from 19%, Mycobacterium bovis 15%, Mycobacterium avium 7%, non-M avium non-tuberculous mycobacteria 6%, with no growth in 53% of samples. M microti, M bovis and M avium were found in almost mutually exclusive clusters within Great Britain (GB) (ie, M bovis in South-West England/Wales/Welsh Border, M avium in eastern England and M microti south of London and in South-West Scotland). While differences were seen in the clinical presentation and distribution of lesions caused by the different infections, these were not sufficiently different to be diagnostic. Cats commonly presented with single or multiple cutaneous lesions (74%), which were sometimes ulcerated or discharging, located most frequently on the head (54%). Lymph nodes were usually involved (47%); typically the submandibular nodes. Systemic or pulmonary signs were rarely seen (10-16%). When a cat is suspected of having mycobacteriosis, accurate identification of the species involved helps to determine appropriate action. Our findings show that knowing the cat's geographic location can be helpful, while the nature of the clinical presentation is less useful. Most cases of feline mycobacterial disease in GB are cutaneous. PMID:22079343

  16. Predictive Clinical Factors in the Diagnosis of Gastrointestinal Kaposi's Sarcoma and Its Endoscopic Severity

    PubMed Central

    Nagata, Naoyoshi; Shimbo, Takuro; Yazaki, Hirohisa; Asayama, Naoki; Akiyama, Junichi; Teruya, Katsuji; Igari, Toru; Ohmagari, Norio; Oka, Shinichi; Uemura, Naomi

    2012-01-01

    Background The diagnosis of gastrointestinal (GI) involvement in Kaposi's sarcoma (KS) is important to make because the need for treatment depends on the extent of the disease. Moreover, severe GI lesions can cause serious complications. Endoscopy with biopsy is an extremely useful method to diagnose GI-KS. However, determining the indications for endoscopy is difficult because KS can occur without GI symptoms or cutaneous KS. This study sought to clarify predictive clinical factors for GI-KS and its severity on endoscopy. Methodology/Principal Findings A total of 1,027 HIV-infected patients who underwent endoscopy were analyzed. Sexual behavior, CD4 count, HIV RNA, history of highly active antiretroviral therapy (HAART), GI symptoms, and cutaneous KS were assessed. Endoscopic severity including bulky tumor, ulceration, and number of lesions were evaluated. Thirty-three patients had GI-KS and 46 patients cutaneous KS. Among the GI-KS patients, 78.8% (26/33) had no GI symptoms and 24.2% (8/33) had no cutaneous KS. Univariate analysis identified men who have sex with men (MSM), CD4 <100 cells/µL, HIV RNA ?10,000 copies/mL, no history of HAART, and cutaneous KS were significantly associated with GI-KS. Among these factors, cutaneous KS was closely related to GI-KS on multivariable analysis. Among patients without cutaneous KS, MSM and CD4 count <100 cells/µL were the only independent clinical factors related to GI-KS. Bulky tumor was significantly associated with CD4 <100 cells/µL and large number of lesions was significantly associated with HIV-RNA ?10,000 copies/mL. Conclusions To diagnose GI-KS, clinical factors need to be considered before endoscopy. The presence of GI symptoms is not useful in predicting GI-KS. MSM and CD4 count <100 cells/µL are predictive factors among patients without cutaneous KS. Caution should be exercised especially in patients with low CD4 counts or high HIV viral loads as they are more likely to develop severe GI-KS lesions. PMID:23226197

  17. Confirmatory Factor Analysis of Scores on the Clinical Experience Rubric: A Measure of Dispositions for Preservice Teachers

    ERIC Educational Resources Information Center

    Flowers, Claudia

    2006-01-01

    This study examines the underlying structure of the Clinical Experience Rubric (CER), which is designed to assess preservice teachers' dispositions during the clinical experiences. Dispositions were conceptualized as being a multidimensional construct with three related factors: (a) professionalism, (b) teaching quality, and (c) relationship with…

  18. Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases

    Microsoft Academic Search

    Hanne H Owen; Jørn Rosborg; Michael Gaihede

    2006-01-01

    BACKGROUND: To evaluate symptoms, clinical findings, and etiological factors in external ear canal cholesteatoma (EECC). METHOD: Retrospective evaluation of clinical records of all consecutive patients with EECC in the period 1979 to 2005 in a tertiary referral centre. Main outcome measures were incidence rates, classification according to causes, symptoms, extensions in the ear canal including adjacent structures, and possible etiological

  19. Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men

    Microsoft Academic Search

    James B. Meigs; Beth Mohr; Michael J. Barry; Mary McNaughton Collins; John B. McKinlay

    2001-01-01

    We defined risk factors for a clinical diagnosis of benign prostatic hyperplasia (BPH) among subjects of the population-based Massachusetts Male Aging Study. In 1987–89 1709 men aged 40–70 provided baseline risk factor data and were followed for a mean of 9 years; 1019 men without prostate cancer provided follow-up data. We classified men with clinical BPH at follow-up if they

  20. Assessment of Nutritional, Clinical, and Immunologic Status of HIV-Infected, Inner-City Patients with Multiple Risk Factors

    Microsoft Academic Search

    ELISABETH LUDER; EMILIE GODFREY; JAMES GODBOLD; DAVID M SIMPSON

    1995-01-01

    Objective To evaluate the nutritional, clinical, and immunologic factors associated with human immunodeficiency virus (HIV)-infected, inner-city patients with multiple risk factors.Design Prospective cross-sectional nutrition evaluation of patients with HIV infection.Setting Patients were interviewed at the outpatient clinic at Mt Sinai Medical Center, New York City, NY.Subjects Our subjects were men and women older than 18 years of age and at

  1. Metacognitive factors that impact student nurse use of point of care technology in clinical settings.

    PubMed

    Kuiper, RuthAnne

    2010-01-01

    The utility of personal digital assistants (PDA) as a point of care resource in health care practice and education presents new challenges for nursing faculty. While there is a plethora of PDA resources available, little is known about the variables that effect student learning and technology adoption. In this study nursing students used PDA software programs which included a drug guide, medical dictionary, laboratory manual and nursing diagnosis manual during acute care clinical experiences. Analysis of student journals comparative reflective statements about the PDA as an adjunct to other available resources in clinical practice are presented. The benefits of having a PDA included readily available data, validation of thinking processes, and facilitation of care plan re-evaluation. Students reported increased frequency of use and independence. Significant correlations between user perceptions and computer self-efficacy suggested greater confidence in abilities with technology resulting in increased self-awareness and achievement of learning outcomes. PMID:20196764

  2. [Clinical and roentgenological diagnostics of the severity of mucositis in the patients presenting with chronic suppurative otitis media].

    PubMed

    Kriukov, A I; Garov, E V; Zelikovich, E I; Azarov, P V; Garova, E E; Sudarev, P A

    2014-01-01

    The objective of the present study was to determine the prevalence of mucositis and its roentgenological manifestations in the patients presenting with chronic suppurative otitis media (CSOM). A total of 390 patients with CSOM (mesotympanitis) and 85 ones suffering CSOM with concomitant mucositis were available for the observation. The signs of mucositis were evaluated based on the patients' complaints, results of otomicroscopy, and computed tomography (CT) of the temporal bones. This randomized clinical study involving 390 patients presenting with CSOM revealed the signs of mucositis in 44.6% of the cases. Analysis of the results of temporal bone CT performed in 85 patients with CSOM and mucositis in the absence exacerbation has demonstrated the possibility of detecting mucositis and evaluating its severity from the changes in the airness of the tympanic cavity, attics, and antrum due to the presence of the pathological substrate in these regions. PMID:25734298

  3. Different Factors Associated with CTX-M-Producing ST131 and Non-ST131 Escherichia coli Clinical Isolates

    PubMed Central

    Nicolas-Chanoine, Marie-Hélène; Robert, Jérôme; Vigan, Marie; Laouénan, Cédric; Brisse, Sylvain; Mentré, France; Jarlier, Vincent

    2013-01-01

    Objectives To determine factors associated with CTX-M-producing ST131 Escherichia coli which is the worldwide predominant lineage among CTX-M-producing E. coli isolates. Methods Consecutive inpatients with a clinical sample positive for CTX-M-producing E. coli and considered as cases in a previous 8-month (2008–2009) case-control study performed in ten university hospitals in the Paris area were included in the present sub-population study. Patients with a CTX-M-producing ST131 E. coli clinical isolate were compared with those with a CTX-M-producing non-ST131 E. coli clinical isolate with regard to 66 variables. Variables were first compared using univariate logistic regression, then a multivariate analysis using a backward selection with variables with p-value <0.1 in univariate analysis was carried out. Results Fifty-five patients with a CTX-M-producing ST131 E. coli clinical isolate were compared to 97 patients with a CTX-producing non-ST131 E. coli clinical isolate. Multivariate analysis showed that only previous residence in long term care facilities (OR?=?4.4; 95% CI?=?1.3–14.7) was positively associated with a CTX-M-producing ST131 E. coli isolate. However, it also showed that regular consumption of poultry products (OR?=?0.2; 95% CI?=?0.1–0.6), having had at least one device in the preceding 6 months (OR?=?0.3; 95% CI?=?0.1–0.7) and stay in ICU (OR?=?0.2; 95% CI?=?0.05–0.8) were negatively associated with isolation of CTX-M-producing ST131 E. coli from clinical samples. Conclusions This study provides more insight into the epidemiological features of ST131 and non-ST131 E. coli producing CTX-M enzymes. It shows, for the first time, that isolation of CTX-M-producing ST131 E. coli from clinical samples is not linked to consumption of various foods and confirms that residence in long term care facilities is a predictor of these isolates. PMID:24023730

  4. Sharp mandibular bone irregularities after lower third molar extraction: Incidence, clinical features and risk factors

    PubMed Central

    Alves-Pereira, Daniela; Valmaseda-Castellón, Eduard; Laskin, Daniel M.; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2013-01-01

    Objectives: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. Study Design: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. Results: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group. Conclusions: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic. Key words:Third molar, postoperative complication, bone irregularities, age. PMID:23524429

  5. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy

    PubMed Central

    Taran, F. A.; Stewart, E. A.; Brucker, S.

    2013-01-01

    Adenomyosis is an important clinical challenge in gynecology and healthcare economics; in its fully developed form, hysterectomy is often used to treat it in premenopausal and perimenopausal women. Symptoms of adenomyosis typically include menorrhagia, pelvic pain and dysmenorrhea. Moreover, adenomyosis and leiomyomas commonly coexist in the same uterus, and differentiating the symptoms for each pathological process can be problematic. Although it has been recognized for over a century, reliable epidemiological studies on this condition are limited, because only postoperative diagnoses were possible in the past. Minimally invasive surgical techniques (endometrial ablation/resection, myometrial excision/reduction, myometrial electrocoagulation, uterine artery ligation) have had limited success in the treatment of adenomyosis, and the reported data for these procedures have been obtained from case reports or small case series with only short follow-up times. However, newer techniques including uterine artery embolization (UAE) and magnetic resonance imaging guided focused ultrasound (MRgFUS) show promise in treating adenomyosis. The data is strongest for UAE; these studies have the largest patient cohorts. However, none of the UAE studies were randomized or controlled. Thus, despite the clinical importance of adenomyosis, there is little evidence on which to base treatment decisions. The objective of this review is to summarize the epidemiology, risk factors, clinical phenotype and to evaluate the accrued experience with surgical and interventional alternatives to hysterectomy. PMID:24771944

  6. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.

    PubMed

    Engh, C A; Bobyn, J D; Glassman, A H

    1987-01-01

    Total hip replacement using porous-coated cobalt-chrome femoral implants designed for biological fixation has been evaluated in 307 patients after two years and in 89 patients after five years. Histological study of 11 retrieved specimens showed bone ingrowth in nine and fibrous tissue fixation in two. Fixation by bone ingrowth occurred in 93% of the cases in which a press fit of the stem at the isthmus was achieved, but in only 69% of those without a press fit. The clinical results at two years were excellent. The incidence of pain and limp was much lower when there was either a press fit of the stem or radiographic evidence of bone ingrowth. Factors such as age, sex, and the disease process did not influence the clinical results. Most cases showed only slight resorptive remodelling of the upper femur, but in a few cases with a larger, more rigid stem, more extensive bone loss occurred. The results after five years showed no deterioration with time. Fixation by the ingrowth of bone or of fibrous tissue both appeared to be stable, but bone ingrowth gave better clinical results. PMID:3818732

  7. Clinical endometritis in an Argentinean herd of dairy cows: risk factors and reproductive efficiency.

    PubMed

    Giuliodori, M J; Magnasco, R P; Becu-Villalobos, D; Lacau-Mengido, I M; Risco, C A; de la Sota, R L

    2013-01-01

    The objectives of this study were to assess the clinical and metabolic risk factors for clinical endometritis, the likelihood for having a normal vaginal discharge during postpartum, and the effects of endometritis on milk yield, reproductive efficiency, and metabolic status in Holstein cows. The study was conducted in a commercial dairy herd (Cordoba, Argentina) where 303 Holstein cows were enrolled. Cows were body condition scored (1 to 5) and tail bled on -14, 7, 21, 31, 41, and 50 d relative to parturition. Cows having a vaginal discharge with presence of pus between 21 and 41 d postpartum (dpp) were diagnosed as having clinical endometritis. Plasma blood samples were analyzed for nonesterified fatty acids (NEFA), ?-hydroxybutyrate (BHBA), and blood urea nitrogen using commercial kits and insulin-like growth factor 1, insulin, and leptin by RIA. Data were analyzed with PROC MIXED, PROC GENMOD, and PROC PHREG of SAS (SAS Institute Inc., Cary, NC). Abnormal calving and puerperal metritis increased the risk for endometritis [adjusted odds ratio (AOR)=2.21 for both]. High prepartum NEFA and high postpartum BHBA increased the risk for endometritis (AOR=1.003 and 1.001, respectively), whereas high prepartum blood urea nitrogen reduced it (AOR=0.853). Cut-offs of 456.6 ?M NEFA and 402.5 ?M BHBA had sensitivities of 0.69 and 0.58, and specificities of 0.88 and 0.86, respectively. The likelihood for having normal vaginal discharge increased with time (?1% × dpp) and with normal calving. Cows with endometritis had higher milk yield than normal herdmates (27.8±0.9 vs. 25.7±0.4 kg/d), lower risk for pregnancy by 100 dpp (AOR=0.10), higher nonpregnancy risk by 200 dpp (AOR=2.87), and higher risk for culling than normal cows (AOR=2.28). Cows with endometritis had a lower hazard rate (0.44) for pregnancy and had approximately 70 d longer calving-to-conception intervals. Finally, endometritis had no effect on metabolic hormones. In conclusion, the risk for clinical endometritis increases with abnormal calving and puerperal metritis, as prepartum NEFA and postpartum BHBA concentrations increase. Prepartum NEFA and postpartum BHBA could be useful for the prediction of endometritis. Last, clinical endometritis has detrimental effects on reproductive efficiency, as affected cows take longer to get pregnant and are at higher risk for culling. PMID:23182361

  8. Clinical Factors Associated with Sperm DNA Fragmentation in Male Patients with Infertility

    PubMed Central

    Komiya, Akira; Kato, Tomonori; Kawauchi, Yoko; Watanabe, Akihiko; Fuse, Hideki

    2014-01-01

    Objective. The clinical factors associated with sperm DNA fragmentation (SDF) were investigated in male patients with infertility. Materials and Methods. Fifty-four ejaculates from infertile Japanese males were used. Thirty-three and twenty-one were from the patients with varicoceles and idiopathic causes of infertility, respectively. We performed blood tests, including the serum sex hormone levels, and conventional and computer-assisted semen analyses. The sperm nuclear vacuolization (SNV) was evaluated using a high-magnification microscope. The SDF was evaluated using the sperm chromatin dispersion test (SCDt) to determine the SDF index (SDFI). The SDFI was compared with semen parameters and other clinical variables, including lifestyle factors. Results. The SDFI was 41.3 ± 22.2% (mean ± standard deviation) and did not depend on the cause of infertility. Chronic alcohol use increased the SDFI to 49.6 ± 23.3% compared with 33.9 ± 18.0% in nondrinkers. The SDFI was related to adverse conventional semen parameters and sperm motion characteristics and correlated with the serum FSH level. The SNV showed a tendency to increase with the SDFI. The multivariate analysis revealed that the sperm progressive motility and chronic alcohol use were significant predictors of the SDF. Conclusion. The SCDt should be offered to chronic alcohol users and those with decreased sperm progressive motility. PMID:25165747

  9. Emerging molecular targets in oncology: clinical potential of MET/hepatocyte growth-factor inhibitors

    PubMed Central

    Smyth, Elizabeth C; Sclafani, Francesco; Cunningham, David

    2014-01-01

    The MET/hepatocyte growth-factor (HGF) signaling pathway plays a key role in the processes of embryogenesis, wound healing, and organ regeneration. Aberrant activation of MET/HGF occurs through multiple mechanisms including gene amplification, mutation, protein overexpression, and abnormal gene splicing interrupting autocrine and paracrine regulatory feedback mechanisms. In many cancers including non-small-cell lung cancer, colorectal, gastric, renal, and hepatocellular cancer, dysregulation of MET may lead to a more aggressive cancer phenotype and may be a negative prognostic indicator. Successful therapeutic targeting of the MET/HGF pathway has been achieved using monoclonal antibodies against the MET receptor and its ligand HGF in addition to MET-specific and multitargeted small-molecule tyrosine-kinase inhibitors with several drugs in late-phase clinical trials including onartuzumab, rilotumumab, tivantinib, and cabozantinib. MET frequently interacts with other key oncogenic tyrosine kinases including epidermal growth-factor receptor (EGFR) and HER-3 and these interactions may be responsible for resistance to anti-EGFR therapies. Similarly, resistance to MET inhibition may be mediated through EGFR activation, or alternatively by increasing levels of MET amplification or acquisition of novel “gatekeeper” mutations. In order to optimize development of effective inhibitors of the MET/HGF pathway clinical trials must be enriched for patients with demonstrable MET-pathway dysregulation for which robustly standardized and validated assays are required. PMID:24959087

  10. 76 FR 55213 - Technical Amendments to Federal Employees' Retirement System; Present Value Conversion Factors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-07

    ...used to convert a lump sum basic employee death benefit under 5 U.S.C. 8442(b...that the revised factor would apply to deaths occurring on or after October 1, 2004. The revised factor, however, applies to deaths occurring on or after October 1,...

  11. A Clinical Analysis of Risk Factors for Interstitial Lung Disease in Patients with Idiopathic Inflammatory Myopathy

    PubMed Central

    Cen, Xiaomin; Zuo, Chuan; Yin, Geng; Xie, Qibing

    2013-01-01

    Interstitial lung disease (ILD) is a common and severe complication of idiopathic inflammatory myopathies (IIM). The aim of our study was to identify risk factors for ILD by evaluating both clinical and biochemical features in IIM patients with or without ILD. From January 2008 to December 2011, medical records of 134 IIM patients in our rheumatology unit were reviewed. The patients were divided into ILD group (83 patients) and non-ILD group (51 patients). The clinical features and laboratory findings were compared. The univariable analyses indicated that arthritis/arthralgia (54.2% versus 17.6%, P < 0.05), Mechanic's hand (16.9% versus 2.0%, P < 0.05), Raynaud's phenomenon (36.1% versus 2.0%, P < 0.05), heliotrope rash (44.6% versus 19.6%, P < 0.05), fever (43.4% versus 21.6%, P < 0.05), elevated ESR (60.2% versus 35.3%, P < 0.05), elevated CRP (55.4% versus 31.4%, P < 0.05), or anti-Jo-1 antibody (20.5% versus 5.9%, P < 0.05) were risk factors for developing ILD in IIM. Multivariable unconditional logistic regression analysis that showed arthritis/arthralgia (OR 7.1, 95% CI 2.8–18.1), Raynaud's phenomenon (OR 29.1, 95% CI 3.6–233.7), and amyopathic dermatomyositis (ADM) (OR 20.2, 95% CI 2.4–171.2) were the independent risk factors for developing ILD in IIM. PMID:24106519

  12. A clinical analysis of risk factors for interstitial lung disease in patients with idiopathic inflammatory myopathy.

    PubMed

    Cen, Xiaomin; Zuo, Chuan; Yang, Min; Yin, Geng; Xie, Qibing

    2013-01-01

    Interstitial lung disease (ILD) is a common and severe complication of idiopathic inflammatory myopathies (IIM). The aim of our study was to identify risk factors for ILD by evaluating both clinical and biochemical features in IIM patients with or without ILD. From January 2008 to December 2011, medical records of 134 IIM patients in our rheumatology unit were reviewed. The patients were divided into ILD group (83 patients) and non-ILD group (51 patients). The clinical features and laboratory findings were compared. The univariable analyses indicated that arthritis/arthralgia (54.2% versus 17.6%, P < 0.05), Mechanic's hand (16.9% versus 2.0%, P < 0.05), Raynaud's phenomenon (36.1% versus 2.0%, P < 0.05), heliotrope rash (44.6% versus 19.6%, P < 0.05), fever (43.4% versus 21.6%, P < 0.05), elevated ESR (60.2% versus 35.3%, P < 0.05), elevated CRP (55.4% versus 31.4%, P < 0.05), or anti-Jo-1 antibody (20.5% versus 5.9%, P < 0.05) were risk factors for developing ILD in IIM. Multivariable unconditional logistic regression analysis that showed arthritis/arthralgia (OR 7.1, 95% CI 2.8-18.1), Raynaud's phenomenon (OR 29.1, 95% CI 3.6-233.7), and amyopathic dermatomyositis (ADM) (OR 20.2, 95% CI 2.4-171.2) were the independent risk factors for developing ILD in IIM. PMID:24106519

  13. Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 1—diagnosis based on clinical presentation, cytology and culture

    PubMed Central

    Beco, L.; Guaguère, E.; Méndez, C. Lorente; Noli, C.; Nuttall, T.; Vroom, M.

    2013-01-01

    Systemic antimicrobials are critically important in veterinary healthcare, and resistance is a major concern. Antimicrobial stewardship will be important in maintaining clinical efficacy by reducing the development and spread of antimicrobial resistance. Bacterial skin infections are one of the most common reasons for using systemic antimicrobials in dogs and cats. Appropriate management of these infections is, therefore, crucial in any policy for responsible antimicrobial use. The goals of therapy are to confirm that an infection is present, identify the causative bacteria, select the most appropriate antimicrobial, ensure that the infection is treated correctly, and to identify and manage any underlying conditions. This is the first of two articles that will provide evidence-led guidelines to help practitioners address these issues. This article covers diagnosis, including descriptions of the different clinical presentations of surface, superficial and deep bacterial skin infections, how to perform and interpret cytology, and how to best use bacterial culture and sensitivity testing. Part 2 will discuss therapy, including choice of drug and treatment regimens. PMID:23292951

  14. Hepatitis B virus infection in patients attending a genitourinary medicine clinic: risk factors and vaccine coverage

    PubMed Central

    Gilson, R. J.; de Ruiter, A.; Waite, J.; Ross, E.; Loveday, C.; Howell, D. R.; Tedder, R. S.; Weller, I. V.

    1998-01-01

    BACKGROUND: The hepatitis B virus (HBV) immunisation policy in the United Kingdom includes offering vaccines selectively to those at risk by sexual contact. Among genitourinary medicine (GUM) clinic attenders, homosexual men are offered vaccine, but estimates of the vaccine uptake are required to monitor policy and estimate the possible impact on transmission; heterosexuals are not routinely offered vaccine, but this policy might change if the prevalence was found to be high. OBJECTIVE: To determine the prevalence of HBV infection and vaccine uptake among patients attending a GUM clinic. METHODS: HBV seroprevalence determined by unlinked anonymous testing of consecutive blood samples sent for syphilis serology. Demographic and risk factor data and history of HBV immunization extracted from clinic notes before unlinking. Prevalence data were compared with a population of first time blood donors from the same area. SETTING: Open access GUM clinic in central London. RESULTS: Samples were obtained and tested from 441 homosexual and 527 heterosexual men and from 821 women over a 4 month period in 1990. After exclusion of injecting drug users and their sexual partners (n = 30) and HBV carriers attending for follow up (n = 12), the prevalence of antibody to HBV core (anti-HBc) was 38.7% in homosexual men, 5.9% in heterosexual men, and 3.5% in women (50.0%, 6.0%, 3.7% respectively if previous vaccinees were also excluded). The prevalence of HBV surface antigen positivity was 4.2%, 0.60%, and 0.39% respectively after exclusion of vaccinees (chi(2) p < 0.001 for homosexual men versus others). The prevalence of the anti-HBc in first time blood donors was 1.1% (8/749). Among male GUM clinic attenders, the prevalence of anti-HBc was higher in those of non-UK origin or place of birth and/or non-white ethnicity (odds ratios 2.87, 95% CI 1.57-5.24 and 8.06, CI 3.39-19.1, in homosexuals and heterosexuals respectively). In homosexual men anti-HBc prevalence increased with age (OR 1.05, CI 1.02-1.07 for each year) and lifetime number of STDs (OR 6.36, CI 3.77-10.8 for > or = 2 versus < 2) and in clinic reattenders compared with new patients (OR 5.42, 95% CI 3.32-9.16). Among heterosexuals, age was associated with anti-HBc prevalence in women (OR 1.09, CI 1.04-1.12) but not men (OR 0.99, 95% CI 0.95-1.02). There were no other associations in heterosexuals. A history of HBV immunisation in homosexual men was recorded in 13/131 (9.9%) of new patients and 103/305 (33.8%; OR 4.63, CI 2.49-8.60) clinic reattenders. CONCLUSIONS: Although higher than a sample of blood donors, the prevalence of serological markers of HBV infection among heterosexuals was low, providing little support for extending HBV immunisation to all heterosexuals attending GUM clinics as a targeted strategy for control of HBV infection. Homosexual men remain at high risk of infection, but many are now being immunised. Efforts to improve compliance with existing vaccine policies in GUM clinics should be encouraged. ??? PMID:9634322

  15. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems

    Microsoft Academic Search

    Shobha Phansalkar; Judy Edworthy; Elizabeth Hellier; Diane L. Seger; Angela Schedlbauer; Anthony J. Avery; David W. Bates

    2010-01-01

    The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of

  16. Virus and Host Factors Affecting the Clinical Outcome of Bluetongue Virus Infection

    PubMed Central

    Caporale, Marco; Di Gialleonorado, Luigina; Janowicz, Anna; Wilkie, Gavin; Shaw, Andrew; Savini, Giovanni; Van Rijn, Piet A.; Mertens, Peter; Di Ventura, Mauro

    2014-01-01

    ABSTRACT Bluetongue is a major infectious disease of ruminants caused by bluetongue virus (BTV), an arbovirus transmitted by Culicoides. Here, we assessed virus and host factors influencing the clinical outcome of BTV infection using a single experimental framework. We investigated how mammalian host species, breed, age, BTV serotypes, and strains within a serotype affect the clinical course of bluetongue. Results obtained indicate that in small ruminants, there is a marked difference in the susceptibility to clinical disease induced by BTV at the host species level but less so at the breed level. No major differences in virulence were found between divergent serotypes (BTV-8 and BTV-2). However, we observed striking differences in virulence between closely related strains of the same serotype collected toward the beginning and the end of the European BTV-8 outbreak. As observed previously, differences in disease severity were also observed when animals were infected with either blood from a BTV-infected animal or from the same virus isolated in cell culture. Interestingly, with the exception of two silent mutations, full viral genome sequencing showed identical consensus sequences of the virus before and after cell culture isolation. However, deep sequencing analysis revealed a marked decrease in the genetic diversity of the viral population after passaging in mammalian cells. In contrast, passaging in Culicoides cells increased the overall number of low-frequency variants compared to virus never passaged in cell culture. Thus, Culicoides might be a source of new viral variants, and viral population diversity can be another factor influencing BTV virulence. IMPORTANCE Bluetongue is one of the major infectious diseases of ruminants. It is caused by an arbovirus known as bluetongue virus (BTV). The clinical outcome of BTV infection is extremely variable. We show that there are clear links between the severity of bluetongue and the mammalian host species infected, while at the breed level differences were less evident. No differences were observed in the virulence of two different BTV serotypes (BTV-8 and BTV-2). In contrast, we show that the European BTV-8 strain isolated at the beginning of the bluetongue outbreak in 2006 was more virulent than a strain isolated toward the end of the outbreak. In addition, we show that there is a link between the variability of the BTV population as a whole and virulence, and our data also suggest that Culicoides cells might function as an “incubator” of viral variants. PMID:24991012

  17. Factors Influencing Attrition in a Multisite, Randomized, Clinical Trial Following Traumatic Brain Injury in Adolescence

    PubMed Central

    Blaha, Robert Z.; Arnett, Anne B.; Kirkwood, Michael W.; Taylor, Gerry; Stancin, Terry; Brown, Tanya M.; Wade, Shari L.

    2015-01-01

    Background Attrition in longitudinal research negatively affects statistical power, disrupts statistical stability, and can produce unwanted bias. Objective To investigate factors associated with shorter length of study participation and lower rates of study completion (ie, attrition) in a large, multisite, longitudinal, randomized, clinical trial examining the efficacy of a Web-based family problem-solving treatment following traumatic brain injury (TBI) in adolescence. Setting Five major trauma centers in the central and western regions of the United States. Participants Children (N = 132) aged 12 to 17 years hospitalized for complicated mild to severe TBI within the previous 6 months. Results Completers had a higher primary caregiver education and higher family income than noncompleters, whereas ethnicity, latency to baseline assessment, and intervention group were not significantly associated with study completion. Conclusion This is the first study that has specifically examined factors of attrition in a pediatric TBI population. The results suggest that research on pediatric TBI populations may be biased toward higher-income families and highlights the importance of designing studies with increased awareness of the impact of participant demographic factors. PMID:24842589

  18. Expression and clinical significance of vascular endothelial growth factor and fms-related tyrosine kinase 1 in colorectal cancer

    PubMed Central

    WEN, LINCHUN; WANG, RUI; LU, XIYAN; YOU, CHUANWEN

    2015-01-01

    The aim of the present study was to investigate the prognostic value of vascular endothelial growth factor (VEGF) and its receptor, fms-related tyrosine kinase-1 (FLT-1), in patients with colorectal cancer. An immunohistochemical approach was used to detect the protein expression of VEGF and FLT-1 in 90 patients with colorectal cancer. The impact of VEGF and FLT-1 tumor cell expression, in addition to other factors, on overall survival (OS) was retrospectively assessed in 90 patients. Multivariate analysis was performed in order to determine the prognostic significance of the factors. The positive expression rate of VEGF in the colorectal cancer tissues was 62.2% (56/90). The positive expression rate of FLT-1 in colorectal cancer tissues was 48.9% (44/90). The results of the log-rank test revealed that improved OS rates were significantly associated with the absence of VEGF expression (P<0.0001). By contrast, FLT-1 expression had no significant impact on OS (P=0.289). Upon multivariate analysis, VEGF expression (P=0.038) and clinical stage (P=0.021) maintained significance. VEGF expression proved to be an independent negative predictor of OS in patients with colorectal cancer. Conversely, FLT-1 expression demonstrated no impact on OS.

  19. Clinical and genetic risk factors for epirubicin-induced cardiac toxicity in early breast cancer patients.

    PubMed

    Vulsteke, Christof; Pfeil, Alena M; Maggen, Charlotte; Schwenkglenks, Matthias; Pettengell, Ruth; Szucs, Thomas D; Lambrechts, Diether; Dieudonné, Anne-Sophie; Hatse, Sigrid; Neven, Patrick; Paridaens, Robert; Wildiers, Hans

    2015-07-01

    Anthracycline-induced cardiotoxicity (ACT) is a well-known serious adverse drug reaction leading to substantial morbidity. The purpose of this study was to assess ACT occurrence and clinical and genetic risk factors in early breast cancer patients. In 6 genes of interest (ABCC1, ABCC2, CYBA, NCF4, RAC2, SLC28A3), 10 single nucleotide polymorphisms (SNPs) involved in ACT were selected based on a literature search. Eight hundred and seventy-seven patients treated between 2000 and 2010 with 3-6 cycles of (neo) adjuvant 5-fluorouracil, epirubicin and cyclophosphamide (FEC) were genotyped for these SNPs using Sequenom MassARRAY. Main outcome measures were asymptomatic decrease of left ventricular ejection fraction (LVEF) > 10 % and cardiac failure grade 3-5 (CTCAE 4.0). To evaluate the impact of these 10 SNPs as well as clinical factors (age, relative dose intensity of epirubicin, left-sided radiotherapy, occurrence of febrile neutropenia, and planned and received cycles of epirubicin) on decrease of LVEF and cardiac failure, we performed uni- and multivariable logistic regression analysis. Additionally, exploratory analyses including 11 additional SNPs related to the metabolism of anthracyclines were performed. After a median follow-up of 3.62 years (range 0.40-9.60), a LVEF decline of > 10 % occurred in 153 patients (17.5 %) and cardiac failure in 16 patients (1.8 %). In multivariable analysis, six cycles of FEC compared to three cycles received and heterozygous carriers of the rs246221 T-allele in ABCC1 relative to homozygous carriers of the T-allele were significantly associated with LVEF decline of > 10 % (OR 1.3, 95 % CI 1.1-1.4, p < 0.001 and OR 1.6, 95 % CI 1.1-2.3, p = 0.02). Radiotherapy for left-sided breast cancer was associated with cardiac failure (OR 3.7, 95 % CI 1.2-11.5, p 0.026). The other 9 SNPs and clinical factors tested were not significantly associated. In our exploratory analysis, no other SNPs related to anthracycline metabolism were retained in the multivariate model for prediction of LVEF decline. ACT in breast cancer patients is related to number of received cycles of epirubicin and left-sided radiotherapy. Additional studies should be performed to independently confirm the potential association between rs246221 in ABCC1 and LVEF. PMID:26017071

  20. [Evaluation of the clinical, psychological and socio-environmental factors, affecting disability of elderly people undergoing surgical myocardial revascularization].

    PubMed

    Kantemirova, R K; Fidarova, Z D; Krivenkov, S G; Khavinson, V Kh; Kozlov, K L

    2014-01-01

    Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization are considered in the article. The authors demonstrate that for each level of the problem there are their own significant factors. Besides, the most essential correlations between investigated factors are marked out. The results obtained will enable to determine more correctly clinical-and-labor prognosis for patients with ischemic heart disease and develop their efficient rehabilitation programs. It is demonstrated that elderly patients have some features of vital activity restriction which are necessary to take into account while medical social expertise and rehabilitation program development. PMID:25306675

  1. Clinical factors related to recurrence after hepatic arterial concurrent chemoradiotherapy for advanced but liver-confined hepatocellular carcinoma

    PubMed Central

    Cha, Hyejung; Yoon, Hong In; Lee, Ik Jae; Koom, Woong Sub; Han, Kwang-Hyub; Seong, Jinsil

    2013-01-01

    Before the sorafenib era, advanced but liver-confined hepatocellular carcinoma (HCC) was treated by liver-directed therapy. Hepatic arterial concurrent chemoradiotherapy (CCRT) has been performed in our group, giving substantial local control but frequent failure. The aim of this study was to analyze patterns of failure and find out predictive clinical factors in HCC treated with a liver-directed therapy, CCRT. A retrospective analysis was done for 138 HCC patients treated with CCRT between May 2001 and November 2009. Protocol-based CCRT was performed with local radiotherapy (RT) and concurrent 5-fluorouracil (5-FU) hepatic arterial infusion chemotherapy (HAIC), followed by monthly HAIC (5-FU and cisplatin). Patterns of failure were categorized into three groups: infield, intrahepatic-outfield and extrahepatic failure. Treatment failure occurred in 34.0% of patients at 3 months after RT. Infield, intrahepatic-outfield and extrahepatic failure were observed in 12 (8.6%), 26 (18.7%) and 27 (19.6%) patients, respectively. Median progression-free survival for infield, outfield and extrahepatic failure was 22.4, 18 and 21.5 months, respectively. For infield failure, a history of pre-CCRT treatment was a significant factor (P = 0.020). Pre-CCRT levels of alpha-fetoprotein and prothrombin induced by vitamin K absence or antagonist-II were significant factors for extrahepatic failure (P = 0.029). Treatment failures after CCRT were frequent in HCC patients, and were more commonly intrahepatic-outfield and extrahepatic failures than infield failure. A history of pre-CCRT treatment and levels of pre-CCRT tumor markers were identified as risk factors that could predict treatment failure. More intensified treatment is required for patients presenting risk factors. PMID:23633620

  2. Whole food versus supplement: comparing the clinical evidence of tomato intake and lycopene supplementation on cardiovascular risk factors.

    PubMed

    Burton-Freeman, Britt M; Sesso, Howard D

    2014-09-01

    Cardiovascular disease (CVD) is a major contributor to morbidity and mortality in the United States and worldwide. A link between diet and CVD is well established, with dietary modification a foundational component of CVD prevention and management. With the discovery of bioactive components beyond the essential nutrients of foods, a new era of nutritional, medical, botanical, physiologic, and analytical sciences has unfolded. The ability to identify, isolate, purify, and deliver single components has expanded the dietary supplement business and health opportunity for consumers. Lycopene is an example of a food component that has attracted attention from scientists as well as food, agriculture, and dietary supplement industries. A major question, however, is whether delivering lycopene through a supplement source is as effective as or more effective than consuming lycopene through whole food sources, specifically the tomato, which is the richest source of lycopene in the Western diet. In this review, we examined clinical trials comparing the efficacy of lycopene supplements with tomato products on intermediate CVD risk factors including oxidative stress, inflammation, endothelial function, blood pressure, and lipid metabolism. Overall, the present review highlights the need for more targeted research; however, at present, the available clinical research supports consuming tomato-based foods as a first-line approach to cardiovascular health. With the exception of blood pressure management where lycopene supplementation was favored, tomato intake provided more favorable results on cardiovascular risk endpoints than did lycopene supplementation. Indeed, future research that is well designed, clinically focused, mechanistically revealing, and relevant to human intake will undoubtedly add to the growing body of knowledge unveiling the promise of tomatoes and/or lycopene supplementation as an integral component of a heart-healthy diet. PMID:25469376

  3. An Evaluation of the Clinical Assessments of Under-Five Febrile Children Presenting to Primary Health Facilities in Rural Ghana

    PubMed Central

    Baiden, Frank; Owusu-Agyei, Seth; Bawah, Justina; Bruce, Jane; Tivura, Mathilda; Delmini, Rupert; Gyaase, Stephaney; Amenga-Etego, Seeba; Chandramohan, Daniel; Webster, Jayne

    2011-01-01

    Background The shift to test-based management of malaria represents an important departure from established practice under the Integrated Management of Childhood Illnesses (IMCI). The possibility of false results of tests for malaria and co-morbidity, however, make it important that guidelines in IMCI case assessment are still followed. Methods and Findings We conducted a cross-sectional observational study to evaluate current practices in IMCI-based assessment of febrile children in 10 health centres and 5 district hospitals, with follow up of a subset of children to determine day 7–10 post-treatment clinical outcome. Clinical consultation, examination and prescribing practices were recorded using a checklist by trained non-medical observers. The facility case management of 1,983 under-five years old febrile children was observed and 593 followed up at home on days 5–10. The mean number of tasks performed from the 11 tasks expected to be done by the IMCI guidelines was 6 (SD 1.6). More than 6 tasks were performed in only 35% of children and this varied substantially between health facilities (range 3–85%). All 11 tasks were performed in only 1% of children. The most commonly performed tasks were temperature measurement (91%) and weighing (88%). Respiratory rate was checked in only 4% of children presenting with cough or difficulty in breathing. The likelihood of performing “better than average number of tasks” (>6) was higher when the consultation was done by medical assistants than doctors (O.R.?=?3.16, 1.02–9.20). The number of tasks performed during assessment did not, however, influence clinical outcome (O.R.?=?1.02, 0.83–1.24). Conclusion Facility-tailored interventions are needed to improve adherence to IMCI guidelines incorporating test-based management of malaria. Studies are needed to re-evaluate the continued validity of tasks defined in IMCI case assessment guidelines. PMID:22174932

  4. Ethnoracial Differences in the Clinical Characteristics of Alzheimer Disease at Initial Presentation at an Urban Alzheimer’s Disease Center

    PubMed Central

    Livney, Melissa Gartenberg; Clark, Christopher M.; Karlawish, Jason H.; Cartmell, Su; Negrón, Mirna; Nuñez-Lopez, Jessica; Xie, Sharon X.; Entenza-Cabrera, Fernando; Vega, Irving E.; Arnold, Steven E.

    2010-01-01

    Objective To compare presentation of Alzheimer disease (AD) at the time of initial evaluation at a university specialty clinic across three ethnoracial groups in order to understand similarities and differences in the demographic, clinical, cognitive, psychiatric, and biologic features. Design Cross-sectional study. Participants A total of 1,341 self-identified African American, Latino (primarily of Caribbean origin), and white non-Hispanic (“WNH”) subjects were recruited from primary care sites or by referral by primary care physicians. Measurements Demographic variables and age of onset of AD, as well as cognitive, functional, and mood impairments at the time of initial presentation and frequencies of apolipoprotein E genotypes, were compared across groups. Results Differences among ethnoracial groups were found for nearly all variables of interest. In particular, the largely immigrant Puerto Rican Latino group had an earlier age of onset of AD, more cognitive impairment, and greater severity of cognitive impairment at the time of initial evaluation in the setting of low average education and socioeconomic status. There was more depression in the Latinos compared with African Americans and WNHs. Greater severity of symptoms was not accounted for by a difference in lag time between onset of symptoms and initial evaluation. The apolipoprotein E-4 genotype was not associated with AD in the Latino cohort. Conclusions Minority groups in Philadelphia, especially Latinos, exhibit a more severe profile of AD at the time of presentation than WNHs. Important potential confounds need to be considered and future research comparing immigrant and nonimmigrant Latino groups will be necessary to elucidate the highly significant differences reported. PMID:21522051

  5. Presentation of an 85-Year-Old Woman With Musculoskeletal Pain to a Chiropractic Clinic: A Case of Ischemic Stroke

    PubMed Central

    Liebich, Julia M.; Reinke, Tari S.

    2014-01-01

    Objective The purpose of this case is to describe a patient who had a stroke preceding a chiropractic appointment and was unaware that the cerebrovascular event had occurred. Clinical features An 85-year-old established patient presented for chiropractic treatment of pain in the left side of the neck, hip, and low back associated with known advanced degenerative spinal disease and lumbar stenosis. On the day of presentation, the patient reported morning nausea, double vision, and right-sided vision loss; she related that she had collided into a car while driving to the appointment. Review of her medical history divulged residual neurological deficits related to a previous subdural hematoma, resulting in craniotomy. Examination revealed a right inferior quadrantanopia in the right eye and right nasal hemianopia in the left eye. Nystagmus was present in the left eye with saccadic intrusion on pursuit right to left. Intervention and outcome The patient was transported immediately to an emergency room,where diagnosis of an Acute infarct in the left cerebrum at the junction of the left occipital, parietal and temporal lobes in the watershed area was confirmed. Conclusion Patients with signs and symptoms of stroke in progress may occasionally present for chiropractic care. It is imperative to complete a thorough history and examination prior to care. PMID:24711785

  6. Solid variant of aneurysmal bone cyst presenting as a giant cervical mass: A clinical, radiological, histopathological dilemma

    PubMed Central

    Savardekar, Amey R.; Patra, Deviprasad; Chatterjee, Debajyoti; Ahuja, Chirag K.; Salunke, Pravin

    2015-01-01

    Background: Typical aneurysmal bone cysts (ABCs) are osteolytic, multicystic lesions with parietal sclerosis and blood-filled cysts. In rare instances, the cystic components may be completely absent. Such solid variants in ABC (s-ABC) exhibit a solid architecture; making the clinical, radiological, and histological differentiation from other solid bone tumors like osteosarcoma (especially giant cell rich osteosarcoma) and giant cell tumor, a difficult task. Case Report: We report the case of a 45–year-old male presenting with a giant solid cervical spine lesion. Histopathology revealed solid variant of ABC, even though the radiological and fine needle aspiration cytology studies pointed toward a giant cell tumor. Conclusion: We aim to discuss the clinical, radiological, and histological findings of solid ABC (a rare benign entity) vis-à-vis the common neoplastic entities of osteosarcoma and giant cell tumor. The histopathological nuisances in making the diagnosis of s-ABC are put forth, along with its impact on management of such giant bony spinal lesions. PMID:26005581

  7. A Mutation-Sensitive Switch Assay to Detect Five Clinically Significant Epidermal Growth Factor Receptor Mutations.

    PubMed

    Liu, Bin; Zhou, Lin; Wang, Qian; Li, Kai

    2015-06-01

    Epidermal growth factor receptor (EGFR) mutations can affect the therapeutic efficacy of drugs used to treat nonsmall-cell lung cancer (NSCLC). We aimed to develop methods to detect five common EGFR somatic mutations in tumor tissues from NSCLC patients by using a nanoscale mutation-sensitive switch consisting of a high-fidelity polymerase and phosphorothioate-modified allele-specific primers. The five clinically significant EGFR mutations examined here are S768I, T790M, L858R, and 15- and 18-bp deletion mutations in exon 19. Our assays showed sensitivities of 100 copies and specificities of more than three log scales for matched templates relative to mismatched templates by routine polymerase chain reaction (PCR), real-time PCR, and multiplex PCR. This assay would be superior to DNA sequencing in situations where mutant DNA is not abundant. PMID:25918867

  8. Chronic disease risk factors, healthy days and medical claims in South African employees presenting for health risk screening

    PubMed Central

    Kolbe-Alexander, Tracy L; Buckmaster, Chris; Nossel, Craig; Dreyer, Liezel; Bull, Fiona; Noakes, Timothy D; Lambert, Estelle V

    2008-01-01

    Background Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour. Methods Employees (n = 1954) from 18 companies were invited to take part in a wellness day, which included a health-risk assessment. Self-reported health behaviour and health status was recorded. Clinical measures included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Health-related age was calculated using an algorithm incorporating the relative risk for all case mortality associated with smoking, physical activity, fruit and vegetable intake, BMI and cholesterol. Medical claims data were obtained from the health insurer. Results The mean percentage of participation was 26% (n = 1954) and ranged from 4% in transport to 81% in the consulting sector. Health-related age (38.5 ± 12.9 years) was significantly higher than chronological age (34.9 ± 10.3 yrs) (p < 0.001). Both chronological and risk-related age were significantly different between the sectors (P < 0.001), with the manufacturing sector being the oldest and finance having the youngest employees. Health-related age was significantly associated with number of days adversely affected by mental and physical health, days away from work and total annual medical costs (p < 0.001). Employees had higher rates of overweight, smoking among men, and physical inactivity (total sample) when compared the general SA population. Increased health-related expenditure was associated with increased number of risk factors, absenteeism and reduced physical activity. Conclusion SA employees' health and lifestyle habits are placing them at increased risk for NCD's, suggesting that they may develop NCD's earlier than expected. Inter-sectoral differences for health-related age might provide insight into those companies which have the greatest need for interventions, and may also assist in predicting future medical expenditure. This study underscores the importance of determining the health and risk status of employees which could assist in identifying the appropriate interventions to reduce the risk of NCD's among employees. PMID:18601718

  9. Epidermal growth factor receptor (EGFR) mutations in lung cancer: preclinical and clinical data

    PubMed Central

    Jorge, S.E.D.C.; Kobayashi, S.S.; Costa, D.B.

    2014-01-01

    Lung cancer leads cancer-related mortality worldwide. Non-small-cell lung cancer (NSCLC), the most prevalent subtype of this recalcitrant cancer, is usually diagnosed at advanced stages, and available systemic therapies are mostly palliative. The probing of the NSCLC kinome has identified numerous nonoverlapping driver genomic events, including epidermal growth factor receptor (EGFR) gene mutations. This review provides a synopsis of preclinical and clinical data on EGFR mutated NSCLC and EGFR tyrosine kinase inhibitors (TKIs). Classic somatic EGFR kinase domain mutations (such as L858R and exon 19 deletions) make tumors addicted to their signaling cascades and generate a therapeutic window for the use of ATP-mimetic EGFR TKIs. The latter inhibit these kinases and their downstream effectors, and induce apoptosis in preclinical models. The aforementioned EGFR mutations are stout predictors of response and augmentation of progression-free survival when gefitinib, erlotinib, and afatinib are used for patients with advanced NSCLC. The benefits associated with these EGFR TKIs are limited by the mechanisms of tumor resistance, such as the gatekeeper EGFR-T790M mutation, and bypass activation of signaling cascades. Ongoing preclinical efforts for treating resistance have started to translate into patient care (including clinical trials of the covalent EGFR-T790M TKIs AZD9291 and CO-1686) and hold promise to further boost the median survival of patients with EGFR mutated NSCLC. PMID:25296354

  10. Clinical significance of serum epidermal growth factor receptor (EGFR) levels in patients with breast cancer.

    PubMed

    Tas, Faruk; Bilgin, Elif; Karabulut, Senem; Duranyildiz, Derya

    2015-01-01

    Epidermal growth factor receptor (EGFR) plays an important role in the pathogenesis of multiple malignancies and its expression strongly also affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of EGFR in breast cancer (BC) patients. A total of 96 patients with a pathologically confirmed diagnosis of BC were enrolled into this study. Serum EGFR levels were determined by the solid-phase sandwich ELISA method. Age and sex matched 30 healthy controls were included in the analysis. Median age of diagnosis was 48years old (range: 29-80). Thirty-seven (39%) consisted of metastatic disease. The baseline serum EGFR levels were significantly higher than in the healthy control group (p<0.001). The serum EGFR concentrations were also significantly higher only in patients with ER-negative and triple-negative tumor (p=0.05 and p=0.04, respectively). The other known clinical variables, including grade of histology, stage of disease, serum CA 15.3 levels, and response to chemotherapy were not found to be correlated with serum EGFR concentrations (p>0.05). Likewise, serum EGFR levels were found to play no prognostic role for survival (p=0.35). In conclusion, while serum EGFR levels were elevated in BC patients, EGFR level has no predictive and prognostic value in these patients. PMID:25259789

  11. Epidermal growth factor receptor (EGFR) mutations in lung cancer: preclinical and clinical data.

    PubMed

    Jorge, S E D C; Kobayashi, S S; Costa, D B

    2014-09-01

    Lung cancer leads cancer-related mortality worldwide. Non-small-cell lung cancer (NSCLC), the most prevalent subtype of this recalcitrant cancer, is usually diagnosed at advanced stages, and available systemic therapies are mostly palliative. The probing of the NSCLC kinome has identified numerous nonoverlapping driver genomic events, including epidermal growth factor receptor (EGFR) gene mutations. This review provides a synopsis of preclinical and clinical data on EGFR mutated NSCLC and EGFR tyrosine kinase inhibitors (TKIs). Classic somatic EGFR kinase domain mutations (such as L858R and exon 19 deletions) make tumors addicted to their signaling cascades and generate a therapeutic window for the use of ATP-mimetic EGFR TKIs. The latter inhibit these kinases and their downstream effectors, and induce apoptosis in preclinical models. The aforementioned EGFR mutations are stout predictors of response and augmentation of progression-free survival when gefitinib, erlotinib, and afatinib are used for patients with advanced NSCLC. The benefits associated with these EGFR TKIs are limited by the mechanisms of tumor resistance, such as the gatekeeper EGFR-T790M mutation, and bypass activation of signaling cascades. Ongoing preclinical efforts for treating resistance have started to translate into patient care (including clinical trials of the covalent EGFR-T790M TKIs AZD9291 and CO-1686) and hold promise to further boost the median survival of patients with EGFR mutated NSCLC. PMID:25211582

  12. Epidermal growth factor receptor (EGFR) mutations in lung cancer: preclinical and clinical data.

    PubMed

    Jorge, S E D C; Kobayashi, S S; Costa, D B

    2014-11-01

    Lung cancer leads cancer-related mortality worldwide. Non-small-cell lung cancer (NSCLC), the most prevalent subtype of this recalcitrant cancer, is usually diagnosed at advanced stages, and available systemic therapies are mostly palliative. The probing of the NSCLC kinome has identified numerous nonoverlapping driver genomic events, including epidermal growth factor receptor (EGFR) gene mutations. This review provides a synopsis of preclinical and clinical data on EGFR mutated NSCLC and EGFR tyrosine kinase inhibitors (TKIs). Classic somatic EGFR kinase domain mutations (such as L858R and exon 19 deletions) make tumors addicted to their signaling cascades and generate a therapeutic window for the use of ATP-mimetic EGFR TKIs. The latter inhibit these kinases and their downstream effectors, and induce apoptosis in preclinical models. The aforementioned EGFR mutations are stout predictors of response and augmentation of progression-free survival when gefitinib, erlotinib, and afatinib are used for patients with advanced NSCLC. The benefits associated with these EGFR TKIs are limited by the mechanisms of tumor resistance, such as the gatekeeper EGFR-T790M mutation, and bypass activation of signaling cascades. Ongoing preclinical efforts for treating resistance have started to translate into patient care (including clinical trials of the covalent EGFR-T790M TKIs AZD9291 and CO-1686) and hold promise to further boost the median survival of patients with EGFR mutated NSCLC. PMID:25296354

  13. Early Australian clinical studies with pegylated recombinant human megakaryocyte growth and development factor.

    PubMed

    Basser, R L

    1998-01-01

    Pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF, an Mpl ligand) is a truncated form of native thrombopoietin currently undergoing clinical development. A series of studies in Australia have examined the safety and biological activities of PEG-rHuMGDF. Administration of PEG-rHuMGDF causes a dose-dependent increase in platelet count but has no effect on white cell count or hematocrit. These platelets are morphologically and functionally normal. When administered following moderately myelosuppressive chemotherapy, PEG-rHuMGDF significantly enhances platelet recovery, although scheduling in relation to chemotherapy may be important in optimizing the full effects. PEG-rHuMGDF mobilizes progenitor cells of multiple hematopoietic lineages, and alters the kinetics of peripheral blood progenitor cell mobilization after chemotherapy and filgrastim. PEG-rHuMGDF is well tolerated and does not cause toxicity similar to that observed with other thrombopoietic cytokines. Numerous studies are underway to help determine the precise role of PEG-rHuMGDF in clinical practice. PMID:11012194

  14. Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study

    PubMed Central

    2014-01-01

    Background Oral presentations of clinical cases by medical students during medical rounds in hospital wards are a source of anxiety and little is known about how this anxiety can be alleviated. The objective of this study was to investigate whether video-based feedback of public oral presentations can reduce anxiety in 4th year medical students. Methods Multicentre randomized study conducted in six intensive care units (ICU) and emergency departments (ED) in France over a 9-month period in 2012. One hundred and forty two 4th year medical students were randomized to two groups: intervention and control. Students in the intervention group were recorded while making an oral presentation of a patient during morning ward rounds, followed by video-based feedback. Students in the control group conducted presented classical oral presentations without being filmed and with no formal feedback. Anxiety levels during a public oral presentation were assessed using the Spielberger State Anxiety Inventory (STAI-S). The primary outcome was the difference in STAI-S scores between groups at the beginning and at the end of a 3-month ICU or ED internship. Results Seventy four students were randomized to the ‘video-based feedback’ group and 68 were randomized to the control group. In both groups, STAI-S scores were significantly lower after 3 months of internship. However, the reduction in STAI-S scores was significantly greater in the “video-based feedback” group than in controls (-9.2?±?9.3 vs. –4.6?±?8.2, p?=?0.024. Compared to the control group, significantly fewer students with high-level anxiety were observed in the “video-based feedback” group after 3 months of internship (68 vs. 28%, p <0.001). Conclusions Compared to “usual practice”, video-assisted oral feedback reduced anxiety and significantly decreased the proportion of students experiencing severe anxiety. PMID:24885005

  15. The immunopathology of siliconosis. History, clinical presentation, and relation to silicosis and the chemistry of silicon and silicone.

    PubMed

    Shanklin, D R; Smalley, D L

    1998-01-01

    Recent evidence confirms the fundamental involvement of the human immune system in the reaction to implantation of silicone-based medical devices. An as yet-to-be particularized epitope of many complex substances sharing siloxane structures is presented through the MHC-II apparatus with development and retention of T cell memory. This memory can be tested for in practical terms using one or more forms of silica, which links the immuno-histopathology and autoimmune attributes of "silicosis" with those of "siliconosis." The lesions of siliconosis are typical of those for persistent antigens and delayed, cell mediated hypersensitivity. The basic descriptive pathology of the reaction to silicone has been known since soon after introduction of silicones in medical procedures, with the exception of some details related to the more recent discoveries on the role of cytokines in the immunopathic process. The clinical consequences of siliconosis are common and can be severe in some individuals implanted with silicone devices. PMID:9951648

  16. Monte Carlo calculations of correction factors for plastic phantoms in clinical photon and electron beam dosimetry

    SciTech Connect

    Araki, Fujio; Hanyu, Yuji; Fukuoka, Miyoko; Matsumoto, Kenji; Okumura, Masahiko; Oguchi, Hiroshi [Department of Radiological Technology, Kumamoto University School of Health Sciences, 4-24-1, Kuhonji, Kumamoto, 862-0976 (Japan); Division of Radiation Oncology, Tokyo Women's Medical University Hospital, Tokyo, 162-8666 (Japan); Department of Central Radiology, Kinki University Hospital, Osaka, 589-8511 (Japan); Department of Central Radiology, Shinshu University Hospital, Matsumoto, 390-8621 (Japan)

    2009-07-15

    The purpose of this study is to calculate correction factors for plastic water (PW) and plastic water diagnostic-therapy (PWDT) phantoms in clinical photon and electron beam dosimetry using the EGSnrc Monte Carlo code system. A water-to-plastic ionization conversion factor k{sub pl} for PW and PWDT was computed for several commonly used Farmer-type ionization chambers with different wall materials in the range of 4-18 MV photon beams. For electron beams, a depth-scaling factor c{sub pl} and a chamber-dependent fluence correction factor h{sub pl} for both phantoms were also calculated in combination with NACP-02 and Roos plane-parallel ionization chambers in the range of 4-18 MeV. The h{sub pl} values for the plane-parallel chambers were evaluated from the electron fluence correction factor {phi}{sub pl}{sup w} and wall correction factors P{sub wall,w} and P{sub wall,pl} for a combination of water or plastic materials. The calculated k{sub pl} and h{sub pl} values were verified by comparison with the measured values. A set of k{sub pl} values computed for the Farmer-type chambers was equal to unity within 0.5% for PW and PWDT in photon beams. The k{sub pl} values also agreed within their combined uncertainty with the measured data. For electron beams, the c{sub pl} values computed for PW and PWDT were from 0.998 to 1.000 and from 0.992 to 0.997, respectively, in the range of 4-18 MeV. The {phi}{sub pl}{sup w} values for PW and PWDT were from 0.998 to 1.001 and from 1.004 to 1.001, respectively, at a reference depth in the range of 4-18 MeV. The difference in P{sub wall} between water and plastic materials for the plane-parallel chambers was 0.8% at a maximum. Finally, h{sub pl} values evaluated for plastic materials were equal to unity within 0.6% for NACP-02 and Roos chambers. The h{sub pl} values also agreed within their combined uncertainty with the measured data. The absorbed dose to water from ionization chamber measurements in PW and PWDT plastic materials corresponds to that in water within 1%. Both phantoms can thus be used as a substitute for water for photon and electron dosimetry.

  17. When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood

    Microsoft Academic Search

    E. Brunner; M. J. Shipley; D. Blane; G. D. Smith; M. G. Marmot

    1999-01-01

    STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women

  18. Factors Associated with Recent Suicide Attempts in Clients Presenting for Addiction Treatment

    ERIC Educational Resources Information Center

    Penney, Alexander; Mazmanian, Dwight; Jamieson, John; Black, Nancy

    2012-01-01

    Factors associated with recent suicide attempts were examined in clients who sought treatment at an addictions facility between 2001 and 2008. Clients who reported being hospitalized for attempting suicide in the past year (n = 76) were compared to all other clients (n = 5914) on demographic, mental health, substance use, and problem gambling…

  19. Factors affecting cure when treating bovine clinical mastitis with cephalosporin-based intramammary preparations

    PubMed Central

    Bradley, A. J.; Green, M. J.

    2009-01-01

    Data were collated for an independent scientific analysis from 2 international, multicenter studies that had compared the efficacy of 3 different cephalosporin-containing intramammary preparations in the treatment of clinical mastitis in dairy cattle [cefalexin (first generation) in combination with kanamycin; cefquinome (fourth generation); and cefoperazone (third generation)]. Quarters were assessed using standard bacteriological techniques before treatment and at 16 and 25 d posttreatment. Additional data were also available on individual cows and study farms, including parity, breed, and cow somatic cell count histories, herd bulk milk somatic cell counts, and farm management regimens. Sufficient data for analysis were available from a total of 491 cases on 192 farms in 3 countries (United Kingdom, France, and Germany) with up to 16 cases being recruited from any one farm. Clinical cases were of diverse etiology, representing both contagious and environmental pathogens. Univariable analysis demonstrated that quarters in the cefalexin + kanamycin and cefquinome treatment groups were not significantly different from each other, but were both significantly more likely to be pathogen free posttreatment than quarters in the cefoperazone group. Multivariable analysis was undertaken using conventional random effects models. Two models were built, with the first incorporating only information available to the practitioner at the time of treatment and the second including all information collected during the study. These models indicated that country, pretreatment rectal temperature (above-normal temperature associated with an increased chance of being pathogen free posttreatment), individual cow somatic cell count (increased somatic cell count associated with a decreased chance of being pathogen free posttreatment), and pathogen (Staphylococcus aureus isolation associated with a decreased chance of being pathogen free posttreatment) were useful predictors of pathogen free status; parity, yield, bulk milk somatic cell counts, and other farm management factors were not. The importance of country in the analysis demonstrates the need to generate local data when assessing treatment regimens. In addition, these results suggest that the factors important in predicting the outcome of treatment of clinical mastitis cases may be dissimilar to those reported to affect the likelihood of cure when treating subclinical intramammary infections. PMID:19389951

  20. Factors affecting cure when treating bovine clinical mastitis with cephalosporin-based intramammary preparations.

    PubMed

    Bradley, A J; Green, M J

    2009-05-01

    Data were collated for an independent scientific analysis from 2 international, multicenter studies that had compared the efficacy of 3 different cephalosporin-containing intramammary preparations in the treatment of clinical mastitis in dairy cattle [cefalexin (first generation) in combination with kanamycin; cefquinome (fourth generation); and cefoperazone (third generation)]. Quarters were assessed using standard bacteriological techniques before treatment and at 16 and 25 d posttreatment. Additional data were also available on individual cows and study farms, including parity, breed, and cow somatic cell count histories, herd bulk milk somatic cell counts, and farm management regimens. Sufficient data for analysis were available from a total of 491 cases on 192 farms in 3 countries (United Kingdom, France, and Germany) with up to 16 cases being recruited from any one farm. Clinical cases were of diverse etiology, representing both contagious and environmental pathogens. Univariable analysis demonstrated that quarters in the cefalexin + kanamycin and cefquinome treatment groups were not significantly different from each other, but were both significantly more likely to be pathogen free posttreatment than quarters in the cefoperazone group. Multivariable analysis was undertaken using conventional random effects models. Two models were built, with the first incorporating only information available to the practitioner at the time of treatment and the second including all information collected during the study. These models indicated that country, pretreatment rectal temperature (above-normal temperature associated with an increased chance of being pathogen free posttreatment), individual cow somatic cell count (increased somatic cell count associated with a decreased chance of being pathogen free posttreatment), and pathogen (Staphylococcus aureus isolation associated with a decreased chance of being pathogen free posttreatment) were useful predictors of pathogen free status; parity, yield, bulk milk somatic cell counts, and other farm management factors were not. The importance of country in the analysis demonstrates the need to generate local data when assessing treatment regimens. In addition, these results suggest that the factors important in predicting the outcome of treatment of clinical mastitis cases may be dissimilar to those reported to affect the likelihood of cure when treating subclinical intramammary infections. PMID:19389951

  1. High phosphohistone h3 expression correlates with adverse clinical, biological, and pathological factors in neuroblastomas.

    PubMed

    Ramani, Pramila; Taylor, Scott; Miller, Elizabeth; Sowa-Avugrah, Emile; May, Margaret T

    2015-06-01

    Phosphohistone H3 (pHH3), a biomarker of the late G2- and M-phase of the cell cycle, provides a powerful indication of the proliferative state of many cancers. We investigated the prognostic significance of pHH3 by immunostaining 80 neuroblastomas and counting the average number of strongly stained nuclei and mitotic figures. The median and 75th percentile pHH3 proliferation indices (PIs) were 0.54% and 1.06% (range, 0.01% to 2.23%) respectively. pHH3 expression was significantly higher in neuroblastomas from patients with adverse clinical characteristics, all unfavorable pathological factors including high mitosis karyorrhexis index (MKI), and adverse biological factors including MYCN oncogene amplification. High pHH3-PIs, at 1% threshold, were significantly associated with a shorter overall survival (OS) and event-free survival (EFS) in the univariable Cox regression analyses. In the multivariable models, high pHH3 counts were significantly associated with worse OS after adjustment for age but were not independent of either high MKI or MYCN amplification. In children less than 18 months of age, high MKIs and high PHH3-PIs were associated with significantly worse OS and EFS. In conclusion, high pHH3 expression correlates strongly with high MKI and MYCN amplification and indicates poor prognosis in neuroblastomas. PMID:25711230

  2. Factors Influencing Condom Use among Sexually Transmitted Infection Clinic Patients in Montego Bay, Jamaica

    PubMed Central

    Nnedu, Obinna N.; McCorvey, Staci; Campbell-Forrester, Sheila; Chang, Janice; Salihu, Hamisu M.; Jolly, Pauline E.

    2009-01-01

    The use of condoms can reduce the risk of sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV) infection. We conducted this study to determine factors that impact condom use among patients attending an STI clinic in Montego Bay, Jamaica. A questionnaire containing sections on socio-demographic characteristics, knowledge of STIs and HIV, preventive measures for STI/HIV transmission and sexual practices including condom use was administered to 212 participants. Using logistic regression, we determined the relationship between the different factors and condom use during the last sexual episode. Approximately 43% of study participants reported condom use during the last sexual episode. Employment (OR=2.2; 95%CI=1.1–4.1) and greater knowledge of STIs (OR=1.9, 95%CI=1.02–3.6) were associated with increased likelihood of condom use during the last sexual episode. Having multiple sexual partners was associated with decreased likelihood to report condom use (OR=0.3, 95%CI=0.1–0.9). Also, persons belonging to a religious organization were less likely to report condom use (OR=0.5, 95%CI=0.2–0.9). The results of this study can be used in formulating effective strategies to increase condom use in Montego Bay. This would decrease the transmission of STIs and HIV. PMID:20182645

  3. Growth status of children in well-baby outpatient clinics and related factors

    PubMed Central

    Çelik, Sercan Bulut; ?ahin, Figen; Beyazova, Ufuk; Can, Hüseyin

    2014-01-01

    Aim: The aim of this study was to determine the state of growth during follow-up of healthy children and the factors affecting growth. Material and Methods: The patient cards of the infants who were born in 2002 and followed up in the well-baby outpatient clinic in Gazi University, Medical Faculty regularly for at least 18 months were examined retrospectively. Their sociodemographic properties including age, education level, occupation of the parents, if the mother was working, caretakers and gender, gestational week, birth weight, birth height and mode of nutrition (breastmilk, formula, cow’s milk, period of feeding, etc.) and growth of the babies (month, percentile) were recorded. Number of siblings and ages of the siblings were also recorded and the children with and without growth problems were compared in terms of these properties. Results: It was found that 290 (39.3%) of 739 children who were followed up continued to grow up in the percentile in which they started (normal growth), 188 (25.4%) lost 2 or more percentiles in any month (growth retardation) and 261 (35.3%) lost less than 2 percentiles (decelerated growth). Deceleration/retardation in growth was observed most commonly in the 9th month. Deceleration in growth was found in the 6th month in 23.6% of the group with deceleration in growth, in the 9th month in 50.2%, in the 12th month in 15.8% and in the 18th month in 3.9%. Growth retardation was found in the 6th month in 35.8% of the group with growth retardation, in the 9th month in 38.0% and in the 18th month in 4.3%. It was found that receiving formula and presence of infection were the main risk factors in terms of deceleration of growth and unemployed mother, the lenght of the total time of breastfeeding and presence of infection were the main risk factors in terms of growth retardation. Conclusions: This study shows the importance of follow-up of growth of children in outpatient clinics for healthy children. It was found that detailed examination and recording of non-organic causes is necessary in addition to investigation of pathological causes of growth retardation. Since it was observed that elimination of the defects determined and educating the family about nutrition and supporting growth had a positive impact on growth retardation, it was concluded that all children should be followed up regularly especially in the first years of life.

  4. Clinical significance of hepatocyte growth factor/c-Met expression in the assessment of gastric cancer progression

    PubMed Central

    NOGUCHI, EIICHIRO; SAITO, NOBORU; KOBAYASHI, MAKIO; KAMEOKA, SHINGO

    2015-01-01

    Among the mechanisms that control cancer progression, cell mobility is a significant factor required for cellular liberation from the primary focus and infiltration. Hepatocyte growth factor (HGF) has been shown to facilitate cell mobility. In the present study, the clinical significance of the HGF/c-Met pathway in the assessment of gastric cancer progression was evaluated. From a cohort of patients with gastric cancer who underwent surgical resection between April 1999 and March 2003, 110 subjects were randomly selected. Preoperative serum HGF levels were measured and various pathological factors were analyzed. Furthermore, 50 subjects were randomly selected from within this group and immunohistochemical staining of tissue preparations for HGF and its receptor c-Met were performed. In the infiltrative growth pattern [(INF)?,? vs. INF?], advanced progression was associated with elevated preoperative serum HGF levels (P<0.001). No correlation was identified between serum HGF levels and immunostaining for HGF or c-Met in the tissue preparations. Immunostaining revealed a significant correlation between c-Met expression and lymphatic vessel invasion (ly0.1 vs. 2.3; P=0.0416), lymph node metastasis (n0.1 vs. 2; P=0.0184) and maximum tumor diameter (?50 mm vs. >50 mm; P=0.0469). Furthermore, c-Met-positivity was associated with a significant difference in overall survival (P=0.0342), despite stage I and II cases accounting for 82% of the total cohort (41 of 50 cases). These results suggested that the expression of the HGF/c-Met pathway in gastric cancer may be a potential predictive factor for disease progression. PMID:25592281

  5. Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan

    PubMed Central

    Nagata, Takashi; Abe, Takeru; Noda, Eiichiro; Hasegawa, Manabu; Hashizume, Makoto; Hagihara, Akihito

    2014-01-01

    Objectives To better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA). Design A population-based, observational study. Setting The National Japan Utstein Registry. Participants 2900 children aged 5–17?years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or 2. A validation study was conducted to verify the model. Results OHCA was identified as cardiac origin in 706 participants and non-cardiac origin in 2194 participants. Rates of CPC 1 or 2 for cardiac and non-cardiac causes were 20% and 6.4%, respectively. Cardiac origin arrest was categorised following signal detection into six subgroups defined by public automated external defibrillator use, defibrillation by emergency medical service, age, initial ECG rhythm and eye-witness to arrest; the ranges of CPC 1 or 2 in the six subgroups were between 87.5% and 0.7%. Non-cardiac origin arrest was categorised into four subgroups. Bystander rescue breathing was the most significant factor contributing to outcome; additionally, two other factors—eye-witness to arrest and age—were also significant. CPC 1 or 2 rates ranged between 38.5% and 4% across the four subgroups. Rates of CPC 1 or 2 in the validation study did not differ among any subgroup. Conclusions For children who have OHCA from non-cardiac origin, bystander rescue breathing is mandatory to achieve CPC 1 or 2. PMID:24525386

  6. Surgical Treatment for Patients with Krukenberg Tumor of Stomach Origin: Clinical Outcome and Prognostic Factors Analysis

    PubMed Central

    Jiang, Rong; Ren, Chao; Jia, Yong-Nin; Li, Jin; Guo, Wei-Jian

    2013-01-01

    Krukenberg tumor originated from stomach in female patients is common in clinical practice, but it is still uncertain whether surgical resection of ovarian metastases could improve the outcome. Some studies suggested that a certain group of patients could benefit from the resection of ovarian metastases. However, conclusions were different between studies and there was no data to illustrate if certain molecular markers were associated with patients’ survival. In this study, we analyzed the effects of resection of ovarian metastases, and investigated prognostic factors in 133 patients with ovarian metastases originated from stomach. Furthermore, we examined the expression of some cancer stem cells (CSCs) markers or related molecules in 64 ovarian metastases specimens and analyzed the correlation between these molecules and patients’ survival. We found that the median overall survival (mOS) of all 133 patients was 16 months, and “gastrectomy” and “without ascites” were two independent prognostic factors associated with longer survival. The mOS of the patients with gastrectomy was longer than that of patients had not undergone gastrectomy (19 vs. 9 months, p?=?0.048). Patients without ascites survived longer than those with ascites (mOS: 21 vs. 13 months, p?=?0.008). We also found that Sox2, CD44 or CD133 positive expression in ovarian metastases were risk factors correlated with poor survival, and Sox2 expression was an independent prognostic indicator. These results suggested that ovarian metastasectomy might help to prolong the survivor of some patients with Krukenberg tumor originated from stomach. Patients without ascites, and with resected or resectable primary gastric cancer lesion could get benefit from and be potential candidate for surgical treatment. The expression of Sox2 might serve as a prognostic indicator for predicting patients’ survival and be helpful for selecting patients in future. PMID:23874550

  7. Surgical treatment for patients with Krukenberg tumor of stomach origin: clinical outcome and prognostic factors analysis.

    PubMed

    Peng, Wei; Hua, Rui-Xi; Jiang, Rong; Ren, Chao; Jia, Yong-Nin; Li, Jin; Guo, Wei-Jian

    2013-01-01

    Krukenberg tumor originated from stomach in female patients is common in clinical practice, but it is still uncertain whether surgical resection of ovarian metastases could improve the outcome. Some studies suggested that a certain group of patients could benefit from the resection of ovarian metastases. However, conclusions were different between studies and there was no data to illustrate if certain molecular markers were associated with patients' survival. In this study, we analyzed the effects of resection of ovarian metastases, and investigated prognostic factors in 133 patients with ovarian metastases originated from stomach. Furthermore, we examined the expression of some cancer stem cells (CSCs) markers or related molecules in 64 ovarian metastases specimens and analyzed the correlation between these molecules and patients' survival. We found that the median overall survival (mOS) of all 133 patients was 16 months, and "gastrectomy" and "without ascites" were two independent prognostic factors associated with longer survival. The mOS of the patients with gastrectomy was longer than that of patients had not undergone gastrectomy (19 vs. 9 months, p?=?0.048). Patients without ascites survived longer than those with ascites (mOS: 21 vs. 13 months, p?=?0.008). We also found that Sox2, CD44 or CD133 positive expression in ovarian metastases were risk factors correlated with poor survival, and Sox2 expression was an independent prognostic indicator. These results suggested that ovarian metastasectomy might help to prolong the survivor of some patients with Krukenberg tumor originated from stomach. Patients without ascites, and with resected or resectable primary gastric cancer lesion could get benefit from and be potential candidate for surgical treatment. The expression of Sox2 might serve as a prognostic indicator for predicting patients' survival and be helpful for selecting patients in future. PMID:23874550

  8. Factors affecting the occurrence of postpartum prolonged luteal activity in clinically healthy high-producing dairy cows

    Microsoft Academic Search

    Mojtaba Kafi; Abdolah Mirzaei; Amin Tamadon; Mehdi Saeb

    The objective was to characterize risk factors affecting the occurrence of prolonged luteal phase (PLP) in postpartum, clinically healthy, high-producing dairy cows. Transrectal ultrasound examinations of the reproductive tract were performed twice weekly, from the 1st to 8th wk after calving in 151 multiparous clinically healthy lactating Holstein cows (mean ± SD of peak milk yield = 56.7 ± 7.4

  9. Clinical Presentation and Pathogenesis of Cold-Induced Autoinflammatory Disease in a Family With Recurrence of an NLRP12 Mutation

    PubMed Central

    Borghini, S; Tassi, S; Chiesa, S; Caroli, F; Carta, S; Caorsi, R; Fiore, M; Delfino, L; Lasigliè, D; Ferraris, C; Traggiai, E; Di Duca, M; Santamaria, G; D'Osualdo, A; Tosca, M; Martini, A; Ceccherini, I; Rubartelli, A; Gattorno, M

    2011-01-01

    Objective NLRP12 mutations have been described in patients affected with peculiar autoinflammatory symptoms. This study was undertaken to characterize NLRP12 mutations in patients with autoinflammatory syndromes, particularly a novel missense mutation, p.D294E, affecting a protein sequence crucial for ATP binding, which was identified in a Caucasian family with familial cold-induced autoinflammatory syndrome in some family members. Methods Fifty patients were tested for NLRP12 mutations. A Caucasian family with the p.D294E missense mutation of NLRP12 in some family members was clinically characterized. In vitro analysis of the effects of the mutation on NF-?B activity was performed in HEK 293 cells after cotransfection of the cells with a luciferase NF-?B–responsive element and mutant or wild-type (WT) NLRP12 expression plasmids. NF-?B activity was also evaluated 24 hours after stimulation with tumor necrosis factor ? in monocytes from individual family members carrying the mutation. Furthermore, secretion of interleukin-1? (IL-1?), production of reactive oxygen species (ROS), and activation of antioxidant systems in patient and healthy donor monocytes, under resting conditions and after stimulation with pathogen-associated molecular patterns (PAMPs), were also assessed. Results In the family assessed, the p.D294E mutation segregated in association with a particular sensitivity to cold exposure (especially arthralgias and myalgia), but not always with an inflammatory phenotype (e.g., urticarial rash or fever). In vitro, the mutant protein maintained the same inhibitory activity as that shown by WT NLRP12. Consistently, NLRP12-mutated monocytes showed neither increased levels of p65-induced NF-?B activity nor higher secretion of IL-1?. However, the kinetics of PAMP-induced IL-1? secretion were significantly accelerated, and high production of ROS and up-regulation of antioxidant systems were demonstrated. Conclusion Even with a variable range of associated manifestations, the extreme sensitivity to cold represents the main clinical hallmark in an individual carrying the p.D294E mutation of the NLRP12 gene. Although regulation of NF-?B activity is not affected in patients, redox alterations and accelerated secretion of IL-1? are associated with this mild autoinflammatory phenotype. PMID:21360512

  10. Severe Clinical Presentation of Visceral Leishmaniasis in Naturally Infected Dogs with Disruption of the Splenic White Pulp

    PubMed Central

    Lima, Isadora S.; Silva, Joselli S.; Almeida, Valter A.; Junior, Floriano G. Leal.; Souza, Patrício AN.; Larangeira, Daniela F.; Moura-Neto, José P.; Fraga, Deborah BM.; de Freitas, Luiz A. R.; dos-Santos, Washington L.C.

    2014-01-01

    In this work, we investigated the association between the disruption of splenic lymphoid tissue and the severity of visceral leishmaniasis in dogs. Clinical and laboratory data from 206 dogs were reviewed. Spleen sections collected during the euthanasia of these animals were analyzed, and the splenic lymphoid tissue samples were classified as well organized (spleen type 1), slightly disorganized (spleen type 2), or moderately to extensively disorganized (spleen type 3). Of 199 dogs with evidence of Leishmania infection, 54 (27%) had spleen type 1, 99 (50%) had spleen type 2, and 46 (23%) had spleen type 3. The number of clinical signs associated with visceral leishmaniasis was significantly higher in the animals with evidence of Leishmania infection and spleen type 2 or 3 than in the animals with spleen type 1. Alopecia, anemia, dehydration, dermatitis, lymphadenopathy, and onychogryphosis were all more frequent among animals with evidence of Leishmania infection and spleen type 3 than among the dogs with evidence of Leishmania infection and spleen type 1. The association between the severity of canine visceral leishmaniasis and the disorganization of the splenic lymphoid tissue was even more evident in the group of animals with positive spleen culture. Conjunctivitis and ulceration were also more common in the animals with spleen type 3 than in the animals with spleen type 1. The serum levels (median, interquartile range) of albumin (1.8, 1.4–2.3 g/dL) and creatinine (0.7, 0.4–0.8 mg/dL) were significantly lower and the serum levels of aspartate aminotransferase were significantly higher (57, 39–95 U) in animals with spleen type 3 than in animals with spleen type 1 (2.8, 2.4–3.4 g/dL; 0.9, 0.7–1.2 mg/dL and 23, 20–32 U, respectively). Our data confirm the hypothesis that disruption of the splenic lymphoid tissue is associated with a more severe clinical presentation of canine visceral leishmaniasis. PMID:24498367

  11. Clinical presentation and causes of the delayed diagnosis of breast cancer in patients with pregnancy associated breast cancer

    PubMed Central

    Al-Amri, Ali M.

    2015-01-01

    Objective: The objective was to assess the clinical presentation, delay of diagnosis, and the causes of delay in the diagnosis of patients with pregnancy-associated breast cancer (PABC) and patients with non-PABC. Patients and Methods: This was a face-to-face interview with women who had histologically confirmed BC. All respondents were interviewed at our hospital. Results: We interviewed 56 patients, 36 with non-PABC and 20 with PABC. Of the 20 patients with PABC, BC was diagnosed in 12 (60%) during pregnancy and 8 (40%) during postpartum. 18 of the patients (90%) with PABC presented mainly with a mass 3 (15%) with pain and ulcer, 5 (25%) with skin redness and thickening, 6 (30%) with nipple retraction and 4 (20%) with discharge 12 (60%) patients with PABC had delayed diagnosis and 8 (40%) of this delay was due to physicians’ reassurance, and 2 (10%) because of fear of cancer. Similarly, 35 (97%) patients with non-PABC presented with breast mass, 3 (8.3%) with infrequent pain 4 (11.11%) with inflammation 2 (5.55%) with ulcer 2 (5.55%) with nipple discharge and4 (11.11%) with thickening of the skin compared with PABC patients. Only 4 (11.11%) in non-PABC had delayed diagnosis, and for half of them the delay was due to the fear of cancer. Two patients with PABC and non-PABC were afraid of cancer 16.66% and 5.55%, respectively. However, 8 (60%) of patients with PABC had delayed diagnosis compared to 0% of patients with non-PABC. Conclusion: In this study, the majority of patients with PABC or non-PABC presented with a breast lump. Other symptoms were more common in patients with PABC than in patients with non-PABC. An increased awareness of clinicians may help reduce delay in the diagnosis of patients with PABC. PMID:25983605

  12. Application and Evaluation of Interactive 3D PDF for Presenting and Sharing Planning Results for Liver Surgery in Clinical Routine

    PubMed Central

    Newe, Axel; Becker, Linda; Schenk, Andrea

    2014-01-01

    Background & Objectives The Portable Document Format (PDF) is the de-facto standard for the exchange of electronic documents. It is platform-independent, suitable for the exchange of medical data, and allows for the embedding of three-dimensional (3D) surface mesh models. In this article, we present the first clinical routine application of interactive 3D surface mesh models which have been integrated into PDF files for the presentation and the exchange of Computer Assisted Surgery Planning (CASP) results in liver surgery. We aimed to prove the feasibility of applying 3D PDF in medical reporting and investigated the user experience with this new technology. Methods We developed an interactive 3D PDF report document format and implemented a software tool to create these reports automatically. After more than 1000 liver CASP cases that have been reported in clinical routine using our 3D PDF report, an international user survey was carried out online to evaluate the user experience. Results Our solution enables the user to interactively explore the anatomical configuration and to have different analyses and various resection proposals displayed within a 3D PDF document covering only a single page that acts more like a software application than like a typical PDF file (“PDF App”). The new 3D PDF report offers many advantages over the previous solutions. According to the results of the online survey, the users have assessed the pragmatic quality (functionality, usability, perspicuity, efficiency) as well as the hedonic quality (attractiveness, novelty) very positively. Conclusion The usage of 3D PDF for reporting and sharing CASP results is feasible and well accepted by the target audience. Using interactive PDF with embedded 3D models is an enabler for presenting and exchanging complex medical information in an easy and platform-independent way. Medical staff as well as patients can benefit from the possibilities provided by 3D PDF. Our results open the door for a wider use of this new technology, since the basic idea can and should be applied for many medical disciplines and use cases. PMID:25551375