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Sample records for 5-year retrospective review

  1. Paediatric anaphylaxis: a 5 year retrospective review.

    PubMed

    de Silva, I L; Mehr, S S; Tey, D; Tang, M L K

    2008-08-01

    To describe the demographic characteristics, clinical features, causative agents, settings and administered therapy in children presenting with anaphylaxis. This was a retrospective case note study of children presenting with anaphylaxis over a 5-year period to the Emergency Department (ED) at the Royal Children's Hospital, Melbourne. One-hundred and twenty-three cases of anaphylaxis in 117 patients were included. There was one death. The median age of presentation was 2.4 years. Home was the most common setting (48%) and food (85%) the most common trigger. Peanut (18%) and cashew nut (13%) were the most common cause of anaphylaxis. The median time from exposure to anaphylaxis for all identifiable agents was 10 min. The median time from onset to therapy was 40 min. Respiratory features were the principal presenting symptoms (97%). Seventeen per cent of subjects had experienced anaphylaxis previously. This is the largest study of childhood anaphylaxis reported. Major findings are that most children presenting to the ED with anaphylaxis are first-time anaphylactic reactions and the time to administration of therapy is often significantly delayed. Most reactions occurred in the home. Peanut and cashew nut were the most common causes of anaphylaxis in this study population, suggesting that triggers for anaphylaxis in children have not changed significantly over the last decade.

  2. Typhoid Fever in an inner city hospital: a 5-year retrospective review.

    PubMed

    Farmakiotis, Dimitrios; Varughese, Julie; Sue, Paul; Andrews, Phyllis; Brimmage, Mary; Dobroszycki, Joanna; Coyle, Christina M

    2013-01-01

    Typhoid is a leading cause of fever in returning travelers. The prevalence is highest in migrants visiting friends and relatives (VFR travelers) in the Indian subcontinent, where reports of resistance have been of concern. This study is a retrospective analysis of patients with typhoid, seen over a 5-year period, in a tertiary center that serves a large immigrant population. Patients with blood cultures positive for Salmonella Typhi were identified between 2006 and 2010. Charts were reviewed for demographic data, travel history, symptoms and signs, basic laboratory results, susceptibility profiles, treatment, and clinical course. Resistance to nalidixic acid was used as a marker of decreased susceptibility to quinolones. Seventeen patients were identified with S Typhi. The median age was 12 years (range: 2-47 y) and 94% (16 of 17) were hospitalized with a median stay of 7 days; two were admitted to the intensive care unit. Fourteen patients (82%) had a history of recent travel. Twelve were VFR travelers in Bangladesh and Pakistan and two had recently immigrated. In our study, typhoid patients had low eosinophil counts and elevated transaminases. Seventy-six percent (12 of 17) of all isolates were resistant to nalidixic acid, 23.5% (4 of 17) were resistant to ampicillin and co-trimoxazole, and one was resistant to ciprofloxacin. All isolates were susceptible to third-generation cephalosporins. Younger VFR travelers appear to be at greater risk of acquiring infection and developing complications. Absolute eosinopenia and increased liver function test values could be useful early diagnostic clues in a returning traveler with fever, once malaria has been excluded. There was a high rate of decreased susceptibility to fluoroquinolones, confirming that the use of third-generation cephalosporins or macrolides in patients from the Indian subcontinent is most appropriate. Prevention in VFR travelers to South Asia is critical and efforts should be targeted at better education

  3. Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

    SciTech Connect

    Power, Sarah Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J.

    2013-04-15

    Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

  4. Suicidal Drug Overdoses in New Mexico: A 5-year Retrospective Review.

    PubMed

    Szymanski, Linda J; Aurelius, Michelle B; Szymanski, Sarah A; Lathrop, Sarah L

    2016-05-01

    To better understand the changing toxicology trends in suicidal drug overdoses in the setting of an increased national trend of multidrug overdoses, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 2008 and 2012 to assess the drug type and current risk factors in suicide deaths. Information on demographics, circumstances, suicide risk factors, toxicology findings, and death certificates was collected and analyzed. Three hundred and forty-two suicide cases of suicide overdoses were identified. Decedents were predominantly female (61.8%). Scene investigation revealed risk factors including suicide ideation (47.4%), previous suicide attempts (38%), and suicide note (38%). Psychiatric illness was present in 72% of cases, with depression being the most common illness. Chronic pain was seen in 27.2% of cases. Most deaths were attributed to multiple drugs (76%). Utilizing the toxicology information will assist in creating public awareness and provide a framework to support targeted efforts to attempt to prevent future suicides.

  5. Mycology of Onychomycosis: A 5-year retrospective review (2011 - 2015) in Hospital Kuala Lumpur.

    PubMed

    Ramalingam, R; Kunalan, S; Tang, M M

    2017-06-01

    Onychomycosis is a common nail disease with numerous etiological pathogens. In order to determine and trend the local mycological pattern of culture-positive diseased nail samples sent from the Department of Dermatology, Hospital Kuala Lumpur, a five-year retrospective audit was carried out, which revealed that non-dermatophyte molds were the predominant fungi isolated, followed by yeasts and dermatophytes. This is similar to two previous studies in Malaysia, but varies greatly from other studies around the world which showed a dermatophyte-predominant prevalence. This could be due to the nature of the environment our patients encountered.

  6. Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years.

    PubMed

    Rutherford, Tim; Nixon, Rosemary; Tam, Mei; Tate, Bruce

    2007-05-01

    Tea tree oil use is increasing, with considerable interest in it being a 'natural' antimicrobial. It is found in many commercially available skin and hair care products in Australia. We retrospectively reviewed our patch test data at the Skin and Cancer Foundation Victoria over a 4.5-year period and identified 41 cases of positive reactions to oxidized tea tree oil of 2320 people patch-tested, giving a prevalence of 1.8%. The tea tree oil reaction was deemed relevant to the presenting dermatitis in 17 of 41 (41%) patients. Of those with positive reactions, 27 of 41 (66%) recalled prior use of tea tree oil and eight of 41 (20%) specified prior application of neat (100%) tea tree oil. Tea tree oil allergic contact dermatitis is under-reported in the literature but is sufficiently common in Australia to warrant inclusion of tea tree oil, at a concentration of 10% in petrolatum, in standard patch-test series. Given tea tree oil from freshly opened tea tree oil products elicits no or weak reactions, oxidized tea tree oil should be used for patch testing.

  7. Eclampsia a 5 years retrospective review of 216 cases managed in two teaching hospitals in Addis Ababa.

    PubMed

    Abate, Misganaw; Lakew, Zufan

    2006-01-01

    to measure the magnitude of eclampsia and its maternal and perinatal outcome. A 5 years retrospective descriptive study was conducted on 216 eclamptic cases diagnosed, admitted and managed from October 1994 to September 1999 in the two teaching hospitals of Addis Ababa; namely Tikur Anbessa and St Paul's Hospitals. There were 257 mothers with eclampsia treated in the given period and 35741 deliveries making the incidence of eclampsia 7.1/1000 deliveries. Eighty-four women (38.9%) had any antenatal care, 157 (72.7%) were nulli-parous and 69 (31.8%) were aged below 20. Convulsion occurred ante-partum in 133 (61.6%), intrapartum in 49 (22.7%) and postpartum in 34 (15.7%) mothers. The most frequently sited symptoms before convulsion include headache in 83.8%, visual disturbance in 41.6% and epigastric pain in 38.4% of the cases. Ninety nine (45.8%) women were delivered by cesarean section making the cesarean section rate among eclamptic mothers significantly higher than the rate among the general population, which was 16.6% at the same period. (P = 0.0001). The multiple pregnancy rate was 5.7%, which was significantly higher than the rate among the general population of 1.5% at the same time. Seventy-four mothers had repeated convulsion after admission to the hospitals and initiation of the standard treatment. Twenty-eight mothers with eclampsia died making the case fatality rate 13%. Seven mothers (3.2%) died before delivery. Forty-four Stillbirths and twenty-five early neonatal deaths occurred making the perinatal mortality rate 312.2/1000 deliveries. Eclampsia is a common complication still associated with high level of maternal and perinatal mortality as well as morbidity. ANC coverage should be strengthened to detect preclampsia, and prevent eclampsia. Management in the hospital should be optimized to prevent recurrent convulsions and complications after admission.

  8. Counting the cost of over-the-counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period.

    PubMed

    Mill, Deanna; Johnson, Jacinta L; Cock, Victoria; Monaghan, Emily; Hotham, Elizabeth D

    2017-09-18

    Combination analgesics containing codeine (CACC) are currently available over-the-counter (OTC) in many countries following a pharmacist's advice. Published case reports detail life-threatening morbidities associated with OTC-CACC misuse, although the cost of treating such patients has not been quantified. This study aims to: (i) identify and detail patients admitted to an Australian tertiary teaching hospital over a 5 year period with sequelae of OTC-CACC misuse; and (ii) estimate the costs of identified hospital admissions. Using International Classification of Diseases (10th revision) diagnostic codes, a structured search was performed to identify admissions to a tertiary teaching hospital, relating to CACC misuse, over the defined period. A retrospective case note review provided data detailing patient characteristics, presenting morbidities and resultant interventions, and an approximate cost was calculated for identified admissions. Ninety-nine OTC-CACC-related admissions (for 30 individual patients) were identified. Most related to gastrointestinal morbidities secondary to ibuprofen/codeine misuse. Mean length of stay per admission was 5.9 days, with 10.1% of admissions requiring intensive care. Patients consumed a daily mean of 28 OTC-CACC tablets for a mean of 606 days prior to admission. These 99 admissions were estimated to cost the health system AU$1 008 082 with a mean cost per admission of AU$10 183. The outcomes of OTC-CACC misuse are serious and come at a significant cost to patient health and the Australian health-care system. Identification and management of this cohort appears sub-optimal with delays in diagnosis and high readmission rates. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  9. Role of laparoscopy in non-trauma emergency pediatric surgery: a 5-year, single center experience a retrospective descriptive study with literature review.

    PubMed

    Abbas, Tariq O; Hayati, Ahmed; Ali, Mansour

    2012-10-05

    Although laparoscopy is rapidly becoming the abdominal surgical modality of choice in adults, there are obstacles to its use in children. We analyzed our experience with pediatric laparoscopic surgery over the past 5 years, with particular emphasis on emergency procedures. We retrospectively evaluated the records of patients aged <14 years who had undergone laparoscopic procedures for non-trauma emergency conditions at our institution from January 2006 to December 2010. The clinical parameters evaluated included operation time, total length of hospital stay, and postoperative complications.During the 5-year study period, 482 laparoscopic procedures were performed on patients aged <14 years, comprising 300 emergency and 182 elective operations. The majority of procedures were laparoscopic appendectomies, with most of the others being resections of ovarian cysts or Meckel's diverticulae, or adhesiolyses. We observed an improvement in outcomes over the 5-year period, as shown by shorter operation times and shorter postoperative hospital stays. The numbers of laparoscopic procedures performed increased over time. Pediatric laparoscopic surgery for emergency conditions provides excellent results, including better exposure and cosmetic outcomes than laparotomy. At our institution, the numbers and types of laparoscopic procedures performed have increased over time, and the outcomes of laparoscopic procedures have improved.

  10. Role of laparoscopy in non-trauma emergency pediatric surgery: a 5-year, single center experience a retrospective descriptive study with literature review

    PubMed Central

    2012-01-01

    Background Although laparoscopy is rapidly becoming the abdominal surgical modality of choice in adults, there are obstacles to its use in children. We analyzed our experience with pediatric laparoscopic surgery over the past 5 years, with particular emphasis on emergency procedures. Findings We retrospectively evaluated the records of patients aged <14 years who had undergone laparoscopic procedures for non-trauma emergency conditions at our institution from January 2006 to December 2010. The clinical parameters evaluated included operation time, total length of hospital stay, and postoperative complications. During the 5-year study period, 482 laparoscopic procedures were performed on patients aged <14 years, comprising 300 emergency and 182 elective operations. The majority of procedures were laparoscopic appendectomies, with most of the others being resections of ovarian cysts or Meckel’s diverticulae, or adhesiolyses. We observed an improvement in outcomes over the 5-year period, as shown by shorter operation times and shorter postoperative hospital stays. The numbers of laparoscopic procedures performed increased over time. Conclusions Pediatric laparoscopic surgery for emergency conditions provides excellent results, including better exposure and cosmetic outcomes than laparotomy. At our institution, the numbers and types of laparoscopic procedures performed have increased over time, and the outcomes of laparoscopic procedures have improved. PMID:23035990

  11. [A 5-year retrospective clinical study of perinatal cytomegalovirus infection].

    PubMed

    Liu, Li-Wei; Qian, Ji-Hong; Zhu, Tian-Wen; Zhang, Yong-Hong; Zhu, Jian-Xing

    2016-02-01

    To investigate the incidence, clinical features, and treatment of perinatal cytomegalovirus (CMV) infection, as well as the factors affecting the therapeutic effect of ganciclovir. The clinical data of 237 infants who were hospitalized and diagnosed with perinatal CMV infection from 2008 to 2012 were retrospectively analyzed. The clinical features of infants with perinatal CMV infection and the proportion of such infants in all hospitalized infants showed no significant differences across the five years. In most infants, two or more systems were involved, and CMV hepatitis plus CMV pneumonia was most common (43.1%). The results of pathogen detection showed that the percentage of the infants with positive blood CMV-IgM and blood/urine CMV-DNA was 3.8%, while 90.3% of all infants had positive blood CMV-IgM alone and 5.9% had positive blood/urine CMV-DNA alone. A total of 197 infants were treated with ganciclovir, and the cure rate was 88.3%. An abnormal history of pregnancy (OR=6.191, 95% CI: 1.597-24.002) and liver involvement before medication (OR=3.705, 95% CI: 1.537-8.931) were the independent risk factors affecting the therapeutic effect of ganciclovir in infants with perinatal CMV infection. The epidemiological characteristics of perinatal CMV infection have remained generally stable for the last 5 years. CMV often involves several organs or systems, especially the liver and lung. Ganciclovir has a significant efficacy in the treatment of perinatal CMV infection, and an abnormal history of pregnancy and liver involvement before medication can increase the risk of ganciclovir resistance in infants with perinatal CMV infection.

  12. Microsurgical Reconstruction of Large Oncologic Chest Wall Defects for Locally Advanced Breast Cancer or Osteoradionecrosis: A Retrospective Review of 26 Cases over a 5-Year Period.

    PubMed

    Arya, Reza; Chow, Whitney T; Rozen, Warren Matthew; Patel, Nakul G; Griffiths, Matthew; Shah, Samir; Ramakrishnan, Venkat V

    2016-02-01

    Locally advanced breast cancer (LABC) and chest wall osteoradionecrosis (ORN) often require extensive and composite tissue resection, including muscles, ribs, pleura, and lung parenchyma. As such, these cases necessitate complex reconstructive procedures for skeletal chest wall reconstruction and soft tissue resurfacing of extensive defects. Traditional local and regional flaps are often inadequate, and many such cases are prospectively labeled "unresectable." We report a single-center experience with the microsurgical reconstruction of such defects over a 5-year period. Between 2007 and 2011, 1,077 microvascular reconstructive cases following breast cancer resection were performed, of which 26 cases comprised LABC or ORN requiring reconstruction. Surgical indications, defect parameters, choice of reconstruction, and outcomes were assessed. Thirty free flap microsurgical reconstructions were undertaken in 26 cases, with a 96.2% flap survival rate. Complications were low, and mean hospital stay was 8.7 days. An algorithmic approach to management is presented. Wide resection and microvascular free tissue transfer provide versatile solutions for the reconstruction of extensive chest wall defects. With good reported perioperative outcomes even in advanced cases, surgical resection of LABC may offer a useful approach in difficult and/or palliative cases. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Epidemiology and outcome analysis of hand burns: A 5-year retrospective review of 378 cases in a burn center in Eastern China.

    PubMed

    Wang, Kang-an; Sun, Yu; Wu, Guo-sheng; Wang, Yi-ru; Xia, Zhao-fan

    2015-11-01

    Hands are frequent sites of burn but few related studies were reported in China. The aim of this study was to examine the impacts of gender, age, seasons, place, etiology, total body surface area (TBSA), depth, infection and comorbidities on prognosis following injury in a cohort of hand burn inpatients. This is a retrospective study of total 378 inpatients admitted to the burn center of Changhai hospital from January 2009 to December 2013. The present research showed the male inpatients were predominant and most of the inpatients aged from 20 to 49. Flame (37.04%) and electricity (25.40%) were the major causes of hand burns. Hand burns happened more commonly in work place (60.85%). The study preliminarily pointed out that male, flame and depth were the most significant factors impacting surgery. The main factors relevant to amputation were identified including the electrical burns and other etiology of burns. In addition, depth of hand burns was proved to have a higher impact on length of hospital stay (LOS) than other factors. The results of this study not only provide the necessary information of hand burns in Eastern China but also give the suggestions for the prevention of hand burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  14. The meaning of a high plasma free haemoglobin: retrospective review of the prevalence of haemolysis and circuit thrombosis in an adult ECMO centre over 5 years.

    PubMed

    Pan, K C; McKenzie, D P; Pellegrino, V; Murphy, D; Butt, W

    2016-04-01

    In adults requiring extracorporeal membrane oxygenation (ECMO), we wanted to determine; i) the frequency of elevated plasma free haemoglobin (PFHb), ii) the reasons for circuit changes and iii) whether elevated PFHb was associated with higher in-hospital mortality. Patients requiring ECMO between January 2010 and August 2014 were identified from a prospectively collected ECMO database. Their scanned medical records and pathology results were reviewed. Relevant patient, biochemical and circuit data were collected on an Excel spreadsheet and analysed using Stata 13 (StataCorp, College Station, TX). The patients were analysed in three groups, depending on their peak PFHb during ECMO: 'Normal PFHb' (<0.1 g/L), 'Low level PFHb' (0.1 - 0.5 g/L), 'High level PFHb' (>0.5 g/L). There were 184 ECMO runs (56 VV, 128 VA) - 61 'Normal PFHb', 99 'Low level PFHb', 24 'High level PFHb'. Circuit thrombosis (pump, oxygenator) or haemolysis requiring exchanges were significantly more common in VV ECMO compared to VA ECMO - 23.21% (13/56) vs. 0.78% (1/128), p<0.001. Elevated PFHb was associated with a longer duration of haemofiltration (p<0.001) and ECMO support (p<0.001). In-hospital mortality rates for the 'Normal PFHb', 'Low level PFHb' and 'High level PFHb' groups were 16.39% (10/61), 30.30% (30/99) and 37.50% (9/24), respectively, p=0.067. Elevated PFHb values during adult ECMO were common. Severe haemolysis or thrombosis requiring circuit changes were uncommon and occurred almost exclusively on VV ECMO. There was a non-statistically significant increase in in-hospital mortality with elevated PFHb and studies of larger registry data may clarify the prognostic value of PFHb in adult patients. © The Author(s) 2015.

  15. Electrical burns: Highlights from a 5-year retrospective analysis.

    PubMed

    Kurt, Alper; Yıldırım, Kamil; Yağmur, Çağlayan; Kelahmetoğlu, Osman; Aslan, Ozan; Gümüş, Murat; Güneren, Ethem

    2016-05-01

    Electrical burns are the third most common cause of burn injuries, after scald and flame burns. In spite of decreasing mortality rates as advancements are made in treatment modalities and medical equipment, significant complications and socioeconomic consequences still accompany electrical burns. Analyzed in the present study were data from patients hospitalized for electrical burns between 2008 and 2012 in the Samsun Training and Research Hospital, the only burn care center in the Black Sea region of Turkey. Data from 94 patients (84 males, 10 females) hospitalized for electrical burns between 2008 and 2012 were retrospectively evaluated. Patient age, gender, occupation, presence of coexisting trauma, burn degree, burned percentage of total body surface area (TBSA), voltage of the electric current (low or high), medical cost (per day and total), and infection rates were analyzed. Mean patient age was 26.4±13.2 years. Ten patients were female (10.6%) and 84 were male (89.4%). High-voltage burns were sustained by 47 patients (50%) and low-voltage burns by 42 (44.7%); the remaining 5 were flash burns. Mean burned TBSA was 21.8±19.8% in high-voltage injuries and 11.9±6.9% in low-voltage injuries. Seven patients had accompanying soft tissue lacerations, major bone fractures, or epidural hematomas. Findings of infection were encountered in 31 patients (32.9%), and appropriate treatments were initiated according to culture results. Mean duration of hospitalization was 21.3±19.8 days in patients with high-voltage burns and 8.6±6.2 days in patients with low-voltage burns. Mean hospital stay was 2.5-fold longer, and total medical costs were 4-fold higher in patients with high-voltage burns. Young adult males who were injured in industrial accidents constituted the majority of high-voltage burn patients. Incidence of these injuries may be reduced by improvements in training regarding the safe use of electrical devices, and correct installation and safe maintenance of

  16. Causative Microorganisms of Infectious Endophthalmitis: A 5-Year Retrospective Study

    PubMed Central

    Duan, Fang; Liao, Jingyu; Zheng, Yongxin; Tan, Junlian

    2016-01-01

    This study aimed to identify the microbial etiology of infectious endophthalmitis and to determine the antibacterial susceptibilities of bacterial isolates at an eye hospital in South China. A retrospective analysis was carried out on 330 patients with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation from January 2010 to December 2014. Of the 330 patients, 193 patients (58.5%) had posttraumatic endophthalmitis, 67 patients (20.3%) had postoperative endophthalmitis, 61 patients (18.5%) had endogenous endophthalmitis, and 9 patients (2.7%) had postcorneal infective endophthalmitis. Of the 105 cases (31.8%) of culture-positive endophthalmitis, 79 cases (75.2%) had bacterial growth and 26 cases (24.8%) had fungal growth. In posttraumatic endophthalmitis, Gram-positive bacteria were the predominant species, followed by Gram-negative bacteria and fungi. In endogenous endophthalmitis, Gram-negative bacteria were the predominant species, followed by fungi and Gram-positive bacteria. In postsurgical endophthalmitis, all infections were bacterial. However, in postcorneal infective endophthalmitis, all infections were fungal. Overall, levofloxacin showed the highest activity against bacterial isolates. There was a significant difference in the susceptibility to tobramycin between the isolates from posttraumatic and postoperative endophthalmitis (p < 0.05). The results of this study identify the microbial spectrum of infectious endophthalmitis in this clinical setting. PMID:27413545

  17. A Study on Mental Disorders: 5-year Retrospective Study

    PubMed Central

    Celine, Thalappillil Mathew; Antony, Jimmy

    2014-01-01

    Background: “Mental disorder” is the most common used term in the modern life and the main reason behind this may be the mechanical way of life or stress and strain among youth. Aim: To find the pattern of mental disorders of hospitalized patients in a medical college hospital from 1st April 2005 to 31st March 2010. Settings and Design: A retrospective study conducted among the patients admitted with mental disorders in a medical college hospital from 1st April 2005 to 31st March 2010. Materials and Methods: Data collected from the registers maintained in the medical records department. Statistical Analysis: Z test is used for the comparison of proportions. Results: A total of 7908 mental disorder cases reported in the medical college hospital, 5564 (70.36%) were males and 2344 (29.64%) were females. Most cases occurred in the age group of 30-44 years. Mental disorder was more among females than males in 0-29 years and ≥ 60 years, but in 30-59 years males were more. In each year, mental disorders were reported more in males than females. Of the cases, most of them were mood disorders. Mental and behavioral disorders due to psychoactive substance use were more among males but schizophrenia, delusional disorders, mood disorders, stress-related disorders, mental retardation, and so on were more among females. Conclusion: Mood disorder was the most occurred mental disorder and the next leading mental disorder was mental and behavioral disorders due to psychoactive substance use. Counseling can be helpful for preventing most of the mental disorders. Improve the mental health care facilities will be the solution for controlling the mental disorders. PMID:24791229

  18. [Water delivery--a 5-year retrospective study].

    PubMed

    Pellantová, S; Vebera, Z; Půcek, P

    2003-05-01

    Comparison of chosen parameters of the I.-III. stage of labour by women, who conducted waterbirth (Group A) and by women, who delivered conventionally in horizontal position (Group B) and comparison of perinatal and postnatal results of newborns in both groups. Retrospective study. Department of Obstetrics and Gynecology, District Hospital Znojmo. Group A constitute 70 women, who delivered in the period 1.1.1998-30.9.2002 into the water (fetus was expelled under water). Control group B formed 70 women, who delivered in a conventional (horizontal position) and in the same time they did not have any contraindication to waterbirth. At first we compared the length of I. and II. stage of labour, the number of episiotomies, the number of some other kinds of injuries, the postpartal uterine hypotony and the volume of blood loss. In the second phase we evaluated clinical condition of the newborn. Waterbirth have chosen 1.95% of the women in our department during this period. There is no statistically significant difference in the duration of I. stage of labour in both groups. The II. stage was prolonged to 9 against 6 minutes in group A, most probably because of hydroanalgetic effect of warm water, due to some inhibition of contractions and "no interference access" to labour. There is no statistical difference in complications during and after the labour in both groups. By group A we found statistically significant higher number of spontaneous, I. grade perineal ruptures, then in group B and we found reciprocal situation in number of episiotomies in both groups. There were no somatic differences by the newborns in both groups after delivery and we did not find higher occurrence of postnatal pathology by the waterbith babies either. Waterbirth is type of alternative obstetrics, which the women in birth demand, but which the obstetricians and neonatologists are afraid of, and which they consider to be possibly hazardous in the same time. There is documented evidence of much

  19. Electrical burns: a retrospective analysis across a 5-year period.

    PubMed

    Luz, D P; Millan, L S; Alessi, M S; Uguetto, W F; Paggiaro, A; Gomez, D S; Ferreira, M C

    2009-11-01

    This study aims to review the experience, at an institution, with patients who suffered electrical burns and study the peculiar characteristics of this type of burn as well as its complications and epidemiological aspects. The study includes medical records of patients with electrical burns who were admitted to the Burn Unit of Hospital das Clínicas in São Paulo, Brazil, from November 2001 to October 2006. They were classified into four categories: high voltage (> or =1000 V), low voltage (<1000 V), 'flash burn' (in which there is no electrical current flow through the body of the patient) and burns caused by lightning. The complications were more severe and common in the high-voltage group, while longer hospital stays and more complex surgical procedures due to the greater depth of burns were also observed in this group. High-voltage burns are mainly labour-/occupation-related. The majority of the patients were young men at the beginning of their professional lives. This factor generates an important socio-economic impact due to the high incidence of sequelae, resulting in amputations, rendering them unable to maintain their occupations.

  20. Circumcision: a refined technique and 5 year review.

    PubMed Central

    Tucker, S. C.; Cerqueiro, J.; Sterne, G. D.; Bracka, A.

    2001-01-01

    The vast majority of circumcisions currently performed in the UK are for phimosis or balanitis and the patients are not looking for the denuded glans appearance of a ritual circumcision. We present a refinement of the sleeve technique of circumcision, which involves Horton's test to define the proximal incision margin, and bipolar electro-dissection. A review of all patients undergoing circumcision at the Wordsley Plastic Surgery Unit, in a 5-year period, has shown this technique to be safe with a haematoma rate of only 1.4%, and an overall complication rate of 3%. Images Figure 1 Figure 1 (G,H) Figure 2 PMID:11320921

  1. A 5-year retrospective study on Replace Select Tapered dental implants.

    PubMed

    Pettersson, Pelle; Sennerby, Lars

    2015-04-01

    Long-term data regarding survival and crestal bone loss for Replace Select Tapered implants (Nobel Biocare AB, Gothenburg, Sweden) are lacking. The study aims to present the 5-year outcomes from a retrospective analysis of Replace Select Tapered implants placed and restored in consecutive patients. A total of 88 consecutive patients (32 male, 56 female, mean age 65 ± 12 years) treated by one clinician (PP) were clinically and radiographically evaluated during at least 5 years of function. A total of 271 dental implants (Replace Select Tapered, Nobel Biocare AB) with an oxidized surface (TiUnite, Nobel Biocare AB) had been placed in both jaws (228 in the maxilla, 43 in the mandible). The majority of implants were placed in healed sites (n = 244), while 27 implants were immediately placed in extraction sockets. The majority of implants (n = 262) healed for 3 to 4 months prior to loading, and nine implants were immediately loaded. A total of 121 implant-supported restorations were delivered; 42 single tooth replacements, 61 fixed partial bridges, 14 fixed full bridges, and 4 fixed partial implant-tooth connected bridges. The marginal bone level was measured in intraoral radiographs taken after surgery (baseline), and after 1, 2, 3, 4, and 5 years. Fifty-one patients with 160 implants were followed throughout the study. One implant failed at healing abutment connection 4 months after insertion, resulting in a cumulative survival rate of 99.6%. The average crestal bone loss was 0.9 ± 1.6 mm after 1 year and 0.1 mm ± 2.4 after 5 years. There were 14.8% of measured implants that showed more than 2 mm and 5.2% more than 3 mm bone loss after 5 years, with no progression since the 1-year examination. One patient (2.0%) treated with six implants presented with significant crestal bone loss and recurrent peri-implant purulent infections at all implants. The present retrospective 5-year study showed high survival rate and steady crestal bone

  2. Homicide in Adana, Turkey: a 5-year review.

    PubMed

    Hilal, Ahmet; Cekin, Nemci; Gülmen, Mete K; Ozdemir, M Hakan; Karanfil, Ramazan

    2005-06-01

    Violence is a significant public health problem. Thus, so as to prevent this problem, homicide, the severest form of violence depriving a human being of his right to live, deserves a detailed examination. This study is a retrospective research examining the 2951 cases of medicolegal autopsies in Adana during a period of 5 years (1997-2001). Among these cases, 620, which were determined to be homicidal, were taken into the scope of this study. The cases were examined with respect to sex, age groups, the method used during the act of homicide, the number and the localization of the wounds on the body. A total of 620 (21%) of the medicolegal autopsies conducted within this period were homicides. Of these cases, 515 (83.06%) were male and 105 (16.94%) female, and the rate of the males to females was 4.9; 72.74% of the victims were between the ages of 21 and 50. It was seen that 54.83% of the homicides involved firearms, while 35.16% of the victims were stabbed to death with a cutting object. It was also determined that the victims suffered a single wound in 47.35% of firearm-related murders and 29.35% of stabbings resulted in death. Alcohol was found in the blood of 7.58% of the homicide victims, while none had any illicit drugs.

  3. Treatment of anal stenosis: a 5-year review.

    PubMed

    Casadesus, Damian; Villasana, Luis E; Diaz, Hector; Chavez, Mariano; Sanchez, Ines M; Martinez, Pedro P; Diaz, Angelina

    2007-07-01

    Benign anal stenosis is an uncommon, disabling and incapacitating disease, occurring mainly after anorectal surgery. Both non-surgical and surgical treatments have been devised in the treatment of anal stenosis with good results. We described the results of the treatment of this disease in the Coloproctology Department of our institution. A retrospective clinical study was undertaken over a 5-year period for consecutive patients operated on for anal stenosis. Twenty-three patients with benign anal stenosis were treated in our department. Haemorrhoidectomy was the most common cause of anal stenosis (74%). Nineteen patients with moderate to severe symptoms of anal stenosis underwent surgical treatment. Lateral mucosal advancement flap was the most frequently carried out operation (63.1%). Four patients were treated with anal dilatation (17.3%). All patients had remission of the preoperative symptoms. There was no re-operation and only minor complications were present in four patients: three patients with anal pruritus and one patient with temporary incontinence. The easy performance, the absence of major complications and the good results obtained confirm that these methods are effective and safe in the treatment of anal stenosis.

  4. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study

    PubMed Central

    Geng, Zhi-Yu; Wang, Dong-Xin

    2017-01-01

    Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies. PMID:28218212

  5. Neonatal tetanus in Awassa: retrospective analysis of patients admitted over 5 years.

    PubMed

    Nida, H

    2001-07-01

    Neonatal tetanus is a significant health problem worldwide, with an estimated 500,000 deaths per year. Retrospective analysis of medical records of neonates admitted to Bushulo Major Health Center with the diagnosis of tetanus neonatorum over 5 years period (1994/98) was made to describe the clinical profile and management out come. There were a total of 43 neonates admitted with a diagnosis of tetanus during the study period. Male to Female ratio was 2:1. Mean age at presentation (incubation period) was 9.5 days (range; 4-20 days). Most patients were brought within 3 days of the onset of symptoms. Common presenting complaints were; rigidity, spasm, failure to suck, trismus, fever and seizure. The overall case fatality was 29/42 (69%). All patients with severe classification and 23/32 (72%) of patients with moderate severity died. Most deaths occurred during the first two days of hospitalization (20/29 died within 2 days), and survivors stayed in hospital for a long period (8-26 days). Improved immunization coverage, clean delivery and clean cord care are recommended to reduce morbidity and mortality of neonatal tetanus.

  6. Metamemory prediction accuracy for simple prospective and retrospective memory tasks in 5-year-old children.

    PubMed

    Kvavilashvili, Lia; Ford, Ruth M

    2014-11-01

    It is well documented that young children greatly overestimate their performance on tests of retrospective memory (RM), but the current investigation is the first to examine children's prediction accuracy for prospective memory (PM). Three studies were conducted, each testing a different group of 5-year-olds. In Study 1 (N=46), participants were asked to predict their success in a simple event-based PM task (remembering to convey a message to a toy mole if they encountered a particular picture during a picture-naming activity). Before naming the pictures, children listened to either a reminder story or a neutral story. Results showed that children were highly accurate in their PM predictions (78% accuracy) and that the reminder story appeared to benefit PM only in children who predicted they would remember the PM response. In Study 2 (N=80), children showed high PM prediction accuracy (69%) regardless of whether the cue was specific or general and despite typical overoptimism regarding their performance on a 10-item RM task using item-by-item prediction. Study 3 (N=35) showed that children were prone to overestimate RM even when asked about their ability to recall a single item-the mole's unusual name. In light of these findings, we consider possible reasons for children's impressive PM prediction accuracy, including the potential involvement of future thinking in performance predictions and PM. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Prevalence and Risk Factors for Delirium in Acute Stroke Patients. A Retrospective 5-Years Clinical Series.

    PubMed

    Alvarez-Perez, Francisco José; Paiva, Fatima

    2017-03-01

    Delirium is characterized by disturbances of attention and cognition that cause functional decline and complications. The predisposing factors of delirium are age, male gender, systemic or metabolic disorders, dementia, and stroke. This study aims to evaluate the prevalence of delirium and to identify risk factors. This is a retrospective study that includes patients admitted over 5 years with acute stroke. Patients with transient ischemic attack or venous thrombosis were excluded. Delirium was defined according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographical characteristics, clinical-radiological profile, dependence on discharge (modified Rankin Scale score of ≥3 and Barthel Index < 65%), and mortality during hospitalization were compared between patients with and without delirium. A total of 1161 patients were admitted (910 ischemic and 162 hemorrhagic). During hospitalization, 118 patients presented with delirium (10.2%) and 93 died (8%). On discharge, 517 patients were dependent (44.5%). Delirium was significantly associated with age, male gender, cortical infarcts in anterior circulation, higher leukocyte count, cholesterol and fibrinogen levels, lower albumin, atrial fibrillation, previous diagnosis of Alzheimer's disease, and hemorrhagic stroke. Logistic regression results showed that only previous Alzheimer's disease was related to delirium (odds ratio 21.68 [95% confidence interval 1.190-395.026, P = .038]). Dependence on discharge was associated with delirium. Ten percent of the patients presented with delirium associated with older age, Alzheimer's disease, and cortical anterior stroke. Patients with delirium had a higher risk of functional dependence on discharge. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. An empirical analysis of suicidal death trends in India: a 5 year retrospective study.

    PubMed

    Badiye, Ashish; Kapoor, Neeti; Ahmed, Shagufa

    2014-10-01

    Suicide, a major problem worldwide, continues to be a criminal offence in most of the developing countries of the world, including India. This paper retrospectively examines the latest trends and the relevant determinants of the suicidal deaths in one of the most important city of central India- Nagpur of Maharashtra state, carried out for a period of 5 years i.e. 2009-2013. Total 2036 cases were analyzed. An alarmingly increasing trend in the rate of suicides has been observed in the region, which increased from 16% to 22.68% during the study period. The male to female suicide ratio was found to be 2.50:1. The rate of suicidal deaths ranged from 15.34 to 21.74 per 100,000 populations. Hanging was found to be the most preferred mean adopted for suicide by males (54.77%) and females (47.65%), while, Family problems was the most common cause of suicide among both male (38.25%) and female (52.65%). The Suicides were concentrated in the age group of 30-44 years for males (35.76%), while in the age group of 15-29 years for females (51.75%). The prevalence was higher among the people who were married, being as high as 1099 (66.73%) males and 372 (56.45%) females. Highest trend has been found among the people with matriculate/secondary education level. The males with job in private sector accounted for 1007 suicides (61.14%) and 434 (65.86%) females in the category of housewives (non-working, homemakers) committed the same. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  9. Ultrasound and PET-CT Correlation in Shoulder Pathology: A 5-Year Retrospective Analysis.

    PubMed

    Burke, Christopher J; Walter, William R; Adler, Ronald S; Babb, James S; Sanger, Joseph; Ponzo, Fabio

    2017-10-01

    To correlate shoulder ultrasound and radiography with F-FDG PET-CT to establish FDG uptake and therefore range of metabolic activity, as defined by SUV analysis, in various symptomatic shoulder pathologies. Retrospective database query was performed for shoulder ultrasound and PET-CT scans between January 2012 and January 2017. Patients who had both studies within 1 year were included. Age- and sex-matched control patients with PET-CT scans only were also included. Retrospective image review determined shoulder pathology, and F-FDG SUVmax was measured using regions of interest placed at the glenohumeral joint, rotator cuff/bursa, and bicipital groove. Glenohumeral and acromioclavicular osteoarthrosis was assessed by radiography using the Kellgren-Lawrence classification system. Thirty-three patients had both imaging studies within 1 year. Ten patients (11 cases) were included, ranging in age from 56 to 90 years (mean, 67.9 years). Control subjects were selected among patients receiving PET-CT within 1 week of symptomatic patients. Glenohumeral osteoarthrosis was mild in 3 (27%), moderate in 2 (18%), and severe in 2 (18%). Six full-thickness rotator cuff tears (55%) were identified. SUVmax means were compared between the pathologic and control groups and were significantly higher in the former: glenohumeral joint (1.96 vs 1.32; P = 0.016), rotator cuff/bursa (2.80 vs 2.0; P = 0.005), and bicipital groove (2.19 vs 1.48; P = 0.007). The highest values were seen in full-thickness rotator cuff tear and severe biceps tenosynovitis. Increased metabolic activity about the shoulder is associated with a spectrum of rotator cuff, glenohumeral joint, and other soft tissue pathology that can be correlated with diagnostic ultrasound findings.

  10. A diagnosis of bipolar spectrum disorder predicts diagnostic conversion from unipolar depression to bipolar disorder: a 5-year retrospective study.

    PubMed

    Woo, Young Sup; Shim, In Hee; Wang, Hee-Ryung; Song, Hoo Rim; Jun, Tae-Youn; Bahk, Won-Myong

    2015-03-15

    The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. This study was conducted using a retrospective design and did not include structured diagnostic interviews. The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective.

    PubMed

    Edmonds, Catherine M; Ribbe, Cheri; Thielman, Emily J; Henry, James A

    2017-09-18

    The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1-5 years after completing the workshops. In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1-5 years after completion of the workshops and the impact on quality-of-life indicators. All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus. The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth). https://doi.org/10.23641/asha.5370883.

  12. 77 FR 5491 - Endangered and Threatened Species; Initiation of 5-Year Review for Sei Whales

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-03

    ...; Initiation of 5-Year Review for Sei Whales AGENCY: National Marine Fisheries Service (NMFS), National Oceanic...; request for information. SUMMARY: NMFS announces a 5-year review of sei whales (Balaenoptera borealis... of any such information on sei whales that has become available since that has become available...

  13. Musculo-skeletal tumors incidence and surgical treatment - A single center 5-year retrospective.

    PubMed

    Patrascu, J M; Vermesan, D; Mioc, M L; Lazureanu, V; Florescu, S; Tarullo, A; Tatullo, M; Abbinante, A; Caprio, M; Cagiano, R; Haragus, H

    2014-01-01

    Muscle-skeletal tumors represent a challenging pathology for orthopedic surgeons worldwide. The extremely invasive character, the local destruction, the high recurrence rate, the high incidence in young patients and the unfavorable prognosis are all very well known. For these patients it is very important to produce an accelerated functional, social and psychological postoperative rehabilitation. We studied 121 cases of muscle-skeletal tumors which were treated in our hospital over a 5 years period. We noticed a high prevalence in males and mainly between the 2nd-3rd and 5th-7th decades of their life. At our observation, most patients were suffering in advanced stages of malignant lesions. We try to manage amputations below 5%, with a significant reduction in introducing reconstructive surgical methods as a choice of treatment (10 prostheses and 12 cases of filling with acrylic cement or bone substituent increased with internal fixation). In this way we could observe an unusual ratio between benign and malignant tumors, probably caused by the patient's lack of concern for minimal symptoms. The rural citizen's addressability towards the medical system is alarmingly low, due to the big gap existing from diagnosis to treatment. There is still an hard effort to develop better reconstructive techniques for the treatment of muscle-skeletal tumors and more studies must be made in order to achieve this goal.

  14. The South American Land Data Assimilation System (SALDAS) 5-Year Retrospective Atmospheric Forcing Datasets

    NASA Technical Reports Server (NTRS)

    deGoncalves, Luis Gustavo G.; Shuttleworth, William J.; Vila, Daniel; Larroza, Elaine; Bottino, Marcus J.; Herdies, Dirceu L.; Aravequia, Jose A.; De Mattos, Joao G. Z.; Toll, David L.; Rodell, Matthew; hide

    2008-01-01

    The definition and derivation of a 5-year, 0.125deg, 3-hourly atmospheric forcing dataset for the South America continent is described which is appropriate for use in a Land Data Assimilation System and which, because of the limited surface observational networks available in this region, uses remotely sensed data merged with surface observations as the basis for the precipitation and downward shortwave radiation fields. The quality of this data set is evaluated against available surface observations. There are regional difference in the biases for all variables in the dataset, with biases in precipitation of the order 0-1 mm/day and RMSE of 5-15 mm/day, biases in surface solar radiation of the order 10 W/sq m and RMSE of 20 W/sq m, positive biases in temperature typically between 0 and 4 K, depending on region, and positive biases in specific humidity around 2-3 g/Kg in tropical regions and negative biases around 1-2 g/Kg further south.

  15. Conservative neck dissection in oral cancer patients: a 5 year retrospective study in Malaysia.

    PubMed

    Balasundram, Sathesh; Mustafa, Wan Mahadzir Wan; Ip, Jolene; Adnan, Tassha Hilda; Supramaniam, Premaa

    2012-01-01

    The impact of ablative oral cancer surgery was studied, with particular reference to recurrence and nodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influences the survival of patients. Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. All individuals had a pre-operative assessment prior to the surgery. The post operative assessment period ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. 87 patients (males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5% had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the median survival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival rate dropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and the three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001). Conservative neck is effective, in conjunction with postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival of the patients, but a prospective trial is required to validate this.

  16. A 5-year retrospective report of Gallibacterium anatis and Pasteurella multocida isolates from chickens in Mississippi.

    PubMed

    Jones, K H; Thornton, J K; Zhang, Y; Mauel, M J

    2013-12-01

    A 5-yr retrospective study (November 2006-December 2011) was conducted to determine the isolation frequency of Pasteurella multocida and Gallibacterium anatis and their antibiograms from chickens submitted to the Mississippi Poultry Research and Diagnostic Laboratory. The number of isolations of G. anatis increased over the last 5 yr in broiler and broiler breeder type chickens. For P. multocida, the number of isolations increased from 2006 to 2010, but decreased through 2011 with all isolations being from boiler breeder type chickens. Gallibacterium anatis demonstrated almost complete resistance to novobiocin, tylosin, lincosamide, and tetracycline antimicrobials with moderate to high sensitivity to sulfonamides, fluoroquinolones, and florfenicol. There was intermediate sensitivity for spectinomycin and erythromycin and variable resistance to β-lactam and aminoglycoside antimicrobials. In sharp contrast, P. multocida showed moderate to high sensitivity to β-lactam, novobiocin, and tetracycline antimicrobials, but had antibiograms similar to G. anatis for the other antimicrobials. Sensitivities were determined using minimum inhibitory concentration. This study examines the trends over a 5-yr period of the number of isolates of P. multocida and G. anatis and their sensitivities. These 2 pathogens produce very similar clinical signs and lesions (fowl cholera-like) in breeders despite having extremely antagonistic sensitivity patterns. This study shows the necessity for producers to attempt culture and sensitivity in suspect fowl cholera-like flocks before initiating antimicrobial treatment commonly used with P. multocida for fear that the culprit may actually be the more antimicrobial-resistant G. anatis.

  17. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series.

    PubMed

    Roman, Horace; Moatassim-Drissa, Salwa; Marty, Noemie; Milles, Mathilde; Vallée, Aurélie; Desnyder, Eulalie; Stochino Loi, Emanuela; Abo, Carole

    2016-11-01

    To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum. Retrospective study using data prospectively recorded in the CIRENDO database. University tertiary referral center. One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years. Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively. Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS). Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously. Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study

    PubMed Central

    2012-01-01

    Background This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children. Methods This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries. Results The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT) component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P<0.001). Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural) (OR=1.80, P<0.001). However, it was not significantly associated with gender and ethnicity. The incidence density of caries, affected persons (IDp) observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt) in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation. Conclusion The majority of 12-year-old school children (70%) were caries-free and most of the caries were concentrated in only a small proportion (30%) of them. We found that the presence of caries in permanent teeth at the age of 6 years was

  19. Distribution and features of hematological malignancies in Eastern Morocco: a retrospective multicenter study over 5 years.

    PubMed

    Elidrissi Errahhali, Mounia; Elidrissi Errahhali, Manal; Boulouiz, Redouane; Ouarzane, Meryem; Bellaoui, Mohammed

    2016-02-25

    Hematological malignancies (HM) are a public health problem. The pattern and distribution of diagnosed hematological cancers vary depending on age, sex, geography, and ethnicity suggesting the involvement of genetic and environmental factors for the development of these diseases. To our knowledge, there is no published report on HM in the case of Eastern Morocco. In this report we present for the first time the overall pattern of HM for this region. Retrospective descriptive study of patients diagnosed with HM between January 2008 and December 2012 in three centres in Eastern Morocco providing cancer diagnosis, treatment or palliative care services. The FAB (French-American-British) classification system has been taken into account in the analysis of myeloid and lymphoid neoplasms. In this study, a total of 660 cases of HM were registered between January 2008 and December 2012. Overall, 6075 cases of cancers all sites combined were registered during this study period, indicating that HM account for around 10.9 % (660/6075) of all cancers recorded. Among the 660 registered cases of HM, 53 % were males and 47 % were females, with a male to female ratio of 1.1. Thus, overall, men are slightly more affected with HM than women. By contrast, a female predominance was observed in the case of Hodgkin's lymphoma (HL), myeloproliferative neoplasms (MPN), acute myeloid leukemia (AML) and the myelodysplastic syndrome (MDS). HM occur at a relatively young age, with an overall median age at diagnosis of 54 years. Non-Hodgkin's lymphoma (NHL) was the most common HM accounting for 29.7 % of all HM, followed by HL, MPN, multiple myelomas (MM), chronic lymphocytic leukemia (CLL), AML, MDS, acute lymphoblastic leukemia (ALL), and Waldenström macroglobulinemia (WM). The majority of HM cases have been observed among patients aged 60 years and over (40.4 % of HM). Among this age group, NHL was the most common HM. In adolescents, HL was the most frequent HM. This study provided for the

  20. A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey.

    PubMed

    Karakus, Ali; Zeren, Cem; Celik, M Murat; Arica, Secil; Ozden, Raif; Duru, Mehmet; Tasın, Veyis

    2015-02-01

    Snakebites are relatively rare medical emergency cases that might lead to serious consequences. This study aims to evaluate snakebite cases in terms of medical follow-up, antivenom therapy and antivenom reactions. Medical records of patients admitted to emergency department between January 1, 2006 and December 31, 2010 were retrospectively investigated. Snakebite-related cases of a total of 125 patients were included in the scope of the study. Of the total 125 cases, 54.4% were male and 45.6% were female. Most of cases (n: 65, 52%) were aged over 30 years, while the mean age was 34.87 ± 19.29 years. Snakebite-related applications to the emergency department were mostly seen in June with 27 cases. Upon admitting, all patients were recorded to be conscious and showing good general conditions; however, they suffered from pain and edema at the site of bite. Of all, 25 patients only suffered from bite injury and ecchymosis due to snakebite. The site of bite was upper extremities in 66 patients (52.8%), whereas it was lower extremities in 58 (46.4%). Of all, antivenom was unnecessary in 25 (20%) patients, while four antivenoms were administered to each of the 23 (18.4%) patients. Furthermore, six (4.8%) patients needed nine antivenom administrations for each. Anaphylaxis (n: 2, 1.6%), compartment syndrome (n: 2, 1.6%) and serum sickness (n: 1, 0.8%) encountered in remaining cases. Of all, 86 (68.8%) patients were hospitalized in the emergency department, while 25 (20.0%) patients were followed up by observation in emergency service. Only one patient was treated and followed up in intensive care unit. Implementation of antivenom therapy is considered unnecessary for the treatment of all snakebite cases. Antivenom reactions and number of related cases might be reduced by continuous close monitoring, appropriate prophylaxis and controlled slow infusion administration of medications. © The Author(s) 2012.

  1. 76 FR 50447 - Endangered and Threatened Species; 5-Year Reviews for 5 Evolutionarily Significant Units of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-15

    ...) California Coastal Chinook salmon; (3) Central California Coast coho salmon; (4) Sacramento River winter-run... Threatened Species; 5-Year Reviews for 5 Evolutionarily Significant Units of Pacific Salmon and 1 Distinct...-year reviews for five ESUs of Pacific salmon (Oncorhynchus sp.) and one DPS of steelhead (Oncorhynchus...

  2. Treatment of neovascular age-related macular degeneration with anti-VEGF agents: retrospective analysis of 5-year outcomes.

    PubMed

    Pedrosa, Ana Catarina; Reis-Silva, Adriana; Pinheiro-Costa, João; Beato, João; Freitas-da-Costa, Paulo; Falcão, Manuel S; Falcão-Reis, Fernando; Carneiro, Ângela

    2016-01-01

    To evaluate the 5-year results obtained in clinical practice in the treatment of neovascular age-related macular degeneration (nAMD) with anti-VEGF agents. We retrospectively analyzed all patients with nAMD who initiated anti-VEGF treatment before October 2009. We collected data regarding visual and anatomical outcomes. A total of 278 patients met the selection criteria. The mean number of intravitreal injections was 5.7 in the first year and 3.7 in the fifth year. A positive mean visual acuity variation of +3.7 Early Treatment Diabetic Retinopathy Study letters occurred in the first year, but no significant differences relative to baseline were observed thereafter. The majority of patients (71%) maintained stable visual acuity throughout follow-up. At 5 years, mean central macular thickness remained substantially inferior to baseline (-96.6 μm), and 56% of patients maintained dry retinas. Anti-VEGF therapy leads to long-term visual stabilization in the great majority of patients.

  3. Treatment of neovascular age-related macular degeneration with anti-VEGF agents: retrospective analysis of 5-year outcomes

    PubMed Central

    Pedrosa, Ana Catarina; Reis-Silva, Adriana; Pinheiro-Costa, João; Beato, João; Freitas-da-Costa, Paulo; Falcão, Manuel S; Falcão-Reis, Fernando; Carneiro, Ângela

    2016-01-01

    Purpose To evaluate the 5-year results obtained in clinical practice in the treatment of neovascular age-related macular degeneration (nAMD) with anti-VEGF agents. Materials and methods We retrospectively analyzed all patients with nAMD who initiated anti-VEGF treatment before October 2009. We collected data regarding visual and anatomical outcomes. Results A total of 278 patients met the selection criteria. The mean number of intravitreal injections was 5.7 in the first year and 3.7 in the fifth year. A positive mean visual acuity variation of +3.7 Early Treatment Diabetic Retinopathy Study letters occurred in the first year, but no significant differences relative to baseline were observed thereafter. The majority of patients (71%) maintained stable visual acuity throughout follow-up. At 5 years, mean central macular thickness remained substantially inferior to baseline (−96.6 μm), and 56% of patients maintained dry retinas. Conclusion Anti-VEGF therapy leads to long-term visual stabilization in the great majority of patients. PMID:27099460

  4. Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up.

    PubMed

    Sudhalkar, Aditya; Sethi, Vaibhav; Gogte, Priyanka; Bondalapati, Sailaja; Khodani, Mitali; Chhablani, Jay Kumar

    2015-12-01

    To provide a detailed analysis of age-related macular degeneration (AMD) with a 5-year follow-up at a Tertiary Eye Care Center in India. In this retrospective institutional study, 408 eyes of 204 subjects (100 males) with a diagnosis of AMD with minimum 5-year follow-up were included. Data collected included demographics, details of the ocular exam, special investigations performed, treatment offered, complications, and systemic diseases, if any. The median age was 74.24 ± 8.23 years. Median follow-up was 5.77 years. The visual acuity (VA) at baseline and last visit was 0.74 ± 0.12 (Snellen's equivalent 20/100) and 0.54 ± 0.12 logarithm of the minimum angle of resolution (Snellen's equivalent 20/50; P = 0.032) in patients with choroidal neovascular membrane (CNVM). The most common complaint was decreased vision (94.5%). AMD (any stage) was found to be bilateral in 93% of patients at baseline and 197 patients (96.56%) at 5 years. Seventeen eyes had active CNVM (12 of these were occult) at presentation. At baseline, 43 eyes had a disciform scar. Three hundred twenty-one eyes had dry AMD at baseline (geographic atrophy - 12 [3.7%] eyes). Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%. Median number of anti-vascular endothelial growth factor injections administered per patient was 2.8 ± 1.2. CNVM bilaterality was low (7.5%). Patients with AMD in India presented later in the course of the disease. Bilateral advanced AMD and geographic atrophy were uncommon. Five-year conversion rate into wet AMD and geographic atrophy was 2.87% and 3.12%.

  5. Prenatal exposure to metronidazole and risk of childhood cancer: a retrospective cohort study of children younger than 5 years.

    PubMed

    Thapa, P B; Whitlock, J A; Brockman Worrell, K G; Gideon, P; Mitchel, E F; Roberson, P; Pais, R; Ray, W A

    1998-10-01

    To evaluate the role of in utero exposure to metronidazole (a carcinogen in some animal models) and the risk of subsequent cancer, the authors conducted a retrospective cohort study of childhood cancer. The cohort included 328,846 children younger than 5 years born to women enrolled in Tennessee Medicaid at any time between the last menstrual period (LMP) and the date of delivery. The cohort was identified by linking files of Tennessee Medicaid mothers ages 15-44 years and children and the children's birth and death certificates for the period January 1, 1975 through December 31, 1992. Exposure data were obtained from Medicaid pharmacy records and exposure was defined as filling a metronidazole prescription that had at least a day's supply between the 30 days prior to the LMP and the date of delivery. Study cases were cohort children diagnosed with a first primary cancer before age 5 years, identified by linking the cohort with a statewide childhood cancer database for the study period. Cohort members contributed 1,172,696 person-years of follow-up for analysis, with children exposed (8.1%) and not exposed (91.9%) in utero to metronidazole contributing 79,716 and 1,092,980 person-years, respectively. Of 952 children younger than 5 years in the statewide cancer database, 175 met study eligibility criteria. Of these, 42 had leukemia, 30 had central nervous system (CNS) tumors, 28 had neuroblastoma, and 75 had other cancers. Using Poisson regression modeling, children exposed to metronidazole in utero had no significant increase in adjusted relative risk (RR) for all cancers (RR: 0.81; 95% confidence interval [95% CI], 0.41-1.59), leukemia (no exposed case), CNS tumors (RR: 1.23; 95% CI, 0.29-5.21), neuroblastomas (RR: 2.60; 95% CI, 0.89-7.59), and other cancers (RR: 0.57; 95% CI, 0.18-1.82). The authors conclude that although there was no increase in risk for all cancers associated with in utero exposure to metronidazole, the observed increased risk for

  6. 77 FR 64959 - Endangered and Threatened Species; Initiation of 5-Year Review for the Southern Distinct...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-24

    ... trends, distribution, abundance, demographics, and genetics; (2) habitat conditions including, but not limited to, amount, distribution, and suitability; (3) conservation measures that have been implemented... the 5-year review and will also be useful in evaluating ongoing research and conservation activities...

  7. Occurrence of Scopulariopsis and Scedosporium in nails and keratinous skin. A 5-year retrospective multi-center study.

    PubMed

    Issakainen, Jouni; Heikkilä, Hannele; Vainio, Eeva; Koukila-Kähkölä, Pirkko; Castren, Mirja; Liimatainen, Oili; Ojanen, Tarja; Koskela, Markku; Meurman, Olli

    2007-05-01

    A 5-year retrospective multicenter study was performed for microascaceous moulds (Microascaceae, Ascomycetes) in Finnish clinical specimens. The files from 1993-1997 of six clinical mycology laboratories in Finland were searched for reports of these fungi, mainly Scopulariopsis and Scedosporium anamorphs in keratinous specimens. From the 521 primary findings, 165 cases were selected for further study based on direct microscopy, colony numbers and accompanying fungi. The clinical records of 148 cases (141 Scopulariopsis, 7 Scedosporium) were studied. Of the nail infections from which Scopulariopsis was recovered, 39 cases were further separated which showed clinical or laboratory-based evidence of dermatophytosis. In the remaining 90 'non-dermatophyte' nail cases, Scopulariopsis spp. were the only documented fungal agents (c. 6 cases/million/year). The patients were mainly elderly, 66% of whom had problems involving their big toe nails. For 74% of them, the nail problem was mentioned as their reason for visiting the physician. However, only 18% had documented benefit from treatment. The Scopulariopsis nail infections seem to be treatment-resistant and the pathogenesis and etiological role of Scopulariopsis remain poorly understood.

  8. Dopaminergic therapy and subthalamic stimulation in Parkinson's disease: a review of 5-year reports.

    PubMed

    Romito, Luigi M; Albanese, Alberto

    2010-11-01

    The long-term efficacy and safety of deep brain stimulation (DBS) implant for Parkinson's disease (PD) is described in several recent papers. This procedure has been reported to permit a stable reduction of dopaminergic therapy requirements for up to 5 years, although some expectation of deterioration in non-dopaminergic signs has been recently stated. Our aim is to perform a literature-based review of papers available describing long-term post-operative follow-up after a bilateral implant for subthalamic DBS (STN-DBS). Only peer-reviewed published papers with a post-operative follow-up of at least 5 years were considered. Clinical outcome, disease progression and side effects were assessed at baseline and 2 (or 3 years) and 5 years after surgery. Seven papers were included in the review. A total of 238 patients were analyzed. STN-DBS was confirmed to be an effective treatment for selected patients with PD. In all studies, off-related motor symptoms improved dramatically, compared with pre-implant, at 2 (or 3, according to the study) years and this result persisted at 5-year evaluations. Antiparkinsonian drug reductions, improvements in motor fluctuations and dyskinesias, functional measures and the progression of underlying PD were also reported in all series. Some axial scores, in particular postural stability and speech, improved transiently. Persisting adverse effects included eyelid opening apraxia, weight gain, psychiatric disorders, depression, dysarthria, dyskinesias, and apathy. The present review of the 5-year observations confirms that STN-DBS is a powerful method in the management of PD, but its long-term effects must be thoroughly assessed.

  9. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

    PubMed Central

    2012-01-01

    Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely

  10. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients.

    PubMed

    Zernikow, Boris; Wager, Julia; Hechler, Tanja; Hasan, Carola; Rohr, Uta; Dobe, Michael; Meyer, Adrian; Hübner-Möhler, Bettina; Wamsler, Christine; Blankenburg, Markus

    2012-05-16

    Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for

  11. Childcare use and overweight in Finland: cross-sectional and retrospective associations among 3- and 5-year-old children.

    PubMed

    Lehto, R; Mäki, P; Ray, C; Laatikainen, T; Roos, E

    2016-04-01

    Different types of non-parental childcare have been found to associate with childhood overweight in several, but not all studies. Studies on the matter are mainly North American. The objective of our study was to examine associations between childcare use and overweight in Finland. The cross-sectional and partly retrospective data consists of 1683 3- and 5-year-old children participating in the Child Health Monitoring Development project (LATE-project) conducted in 2007-2009 in Finland. Children were measured at health check-ups and information on child's age when entering childcare, the number of childcare places the child has had, current type of childcare (parental, informal, [group] family childcare, childcare centre) and the current amount of childcare (hours) were gathered. Parents' body mass indices, family educational level, family structure, maternal smoking during pregnancy and child's birth weight were treated as covariates. Beginning childcare before age 1 (adjusted model: odds ratio [OR] 2.53, 95% confidence interval [CI] 1.41-4.52) and, for girls only, number of childcare places (adjusted model: OR 1.33, 95% CI 1.11-1.60), were associated with an increased risk of overweight. The current type of childcare or the time currently spent in childcare was not associated with overweight. Beginning childcare before age 1, which is quite rare in Finland, and having attended several childcare places were associated with overweight even when adjusting for family socioeconomic status and other family background variables. The significance of these findings needs to be further studied. © 2015 World Obesity.

  12. 77 FR 70410 - Endangered and Threatened Wildlife and Plants; Initiation of Status Review and 5-Year Review of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... Status Review and 5-Year Review of the Preble's Meadow Jumping Mouse AGENCY: Fish and Wildlife Service...), announce the initiation of a status review of the Preble's meadow jumping mouse (Zapus hudsonius preblei... jumping mouse (Zapus hudsonius), a species that ranges from the Pacific Coast of Alaska to the Atlantic...

  13. Epidemiological study of acute poisoning in children: a 5-year retrospective study in the Paediatric University Hospital in Białystok, Poland.

    PubMed

    Pawłowicz, Urszula; Wasilewska, Anna; Olański, Witold; Stefanowicz, Marta

    2013-09-01

    Poisoning among children and youths in the northeastern part of Poland accounted for 25% of the total number of patients admitted to the Hospital Emergency Department of the Paediatric University Hospital of Białystok. We hypothesise that the epidemiology of poisoned paediatric patients admitted is related to increase in 'designer drugs' (mainly amphetamine- and ecstasy-like psychostimulants, hallucinogens and synthetic cannabinoids ('spice') intake, which became popular 5 years ago in our country. A retrospective chart review of medical records of 489 patients admitted due to poisoning in the 5-year period (2006-2010). The data included: age, sex, place of residence, nature of the substance, causes of poisoning, former use of psychoactive stimulants, accompanying self-mutilation and injuries and length of hospitalisation. Categorical variables were expressed as percentages, and continuous variables as mean and SD. The data were collected in a Microsoft Excel database. Statistical analysis was performed using the Statistical Programme for Social Sciences. Out of 2176 hospitalised children, 489 were admitted because of poisoning. Out of these, 244 (49.9%) were hospitalised due to intoxication by alcohol. Only eight children used designer drugs. The mean age of all patients in our group was 12.86±5.04 years, of which 52.4% were male. Poisoning was intentional in 75.5%, and accidental in 24.5% of cases. Appearance of 'designer drugs' had no significant impact on the number and epidemiology of poisonings in our group.

  14. Annual Energy Outlook Retrospective Review

    EIA Publications

    2015-01-01

    The Annual Energy Outlook Retrospective Review provides a yearly comparison between realized energy outcomes and the Reference case projections included in previous Annual Energy Outlooks (AEO) beginning with 1982. This edition of the report adds the AEO 2012 projections and updates the historical data to incorporate the latest data revisions.

  15. Annual Energy Outlook Retrospective Review

    EIA Publications

    2015-01-01

    The Annual Energy Outlook Retrospective Review provides a yearly comparison between realized energy outcomes and the Reference case projections included in previous Annual Energy Outlooks (AEO) beginning with 1982. This edition of the report adds the AEO 2012 projections and updates the historical data to incorporate the latest data revisions.

  16. 75 FR 53978 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews for Lomatium cookii (Cook's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    ... Fish and Wildlife Service Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews for... Meadowfoam) AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of initiation of reviews; request for information. SUMMARY: We, the U.S. Fish and Wildlife Service, are initiating 5-year reviews for two...

  17. Restoration of menses with nonpharmacologic therapy in college athletes with menstrual disturbances: a 5-year retrospective study.

    PubMed

    Arends, Julie C; Cheung, Min-Yuen C; Barrack, Michelle T; Nattiv, Aurelia

    2012-04-01

    Functional hypothalamic amenorrhea is common among female athletes and may be difficult to treat. Restoration of menses (ROM) is crucial to prevent deleterious effects to skeletal and reproductive health. To determine the natural history of menstrual disturbances in female college athletes managed with nonpharmacologic therapies including increased dietary intake and/or decreased exercise expenditure and to identify factors associated with ROM. A 5-yr retrospective study of college athletes at a major Division I university. 373 female athletes' charts were reviewed. For athletes with menstrual disturbances, morphometric variables were noted. Months to ROM were recorded for each athlete. Fifty-one female athletes (19.7%) had menstrual disturbances (14.7% oligomenorrheic, 5.0% amenorrheic). In all, 17.6% of oligo-/amenorrheic athletes experienced ROM with nonpharmacologic therapy. Mean time to ROM among all athletes with menstrual disturbances was 15.6 ± 2.6 mo. Total absolute (5.3 ± 1.1 kg vs. 1.3 ± 1.1 kg, p < .05) and percentage (9.3% ± 1.9% vs. 2.3% ± 1.9%, p < .05) weight gain and increase in body-mass index (BMI; 1.9 ± 0.4 kg/m2 vs. 0.5 ± 0.4 kg/m2, p < .05) emerged as the primary differentiating characteristics between athletes with ROM and those without ROM. Percent weight gain was identified as a significant positive predictor of ROM, OR (95% CI) = 1.25 (1.01, 1.56), p < .05. Nonpharmacologic intervention in college athletes with menstrual disturbances can restore regular menstrual cycles, although ROM may take more than 1 yr. Weight gain or an increase in BMI may be important predictors of ROM.

  18. A 5-year review of pattern of placenta previa in Ilorin, Nigeria

    PubMed Central

    Omokanye, L. O.; Olatinwo, A. W. O.; Salaudeen, A. G.; Ajiboye, A. D.; Durowade, K. A.

    2017-01-01

    Background: Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. Methodology: This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study. Results: There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a significant association between patients’ age, parity, booking status, and types of placenta previa (P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa (P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality. Conclusion: From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa. PMID:28539861

  19. A 5-year review of pattern of placenta previa in Ilorin, Nigeria.

    PubMed

    Omokanye, L O; Olatinwo, A W O; Salaudeen, A G; Ajiboye, A D; Durowade, K A

    2017-01-01

    Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study. There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a significant association between patients' age, parity, booking status, and types of placenta previa (P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa (P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality. From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa.

  20. 75 FR 38979 - Endangered and Threatened Species; Initiation of a 5-Year Review of the Eastern Distinct...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-07

    ... of a 5-Year Review of the Eastern Distinct Population Segment of the Steller Sea Lion AGENCY... of a 5-year review of the eastern Distinct Population Segment (DPS) of the Steller Sea Lion... for the eastern Distinct Population Segment of the Steller sea lion (75 FR 37385). NMFS inadvertently...

  1. 75 FR 53272 - Endangered and Threatened Species; Initiation of 5-Year Review of the Eastern Distinct Population...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-31

    ... of 5-Year Review of the Eastern Distinct Population Segment of the Steller Sea Lion AGENCY: National... the Steller Sea Lion (Eumetopias jubatus) under the Endangered Species Act of 1973, as amended (ESA... subject line of the e-mail: ``Comments on the 5-year review for the eastern DPS of Steller sea lion.'' Fax...

  2. Global Causes of Diarrheal Disease Mortality in Children <5 Years of Age: A Systematic Review

    PubMed Central

    Lanata, Claudio F.; Fischer-Walker, Christa L.; Olascoaga, Ana C.; Torres, Carla X.; Aryee, Martin J.; Black, Robert E.

    2013-01-01

    Estimation of pathogen-specific causes of child diarrhea deaths is needed to guide vaccine development and other prevention strategies. We did a systematic review of articles published between 1990 and 2011 reporting at least one of 13 pathogens in children <5 years of age hospitalized with diarrhea. We included 2011 rotavirus data from the Rotavirus Surveillance Network coordinated by WHO. We excluded studies conducted during diarrhea outbreaks that did not discriminate between inpatient and outpatient cases, reporting nosocomial infections, those conducted in special populations, not done with adequate methods, and rotavirus studies in countries where the rotavirus vaccine was used. Age-adjusted median proportions for each pathogen were calculated and applied to 712 000 deaths due to diarrhea in children under 5 years for 2011, assuming that those observed among children hospitalized for diarrhea represent those causing child diarrhea deaths. 163 articles and WHO studies done in 31 countries were selected representing 286 inpatient studies. Studies seeking only one pathogen found higher proportions for some pathogens than studies seeking multiple pathogens (e.g. 39% rotavirus in 180 single-pathogen studies vs. 20% in 24 studies with 5–13 pathogens, p<0·0001). The percentage of episodes for which no pathogen could be identified was estimated to be 34%; the total of all age-adjusted percentages for pathogens and no-pathogen cases was 138%. Adjusting all proportions, including unknowns, to add to 100%, we estimated that rotavirus caused 197 000 [Uncertainty range (UR) 110 000–295 000], enteropathogenic E. coli 79 000 (UR 31 000–146 000), calicivirus 71 000 (UR 39 000–113 000), and enterotoxigenic E. coli 42 000 (UR 20 000–76 000) deaths. Rotavirus, calicivirus, enteropathogenic and enterotoxigenic E. coli cause more than half of all diarrheal deaths in children <5 years in the world. PMID:24023773

  3. A 5-year analysis of peer-reviewed journal article publications of pharmacy practice faculty members.

    PubMed

    Chisholm-Burns, Marie A; Spivey, Christina; Martin, Jennifer R; Wyles, Christina; Ehrman, Clara; Schlesselman, Lauren S

    2012-09-10

    To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates. Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH). Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006). Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications.

  4. A 5-Year Analysis of Peer-Reviewed Journal Article Publications of Pharmacy Practice Faculty Members

    PubMed Central

    Spivey, Christina; Martin, Jennifer R.; Wyles, Christina; Ehrman, Clara; Schlesselman, Lauren S.

    2012-01-01

    Objectives. To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates. Methods. Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH). Results. Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006). Conclusion. Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications. PMID:23049099

  5. Interventions to Increase Physical Activity in Children Aged 2-5 Years: A Systematic Review.

    PubMed

    Ling, Jiying; Robbins, Lorraine B; Wen, Fujun; Peng, Wei

    2015-08-01

    Comprehensive evaluation of prior interventions designed to increase preschoolers' physical activity is lacking. This systematic review aimed to examine the effect of interventions on objectively measured physical activity in children aged 2-5 years. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In May 2014, we searched PubMed, CINAHL, PsycINFO, ERIC, SPORTDiscus, Cochrane, and Embase. Two reviewers independently identified and appraised the studies. Twenty-four articles describing 23 independent studies and 20 unique interventions met inclusion criteria. Of the 8 interventions resulting in a significant effect in objectively measured physical activity, all were center-based and included a structured physical activity component, 6 included multiple components, 5 integrated theories or models, and 4 actively involved parents. Seven of the 8 were randomized controlled trials. Due to the heterogeneity of the study designs, physical activity measures, and interventions, drawing definitive conclusions was difficult. Although the overall intervention effect was less than optimal, the review indicated that theory-driven, multicomponent interventions including a structured physical activity component and targeting both parents and their children may be a promising approach for increasing preschoolers' physical activity and warrant continued investigation using rigorous designs to identify those that are most effective.

  6. Re-presentations and recurrent events following initial management of the acute paediatric scrotum: a 5-year review.

    PubMed

    Lala, Shareena; Price, Neil; Upadhyay, Vipul

    2017-02-27

    Previous reviews report relatively low rates of post-operative complications for acute scrotal exploration. The aim of this study was to evaluate the re-presentation to hospital in boys with previous acute scrotal pathology, reviewing contralateral symptoms, post-operative complications, testicular torsion following fixation and failure of conservative management of testicular appendage (TA) torsion. All boys under 16 years presenting to our unit with an acute scrotum from January 2008 to December 2012 (5-year period) were identified. A retrospective review of clinical records was performed. A total of 683 boys presented over this 5-year period, with an overall re-presentation rate of 10%. Seventeen (25%) re-presentations were metachronous. Post-operative complication rate was 2.2%. Testicular torsion rate following orchiopexy was 0.3% (1/292). Thirty-three percent of those managed conservatively for TA torsion returned with ongoing pain; 80% underwent scrotal exploration on return. Eight boys returned following excision of a torted TA with contralateral torted TA confirmed, accounting for 2.6% (8/308) of boys with a torted TA at first presentation. This gives a number-needed-to-treat of 39 for bilateral scrotal exploration and prophylactic excision of contralateral non-torted TA, to prevent one boy from returning to hospital with a metachronous presentation. Further prolonged follow-up is needed to adequately assess recurrence rates of testicular torsion following orchiopexy to validate routine orchiopexy. Post-operative complication rates equal that of the return rate for a contralateral torted TA; this needs to be considered in proceeding to bilateral scrotal exploration on finding a torted TA at initial presentation. © 2017 Royal Australasian College of Surgeons.

  7. Tympanoplasty: a 5-year review of results using the a la demanda (AAD) technique.

    PubMed

    Olaizola, F

    1988-07-01

    The effectiveness of different surgical procedures to eradicate cholesteatoma in the middle ear was studied. The author reviewed 1405 cases conducted during 10 years (1974 to 1984) and found that the most important causes of failure are pocket cholesteatoma and residual cholesteatoma. With the goal of diminishing these factors, a la demanda (AAD) technique has been used for the past 5 years, with optimistic results--only 2.4% failures during this period. Other causes of failures have also been studied. The evolution of the surgical technique has had two orientations: to improve the results and to eliminate the failures. In the author's clinic there has been a percentage of failures, which has motivated an orientation toward more resolutive and destructive instead of conservative, techniques.

  8. Sinus floor augmentation with autogenous bone vs. a bovine-derived xenograft - a 5-year retrospective study.

    PubMed

    Lutz, Rainer; Berger-Fink, Susanne; Stockmann, Philipp; Neukam, Friedrich Wilhelm; Schlegel, Karl Andreas

    2015-06-01

    The long-term outcome after sinus augmentation with autogenous bone or a bovine xenograft (Bio-Oss(®)) was assessed in 47 patients. Inclusion criterion was a vertical dimension of the maxilla of <4 mm. After a functional loading period of 60 months, implant survival and reduction in the augmentation height were compared between the two groups evaluated. Sinus augmentation was performed using mandibular bone grafts or Bio-Oss(®). In the autogenous bone group, 70 implants were placed in 23 patients, while in the Bio-Oss(®) group, 24 patients received 98 implants. Fisher's exact test and equivalence testing were used to compare implant survival rates. The overall survival rate of the implants was 95.8% 5 years after implant insertion. In the autogenous bone group, the implants had a survival rate of 97.1%, while in the Bio-Oss(®) group, 94.9% of the implants survived. The difference was not statistically significant (P > 0.05); both treatments are equivalent (confidence interval 90%) for the equivalence interval [-0.1; 0.1]. 43.5% of the cases showed no reduction in the augmentation height 5 years after implant insertion, when augmentation was performed with autogenous bone, while in the Bio-Oss(®) group, no resorption was found in 50% of the augmented areas. Up to 25% reduction in augmentation height was found in 47.8% in the autogenous and in 45.8% in the Bio-Oss(®) group. In 8.7% of all cases in the autogenous bone group and in 4.2 % in the Bio-Oss(®) group, up to 50% of the augmented height was resorbed. After a 5 years evaluation period, Bio-Oss(®) as material for the indication maxillary sinus augmentation shows to be equivalent to autogenous bone grafting. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Stability and change in retrospective reports of childhood experiences over a 5-year period: findings from the Davis Longitudinal Study.

    PubMed

    Yancura, Loriena A; Aldwin, Carolyn M

    2009-09-01

    The paths via which childhood experiences influence well-being in adulthood are not well defined because most research relies on retrospective reports. This study examined the influence of demographic characteristics and current mood states on the reliability of reports of childhood experiences. The Child Experiences Scale (CES) was administered in 1996 and 2001 to participants in the Davis Longitudinal Study (N = 571; age range 22-61 years). Responses showed moderate to high cross-time reliability. Males were slightly more likely to change their responses. The influence of mood states was weak and more evident for global ratings of childhood than for specific experiences. These findings support the use of retrospective reports of childhood.

  10. WHO global rotavirus surveillance network: a strategic review of the first 5 years, 2008-2012.

    PubMed

    Agócs, Mary M; Serhan, Fatima; Yen, Catherine; Mwenda, Jason M; de Oliveira, Lúcia H; Teleb, Nadia; Wasley, Annemarie; Wijesinghe, Pushpa R; Fox, Kimberley; Tate, Jacqueline E; Gentsch, Jon R; Parashar, Umesh D; Kang, Gagandeep

    2014-07-25

    Since 2008, the World Health Organization (WHO) has coordinated the Global Rotavirus Surveillance Network, a network of sentinel surveillance hospitals and laboratories that report to ministries of health (MoHs) and WHO clinical features and rotavirus testing data for children aged <5 years hospitalized with acute gastroenteritis. In 2013, WHO conducted a strategic review to assess surveillance network performance, provide recommendations for strengthening the network, and assess the network's utility as a platform for other vaccine-preventable disease surveillance. The strategic review team determined that during 2011 and 2012, a total of 79 sites in 37 countries met reporting and testing inclusion criteria for data analysis. Of the 37 countries with sites meeting inclusion criteria, 13 (35%) had introduced rotavirus vaccine nationwide. All 79 sites included in the analysis were meeting 2008 network objectives of documenting presence of disease and describing disease epidemiology, and all countries were using the rotavirus surveillance data for vaccine introduction decisions, disease burden estimates, and advocacy; countries were in the process of assessing the use of this surveillance platform for other vaccine-preventable diseases. However, the review also indicated that the network would benefit from enhanced management, standardized data formats, linkage of clinical data with laboratory data, and additional resources to support network functions. In November 2013, WHO's Strategic Advisory Group of Experts on Immunization (SAGE) endorsed the findings and recommendations made by the review team and noted potential opportunities for using the network as a platform for other vaccine-preventable disease surveillance. WHO will work to implement the recommendations to improve the network's functions and to provide higher quality surveillance data for use in decisions related to vaccine introduction and vaccination program sustainability.

  11. Preventing dental caries in children <5 years: systematic review updating USPSTF recommendation.

    PubMed

    Chou, Roger; Cantor, Amy; Zakher, Bernadette; Mitchell, Jennifer Priest; Pappas, Miranda

    2013-08-01

    Screening and preventive interventions by primary care providers could improve outcomes related to early childhood caries. The objective of this study was to update the 2004 US Preventive Services Task Force systematic review on prevention of caries in children younger than 5 years of age. Searching Medline and the Cochrane Library (through March 2013) and reference lists, we included trials and controlled observational studies on the effectiveness and harms of screening and treatments. One author extracted study characteristics and results, which were checked for accuracy by a second author. Two authors independently assessed study quality. No study evaluated effects of screening by primary care providers on clinical outcomes. One good-quality cohort study found pediatrician examination associated with a sensitivity of 0.76 for identifying a child with cavities. No new trials evaluated oral fluoride supplementation. Three new randomized trials were consistent with previous studies in finding fluoride varnish more effective than no varnish (reduction in caries increment 18% to 59%). Three trials of xylitol were inconclusive regarding effects on caries. New observational studies were consistent with previous evidence showing an association between early childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk prediction instruments in primary care settings is not available. There is no direct evidence that screening by primary care clinicians reduces early childhood caries. Evidence previously reviewed by the US Preventive Services Task Force found oral fluoride supplementation effective at reducing caries incidence, and new evidence supports the effectiveness of fluoride varnish in higher-risk children.

  12. Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5-Year Retrospective Results.

    PubMed

    Al Amri, Mohammad D; Alfadda, Sara A; Labban, Nawaf Y; Alasqah, Mohammed N; Alshehri, Fahad A; Al-Rasheed, Abdulaziz S

    2017-09-28

    To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1β] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1β and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1β, and MMP-9 among implants in both groups. Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants. © 2017 by the American College of Prosthodontists.

  13. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India

    PubMed Central

    Naveen, Kikkeri Narayanasetty; Pai, Varadraj V.; Rai, Vijetha; Athanikar, Sharatchandra B.

    2013-01-01

    Objective: Cutaneous drug reactions are the most common type of adverse drug reactions. Adverse cutaneous drug reactions form 2-3% of the hospitalized patients. 2% of these are potentially serious. This study aims to detect the drugs commonly implicated in Steven Johnson Syndrome-Toxic Epidermal Necrosis (SJS-TEN). Materials and Methods: A retrospective analysis was done in all patients admitted in the last five years in SDM hospital with the diagnosis of SJS-TEN. Results: A total of 22 patients with SJS-TEN were studied. In 11 patients anti-epileptics was the causal drug and in 7, anti-microbials was the causal drug. Recovery was much faster in case of anti epileptics induced SJS-TEN as compared to that induced by ofloxacin. Conclusion: SJS-TEN induced by ofloxacin has a higher morbidity and mortality compared to anti convulsants. PMID:23543919

  14. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India.

    PubMed

    Naveen, Kikkeri Narayanasetty; Pai, Varadraj V; Rai, Vijetha; Athanikar, Sharatchandra B

    2013-01-01

    Cutaneous drug reactions are the most common type of adverse drug reactions. Adverse cutaneous drug reactions form 2-3% of the hospitalized patients. 2% of these are potentially serious. This study aims to detect the drugs commonly implicated in Steven Johnson Syndrome-Toxic Epidermal Necrosis (SJS-TEN). A retrospective analysis was done in all patients admitted in the last five years in SDM hospital with the diagnosis of SJS-TEN. A total of 22 patients with SJS-TEN were studied. In 11 patients anti-epileptics was the causal drug and in 7, anti-microbials was the causal drug. Recovery was much faster in case of anti epileptics induced SJS-TEN as compared to that induced by ofloxacin. SJS-TEN induced by ofloxacin has a higher morbidity and mortality compared to anti convulsants.

  15. Anxiety, depression and fatigue at 5-year review following CNS demyelination.

    PubMed

    Simpson, S; Tan, H; Otahal, P; Taylor, B; Ponsonby, A-L; Lucas, R M; Blizzard, L; Valery, P C; Lechner-Scott, J; Shaw, C; Williams, D; van der Mei, I

    2016-12-01

    Anxiety and depression are common in multiple sclerosis (MS). We evaluated the prevalence and factors associated with anxiety, depression and fatigue at the 5-year review of a longitudinal cohort study following a first clinical diagnosis of CNS demyelination (FCD). Cases with a FCD were recruited soon after diagnosis and followed annually thereafter. A variety of environmental, behavioural and clinical covariates were measured at five-year review. Anxiety and depression were measured using the Hospital Anxiety & Depression Scale (HADS), and fatigue by the Fatigue Severity Scale (FSS). Of the 236 cases, 40.2% had clinical anxiety (median HADS-A: 6.0), 16.0% had clinical depression (median HADS-D: 3.0), and 41.3% had clinical fatigue (median FSS: 4.56). The co-occurrence of all three symptoms was 3.76 times greater than expectation. Younger age, higher disability, concussion or other disease diagnosis were independently associated with a higher anxiety score; male sex, higher disability, being unemployed, less physical activity, and antidepressant and/or anxiolytic-sedative medication use were independently associated with a higher depression score. Higher disability, immunomodulatory medication use, other disease diagnosis and anxiolytic-sedative medication use were independently associated with having fatigue, while female sex, higher BMI, having had a concussion, being unemployed and higher disability were associated with a higher fatigue score. These results support previous findings of the commonality of anxiety, depression and fatigue in established MS and extend this to post-FCD and early MS cases. The clustering of the three symptoms indicates that they may share common antecedents. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Incidence and economic burden of acute otitis media in children aged up to 5years in three Middle Eastern countries and Pakistan: A multinational, retrospective, observational study.

    PubMed

    Mustafa, Ghulam; Al Aidaroos, Amal Y; Al Abaidani, Idris S; Meszaros, Kinga; Gopala, Kusuma; Ceyhan, Mehmet; Al-Tannir, Mohamad; DeAntonio, Rodrigo; Bawikar, Shyam; Schmidt, Johannes E

    2017-06-01

    Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia=1023, Oman=998, Pakistan=1022, Turkey=1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person-years was: Saudi Arabia, 207 [95% confidence interval (CI): 178-238]; Oman, 105 (95% CI: 85-127); Pakistan, 138 (95% CI: 116-163); and Turkey, 99 (95% CI: 79-123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD)=93.0], Oman USD16.1 (SD=16.4), Pakistan USD22.1 (SD=20.5), and Turkey USD33.6 (SD=44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  17. Epidemiology and evolution of antibiotic resistance of Haemophilus influenzae in children 5 years of age or less in France, 2001-2008: a retrospective database analysis.

    PubMed

    Dabernat, H; Delmas, C

    2012-10-01

    Trends in the evolution of antimicrobial resistance and mechanisms of resistance of Haemophilus influenzae to β-lactam antibiotics in France were assessed through a retrospective database review. The antimicrobial resistance of 2,206 H. influenzae strains from children aged ≤5 years was studied between 2001 and 2008. Strains were isolated from blood or cerebrospinal fluid (n = 170), bronchial secretions (n = 188), middle ear fluid, and nasopharynx or conjunctiva (n = 1,848). A proportion of 95.1 % (n = 2,097) were non-typeable H. influenzae (NTHi). β-lactamase production was identified in 27.5 % of NTHi isolates (all TEM-1), while β-lactamase-negative ampicillin resistance and β-lactamase-negative amoxicillin-clavulanate resistance among NTHi was 16.9 and 6.4 %, respectively. Over time, a statistically significant decrease in β-lactamase-producing strain prevalence (p < 0.0001) and a statistically significant increase in β-lactamase-negative ampicillin-resistant (BLNAR) strains (p < 0.0001) were observed in NTHi isolates from 2001 to 2008. The largest changes coincided with a campaign to reduce antibiotic use in France. An increasing diversity of amino acid substitution patterns was observed, with the emergence of group III/'III-like' patterns linked to high-level resistance. In France, amino acid substitution patterns are increasingly diverse, and strains with high-level antibiotic resistance are emerging. This study highlights the complexity of resistance dynamics within a given country. These results have implications on antibiotic guidelines and illustrate the importance of continued surveillance.

  18. 75 FR 18232 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 15 Caribbean Species

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-09

    ... Fish and Wildlife Service Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 15 Caribbean Species AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of initiation of reviews... status reviews of 15 species under the Endangered Species Act of 1973, as amended (Act). We conduct...

  19. Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India

    PubMed Central

    John, Deepa; Philip, Swetha Sara; Mittal, Rashmi; John, Sheeja Susan; Paul, Padma

    2015-01-01

    Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study. Results: Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2–13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered. PMID:26669336

  20. Indigenous birth outcomes at a Victorian urban hospital, a retrospective 5-year cohort study 2010-2014.

    PubMed

    Whish-Wilson, Thomas; Tacey, Mark; McCarthy, Elizabeth; Howat, Paul

    2016-06-01

    Indigenous people in Australia experience higher rates of preterm birth and low birthweight than their nonindigenous counterparts. There is currently no data on these rates from Victoria, with the data coming from states with higher indigenous proportions. Five years (1st January 2010-31st December 2014) of retrospective data from The Northern Hospital's (Melbourne, Victoria) database were analysed. Mothers and babies were split according to self-reported indigenous status: 13800 nonindigenous mothers, 185 indigenous mothers, 301 indigenous babies and 13843 nonindigenous babies. Primary outcomes measured were low birthweight (LBW) and preterm birth. There was a higher incidence of indigenous babies born preterm (8.8% vs 5.9%, P = 0.034), but the adjusted odds ratios for preterm birth were not significant (indigenous babies OR 1.19, 95% CI: 0.77-1.87, indigenous mothers OR 0.97, CI: 0.52-1.80). There was a similar incidence of LBW among indigenous and nonindigenous babies (6.5% vs 5.4%, P = 0.416). The rate of indigenous women smoking was 29.3% compared to 12.3% of nonindigenous women (P < 0.001), and 40.3% were obese compared to 28.7% (P = 0.001). Indigenous women had lower rates of diabetes (pre-existing or gestational diabetes, 6.1% vs 13.5% P = 0.003). Heterogeneity of indigenous people and geography means that inferences about indigenous health are difficult to make. It appears that Victorian urban indigenous women have similar rates of preterm birth and LBW to nonindigenous women. While there were pleasing results concerning LBW, antenatal care, diabetes and preterm birth, the rates of smoking and obesity remain a challenge in the indigenous population. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. A 5-year Review of Darning Technique of Inguinal Hernia Repair

    PubMed Central

    Olasehinde, Olalekan O; Adisa, Adewale O; Agbakwuru, Elugwaraonu A; Etonyeaku, Amarachukwu C; Kolawole, Oladapo A; Mosanya, Arinze O

    2015-01-01

    Context: The Darning technique of inguinal hernia repair is a tissue-based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting. Study Design: A descriptive retrospective study. Patients and Methods: Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed. Statistical Analysis Used: simple frequencies, proportions and cross-tabulations. Results: A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow-up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001). Conclusions: The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting. PMID:25838768

  2. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients

    PubMed Central

    Di Lorenzo, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola

    2016-01-01

    Background Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. Methods This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to “The Medlar” (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. Results Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient −2.28, 95% confidence interval [CI]: −3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was “conduct disorder”, more frequent in males, followed by “adjustment disorder”, more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period

  3. [The effectiveness of specific immunotherapy of allergic diseases of respiratory organs from the standpoint of evidence-based medicine. The results of a 5-year retrospective study].

    PubMed

    Zabolotnyĭ, D I; Gogunskaia, I V; Zabolotnaia, D D; Zaritskaia, I S

    2013-01-01

    The objective of this first Ukrainian 5-year retrospective study was to subjectively evaluate the effectiveness of specific immunotherapy (sublingual and injection) of the upper respiratory tract in the patients presenting with seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), SAR and PAR with polyvalent sensitization. The analysis of the results of sublingual, injection, and combined specific immunotherapy given to 750 patients allowed to describe them as "excellent" and "good" in the groups with PAR (83% of the total number), SAR (93%), SAR and PAR with polyvalent sensitization (84%).

  4. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

    PubMed Central

    Peker, Elif; Öğütlü, Faruk; Karaca, İnci Rana; Gültekin, Elif Sibel; Çakır, Merve

    2016-01-01

    Introduction: The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations. Aims and Objectives: This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions. Material and Methods: Biopsy of 1938 lesions (2008–2013) was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions. Statistical Analysis: The variables were recorded and analysed using descriptive statistics. Results and Observations: Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination. Conclusion: Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized. PMID:27194866

  5. Adult intussusception: a retrospective review.

    PubMed

    Honjo, Hirotaka; Mike, Makio; Kusanagi, Hiroshi; Kano, Nobuyasu

    2015-01-01

    Intussusception is common in children but rare in adults. The goal of this study was to review retrospectively the symptoms, diagnosis, and treatment of intussusception in adults. From 1997 to 2013, we experienced 44 patients of intussusception in patients older than 18 years. The patients were divided into enteric, ileocolic, ileocecal, and colocolonic (rectal) types. The diagnosis and treatment of these patients were reviewed. Of the 44 patients of adult intussusception, 42 were diagnosed with abdominal ultrasonography and abdominal computed tomography. There were 12 patients of enteric intussusception, six patients of ileocolic intussusception, 16 patients of ileocecal type intussusception, and 10 patients of colonic (rectal) intussusception. Among them, 77.3 % were associated with a tumor. Among 12 patients of enteric intussusception, three were associated with a metastatic intestinal tumor, and one was associated with a benign tumor. Among six patients of ileocolic intussusception, two patients were associated with malignant disease. Also, 93.8 % of ileocecal intussusceptions were associated with tumors, 80.0 % of which were malignant. Similarly, 90.0 % of colonic intussusceptions were associated with malignant tumors. Intussusception was reduced before or during surgery in 28 patients. Surgery was performed in 41 patients, and laparoscopy-assisted surgery was performed for ab underlying disease in 12 patients. Preoperative diagnoses were possible in almost all patients. Reduction greatly benefited any surgery required and the extent of the resection regardless of the underlying disease and surgical site.

  6. Management of hypersensitivity reactions to Carboplatin and Paclitaxel in an outpatient oncology infusion center: a 5-year review.

    PubMed

    Banerji, Aleena; Lax, Timothy; Guyer, Autumn; Hurwitz, Shelley; Camargo, Carlos A; Long, Aidan A

    2014-01-01

    A high incidence of hypersensitivity reactions (HSR) to carboplatin and Taxol is limiting the use of carboplatin and Taxol. We conducted a 5-year study of all patients with HSR to carboplatin or Taxol to better understand the nature of infusion HSR and success or failure of management plans after the initial HSR. We performed a retrospective chart review of all safety reports from the Massachusetts General Hospital outpatient chemotherapy infusion center between January 2006 and February 2011. All the patients with HSRs to carboplatin or Taxol were identified and included in the final analysis. We reviewed patient characteristics, clinical symptoms, timing, and treatment of the initial HSR, and determined if the patient was rechallenged despite an initial HSR. We identified 152 patients with HSR to carboplatin (n = 45) or Taxol (n = 107). Carboplatin HSR was less severe than Taxol HSR. When comparing the 2 groups, the patients with carboplatin HSRs more commonly described itchy palms and feet, generalized itch, and general urticaria and/or erythema, whereas patients with Taxol HSR more commonly described facial flushing, back pain, and chest or throat tightness (all P < .05). Among 40 patients with mild-to-moderate carboplatin HSRs, only 7 were rechallenged, and 100% tolerated rechallenge without desensitization. None of the patients with severe carboplatin HSRs (n = 5) were rechallenged. Most patients (75%) with Taxol HSRs were rechallenged, and 91% tolerated rechallenge without desensitization; the patients with a severe HSR to Taxol were less likely to be rechallenged. The clinical symptoms and timing of carboplatin HSR are distinct from Taxol HSR. Most patients with carboplatin HSR were not rechallenged, whereas most patients with Taxol HSR were successfully rechallenged. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. 78 FR 24767 - Endangered and Threatened Wildlife and Plants; Announcement of Active 5-Year Status Review of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-26

    ... Status Review of the Southwest Alaska Distinct Population Segment of the Northern Sea Otter AGENCY: Fish...) of ] the northern sea otter (Enhydra lutris kenyoni). A 5-year status review is based on the best... Williams, Chief, Marine Mammals Management, U.S. Fish and Wildlife Service, attention: Northern Sea Otter 5...

  8. 75 FR 18233 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 10 Southeastern Species

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-09

    ... Fish and Wildlife Service Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 10... status reviews of 10 species under the Endangered Species Act of 1973, as amended (Act). We conduct these... any of these 10 species indicating that a change in classification may be warranted, we may propose...

  9. 75 FR 42684 - Endangered and Threatened Species; Initiation of a 5-year Review of the Baiji/Chinese River...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-22

    ... of a 5-year Review of the Baiji/Chinese River Dolphin/Yangtze River Dolphin AGENCY: National Marine... submit comments, identified by , by either of the following methods: Mail: Angela Somma, National Marine... recent status review. Categories of requested information include the following: (A) species...

  10. 75 FR 17377 - Endangered and Threatened Species; Initiation of 5-Year Review for Southern Resident Killer Whales

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ... of 5-Year Review for Southern Resident Killer Whales AGENCY: National Marine Fisheries Service (NMFS... in November 2006 (71 FR 69054) and includes 2,560 square miles (6,630 sq km) of marine habitat in... determination or most recent status review. Categories of requested information include: (1) species...

  11. Katrina Retrospective: 5 Years Later

    NASA Image and Video Library

    Five years after Hurricane Katrina struck the Gulf Coast, NASA revisits the storm with a short video that shows Katrina as captured by satellites. Before and during the hurricane's landfall, NASA p...

  12. 77 FR 61573 - Endangered and Threatened Species; Initiation of 5-Year Review for Kemp's Ridley, Olive Ridley...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-10

    ...; Initiation of 5-Year Review for Kemp's Ridley, Olive Ridley, Leatherback, and Hawksbill Sea Turtles AGENCY... (Dermochelys coriacea), and hawksbill (Eretmochelys imbricata) sea turtles under the Endangered Species Act of..., leatherback, and hawksbill sea turtles. Public Solicitation of New Information To ensure that the...

  13. 75 FR 71726 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 58 Species in Washington...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-24

    ... Species in Washington, Oregon, California, and Hawaii AGENCY: Fish and Wildlife Service, Interior. ACTION..., are initiating 5-year reviews for 58 species in Washington, Oregon, California, and Hawaii under the... the 52 species in Hawaii (see Table 1 below), submit information to: Field Supervisor, Attention: 5...

  14. 78 FR 8185 - Endangered and Threatened Wildlife and Plants; Initiation of 5-Year Status Reviews of 44 Species...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... suitability; (C) Conservation measures that have been implemented that benefit the species; (D) Threat status... 49 FR 33881; 08/ Ocean--U.S.A 27/1984. (Guam). White-eye, Rota bridled........ Zosterops Endangered... completed and currently active 5-year reviews addressing species for which the Pacific Region of the Service...

  15. 78 FR 8576 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of Ocelot and Mexican...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... Ocelot and Mexican Spotted Owl in the Southwest Region AGENCY: Fish and Wildlife Service, Interior...), of the endangered ocelot (Leopardus pardalis) and the threatened Mexican spotted owl (Strix..., Sternberg@fws.gov Attention 5-Year (email). Review, 3325 Green Jay Road, Alamo, TX 78516. Owl, Mexican...

  16. 75 FR 15454 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 14 Southwestern Species

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ... Service, Arizona Ecological Services Field Office, 2321 West Royal Palm Road, Suite 103, Phoeniz, AZ 85021... Ecological Services Field Office, 17629 El Camino Real, Suite 211, Houston, TX 77058. The office phone number... Supervisor, Attention 5-year Review, U.S. Fish and Wildlife Service, Corpus Christi Ecological Services...

  17. Implant-Supported Immediately Loaded Full-Arch Rehabilitations: Comparison of Resin and Zirconia Clinical Outcomes in a 5-Year Retrospective Follow-Up Study.

    PubMed

    Tartaglia, Gianluca Martino; Maiorana, Carlo; Gallo, Maria; Codari, Marina; Sforza, Chiarella

    2016-02-01

    We analyzed complications and failures of final full-arch implant-supported rehabilitations, comparing resin and zirconia prosthesis materials. Prostheses were retrospectively followed up for 5 years. One hundred twenty-five patients who received one or two four to six implant-supported immediately loaded full-arch rehabilitations in resin (166 prostheses) or zirconia (48 prostheses) were analyzed. One hundred thirteen patients (53 men, 60 women), with 214 full-arch prostheses (105 maxillary, 109 mandibular), were analyzed. During the follow-up interval, the prosthesis annual complication rate was 6.6%, free complications survival was 75.5% (60 months). Age, number of implants, and prosthesis material did not influence complication risk. Men had a higher risk of complications than women. Prosthesis annual failure rate was 4.6%, free survival was 85.5% (60 months). Age, number of implants, and prosthesis material did not influence failure risk. Men and maxillary arch prostheses had a higher risk of failures than women and mandibular arch prostheses. Implant-supported, immediately loaded full-arch rehabilitations supporting resin or zirconia based prostheses were clinically successful in a 5-year follow-up. Prosthesis material did not influence complication risk.

  18. Genital prolapse: A 5-year review at Federal Medical Centre Umuahia, Southeastern Nigeria.

    PubMed

    Oraekwe, Obinna Izuchukwu; Udensi, Maduabuchi Amagh; Nwachukwu, Kelechi Chiemela; Okali, Uka Kalu

    2016-01-01

    Genital prolapse is an important cause of morbidity among postmenopausal and multiparous women especially in our environment where a high premium is placed on large family size. This study was done to determine the prevalence, risk factors, clinical presentation, and management options of genital prolapse. Data of those diagnosed with genital prolapse were retrieved from records in the clinic, wards, theater, and from patients' folders in the medical records department. Data were analyzed using Statistical Package for Social Sciences version 20 with P < 0.05. Genital prolapse accounted for 0.8% of gynecological clinic attendances and 5.2% of major gynecological operations. The mean age of patients was 56.7 ± 15.5 years. Farmers constituted 60.7% of the patients while 72.1% and 70.5% were postmenopausal and grandmultiparous women, respectively. The sensation of something coming down the vagina was the most common symptom noted in 98.4% of the patients. Most (23.0%) of the patients had unsupervised delivery at home. Uterovaginal prolapse was the most common (70.5%) type of genital prolapse, and third-degree uterovaginal prolapse was its most frequent presentation. Majority of the patients (44.4%) were managed expectantly while the most common surgery performed was vaginal hysterectomy with pelvic floor repair (33.3%). Widespread availability of antenatal services especially in the rural communities and limitation on family size can significantly reduce the burden of this disease.

  19. Genital prolapse: A 5-year review at Federal Medical Centre Umuahia, Southeastern Nigeria

    PubMed Central

    Oraekwe, Obinna Izuchukwu; Udensi, Maduabuchi Amagh; Nwachukwu, Kelechi Chiemela; Okali, Uka Kalu

    2016-01-01

    Background: Genital prolapse is an important cause of morbidity among postmenopausal and multiparous women especially in our environment where a high premium is placed on large family size. This study was done to determine the prevalence, risk factors, clinical presentation, and management options of genital prolapse. Patients and Methods: Data of those diagnosed with genital prolapse were retrieved from records in the clinic, wards, theater, and from patients' folders in the medical records department. Statistical Analysis Used: Data were analyzed using Statistical Package for Social Sciences version 20 with P < 0.05. Results: Genital prolapse accounted for 0.8% of gynecological clinic attendances and 5.2% of major gynecological operations. The mean age of patients was 56.7 ± 15.5 years. Farmers constituted 60.7% of the patients while 72.1% and 70.5% were postmenopausal and grandmultiparous women, respectively. The sensation of something coming down the vagina was the most common symptom noted in 98.4% of the patients. Most (23.0%) of the patients had unsupervised delivery at home. Uterovaginal prolapse was the most common (70.5%) type of genital prolapse, and third-degree uterovaginal prolapse was its most frequent presentation. Majority of the patients (44.4%) were managed expectantly while the most common surgery performed was vaginal hysterectomy with pelvic floor repair (33.3%). Conclusion: Widespread availability of antenatal services especially in the rural communities and limitation on family size can significantly reduce the burden of this disease. PMID:27833248

  20. Facial and oral injuries in Brazilian children aged 5-17 years: 5-year review.

    PubMed

    Cavalcanti, A L; Melo, T R

    2008-06-01

    This was to assess causes of maxillofacial trauma using a retrospective study in Paraiba, Brazil. Records of 256 patients with maxillofacial injuries aged 5-17 years treated between January 2002 to May 2006 were analyzed according to sex, age, cause of injury, frequency of dentoalveolar trauma, intraoral soft tissue injury, frequency and site of facial fracture. Chi-square and Fisher's Exact Tests were used at a significance level of 5%; odds ratio (OR) with confidence intervals to 95% were calculated (IC95%). Facial injuries were most frequent in males (78.1%) and in 13-17 year olds (60.9%); they tended to be more frequent during weekends (48%). Commonest causes were falls (37.9%) and traffic accidents (21.1%). Nasal fractures were most common (51.3%), followed by the zygomatic-orbital complex (25.4%); dentoalveolar injuries were present in 25.8% of cases. There was a positive association between facial fracture and dentoalveolar trauma, alveolar and tooth fracture, avulsion and intraoral soft tissue injury. Accidental falls were found to be the leading cause of maxillofacial fractures, affecting males 3 times more than females.

  1. 75 FR 13082 - Listing Endangered and Threatened Species; Initiation of 5-Year Reviews for 27 Evolutionarily...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ... will undertake reviews for the following salmon ESUs: (1) Sacramento River winter-run Chinook salmon... Pacific Salmon and Steelhead AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and... Pacific salmon (Oncorhynchus sp.) and 11 distinct population segments (DPSs) of steelhead (Oncorhynchus...

  2. The AMHCA Journal: A Review of the Last 5 Years and Future Possibilities.

    ERIC Educational Resources Information Center

    Seligman, Linda; Weinstock, Leslie D.

    1984-01-01

    Reviewed and analyzed the first 13 issues of the AMHCA Journal, published from January 1979 to January 1984, with respect to editorial board membership, nature and content of articles, and authors. Data-based research articles have formed the core of the journal, followed by applied and theoretical articles. (JAC)

  3. 76 FR 50448 - Endangered and Threatened Species; 5-Year Reviews for 17 Evolutionarily Significant Units and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-15

    .... SUPPLEMENTARY INFORMATION: Background Under the ESA, a list of endangered and threatened wildlife and plant....12 (for plants). Section 4(c)(2)(A) of the ESA requires that we conduct a review of listed species at... Northwest Fisheries Science Center to collect and analyze new information about species viability. To...

  4. Northern obstetrics: a 5-year review of delivery among Inuit women.

    PubMed Central

    Lessard, P; Kinloch, D

    1987-01-01

    There are over 18,000 Inuit in the Northwest Territories. As a group they have the highest birth rate, the lowest cesarean section rate and one of the highest perinatal death rates in Canada. We reviewed the obstetric experience of 512 Inuit women who either gave birth at Stanton Yellowknife Hospital or were referred from Yellowknife and gave birth at a southern facility between January 1981 and December 1985. Our experience is consistent with that documented in earlier reviews, which concluded that Inuit women tend to have efficient uterine action, to endure labour well and to rarely have dystocia. During the periods covered by these reviews delivery was frequently in the settlements; now hospital delivery is the norm. Substantial improvements in perinatal outcome are evident, but there remains a considerable gap between the northern and southern experience. Those attempting further progress must recognize that the need for obstetric care away from the home community is not fully appreciated by Inuit women, their families or their communities. PMID:3676945

  5. Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment: a 5-year retrospective study after non-surgical treatment

    PubMed Central

    Chang, Hee-Yung; Park, Shin-Young; Kim, Jin-Ah; Kim, Young-Kyun

    2015-01-01

    Purpose This retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment. Methods Thirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed. Results Timing of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss. Conclusions Early peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant. Graphical Abstract PMID:26131368

  6. Radiographic analysis of a transalveolar sinus-lift technique: a multipractice retrospective study with a mean follow-up of 5 years.

    PubMed

    Soardi, Elisa; Cosci, Ferdinando; Checchi, Vittorio; Pellegrino, Gerardo; Bozzoli, Paolo; Felice, Pietro

    2013-08-01

    Various sinus-lift techniques have been described in the literature. The aim of this retrospective study is to evaluate the efficacy of a transalveolar sinus-lift technique in terms of implant survival, marginal bone loss, and complications. A total of 538 patient records were examined, and after applying exclusion and inclusion criteria, a sample of patients was included with a mean follow-up of 5 years. Implants with a smooth or tapered surface were considered. Therefore, only sinus lifts with inorganic bovine bone matrix or demineralized bone matrix were included, and 1,536 periapical radiographs were analyzed. Outcome measures were implant success, implant failure (peri-implantitis and loss of osseointegration), marginal bone resorption, and biologic complications (membrane perforations, sinusitis, and intraoperative and/or postoperative hemorrhage). Periapical radiographs were evaluated before surgery, post-surgery, and after 6 months and 1, 3, and 5 years. We analyzed the residual crestal bone height under the sinus, the amount (mm) of height increase after surgery, and values of implant marginal bone resorption for considered follow-ups. Two hundred eighty-two (282) patients were excluded. Therefore, 256 patients treated with the transalveolar sinus-lift technique were included. A total of 376 dental implants and 323 sinus lifts were analyzed. The overall rates of implant success and failure were 94.9% and 5.1%, respectively. The mean bone loss around implants was 1.98 mm (mean follow-up of 5 years). Patients treated with inorganic bovine bone matrix showed a better implant success rate (P = 0.03) than did patients treated with demineralized human matrix. Three Schneiderian membrane perforations occurred in the 323 sinus lifts. In these cases, the surgeon performed another surgical operation after 3 months. Postoperative complications were peri-implantitis (six cases) and osseointegration losses (13 cases). The transalveolar sinus-lift technique was a safe

  7. Relationship between indication for tooth extraction and outcome of immediate implants: A retrospective study with 5 years of follow-up

    PubMed Central

    Tarazona-Álvarez, Pablo; Peñarrocha-Oltra, David; Peñarrocha-Diago, Maria

    2014-01-01

    Objectives: The aims of this retrospective study were to evaluate the survival rate of a series of immediate implants after 3 years of follow-up and to study the relationship between survival and indication for tooth extraction. Study Design: A retrospective study of patients treated with immediate implants between January 2003 and December 2008 was carried out. All patients receiving at least one post-extraction implant and a minimum follow-up of 5 years were included. Results: After 60 months, 30 immediate implants had been lost in 17 patients, yielding a total implant success rate of 93.8%. None of the implants placed failed after the extraction of included canines (100% success rate). In 20 failed implants the reason for extraction had been severe periodontal disease (91.8% SR), in 4 endodontic failure (88.6%SR), in 3 unrestorable caries (95.9% SR), in 1 untreatable fracture (95.2% SR) and in 2 improvement of prosthetic design (98.1% SR). No statistically significant influence was found between immediate implant failure and the reason for tooth extraction (p=0.11). Conclusions: The use of immediate implants is a successful alternative to replace missing teeth for severe periodontal disease, periapical pathology or by decay or untreatable fractures. Some reasons, such as periodontal disease itself is associated with a success rate significantly below the overall average. Similarly, the prosthetic design is associated with a better prognosis than all other reasons. Key words:Tooth extraction, immediate implants, success rate. PMID:25593661

  8. Effects of shift work on abdominal obesity among 20-39-year-old female nurses: a 5-year retrospective longitudinal study.

    PubMed

    Lee, Gyeong-Jin; Kim, Kunhyung; Kim, Se-Yeong; Kim, Jeong-Ho; Suh, Chunhui; Son, Byung-Chul; Lee, Chae-Kwan; Choi, Junghye

    2016-01-01

    This study aimed to investigate the effects of shift work on abdominal obesity among young and middle-aged female nurses during a 5-year retrospective study. This retrospective study included female nurses (20-39 years old) who worked at a university hospital in Korea and had available health screening results from 2010-2015. Among 2,611 employees, 934 healthy 20-39-year-old female nurses were identified, and data regarding their demographic information (age and date of employment), waist circumferences (WC), and lifestyle factors (alcohol and exercise) were obtained. Abdominal obesity was defined as a WC of ≥80 cm, based on the World Health Organization's Asia-West Pacific standard in 2000. The mean WC change from baseline was analyzed using the paired t test, and the association between shift work and abdominal obesity was analyzed using the generalized estimating equation. Compared to all day workers (both age groups), the 20-29-year-old nurses did not exhibit significant changes in WC at each follow-up. However, among the 30-39-year-old nurses, shift workers exhibited a significant change in WC (vs. baseline) during years 4 and 5, compared to day workers. After adjusting for effective confounders and stratifying the participants according to age, the 20-29-year-old nurses exhibited an odds ratio of 3.21 (95 % confidence interval: 1.29-7.98) for shift work-associated obesity, although the odds ratio for the 30-39-year-old nurses was not statistically significant. In the study population, shift work was associated with a significant change in mean WC among 30-39-year-old nurses, and the shift work-associated risk of abdominal obesity was significant among 20-29-year-old nurses. These results indicate that shift work may influence abdominal obesity differently in 20-29-year-old and 30-39-year-old female nurses.

  9. Pattern of injuries seen during an insurgency: a 5-year review of 1339 cases from Nigeria.

    PubMed

    Dabkana, T M; Bunu, B; Na'aya, H U; Tela, U M; Adamu, A S

    2015-01-01

    When there is an insurgency, the use of force in the form of weaponry, is employed. This may lead to the total breakdown of law and order, resulting in destruction of life and property. Health workers may be killed or captured, and, health facilities destroyed or stretched beyond their functional capacity. This is a report of experience with injuries seen in a tertiary hospital in north eastern Nigeria, under an insurgency situation. After obtaining clearance from the medical Ethics Committee of UMTH, we reviewed the case files of all patients treated for injuries sustained as a result of the Boko Haram insurgency from January 2009 to December 2013. Those brought in dead, were not included in the study. We reviewed the case files, theatre notes, admission and discharge registers of 1339 cases. 1223 (91.3%) of the victims were males, while 116 (8.7%) were females. Gunshot wounds accounted for 1229 (91.8%) of the injuries, bomb blast 90 (6.7%), others 15 (1.1%) knife (Cut throat) 4 (0.3%) and road traffic accident 1 (0.01%). Casualties were made up of civilians 1144 (85.4%), the joint task force (a force made up of the Military, Police, Customs and Immigration, against the insurgents) 117 (8.7%), and insurgents 22 (1.6%). The ages of the patients ranged from 1 to 80 years, peaking at the 21-40 age brackets (796 or 59.4%). The extremities were most affected, 734 (54.8%), followed by the torso 423 (31.6%), multiple injuries 93 (6.9%) and head and neck 89 (6.6%). 1226 (91.6%) of the victims survived while 113 (8.4%) died from their injuries. This followed massive blood loss from injuries to the torso 69 (61.1%) multiple injuries 15 (13.3) and extremities 6 (5.3%). Others causes were fatal injuries to the head and neck 22 (19.5%) and 90% burns following bomb blast 1 (0.9%). Injuries resulting from insurgency will continue to be a problem in many developing countries because their health facilities in terms of personnel and materials are ill prepared for such a situation .

  10. Drowning-related fatalities during a 5-year period (2008-2012) in South-West Hungary--a retrospective study.

    PubMed

    Rácz, Evelin; Könczöl, Franciska; Mészáros, Hajnalka; Kozma, Zsolt; Mayer, Mátyás; Porpáczy, Zoltán; Poór, Viktor S; Sipos, Katalin

    2015-04-01

    The purpose of the present study was to investigate all the drowning-related cases in South-West Hungary between 2008 and 2012. It is a retrospective and descriptive study of 114 drowning-related deaths during that 5-year period. The investigation includes both unintentional and intentional drowning cases. We found that the most considerable risk factor of drowning in this area of Hungary is alcohol consumption, because in more than half of the cases the victims were under the influence of alcohol. We also concluded that more than two third of the cases included males. The cause of drowning in younger victims was mostly accident. In both genders subjects aged 50-70 had the highest risk of drowning in the period investigated. Seniors frequently committed suicide by drowning. Drowning deaths occurred in all types of water, mostly in lakes, rivers, canals and other types of catchment in the vicinity of victims' homes (most commonly in wells). This study might help to understand the circumstances and the causes leading to drowning and it may draw the attention to the possible preventive interventions.

  11. Assessment and Predicting Factors of Repeated Brain Computed Tomography in Traumatic Brain Injury Patients for Risk-Stratified Care Management: A 5-Year Retrospective Study

    PubMed Central

    Sumritpradit, Preeda; Setthalikhit, Thitipong

    2016-01-01

    Background and Objective. To determine the value of repeated brain CT in TBI cases for risk-stratified care management (RSCM) and to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Methods. A 5-year retrospective study from January 2009 to August 2013 was conducted. The primary outcome was the value of repeated brain CT in TBI cases. The secondary outcome is to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Results. There were 145 consecutive patients with TBI and repeated brain CT after initial abnormal brain CT. Forty-two percent of all cases (N = 61) revealed the progression of intracranial hemorrhage after repeated brain CT. In all 145 consecutive patients, 67.6% of cases (N = 98) were categorized as mild TBI. For mild head injury, 8.2% of cases (N = 8) had undergone neurosurgical management after repeated brain CT. Only 1 from 74 mild TBI patients with repeated brain CT had neurosurgical intervention. Clopidogrel and midline shift more than 2 mm on initial brain CT were significant predicting factors to indicate the neurosurgical management in mild TBI cases. Conclusion. Routine repeated brain CT for RSCM had no clinical benefit in mild TBI cases. PMID:27703812

  12. Pediatric parotitis: a 5-year review at a tertiary care pediatric institution.

    PubMed

    Stong, Benjamin C; Sipp, James A; Sobol, Steven E

    2006-03-01

    Parotitis is a well recognized entity in the adult population, however there are very few studies concerning the clinical presentation and management of this condition in children. To characterize pediatric parotitis in a tertiary care setting, with the goal of clarifying management recommendations and outcomes. The charts of all pediatric patients with a diagnosis of parotitis treated at a tertiary care academic institution from 1999 to 2004 were reviewed. The management of inpatients and outpatients were characterized to define differences in presentation and care. Twenty-one children (6 months-15 years) with a diagnosis of parotitis were identified. Thirteen (62%) children were treated as inpatients, of which seven (54%), had significant medical co-morbidities. The most common clinical presentations of the inpatient group included dehydration (46%), fever (38%) and leukocytosis (46%). Two inpatients (15%) required surgical drainage due to abscess formation. Eight children (38%) were treated as outpatients, none with associated co-morbidity, fever, leukocytosis, or complication due to infection. All outpatients were treated with oral antibiotics or conservative therapy with eventual resolution. Parotitis in the pediatric population is uncommon. The presence of a significant co-morbidity, fever, or leukocytosis may require inpatient therapy and imaging if patients fail to improve with medical therapy. Other than abscess drainage, surgery for parotitis in children is not routinely recommended.

  13. The review of new evidence 5 years later: SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP).

    PubMed

    Jobli, Edessa C; Gardner, Stephen E; Hodgson, Anna B; Essex, Alyson

    2015-02-01

    The Substance Abuse and Mental Health Services Administration (SAMHSA) decided that NREPP should offer a second review option for interventions that have already been reviewed and included in the registry for 5 years. Principals from 135 such interventions were invited to participate in a second review, and an exploratory study of the Principals' responses to this invitation was conducted. The study used a mixed-method approach, quantitatively describing characteristics of Principals and their interventions and qualitatively summarizing feedback from phone interviews with a convenience sample of Principals participating in a second review. Of the Principals invited, 21% accepted a second review, 24% were interested but unable or not ready to submit materials, and 56% did not accept or did not respond. Mental health treatment interventions were more likely to undergo a second review, and substance abuse treatment interventions were less likely. Similar percentages of interventions undergoing a second review had received funding from the National Institutes of Health (86%) and had been evaluated in a comparative effectiveness research study (79%). Overall ratings for interventions improved in each second review completed. The interviewed Principals perceived potentially lower ratings as the only risk in participating in a second review. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: Controlled retrospective study with 5 years of follow-up

    PubMed Central

    Candel-Marti, Eugenia; Peñarrocha-Oltra, David; Bagán, Leticia; Peñarrocha-Diago, Maria

    2015-01-01

    Background To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. Material and Methods A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessed: age, sex, frequency of tooth brushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student’s t-test using alpha set at 0.05. Results A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily tooth brushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss. Conclusions Despite its limitations the outcomes of the present study suggest

  15. Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: Controlled retrospective study with 5 years of follow-up.

    PubMed

    Candel-Marti, Eugenia; Peñarrocha-Oltra, David; Bagán, Leticia; Peñarrocha-Diago, Maria; Peñarrocha-Diago, Miguel

    2015-05-01

    To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years. A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessd: age, sex, frequency of toothbrushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student's t-test using alpha set at 0.05. A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily toothbrushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss. Despite its limitations the outcomes of the present study suggest that palatal positioned implants may be a good treatment

  16. Outcome of dental implants in patients with and without a history of periodontitis: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients.

    PubMed

    Gianserra, Rodolfo; Cavalcanti, Raffaele; Oreglia, Francesco; Manfredonia, Massimo Francesco; Esposito, Marco

    2010-01-01

    To evaluate the outcome of dental implants placed in patients with a history of periodontitis. Patients with no or mild history of periodontitis served as controls. A total of 1727 patients were consecutively treated in four private practices. Patients were divided into three groups according to their initial periodontal conditions assessed with a modified periodontal screening and recording (PSR) index: 630 patients were in the severe periodontitis (SP) group, 839 in the moderate periodontitis (MP) group, and 258 had no periodontitis (NP). Patients requiring periodontal treatment were treated prior to implantation. Various implant systems and procedures were used. In total, 3260 implants and 1707 implant-supported prostheses were placed in the SP group, 2813 implants and 1744 implant-supported prostheses in the MP group, and 647 implants and 424 implant-supported prostheses in the NP group. Mixed implant–tooth supported prostheses (98 prostheses in 89 patients) were not considered. Outcome measures were prosthesis and implant survival. Two-hundred and fifty patients were lost to follow-up 5 years after loading. Regarding prosthesis failures, 13 prostheses could not be placed or failed in 13 patients of the SP group (0.8%), 11 prostheses could not be placed or failed in 9 patients of the MP group (0.7%), and 3 prostheses failed in 3 patients of the NP group (0.9%). For implant failures, 130 (4.5%) implants failed in the SP group, 74 (3.1%) implants failed in the MP group, and 15 (3.0%) implants failed in the NP group. Most of the implant failures (90%) occurred before implant loading. Fitting a logistic regression for early implant failures and total implant failures, taking into account the clustering of implants in patients, there were no statistically significant differences between the three PSR groups (P > 0.05). Owing to the retrospective nature of this study, conclusions need to be interpreted with caution. A previous history of periodontal disease may not

  17. 78 FR 69436 - Endangered and Threatened Wildlife and Plants; Initiation of a 5-Year Review of the Vicuña in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-19

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  18. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study.

    PubMed

    Girum, Tadele; Kote, Mesfin; Tariku, Befikadu; Bekele, Henok

    2017-01-01

    Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell's concordance, and fitness was checked by Cox-Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101-7.329), altered pulse rate (AHR =3.926, 95% CI =1.579-9.763), altered temperature (AHR =7.173, 95% CI =3.05-16.867), shock (AHR =3.805, 95% CI =1.829-7.919), anemia (AHR =2.618, 95% CI =1.148-5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18-8.575), hypoglycemia (AHR =2.74, 95% CI =1.279-5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638-13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.

  19. Poorly Cited Articles in Peer-Reviewed Cardiovascular Journals from 1997–2007: Analysis of 5-Year Citation Rates

    PubMed Central

    Ranasinghe, Isuru; Shojaee, Abbas; Bikdeli, Behnood; Gupta, Aakriti; Chen, Ruijun; Ross, Joseph S.; Masoudi, Frederick; Spertus, John A.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.

    2015-01-01

    Background The extent to which articles are cited is a surrogate of the impact and importance of the research conducted; poorly cited papers may identify research of limited use and potential wasted investments. We assessed trends in the rates of poorly cited articles and journals in the cardiovascular literature from 1997–2007. Methods and Results We identified original articles published in cardiovascular journals and indexed in the Scopus citation database from 1997–2007. We defined poorly cited articles as those with ≤5 citations in the 5 years following publication and poorly cited journals as those with >75% of journal content poorly cited. We identified 164,377 articles in 222 cardiovascular journals from 1997–2007. From 1997–2007, the number of cardiovascular articles and journals increased by 56.9% and 75.2% respectively. Of all the articles, 75,550 (46.0%) were poorly cited, of which 25,650 (15.6% overall) had no citations. From 1997–2007, the proportion of poorly cited articles declined slightly (52.1% to 46.2%, trend P<0.001), although the absolute number of poorly cited articles increased by 2,595 (trend P<0.001). At a journal level, 44% of cardiovascular journals had more than three quarters of the journal’s content poorly cited at 5 years. Conclusion Nearly half of all peer-reviewed articles published in cardiovascular journals are poorly cited 5 years after publication, and many are not cited at all. The cardiovascular literature, and the number of poorly cited articles, have both increased substantially from 1997–2007. The high proportion of poorly cited articles and journals suggest inefficiencies in the cardiovascular research enterprise. PMID:25812573

  20. Poorly cited articles in peer-reviewed cardiovascular journals from 1997 to 2007: analysis of 5-year citation rates.

    PubMed

    Ranasinghe, Isuru; Shojaee, Abbas; Bikdeli, Behnood; Gupta, Aakriti; Chen, Ruijun; Ross, Joseph S; Masoudi, Frederick A; Spertus, John A; Nallamothu, Brahmajee K; Krumholz, Harlan M

    2015-05-19

    The extent to which articles are cited is a surrogate of the impact and importance of the research conducted; poorly cited articles may identify research of limited use and potential wasted investments. We assessed trends in the rates of poorly cited articles and journals in the cardiovascular literature from 1997 to 2007. We identified original articles published in cardiovascular journals and indexed in the Scopus citation database from 1997 to 2007. We defined poorly cited articles as those with ≤5 citations in the 5 years following publication and poorly cited journals as those with >75% of journal content poorly cited. We identified 164 377 articles in 222 cardiovascular journals from 1997 to 2007. From 1997 to 2007, the number of cardiovascular articles and journals increased by 56.9% and 75.2%, respectively. Of all the articles, 75 550 (46.0%) were poorly cited, of which 25 650 (15.6% overall) had no citations. From 1997 to 2007, the proportion of poorly cited articles declined slightly (52.1%-46.2%, trend P<0.001), although the absolute number of poorly cited articles increased by 2595 (trend P<0.001). At a journal level, 44% of cardiovascular journals had more than three-fourths of the journal's content poorly cited at 5 years. Nearly half of all peer-reviewed articles published in cardiovascular journals are poorly cited 5 years after publication, and many are not cited at all. The cardiovascular literature and the number of poorly cited articles both increased substantially from 1997 to 2007. The high proportion of poorly cited articles and journals suggests inefficiencies in the cardiovascular research enterprise. © 2015 American Heart Association, Inc.

  1. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study

    PubMed Central

    Girum, Tadele; Kote, Mesfin; Tariku, Befikadu; Bekele, Henok

    2017-01-01

    Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell’s concordance, and fitness was checked by Cox–Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101–7.329), altered pulse rate (AHR =3.926, 95% CI =1.579–9.763), altered temperature (AHR =7.173, 95% CI =3.05–16.867), shock (AHR =3.805, 95% CI =1.829–7.919), anemia (AHR =2.618, 95% CI =1.148–5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18–8.575), hypoglycemia (AHR =2.74, 95% CI =1.279–5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638–13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions. PMID:28176953

  2. Arthroscopic release of shoulder contracture secondary to obstetric brachial plexus palsy: retrospective study of 18 children with an average follow-up of 4.5 years.

    PubMed

    Breton, A; Mainard, L; De Gaspéri, M; Barbary, S; Maurice, E; Dautel, G

    2012-10-01

    Children affected by obstetric brachial plexus palsy have an internal rotation contracture of the shoulder and a deformed glenohumeral joint. In 2003, Pearl proposed doing an arthroscopic release of the shoulder to restore external rotation and allow the glenohumeral joint to remodel. The goal of the current study was to evaluate the active and passive shoulder external rotation range of motion and glenohumeral joint remodelling in children treated with arthroscopic-directed release. Between 2004 and 2010, 18 children with passive external rotation under 10° were treated with shoulder arthroscopy to release the anterior capsule and ligaments and perform a subscapularis tenotomy; no tendon transfer was performed. The average age was 4 years, 2 months. Nine children had an injury at C5C6, four had an injury at C5C6C7 and five had a complete injury. The average follow-up was 4.5 years. The clinical evaluation consisted of active and passive external rotation (ER) with elbow at the side, active internal rotation, and the modified Mallet score. One child who required an external rotation osteotomy of the proximal humerus was excluded from the clinical outcomes. An MRI was performed on both shoulders to assess glenoid retroversion, glenoid type, degree of posterior subluxation (measured by the percentage of humeral head anterior to the middle glenoid fossa) and humeral head hypoplasia. At the latest follow-up, passive ER was 58° on average and active ER was 42°. Eleven children had regained more than 30° of active ER. The average internal rotation had decreased after the release. The MRI assessment showed that the glenohumeral joint had remodelled in 66% of cases; the glenoid type had improved, the glenoid retroversion had diminished and the humeral head was recentred. Humeral head hypoplasia was found in 28% of cases. Arthroscopic release of the shoulder results in more external rotation and allows for glenohumeral joint remodelling. Tendon transfer is not always

  3. Congenital cystic lesions of lung in the paediatric population: A 5-year single institutional study with review of literature

    PubMed Central

    Barman, Shibsankar; Mandal, Kartik Chandra; Kumar, Rajarshi; Biswas, Sumitra Kumar; Mukhopadhyay, Madhumita; Mukhopadhyay, Biswanath

    2015-01-01

    Background: The aim was to evaluate the clinical presentation, investigation modalities, operative management, pathology, outcome (morbidity and mortality) and short term follow-up of congenital cystic lesions of the lung. Materials and Methods: This is a retrospective study. Study period was 5 years (December 2008-November 2013) in the Department of paediatric surgery, Nil Ratan Sircar Medical College. Study population: Total number = 10 patients. Age range: 2 days-7 years. (Neonate-4). Male and female ratio = 1:1. Result: Among 10 cases of lung cyst four having congenital lobar emphysema, four having congenital pulmonary airway malformation, one sequestration and one teratoma. All patients have undergone surgical excision in terms of lobectomy or excision of the lesion. Post-operative histopathology confirmed the diagnosis. Recovery was uneventful. Conclusion: Although our experience is limited, operative management of lung cysts seems to be safe with rewarding results. However we are yet to encounter many of the other varieties of the cysts found in the lung, which may be associated with other congenital anomalies and have an impact on prognosis. PMID:25659554

  4. EARLY OR DELAYED SURGICAL TREATMENT IN COMPOUND LIMB FRACTURES DUE TO HIGH VELOCITY MISSILE INJURIES: A 5-YEAR RETROSPECTIVE STUDY FROM MEDICAL CITY IN BAGHDAD

    PubMed Central

    Al-Hilli, Ali Bakir; Salih, Dheyaa Saeed

    2010-01-01

    Background Compound limb fractures due to high-velocity missiles are complex and usually associated with multiple other injuries. These can occur in both military and civilian settings. Highvelocity missiles are presently used by terrorists worldwide. Early surgical debridement and skeletal fixation are the gold standards in managing these injuries, but data supporting these recommendations are lacking. Aim of the study Our aim was to determine the relationship between time (the time of injury to the time of surgical treatment) and the rate of deep infection in patients treated in Medical City, Baghdad, Iraq due to terrorist activity from 2004-2008. Design This is a retrospective review of a series of open limb fractures. Patients and method A total of 102 civilian patients with 114 limb fractures due to high-velocity missile injuries were selected for this study from Medical City records. Patients were followed in the outpatient department in Medical City Teaching Complex both clinically and radiologically. Results Surgical treatment was accomplished in less than six hours from time of injury in group A (55 fractures, 48.4%) and more than six hours in group B (59 fractures, 51.7%). The infection rate for group A was 30.9% and group B was 23.7%. Conclusion A very high infection rate was noted for these injuries, and there was no increase in the rate of deep infection in patients treated more than six hours after the injury. PMID:21045979

  5. Ticks and associated diseases: a retrospective review.

    PubMed

    Walker, A R

    2014-08-01

    This is a retrospective review of contributions to the understanding of ticks and associated diseases published in Medical and Veterinary Entomology since its first issue. It highlights the large and significant changes in the style and conduct of this field over the last 25 years. The selected papers refer to disease-related categories of host immunity to ticks, population dynamics, pathogen transmission and tick control. © 2014 The Royal Entomological Society.

  6. Alternative endpoints to the 5-year overall survival and locoregional control for nasopharyngeal carcinoma: A retrospective analysis of 2,450 patients.

    PubMed

    Chen, Chen; Yi, Wei; Gao, Jin; Li, Xiao-Hui; Shen, Lu-Jun; Li, Bo-Fei; Tu, Zi-Wei; Tao, Ya-Lan; Jiang, Chang-Bin; Xia, Yun-Fei

    2014-05-01

    The purpose of the present study was to investigate alternative endpoints to the 5-year overall survival (OS) and locoregional control (LRC) for nasopharyngeal carcinoma (NPC). A total of 2,450 NPC patients were enrolled in this study, including 1,842 patients treated with two-dimensional (2D) radiotherapy (RT), 451 treated with 3D conformal RT (CRT) and 157 treated with intensity-modulated RT (IMRT). We sequentially calculated the 1-, 2-, 3- and 4-year survival rates using a life table and compared these with the 5-year survival rate using the McNemar method, with the survival rate of the last indifferent comparison being considered as the alternative endpoint. For 2D RT, stage I patients exhibited similar survival rates at 1 and 5 years (98.9 vs. 94.4%, respectively; P=0.125 for both OS and LRC); stage N3 patients exhibited similar 4-year OS (55.2 vs. 53.5%; P=1.000) and 2-year LRC (78.3 vs. 71.2%; P=0.125) to the 5-year OS and LRC. For IMRT, the 1-, 2-, 3-, 4- and 5-year OS and LRC rates in stage I/II NPC patients were 100, 98, 96, 94 and 94% for OS and 100, 98, 96, 96 and 96% for LRC, respectively. No significant differences were observed for all the comparisons. For stage III/IV NPC patients treated with IMRT, the 1-, 2-, 3-, 4- and 5-year rates were 99.1, 96.3, 92.5, 88.8 and 85.0% for OS and 98.1, 97.2, 95.3, 90.7 and 89.7% for LRC, respectively. Only the 4-year OS and LRC rates were indifferent from those at 5 years (P=0.125 for OS and P=1.00 for LRC). In conclusion, the 1-year OS and LRC for stage I NPC patients treated with 2D RT or stage I/II NPC patients treated with IMRT, the 4-year OS and 2-year LRC for stage N3 NPC patients treated with 2D RT and the 4-year OS and LRC for stage III/IV NPC patients treated with IMRT were determined as the alternative endpoints to the 5-year OS and LRC for NPC patients.

  7. Iodine and Mental Development of Children 5 Years Old and Under: A Systematic Review and Meta-Analysis

    PubMed Central

    Bougma, Karim; Aboud, Frances E.; Harding, Kimberly B.; Marquis, Grace S.

    2013-01-01

    Several reviews and meta-analyses have examined the effects of iodine on mental development. None focused on young children, so they were incomplete in summarizing the effects on this important age group. The current systematic review therefore examined the relationship between iodine and mental development of children 5 years old and under. A systematic review of articles using Medline (1980–November 2011) was carried out. We organized studies according to four designs: (1) randomized controlled trial with iodine supplementation of mothers; (2) non-randomized trial with iodine supplementation of mothers and/or infants; (3) prospective cohort study stratified by pregnant women’s iodine status; (4) prospective cohort study stratified by newborn iodine status. Average effect sizes for these four designs were 0.68 (2 RCT studies), 0.46 (8 non-RCT studies), 0.52 (9 cohort stratified by mothers’ iodine status), and 0.54 (4 cohort stratified by infants’ iodine status). This translates into 6.9 to 10.2 IQ points lower in iodine deficient children compared with iodine replete children. Thus, regardless of study design, iodine deficiency had a substantial impact on mental development. Methodological concerns included weak study designs, the omission of important confounders, small sample sizes, the lack of cluster analyses, and the lack of separate analyses of verbal and non-verbal subtests. Quantifying more precisely the contribution of iodine deficiency to delayed mental development in young children requires more well-designed randomized controlled trials, including ones on the role of iodized salt. PMID:23609774

  8. Multi-disciplinary management of complex pressure sore reconstruction: 5-year review of experience in a spinal injuries centre.

    PubMed

    Thomson, C H; Choudry, M; White, C; Mecci, M; Siddiqui, H

    2017-02-01

    INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide descriptive data as well as share the experience of treating these complex wounds. MATERIALS AND METHODS Patients operated on as a joint case from 2010 to 2014 were identified through a locally held database and hospital records were then retrospectively reviewed for perioperative variables. Descriptive statistics were collected. RESULTS 12 patients underwent 15 procedures as a joint collaboration between plastic surgery and other surgical specialties: one with spinal surgery, 12 with orthopaedic and two with both orthopaedic and urology involvement. Ischial and trochanteric wounds accounted for 88% of cases with five Girdlestone procedures being performed and 12 requiring soft-tissue flap reconstruction. Mean operative time was 3.8hours. Four patients required high-dependency care and 13 patients received long-term antibiotics. Only three minor complications (20%) were seen with postoperative wound dehiscence. DISCUSSION The multidisciplinary team clinic allows careful assessment and selection of patients appropriate for surgical reconstruction and to help match expectations and limitations imposed by surgery, which are likely to influence their current lifestyle in this largely independent patient group. Collaboration with other specialties gives the best surgical outcome both for the present episode as well as leaving avenues open for potential future reconstruction.

  9. Review of 5 years of a combined dietary and physical fitness intervention for control of serum cholesterol

    NASA Technical Reports Server (NTRS)

    Angotti, C. M.; Levine, M. S.

    1994-01-01

    A chart review covering the first 5 years of clinical experience with a combined dietary and exercise intervention program for the reduction of hypercholesterolemia at the National Aeronautics and Space Administration headquarters demonstrated the program's success in maintaining high-density lipoprotein cholesterol (HDL-C) levels while significantly lowering total serum cholesterol levels. This combined program also resulted in improved ratios of total serum cholesterol to HDL-C and lowered levels of low-density lipoprotein cholesterol, thus further reducing the risk for cardiovascular disease. The National Aeronautics and Space Administration Cardiovascular Risk Reduction Program was developed after it was determined that although dietary intervention alone improved total cholesterol levels, it often resulted in a more than proportionate decrease in HDL-C and a worsening of the ratio of cholesterol to HDL-C. An approach was needed that would positively affect all factors of the lipid profile. The findings from the program indicate that reduction of cardiovascular risk can be accomplished easily and effectively at the worksite through dietary intervention, personal monitoring, and a reasonable exercise program.

  10. Review of 5 years of a combined dietary and physical fitness intervention for control of serum cholesterol

    NASA Technical Reports Server (NTRS)

    Angotti, C. M.; Levine, M. S.

    1994-01-01

    A chart review covering the first 5 years of clinical experience with a combined dietary and exercise intervention program for the reduction of hypercholesterolemia at the National Aeronautics and Space Administration headquarters demonstrated the program's success in maintaining high-density lipoprotein cholesterol (HDL-C) levels while significantly lowering total serum cholesterol levels. This combined program also resulted in improved ratios of total serum cholesterol to HDL-C and lowered levels of low-density lipoprotein cholesterol, thus further reducing the risk for cardiovascular disease. The National Aeronautics and Space Administration Cardiovascular Risk Reduction Program was developed after it was determined that although dietary intervention alone improved total cholesterol levels, it often resulted in a more than proportionate decrease in HDL-C and a worsening of the ratio of cholesterol to HDL-C. An approach was needed that would positively affect all factors of the lipid profile. The findings from the program indicate that reduction of cardiovascular risk can be accomplished easily and effectively at the worksite through dietary intervention, personal monitoring, and a reasonable exercise program.

  11. Soft tissue conditions and marginal bone levels of implants with a laser-microtextured collar: a 5-year, retrospective, controlled study.

    PubMed

    Iorio-Siciliano, V; Matarasso, R; Guarnieri, R; Nicolò, M; Farronato, D; Matarasso, S

    2015-03-01

    To compare clinical and radiographic outcomes of implants with a Laser-Lok®-microtextured collar to implants with a resorbable blast textured (RBT) collar after a 5-year follow-up period. Thirty-four implants with a Laser-Lok®-microtextured collar (test group [TG]) and 31 implants with an RBT collar (control group [CG]) were placed in 45 non-smoking, periodontally healthy patients. The full-mouth plaque score, full-mouth bleeding score, number of sites with plaque, and the number of sites with bleeding on probing (BOP) were recorded at baseline, and at 1-, 2-, 3-, 4-, and 5-year follow-up. Probing depth (PD) and mucosal recession were assessed at baseline and after the 5-year follow-up period. The radiographic marginal bone loss (MBL) was calculated by subtracting the bone level at the time of crown insertion from the bone level at the 5-year follow-up. An implant survival rate of 94% and of 90% was reported for the TG and the CG, respectively. No statistical differences were found between the study groups for presence of plaque (10.1% vs. 25%) or for number of sites with BOP (10.3% vs. 23%). The differences between both study groups were statistically significant for mean MBL (0.81 ± 0.24 vs. 2.02 ± 0.32 mm), mean PD (2.32 ± 0.44 vs. 4.25 ± 0.87 mm), and mean mucosal recession (0.16 ± 0.3 vs. 0.22 ± 0.3 mm). Within the limitations of this study, results suggest that the laser-microtextured implant collar surface may provide more favorable conditions for the attachment of hard and soft tissues, and reduce the level of MBL. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Determining return to work in a compensation setting: a review of New South Wales workplace rehabilitation service provider referrals over 5 years.

    PubMed

    Casey, Petrina P; Guy, Lynette; Cameron, Ian D

    2014-01-01

    Australian workers' compensation data reports a reduction in injury rates and claim incidence but no improvement in Return to Work (RTW) rates. To identify factors associated with a positive RTW outcome and describe those referred to Workplace Rehabilitation Providers (WRPs) in the New South Wales (NSW) Australian workers' compensation scheme. A retrospective review of 65,762 de-identified WRP case records over a 5 year period. 9,262 cases specifically referred for RTW assistance were analysed to identify factors associated with a positive RTW outcome Overall 47% of those referred for RTW services were able to upgrade their work status whilst 30% maintained their Stay at Work or pre-referral work status. The significant independent predictors associated with a positive RTW outcome were a shorter duration of disability (p< 0.001) (0R, 0.971; 95% CI, 0.964-0.977) and a higher socio economic index score (p=0.002) (OR, 1.131; 95% CI, 1.045-1.223). The study suggests that WRPs are seeing an increased focus on management of workers with increasing disability, with socio-economic disadvantage, increasing age, from blue collar backgrounds. The duration of disability is a significant determinant in achieving positive RTW outcomes suggesting that injured workers should be referred earlier for RTW services.

  13. Tapentadol Prolonged Release for Chronic Pain: A Review of Clinical Trials and 5 Years of Routine Clinical Practice Data.

    PubMed

    Baron, Ralf; Eberhart, Leopold; Kern, Kai-Uwe; Regner, Stefan; Rolke, Roman; Simanski, Christian; Tölle, Thomas

    2016-09-09

    Tapentadol prolonged release (PR) for the treatment of moderate to severe chronic pain combines 2 modes of action. These are μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule that allow higher analgesic potency through modulation of different pharmacological targets within the pain transmitting systems. At the same time, this can also serve as a clue for modulation of different pain-generating mechanisms according to nociceptive, neuropathic, or mixed pain conditions. Tapentadol PR has now been on the market for 5 years, with over 4.6 million people treated worldwide. A panel of pain specialists convened in Germany to review the clinical program and to discuss the role of tapentadol PR in the management of chronic pain. The clinical study program demonstrated effective and generally well-tolerated treatment for up to 2 years in a broad range of chronic pain conditions, including those with neuropathic pain components. This was confirmed in routine clinical practice observations. Head-to-head studies with World Health Organization (WHO) III opioids such as oxycodone controlled release and oxycodone/naloxone PR showed at least comparable pain relief in the treatment of moderate-to-severe musculoskeletal pain. Rotation from poorly tolerated WHO III opioids to tapentadol PR provided effective pain relief and better symptom control for musculoskeletal pain compared to previous medication. Functionality, health status and quality of life also improved under tapentadol PR treatment. The gastrointestinal tolerability profile was more favorable compared to other tested WHO III opioids. Tapentadol PR has a good safety profile and no evidence of acquired tolerance from the long-term data so far collected. Overall, tapentadol PR represents an effective and generally well-tolerated alternative to "classical" opioidergic drugs.

  14. Peri-implant bone tissues around retrieved human implants after time periods longer than 5 years: a retrospective histologic and histomorphometric evaluation of 8 cases.

    PubMed

    Iezzi, Giovanna; Piattelli, Adriano; Mangano, Carlo; Shibli, Jamil A; Vantaggiato, Giovanni; Frosecchi, Massimo; Di Chiara, Claudio; Perrotti, Vittoria

    2014-01-01

    Only rarely, it is possible to find in the literature histological reports of human retrieved implants, especially after several years of functional loading. These implants can help us in understanding the reactions of peri-implant bone. The aim of this study was to perform a histologic and histomorphometric analysis of the peri-implant tissues behavior and of the bone-titanium interface in titanium dental implants retrieved from patients after time periods longer than 5 years. The archives of the Implant Retrieval Center of the Dental School of the University of Chieti-Pescara, Italy were searched for human dental implants, retrieved after a loading period of more than 5 years. A total of 8 implants were found: 3 of these had been retrieved after 5 years, 1 after 6 years, one after 10 years, 1 after 14 years, 1 after 18 years, 1 after 22 years. Only the bone to implant contact in the three best threads was evaluated. Compact, mature, lamellar bone, with few and small marrow spaces, was present around the implants. Osteons with Haversian canals were present inside some threads, in close proximity to the interface, at both cortical and trabecular regions. Other osteons had a direction perpendicular to the direction of the long axis of the implants. Numerous reversal lines were present. At higher magnification, no gaps or fibrous, connective tissues were present at the interface. The BIC of the three best threads for all implants varied from 94 to 100 %.In conclusion, within the limitations of the present report histology showed that implants with different surfaces all presented the potential to maintain osseointegration over a long period, with a continuous remodeling at the interface, as indicated by the presence of reversal lines.

  15. Nursing student medication errors: a retrospective review.

    PubMed

    Harding, Lorill; Petrick, Teresa

    2008-01-01

    This article presents the findings of a retrospective review of medication errors made and reported by nursing students in a 4-year baccalaureate program. Data were examined in relation to the semester of the program, kind of error according to the rights of medication administration, and contributing factors. Three categories of contributing factors were identified: rights violations, system factors, and knowledge and understanding. It became apparent that system factors, or the context in which medication administration takes place, are not fully considered when students are taught about medication administration. Teaching strategies need to account for the dynamic complexity of this process and incorporate experiential knowledge. This review raised several important questions about how this information guides our practice as educators in the clinical and classroom settings and how we can work collaboratively with practice partners to influence change and increase patient safety.

  16. A Longitudinal Review of Gait Following Treatment for Idiopathic Clubfoot: Gait Analysis at 2 and 5 Years of Age.

    PubMed

    Jeans, Kelly A; Erdman, Ashley L; Jo, Chan-Hee; Karol, Lori A

    2016-09-01

    Initial correction following nonoperative (NonOp) treatment for idiopathic clubfoot has been reported in 95% of feet by age 2; however, by age 4, approximately one third of feet undergo surgery due to relapse. The purpose of this study was to assess the longitudinal effect of growth and surgical (Sx) intervention on gait following NonOp and Sx treatment for clubfoot. Children with idiopathic clubfoot were seen for gait analysis at 2 and 5 years of age. Kinematic data were collected at both visits, and kinetic data were collected at age 5 years. Group comparisons were made between feet treated with the Ponseti casting technique (Ponseti) and the French physical therapy method (PT) and between feet treated nonoperatively and surgically. Comparisons were made between feet treated with a limited release or tendon transfer (fair) and those treated with a full posteromedial release (poor). The α was set to 0.05 for all statistical analyses. Gait data from 181 children with 276 idiopathic clubfeet were collected at both age 2 and 5 years. Each foot was initially treated with either the Ponseti (n=132) or PT (n=144) method but by the 5-year visit, 30 Ponseti and 61 PT feet required surgery. Gait outcomes showed limitations primarily in the Sx clubfeet. Normal ankle motion was only present in 17% of Ponseti and 21% of PT feet by age 5 following Sx management. Sx PT feet showed persistent intoeing at age 2 and 5. Within the Sx group, feet initially treated with PT had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. Feet treated with posteromedial releases had significantly less ankle power than those treated with limited surgery or that remained NonOp at 5 years. This longitudinal study shows subtle changes between 2 and 5 years, and continues to support a NonOp approach in the treatment of clubfoot. Level II-therapeutic.

  17. Partial Rehabilitation with Distally Tilted and Straight Implants in the Posterior Maxilla with Immediate Loading Protocol: A Retrospective Cohort Study with 5-Year Follow-up.

    PubMed

    Queridinha, Bruno Mt; Almeida, Ricardo F; Felino, António; de Araújo Nobre, Miguel; Maló, Paulo

    2016-01-01

    The purpose of this study was to compare the outcome of fixed partial prostheses in the posterior maxilla with two axially placed implants or one implant placed distally tilted and one axially placed implant following an immediate loading protocol. A sample of 60 patients was divided into two groups-group 1: 30 patients rehabilitated with one axially placed implant and one implant placed distally tilted in the posterior maxilla; group 2: 30 patients rehabilitated with two axially placed implants in the posterior maxilla. Outcome measures were implant survival based on function, marginal bone resorption, and the incidence of mechanical and biologic complications at 5 years; inferential statistics were used to analyze the intergroup and intragroup differences. The level of significance was set at 5%. No significant differences were found between both groups in survival, complications, or marginal bone resorption. One axially placed implant was lost at 58 months in group 1, rendering a cumulative survival estimate at 5 years of 96.7% and 98.3% in group 1 and the total sample, respectively (P = .317). Mechanical complications occurred in 16 patients (26.7%; n = 8 patients in each group; [P > .999]), consisting of fractures in the provisional prosthesis (n = 8 patients), chipped ceramics of the definitive prosthesis (n = 2 patients), loosening of prosthetic components (n = 5 patients), and fracture of an attachment screw (n = 1 patient). Biologic complications occurred in 5 patients (8.3%; group 1 = 4 patients; group 2 = 1 patient; [P = .161]), consisting of peri-implant pathology. The mean ± SD marginal bone loss was 2.02 ± 0.36 mm and 1.90 ± 0.69 mm for groups 1 and 2, respectively (P = .235). In group 1, the mean ± SD marginal bone loss was 1.92 ± 0.48 mm and 2.11 ± 0.44 mm for the implant placed distally tilted and axially placed implant, respectively; the difference was significant (P < .001). Within the limitations of this study, the use of implants placed

  18. Implant-Supported Telescopic Crown-Retained Overdentures for Oral Rehabilitation of Patients with Severe Bony Defects: A 5-Year Retrospective Study.

    PubMed

    Zou, Duohong; Wang, Feng; Wu, Yiqun; Huang, Wei; Zhang, Chenping; Zhang, Zhiyuan

    2015-01-01

    To evaluate the performance of dental implant-supported telescopic crown (TC)-retained overdentures to restore the oral function of patients who have insufficient jawbone volume resulting from tumor resection or trauma. From January 2004 to December 2008, implant-supported TC-retained overdentures were used to restore the oral function of patients with severe bony defects resulting from tumor resection or trauma. Clinical data, including implant success and survival rates, biologic and mechanical complications, prosthodontic maintenance efforts, and patient satisfaction, were analyzed annually after delivery of the final prostheses. Twenty-four patients were treated, and a total of 88 implants were inserted to support TC-retained overdentures. The mean modified plaque index of implants remained low (<20%), and the majority of implants (>76.3%) in the study showed the absence of bleeding on probing at follow-up visits. Peri-implant marginal bone loss (MBL) ranged from 0.8 to 1.2 mm. There was no statistically significant difference in the MBL between maxillary and mandibular implants (P = .43). The implant success rate was 100% after 5 years, and the prosthodontic maintenance and complication rate was 0.22 times per year. More than 90% of patients were satisfied with the restoration of their oral function using TCs. Based on our study of 24 patients treated with TC-retained overdentures, it appears that this treatment may be a viable option for patients with insufficient jawbone volume.

  19. A Study on Mortality Profile among Fifty Plus- (50+-) Population (FPP) of India: A 5-Year Retrospective Study at New Delhi District.

    PubMed

    Chaudhary, B L; Vidua, Raghvendra K; Kumar, Arvind; Bajaj, Amrita V

    2016-01-01

    Objectives. To find out the mortality profile vis-a-vis different epidemiological factors at the time of autopsy among the 50+-Population. Material and Method. A five-year retrospective evaluation of medicolegal records between 2006 and 2010 was done at Lady Hardinge Medical College, New Delhi. Results. A total of 493 (17.78%) cases belonged to 50+-Population age group out of total 2773 autopsies performed. The proportion of unidentified/unknown persons among this age group was 36.51%. The unnatural and natural causes constituted 44.62% and 55.38% cases, respectively. The unspecified pneumonitis (50.18%) was reported as the commonest cause followed by coronary artery disease and respiratory tuberculosis among natural ones and the transport accident (57.27%) followed by accidental and intentional self-poisoning and exposure to noxious substances and falls among the unnatural ones. Conclusion. The findings reveal that this age group most commonly dies of natural causes rather than the unnatural ones even in autopsy cases. They have definite cure with timely interventions. The study also points out the need to devise the road and home safety measures to reduce mortality among the study population.

  20. The role of Ki-67 in women with a resistant prolactinoma: a retrospective analysis in 199 hospitalized patients over a period of 5 years.

    PubMed

    Lu, Chao; Ren, Zongming; Huan, Cheng; Cui, Guihua

    2014-07-01

    Proliferation-associated antigen Ki-67 is used for the histological evaluation of different tumors. Few studies have been conducted on women with a resistant prolactinoma. To better define the characteristics and to evaluate the differences between patients with different Ki-67 labeling index (LI), a retrospective study was designed to recruit 199 females with a resistant prolactinoma. The patients were divided into two groups, patients with Ki-67 LI≥3% and patients with Ki-67 LI<3%. Tumors in the LI>3% group were also larger (p=0.043), had a higher rate of invasion (p=0.014), and were associated with more frequent polyuria and polydipsia (p=0.008) compared to the LI<3% group. The pre- and post-operative PRL levels in the LI>3% group remained significantly higher compared to patients with LI<3% (p<0.05). The incidences of transient diabetes insipidus and hyponatremia in the LI>3% group were also significantly higher (p=0.037, p=0.041). Additionally, the postoperative PRL normalization rate was lower in patients with LI>3% compared with patients with LI<3% (p=0.028). The recurrence rate in the LI>3% and LI<3% groups were 27.27% and 8.47%, respectively. In conclusion, high Ki-67 LI is predictive sign of a poor prognosis in women with resistant prolactinoma.

  1. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  2. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  3. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  4. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Retrospective drug use review. 456.709 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  5. Immediate sequential bilateral cataract surgery: A 5-year retrospective analysis of 2470 eyes from a tertiary care eye center in South India.

    PubMed

    Ganesh, Sri; Brar, Sheetal; Sreenath, Rohit

    2017-05-01

    The purpose of this study is to evaluate the safety and benefits of immediate sequential bilateral cataract surgery. Retrospective data analysis of patients who underwent immediate sequential bilateral phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia from January 2011 to September 2016 was performed. Patients with visually significant bilateral cataract within the axial length range of 21.0-26.5 mm were included in the study. Intraoperative and postoperative complications were evaluated. Two thousand four hundred and seventy eyes from 1235 patients with a mean age of 68.34 years (range: 4-90 years) were analyzed. Best-corrected visual acuity improved from 0.40 ± 0.17 to 0.08 ± 0.10 (logarithm of the minimum angle of resolution). Nearly 92.05% eyes achieved a target postoperative refraction of ± 0.5 D spherical equivalent. Main complications observed were prolonged postoperative inflammation in 25% (n = 31), posterior capsular tears in 0.45% (n = 11), and unilateral cystoid macular edema in 0.08% (n = 2) eyes. No sight-threatening complications such as endophthalmitis, retinal detachment, corneal decompensation and intraocular hemorrhage occurred in any of the eyes. Out of the 288 (23.2%) patients who underwent bilateral multifocal IOL implantation, 23 patients (46 eyes) had femtolaser-assisted cataract surgery procedure. Two pediatric and one Downs syndrome patient underwent bilateral cataract surgery under general anesthesia and intravenous sedation, respectively. IBSCS may be considered as a preferred practice in eligible cases considering significant patient benefits such as early visual rehabilitation, time and cost-effectiveness, and better compliance with postoperative medications. In debilitated patients and special situations, such as pediatric cataract and Downs syndrome requiring general anesthesia it may be the ideal procedure.

  6. A retrospective review of rattlesnake bites in 100 children.

    PubMed

    Sotelo-Cruz, Norberto; Gómez-Rivera, Norberto

    2017-04-01

    A retrospective review of clinical features and treatment of children hospitalized for rattlesnake bite. One hundred clinical records were reviewed. Variables included: age, gender, season of the year, signs, symptoms, poisoning grade, complications, treatment and sequelae. Fifty-nine percent were males and 37% were less than 5 years of age; 87% occurred in rural areas; 63% of the snakebites occurred during the summer, of them, 39% occurred within the perimeter of the domicile and 8% within the home. Sixty-seven percent of children bitten by snakes reached the second degree of envenomation. During the first period (1977-1996), treatment for intoxication included treatment with polyvalent equine anti-snake venom serum. During the second period (1997-2014, a polyvalent polyclonal horse anti-snake venom F(Ab) was used. The second period hospitalization time was reduced to 3.9 days (P<0.0001). Hematological complications dominated during the first period (P=0.093) with wound infections occurring in 26% of the cases, neurological symptoms in 24 %, fasciotomy in 6% and mortality in 1%. The second degree poisoning was more frequent and was more severe in 7% of the patients. It was determined that the best treatment for snakebite was F(Ab') 2 therapy. Mortality occurred in 1% of the cases. Rattlesnake (Crotalus sp.) bite, in Mexico is less frequent as compared to other crotalidae species. The hematological complications are more frequent. We did not observe any recurrent phenomenons.

  7. Retrospective review of norethindrone use in adolescents.

    PubMed

    Santos, M; Hendry, Deborah; Sangi-Haghpeykar, Haleh; Dietrich, Jennifer E

    2014-02-01

    Our objectives were to review norethindrone use in an adolescent population in a tertiary care center and to assess the effectiveness of the norethindrone taper in the management of acute heavy menstrual bleeding in adolescents. Retrospective cohort study. Tertiary care center. 176 adolescent females prescribed norethindrone 0.35 mg between July 2007 and September 2010. None. Discontinuation and irregular bleeding rates. Mean age was 14.8 ± 2.3 years. Most common indication for use was heavy menstrual bleeding (32.9%). Most common reasons for use of a progestin only pill were neurologic (27.8%) and cardiovascular diseases (17.6%). Discontinuation rate was 48.5%, most commonly for irregular bleeding (54.5%). Irregular bleeding and systemic side effects were associated with discontinuation (P = .006 and .003 respectively). No serious adverse events were reported. Twenty patients required norethindrone taper for heavy bleeding; of this group 78.9% experienced complete cessation of bleeding within 7 days. Our findings support use of norethindrone as an effective alternative among adolescents with contraindications to administration of estrogen and for whom control of acute heavy menstrual bleeding is desired. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  8. 76 FR 22139 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of Three Species in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-20

    ... reviews for the Oregon silverspot butterfly (Speyeria zerene hippolyta), northern spotted owl (Strix... of these species (Oregon silverspot butterfly, northern spotted owl, and Stephanomeria malheurensis...

  9. 76 FR 76386 - Endangered and Threatened Species; 5-Year Reviews for 4 Distinct Population Segments of Steelhead...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... Reviews for 4 Distinct Population Segments of Steelhead in California AGENCY: National Marine Fisheries... Viable Salmonid Population framework, which relies on evaluating four key population parameters...

  10. 77 FR 13251 - Endangered and Threatened Wildlife and Plants; Initiation of a 5-Year Review of Nine Northeastern...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-06

    ... darter, Virginia fringed mountain snail, Virginia big-eared bat, Hay's Spring amphipod, Lee County Cave...-year review assesses the best scientific and commercial data available at the time of the review. We... data available, and we only consider delisting if data substantiate that the species is neither...

  11. Thromboembolism Following Shoulder Arthroscopy: A Retrospective Review.

    PubMed

    Schick, Cameron W; Westermann, Robert W; Gao, Yubo; Wolf, Brian R

    2014-11-01

    Thromboembolism following shoulder arthroscopy is considered an uncommon complication, with fewer than 50 cases reported in the literature. Arthroscopy of the shoulder is one of the most commonly performed orthopaedic procedures, with low associated risks. To identify potential risk factors for the development of venous thromboembolism (VTE) following shoulder arthroscopy and to determine the overall incidence of this complication. Case-control study; Level of evidence, 3. A retrospective case-control review was performed of patients who developed symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) following shoulder arthroscopy. Multiple surgeons from across North America were queried. For every case of DVT or PE identified, 2 control cases of shoulder arthroscopy were analyzed. The incidence of DVT/PE following shoulder arthroscopy was determined. A univariate analysis and a multivariate logistic regression model were conducted to identify any potential risk factors for the development of VTE following shoulder arthroscopy. A total of 17 surgeons participated in this study and had performed a total of 15,033 cases of shoulder arthroscopy from September 2002 through August 2011. Eleven of the 17 participating surgeons had had a patient with a VTE complication during this time frame. The incidence of VTE in the 15,033 cases was 0.15%; 22 patients of the 15,033 patients had a DVT (n = 15) and/or PE (n = 8). Forty-four control cases were also analyzed. Univariate and multivariate analyses were performed. No significant risk factors were identified other than patient positioning. All cases and controls were positioned in the beach-chair position for surgery. The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. The variables analyzed in the cases of VTE compared with the control cases did not show any significant risk factors. All cases were positioned in the beach-chair position. Further

  12. A 5-year retrospective analysis of 5α-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride.

    PubMed

    Kaplan, S A; Chung, D E; Lee, R K; Scofield, S; Te, A E

    2012-11-01

    We evaluated 5-year safety, efficacy and prostate volume data from BPH patients treated with finasteride or dutasteride. A retrospective analysis of 378 consecutive men treated with 5α-reductase inhibitor monotherapy between January 2004 and September 2009 (197 on finasteride and 211 on dutasteride) in a single clinic was performed. Efficacy assessments included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), prostate-specific antigen (PSA) and prostate volume (PV). Safety assessments included International Index of Erectile Function (IIEF) and adverse events. Patients were evaluated at 3 months, 1 year and yearly thereafter. Mean age of the group was 58.7 ± 6.7 years. Maintenance of therapy at 5 years was 57.4% and 42.5% for the finasteride and dutasteride groups respectively. Changes in IPSS, Qmax, PVR, PV and PSA were similar for both groups at 5 years. The incidence of erectile dysfunction, ejaculatory dysfunction and decreased libido resulting in discontinuation from therapy was significantly (p < 0.01) higher in the dutasteride (5.1%, 2.4%, 2.7% respectively) compared with the finasteride (2.1%, 1.8%, 1.4% respectively) group. In addition, the incidence of self-reported breast tenderness and/or enlargement was significantly (p < 0.01) greater in the dutasteride (3.5%) compared with the finasteride (1.2%) group. In this retrospective analysis of data from consecutive patients treated at a single clinic, both finasteride and dutasteride were effective therapies for the management of lower urinary tract symptoms. However, dutasteride resulted in significantly more sexual side effects and breast complications than finasteride. © 2012 Blackwell Publishing Ltd.

  13. Xanthogranulomatous Pyelonephritis: A Retrospective Review of 16 Cases

    PubMed Central

    Ramprasad, Kowsalya; MuddeGowda, Mythri Kuthagale

    2011-01-01

    Purpose Xanthogranulomatous pyelonephritis is an uncommon disorder of unknown etiology that is characterized by extensive destruction of the involved kidney. It is being increasingly recognized as an important cause of renal morbidity around the world. Materials and Methods This retrospective study was undertaken to review the xanthogranulomatous pyelonephritis cases presented at our tertiary care referral center in Bangalore, India. Results A total of 16 biopsy-proven cases of xanthogranulomatous pyelonephritis from October 2007 to March 2010 treated at our institute were included in the study. There were 10 females and 6 males with a mean age of 51.5 years. Flank pain was the most common presenting symptom followed by fever. All patients had unilateral disease and underwent total nephrectomy of the affected nonfunctional kidney. Conclusions Xanthogranulomatous pyelonephritis is a chronic and unusual infectious inflammatory condition involving the renal parenchyma. The definite treatment is nephrectomy. Early identification and prompt treatment of this relatively benign and uncommon condition is important to minimize morbidity and mortality. PMID:21750755

  14. Assault in children admitted to trauma centers: Injury patterns and outcomes from a 5-year review of the national trauma data bank.

    PubMed

    Barmparas, Galinos; Dhillon, Navpreet K; Smith, Eric J T; Tatum, James M; Chung, Rex; Melo, Nicolas; Ley, Eric J; Margulies, Daniel R

    2017-07-01

    While assault is commonly reported or suspected in children with traumatic wounds, a recent overview of these injuries, especially those requiring trauma surgery consultation is lacking in the literature. Explore the incidence, demographics and injury patterns of children presenting to trauma centers following an assault. Retrospective review of the National Trauma Data Bank 2007 to 2011. Subjects up to 18 years old with "assault" reported as the intent of injury. Patients were divided into infants (<2 years), young children (2-5 years), children (6-11 years), and adolescents (12-18 years). Mechanism of injury, injury severity and mortality based on age groups and race. Of 609,207 children, 58,299 (9.6%) were victims of an assault. The median age was 16 years and 81% were male, with a median injury severity score (ISS) of 8. The majority of patients were adolescents (76%), followed by infants (17%) and young children (4%). There was a stepwise increase in the proportion of assaulted Black children with increasing age (23.2% for infants and up to 46.7% for adolescents, trend p < 0.01, effect size: 0.175) while the opposite applied for White children (46.0% for infants and down to 19.5% for adolescents, trend p < 0.01, effect size: -0.230). With increasing age, White subjects had the highest trend of being assaulted during an unarmed fight or brawl (p < 0.01, effect size: 0.393), while for Black victims the highest trend was noted for assault with a firearm (p < 0.01, effect size: 0.323). Almost 2 out of 3 infants sustained severe head trauma (59%). The overall mortality was 8%, highest among young children, where it reached 16% (p < 0.01). Up to 10% of children admitted following trauma are victims of assault with traumatic brain injuries predominant in infants and firearm injuries predominant in adolescents. Injury patterns largely correlate to age and race. Assault in children is associated with a high mortality risk. These data highlight the magnitude

  15. A comparison of intimate partner violence and associated physical injuries between cohabitating and married women: a 5-year medical chart review.

    PubMed

    Wong, Janet Yuen-Ha; Choi, Anna Wai-Man; Fong, Daniel Yee-Tak; Choi, Edmond Pui Hang; Wong, John Kit-Shing; So, Fung Ling; Lau, Chu-Leung; Kam, Chak-Wah

    2016-11-29

    Cohabitation, referring to a co-residential romantic relationship between two intimate partners without a marriage license, has become widely accepted in contemporary societies. It has been found that cohabitating women have a higher risk of experiencing intimate partner violence (IPV) than married women. However, as yet, no studies have investigated the level and pattern of IPV-associated physical injuries and its mental health impact on cohabitating women. Therefore, we aim to compare IPV-associated physical injuries between cohabitating and married women by conducting a review of 5-year medical records from the emergency departments of two major public hospitals in Hong Kong. This is a retrospective cohort study. Using two computerized systems, we identified the medical charts of 1011 women who had experienced IPV and presented at emergency departments between 2010 and 2014, of which, 132 were cohabitating and 833 were married. Cohabitating women were significantly younger (p-value < .0001) and had obtained a higher educational level (p-value = .008) than married women. After adjusting for those two variables, the logistic regression models showed that cohabitating women were approximately 2.1 times more likely than married women to present with head, neck, or facial injuries (OR = 2.1, 95% CI = 1.30-3.40, p = .002), and the risk of having multiple injuries in different locations (head, neck, face, torso, limbs) was almost twice that for cohabitating women compared with married women (OR = 1.82, 95% CI = 1.25-2.65, p = .001). Furthermore, cohabitating women were almost two times as likely as married women to experience more than one method of physical violence (OR = 1.72, 95% CI = 1.18-2.51, p = .005). There were no significant differences regarding mental health, police reporting, and discharge plans. Owing to recent social changes to the family structure, including the growing acceptance of cohabitation, it is

  16. Complete Edentulous Rehabilitation Using an Immediate Function Protocol and an Implant Design Featuring a Straight Body, Anodically Oxidized Surface, and Narrow Tip with Engaging Threads Extending to the Apex of the Implant: A 5-year Retrospective Clinical Study.

    PubMed

    Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando; Ferro, Ana; Gravito, Inês

    2016-01-01

    To report the 5-year outcome of NobelSpeedy design implants in immediate function fixed prosthetic rehabilitations. This retrospective clinical study included 46 consecutive patients (29 women and 17 men) with an average age of 55 years (range, 32 to 78 years) who were rehabilitated between 2003 and 2004 with full-arch restorations supported by dental implants in immediate function. The primary outcome measures were implant survival calculated based on implant function and using life tables. The secondary outcome measures were marginal bone levels measured at 3 and 5 years, and the incidence of mechanical and biologic complications. Five patients with 21 study implants dropped out (11%). One-hundred eighty-nine implants were inserted in the maxilla (n = 166) and mandible (n = 23). Five patients lost five implants, giving a cumulative survival rate of 97.3% at 5 years of follow-up. The average (SD) marginal bone levels were 1.45 mm (0.83 mm) and 1.72 mm (1.04 mm) at 5 years of follow-up. The incidence of mechanical complications in the provisional and definitive prostheses was registered in 14 and 6 patients, respectively: prosthetic screw loosening (n = 4 provisional prostheses, n = 3 definitive prostheses), abutment screw loosening (n = 5 provisional prostheses), fracture of the acrylic resin prostheses (n = 5 provisional prostheses, n = 1 definitive prosthesis), chipping of a ceramic crown (n = 1 definitive prosthesis), and fracture of a ceramic crown (n = 1 definitive prosthesis). The incidence of biologic complications (peri-implant pathology) was registered in 6 patients and 12 implants (7.1%). Within the limitations of this study, it is possible to conclude that implants of the NobelSpeedy type used in immediate function for support of fixed prosthetic full-arch rehabilitations are a valid option, with a high survival rate.

  17. 76 FR 35906 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 12 Species in the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-20

    ... var. aestivalis), clay phacelia (Phacelia argillacea), Colorado butterfly plant (Gaura neomexicana ssp....A. (UT)....... September 28, 1978 argillacea. (43 FR 44810). Colorado butterfly plant........ Gaura....gov. Review, 2369 West Orton Circle, Suite 50, West Valley City, UT 84119. Colorado butterfly plant...

  18. 78 FR 50439 - Endangered and Threatened Wildlife and Plants; Initiation of a 5-Year Review of Nine Northeastern...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... northeastern species. We will review the following endangered species: Peter's Mountain mallow, Jesup's milk...). PLANTS Peter's Mountain mallow........ (Iliamna corei)... Endangered......... Entire: VA........ May 12... Lane, Gloucester, VA 23061. Peter's Mountain mallow....... Troy Andersen, U.S. Fish and 804-693-6694; e...

  19. Parental Influences on the Diets of 2-5-Year-Old Children: Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Peters, Jacqueline; Sinn, Natalie; Campbell, Karen; Lynch, John

    2012-01-01

    During the early years, parents have a major influence on their children's diets, food choices and development of eating habits. However, research concerning the influence of parental feeding practices on young children's diets is limited. This paper presents a systematic review of intervention studies with parents of preschool children. The aim…

  20. Parental Influences on the Diets of 2-5-Year-Old Children: Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Peters, Jacqueline; Sinn, Natalie; Campbell, Karen; Lynch, John

    2012-01-01

    During the early years, parents have a major influence on their children's diets, food choices and development of eating habits. However, research concerning the influence of parental feeding practices on young children's diets is limited. This paper presents a systematic review of intervention studies with parents of preschool children. The aim…

  1. [Urinary tract infections: review of the case records of the 5-year-old population of Novara].

    PubMed

    Alloni, V; Aitink, O; Cadario, F; Chirio, F; Quaglia, P; Bona, G

    2004-10-01

    A feverish high temperature is the symptom that most frequently leads families to take their children to a Pediatric First Aid unit. In the differential diagnosis of the causes of hyperpyrexia the presence of infections of the genito-urinary tract have to be excluded. Infections of the urinary ways are often the cause of high temperatures in infancy, particularly during the 1st year of life; early identification at the moment of examination at the Paediatric First Aid clinic of patients with infections of the urinary ways makes it possible to prevent the onset of renal complications. We carried out a retrospective study with the purpose of evaluating the incidence of infections of the urinary ways and their complications in paediatric patients who had come to the First Aid unit for hyperpirexia and were later hospitalised after examination of the urine revealed and infection of the urinary ways. The study was carried out by consulting the registers listing arrivals at the First Aid unit and the subsequent discharge diagnosis. We then consulted the clinical records of patients who required admission to our Paediatrics Clinic arter the first aid examination. Re-reading the registers of examination carried out and the clinica records of hospitalised patients there emerged an increase in the observation of this pathology, diagnosed at the moment of the First Aid examination by means of rapid tests and thereafter assessed by haematochemical and radiological tests. In our opinion this increase could be attributed to the greater attention paid to diagnosing the causes of fever of apparently unknown origin.

  2. Gastric peritoneal carcinomatosis - a retrospective review

    PubMed Central

    Tan, Hwee Leong; Chia, Claramae Shulyn; Tan, Grace Hwei Ching; Choo, Su Pin; Tai, David Wai-Meng; Chua, Clarinda Wei Ling; Ng, Matthew Chau Hsien; Soo, Khee Chee; Teo, Melissa Ching Ching

    2017-01-01

    AIM To characterize patients with gastric peritoneal carcinomatosis (PC) and their typical clinical and treatment course with palliative systemic chemotherapy as the current standard of care. METHODS We performed a retrospective electronic chart review of all patients with gastric adenocarcinoma with PC diagnosed at initial metastatic presentation between January 2010 and December 2014 in a single tertiary referral centre. RESULTS We studied a total of 271 patients with a median age of 63.8 years and median follow-up duration of 5.1 mo. The majority (n = 217, 80.1%) had the peritoneum as the only site of metastasis at initial presentation. Palliative systemic chemotherapy was eventually planned for 175 (64.6%) of our patients at initial presentation, of which 171 were initiated on it. Choice of first-line regime was in accordance with the National Comprehensive Cancer Network Guidelines for Gastric Cancer Treatment. These patients underwent a median of one line of chemotherapy, completing a median of six cycles in total. Chemotherapy disruption due to unplanned hospitalizations occurred in 114 (66.7%), while cessation of chemotherapy occurred in 157 (91.8%), with 42 cessations primarily attributable to PC-related complications. Patients who had initiation of systemic chemotherapy had a significantly better median overall survival than those who did not (10.9 mo vs 1.6 mo, P < 0.001). Of patients who had initiation of systemic chemotherapy, those who experienced any disruptions to chemotherapy due to unplanned hospitalizations had a significantly worse median overall survival compared to those who did not (8.7 mo vs 14.6 mo, P < 0.001). CONCLUSION Gastric PC carries a grim prognosis with a clinical course fraught with disease-related complications which may attenuate any survival benefit which palliative systemic chemotherapy may have to offer. As such, investigational use of regional therapies is warranted and required validation in patients with isolated PC to

  3. Tasks and communication as an avenue to enhance parenting of children birth-5 years: an integrative review.

    PubMed

    Mooney-Doyle, Kim; Deatrick, Janet A; Horowitz, June Andrews

    2015-01-01

    Every day, normative functions of parenting and their significance are under-investigated. An integrative review of tasks and communication involved in parenting young children informed by Horowitz (1995) and Blumer (1969) was conducted.Research articles consistent with inclusion criteria were published from 1995 to 2013 and focused on parenting tasks and communication. Themes consistent with Horowitz and Blumer were identified. Nurses are reminded about the significance of attending to the everyday, normative work of parenting young children, the potential meaning derived from this work, and the importance of assessing parental development as well as the importance of continuing research in this area. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities: historical review, rationale, and implications 5 years after publication.

    PubMed

    Carmona, Richard H; Giannini, Margaret; Bergmark, Brian; Cabe, Jennifer

    2010-10-01

    This article reviews much of the history of the Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities and its implications 5 years after publication. This article also reviews historical trends related to disability legislation such as the Social Security Act, the Civil Rights Era and the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and the New Freedom Initiative. Most Americans will have a disability at some point in their lives. The etiologies of disabilities are many, including genetic, congenital, traumatic, or due to chronic illnesses or the aging process. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level.

    PubMed

    Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando; Ferro, Ana; Gravito, Inês

    2015-10-01

    Studies are needed to evaluate long-term outcomes of the All-on-4® treatment concept (Nobel Biocare AB) for rehabilitation of edentulous mandibles by assessing marginal bone levels and risk indicators for implant failure. To evaluate 7-year clinical outcomes and 5-year radiographic outcomes of the All-on-4 treatment concept. This retrospective case series included patients admitted for implant rehabilitations in the mandible, who were followed for 7 years clinically and 5 years radiographically. Primary outcome measures were cumulative prosthetic and implant survival using patient as the unit of analysis (Kaplan-Meier product limit estimator). Secondary outcome measure was marginal bone level (MBL) at 5 years. Variables associated with implant failure were analyzed using the Cox proportional hazards regression model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Binary logistic regression was used to compute odds ratio (OR) with 95% CIs for variables associated with MBL ≥2.8 mm at 5 years. A total of 324 patients (194 women, 130 men, average age = 58.9 years) were rehabilitated with 1,296 implants supporting 324 full-arch fixed immediately loaded mandibular prostheses. Sixty-four patients (19.8%) were lost to follow-up. Prosthetic survival was 323/324 (99.7%), and 14 patients lost 18 implants, with an estimated cumulative survival rate of 95.4% at 7 years. Variables associated with implant failure were smoking (HR = 5.28; 95% CI: 1.33, 20.91]) and the learning curve effect (0.69 < HR < 0.33 for more experienced levels). Mean MBL at 5 years was 1.81 mm (95% CI: 1.70, 1.92), and smoking was associated with MBL ≥2.8 mm (OR = 2.4; 95% CI: 1.02, 5.62). The high implant and prosthetic survival rates and excellent MBL outcome confirm the predictability and safety of the All-on-4 treatment concept over a longer term than previously reported. © 2014 Wiley Periodicals, Inc.

  6. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study.

    PubMed

    Shah, Tejshri; Greig, Jane; van der Plas, Linda Margaretha; Achar, Jay; Caleo, Grazia; Squire, James Sylvester; Turay, Alhaji Sayui; Joshy, Grace; D'Este, Catherine; Banks, Emily; Vogt, Florian; Lokuge, Kamalini

    2016-07-01

    Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality. In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling. We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2-5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5-8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8-22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died. This description of the clinical features of Ebola virus disease over

  7. A 10-year epidemiologic review of homicide cases in children younger than 5 years in Fulton County, GA: 1996-2005.

    PubMed

    Fajardo, Geroncio Cagigas; Hanzlick, Randy L

    2010-12-01

    The primary purpose of this study was to present the epidemiologic review of homicide deaths certified by the Fulton County Medical Examiner's Office from January 1, 1996 through December 31, 2005 in children younger than 5 years. The secondary purpose of this study was to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County are significantly greater than expected when compared with those in the State of Georgia. For purposes of this study, only homicide deaths of Fulton County residents were included. The authors reviewed all homicide cases in children younger than 5 years: infancy (<1 year) and early childhood (1-4 years). χ values were calculated using Epi Info (version 3.4.1; Centers for Disease Control and Prevention, Atlanta, Ga) to determine differences in homicide among age group, race, and sex variables. In addition, a χ test at the α level of 0.05 was done to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County were significantly greater than expected when compared with those in the State of Georgia. There were 49 homicide cases in children younger than 5 years identified over this 10-year period. The yearly distribution of these 49 homicide deaths ranged from 1 death in 2003 to 9 deaths in 2004. Most of the patients were male (n=29, 59.2%) and black (n=44, 89.8%). Between infancy and early childhood cases, homicide victims were nearly equally divided between the 2 groups. However, χ values showed that decedents younger than 5 years are more likely to have died of homicide compared with decedents 5 years or older (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.29-2.35). Black decedents younger than 5 years are more likely to have died of homicide compared with other races (OR, 3.21; 95% CI, 1.21-9.28). Male and female decedents are equally at risk to have died of homicide (OR, 1.14; 95% CI, 0.61-2.11). The authors also determined that the

  8. 5-Year Budget Forecasting.

    ERIC Educational Resources Information Center

    Conyers, John G.; Lingel, George; Piekarski, Robert

    2000-01-01

    Financial planning is the key to providing a high-quality instructional plan. A 5-year financial plan is typically updated by looking at district financial history, future instructional plans, staffing requirements, and revenue projections. Planning assumptions must be clearly understood by the financial team and the community. (MLH)

  9. 5-Year Budget Forecasting.

    ERIC Educational Resources Information Center

    Conyers, John G.; Lingel, George; Piekarski, Robert

    2000-01-01

    Financial planning is the key to providing a high-quality instructional plan. A 5-year financial plan is typically updated by looking at district financial history, future instructional plans, staffing requirements, and revenue projections. Planning assumptions must be clearly understood by the financial team and the community. (MLH)

  10. Moving forward monitoring of the social determinants of health in a country: lessons from England 5 years after the Marmot Review.

    PubMed

    Goldblatt, Peter O

    2016-01-01

    England has a long history of government-commissioned reviews of national inequalities. The latest review, the Marmot Review, was commissioned by a government headed by the same party (the Labour Party) that had introduced the National Health Service in 1948, but the review was implemented by a coalition of different parties (Conservatives and Liberal Democrats). At the same time, a government reform of health services took place, and the monitoring of the existing inequality strategy was changed. This paper examines the lessons that can be learned about indicators for monitoring social determinants of health inequalities from the Marmot Review and recent health inequality strategies in England. The paper provides a narrative review of key findings on the collection, presentation, and analysis of routine data in England in the past 5 years, comparing what has been learned from the Marmot Review and other evaluations of the first health inequality strategy in England. The emphasis on monitoring has progressively shifted from monitoring a small number of targets and supporting information to frameworks that monitor across a wide range of determinants of both the causes of ill-health and of health service performance. As these frameworks become ever larger, some consideration is being given to the key indicators. Although the frameworks used in England for monitoring health inequality strategies have developed considerably since the first strategy began, lessons continue to be learned about how monitoring could be improved. Many of these are applicable to countries initiating or reviewing their strategies.

  11. Moving forward monitoring of the social determinants of health in a country: lessons from England 5 years after the Marmot Review.

    PubMed

    Goldblatt, Peter O

    2016-01-01

    Background England has a long history of government-commissioned reviews of national inequalities. The latest review, the Marmot Review, was commissioned by a government headed by the same party (the Labour Party) that had introduced the National Health Service in 1948, but the review was implemented by a coalition of different parties (Conservatives and Liberal Democrats). At the same time, a government reform of health services took place, and the monitoring of the existing inequality strategy was changed. Objectives This paper examines the lessons that can be learned about indicators for monitoring social determinants of health inequalities from the Marmot Review and recent health inequality strategies in England. Design The paper provides a narrative review of key findings on the collection, presentation, and analysis of routine data in England in the past 5 years, comparing what has been learned from the Marmot Review and other evaluations of the first health inequality strategy in England. Results The emphasis on monitoring has progressively shifted from monitoring a small number of targets and supporting information to frameworks that monitor across a wide range of determinants of both the causes of ill-health and of health service performance. As these frameworks become ever larger, some consideration is being given to the key indicators. Conclusions Although the frameworks used in England for monitoring health inequality strategies have developed considerably since the first strategy began, lessons continue to be learned about how monitoring could be improved. Many of these are applicable to countries initiating or reviewing their strategies.

  12. Recurrent Optic Neuropathy Caused by a Mucocele of the Anterior Clinoid Process after a 5-Year Remission: A Case Report and Literature Review.

    PubMed

    Aoyama, Yuka; Ohtomo, Kazuyoshi; Sawamura, Hiromasa

    2014-01-01

    A 32-year-old male presented with acute left vision loss during a second recurrence of optic neuropathy. Steroid pulse therapy had been effective in both the first episode 9 years previously and the first recurrence 5 years previously. Magnetic resonance imaging demonstrated an anterior clinoid process mucocele compressing the optic nerve. Although surgical treatment was performed, improvement was limited. This report indicates that steroid pulse therapy could be an alternative treatment to obtain temporary remission, but surgical treatment should be considered to prevent irreversible neurological deficits. This paper also presents a review of the literature on anterior clinoid process mucoceles.

  13. Diastematomyelia: a retrospective review of 138 patients.

    PubMed

    Cheng, B; Li, F T; Lin, L

    2012-03-01

    Diastematomyelia is a rare congenital abnormality of the spinal cord. This paper summarises more than 30 years' experience of treating this condition. Data were collected retrospectively on 138 patients with diastematomyelia (34 males, 104 females) who were treated at our hospital from May 1978 to April 2010. A total of 106 patients had double dural tubes (type 1 diastematomyelia), and 32 patients had single dural tubes (type 2 diastematomyelia). Radiographs, CT myelography, and MRI showed characteristic kyphoscoliosis, widening of the interpedicle distance, and bony, cartilaginous, and fibrous septum. The incidences of symptoms including characteristic changes of the dorsal skin, neurological disorders, and congenital spinal or foot deformity were significantly higher in type 1 than in type 2. Surgery is more effective for patients with type 1 diastematomyelia; patients without surgery showed no improvement.

  14. Pattern and Outcome of Heart Failure-Related Hospitalization Over 5 Years in a Remote Australian Population: A Retrospective Administrative Data Cohort of 617 Indigenous and non-Indigenous Cases.

    PubMed

    Tuttle, Camilla; Reeves, Matthew; Zhong Hu, Ta-Chi; Keates, Ashley K; Brady, Stephen; Maguire, Graeme; Stewart, Simon

    2017-10-01

    The aim of this work was to understand the pattern and outcomes for heart failure (HF)-related hospitalization among Indigenous and non-Indigenous patients living in Central Australia. A retrospective analysis of administrative data for patients presenting with a primary or secondary diagnosis of HF to Central Australia's Alice Springs Hospital during 2008-2012 was performed. The population rate of admission and subsequent outcomes (including mortality and readmission) during the 5-year study period were examined. A total of 617 patients, aged 55.8 ± 17.5 years and 302 (49%) female constituted the study cohort. The 446 Indigenous patients (72%) were significantly younger (50.8 ± 15.9 vs 68.7 ± 14.9; P < .001) and clinically more complex compared with the non-Indigenous patients. Annual prevalence of any HF hospitalization was markedly higher in the Indigenous population (1.9%, 95% CI 1.7-2.1) compared with the non-Indigenous population (0.5%, 95% CI 0.4-0.6); the greatest difference being for women. Overall, non-Indigenous patients had poorer outcomes and were significantly more likely to die (P < .0001), but this was largely driven by age differences. Alternatively, Indigenous patients were significantly more likely to have a higher number of hospitalizations, although indigeneity was not a predictor for 30- or 365-day rehospitalization from the index admission. The pattern of HF among Indigenous Australians in Central Australia is characterized by a younger population with more clinically complex cases and greater health care utilization. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. [Chronic pancreatitis: Retrospective review of 121 cases].

    PubMed

    Berger F, Zoltán; Mancilla A, Carla

    2016-12-01

    Chronic pancreatitis (CP) is a rare disease in Chile, without a clear explanation for this low prevalence. To analyze the characteristics of our patients with pancreatitis. Retrospective analysis of a database of patients with pancreatitis of a clinical hospital. Morphological proof of diagnosis (calcifications/calculi, alterations of ducts, local complication or histology) was obtained for every patient. History of acute pancreatitis was recorded and exocrine-endocrine function was assessed. We retrieved information of 121 patients with pancreatitis (86 males) in a period of 20 years. The number of cases increased markedly every five years. The calculated incidence and prevalence was 0.8/100,000/year and 6/100,000, respectively. Pancreatic calcifications were initially observed in 93 patients and became evident during the follow-up in another six patients. Severe pain or local complications occurred in 27 patients, requiring surgery in 10 or endoscopic treatment in 15. During the years of follow-up, 55 patients were free of symptoms. Exocrine and endocrine insufficiency was demonstrated and treated in 81 and 67 patients, respectively. Alcoholic etiology was evident in 40% of patients. In 29% no etiology was identified. Mapuche origin was exceptional. Late diagnosis of CP is common, since most of our patients presented with advanced stages. Even though CP is increasingly diagnosed in our hospitals, the number of cases is still far fewer when compared to other countries. Underdiagnosis alone cannot explain this difference and genetic factors might be of importance.

  16. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: a retrospective analysis of 130 reconstructions performed over a period of 5 years in a single department.

    PubMed

    Mitsimponas, Konstantinos T; Iliopoulos, Christos; Stockmann, Philipp; Bumiller, Lars; Nkenke, Emeka; Neukam, Friedrich W; Schlegel, Karl-Andreas

    2014-07-01

    The scapular/parascapular free flap was described by Saijo in 1978 and has since then been widely used in reconstructive procedures. This is a retrospective study, describing our experience with the use of free scapula/parascapular flap in 130 reconstructions over a period of 5 years in the Department of Oral and Maxillofacial Surgery of the University Hospital of Erlangen. Demographical data, data regarding the underlying pathology, flap raising details, microvascular anastomoses, early and late postoperative complications will be presented. The flap was raised without problems and the donor site was primarily closed in all cases. Sixteen flaps required revision. Five transplants were lost (failure rate of 3.85%). Loss of part of the flap was observed in 3 cases (2.3%). The free scapula/parascapular flap is a versatile and reliable flap that can find many applications in the reconstruction of complex head and neck defects. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Stratification of prosthetic complications by manufacturer in implant-supported restorations with a 5 years' follow-up: systematic review of the literature.

    PubMed

    Storelli, Stefano; Scanferla, Massimo; Palandrani, Giulia; Mosca, Daniela; Romeo, Eugenio

    2017-08-01

    Prosthetic complications on implant-supported restorations have been documented in several papers published in the literature. Several manufacturers are present on the market but results are often cumulated and may thus be misleading. The objective of the present review is to assess the prosthetic complications of implant-supported restorations with particular interest of the results obtained with prostheses from different manufacturers. A manual search of Medline/PubMed was carried out up to June 2016, yielding a total of 6832 articles, which were narrowed down to 1450, then 347 abstracts to include 55 papers after full text reading. Papers with at least 5 years of follow-up reporting on prosthetic complications of single and fixed partial prosthesis were included. Prosthetic complications were divided into mechanical and technical complications, and reported in a table. Overall 14.4% of prosthetic complication was found for a total of 6623 restorations followed for an average of 7.4 years (range 5-16 years). Results where then sorted and compared. Single crowns were affected by 1.4% of mechanical complications and 10.9% of technical complications after a mean of 7.4 years. Fixed partial prosthesis were affected by 2.5% of mechanical complications and 18% of technical complications. Screw-retained and cemented restorations were calculated to have a 5 years rate of complications of 21.2% and 9.3%, respectively, which demonstrated a statistically difference with fisher exact test with P<0.1. Only 3 manufacturers presented more than 10 articles and were directly compared with Fisher's exact test with P<0.1. The incidence of overall complications was estimated to be after 5 years of 11.2%, 10.8% and 13.8% for Straumann, Nobel, and Astratech, respectively, but dividing results in mechanical and technical complications, gave different results. Straumann was estimated to have less mechanical complications after 5 years in respect to Nobel and Astratech, but the three

  18. 42 CFR 456.709 - Retrospective drug use review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... through the State's mechanized drug claims processing and information retrieval systems approved by CMS (that is, the Medicaid Management Information System (MMIS)) or an electronic drug claims processing... Claims Management System for Outpatient Drug Claims § 456.709 Retrospective drug use review. (a)...

  19. 76 FR 31892 - Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... ADMINISTRATION 20 CFR Chapter III Retrospective Review Under E.O. 13563 AGENCY: Social Security Administration. ACTION: Request for information. SUMMARY: In accordance with Executive Order (E.O.) 13563, ``Improving... . SUPPLEMENTARY INFORMATION: On January 18, 2011, the President issued E.O. 13563, ``Improving Regulation...

  20. Iliac crest autogenous bone graft versus alloplastic graft and guided bone regeneration in the reconstruction of atrophic maxillae: a 5-year retrospective study on cost-effectiveness and clinical outcome.

    PubMed

    Dahlin, Christer; Johansson, Anita

    2011-12-01

    Reconstruction of the atrophic maxillae with autogenous bone graft and jawbone-anchored bridges is a well-proven technique. However, the morbidity associated with the concept should not be neglected. Furthermore, the costs for such treatment, including general anesthesia and hospital stay, are significant. Little data are found in the literature with regard to a cost-benefit approach to various treatment alternates. The aim of this retrospective study was to compare from a health-economical and clinical perspective the reconstruction of the atrophic maxillae prior to oral implant treatment either with autogenous bone grafts harvested from the iliac crest or the use of demineralized freeze-dried bone (DFDB) in combination with a thermoplastic carrier (Regeneration Technologies Inc., Alachua, FL, USA) and guided bone regeneration (GBR). A total of 26 patients (13 + 13) were selected and matched with regard to indication, sex, and age. The study was performed 5 years after the completion of the treatment. Implant survival, morbidity, and complications were analyzed. Furthermore, a detailed analysis of the total cost for the respective treatment modality was performed, including material, costs for staff, sick leave, etc. The study revealed no statistical difference with regard to implant survival for the respective groups. The average total cost, per patient, for the DFDB group was 22.5% of the total cost for a patient treated with autogenous bone grafting procedures. The study concluded that reconstruction of atrophic maxillae with a bone substitute material (DFDB) in combination with GBR can be performed with an equal treatment outcome and with less resources and a significant reduced cost in selected cases compared with autogenous bone grafts from the iliac crest. © 2010 Wiley Periodicals, Inc.

  1. Retrospective review of rectal cancer surgery in northern Alberta

    PubMed Central

    Pelletier, Jean-Sébastien; DeGara, Christopher; Porter, Geoff; Ghosh, Sunita; Schiller, Dan

    2013-01-01

    Introduction Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved. Methods We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region. Results We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage. Conclusion Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS. PMID:23883504

  2. Retrospective review of rectal cancer surgery in northern Alberta.

    PubMed

    Pelletier, Jean-Sébastien; Degara, Christopher; Porter, Geoff; Ghosh, Sunita; Schiller, Dan

    2013-08-01

    Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved. We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region. We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage. Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.

  3. Review of retrospective dosimetry techniques for external ionising radiation exposures.

    PubMed

    Ainsbury, E A; Bakhanova, E; Barquinero, J F; Brai, M; Chumak, V; Correcher, V; Darroudi, F; Fattibene, P; Gruel, G; Guclu, I; Horn, S; Jaworska, A; Kulka, U; Lindholm, C; Lloyd, D; Longo, A; Marrale, M; Monteiro Gil, O; Oestreicher, U; Pajic, J; Rakic, B; Romm, H; Trompier, F; Veronese, I; Voisin, P; Vral, A; Whitehouse, C A; Wieser, A; Woda, C; Wojcik, A; Rothkamm, K

    2011-11-01

    The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements.

  4. 76 FR 23520 - Periodic Review of Existing Regulations; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Chapter I Periodic Review of Existing Regulations; Retrospective Review Under E.O. 13563 AGENCY: Food and Drug Administration, HHS. ACTION: Notification for... Regulatory Review,'' the Food and Drug Administration (FDA) is conducting a review of its...

  5. 77 FR 59567 - Retrospective Regulatory Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ..., 1216, 1235 RIN 1125-AA71 Retrospective Regulatory Review Under E.O. 13563 AGENCY: Executive Office for...), entitled ``Reducing Regulatory Burden; Retrospective Review Under E.O. 13563,'' on March 1,...

  6. Vision Screening in Children Aged 6 Months to 5 Years: Evidence Report and Systematic Review for the US Preventive Services Task Force.

    PubMed

    Jonas, Daniel E; Amick, Halle R; Wallace, Ina F; Feltner, Cynthia; Vander Schaaf, Emily B; Brown, Callie L; Baker, Claire

    2017-09-05

    Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life. To review the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force. MEDLINE, Cochrane Library, CINAHL, and trial registries through June 2016; references; and experts, with surveillance of the literature through June 7, 2017. English-language randomized clinical trials (RCTs) or prospective cohort studies that evaluated screening, studies evaluating test accuracy, RCTs of treatment vs inactive controls, and cohort studies or case-control studies assessing harms. Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Studies were not quantitatively pooled because of clinical and methodological heterogeneity. Visual acuity, amblyopia, school performance, functioning, quality of life, test accuracy, testability, and harms. Forty studies were included (N = 34 709); 34 evaluated test accuracy. No RCTs compared screening with no screening, and no studies evaluated school performance, function, or quality of life. Studies directly assessing earlier or more intensive screening were limited by high attrition. Positive likelihood ratios were between 5 and 10 for amblyopia risk factors or nonamblyogenic refractive error in most studies of test accuracy and were greater than 10 in most studies evaluating combinations of clinical tests. Inability to cooperate may limit use of some tests in children younger than 3 years. Studies with low prevalence (<10%) of vision abnormalities showed high false-positive rates (usually >75%). Among children with amblyopia risk factors (eg, strabismus or anisometropia), patching improved visual acuity of the amblyopic eye by a mean of less than 1 line on a standard chart after 5 to 12 weeks for children

  7. Dermatologic manifestation of hyperandrogenism: a retrospective chart review.

    PubMed

    Clark, Charlotte M; Rudolph, Jennifer; Gerber, Donald A; Glick, Sharon; Shalita, Alan R; Lowenstein, Eve J

    2014-01-01

    Several studies have described a wide spectrum of hyperandrogenism diseases, many of which are difficult to distinguish from each other. In order to better understand diseases of hyperandrogenism, the authors performed a retrospective study of the cutaneous features and metabolic findings in women with hyperandrogenism. A retrospective chart analysis compiled by three dermatologists in both academic and private settings was performed, including patients presenting with > or = 2 manifestations of hyperandrogenism. Relevant dermatologic and associated manifestations and laboratory and imaging study findings were reviewed. Moderate to severe acne was the most common manifestation. Other common manifestations that patients first presented with include hirsutism, acanthosis nigricans, androgenic alopecia, and skin tags. Oligomenorrhea was the most common systemic presenting sign. Statistical analysis of various clinical markers revealed correlations with hyperandrogenemia. Acanthosis nigricans and hirsutism were found to be useful clinical markers for hyperandrogenism, whereas androgenic alopecia was not. This study provides some insights into the presentation and diverse manifestations seen in hyperandrogenism.

  8. 78 FR 17888 - Periodic Review of Existing Regulations; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... Chapter V 48 CFR Chapter 28 Periodic Review of Existing Regulations; Retrospective Review Under E.O. 13563... issued Executive Order 13563, ``Improving Regulation and Regulatory Review,'' which sets forth principles and requirements designed to promote public participation, improve integration and innovation...

  9. Tibial sesamoidectomy: a review of the literature and retrospective study.

    PubMed

    Kaiman, M E; Piccora, R

    1983-01-01

    Tibial sesamoid afflictions have been subject to various methods of treatment. A review of current concepts was challenged by a retrospective study involving patients in whom surgical intervention was performed. Data was collected from pre- and postoperative radiographs to determine if a change in the osseous relationships around the first metatarsophalangeal joint had occurred, thereby necessitating adjunctive procedures to compensate. The results obtained from our patient population substantiate the fact that a need does exist to evaluate these surgical candidates adequately in order to include additional procedures necessary to decrease morbidity.

  10. Two anomalous localizations of mucocele: clinical presentation and retrospective review.

    PubMed

    Cavazza, S; Bocciolini, C; Laudadio, P; Tassinari, G; Dall'Olio, D

    2007-08-01

    Two Caucasian males (57 and 70 years old) were referred to our attention with parasinus mucoceles, maxillary and frontal mucocele, respectively, that had eroded the orbital rim and caused swelling of the eyelids and brow. Invasion of the orbital space caused several ophthalmic symptoms such as diplopia, proptosis, ptosis, and the formation of a palpable mass. Ophthalmic involvement was the first sign of the mucocele. The mucoceles were completely excised through a skin incision and the diseased mucosa of the sinuses was removed: endonasal fibre optic surgery and the Caldwell-Luc procedure were used in the patient with maxillary mucocele. The cases are described with retrospective review.

  11. Two anomalous localizations of mucocele: Clinical presentation and retrospective review

    PubMed Central

    Cavazza, S; Bocciolini, C; Laudadio, P; Tassinari, G; Dall’Olio, D

    2007-01-01

    Summary Two Caucasian males (57 and 70 years old) were referred to our attention with parasinus mucoceles, maxillary and frontal mucocele, respectively, that had eroded the orbital rim and caused swelling of the eyelids and brow. Invasion of the orbital space caused several ophthalmic symptoms such as diplopia, proptosis, ptosis, and the formation of a palpable mass. Ophthalmic involvement was the first sign of the mucocele. The mucoceles were completely excised through a skin incision and the diseased mucosa of the sinuses was removed: endonasal fibre optic surgery and the Caldwell-Luc procedure were used in the patient with maxillary mucocele. The cases are described with retrospective review. PMID:17957852

  12. Child abuse-related homicides in New Mexico: a 6-year retrospective review.

    PubMed

    Lee, Carol K; Lathrop, Sarah L

    2010-01-01

    We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.

  13. Supracricoid hemilaryngopharyngectomy for selected pyriform sinus carcinoma patients – a retrospective chart review

    PubMed Central

    Papacharalampous, George X; Kotsis, Georgios P; Vlastarakos, Petros V; Georgolios, Alexandros; Seggas, Ioannis; Yiotakis, Ioannis E; Manolopoulos, Leonidas

    2009-01-01

    Background The aim of this study is to assess the functional and oncologic results of supracricoid hemilaryngopharyngectomy and report our experience in the technique, local control and overall survival rates. Materials and methods 18 selected patients with pyriform sinus cancer treated by supracricoid hemilaryngopharyngectomy in a University Hospital setting. Retrospective chart review was used to assess functional and oncologic results of the procedure. Results The actuarial 5 year survival rate in our study was 55.56% and the actuarial neck recurrence rate was 16.67%. All patients were successfully decannulated. Aspiration pneumonia was the most common postoperative complication (22.23%) and was treated mostly conservatively. One patient required a temporary gastrostomy but no patient needed total laryngectomy in the postoperative period. Conclusion Supracricoid hemilaryngopharyngectomy in experienced hands is a reliable technique for selected patients with pyriform sinus cancer. PMID:19671141

  14. Implant and prosthodontic survival rates with implant fixed complete dental prostheses in the edentulous mandible after at least 5 years: a systematic review.

    PubMed

    Papaspyridakos, Panos; Mokti, Muizzaddin; Chen, Chun-Jung; Benic, Goran I; Gallucci, German O; Chronopoulos, Vasilios

    2014-10-01

    The treatment of mandibular edentulism with implant fixed complete dental prostheses (IFCDPs) is a routinely used treatment option. The study aims to report the implant and prosthodontic survival rates associated with IFCDPs for the edentulous mandible after an observation period of a minimum 5 years. An electronic MEDLINE/PubMED search was conducted to identify randomized controlled clinical trials and prospective studies with IFCDPs for the edentulous mandible. Clinical studies with at least 5-year follow-up were selected. Pooled data were statistically analyzed and cumulative implant- and prosthesis survival rates were calculated by meta-analysis, regression, and chi-square statistics. Implant-related and prosthesis-related factors were identified and their impact on survival rates was assessed. Seventeen prospective studies, including 501 patients and 2,827 implants, were selected for meta-analysis. The majority of the implants (88.5% of all placed implants) had been placed in the interforaminal area. Cumulative implant survival rates for rough surface ranged from 98.42% (95% confidence interval [CI]: 97.98-98.86) (5 years) to 96.86% (95% CI: 96.00-97.73) (10 years); smooth surface implant survival rates ranged from 98.93% (95% CI: 98.38-99.49) (5 years) to 97.88% (95% CI: 96.78-98.98) (10 years). The prosthodontic survival rates for 1-piece IFCDPs ranged from 98.61% (95% CI: 97.80-99.43) (5 years) to 97.25% (95% CI: 95.66-98.86) (10 years). Treatment with mandibular IFCDPs yields high implant and prosthodontic survival rates (more than 96% after 10 years). Rough surface implants exhibited cumulative survival rates similar to the smooth surface ones (p > .05) in the edentulous mandible. The number of supporting implants and the antero-posterior implant distribution had no influence (p > .05) on the implant survival rate. The prosthetic design and veneering material, the retention type, and the loading protocol (delayed, early, and immediate) had no

  15. 5-year follow-up of a randomized clinical study comparing everolimus plus reduced-dose cyclosporine with mycophenolate mofetil plus standard-dose cyclosporine in de novo kidney transplantation: Retrospective single center assessment.

    PubMed

    Hiramitsu, Takahisa; Okada, Manabu; Futamura, Kenta; Yamamoto, Takayuki; Tsujita, Makoto; Goto, Norihiko; Narumi, Shunji; Watarai, Yoshihiko; Takeda, Asami; Iwasaki, Kenta; Uchida, Kazuharu; Kobayashi, Takaaki

    2016-10-01

    The aim of this study is to evaluate the efficacy and safety of everolimus plus reduced-dose cyclosporine compared with mycophenolate mofetil plus standard-dose cyclosporine 5years after living donor kidney transplantation. Between March 2008 and August 2009, 24 living donor kidney transplantations were enrolled in a 2-year, multicenter, randomized phase 3 study (RAD001A1202 study). 24 recipients were randomly classified into two groups and closely observed for 5years. 13 recipients were administered steroid, reduced-dose cyclosporine, everolimus and basiliximab (EVR group). 11 recipients were administered steroid, standard-dose cyclosporine, mycophenolate mofetil and basiliximab (STD group). Two groups were compared not only in graft function including estimated glomerular filtration rate (eGFR), and proteinuria, but also in adverse events such as de novo donor-specific antibody (DSA) production, rejection, new-onset diabetes, hyperlipidemia, and cytomegalovirus (CMV) infection. No graft loss was identified in 5years. The incidences of acute T cell rejection, de novo DSA production, hyperlipidemia, and new-onset diabetes were similar. eGFR levels throughout the observation periods were similar. Three cases of proteinuria were identified in STD group. One case of proteinuria observed in EVR group was well controlled with angiotensin receptor blocker. Incidence of CMV infection in CMV antibody-positive recipients was significantly lower in EVR group. The safety and efficacy of reduced-dose cyclosporine and everolimus protocol were similar to those of standard-dose cyclosporine and mycophenolate mofetil other than for superior prevention of CMV infection. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Risperidone treatment for juvenile bipolar disorder: a retrospective chart review.

    PubMed

    Frazier, J A; Meyer, M C; Biederman, J; Wozniak, J; Wilens, T E; Spencer, T J; Kim, G S; Shapiro, S

    1999-08-01

    To investigate the effectiveness and tolerability of the atypical neuroleptic risperidone in the treatment of juvenile mania. This is a retrospective chart review of outpatients with the diagnosis of bipolar disorder (DSM-IV) treated with risperidone at a university center. Response to treatment was evaluated using the Clinical Global Impression Scale (CGI) with separate assessments of mania, psychosis, aggression, and attention-deficit/hyperactivity disorder (ADHD). Twenty-eight youths (mean +/- SD age, 10.4 +/- 3.8 years) with bipolar disorder (25 mixed and 3 hypomanic) who had been treated with risperidone were identified. These children received a mean dose of 1.7 +/- 1.3 mg over an average period of 6.1 +/- 8.5 months. Using a CGI Improvement score of < or = 2 (very much/much improved) to define robust improvement, 82% showed improvement in both their manic and aggressive symptoms, 69% in psychotic symptoms, but only 8% in ADHD symptoms. Although limited by its retrospective nature, this study suggests that risperidone may be effective in the treatment of manic young people and indicates the need for controlled clinical trials of risperidone and other atypical neuroleptics in juvenile mania.

  17. The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review.

    PubMed

    Yadav, Krishna Kumar; Awasthi, Shally

    2016-06-01

    India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour.

  18. Blount's disease: a retrospective review and recommendations for treatment.

    PubMed

    Schoenecker, P L; Meade, W C; Pierron, R L; Sheridan, J J; Capelli, A M

    1985-01-01

    Thirty-two patients treated for Blount's disease were retrospectively reviewed. The results of treatment were assessed by clinical and radiographic parameters and arbitrarily classified good, fair, or poor. Five patients were definitively treated with braces; five extremities were rated good and one poor. Twelve patients were treated with a proximal tibial osteotomy performed before their fifth birthday. Nineteen extremities were rated good, one fair, and three poor. Fifteen patients had their initial surgical procedure after the fifth birthday. Eight extremities were rated good, six fair, and seven poor. Recurrence of the varus deformity secondary to an unsuspected medial bony physeal bar occurred in four patients. Resection of this bony bridge concomitant with a varus correcting osteotomy may be indicated. For severe deformity in older children, several different salvage procedures were used.

  19. A Review of the Literature on the Social and Environmental Factors Which Influence Children (Aged 3-5 Years) to Be Obese/Overweight and the Accuracy of Parental Perceptions

    ERIC Educational Resources Information Center

    McMullan, Julie; Keeney, Sinead

    2014-01-01

    Objective: This article aims to review the previously published literature on the social and environmental factors which influence children (aged 3-5 years) to be obese/overweight and the accuracy of parental perceptions. Obesity levels are on the increase in today's society and habits are being passed from parents to children, with family…

  20. A Review of the Literature on the Social and Environmental Factors Which Influence Children (Aged 3-5 Years) to Be Obese/Overweight and the Accuracy of Parental Perceptions

    ERIC Educational Resources Information Center

    McMullan, Julie; Keeney, Sinead

    2014-01-01

    Objective: This article aims to review the previously published literature on the social and environmental factors which influence children (aged 3-5 years) to be obese/overweight and the accuracy of parental perceptions. Obesity levels are on the increase in today's society and habits are being passed from parents to children, with family…

  1. [Rectal squamous cell carcinoma treatment: Retrospective experience in two French university hospitals, review and proposals].

    PubMed

    Schernberg, A; Servagi-Vernat, S; Loganadane, G; Touboul, E; Bosset, J-F; Huguet, F

    2016-12-01

    After publishing a retrospective series of 23 patients treated for a rectal squamous cell carcinoma with exclusive curative and conservative intent chemoradiation, we aim to propose a review of the literature about this rare tumour. We identified 11 retrospective studies, on 106 patients, treated between 2007 and 2016. Treatment of rectal squamous cell carcinoma should be similar to anal carcinoma, based on exclusive chemoradiation, displaying a 5-year overall survival rate over 80%, while it was 32% in surgical series. Baseline explorations should be similar as for anal carcinoma, with an interest in PET-CT at diagnosis and monitoring, after a delay over 6 weeks after chemoradiation. Intensity-modulated radiotherapy is legitimate, to a prophylactic dose between 36 and 45Gy, and over 54Gy to the tumour. Concomitant chemotherapy should combine an antimetabolite (5-fluorouracil or capecitabine) and mitomycin C, or cisplatin. This treatment seems well tolerated, associated with grade 2 or above toxicity below 30%. Follow-up should be established on anal squamous cell carcinoma schedule, with endoscopic ultrasonography and PET-CT. Rectal squamous cell carcinoma is a rare tumour; it management should be based on anal curative and conservative intent chemoradiation.

  2. Predicting the effectiveness of insulin pump therapy on glycemic control in clinical practice: a retrospective study of patients with type 1 diabetes from 10 outpatient diabetes clinics in Sweden over 5 years.

    PubMed

    Clements, Mark; Matuleviciene, Viktorija; Attvall, Stig; Ekelund, Magnus; Pivodic, Aldina; Dahlqvist, Sofia; Fahlén, Martin; Haraldsson, Börje; Lind, Marcus

    2015-01-01

    Multicenter long-term studies of predictors for the effectiveness of continuous subcutaneous insulin infusion (CSII) in clinical practice are lacking. We hypothesized that there are substantially greater reductions in hemoglobin A1c (HbA1c) in patients with poor glycemic control and that other predictors may also exist. We used data from 10 outpatient diabetic clinics in Sweden and studied CSII treatment over 5 years. Patients with HbA1c values available ≤ 6 months before starting CSII and at 5 years were included (n = 272, 82% of CSII patients) along with 2,437 contemporaneous controls on multiple daily insulin injections (MDI). Baseline variables evaluated were age, sex, diabetes duration, insulin dose, body mass index (BMI), HbA1c at baseline, and outpatient clinical care unit. At 5 years, significantly greater reductions in HbA1c by CSII compared with MDI were found for patients with higher baseline HbA1c (P = 0.032) and lower baseline BMI (P = 0.013). For baseline HbA1c levels of 7.0%, 8.0%, and 9.0% and a BMI of 25 kg/m(2), the reduction in HbA1c level by CSII was 0.08% (difference not significant), 0.16% (95% confidence interval, 0.03-0.29%), and 0.25% (95% confidence interval, 0.11-0.39%), respectively. Corresponding analyses for the change in HbA1c level from start to 1 and 2 years revealed a significant interaction of insulin pump therapy only with baseline HbA1c levels (P < 0.001 and P = 0.030, respectively). The interaction term between outpatient clinical care unit and CSII treatment was statistically significant for some care units, with some care units demonstrating a benefit from CSII and others demonstrating a detriment. Patients with high HbA1c levels have a greater probability of improved HbA1c after initiating pump therapy, but effects remain relatively modest even for patients with poor control. Factors predicting successful insulin pump use need further study.

  3. Systematic review of the survival rate and the biological, technical, and aesthetic complications of fixed dental prostheses with cantilevers on implants reported in longitudinal studies with a mean of 5 years follow-up.

    PubMed

    Romeo, E; Storelli, S

    2012-10-01

    A systematic review was carried out to evaluate the success and survival rate of implants supporting cantilever prosthesis, as well as the incidence of technical and biological complications. A MEDLINE search was conducted up to December 2011 for studies with a mean follow-up of 5 years or more. Two independent reviewers screened the retrieved articles and extracted the data independently. Data on survival, failure, mechanical/technical and biological complications were analyzed. One-hundred and sixty articles were selected as abstract. Only 18 underwent a full-text analysis and only six were included in the study. The estimated cumulative survival rate of implants supporting cantilevered prosthesis was 98.9% (95% CI: 97.4-99.5%), whereas ICFDP survival was estimated to be about 97.1% (95% CI: 90.1-99.2%). Implant failures before prosthetic delivery were not considered. Biological complications were estimated to be 5.7% (95% CI: 4.2-7.6%) at implant level after 5 years. Technical complications were analyzed: the most common complications were veneer fractures (5-year estimate: 10.1%; 95% CI: 3.7-16.5%) and abutment screw fractures (5-year estimate: 1.6%; 95% CI: 0.8-3.5%). Decementation and screw loosening were estimated to be at 5 years 5.9% (95% CI: 1.7-16.8%) and 7.9% (95% CI: 3.2-18.2%), respectively. Implant fracture was rare (5-year estimate: 0.7%; 95% CI: 0.1-4.7%); no framework fracture was reported. Radiographic bone level changes did not yield statistically significant differences. No aesthetic outcome was reported. ICFDPS can be considered a reliable treatment: the systematic review assessed that there is no increase in complication rate due to the presence of the cantilever. © 2012 John Wiley & Sons A/S.

  4. Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

    PubMed

    Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

    2014-01-01

    Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

  5. 76 FR 36887 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-23

    ... ADMINISTRATION 13 CFR Chapter I Reducing Regulatory Burden; Retrospective Review Under E.O. 13563 AGENCY: Small... Order 13563, Improving Regulation and Regulatory Review, the Small Business Administration (SBA) has developed a preliminary retrospective review plan for periodically analyzing its existing significant...

  6. Viral Hepatitis: Retrospective Review in a Canadian Pediatric Hospital

    PubMed Central

    Cybulska, Paulina; Ni, Andy; Jimenez-Rivera, Carolina

    2011-01-01

    Introduction. Clinical presentation of viral hepatitis ranges from mild symptoms to fulminant hepatitis. Our aim is to describe clinical presentation and outcomes of children with viral hepatitis from the Eastern Ontario/Western Quebec regions of Canada. Methods. Retrospective chart review of children diagnosed with viral hepatitis at our institution from January 1, 1998, to December 31, 2007. Results. There were 261 charts reviewed, only 64 had a confirmed viral etiology: 34 (53%) hepatitis B (HBV), 16 (25%) hepatitis C (HCV), 4 (6.3%) hepatitis A (HAV), 7 (11%) cytomegalovirus (CMV), and 3 (4.7%) Epstein-Barr virus (EBV). Children with HBV presented at a mean age of 6.4 ± 4.6 years. Spontaneous seroconversion (appearance of HBVeAb and loss of HBVeAg) occurred in 21/34 (61.7%). Children with acute hepatitis (HAV, CMV, and EBV) presented with mild abdominal pain, jaundice, and fevers. Overall outcome was excellent. Conclusion. Acute and chronic hepatitis in children has a benign course; moreover, HBV spontaneous seroconversion is common in pediatric patients. PMID:22482064

  7. Protocol of the PSYCHOTSH study: association between neonatal thyroid stimulating hormone concentration and intellectual, psychomotor and psychosocial development at 4–5 year of age: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background Several European countries, including Belgium, still suffer from mild iodine deficiency. Thyroid stimulating hormone (TSH) concentration in whole blood measured at birth has been proposed as an indicator of maternal iodine status during the last trimester of pregnancy. It has been shown that mild iodine deficiency during pregnancy may affect the neurodevelopment of the offspring. In several studies, elevated TSH levels at birth were associated with suboptimal cognitive and psychomotor outcomes among young children. This paper describes the protocol of the PSYCHOTSH study aiming to assess the association between neonatal TSH levels and intellectual, psychomotor and psychosocial development of 4–5 year old children. The results could lead to a reassessment of the recommended cut-off levels of 5 > mU/L used for monitoring iodine status of the population. Methods In total, 380 Belgian 4–5 year old preschool children from Brussels and Wallonia with a neonatal blood spot TSH concentration between 0 and 15 mU/L are included in the study. For each sex and TSH-interval (0–1, 1–2, 2–3, 3–4, 4–5, 5–6, 6–7, 7–8, 8–9 and 9–15 mU/L), 19 newborns were randomly selected from all newborns screened by the neonatal screening centre in Brussels in 2008–2009. Infants with congenital hypothyroidism, low birth weight and prematurity were excluded from the study. Neonatal TSH concentration was measured by the Autodelphia method in dried blood spots, collected by heel stick on filter paper 3 to 5 days after birth. Cognitive abilities and psychomotor development are assessed using the Wechsler Preschool and Primary Scale of Intelligence - third edition - and the Charlop-Atwell Scale of Motor coordination. Psychosocial development is measured using the Child Behaviour Check List for age 1½ to 5 years old. In addition, several socioeconomic, parental and child confounding factors are assessed. Conclusions This study aims to clarify the effect of

  8. Histologic features of secondary syphilis: A multicenter retrospective review.

    PubMed

    Flamm, Alexandra; Parikh, Kruti; Xie, Qiang; Kwon, Eun Ji; Elston, Dirk M

    2015-12-01

    Secondary syphilis has a wide spectrum of clinical and histologic manifestations. We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). This was a retrospective review. The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years.

    PubMed

    Jung, Ronald E; Zembic, Anja; Pjetursson, Bjarni E; Zwahlen, Marcel; Thoma, Daniel S

    2012-10-01

    To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur? A Medline search (2006-2011) was performed for clinical studies focusing on implant-supported SCs with a mean follow-up of at least 5 years. The search was complemented by an additional hand search and the inclusion of 24 studies from a previous systematic review (Jung et al. 2008a). Survival and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year proportions. Forty-six studies derived from an initial search count of 1083 titles and the complementary publications from the previous systematic review (Jung et al. 2008a) were selected and the data were extracted. Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%). The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years. For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4-11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1-8.6%) were calculated. Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years. The cumulative 5-year aesthetic complication rate amounted to 7.1% (95% CI: 3.6-13.6%). The outcomes of the meta-analysis demonstrated high implant survival rates for both the single tooth implants and the

  10. Sarcomatoid Carcinoma of the Prostate: Retrospective Review of a Case Series from Johns Hopkins Hospital

    PubMed Central

    Markowski, Mark C.; Eisenberger, Mario; Zahurak, Marianna; Epstein, Jonathan I.; Paller, Channing

    2015-01-01

    Objective To identify survival differences in patients with sarcomatoid prostate cancer based on initial staging and treatment regimens. Methods We retrospectively reviewed the clinical outcomes of patients with a pathologically confirmed diagnosis of sarcomatoid prostate cancer. The primary statistical objective was to estimate overall survival and assess the survival of patients at different stages treated with either local and/or systemic approaches. Results We identified 70 transurethral resections, needle biopsies or prostatectomy specimens that were reviewed by the Department of Pathology at Johns Hopkins Hospital from 2002–2012 and given the diagnosis of sarcomatoid prostate cancer. Of the 45 patients with available survival data, complete medical histories were obtained on 27 patients who were stratified based on a modified staging system (local disease, local disease with bladder invasion, and metastatic disease). After a median follow-up of 106 months, the median overall survival (OS) of patients in the local disease group was not reached. Notably, five of the 9 patients diagnosed with local disease survived > 5 years and were treated with surgery and/or external beam radiation therapy. The OS hazard was significantly increased in patients with either clinical evidence of bladder invasion (HR: 20.46 [95% CI: 2.43,172]; p = < 0.0001) or metastatic disease (HR: 43.34 [95% CI: 4.39,427.4]; p = < 0.0001), which both demonstrated poor outcomes (median OS: local with bladder invasion – 9 months; metastatic disease – 7.1 months). Conclusions This retrospective analysis suggests that local sarcomatoid prostate cancer can be effectively treated with definitive therapy leading to favorable outcomes. PMID:26126695

  11. Sarcomatoid Carcinoma of the Prostate: Retrospective Review of a Case Series From the Johns Hopkins Hospital.

    PubMed

    Markowski, Mark C; Eisenberger, Mario A; Zahurak, Marianna; Epstein, Jonathan I; Paller, Channing J

    2015-09-01

    To identify survival differences in patients with sarcomatoid prostate cancer based on initial staging and treatment regimens. We retrospectively reviewed the clinical outcomes of patients with a pathologically confirmed diagnosis of sarcomatoid prostate cancer. The primary statistical objective was to estimate overall survival (OS) and to assess the survival of patients at different stages treated with local and/or systemic approaches. We identified 70 transurethral resections, needle biopsies, or prostatectomy specimens that were reviewed by the Department of Pathology at the Johns Hopkins Hospital from 2002-2012 and given the diagnosis of sarcomatoid prostate cancer. Of the 45 patients with available survival data, complete medical histories were obtained for 27 patients who were stratified based on a modified staging system (local disease, local disease with bladder invasion, and metastatic disease). After a median follow-up of 106 months, the median OS of patients in the local disease group was not reached. Notably, 5 of the 9 patients diagnosed with local disease survived >5 years and were treated with surgery and/or external beam radiation therapy. The OS hazard was significantly increased in patients with either clinical evidence of bladder invasion (HR: 20.46 [95% CI: 2.43,172]; P = 0.005) or metastatic disease (HR: 43.34 [95% CI: 4.39,427.4]; P = 0.001), which both demonstrated poor outcomes (median OS: local disease with bladder invasion-9 months; metastatic disease-7.1 months). This retrospective analysis suggests that local sarcomatoid prostate cancer can be effectively treated with definitive therapy leading to favorable outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. 7-year retrospective review of quad bike injuries admitted to Starship Children's Hospital.

    PubMed

    Pearce, Rebecca; Miles, Fiona

    2015-05-15

    To ascertain morbidity and mortality of children who presented to Starship Children's Hospital with injuries from a quad bike incident from 2007 to 2014, and to review whether current guidelines are sufficient to prevent injury. A retrospective case note review of all children under the age of 16 years who presented to Starship Hospital with an injury sustained whilst riding a quad bike between January 2007 and July 2014. Twenty-seven patients were identified through both the Starship Children's Hospital Trauma and Paediatric Intensive Care databases with injuries resulting from a quad bike incident. Fifteen patients (56%) had multisystem injuries. The average injury severity score (ISS) was 14 (range 1-75). ISS was higher in those of younger age (<5 years), lower body weight (<20kg), requiring PICU admission and those sustaining head injuries with no helmet. Seven (25.9%) patients required PICU admission, two patients died (7.4%) and three patients (12%) survived to discharge with disability. This study supports current published guidelines which recommend limiting the use of quad bikes by children. Current guidelines do not, however, prevent injury in the paediatric population.

  13. Reduction of the risk of transfusion-transmitted viral infection by nucleic acid amplification testing in the Western Cape of South Africa: a 5-year review.

    PubMed

    Cable, R; Lelie, N; Bird, A

    2013-02-01

    In October 2005, individual donation nucleic acid amplification testing (ID-NAT) for HIV, HBV and HCV was introduced in the Western Cape Province of South Africa. After 5 years, the impact on HIV, HBV and HCV transmission risk was assessed. A total of 649745 donations were tested by ID-NAT using the Ultrio assay on the Tigris instrument (Novartis Diagnostics) and for anti-HIV, HBsAg and anti-HCV (Abbott Prism). Initial reactive samples were repeated in duplicate. Discrepant repeat reactive samples were subjected to confirmatory assays. ID-NAT nonrepeat reactive donations were further screened for occult HBV infection (OBI) by anti-HBc assay. ID-NAT yielded 6 HIV-RNA-positive donations in the anti-HIV-negative window period (WP) but only 2 were p24 Ag nonreactive (1:325000). Mathematical modelling estimated a similar HIV transmission risk for lapsed and repeat donations, in the order of 3 per million. The WP risk for HBV was 13 per million. Eight acute (1:81000) and 13 chronic OBI yield cases (1:50000) were interdicted. There were significantly more anti-HBc-positive donors in the Ultrio initial reactive/nonrepeat reactive group (12%) than in an Ultrio nonreactive control group (6%). ID-NAT in the Western Cape Province of South Africa has contributed significantly to enhancing blood safety, particularly for HBV transmission risk and to a lesser extent for HIV. Anti-HBc testing of NAT nonrepeat reactive donations seems useful in identifying a subgroup of donors with OBI who may be at risk of transmitting HBV. © 2012 The Author(s). Vox Sanguinis © 2012 International Society of Blood Transfusion.

  14. Cervicofacial Lymphatic Malformations: A Retrospective Review of 40 Cases

    PubMed Central

    Cho, Byung Chae; Kim, Jae Bong; Lee, Jeong Woo; Choi, Kang Young; Yang, Jung Dug; Lee, Seok-Jong; Kim, Yong-Sun; Lee, Jong Min; Huh, Seung

    2016-01-01

    Background Lymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment. Methods In this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment. Results Suspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2–V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients. Conclusions LM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM. PMID:26848440

  15. Socioeconomic status, gender, and burn injury: A retrospective review.

    PubMed

    Dissanaike, Sharmila; Ha, Daniel; Mitchell, Diana; Larumbe, Eneko

    2017-10-01

    Burn injury rates appear to be influenced by socioeconomic status (SES) and gender globally, but the impact of poverty and gender on burn injury has not been studied in a developed country. This study was a retrospective chart review conducted at a regional burn center in the Southwest US that included 340 patients with TBSA burns >15%. SES was determined using zip code and US census data. The distribution of mechanism of injury was significantly different by gender (χ(2)(6) = 36.14, p < 0001), but not significantly different by SES (χ(2)(12) = 19.68, p = 0.073). Burn rates in women was found to have a significant and linear increase (χ(2) = 13.8513, p = 0.001) with increasing poverty. Women had higher frequencies of being burned at home, and men had higher frequencies of being burned at work. While poverty did not appear to increase the risk of burn injury overall in a mixed population, it was associated with a significant increase in the risk of burn injury in women. Thus, strategies for decreasing risk factors should be targeted toward low SES females and the working male. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. RETROSPECTIVE REVIEW OF MORTALITY IN GIANT PACIFIC OCTOPUS (ENTEROCTOPUS DOFLEINI).

    PubMed

    Seeley, Kathryn E; Clayton, Leigh A; Hadfield, Catherine A; Muth, Dillon; Mankowski, Joseph L; Kelly, Kathleen M

    2016-03-01

    The giant Pacific octopus (Enteroctopus dofleini) is a popular exhibit species in public display aquaria, but information on health and disease is limited. This retrospective review evaluates time in collection and describes antemortem clinical signs and pathology of giant Pacific octopuses in an aquarium setting. Between March 2004 and December 2013, there were 19 mortalities: eight males, 10 females, and one individual whose sex was not recorded. Average time spent in collection for all octopuses was 375 ± 173 days (males 351 ± 148 days, females 410 ± 196 days). Ten (52.6%) of the octopuses were sexually mature at the time of death, six (31.6%) were not sexually mature, and reproductive status could not be determined in three octopuses (15.8%). Minimal changes were noted on gross necropsy but branchitis was histologically evident in 14 octopuses, often in conjunction with amoeboid or flagellate parasites. Senescence, parasitism, and husbandry were all important contributors to mortality and should be considered when caring for captive octopuses.

  17. Management of Calvarial Tumors: A Retrospective Analysis and Literature Review.

    PubMed

    Ozgiray, Erkin; Perumal, Karthikeyan; Cinar, Celal; Caliskan, Kadir Emre; Ertan, Yesim; Yurtseven, Taskin; Oktar, Nezih; Ovul, Izzet; Oner, Kazim

    2016-01-01

    Tumors of various organs that metastasize to bone do not neglect calvarium as a target. The aim of this study was to characterize the calvarial tumors. We retrospectively reviewed 45 consecutive patients operated for calvarial masses from January 2002 till May 2012 at our hospital. Skull base tumors and patients ≤18 years were excluded. Three groups of lesions were found - calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality. Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.

  18. Complicated sinusitis in a developing country, a retrospective review.

    PubMed

    Schlemmer, Kurt Denton; Naidoo, Shamlan Krishna

    2013-07-01

    The aim of our study was to assess the incidence rate, mode of presentation, treatment and outcome measures associated with complicated sinusitis in our developing world setting. Additionally we had hope to identify possible patterns or predisposing factors that may assist us in decreasing the significant morbidity and mortality associated with this serious disease. A retrospective chart review was performed on all patients treated for complicated sinusitis at 3 referral hospitals in Durban South Africa between January 2006 and September 2009. A total of 220 patients were identified including 138 patients with orbital complications only and 82 with intracranial complications with or without orbital manifestations. We report on the demographics, mode of presentation, microbiology, impact on resources, management and mortality of the study group. The incidence rate was found to be 5.83 per million, the most common risk factors associated with intracranial complications, a persistent headache beyond 1 week and referral from a rural rather than urban area (OR 3.24). We found a high mortality rate of 20.7% in those patients with intracranial complications of their sinusitis. Complicated sinusitis is still far too common in the developing world with young adolescent males most at risk. A high index of suspicion must be maintained in detecting orbital as well as intracranial extension of disease and appropriate referral for investigation and management swift and aggressive in preventing extensive morbidity and mortality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Adult intussusception: A retrospective review of 41 cases

    PubMed Central

    Wang, Ning; Cui, Xing-Yu; Liu, Yu; Long, Jin; Xu, Yuan-Hong; Guo, Ren-Xuan; Guo, Ke-Jian

    2009-01-01

    AIM: To optimize the preoperative diagnosis and surgical management of adult intussusception (AI). METHODS: A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted. RESULTS: Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal intussusceptions. 65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo. Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion. CONCLUSION: CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided. PMID:19598308

  20. Intermediate probability lung scans (IPLS): retrospective review of 82 cases.

    PubMed

    Wong, W Y; Ng, D C; Ang, E S; Goh, A S; Sundram, F X

    2001-10-01

    In the light of a reported 30-40% prevalence of pulmonary embolism (PE) in intermediate probability lung scans (IPLS) based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, we examined the frequency of documented PE in 82 patients with IPLS, the management strategy employed in these patients with regards to additional imaging (e.g. further evaluation with venous sonography or spiral computed tomographic angiography (CTA)), anticoagulation therapy, and subsequent follow-up outcomes. Retrospective review of the medical records of 82 patients with intermediate probability ventilation-perfusion (V/Q) lung scans from January 1998 to July 1999. 14.1% of V/Q scans were reported as having an intermediate probability of PE. 72% of IPLS were subject to further evaluation with venous Doppler ultrasound and/or CTA, and 39% of these patients had evidence of thrombo-embolic disease. All patients with imaging evidence of thromboembolic disease were started on anticoagulation therapy. In addition, 19 patients were treated based on clinical judgement. Amongst the 35 patients who were not treated, 17 (49%) were based on clinical findings without further imaging. There was no mortality on follow-up of 28 cases of untreated IPLS. The majority of IPLS will have further imaging, out of which over one-third will have thrombo-embolic disease. Approximately half of IPLS cases will receive anticoagulation therapy. No mortality or PE was found on follow-up of patients who were not treated.

  1. Retrospective review of Prothrombinex use by SAAS MedSTAR.

    PubMed

    Fischer, Roy; Brettig, Simon; Pearce, Andrew

    2017-04-01

    The aim of this study was to review and describe the use of Prothrombinex by a physician-led retrieval service based remote from a hospital blood bank. This is a retrospective observational study. Patients to whom Prothrombinex was administered by the retrieval team were identified from the retrieval service patient database. The paper case cards of the identified patients were then manually reviewed and the data matched to patients in the state-wide electronic laboratory record. Between 1 January 2010 and 30 November 2013 38 cases were identified. For 28 the indication was warfarinisation associated with life-threatening bleeding (most commonly intracranial or gastrointestinal tract). In the remaining 10 cases, Prothrombinex was used to treat coagulopathy associated with liver disease or massive haemorrhage. The median time saved by the retrieval team administering PTX-VF, rather than waiting to the receiving centre, was 120 min (interquartile range: 85-195 min). The median dose of PTX-VF administered was 23.25 IU/kg (interquartile range: 20-33 IU/kg). Paired international normalised ratios (INRs) were available for 33 of the 38 patients. In the warfarin group, all patients had an improvement in their INR and 21 of 25 had correction of their INR. In the non-warfarin group, the effect on INR was more variable. Prothrombinex is a clinically useful product that can be relatively easily stored and used by retrieval services, even if they are based in isolation from a hospital blood bank. More research is required to look at the utility of Prothrombinex for non-warfarin-related bleeding in the pre-hospital and retrieval environment. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. Counterfeit medicines in Peru: a retrospective review (1997–2014)

    PubMed Central

    Medina, Edwin; Bel, Elvira; Suñé, Josep María

    2016-01-01

    Objective To consolidate and assess information on counterfeit medicines subject to pharmaceutical alerts issued by the Peruvian Medicines Regulatory Authority over 18 years (1997–2014) of health monitoring and enforcement. Design A retrospective review of drug alerts. Setting A search of the website of the General Directorate of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health of Peru for drug alerts issued between 1997 and 2014. Eligibility criteria Drug alerts related to counterfeit medicines. Results A total of 669 DIGEMID alerts were issued during the study period, 354 (52.91%) of which cover 1738 cases of counterfeit medicines (many alerts deal with several cases at a time). 1010 cases (58.11%) involved pharmaceutical establishments and 349 (20.08%) involved non-pharmaceutical commercial outlets. In 126 cases (7.25%), counterfeit medicines were seized in an unauthorised trade (without any marketing authorisation); in 253 cases (14.56%) the type of establishment or business associated with the seized product was not identified. Conclusions Counterfeit medicines are a serious public health problem in Peru. A review of the data cannot determine whether counterfeit medicines in Peru increased during the study period, or if monitoring by different government health agencies highlighted the magnitude of the problem by providing more evidence. The problem is clearly structural, since the majority of cases (58.11% of the total) were detected in legitimate supply chains. Most counterfeit medicines involve staple pharmaceutical products and common dosage forms. Considerable work remains to be done to control the serious problem of counterfeit medicines in Peru. PMID:27044580

  3. Outcomes following cervical disc arthroplasty: a retrospective review.

    PubMed

    Cody, John P; Kang, Daniel G; Tracey, Robert W; Wagner, Scott C; Rosner, Michael K; Lehman, Ronald A

    2014-11-01

    Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. We performed a retrospective review of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty from August 2008 to August 2012. The clinical outcomes and complications associated with the procedure were evaluated. A total of 219 consecutive patients were included in the review, with an average follow-up of 11.2 (±11.0)months. Relief of pre-operative symptoms was noted in 88.7% of patients, and 92.2% of patients were able to return to full pre-operative activity. There was a low rate of complications related to the anterior cervical approach (3.2% with recurrent laryngeal nerve injury, 8.9% with dysphagia), with no device/implant related complications. Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.

  4. Counterfeit medicines in Peru: a retrospective review (1997-2014).

    PubMed

    Medina, Edwin; Bel, Elvira; Suñé, Josep María

    2016-04-04

    To consolidate and assess information on counterfeit medicines subject to pharmaceutical alerts issued by the Peruvian Medicines Regulatory Authority over 18 years (1997-2014) of health monitoring and enforcement. A retrospective review of drug alerts. A search of the website of the General Directorate of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health of Peru for drug alerts issued between 1997 and 2014. Drug alerts related to counterfeit medicines. A total of 669 DIGEMID alerts were issued during the study period, 354 (52.91%) of which cover 1738 cases of counterfeit medicines (many alerts deal with several cases at a time). 1010 cases (58.11%) involved pharmaceutical establishments and 349 (20.08%) involved non-pharmaceutical commercial outlets. In 126 cases (7.25%), counterfeit medicines were seized in an unauthorised trade (without any marketing authorisation); in 253 cases (14.56%) the type of establishment or business associated with the seized product was not identified. Counterfeit medicines are a serious public health problem in Peru. A review of the data cannot determine whether counterfeit medicines in Peru increased during the study period, or if monitoring by different government health agencies highlighted the magnitude of the problem by providing more evidence. The problem is clearly structural, since the majority of cases (58.11% of the total) were detected in legitimate supply chains. Most counterfeit medicines involve staple pharmaceutical products and common dosage forms. Considerable work remains to be done to control the serious problem of counterfeit medicines in Peru. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital.

    PubMed

    Olufowobi, O; Sharif, K; Papaionnou, S; Neelakantan, D; Mohammed, H; Afnan, M

    2004-06-01

    Fibroids are the most common benign tumours of the pelvis in women, with a prevalence estimated at 20-50%. They are more common towards the end of the reproductive years. There is a racial preponderance, being more common in black than white women. This may relate to the aetiology, which is still poorly understood. Generally, fibroids do not cause symptoms but some sufferers do complain about pressure symptoms, abnormal vaginal bleeding and infertility. For these reasons, myomectomy is often resorted to after failure of medical interventions on the premise that it brings about improvement/cure of symptoms and enhancement of fertility. However, the evidence for these indications for surgery is hazy. An analysis of the 109 medical records of symptomatic patients who had myomectomy over a 5-year period at a tertiary centre revealed the following. Single-symptom presentation in 41 (38%), menorrhagia in 20 (18%) being the most common. Only 52 (48%) patients had medical treatment of one form or another before myomectomy. Additional operative findings included pelvic adhesions, evidence of PID and endometriosis. Thirty-four (31%) had an estimated blood loss 500 ml and 23 of these patients needed blood transfusion. There were four cases of unscheduled hysterectomies due to uncontrollable bleeding. Pyrexia was the most common (38%) postoperative complication followed by superficial wound infection in 5%. We observed improvement of symptoms, assessed over a range of 2-24 months, in 34 cases (68%) in patients without fertility symptoms who accounted for 50 of these women. The symptomatic benefit was less (36%) in the 'infertility group'. Following an observation period of over 12-36 months, 17 patients in the 'infertility group' were lost to follow-up. Two (14%) of the 14 patients who attempted in vitro fertilisation (IVF) were successful. In the non-IVF group, 13 (46%) of the 28 achieved natural conception. These results suggest that symptomatic improvement and fertility

  6. What Clinical Changes Can We Expect in the Next 5 Years? A Review of the 26th International Congress of The Transplantation Society.

    PubMed

    Gill, John S

    2016-12-01

    Scientific presentations at the 26th International Congress of The Transplantation Society held in Hong Kong from August 18 to 23, 2016, highlighted accomplishments, challenges and opportunities in contemporary clinical organ transplantation. With nearly 1600 original abstract submissions, this review summarizes notable presentations in addressing a diversity of issues including deceased and living organ donation, improving allograft survival and unmet clinical needs in organ transplantation.

  7. Germ line polymorphisms as predictive markers for pre-surgical radiochemotherapy in locally advanced rectal cancer: a 5-year literature update and critical review.

    PubMed

    Pezzolo, Elisa; Modena, Yasmina; Corso, Barbara; Giusti, Pietro; Gusella, Milena

    2015-05-01

    Locally advanced rectal cancer is currently treated with pre-surgical radiotherapy and chemotherapy. Approximately one-half of patients obtain a relevant shrinkage/disappearance of tumour, with major clinical advantages. The remaining patients, in contrast, show no benefit and possibly need alternative treatment. To provide the best therapeutic option for each individual patient, predictive markers have been widely researched. This review was undertaken to evaluate recent progress made in this field. A systematic literature search was performed using PubMed and Scopus database, focused on germ line gene polymorphisms as biomarkers and response and toxicity as outcomes. Because an exhaustive previous review was available describing findings up to 2008, we restricted our analysis to the last 5 years. Ten original research articles were found, reporting promising results for some candidate genes in drug metabolism (TYMS, MTHFR), DNA repair (XRCC1, OGG1, CCND1) and inflammation (SOD2, TGFB1)/immunity (IL13) pathways, but with no firm conclusion. All the studies had small sample size and were defined as exploratory. This review highlights pivotal molecular, clinical, genetic and statistical issues in the investigation of genetic polymorphisms as outcome predictors for rectal cancer and offers suggestions for future development. What emerges is a clear need for new proposals, especially in view of the increasing evidence for tumour-host and gene-gene interactions during anticancer treatment, together with stronger adherence to proper methodological requirements.

  8. 76 FR 15859 - Reducing Regulatory Burden; Retrospective Review under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... Chapters 5 and 61 Reducing Regulatory Burden; Retrospective Review under E.O. 13563 AGENCY: Office of... Executive Order (EO) 13563, ``Improving Regulation and Regulatory Review.'' E.O. 132563 was signed...

  9. Notification: Project Notification Memorandum for OIG Evaluation of EPA's Regulatory Flexibility Act Retrospective Reviews

    EPA Pesticide Factsheets

    Project #OPE-FY11-0024, January 6, 2012. Our overall evaluation objective remains to assess the efficiency and effectiveness of policies and procedures in place for conducting RFA Section 610 retrospective reviews and the concerns regarding past reviews.

  10. Effects of peptides, with emphasis on feeding, pain, and behavior A 5-year (1999-2003) review of publications in Peptides.

    PubMed

    Yu, Yongmei; Jawa, Ali; Pan, Weihong; Kastin, Abba J

    2004-12-01

    Novel effects of naturally occurring peptides are continuing to be discovered, and their mechanisms of actions as well as interactions with other substances, organs, and systems have been elucidated. Synthetic analogs may have actions similar or antagonistic to the endogenous peptides, and both the native peptides and analogs have potential as drugs or drug targets. The journal Peptides publishes many leading articles on the structure-activity relationship of peptides as well as outstanding reviews on some families of peptides. Complementary to the reviews, here we extract information from the original papers published during the past five years in Peptides (1999-2003) to summarize the effects of different classes of peptides, their modulation by other chemicals and various pathophysiological states, and the mechanisms by which the effects are exerted. Special attention is given to peptides related to feeding, pain, and other behaviors. By presenting in condensed form the effects of peptides which are essential for systems biology, we hope that this summary of existing knowledge will encourage additional novel research to be presented in Peptides.

  11. Paediatric lymphoedema: A retrospective chart review of 86 cases.

    PubMed

    Watt, Hilary; Singh-Grewal, Davinder; Wargon, Orli; Adams, Susan

    2017-01-01

    To define the clinical characteristics, investigations, management and outcomes of lymphoedema in a paediatric cohort. A retrospective chart review of children with lymphoedema seen at two tertiary paediatric hospitals since 1998. Telephone interviews with parents were performed when information was missing. Information recorded included demographic data, features of diagnosis and clinical presentation, symptoms, complications and treatment. A total of 86 patients with lymphoedema were identified. Eighty cases (93%) were primary and six cases (7%) were secondary. Most were female (60%). Location of swelling was most commonly the lower limbs (94%). There were 13 cases (15%) of genital involvement. Swelling presented in the first 12 months of life in 60% of primary lymphoedema patients. Complications of lymphoedema occurred in 73% of patients. Lymphoscintigraphy was the most common investigation used (65%), followed by ultrasound (57%) and magnetic resonance imaging (MRI) (35%). Eight of the 48 (17%) lymphoscintigraphs produced a false negative result or were inconclusive with a correct diagnosis subsequently made clinically and using MRI. Average time to diagnosis was 9 months. Lymphoedema was managed with compression garments (99%), manual lymph drainage (97%) and multilayered bandaging (68%). Eight patients had an operative procedure as a part of management. Primary lymphoedema is more common than secondary lymphoedema in children. Onset tends to be during infancy for both males and females, and the lower limb is typically involved. Causes of secondary lymphoedema are diverse and rare. Diagnosis in children is often delayed but is possible based on history and physical examination alone and when further investigation is necessary MRI is effective. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  12. A retrospective review of the prehospital use of activated charcoal.

    PubMed

    Villarreal, Joseph; Kahn, Christopher A; Dunford, James V; Patel, Ekta; Clark, Richard F

    2015-01-01

    We studied the complications and timing implications of prehospital activated charcoal (PAC). Appropriateness of PAC administration was also evaluated. We retrospectively reviewed prehospital records over 32 months for overdose cases, where PAC was administered. Cases were assessed for amount and type of ingestant, clinical findings, timing of PAC, timing of transport and arrival into the emergency department (ED), and complications. Encounter duration in cases of PAC was compared with that, for all cases during the study period, where an overdose patient who did not receive activated charcoal was transported. Two thousand eight hundred forty-five total cases were identified. In 441 cases, PAC was given; and complications could be assessed. Two hundred eighty-one of these had complete information regarding timing of ingestion, activated charcoal administration, and transport. The average time between overdose and PAC was 49.8 minutes (range, 7-199 minutes; median, 41.0 minutes; SD, 30.4 minutes). Complications included emesis (7%), declining mental status (4%), declining blood pressure (0.4%), and declining oxygen saturation (0.4%). Four hundred seventeen cases of PAC had documentation of timing of emergency medical service (EMS) arrival on scene and arrival at the ED. Average EMS encounter time was 29 minutes (range, 10-53 minutes; median, 27.9 minutes). Two thousand forty-four poisoning patients were transported who did not receive PAC. The average EMS encounter time for this group was 28.1 minutes (range, 4-82 minutes; median, 27.3 minutes), not significantly different (P =.114). Prehospital activated charcoal did not appear to markedly delay transport or arrival of overdose patients into the ED and was generally safe. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Retrospective review of congenital heart disease in 976 dogs.

    PubMed

    Oliveira, P; Domenech, O; Silva, J; Vannini, S; Bussadori, R; Bussadori, C

    2011-01-01

    Knowledge of epidemiology is important for recognition of cardiovascular malformations. Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions. Nine hundred and seventy-six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010. A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test. CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified. The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist. Copyright © 2011 by the American College of Veterinary Internal Medicine.

  14. Outcomes After Unilateral Uterine Artery Embolization: A Retrospective Review

    SciTech Connect

    Bratby, M. J.; Hussain, F. F.; Walker, W. J.

    2008-03-15

    Purpose. Bilateral uterine artery embolization (UAE) is considered necessary to provide effective treatment for symptomatic uterine fibroids. Occasionally, only unilateral embolization is performed, and this study evaluates these outcomes. Materials and Methods. As part of a prospective observational study of more than 1600 patients treated with UAE since 1996, there have been 48 patients in whom unilateral embolization has been performed. This study retrospectively reviews clinical response as assessed by our standard questionnaire and radiological response assessed by either magnetic resonance imaging or ultrasound. Results. Two principal groups emerged: the largest, where only the dominant unilateral arterial supply was electively embolized (30 patients); and the second, where there was technical failure to catheterize the second uterine artery as a result of anatomical constraints (12 patients). Favorable clinical response with a reduction in menorrhagia at 1 year was seen in 85.7% (18/21) of those patients with a dominant arterial supply to the fibroid(s). In contrast, in those patients where there was technical failure to embolize one uterine artery, there was a high rate of clinical failure requiring further intervention in 58.3% (7/12). Comparison of the technical failure group with the dominant uterine artery group demonstrated a statistically significant (Fisher's exact test) difference in the proportion of patients with evidence of persistent fibroid vascularity (p < 0.001) and requiring repeat intervention (p < 0.01). Conclusion. We conclude that unilateral UAE can achieve a positive clinical result in the group of patients where there is a dominant unilateral artery supplying the fibroid(s), in contrast to the poor results seen following technical failure.

  15. Fate of the peer review process at the ESA: long-term outcome of submitted studies over a 5-year period.

    PubMed

    Raptis, Dimitri A; Oberkofler, Christian E; Gouma, Dirk; Garden, O James; Bismuth, Henri; Lerut, Toni; Clavien, Pierre-Alain

    2010-11-01

    To critically evaluate the outcome of the peer review process of the European Surgical Association (ESA) and its contribution to Annals of Surgery. The ESA was created in 1993 as an equivalent of the well-established American Surgical Association. Submitted abstracts and manuscripts were subjected to a stringent multistep peer review process to offer only the best studies for publication in the special issue of Annals of Surgery. A critical evaluation was felt necessary to identify factors that favored the acceptance of abstracts and manuscripts, respectively. The citations of the manuscripts published in Annals of Surgery and the outcome of the rejected studies were also researched. All submissions to the ESA between 2002 and 2007 were analyzed and followed over a period of 2 years. A database was established to identify factors favoring acceptance. A comprehensive search was undertaken to identify plagiarisms and the 2-year citations of all accepted manuscripts and later publications of the rejected studies in Annals of Surgery or elsewhere. Altogether, 545 abstracts were submitted to the ESA during the study period. About one-third was accepted for presentation at the annual meeting, and, of those, 40% were published in Annals of Surgery. The majority of these studies originated from 4 European Countries. The only independent factors favoring presentation were randomized controlled trials and a sample size of more than 100 patients. All plagiarisms were identified before acceptance. Only 4% and 2% of the rejected abstracts and manuscripts, respectively, were published in higher impact factor journals than in Annals of Surgery. Twelve percent of the rejected manuscripts were eventually published in a later issue of Annals of Surgery, whereas more than two-thirds of the rejected studies appeared in a journal with a lower impact factor. The 2-year citations of the ESA manuscripts were in the range of all the other types of manuscripts published in Annals of Surgery

  16. Burden of Pneumonia and Meningitis Caused by Streptococcus pneumoniae in China among Children under 5 Years of Age: A Systematic Literature Review

    PubMed Central

    Mo, Qi-Mei; Jia, Huan; Wang, Qun; Li, Song-Guang; Li, Xiang; Yao, Bao-Dong; Liu, Cheng-Jun; Zhan, Yi-Qiang; Ji, Chen; Lopez, Anna Lena; Wang, Xuan-Yi

    2011-01-01

    Background and Methods To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae–attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials. Results Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114–4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638–23,904) and 75 (9–370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845–1,216,918) and 28,542 (7,136–49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted. PMID:22110628

  17. Burden of pneumonia and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review.

    PubMed

    Chen, Ying; Deng, Wei; Wang, Song-Mei; Mo, Qi-Mei; Jia, Huan; Wang, Qun; Li, Song-Guang; Li, Xiang; Yao, Bao-Dong; Liu, Cheng-Jun; Zhan, Yi-Qiang; Ji, Chen; Lopez, Anna Lena; Wang, Xuan-Yi

    2011-01-01

    To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials. Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.

  18. Toxicology and pathology of deaths related to methadone: retrospective review

    PubMed Central

    Karch, Steven B; Stephens, Boyd G

    2000-01-01

    Objectives To clarify the mechanisms and risk factors of methadone toxicity and to describe the findings of deaths related to methadone use Design Retrospective review of case notes in the records of the San Francisco Medical Examiner comparing the findings in cases where methadone was deemed the cause of death with findings in decedents where methadone was an incidental finding, and with 50 age-matched, disease and drug free, trauma victims. Results 38 cases out of the 3317 processed by our office during 1997-1998 were identified in which methadone had been detected. Cases were mostly male 28/38 (74%) and white, 28/38 (74%). In 17 of 38 cases death was deemed to have been caused by methadone toxicity. For the group the mean blood methadone concentration for all 38 patients, was 957 ng/ml SD =.681, SE =.14). The mean blood concentration of the main methadone metabolite (EDDP) was 253 ng/ml, SD = 529 ng/ml, SE =.089. The mean ratio of methadone in the blood to EDDP in the blood was 13.6:1 Values were not significantly different between cases in which methadone toxicity was the cause of death and in those in which it was an incidental finding. Cocaine, or the cocaine metabolite benzoylecgonine, was detected in the blood or urine of 16/38 cases (42%); morphine in one-third (13/38) and methamphetamine in only one. Pulmonary edema was evident in all cases, coronary artery disease in 9/38 (24%) and cirrhosis in 7/38 (18%) of the methadone users. Necrotizing fasciitis was the cause of death in 4 of the 38 methadone users (11%). Nationally, a sizeable percent of methadone deaths are from drugs diverted from treatment programs. Conclusions The presence of methadone is often an incidental finding during postmortem examination which is unrelated to the cause of death. Postmortem measurements of methadone or its metabolite, or both, cannot be used in isolation to identify which deaths are associated with methadone toxicity. PMID:10695434

  19. 77 FR 70123 - Retrospective Review Under Executive Order 13579

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-23

    ... analysis of existing rules; request for comment. SUMMARY: The U.S. Nuclear Regulatory Commission (NRC or the Commission) is making available its draft Plan for the retrospective analysis of its existing regulations. The draft Plan describes the processes and activities that the NRC uses to determine whether...

  20. The Amphibian Research and Monitoring Initiative (ARMI): 5-year report

    USGS Publications Warehouse

    Muths, Erin; Gallant, Alisa L.; Campbell Grant, Evan H.; Battaglin, William A.; Green, David E.; Staiger, Jennifer S.; Walls, Susan C.; Gunzburger, Margaret S.; Kearney, Rick F.

    2006-01-01

    This report is a 5-year retrospective of the structure, methodology, progress, and contributions to the broader scientific community that have resulted from this national USGS program. We evaluate ARMI’s success to date, with regard to the challenges faced by the program and the strengths that have emerged. We chart objectives for the next 5 years that build on current accomplishments, highlight areas meriting further research, and direct efforts to overcome existing weaknesses.

  1. Retrospective record review in proactive patient safety work – identification of no-harm incidents

    PubMed Central

    2013-01-01

    Background In contrast to other safety critical industries, well-developed systems to monitor safety within the healthcare system remain limited. Retrospective record review is one way of identifying adverse events in healthcare. In proactive patient safety work, retrospective record review could be used to identify, analyze and gain information and knowledge about no-harm incidents and deficiencies in healthcare processes. The aim of the study was to evaluate retrospective record review for the detection and characterization of no-harm incidents, and compare findings with conventional incident-reporting systems. Methods A two-stage structured retrospective record review of no-harm incidents was performed on a random sample of 350 admissions at a Swedish orthopedic department. Results were compared with those found in one local, and four national incident-reporting systems. Results We identified 118 no-harm incidents in 91 (26.0%) of the 350 records by retrospective record review. Ninety-four (79.7%) no-harm incidents were classified as preventable. The five incident-reporting systems identified 16 no-harm incidents, of which ten were also found by retrospective record review. The most common no-harm incidents were related to drug therapy (n = 66), of which 87.9% were regarded as preventable. Conclusions No-harm incidents are common and often preventable. Retrospective record review seems to be a valuable tool for identifying and characterizing no-harm incidents. Both harm and no-harm incidents can be identified in parallel during the same record review. By adding a retrospective record review of randomly selected records to conventional incident-reporting, health care providers can gain a clearer and broader picture of commonly occurring, no-harm incidents in order to improve patient safety. PMID:23876023

  2. 76 FR 15224 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... Regulatory Burden; Retrospective Review Under E.O. 13563 AGENCY: Office of the Secretary, Labor. ACTION...: E.O. 13653, 76 FR 3821, Jan. 21, 2011; E.O. 12866, 58 FR 51735, Oct. 4, 1993. Dated: March 15,...

  3. 76 FR 40645 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-11

    ... Chapter 14 50 CFR Chapters I and IV Reducing Regulatory Burden; Retrospective Review Under E.O. 13563... cannot guarantee that we will be able to do so. Authority: E.O. 13653, 76 FR 3821, Jan. 21, 2011;...

  4. 76 FR 18104 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-01

    ... Regulatory Burden; Retrospective Review Under E.O. 13563 AGENCY: Office of the Secretary, Labor. ACTION...: E.O. 13653, 76 FR 3821, Jan. 21, 2011; E.O. 12866, 58 FR 51735, Oct. 4, 1993. William E....

  5. 77 FR 57566 - Announcement of Public Meeting on the Consumer Confidence Report (CCR) Rule Retrospective Review...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-18

    ... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY Announcement of Public Meeting on the Consumer Confidence Report (CCR) Rule Retrospective Review and Request for Public Comment on Potential Approaches to Electronic Delivery of the CCR;...

  6. The not so innocent heart murmur: a 5-year experience.

    PubMed

    Kueh, Shaw-Hua; Pasley, Thomas; Wheeler, Miriam; Pemberton, James

    2017-02-01

    Auckland City Hospital (ACH) established a Heart Murmur Clinic (HMC) with the aim of providing prompt assessment of patients with asymptomatic systolic murmurs. This may lead to early intervention and improved outcomes if significant structural heart disease is detected and reassurance if no significant findings are found. Similar clinics for children have proven beneficial; the benefit of a HMC in an adult population has been difficult to determine. To review the clinical demographics and echocardiographic information of patients presenting to our HMC, to assess what proportion of significance structural heart disease had and determine the common structural abnormalities in this population. This is a retrospective review of patients aged ≥15 years presenting to our HMC between March 2010 and December 2015 with an asymptomatic systolic murmur. Patients with previous cardiac surgery or known congenital or valvular heart disease were excluded. A total of 1221 patients was reviewed over the 5-year period; 980 underwent echocardiography. Significant cardiac disease was detected in 156 patients, with 23 patients requiring surgical intervention over the 5-year period. Significant aortic stenosis (n = 43) and mitral regurgitation (n = 48) were the most common pathologies. Patients > 65 years were more likely to have structural heart disease (16% vs 11%, P < 0.05). Establishing a HMC has allowed the screening of a large number of patients who would otherwise have low priority for assessment. We have identified a large proportion with significant structural disease, which has allowed for early surgical intervention when appropriate and may potentially result in improved patient outcomes. © 2016 Royal Australasian College of Physicians.

  7. 76 FR 32133 - FAR Council's Plan for Retrospective Review Under Executive Order 13563-Preliminary Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-03

    ...'s Plan for Retrospective Review Under Executive Order 13563--Preliminary Plan AGENCIES: Department... accordance with Executive Order (E.O.) 13563, ``Improving Regulation and Regulatory Review.'' The E.O. sets forth principles and requirements designed to strengthen regulations and regulatory review by promoting...

  8. 76 FR 70927 - USACE's Plan for Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-16

    ... Department of the Army, Corps of Engineers 33 CFR Chapter II USACE's Plan for Retrospective Review Under E.O.... Executive Order 13563, ``Improving Regulation and Regulatory Review'' (E.O.), issued on January 18, 2011... pursuant to E.O. 13563. The E.O. further directs each agency to periodically review its...

  9. 77 FR 3211 - USACE's Plan for Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-23

    ... 33 CFR Chapter II USACE's Plan for Retrospective Review Under E.O. 13563 AGENCY: U.S. Army Corps of... Executive Order 13563, ``Improving Regulation and Regulatory Review'' (E.O.), issued on January 18, 2011... pursuant to E.O. 13563. The E.O. further directs each agency to periodically review its...

  10. The value of 100% retrospective peer review in a forensic pathology practice.

    PubMed

    Obenson, Ken; Wright, Claire M

    2013-11-01

    Peer review in forensic pathology practice has become an important cornerstone of continuous quality improvement. Although there are several components to an effective and transparent peer review process, one of the most essential is the review of completed reports. The autopsy report may be reviewed prospectively (report reviewed before sign out) or retrospectively (report reviewed after sign out). Prospective reviews are more likely to be performed on criminal or criminally suspicious cases, pediatric and SIDS deaths and high profile cases. Retrospective reviews on the other hand are performed on a proportion of all other signed-out routine medico-legal cases. The actual percentage varies by jurisdiction since there are no agreed minimum standards. Manpower and workload factors appear to be critical to determining what percentage of cases are reviewed retrospectively. The objective of this report is to present a mechanism by which a 100% retrospective review policy has been implemented, how it integrates with quality management protocols, the outcomes of the reviews and what challenges remain to improve compliance with key quality indicators especially turn around time (TAT) statistics.

  11. How to treat two adjacent missing teeth with dental implants. A systematic review on single implant-supported two-unit cantilever FDP's and results of a 5-year prospective comparative study in the aesthetic zone.

    PubMed

    Van Nimwegen, W G; Raghoebar, G M; Tymstra, N; Vissink, A; Meijer, H J A

    2017-06-01

    To conduct a systematic review on the clinical outcome of single implant-supported two-unit cantilever FDP's and to conduct a 5-year prospective comparative pilot study of patients with a missing central and lateral upper incisor treated with either a single implant-supported two-unit cantilever FDP or two implants with solitary implant crowns in the aesthetic zone. Medline, Embase and the Cochrane Central Register of Controlled Trials were searched (last search 1 August 2016) for eligible studies. In the comparative pilot study, an implant-cantilever group of five patients with a single implant-supported two-unit cantilever FDP (NobelReplace Groovy Regular Platform) was compared with an implant-implant group of five patients with two adjacent single implant-supported crowns (NobelReplace Groovy Regular Platform) in the aesthetic zone. Implant survival, marginal bone level (MBL) changes, pocket probing depth, papilla index and patient satisfaction were assessed during a 5-year follow-up period. Five of 276 articles were considered eligible for data extraction. Implant survival ranged from 96·6% to 100%. Marginal bone level changes were higher in the anterior region than in the posterior region. Technical complications occurred more often in the posterior than anterior region. In the 5-year comparative pilot study, no clinically significant differences in hard and soft peri-implant tissue levels occurred between both groups. Single implant-supported two-unit cantilever FDP's can be a viable alternative to the placement of two adjacent single implant crowns in the aesthetic zone. Due to technical complications, placement of two-unit cantilever crowns in the posterior region can be considered unwise. © 2017 John Wiley & Sons Ltd.

  12. A 10-Year Retrospective Review of Nephrolithiasis in the Navy and Navy Pilots.

    PubMed

    Masterson, James H; Phillips, Christopher J; Crum-Cianflone, Nancy F; Krause, Robert J; Sur, Roger L; L'Esperance, James O

    2017-02-21

    Little is known about the incidence of nephrolithiasis in the United States Navy. Navy pilots must be kidney stone-free and are often referred for treatment of small asymptomatic stones. The primary objectives of this study were to determine the incidence of nephrolithiasis and computerized tomography, proportion undergoing treatment and incidence of stone related mishaps in Navy pilots compared with other Navy personnel. We retrospectively studied the records of all Navy service members from 2002 to 2011 for nephrolithiasis based on ICD-9 stone codes to determine the mentioned rates. We also reviewed NSC (Naval Safety Center) data for a history of accidents associated with nephrolithiasis. Rates of disease were calculated using person-years of followup and inferential statistics were done using univariable and multivariable analyses. We evaluated 667,840 Navy personnel with a total of 3,238,331 person-years of followup. The annual incidence of nephrolithiasis was 240/100,000 person-years with a 5-year recurrence rate of 35.3%. On multivariable analysis pilots had nephrolithiasis incidence and treatment rates similar to those of the overall Navy population. Women had a higher incidence of nephrolithiasis compared with men (OR 1.17, p <0.0001). The rate of computerized tomography was lower in pilots than in the rest of the Navy (39 vs 66/10,000 person-years, p <0.0001). No recorded accidents were associated with kidney stones. Navy pilots had a similar incidence of nephrolithiasis and were no more likely to undergo a surgical procedure. Given that no accidents were associated with nephrolithiasis, this study suggests reconsidering current military policies necessitating pilots to be completely stone-free. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review.

    PubMed

    de Oliveira, Lucia Helena; Camacho, Luiz Antonio B; Coutinho, Evandro S F; Martinez-Silveira, Martha S; Carvalho, Ana Flavia; Ruiz-Matus, Cuauhtemoc; Toscano, Cristiana M

    2016-01-01

    Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs. We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region. We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies. We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8-37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4-20.6% for clinical pneumonia, and 13.3-87.7% for meningitis hospitalizations, and 56-83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design. Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis

  14. Penile brachytherapy-Retrospective review of a single institution.

    PubMed

    Pimenta, Ana; Gutierrez, Cristina; Mosquera, David; Pera, Juan; Martínez, Evelyn; Londres, Bradley; Pino, Francisco; Moreno, Sergio; Garcia, Marc; Guedea, Ferran

    2015-01-01

    To analyze the results of exclusive brachytherapy (BT) to treat patients with penile squamous cell carcinoma confined to the glans or prepuce. Retrospective analysis of 25 patients treated for T1-T2 penile cancer with exclusive interstitial BT between July 1989 and March 2014 at our institution. Median followup was 9.2 years (range, 0-19). The mean patient age was 65.3 years (range, 51-80). Most patients underwent exclusive low-dose-rate BT (56%; n = 14) or pulsed-dose-rate BT (40%; n = 10). Only 1 patient received high-dose-rate BT (4%). The median prescribed dose was 60 Gy. Eight patients died during follow-up because of systemic progression (one case) and other intercurrent causes (seven cases). Two failures were recorded (one local and one regional), both at 4 months after BT. The remaining patients continued follow-up at our institution and maintained response. Two patients underwent partial phallectomy for toxicity. At the time of this report, 12 of the 25 patients are alive and free of disease. The most common late toxicities were telangiectasia, urethral stenosis, and atrophy, in 48%, 43%, and 17.4% of patients, respectively. BT with low dose rate/pulsed dose rate provides excellent locoregional control for small (≤4 cm) T1-T2 squamous cell carcinoma of the penile glans. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  15. Retrospective review of pharyngeal gonorrhea treatment failures in Alberta, Canada.

    PubMed

    Gratrix, Jennifer; Bergman, Joshua; Egan, Cari; Drews, Steven J; Read, Ron; Singh, Ameeta E

    2013-11-01

    Our review of Neisseria gonorrhoeae pharyngeal treatment failures from sexually transmitted infection clinics in Alberta suggests that treatment failures with oral cefixime monotherapy were not related to elevated cefixime minimum inhibitory concentrations. Dual therapy with oral cefixime and azithromycin may be a suitable alternate for the treatment of pharyngeal gonorrhea.

  16. 75 Years of the International Labour Review: A Retrospective.

    ERIC Educational Resources Information Center

    Thomas, Albert; And Others

    1996-01-01

    Contains 18 articles published in International Labour Review from 1921-1975 that discuss the International Labour Organisation, international labor movement and law, economics and the labor market, family security, full employment, population growth, industrial welfare, trade policy and employment growth, and income expectations and rural-urban…

  17. Retrospective Review Article: Speaking--The Second Skill.

    ERIC Educational Resources Information Center

    System, 1995

    1995-01-01

    Reviews four books on speech research: (1) "The Speech Chain: The Physics and Biology of Spoken Language" (Peter B. Denes and Elliot N. Pinson); (2) "Speaking: From Intention to Articulation" (Willem J. M. Levelt); (3) "Talking to Learn: Conversation in Second Language Acquisition" (Richard R. Day); and (4) "Speaking" (Martin Bygate). (eight…

  18. 75 Years of the International Labour Review: A Retrospective.

    ERIC Educational Resources Information Center

    Thomas, Albert; And Others

    1996-01-01

    Contains 18 articles published in International Labour Review from 1921-1975 that discuss the International Labour Organisation, international labor movement and law, economics and the labor market, family security, full employment, population growth, industrial welfare, trade policy and employment growth, and income expectations and rural-urban…

  19. General Principles for 5-year Regional Haze Progress Reports

    EPA Pesticide Factsheets

    This guidance document was developed by the U.S. EPA for EPA Regional Offices and states in preparing and reviewing the 5-year progress reports for the initial regional haze state implementation plans.

  20. Comparison of the more than 5-year clinical outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion: A protocol for a systematic review and meta-analysis of prospective randomized controlled trials.

    PubMed

    Shao, Min-Min; Chen, Chun-Hui; Lin, Zhong-Ke; Wang, Xiang-Yang; Huang, Qi-Shan; Chi, Yong-Long; Wu, Ai-Min

    2016-12-01

    Anterior cervical discectomy and fusion (ACDF) was almost the "golden standard" technique in treatment of symptomatic cervical degenerative disc disease, however, it cause motion loss of the indexed level, increase the intradiscal pressure and motion of the adjacent levels, and may accelerate the degeneration of adjacent level. Cervical disc arthroplasty (CDA) was designed to preserve the motion of index level, avoid the over-activity of adjacent levels and reduce the degeneration of adjacent disc levels, the process of degeneration of adjacent level is very slowly, long term follow up studies should be conducted, this study aim to compare the more than 5 years' long-term clinical outcomes and safety between CDA and ACDF. A systematic review and meta-analysis that will be performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The electric database of Medline, Embase, and Cochrane library will be systematic search. A standard data form will be used to extract the data of included studies. We will assess the studies according to the Cochrane Handbook for Systematic Reviews of Interventions, and perform analysis in software STATA 12.0. Fixed-effects models will be used for homogeneity data, while random-effects will be used for heterogeneity data. The overall effect sizes will be determined as weighted mean difference (WMD) for continuous outcomes and Relative risk (RR) for dichotomous outcomes. The results of study will be disseminated via both international conference and peer-review journal. The conclusion of our study will provide the long-term and updated evidence of clinical outcomes and safety between CDA and ACDF, and help surgeon to change better surgical technique for patients.

  1. Electroneuromyographic Features in Fabry Disease: A Retrospective Review

    PubMed Central

    AKPINAR, Çetin Kürşad; TÜRKER, Hande; BAYRAK, Oytun; CENGİZ, Nilgün

    2015-01-01

    can be normal at the early stages. Quantitative sensory test, autonomic tests (R-R interval and sympathetic skin response) and skin biopsy should be performed in such cases. In our country, pediatric physicians work on Fabry disease more than physicians dealing with Fabry disease in adults. Therefore, in this retrospective study, we aimed to draw adult and pediatric neurologists’ attention to Fabry disease.

  2. Retrospective review of 99 patients with secondary alveolar cleft repair.

    PubMed

    Miller, Lisa L; Kauffmann, Daniel; St John, Dane; Wang, Deli; Grant, John H; Waite, Peter D

    2010-06-01

    The purpose of the present review was to evaluate the protocol and technique used in a large population of patients with cleft lip and palate when secondary grafting is performed during the early mixed dentition stage, as determined by eruption of the central incisor. In the United States, most investigators have recommended alveolar grafting at the 9- to 11-year age range or before eruption of the permanent canines. An institutional review board-approved chart review of 99 patients undergoing alveolar cleft bone grafting during a 7-year period at a single institution was performed. Data were collected regarding demographics, operative time, length of hospitalization, follow-up time, complications, and additional procedures performed. The cases were divided by patient age into 2 groups: group 1, aged 6 to 8 years (n = 61); and group 2, aged 9 years and older (n = 38). Statistical analysis was performed for various comparisons in the study. The average operative time for groups 1 and 2 was 86 and 103 minutes, respectively. The complication rate, length of stay, and follow-up time between the 2 groups was not statistically significant at the P = .05 significance level. We recommend earlier bone grafting at or before the eruption of the central incisor, rather than delaying until the cuspid tooth root is 25% formed. We believe this will provide better bone support for the dentition, a decreased burden of treatment for the patient, and improved quality of life. Performing the procedure at this time can lead to decreased operative times, with comparable postoperative outcomes. Published by Elsevier Inc.

  3. Public health workforce research in review: a 25-year retrospective.

    PubMed

    Hilliard, Tracy M; Boulton, Matthew L

    2012-05-01

    The Robert Wood Johnson Foundation commissioned a systematic review of public health workforce literature in fall 2010. This paper reviews public health workforce articles published from 1985 to 2010 that support development of a public health workforce research agenda, and address four public health workforce research themes: (1) diversity; (2) recruitment, retention, separation, and retirement; (3) education, training, and credentialing; and (4) pay, promotion, performance, and job satisfaction. PubMed, ERIC, and Web of Science databases were used to search for articles; Google search engine was used to identify gray literature. The study used the following inclusion criteria: (1) articles written in English published in the U.S.; (2) the main theme(s) of the article relate to at least one of the four public health workforce research themes; and (3) the document focuses on the domestic public health workforce. The literature suggests that the U.S. public health workforce is facing several urgent priorities that should be addressed, including: (1) developing an ethnically/racially diverse membership to meet the needs of an increasingly diverse nation; (2) recruiting and retaining highly trained, well-prepared employees, and succession planning to replace retirees; (3) building public health workforce infrastructure while also confronting a major shortage in the public health workforce, through increased education, training, and credentialing; and (4) ensuring competitive salaries, opportunities for career advancement, standards for workplace performance, and fostering organizational cultures which generate high levels of job satisfaction for effective delivery of services. Additional research is needed in all four thematic areas reviewed to develop well-informed, evidence-based strategies for effectively addressing critical issues facing the public health workforce. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights

  4. Intraventricular hemorrhage after ventriculoperitoneal shunt revision: a retrospective review.

    PubMed

    Calayag, Mark; Paul, Alexandra R; Adamo, Matthew A

    2015-07-01

    OBJECT The authors review their ventriculoperitoneal (VP) shunt revisions over a 3-year period to determine the rate of intraventricular hemorrhage (IVH) and subsequent need for re-revision. METHODS Review of medical records identified 35 pediatric patients who underwent 52 VP shunt revisions between 2009 and 2012. The presence and amount of IVH as determined by CT and the time to re-revision were documented. The reason for shunting, catheter position, and time between initial VP shunt placement and subsequent revisions were also recorded. RESULTS After 13 (25%) of the 52 revisions, IVH was evident on postoperative CT scans. The majority of patients had a trace amount of IVH, with only 2% having IVH greater than 5 ml. After 2 (15%) of the 13 revisions associated with IVH, re-revision was required within 1 month. In contrast, the re-revision rate in patients without IVH was 18%. All of the patients who developed IVH had occipital catheters. CONCLUSIONS Some degree of IVH can be expected after approximately one-quarter of all VP shunt revision procedures in pediatric patients, but the rate of significant IVH is low. Furthermore, the presence of IVH does not necessitate an early shunt revision.

  5. Retrospective economic and outcomes analyses using non-US databases: a review.

    PubMed

    Shi, Lizheng; Wu, Eric Q; Hodges, Meredith; Yu, Andrew; Birnbaum, Howard

    2007-01-01

    Retrospective database analyses pose a series of methodological challenges, some of which are unique to their data sources, particularly in countries outside the US. This study aimed to qualitatively review the methodological challenges of using non-US databases to conduct retrospective economic and outcomes research studies. We conducted a MEDLINE search to obtain a sample of literature published after the year 2000 on retrospective analyses using non-US databases. We reviewed all relevant components of the selected articles in accordance with the checklist proposed for retrospective database studies by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force and identified issues found in the data sources, methods, study designs, statistics and sources of possible threats to internal and external validity. We found a wide variation in the quality of studies in terms of outcome definitions, patient selection criteria, data collection methods, sample sizes, risk adjustment methods, potential measurement errors and external validity of the studies. Few economic studies included information on indirect cost components because of a lack of relevant data. The quality of non-US retrospective database analyses varied. Future such analyses may be improved if researchers implement the checklist developed by the ISPOR Task Force on Retrospective Database Studies.

  6. Molecular and Functional Characterization of Bacopa monniera: A Retrospective Review

    PubMed Central

    Rajan, Koilmani Emmanuvel; Preethi, Jayakumar; Singh, Hemant K.

    2015-01-01

    Over the last 50 years, laboratories around the world analyzed the pharmacological effect of Bacopa monniera extract in different dimensions, especially as a nerve tonic and memory enhancer. Studies in animal model evidenced that Bacopa treatment can attenuate dementia and enhances memory. Further, they demonstrate that Bacopa primarily either acts via antioxidant mechanism (i.e., neuroprotection) or alters different neurotransmitters (serotonin (5-hydroxytryptamine, 5-HT), dopamine (DA), acetylcholine (ACh), γ-aminobutyric acid (GABA)) to execute the pharmacological effect. Among them, 5-HT has been shown to fine tune the neural plasticity, which is a substrate for memory formation. This review focuses on the studies which trace the effect of Bacopa treatment on serotonergic system and 5-HT mediated key molecular changes that are associated with memory formation. PMID:26413131

  7. Is dream recall underestimated by retrospective measures and enhanced by keeping a logbook? A review.

    PubMed

    Aspy, Denholm J; Delfabbro, Paul; Proeve, Michael

    2015-05-01

    There are two methods commonly used to measure dream recall in the home setting. The retrospective method involves asking participants to estimate their dream recall in response to a single question and the logbook method involves keeping a daily record of one's dream recall. Until recently, the implicit assumption has been that these measures are largely equivalent. However, this is challenged by the tendency for retrospective measures to yield significantly lower dream recall rates than logbooks. A common explanation for this is that retrospective measures underestimate dream recall. Another is that keeping a logbook enhances it. If retrospective measures underestimate dream recall and if logbooks enhance it they are both unlikely to reflect typical dream recall rates and may be confounded with variables associated with the underestimation and enhancement effects. To date, this issue has received insufficient attention. The present review addresses this gap in the literature. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Retrospective review of tracheoplasty for congenital tracheal stenosis.

    PubMed

    Wijeweera, O; Ng, S B A

    2011-10-01

    Congenital tracheal stenosis is a rare but life-threatening obstructive airway disease. It usually presents in early infancy and requires surgical intervention. This study is a review of our experience in the management of congenital tracheal stenosis in children at KK Women's and Children's Hospital, Singapore. All children who had undergone tracheoplasty for congenital tracheal stenosis between January 1999 and December 2008 were included. The patients' medical records were retrieved from our database, and the demographic data, comorbidities, clinical presentation and management, surgery performed, postoperative complications, final outcomes and follow-up were reviewed. A total of 11 children aged 12 days to six years underwent surgery for congenital long-segment tracheal stenosis, of which ten (90.9 percent) had associated cardiac and vascular anomalies and nine (81.8 percent) had left pulmonary artery sling predominance. Five (45.4 percent) children had associated bronchopulmonary abnormalities. All the patients underwent slide tracheoplasty with concomitant repair of congenital heart defects. Overall mortality was 45.4 percent (n is 5), including one late mortality due to an unrelated cause. With the exception of one, the follow-up of all patients was complete at this writing. One patient had mild residual tracheal stenosis and another had bilateral bronchomalacia. This is the largest case series of congenital long-segment tracheal stenosis reported in Southeast Asia to date. Slide tracheoplasty with concomitant repair of cardiac lesions is currently the preferred management for long-segment stenosis. Management of such patients remains a challenge for clinicians and the patients' families, and requires a multidisciplinary approach.

  9. Helicopter Scene Response for Stroke Patients: A 5-Year Experience.

    PubMed

    Hawk, Andrew; Marco, Catherine; Huang, Matt; Chow, Bonnie

    The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study. A retrospective chart review was completed for all CareFlight CVA scene flights for 5 years (2011-2015). A total of 136 adult patients were transported. EMS criteria included CVA symptom presence for less than 3 hours or awoke abnormal, nonhypoglycemia, and a significantly positive Cincinnati Prehospital Stroke Scale. The majority of patients (75%) met all 3 EMS CVA scene criteria; 27.5% of these patients received peripheral tissue plasminogen activator, and 9.8% underwent a neurointerventional procedure. Using a 3-step EMS triage for acute CVA, air medical transport from the scene to a comprehensive stroke center allowed for the timely administration of tissue plasminogen activator and/or a neurointerventional procedure in a substantive percentage of patients. Further investigation into air medical scene response for acute stroke is warranted. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  10. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review.

    PubMed

    Laws, Rachel; Campbell, Karen J; van der Pligt, Paige; Russell, Georgina; Ball, Kylie; Lynch, John; Crawford, David; Taylor, Rachael; Askew, Deborah; Denney-Wilson, Elizabeth

    2014-08-01

    Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. There is an urgent need for further research on effective obesity prevention interventions for Indigenous children

  11. Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

    PubMed Central

    de Oliveira, Lucia Helena; Camacho, Luiz Antonio B.; Coutinho, Evandro S. F.; Martinez-Silveira, Martha S.; Carvalho, Ana Flavia; Ruiz-Matus, Cuauhtemoc; Toscano, Cristiana M.

    2016-01-01

    Background Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs. Objectives We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region. Methods We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies. Results We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design. Conclusions Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one

  12. Youth suicide in New Mexico: a 26-year retrospective review.

    PubMed

    Singh, Veena D; Lathrop, Sarah L

    2008-05-01

    Although suicidal behavior in children and adolescents is a major public health problem, large-scale research on suicide in this population is uncommon. In this study, we reviewed autopsy and field reports for all pediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005. The age-adjusted suicide rate was 4.8 per 100,000. Psychologic stressors and parasuicidal behavior were identified in some cases. Seventy-six percent of suicides occurred in the victim's home or yard, and 25% left a suicide note. In 26% of cases, alcohol or other drugs were detected in postmortem. Gunshot wound was the most common method overall (58%), followed by hanging (30%). Although the age-adjusted suicide rate is higher in New Mexico than nationally, the trends in the population are similar. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of child and adolescent death.

  13. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis.

    PubMed

    Spitaleri, Gianluca; Toesca, Antonio; Botteri, Edoardo; Bottiglieri, Luca; Rotmensz, Nicole; Boselli, Sabrina; Sangalli, Claudia; Catania, Chiara; Toffalorio, Francesca; Noberasco, Cristina; Delmonte, Angelo; Luini, Alberto; Veronesi, Paolo; Colleoni, Marco; Viale, Giuseppe; Zurrida, Stefano; Goldhirsch, Aron; Veronesi, Umberto; De Pas, Tommaso

    2013-11-01

    Complete surgical resection is the standard treatment for localized breast phyllodes tumors. Post-surgical treatments are still a matter of debate. We carried out an overview of the literature to investigate the clinical outcome of patients with phyllodes tumor. A retrospective analysis of mono-institutional series has been included as well. We reviewed all the retrospective series reported from 1951 until April 2012. We analyzed cases treated at our institution from 1999 to 2010. Eighty-three articles (5530 patients; 1956 malignant tumors) were reviewed. Local recurrences were independent of histology. Distant recurrences were more frequent in the malignant tumors (22%). A total of 172 phyllodes tumors were included in the retrospective analysis. Prognosis of phyllodes tumors is excellent. There are no convincing data to recommend any adjuvant treatment after surgery. Molecular characterization may well provide new clues to permit identification of active treatments for the rare poor prognosis cases. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review.

    PubMed

    Krizova, Adriana; Clarke, Blaise A; Bernardini, Marcus Q; James, Sarah; Kalloger, Steve E; Boerner, Scott L; Mulligan, Anna Marie

    2011-01-01

    Total laparoscopic hysterectomy (LH) is a minimally invasive technique, which results in comparable morbidity and better cosmesis compared with total abdominal hysterectomy. The literature is discrepant as to whether it is associated with a higher incidence of positive peritoneal cytology compared with total abdominal hysterectomy and recently, associated artifacts, including vascular pseudoinvasion (VPI), have been described. A retrospective histopathologic review of 266 hysterectomy specimens from 2 centers was performed. The observers, blinded to the surgical technique, assessed for the presence of artifactual changes including disruption of the endometrial lining, nuclear crush artifact, VPI, endomyometrial cleft artifact with or without epithelial displacement, inflammatory debris within vessels, serosal carryover, and intratubal contaminants. In addition, the rates of positive peritoneal washings over a 5-year period, and the use of immunohistochemistry (IHC) to aid in cell typing over a 3-year period, were compared between hysterectomies in which a uterine manipulator (UM) device had and had not (nonmanipulated hysterectomies) been used. The hysterectomies were performed for malignant (n=160) and benign (n=102) uterine disease or for ovarian or cervical disease (n=4), and included total abdominal (n=108), vaginal (n=17), laparoscopy-assisted vaginal (n=24), laparoscopy converted to laparotomy (n=10), nonrobotic laparoscopic (n=51), and robot-assisted laparoscopic (n=56) hysterectomies. One hundred and two (38%) of these hysterectomies involved the use of a UM. Artifactual changes of disruption of the endometrial lining, endomyometrial clefts, intratubal contaminants, nuclear crush artifact, intravascular inflammatory debris, and VPI were significantly more common with LH and with the use of a UM, independent of whether the endometrial pathology was benign or malignant. IHC to aid in endometrial cancer subtyping was more likely to be used in manipulated

  15. Correction of congenital penoscrotal webbing in children: A retrospective review of three surgical techniques.

    PubMed

    Bonitz, R P; Hanna, M K

    2016-06-01

    Congenital penoscrotal webbing (PSW) is a condition that leads to penile shortening and is a common cause of delayed circumcision. While various techniques for PSW repair have been described, no comparative studies are currently available. The goal of this study was to validate and critique three commonly utilized techniques for PSW repair. A retrospective chart review was performed on all patients who underwent repair for PSW, with or without concomitant surgical procedure, by a single surgeon (MKH) over a 7-year period. Inclusion criteria were: aged <5 years, diagnosis of PSW, documented surgical approach undertaken to correct the PSW, and follow-up for a minimum of 6 months. A total of 196 patients aged 6 months-3.4 years (average 7.8 months) were included, and underwent three different types of procedure: Heineke-Mikulicz (HM) scrotoplasty, VY scrotoplasty or Z scrotoplasty. Out of 196 patients, 10 (6.7%) had complications, with four (2.7%) requiring surgical revision or correction. Two patients had excision of 'dog-ear' skin tags, one required excision of a suture tract, and the fourth required revision of skin contraction after HM repair with Z scrotoplasty. Congenital penoscrotal webbing is a common condition that often requires pediatric urology consultation. Although it is felt that the severity of the defect may not impact on the operative technique for repair of PSW, data comparing these techniques is lacking. This single-surgeon series highlighted that amongst the patients who underwent one of the three described techniques (HM, VY or Z scrotoplasty), there were no significant postoperative differences in complications or parent satisfaction. Although the ease of the HM repair for minor webbing is acknowledged, Z scrotoplasty is the authors' preference for repair given its ability to address the most severe webbing. In this comparison of three surgical techniques for the correction of PSW, it was demonstrated that each choice is safe, with no option

  16. 76 FR 63276 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... [Federal Register Volume 76, Number 197 (Wednesday, October 12, 2011)] [Proposed Rules] [Pages 63276-63277] [FR Doc No: 2011-26309] DEPARTMENT OF TRANSPORTATION Surface Transportation Board 49 CFR Chapter X [EP 712] Reducing Regulatory Burden; Retrospective Review Under E.O. 13563 AGENCY:...

  17. 76 FR 10526 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-25

    ... Chapter 14 50 CFR Chapters I and IV Reducing Regulatory Burden; Retrospective Review Under E.O. 13563.... Authority: E.O. 13653, 76 FR 3821, Jan. 21, 2011; E.O. 12866, 58 FR 51735, Oct. 4, 1993. Dated: February...

  18. 76 FR 34177 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... Regulatory Burden; Retrospective Review Under E.O. 13563 AGENCY: Office of the Secretary, Labor. ACTION... made available to the public on http://dolregs.ideascale.com . Authority: E.O. 13653, 76 FR 3821, Jan. 21, 2011; E.O. 12866, 58 FR 51735, Oct. 4, 1993. Dated: June 7, 2011. e. christi...

  19. 76 FR 66235 - Bar Code Technologies for Drugs and Biological Products; Retrospective Review Under Executive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Parts 201 and 610 Bar Code Technologies for Drugs and Biological Products; Retrospective Review Under Executive Order 13563; Request for Comments AGENCY: Food and Drug Administration, HHS. ACTION: Notice; request for comments. SUMMARY: The Food and Drug...

  20. Intradural conus and cauda equina tumours: a retrospective review of presentation, diagnosis and early outcome.

    PubMed Central

    Mathew, P; Todd, N V

    1993-01-01

    This is a retrospective review of the clinical presentation, diagnosis and management of 62 patients with histologically proven intradural conus and cauda equina tumours. In the majority of cases the clinical presentation clearly suggests the need for further investigation. One fifth of the patients had small intramedullary tumours, which presented particular diagnostic difficulty and required sophisticated cross sectional imaging. Images PMID:8429326

  1. 76 FR 26651 - Reducing Regulatory Burden; Retrospective Review Under E.O. 13563

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... July 16, 2004, DOS ceased visa reissuance (visa revalidation) for the C, E, H, I, L, O, and P... Burden; Retrospective Review Under E.O. 13563 AGENCY: United States Department of State. ACTION: Request... comments within 60 days of the publication of this notice. To submit comments: By e-mail to Regulatory...

  2. [Cancer of the tonsillar region. Retrospective study and review of the literature].

    PubMed

    Lacosta, J L; Calzada, G; Infante, J C; Ramalle-Gómara, E

    2001-01-01

    It has been carried out a retrospective analysis of 34 patients suffering from carcinoma epidermoid of the tonsillar fossa being treated with two different therapies from 1989 to 1996. Twenty three of them were treated with surgery (transoral resection or bloc radical tonsillectomy with myocutaneous flap reconstruction and ipsilateral lymph node dissection). Eleven of them were treated with chemotherapy and radiotherapy. The rate of overall survival at 5 years were 41.2%. Actuarial survival rates were (71.4%) in stages I-II and 33.3% in stages III-IV (p = 0.08). On multivariate analysis, age (p = 0.28) and modality of treatment (p = 0.80) were not significant effect on survival. Advanced stages (III-IV) showed 3.4 times much more risk of death than early stages (I-II) (p = 0.11).

  3. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    PubMed

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  4. C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

    PubMed

    Thompson, Sara E; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Mroz, Thomas E; Fish, David E; Wang, Jeffrey C; Fehlings, Michael G; Tannoury, Chadi A; Tannoury, Tony; Tortolani, P Justin; Traynelis, Vincent C; Gokaslan, Ziya; Hilibrand, Alan S; Isaacs, Robert E; Mummaneni, Praveen V; Chou, Dean; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Sasso, Rick C; Arnold, Paul M; Buser, Zorica; Bydon, Mohamad; Clarke, Michelle J; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce; Lord, Elizabeth L; Lubelski, Daniel; Massicotte, Eric M; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; McBride, Owen J; Roe, Allison K; Yanez, Marisa Y; Stroh, D Alex; Than, Khoi D; Riew, K Daniel

    2017-04-01

    A multicenter, retrospective review of C5 palsy after cervical spine surgery. Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for categorical variables. Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

  5. Generic substitution of antiepileptic drugs: a systematic review of prospective and retrospective studies.

    PubMed

    Yamada, Mikiko; Welty, Timothy E

    2011-11-01

    To systematically review the literature on generic antiepileptic drugs (AEDs), evaluate the efficacy and safety of generic AED substitution, and perform pharmacokinetic (PK) analysis using the American Academy of Neurology (AAN) scheme to classify evidence. PubMed and Cumulative Index to Nursing and Allied Health Literature searches from January 1, 1980, to October 15, 2010, were performed using the search terms anticonvulsant, antiepileptic drug, carbamazepine, divalproex, ethosuximide, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pheno-barbital, phenytoin, primidone, topiramate, valproate, valproic acid, and zonisamide; bioavailability, bioequivalence, bioequivalency, bioequivalent, and substitution; and generic. Retrospective and prospective controlled studies of generic substitution of AEDs were included in the review. Non-English-language articles and uncontrolled clinical studies were excluded. Published articles were categorized using the AAN criteria for systematic reviews. We identified 156 articles. Of these, 20 met our inclusion criteria; 7 were retrospective studies, 6 were prospective studies in patients with epilepsy, and 7 were prospective studies in healthy subjects. All articles were rated Class I to Class III, using AAN criteria. The retrospective studies were categorized as Class III and showed a significant relationship between generic substitution and increased use of health care resources because of seizures or AED toxicity. Prospective studies were categorized as Class I, II, and III. Prospective studies in patients showed no differences between brand and generic drugs in PK parameters of bioequivalence. Three prospective studies in healthy subjects reported significant differences in maximum drug concentrations. Comparison of brand and generic drugs revealed no significant difference in seizure frequency; however, some prospective studies showed significant differences in PK parameters, primarily those not used for bioequivalence

  6. A Retrospective Review of Chemotherapy for Patients with Small Bowel Adenocarcinoma in British Columbia

    PubMed Central

    Duerr, Donat; Ellard, Susan; Zhai, Yongliang; Taylor, Marianne; Rao, Sanjay

    2016-01-01

    Background: Small bowel adenocarcinoma (SBA) is associated with a poor prognosis. It is an uncommon malignancy and therefore difficult to study. Randomized phase III trials are not available to guide best approaches. The Provincial Cancer Registry of the British Columbia Cancer Agency contains long-term data on patients with SBA. The authors analyzed characteristics and treatment outcomes for SBA patients diagnosed between 1990 and 2008. Material and methods: Charts of 150 patients with a histological diagnosis of SBA were retrospectively analyzed. Epidemiological and treatment data were collected. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Baseline characteristics, such as median age at diagnosis (64.5 years), tumor stage (I-II 33%, III-IV 58%, unknown 9%), and location (duodenum 48%, jejunum 31%, ileum 21%) were consistent with published data. 55% of patients had a positive family history of cancer. DFS and OS of 29 patients treated with adjuvant chemotherapy were not significantly different to that of 47 patients without (p = 1 and p = 0.211, respectively). In the palliative setting patients treated with polychemotherapy (21 patients) had statistically better OS than patients treated with monochemotherapy (12 patients) (p = 0.0228). Conclusions: Our study suggests a survival benefit for advanced-stage SBA patients treated with poly- versus monochemotherapy. This, however, was a retrospective analysis with several potential confounders. Nevertheless, our study adds to the evidence suggesting that chemotherapy may be beneficial for patients with SBA, at least in the palliative setting. PMID:27994666

  7. Dissociative sensibility disorders - A retrospective case series and systematic literature review.

    PubMed

    Weber, Peter; Erlacher, Rahel

    2017-09-01

    Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused on. To identify the clinical characteristics and outcomes of dissociative sensibility disorders in children and adolescents, and to review the use of diagnostic procedures. For the review, a literature search used Pubmed, Embase, Web of Science, and PubPsych (to 02/2015) and the reference lists of the studies identified. Screening of titles and abstracts; full-text assessment by two reviewers. The original case series was identified by using the local data register. Two reviewers independently reviewed the data and, if they agreed on the relevance, extracted the data. In the original case series, data were extracted retrospectively from the records. Sixteen studies and seven case reports were identified, including 931 cases with dissociative disorders. In 210 cases the patient suffered either from a single sensibility disorder or predominantly from sensibility disorders. We identified thirteen further cases in our cohort. In both groups there was female predominance; the mean age of manifestation was early adolescence. The timing of admissions was variable. In approximately 50% of cases a premorbid stressful life event could be identified. Over 75% of cases had a good prognosis with complete resolution. Retrospective character of our own data collection, partially missing differentiation between the subgroups of dissociative disorders in the reviewed studies. There is no uniform procedure for diagnostic work-up. The overall short-term prognosis is good. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  8. Therapeutic Touch(®) in a geriatric Palliative Care Unit - A retrospective review.

    PubMed

    Senderovich, Helen; Ip, Mary Lou; Berall, Anna; Karuza, Jurgis; Gordon, Michael; Binns, Malcolm; Wignarajah, Shaira; Grossman, Daphna; Dunal, Lynda

    2016-08-01

    Complementary therapies are increasingly used in palliative care as an adjunct to the standard management of symptoms to achieve an overall well-being for patients with malignant and non-malignant terminal illnesses. A Therapeutic Touch Program was introduced to a geriatric Palliative Care Unit (PCU) in October 2010 with two volunteer Therapeutic Touch Practitioners providing treatment. To conduct a retrospective review of Therapeutic Touch services provided to patients in an in-patient geriatric palliative care unit in order to understand their responses to Therapeutic Touch. A retrospective medical chart review was conducted on both patients who received Therapeutic Touch as well as a random selection of patients who did not receive Therapeutic Touch from October 2010-June 2013. Client characteristics and the Therapeutic Touch Practitioners' observations of the patients' response to treatment were collected and analyzed. Patients who did not receive Therapeutic Touch tended to have lower admitting Palliative Performance Scale scores, shorter length of stay and were older. Based on a sample of responses provided by patients and observed by the Therapeutic Touch practitioner, the majority of patients receiving treatment achieved a state of relaxation or sleep. This retrospective chart review suggests that implementation of a TT program for an inpatient geriatric Palliative Care Unit is feasible, and appears to be safe, and well-tolerated. Moreover, patient responses, as recorded in the Therapeutic Touch practitioners' session notes, suggest beneficial effects of Therapeutic Touch for a significant number of participants with no evidence of negative sequelae. Therefore, the use of TT in this difficult setting appears to have potential value as an adjunct or complementary therapy to help patients relax. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  9. Leber's congenital amaurosis. Retrospective review of 43 cases and a new fundus finding in two cases.

    PubMed

    Schroeder, R; Mets, M B; Maumenee, I H

    1987-03-01

    Leber's congenital amaurosis is a hereditary clinical disorder that may be associated with several different diseases. This study consists of a retrospective review of 43 cases. Twenty of our patients had fundus appearances that resembled retinitis pigmentosa. Five had normal-appearing fundi. The remainder had other, previously reported fundus abnormalities, with the exception of two patients who demonstrated a new fundus finding, a nummular pigmentary pattern. Other associated eye anomalies included cataracts, keratoconus, ptosis, and strabismus. The most frequent systemic associations were mental retardation, cystic renal disease, skeletal disorders, and hydrocephalus.

  10. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  11. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  12. Maxillofacial metastases: a retrospective review of one institution's 15-year experience.

    PubMed

    McClure, Shawn A; Movahed, Reza; Salama, Andrew; Ord, Robert A

    2013-01-01

    Metastasis to the maxillofacial region is a rare occurrence. In our retrospective study of patients with metastasis to the maxillofacial region, the subjects were evaluated to define the clinical behavior patterns in response to the treatment given. A retrospective record review during a 15-year period (1990 to 2005) was conducted. The patients were selected for inclusion in the present study if they had histologically confirmed maxillofacial metastases. In our retrospective study, during the 15-year period, 1,221 new patients with maxillofacial/oral cancer were seen and evaluated. Of these 1,221 patients, 26 (16 men and 10 women) were identified as having a histologically confirmed metastasis to the maxillofacial region, for an incidence of 2.1%. Patients with metastasis to the maxillofacial region are often deemed to not be surgical candidates because of the extensive nature of the metastatic disease. We believe that surgical intervention plays a beneficial role in improving quality of life in a properly selected group of patients with metastasis to the maxillofacial region. In our case series, surgery was performed in about 50% of the patients, and palliation and radiotherapy were the most commonly used modalities. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Interobserver agreement in retrospective chart reviews for factors associated with cervical spine injuries in children.

    PubMed

    Olsen, Cody S; Kuppermann, Nathan; Jaffe, David M; Brown, Kathleen; Babcock, Lynn; Mahajan, Prashant V; Leonard, Julie C

    2015-04-01

    The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs). Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (κ) statistic, with lower 95% confidence intervals. Moderate or better agreement (κ > 0.4) was achieved for most candidate CSI predictors, including altered mental status (κ = 0.87); focal neurologic findings (κ = 0.74); posterior midline neck tenderness (κ = 0.74); any neck tenderness (κ = 0.89); torticollis (κ = 0.79); complaint of neck pain (κ = 0.83); history of loss of consciousness (κ = 0.89); nonambulatory status (κ = 0.74); and substantial injuries to the head (κ = 0.50), torso/trunk (κ = 0.48), and extremities (κ = 0.59). High-risk mechanisms showed near-perfect agreement (diving, κ = 1.0; struck by car, κ = 0.93; other motorized vehicle crash, κ = 0.93; fall, κ = 0.92; high-risk motor vehicle collision, κ = 0.89; hanging, κ = 0.80). Fair agreement was found for clotheslining mechanisms (κ = 0.36) and substantial face injuries (κ = 0.40). Most retrospectively assessed variables thought to be predictive of CSIs in blunt trauma-injured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI. © 2015 by the Society for Academic Emergency Medicine.

  14. Soviet business chaos seen lasting 5 years

    SciTech Connect

    Not Available

    1991-12-16

    This paper reports that companies seeking work in the collapsing Soviet Union can expect political uncertainty for another 5 years. PW discussed changes in the Soviet Union and offered advice on dealing with officials of the central government and Soviet republics at a recent meeting in Houston with executives of oil field service companies. That meeting preceded reports of the Russian federation, Ukraine, and Byelorussia agreeing to form a Slavic commonwealth.

  15. Minor surgery procedures: A retrospective review and prospective survey in a pediatric population

    PubMed Central

    Chan, Emily; Bucevska, Marija; Verchere, Cynthia

    2015-01-01

    OBJECTIVE: The present study evaluated minor surgery procedures undertaken by a single plastic surgeon at BC Children’s Hospital (Vancouver, British Columbia) for patient and physician satisfaction, parent impressions, psychological concerns and complications. METHODS: Data were collected from a retrospective chart review and a prospective patient survey. Eligible subjects for the retrospective study included all pediatric patients undergoing minor surgery between May 2011 and April 2013. Parameters of interest included patient demographics, minor surgery specifics, complications and outcomes. Eligible subjects for the prospective patient survey included consecutive patients undergoing minor surgery between June 2013 and August 2013, as well as their parents. RESULTS: A total of 219 procedures were included in the retrospective review. The mean age of subjects was 13.1 years (range two weeks to 18 years). The median length of follow-up was 46 days (range four to 606 days). There were no major complications; however, 45 minor complications in 36 patients were found. Complications included crusting (4.6%), delayed wound healing (3.2%), hypersensitivity (2.3%), scar hypertrophy (1.8%), infection (0.9%) and other (7.8%). Outcomes were categorized as one of four outcomes: both satisfied (89.9%); patient satisfied but physician unsatisfied (0.8%); patient unsatisfied and physician satisfied (3.1%); and both unsatisfied (6.2%). In the prospective study, 32 subjects consented to participate in the survey. Of these subjects, 10 children and 12 parents responded to the questionnaires. Eighty-three percent of respondents indicated that their goals were accomplished by their procedure and that they would be willing to undergo minor surgery again. CONCLUSION: Minor surgery is possible and practical in pediatric plastic surgery clinics, with few complications and high patient and surgeon satisfaction. PMID:26361627

  16. Survival analysis of Y-90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10-year retrospective review.

    PubMed

    Turkmen, C; Kilicoglu, O; Dikici, F; Bezgal, F; Kuyumcu, S; Gorgun, O; Taser, O; Zulfikar, B

    2014-01-01

    Despite recent advances including new therapeutic options and availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide. We retrospectively reviewed our 10-year experience with Y-90 radiosynovectomy to determine the outcome in the knee joints of patients with haemophilic synovitis. Between 2002 and 2012, 82 knee joints of 67 patients with haemophilic synovitis were treated with Y-90 radiosynovectomy. The mean age was 16.8 ± 7.8 years (range: 5-39 years). The mean follow-up period was 39.6 ± 25.6 months (range: 12-95 months). Failure of therapy represented re-bleeding after a radiosynovectomy was used as an end point in patient time to progression (TTP) analysis. The median TTP was calculated as 72.0 ± 3.6 months (95% CI 64.8-79.1 months) in Kaplan-Meier analysis. The 1, 3 and 5-year survival rates were 89%, 73% and 63% respectively. Longer TTP (hazard ratio for progression, 2.5; P = 0.00) was evident in patients who have greater reduction in bleeding frequency within 6 months after radiosynovectomy. We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion status of joints and the pretreatment bleeding frequency. We concluded that Y-90 radiosynovectomy in knee joint represents an important resource for the treatment of haemophilic synovitis, markedly reducing joint bleeding and long-term durability, irrespective of the radiographic stage and inhibitor status.

  17. The role of examination under anesthesia (EUA) and vaginoscopy in pediatric and adolescent gynecology: a retrospective review.

    PubMed

    Nakhal, Rola S; Wood, Dan; Creighton, Sarah M

    2012-02-01

    Examination under anesthesia (EUA) with diagnostic vaginoscopy is an invaluable method in the lower genital tract assessment of pediatric and adolescent females. The literature on this topic remains scarce. This is a retrospective medical notes review of all patients who underwent EUA with or without vaginoscopy over the past 5 years at a pediatric and adolescent gynecology unit specializing in disorders of sex development (DSD). From 2005 to 2010, 83 patients underwent 92 procedures. All procedures were performed under general anesthesia, and a 3-mm pediatric cystoscope was used for vaginoscopy. Of the 92 cases, 33 (36%) were EUA alone and 59 (64%) consisted of a combined EUA and vaginoscopy. The mean age was 13.3 ± 3.7 years. The most common indications included assessment for reconstructive surgery (33.7%), vaginal stenosis (21.7%), vaginal discharge (19.6%), vaginal bleeding (16.3%), and pelvic pain (8.7%). Most (61%) of those presenting for assessment for reconstructive surgery had a DSD and history of surgical correction in early childhood. In 88 cases (96%), the evaluation was satisfactory and a diagnosis was reached or normality confirmed. Four cases (4%) required further investigation. No significant intraoperative or postoperative complications were encountered. Of the 92 cases, 15 (16%) required a further minor procedure, which was performed at the time of the EUA/vaginoscopy. Another 33 (36%) required further major surgery, which was performed at a later date. EUA/vaginoscopy is a safe and highly useful method in the assessment of the lower genital tract in pediatric and adolescent patients. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  18. An evaluation of low-dose simvastatin in achieving LDL goal: a retrospective chart review.

    PubMed

    Schnee, David M; Bogdanski, Laura; Zaiken, Kathy; McCloskey, William W

    2007-05-01

    Treatment for hyperciholesterolemia targets low-density lipoprotein (LDL) cholesterol. In July 2004, an update to the existingcholesterol guidelines was published that recommended more intense lowering of LDL levels. This study, a retrospective chart review conducted at a multispecialty medical group practice, aimed to determine iflow-dose simvastatin (5 or 10 mg) was effective at achieving LDL goal, in light of these more aggressive guidelines. Demographic data, including risk factors and LDL levels, were collected on 173 patients identified as taking low-dose simvastatin. The review indicated that 66% of patients with low-to-rnoderate cardiovascular risk treated with low-dose simvastatin achieved their risk-appropriate LDL goalMore than 50% of patients who achieved this LDL goal on low-dose simvastatin fell into lower-risk cattegories. Therefore, low-dose simvastatin may be a beneficial treatment option for patients in lower cardiovascular-risk categories.

  19. Clozapine Treatment and Cannabis Use in Adolescents with Psychotic Disorders – A Retrospective Cohort Chart Review

    PubMed Central

    Tang, Sephora M.; Ansarian, Aylar; Courtney, Darren B.

    2017-01-01

    Objectives To examine the association between clozapine treatment and frequency of cannabis use in adolescents with co-occurring psychotic and cannabis use disorder in a retrospective cohort chart review. Method We conducted a retrospective cohort chart review of patients diagnosed with a psychotic disorder and concurrent cannabis use disorder admitted to a tertiary care youth inpatient unit from 2010–2012. Longitudinal exposure and outcome data was coded month-by-month. Frequency of cannabis use was measured using a 7-point ordinal scale. Severity of psychosis was measured on a 3-point ordinal scale. Mixed effects regression modeling was used to describe the relationship between exposure and outcome variables. Results Thirteen patients had exposure to clozapine and fourteen had no exposure to clozapine. Cannabis use decreased in patients treated with clozapine, compared to patients treated with other antipsychotics (OR 2.8; 95% CI 0.97–7.9). Compared to no medication, clozapine exposure was associated with significantly less cannabis use (OR 7.1; 95% CI 2.3–22.3). Relative to treatment with other antipsychotics, clozapine exposure was significantly associated with lower severity of psychotic symptoms (OR 3.7; 95% CI 1.2–11.8). Conclusions Clozapine may lead to decreased cannabis use and psychotic symptoms in adolescents with concurrent psychosis and substance use. Clinical trials are warranted. PMID:28331504

  20. Clozapine Treatment and Cannabis Use in Adolescents with Psychotic Disorders - A Retrospective Cohort Chart Review.

    PubMed

    Tang, Sephora M; Ansarian, Aylar; Courtney, Darren B

    2017-01-01

    To examine the association between clozapine treatment and frequency of cannabis use in adolescents with co-occurring psychotic and cannabis use disorder in a retrospective cohort chart review. We conducted a retrospective cohort chart review of patients diagnosed with a psychotic disorder and concurrent cannabis use disorder admitted to a tertiary care youth inpatient unit from 2010-2012. Longitudinal exposure and outcome data was coded month-by-month. Frequency of cannabis use was measured using a 7-point ordinal scale. Severity of psychosis was measured on a 3-point ordinal scale. Mixed effects regression modeling was used to describe the relationship between exposure and outcome variables. Thirteen patients had exposure to clozapine and fourteen had no exposure to clozapine. Cannabis use decreased in patients treated with clozapine, compared to patients treated with other antipsychotics (OR 2.8; 95% CI 0.97-7.9). Compared to no medication, clozapine exposure was associated with significantly less cannabis use (OR 7.1; 95% CI 2.3-22.3). Relative to treatment with other antipsychotics, clozapine exposure was significantly associated with lower severity of psychotic symptoms (OR 3.7; 95% CI 1.2-11.8). Clozapine may lead to decreased cannabis use and psychotic symptoms in adolescents with concurrent psychosis and substance use. Clinical trials are warranted.

  1. The Use of Latex Catheters to Close Enterocutaneous Fistulas: An Institutional Protocol and Retrospective Review.

    PubMed

    Young, Shamar; D'Souza, Donna; Hunter, David; Golzarian, Jafar; Rosenberg, Michael

    2017-06-01

    The objective of our study was to retrospectively review an institutional protocol that uses latex catheters for the treatment of enterocutaneous fistulas (ECFs) that are resistant to simple drainage. Forty-six consecutive patients with ECFs that did not close with simple abscess drainage were treated with latex catheters. These patients' charts were retrospectively reviewed to determine treatment success rates and the relationship of treatment success to clinical characteristics. ECFs in 26 of the 46 (56.5%) patients were treated successfully with latex catheters. On univariate analysis, the fistulas that originated from the stomach were statistically less likely to close (p = 0.03), whereas those originating from the small bowel were more likely to close (p = 0.01). The duration of treatment was significantly longer in patients for whom the treatment failed than in those who were successfully treated (p = 0.003). After a total treatment time of more than 116 days (odds ratio [OR], 9.8 [95% CI, 2.5-38.4]; p = 0.001) or latex catheter treatment time of more than 74 days (OR, 8.9 [95% CI, 2.2-35.0]; p = 0.002), the chance of ECF closure decreased significantly. Treatment of ECFs that are resistant to simple abscess cavity drainage with a latex catheter is possible and decreases the need for surgery.

  2. [Fissure sealants--5 years of use].

    PubMed

    Azul, A M

    1990-01-01

    This study assesses the caries prevalence, retention and cost-effectiveness of a pit and fissure sealant in a children population with 622 cases, 5 years after a single application of an auto-polymerized sealant to permanent molars. The status of the sealant and the presence of caries or restaurations on the sealed teeth was assessed. In a self-controlled group of children, the prevalence of disease (caries and restaurations) was also assessed in non-sealed teeth, for comparison. The sealant application was compared with Class I-restauration with amalgam for cost-effectiveness analysis.

  3. Onychomatricoma: A Case Report with 5-year Follow-up

    PubMed Central

    Ishida, Cleide Eiko; Gouveia, Bruna Melhoranse; Cuzzi, Tullia; Ramos-e-Silva, Marcia

    2016-01-01

    The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented. PMID:28163462

  4. Primary neuroendocrine breast carcinomas: a retrospective analysis and review of literature

    PubMed Central

    Yang, Xin; Cao, Youde; Chen, Chen; Liu, Lin; Wang, Cheng; Liu, Shengchun

    2017-01-01

    Background Primary neuroendocrine breast carcinomas (NEBCs) are a rare type of breast carcinomas that lack comprehensive recognition, including the clinicopathological features, therapeutic strategies, and prognostic significance. The aim of this retrospective analysis is to present and analyze our own data of primary NEBCs. Materials and methods We retrospectively reviewed the medical records from 2005 to 2015 in The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China to obtain a cohort of breast carcinoma patients who were confirmed to have primary NEBC by histopathology. The detailed clinical data along with histopathology, treatment, and follow-up aspects were gathered for analysis. Results This retrospective analysis included 19 patients with a histopathological diagnosis of primary NEBC from 2005 to 2015. Their mean age was 59.2 years (ranging from 17 to 82 years). The majority of patients (15/19) focused on stages I and II. Of the 15 patients, 14 were positive for estrogen receptor, and 11 were positive for progesterone receptor. For neuroendocrine markers, the expression rates were 8/19, 14/18, 12/14, and 2/6 for chromogranin A, synaptophysin, neuron-specific enolase, and CD56, respectively. All operable patients except the one stage M1 underwent a surgery and 4/18 had axillary lymph node metastasis. Chemotherapy was performed in 12/19, and endocrine therapy in 8/10. With a median follow-up of 59.2 months, only 2 cases progressed after postoperative systemic therapy. Conclusion The understanding of NEBC is limited due to its rarity. More evidence should be provided to enhance the understanding of NEBC, especially for diagnosis, treatment, and prognosis. PMID:28176908

  5. Use of gabapentin and pregabalin for pruritus and neuropathic pain associated with major burn injury: A retrospective chart review.

    PubMed

    Kaul, Isha; Amin, Ami; Rosenberg, Marta; Rosenberg, Laura; Meyer, Walter J

    2017-08-16

    Pruritis after burn is one of the most common chronic complaints in burn survivors. Pruritus is often indistinguishable from neuropathic pain. There is a paucity of studies reporting the use of gabapentin and pregabalin to treat both pruritus and neuropathic pain. The purpose of this current study is to explore and document the effect of gabapentin and pregabalin in children and adolescent burn survivors. A retrospective review of charts and pharmacy records of gabapentin and pregabalin dispensed to control pruritus and/or pain was conducted for burn survivors up to 20 years of age. Data collected included medication doses, age and weight of patients, presence of neuropathic pain and pruritus, reported response to medication, and side effects of these medications. 136 individuals who received gabapentin, pregabalin, or both medications are included in the study. 112 received only gabapentin, none received only pregabalin, and 24 received both. All results are documented in mean±standard deviation (s.d.) dose/kg/day. 104 individuals experienced pruritus exclusively, two experienced neuropathic pain exclusively, and 30 experienced both. Use of medications was considered effective if the individuals reported pruritus or pain relief from the medication. The medication was considered safe if the individuals did not experience adverse side effects warranting discontinuation of the drugs. Medications were continued with dose adjustments if an individual reported minor side effects such as sedation or hyperactivity. The average effective dose mg/kg/day for gabapentin and pregabalin was calculated for each of the three age groups (≤5years, 6-12 years, and >12years). The average effective dose of gabapentin was 23.9±10.3mg/kg/day for children ≤5years, 27.0±15.3mg/kg/day for children 6-12 years, and 34.1±15.7mg/kg/day for children >12years. The average effective dose of pregabalin was 6.5±3.5mg/kg/day for children 6-12 years and 4.7±1.6mg/kg/day for children >12

  6. Effects of Intravitreal Ranibizumab Injection on Chinese Patients with Wet Age-Related Macular Degeneration: 5-Year Follow-Up Results

    PubMed Central

    Lu, Yingyi; Huang, Jianfeng; Zhao, Jing; Long, Li

    2016-01-01

    Purpose. To observe the effect of intravitreal ranibizumab injection on wet age-related macular degeneration (wAMD) over 5 years in Chinese patients. Methods. Thirty-seven patients who were diagnosed with wAMD in our hospital from June 2007 to June 2014 were retrospectively reviewed. The PRN regimen and the treatment and extend regimen were applied. Best corrected visual acuity (BCVA), number of ranibizumab injections, and changes in the choroidal neovascularization (CNV) lesion over 5 years were analyzed. Results. The mean BCVA measured by the ETDRS chart at baseline was 47.4 and 5 years after the treatment it was 34.89 letters, which was significantly different (p = 0.013). Fourteen eyes (37.8%) had improved visual acuity after 5 years. The number of injections in 5 years was 11.53, and most of the injections were in the first two years. Seventeen (45.9%) cases developed fibrous lesions, and 2 (5.4%) cases had atrophic lesions after 5 years. The fibrosis/atrophy was significantly correlated with the injection numbers (Pearson, r = 0.663, and p = 0.000). Conclusion. Most of the patients can maintain visual acuity treated by ranibizumab in the first 3 years. After 5 years, some patients can still improve or maintain visual acuity. Fibrous scarring of the lesion is the main reason for a decrease in vision of wAMD patients. PMID:27885338

  7. Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

    PubMed

    Barrio, Pablo; Ezzeldin, Mohamed; Bruguera, Pol; Pérez, Ana; Mansilla, Sara; Fàbrega, Marina; Lligoña, Anna; Mondón, Sílvia; Balcells, Mercè

    2016-06-14

    Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

  8. Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis.

    PubMed

    Sklar, Cindy M; Chan, Emily; Nasr, Ahmed

    2014-07-01

    Intestinal intussusception is a frequent cause of bowel obstruction in children. Initial treatment involves pneumatic reduction. If this fails, operative reduction is indicated. There is controversy regarding use of the laparoscopic (LAP) versus the conventional open approach. We performed a retrospective review of all children with intussusception who required operative reduction at our institution over a 12-year time period. We also performed a meta-analysis to combine our data with the published literature. We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012. Five patients underwent LAP reduction, and 23 patients underwent open reduction. Operative times were not statistically different. The rate of overall complications was not statistically different, with 1 of 5 (20%) and 7 of 23 (30%) having complications in the LAP and open groups, respectively. Mean length of stay was 3.8±2.1 days in both the LAP and open groups, with no significant difference. Our meta-analysis identified five retrospective studies comparing LAP and open techniques for reduction of intussusception. We did not find a significant difference between groups with respect to operative time, overall complication rates, or re-operation rates. However, the length of hospital stay was significantly longer in the open group. LAP reduction of intussusception is a safe and feasible alternative to the open approach. Length of stay may be shorter in the LAP group.

  9. A retrospective chart review to identify perinatal factors associated with food allergies.

    PubMed

    Dowhower Karpa, Kelly; Paul, Ian M; Leckie, J Alexander; Shung, Sharon; Carkaci-Salli, Nurgul; Vrana, Kent E; Mauger, David; Fausnight, Tracy; Poger, Jennifer

    2012-10-19

    Gut flora are important immunomodulators that may be disrupted in individuals with atopic conditions. Probiotic bacteria have been suggested as therapeutic modalities to mitigate or prevent food allergic manifestations. We wished to investigate whether perinatal factors known to disrupt gut flora increase the risk of IgE-mediated food allergies. Birth records obtained from 192 healthy children and 99 children diagnosed with food allergies were reviewed retrospectively. Data pertaining to delivery method, perinatal antibiotic exposure, neonatal nursery environment, and maternal variables were recorded. Logistic regression analysis was used to assess the association between variables of interest and subsequent food allergy diagnosis. Retrospective investigation did not find perinatal antibiotics, NICU admission, or cesarean section to be associated with increased risk of food allergy diagnosis. However, associations between food allergy diagnosis and male gender (66 vs. 33; p=0.02) were apparent in this cohort. Additionally, increasing maternal age at delivery was significantly associated with food allergy diagnosis during childhood (OR, 1.05; 95% CI, 1.017 to 1.105; p=0.005). Gut flora are potent immunomodulators, but their overall contribution to immune maturation remains to be elucidated. Additional understanding of the interplay between immunologic, genetic, and environmental factors underlying food allergy development need to be clarified before probiotic therapeutic interventions can routinely be recommended for prevention or mitigation of food allergies. Such interventions may be well-suited in male infants and in infants born to older mothers.

  10. A retrospective chart review to identify perinatal factors associated with food allergies

    PubMed Central

    2012-01-01

    Background Gut flora are important immunomodulators that may be disrupted in individuals with atopic conditions. Probiotic bacteria have been suggested as therapeutic modalities to mitigate or prevent food allergic manifestations. We wished to investigate whether perinatal factors known to disrupt gut flora increase the risk of IgE-mediated food allergies. Methods Birth records obtained from 192 healthy children and 99 children diagnosed with food allergies were reviewed retrospectively. Data pertaining to delivery method, perinatal antibiotic exposure, neonatal nursery environment, and maternal variables were recorded. Logistic regression analysis was used to assess the association between variables of interest and subsequent food allergy diagnosis. Results Retrospective investigation did not find perinatal antibiotics, NICU admission, or cesarean section to be associated with increased risk of food allergy diagnosis. However, associations between food allergy diagnosis and male gender (66 vs. 33; p=0.02) were apparent in this cohort. Additionally, increasing maternal age at delivery was significantly associated with food allergy diagnosis during childhood (OR, 1.05; 95% CI, 1.017 to 1.105; p=0.005). Conclusions Gut flora are potent immunomodulators, but their overall contribution to immune maturation remains to be elucidated. Additional understanding of the interplay between immunologic, genetic, and environmental factors underlying food allergy development need to be clarified before probiotic therapeutic interventions can routinely be recommended for prevention or mitigation of food allergies. Such interventions may be well-suited in male infants and in infants born to older mothers. PMID:23078601

  11. Hereditary angioedema and lupus: A French retrospective study and literature review.

    PubMed

    Gallais Sérézal, Irène; Bouillet, Laurence; Dhôte, Robin; Gayet, Stéphane; Jeandel, Pierre-Yves; Blanchard-Delaunay, Claire; Martin, Ludovic; Mekinian, Arsène; Fain, Olivier

    2015-06-01

    Hereditary angioedema (HAE) is a rare genetic disorder that is primarily caused by a defect in the C1 inhibitor (C1-INH). The recurrent symptoms are subcutaneous edema and abdominal pain. Laryngeal edema, which can also occur, is life threatening if it goes untreated. HAE can be associated with some inflammatory and autoimmune disorders, particularly lupus. The aim of this study was to describe cases of lupus among HAE patients in France and to perform a literature review of lupus and HAE studies. Case detection and data collection (a standardized form) were performed, thanks to the French Reference Center for Kinin-related angioedema. Data were collected from 6 patients with type 1 HAE and lupus in France; no cases of systemic lupus erythematosus were reported. In the literature review, 32 cases of lupus combined with HAE were identified, including 26 female patients. The median patient age at the time of first reported HAE symptoms and at diagnosis were 17.5 years (range, 9-41 years) and 19 years (range, 9-64 years), respectively for our 6 patients and 14 years (range, 3-30 years) and 17 years (range, 7-48 years), respectively, for the literature review. The clinical manifestations of HAE were mainly abdominal pain (83% in our patients vs 47% in the literature) and edema of the limbs (83% vs 38%). The C4 levels were low (for 100% of our cases vs 93% in the literature). Eighteen patients in the literature demonstrated HAE symptoms prior to the lupus onset vs 5 for our patients. The mean patient age at lupus onset was 20 years (range, 13-76 years) for our patients and 19.5 years (range, 1-78 years) in the literature, respectively. In the literature, 81% of the patients had skin manifestations, 25% had renal involvement and 28% received systemic steroids to treat lupus. Treatment with danazol did not modify the clinical expression of lupus. The association between lupus and HAE is a rare but not unanticipated event. Patients are often symptomatic for HAE before

  12. Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study.

    PubMed

    Hopewell, Sally; Collins, Gary S; Boutron, Isabelle; Yu, Ly-Mee; Cook, Jonathan; Shanyinde, Milensu; Wharton, Rose; Shamseer, Larissa; Altman, Douglas G

    2014-07-01

    To investigate the effectiveness of open peer review as a mechanism to improve the reporting of randomised trials published in biomedical journals. Retrospective before and after study. BioMed Central series medical journals. 93 primary reports of randomised trials published in BMC-series medical journals in 2012. Changes to the reporting of methodological aspects of randomised trials in manuscripts after peer review, based on the CONSORT checklist, corresponding peer reviewer reports, the type of changes requested, and the extent to which authors adhered to these requests. Of the 93 trial reports, 38% (n=35) did not describe the method of random sequence generation, 54% (n=50) concealment of allocation sequence, 50% (n=46) whether the study was blinded, 34% (n=32) the sample size calculation, 35% (n=33) specification of primary and secondary outcomes, 55% (n=51) results for the primary outcome, and 90% (n=84) details of the trial protocol. The number of changes between manuscript versions was relatively small; most involved adding new information or altering existing information. Most changes requested by peer reviewers had a positive impact on the reporting of the final manuscript--for example, adding or clarifying randomisation and blinding (n=27), sample size (n=15), primary and secondary outcomes (n=16), results for primary or secondary outcomes (n=14), and toning down conclusions to reflect the results (n=27). Some changes requested by peer reviewers, however, had a negative impact, such as adding additional unplanned analyses (n=15). Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication. © Hopewell et al 2014.

  13. Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study

    PubMed Central

    Collins, Gary S; Boutron, Isabelle; Yu, Ly-Mee; Cook, Jonathan; Shanyinde, Milensu; Wharton, Rose; Shamseer, Larissa; Altman, Douglas G

    2014-01-01

    Objective To investigate the effectiveness of open peer review as a mechanism to improve the reporting of randomised trials published in biomedical journals. Design Retrospective before and after study. Setting BioMed Central series medical journals. Sample 93 primary reports of randomised trials published in BMC-series medical journals in 2012. Main outcome measures Changes to the reporting of methodological aspects of randomised trials in manuscripts after peer review, based on the CONSORT checklist, corresponding peer reviewer reports, the type of changes requested, and the extent to which authors adhered to these requests. Results Of the 93 trial reports, 38% (n=35) did not describe the method of random sequence generation, 54% (n=50) concealment of allocation sequence, 50% (n=46) whether the study was blinded, 34% (n=32) the sample size calculation, 35% (n=33) specification of primary and secondary outcomes, 55% (n=51) results for the primary outcome, and 90% (n=84) details of the trial protocol. The number of changes between manuscript versions was relatively small; most involved adding new information or altering existing information. Most changes requested by peer reviewers had a positive impact on the reporting of the final manuscript—for example, adding or clarifying randomisation and blinding (n=27), sample size (n=15), primary and secondary outcomes (n=16), results for primary or secondary outcomes (n=14), and toning down conclusions to reflect the results (n=27). Some changes requested by peer reviewers, however, had a negative impact, such as adding additional unplanned analyses (n=15). Conclusion Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication. PMID:24986891

  14. Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities: A Retrospective Five-Year Review.

    PubMed

    McGuire, Amanda L; Carson, Christine F; Inglis, Timothy J J; Chakera, Aron

    2015-12-01

    ♦ Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. ♦ We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. ♦ The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. ♦ Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents. Copyright © 2015 International Society for Peritoneal Dialysis.

  15. The development of one-stop wide-awake dupuytren's fasciectomy service: a retrospective review

    PubMed Central

    Bismil, QMK; Bismil, MSK; Bismil, Annamma; Neathey, Julia; Gadd, Judith; Roberts, Sue; Brewster, Jennifer

    2012-01-01

    Objectives To detail the transition to a totally one-stop wide-awake (OSWA) Dupuytren's contracture surgical service. Design Retrospective review of Dupuytren's component of last 1000 OSWA cases. Setting The UK's first totally one-stop wide-awake orthopaedic service. Participants 270 patients with Dupuytren's contracture out of the last 1000 OSWA cases. Main outcome measures Surgical outcomes, patient satisfaction and cost-effectiveness and efficiency. Results The OSWA Dupuytren's model is safe, efficient and effective; with a low complication rate, extremely high patient satisfaction; and cost-savings to the nhs of £2500 per case treated. The service saved the NHS approximately £675,000 for the 270 cases presented. Conclusions A totally one-stop wide-awake Dupuytren's Contracture service is practicable and feasible alternative to the conventional treatment pathway, with benefits in terms of efficiency and cost-effectiveness. PMID:22908029

  16. Review of translocations detected by FISH for retrospective biological dosimetry applications.

    PubMed

    Edwards, A A; Lindholm, C; Darroudi, F; Stephan, G; Romm, H; Barquinero, J; Barrios, L; Caballin, M R; Roy, L; Whitehouse, C A; Tawn, E J; Moquet, J; Lloyd, D C; Voisin, P

    2005-01-01

    Several European laboratories have combined their research efforts to arrive at a consensus view on using fluorescence in situ hybridisation (FISH) for retrospective dosimetry. The aim of this review is to report these views and to highlight some areas where further work is needed. Translocations in the stable cells should be measured only in the cells that contain the full complement of the painted material. Two-way and one-way translocations should be combined with equal weight. The control level of translocations has a strong dependence on age, which has now been measured and the system has been calibrated. In conclusion, the technique works and a lifetime dose to the bone marrow from low-linear energy transfer radiation of 0.5 Gy above normal background levels can be measured for any individual. The main application is considered to provide an independent verification of lifetime doses to individuals who might form a part of an epidemiological study.

  17. Muscle necrosis in the extremities: evaluation with Tc-99m pyrophosphate scanning--a retrospective review

    SciTech Connect

    Timmons, J.H.; Hartshorne, M.F.; Peters, V.J.; Cawthon, M.A.; Bauman, J.M.

    1988-04-01

    A retrospective review was done of 34 extremities studied between 1981 and 1985 with technetium-99m pyrophosphate scanning; 22 were subsequently amputated. Results of detailed pathologic examination or immediate postoperative examination of the resected extremity were available in 16 cases. In these cases, scanning had allowed correct prediction of the level of amputation and of the specific areas of muscle infarction in 13 cases. In the one case in which amputation was performed for infection rather than muscle necrosis, the lack of necrosis was correctly predicted with the scan. The limited results of this study indicate that the Tc-99m pyrophosphate scan allows the location of necrotic muscle to be predicted accurately and may therefore be a useful adjunct in determining the best level for ultimate amputation. Special caution is required in those cases in which muscle necrosis is due to acute causes (e.g., traumatic thrombosis) rather than chronic vascular disease.

  18. [Effectiveness of regional anesthesia for loco-regional carotid surgery. Retrospective review of 147 interventions].

    PubMed

    Bartoloni, A; Savron, F; Rigo, V; Pasetto, A; Spezie, C; Ischia, A; Perbellini, A

    1991-03-01

    The Authors present a retrospective review that compares general anesthesia with regional anesthesia performed during carotid endarterectomy surgery. The study includes 147 procedures, performed on 144 patients: 76 had general anesthesia and 71 had regional anesthesia. After emphasizing the importance of conscience preservation during regional anesthesia to allow a simple and secure monitoring of the patient's neurologic functions, the Authors point out the decrease of peri- and postoperative accidents, whether neurologic or not, obtained with regional anesthesia. Another essential advantage of this technique is the possibility to insert the transitory shunt only when objectively necessary, ulteriorly reducing neurologic complications. Cervical plexus block is primarily indicated for high risk patients with instable neurologic simptomatology, severe stenosis of the contralateral carotid, coronary heart disease. The technique has proved to be of easy execution, safe and well accepted by the patient and the surgeon.

  19. Is malignant otitis externa on the increase? A retrospective review of cases.

    PubMed

    Bhasker, Diana; Hartley, Angela; Agada, Frank

    2017-02-01

    We performed a retrospective review of all patients with malignant otitis externa (MOE) treated in our center between July 2004 and December 2012 to evaluate the current epidemiology in our region and to ascertain causative factors associated with the perceived increase in the number of cases diagnosed. Eleven patients were identified (5 men and 6 women), with a mean age of 77 years (range: 38 to 97 years). Diabetes was present in 36%. Pseudomonas aeruginosa was the causative organism in 64% of cases; all pathogens were sensitive to ciprofloxacin. We noted a significant increase in the diagnostic frequency of MOE during the study period (p = 0.0027) No obvious causative factors were identified. Due to the mortality associated with this condition, further studies are required to establish national trends.

  20. Use of the CTrach Laryngeal Mask Airway in adult patients: a retrospective review of 126 cases.

    PubMed

    Maurtua, Marco A; Fernando, Michael; Finnegan, Patrick S; Mehta, Behram; Wu, Jiang; Foss, Joseph; Perilla, Mauricio; Zura, Andrew; Doyle, D John

    2012-08-01

    To evaluate the effectiveness of the CTrach Laryngeal Mask Airway (LMA) when used electively. Retrospective analysis. Operating room of an academic hospital. Data from 126 patients who were electively intubated with the CTrach LMA over a 16-month period were reviewed. Each patient's weight, height, ASA physical status classification, Mallampati score, thyromental distance, and cervical spine range of motion were recorded. Successful ventilation was achieved in 100% of patients, while successful intubation was achieved in 89.7% of patients. The most common reason for failure to intubate was poor airway visualization and the inability to appropriately position the device anterior to the vocal cords. The major advantage of the CTrach LMA is that it is the only device that allows airway visualization during patient ventilation; however, it does not have 100% success with intubation. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review

    PubMed Central

    Brody, Jennifer K.; León, Casey; Baggett, Travis P.

    2016-01-01

    Drug overdose is a major cause of death among homeless people, but little is known about the characteristics of homeless overdose decedents. We conducted a retrospective record review of 219 adult patients of Boston Health Care for the Homeless Program (BHCHP) who died of drug overdose in 2003–2008. We assessed the substances implicated in overdose and the health and service use characteristics of decedents prior to death. Eighty-one percent of overdose deaths involved opioids and 40% involved multiple drugs. Problem substance use (85%), psychiatric illness (61%), and chronic pain (45%) were common, and 32% had documentation of all three. Half were well-connected to BHCHP, and 35% had a clinic visit within 90 days of death. The complex health histories and frequent health care contacts of homeless drug overdose decedents suggest that clinical facilities may be an important frontline venue for overdose education, naloxone distribution, and integrated substance use treatment programming. PMID:27180712

  2. Sudden cardiac death while playing Australian Rules football: a retrospective 14 year review.

    PubMed

    Parsons, Sarah; Lynch, Matthew

    2016-06-01

    Australian Rules football is a sport which evolved from Gaelic football and which is played by a large number of predominantly male participants in a number of countries. The highest participation rates are in the southern states of Australia. A retrospective review over a period of 14 years identified 14 cases of sudden cardiac death that occurred in individuals while playing the sport. All were male and ranged in age from 13 to 36 years with a mean and median age of 23 years. A spectrum of cardiac causes was identified including coronary artery atherosclerosis, myocarditis, anomalous coronary artery anatomy, arrhythmogenic right ventricular cardiomyopathy, and healed Kawasaki disease. In 5 cases the heart was morphologically normal raising the possibility of a channelopathy. No traumatic deaths were identified. Some of the individuals had experienced symptoms prior to the fatal episode and the role of pre participation screening in reducing mortality is discussed.

  3. Interdisciplinary behavioral rehabilitation of pediatric pain-associated disability: retrospective review of an inpatient treatment protocol.

    PubMed

    Maynard, Cynthia S; Amari, Adrianna; Wieczorek, Beth; Christensen, James R; Slifer, Keith J

    2010-03-01

    A biopsychosocial model was used to treat pain-associated disability in children and adolescents. We assessed the clinical outcomes of children and adolescents (8-21 years of age) with pain-associated disability who were treated in an interdisciplinary inpatient rehabilitation program which included physical, occupational, and recreational therapy, medicine, nursing, pediatric psychology, neuropsychology, psychiatry, social work, and education. Psychological treatment emphasized cognitive-behavioral intervention for pain and anxiety management, and behavioral shaping to increase functioning. We conducted a retrospective chart review of 41 consecutive patients. School attendance, sleep, and medication usage were assessed at admission and discharge; functional disability and physical mobility were assessed at admission, discharge, and 3-month follow-up. As a group, significant improvements were observed in school status, sleep, functional ability, physical mobility, and medication usage. Findings support the efficacy of an inpatient interdisciplinary behavioral rehabilitation approach to the treatment of pain-associated disability in pediatric patients.

  4. Pelvic floor physical therapy for lifelong vaginismus: a retrospective chart review and interview study.

    PubMed

    Reissing, Elke D; Armstrong, Heather L; Allen, Caroline

    2013-01-01

    Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation.

  5. Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature.

    PubMed

    Wang, S-H; Chi, C-C; Wong, Y W; Salim, A; Manek, S; Wojnarowska, F

    2010-07-01

    The association of lichen sclerosus (LS) with genital squamous cell carcinoma is well recognized. However, the relationship between LS and verrucous carcinoma remains unclear. To evaluate the associations of genital and perianal verrucous carcinomas with LS. We conducted a retrospective study on patients with a genital or perianal verrucous carcinoma and reviewed their histopathology specimens and clinical notes. We also conducted a literature review. We identified a total of 13 patients (including 6 women and 7 men) with a genital or perianal verrucous carcinoma. All 5 women with vulval verrucous carcinoma had coexisting LS (5/5), and 1 man with penile verrucous carcinoma had coexisting LS (1/3). In contrast, no coexisting LS was found in all 5 cases of perianal verrucous carcinoma (0/5). Half of the cases of verrucous carcinoma with coexisting LS had recurrences (3/6), while no recurrences were found in those without coexisting LS (0/7). Our study and review of the literature demonstrate that vulval verrucous carcinoma is strongly associated with LS. In contrast, perianal verrucous carcinoma is not associated with LS. When genital verrucous carcinoma is diagnosed, it is important to consider LS as a potential concomitant diagnosis and offer appropriate treatments and close follow-up to detect recurrence of verrucous carcinoma.

  6. Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

    PubMed Central

    Akbulut, Sami; Tas, Mahmut; Sogutcu, Nilgun; Arikanoglu, Zulfu; Basbug, Murat; Ulku, Abdullah; Semur, Heybet; Yagmur, Yusuf

    2011-01-01

    AIM: To document unusual findings in appendectomy specimens. METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens. RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed. CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination. PMID:21528073

  7. A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations.

    PubMed

    Jayaram, Anupam; Cohen, Liza M; Lissner, Gary S; Karagianis, Achilles G

    2017-04-03

    The purpose of this study is to examine orbital lesions identified on preoperative radiologic imaging as cavernous venous malformations (CVMs), identify their imaging characteristics, and determine if these may help differentiate CVMs from other intraorbital masses. An IRB-approved retrospective chart review over 30 years was undertaken identifying lesions "consistent with cavernous hemangioma" on radiologic studies, which were subsequently surgically resected with a tissue diagnosis. All radiologic images (CT and MRI) obtained preoperatively were re-reviewed by a single masked neuroradiologist. The pattern of contrast enhancement on sequential MRI views was used to determine whether the enhancing characteristics helped identify CVMs compared to other intraorbital masses. Fifty-seven orbital lesions consistent with a CVM were identified on imaging. Fourteen (25%) of them were resected, of which nine (64%) were found to be CVMs on pathologic examination. Five (36%) were found to be a different lesion, most commonly schwannoma (21%). On imaging, CVMs tended to display heterogeneous progressive enhancement, whereas other tumors, in particular schwannomas, enhanced at their maximum level immediately. Based on these characteristics, on re-review, the masked neuroradiologist was able to differentiate a CVM versus other tumors for all 14 imaging cases. This study suggests that examining the pattern of contrast enhancement may help to correctly differentiate a CVM from other isolated, encapsulated orbital lesions on CT/MR imaging.

  8. Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review.

    PubMed

    Sarkar, Pamela; Cole, Alice; Scolding, Neil J; Rice, Claire M

    2017-05-01

    With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome. A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items "percutaneous endoscopic gastrostomy" and "neurology" or "neurodegenerative disease." Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin. This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

  9. Retrospective review of grafting techniques utilized in conjunction with endosseous implant placement.

    PubMed

    Meraw, S J; Eckert, S E; Yacyshyn, C E; Wollan, P C

    1999-01-01

    Bone resorptive patterns may prevent the ideal placement of endosseous implants. Numerous techniques have been described to create a more favorable surgical site for implant placement. This retrospective review was conducted to determine the frequency of need for implant site preparation in an outpatient clinical setting. In addition, different techniques of surgical site preparation were evaluated to determine their frequency of use and surgical outcome. A history review was conducted of all consecutively treated partially edentulous patients between January 1993 and December 1997. This review evaluated the number of implants placed, the age and gender of patient, the type of graft used, and the status of the implant. In all, 542 patients were seen in this time interval, with a total of 1,313 implants placed. Implant site preparation was needed in 4.4% of the patients, with the requirement for grafts occurring more frequently in the maxilla. Implant site preparation is a relatively infrequent requirement in the general population. Grafts are required more frequently in the maxilla than in the mandible. Complications following grafting were relatively infrequent and were not severe.

  10. High risk use of OTC NSAIDs and ASA in family medicine: A retrospective chart review.

    PubMed

    Hamilton, Kevin; Davis, Christine; Falk, Jamie; Singer, Alex; Bugden, Shawn

    2015-01-01

    Complications associated with the use of NSAIDs, antiplatelet agents, and anticoagulants are among the top causes of preventable drug-related ER visits, hospitalizations and death. Although over-the-counter (OTC) NSAIDs and ASA also contribute to this preventable risk, it is unclear how well these medications are documented in primary care records. A retrospective electronic and paper chart review was conducted to evaluate the prevalence of 13 evidence-based high-risk prescriptions and the contribution of OTC NSAIDs and ASA to these potentially inappropriate prescriptions (PIPs). Of the 148 patients included in the review, ASA was taken by 117 patients (79%) while OTC NSAIDs were taken by 36 (24%). OTC NSAIDs were never documented within the "medication" section of the electronic record, whereas ASA was documented in 65 (56%) cases. Eighty percent (118/148) taking either OTC NSAIDs or ASA were identified as having at least one PIP. OTC NSAIDs and ASA are widely available and are commonly taken without the knowledge of the prescriber. These medications contribute to the overall risk of bleeding. Review and documentation of OTC NSAIDs and ASA use should be part of all relevant patient encounters when prescribing NSAIDs, antiplatelets and anticoagulants.

  11. Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.

    PubMed

    Robbins, J Will; Lundy, Paige A; Gard, Andrew P; Puccioni, Mark J

    2015-11-01

    Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity. Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted. Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms. Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.

  12. Endovascular Management of Ruptured Distal Anterior Cerebral Artery (Daca) Aneurysms: A Retrospective Review Study.

    PubMed

    Husain, Shakir; Andhitara, Yovita; Jena, Somnath Prasad; Padilla, Jorge; Aritonang, Sahat; Letsoin, Igor

    2017-08-17

    Distal anterior cerebral artery (DACA) aneurysms are rare and their treatment by both surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains as a challenge in their management. To review clinical presentation, angiographic presentation of DACA aneurysms, complication and outcome of their endovascular treatment in our institutional experience. Retrospective review study among 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We reported clinical presentations, cerebral angiographic findings, endovascular treatment, complications and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and Raymond scale, respectively. Of 11 patients, 54.5% were female and 45.5% were male with mean age was 48.4 years (33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All of DACA aneurysms were small size. Post-coiling angiograms showed complete occlusion in 9 patients. Two patients had intra-procedural aneurysm rupture but without any clinical sequelae and 1 patient had thrombus formation which was thrombolysed at the end of coiling. All patients had good outcome. Our experience with 11 patients showed endovascular management of small DACA aneurysms though associated with higher intra-procedural events, is associated with good outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Picosecond pulse duration laser treatment for dermal melanocytosis in Asians : A retrospective review.

    PubMed

    Ohshiro, Takafumi; Ohshiro, Toshio; Sasaki, Katsumi; Kishi, Kazuo

    2016-06-29

    Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; Excellent, 75-94%; and Complete, 95-100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events.

  14. Picosecond pulse duration laser treatment for dermal melanocytosis in Asians : A retrospective review

    PubMed Central

    Ohshiro, Toshio; Sasaki, Katsumi; Kishi, Kazuo

    2016-01-01

    Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0–24%; Fair, 25–49%; Good, 50–74%; Excellent, 75–94%; and Complete, 95–100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events. PMID:27721561

  15. Tissue Liquefaction Liposuction for Body Contouring and Autologous Fat Transfer: A Retrospective Review Over 3 Years

    PubMed Central

    Godek, Christopher P.

    2016-01-01

    Objective: Tissue liquefaction lipoplasty is a novel, low-energy method cleared for use in aesthetic body contouring and autologous fat transfer. This is a retrospective review of the clinical effectiveness and safety of a liquefaction lipoplasty system for liposuction and autologous fat transfer. Methods: A retrospective review was done evaluating all liquefaction lipoplasty procedures with or without autologous fat transfer performed by a single surgeon (March 2013 to June 2016). Patient demographics, operative details, and any complications were tabulated from patient charts. A typical case reported is presented with pre-/postoperative photographs. Results: Two hundred fifty-five consecutive liquefaction lipoplasty procedures were performed over 39 months. The average lipoaspirate volume was 1208 ± 991 mL and the average fat graft volume was 322 ± 277 mL. The overall complication rate was 9 of 255 (3.52%). There were 2 episodes of seroma (0.78%) that were aspirated and 2 episodes of cellulitis (0.78%) that responded to oral antibiotics. In the autologous fat transfer cohort, there were 5 of 103 (4.85%) cases of mild to moderate fat necrosis, with 1 patient requiring return to the operating room for removal of an oil cyst. No revisions of donor sites were required. Conclusions: Liquefaction lipoplasty appears safe for liposuction and autologous fat transfer, with a complication profile that is comparable with other widely used forms of suction-assisted liposuction. The liquefaction lipoplasty technology also provides potential time savings in the operating room that can minimize surgeon fatigue when harvesting large volumes of high-quality fat. Liquefaction lipoplasty appears to have advantages for both the patient and the surgeon, and further studies are underway. PMID:28077985

  16. Tissue Liquefaction Liposuction for Body Contouring and Autologous Fat Transfer: A Retrospective Review Over 3 Years.

    PubMed

    Borab, Zachary M; Godek, Christopher P

    2016-01-01

    Objective: Tissue liquefaction lipoplasty is a novel, low-energy method cleared for use in aesthetic body contouring and autologous fat transfer. This is a retrospective review of the clinical effectiveness and safety of a liquefaction lipoplasty system for liposuction and autologous fat transfer. Methods: A retrospective review was done evaluating all liquefaction lipoplasty procedures with or without autologous fat transfer performed by a single surgeon (March 2013 to June 2016). Patient demographics, operative details, and any complications were tabulated from patient charts. A typical case reported is presented with pre-/postoperative photographs. Results: Two hundred fifty-five consecutive liquefaction lipoplasty procedures were performed over 39 months. The average lipoaspirate volume was 1208 ± 991 mL and the average fat graft volume was 322 ± 277 mL. The overall complication rate was 9 of 255 (3.52%). There were 2 episodes of seroma (0.78%) that were aspirated and 2 episodes of cellulitis (0.78%) that responded to oral antibiotics. In the autologous fat transfer cohort, there were 5 of 103 (4.85%) cases of mild to moderate fat necrosis, with 1 patient requiring return to the operating room for removal of an oil cyst. No revisions of donor sites were required. Conclusions: Liquefaction lipoplasty appears safe for liposuction and autologous fat transfer, with a complication profile that is comparable with other widely used forms of suction-assisted liposuction. The liquefaction lipoplasty technology also provides potential time savings in the operating room that can minimize surgeon fatigue when harvesting large volumes of high-quality fat. Liquefaction lipoplasty appears to have advantages for both the patient and the surgeon, and further studies are underway.

  17. Pediatric injuries in maxillofacial trauma: a 5 year study.

    PubMed

    Kumaraswamy, S V; Madan, Nanjappa; Keerthi, R; Singh, Deora Shakti

    2009-06-01

    Fractures of the facial skeleton in children are less frequent. This clinical retrospective study of 5 year was conducted on 95 patients aged less than 16 years who sustained maxillofacial injuries during the period 2003 to 2008. Age, sex, etiology incidence and type of fracture were studied. The ratio of boys to girls was 1.9:1. The 7-12 year age group was commonly involved and the highest incidence was at age of ten years. Falls were the most common cause of injury accounting for 41%, followed by road traffic accidents (30%). Sports related injuries, assault and child abuse were also the causes of injury in children. Dentoalveolar injuries were found to be highest incidence with 42.1% followed by mandibular fractures. The soft tissue injuries were associated the pediatric maxillofacial trauma were found to be 34.7% of all cases.

  18. Outcomes of 5-year survivors of pediatric liver transplantation: report on 461 children from a north american multicenter registry.

    PubMed

    Ng, Vicky Lee; Fecteau, Annie; Shepherd, Ross; Magee, John; Bucuvalas, John; Alonso, Estella; McDiarmid, Suzanne; Cohen, Geoff; Anand, Ravinder

    2008-12-01

    Although liver transplantation has been the standard of care therapy for life-threatening liver diseases for >20 years, data on the long-term impact of liver transplantation in children have been primarily limited to single-center experiences. The objective of this study was to characterize and evaluate the clinical course of children who have survived >or=5 years after pediatric liver transplantation in multiple centers across North America. Patients enrolled in the Studies of Pediatric Liver Transplantation database registry who had undergone liver transplantation at 1 of 45 pediatric centers between 1996 and 2001 and survived >5 years from liver transplantation were identified and their clinical courses retrospectively reviewed. The first graft survival for 461 five-year survivors was 88%, with 55 (12%) and 10 (2%) children undergoing a second and third liver transplantation. At the 5-year anniversary clinic visit, liver function was preserved in the majority with daily use of immunosuppression therapy, including a calcineurin inhibitor and oral prednisone, reported by 97% and 25% of children, respectively. The probability of an episode of acute cellular rejection occurring within 5 years after liver transplantation was 60%. Chronic rejection occurred in 5% patients. Posttransplant lymphoproliferative disease was diagnosed in 6% children. Calculated glomerular filtration rate was <90 mL/minute per 1.73 m2 in 13% of 5-year survivors. Age- and gender-adjusted BMI>95th percentile was noted in 12%, with height below the 10th percentile in 29%. Children who are 5-year survivors of liver transplantation have good graft function, but chronic medical conditions and posttransplantation complications affect extrahepatic organs. A comprehensive approach to the management of these patients' multiple unique needs requires the expertise and commitment of health care providers both beyond and within transplant centers to further optimize long-term outcomes for pediatric liver

  19. University Hospital Waterford: 5-year experience of cutaneous melanoma.

    PubMed

    Sehgal, R; Cheung, C X; Alradadi, R; Healy, D A; Landers, R; O'Donoghue, G T

    2017-05-01

    The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010. To summarize 5-year experience (2010-2015) of primary CM presenting to UHW. Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis. 592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78 ± 18.29 years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4 ± 3.7 mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%). There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.

  20. Acute headache and subarachnoid haemorrhage: a retrospective review of CT and lumbar puncture findings.

    PubMed

    O'Neill, J; McLaggan, S; Gibson, R

    2005-11-01

    Assess and correlate the clinical presentation, cranial CT and lumbar puncture (LP) findings in patients presenting with acute headache, clinically suspicious of subarachnoid haemorrhage, from the Accident and Emergency (A/E) department of a main teaching hospital. We retrospectively reviewed over a 1-year period all patients referred for cranial CT from the A/E department, with clinically suspected non-traumatic SAH. Patients with a negative CT, with a diagnosis of SAH on LP, had their initial CT examination reassessed in a double blind review. 116 consecutive patients were included in the study. Patients were divided into 3 groups post CT results: diagnostic of SAH (19), abnormal without evidence of SAH (16) and normal (81). The clinical management of the latter group was analysed with particular emphasis on the performance and results of lumbar puncture (LP). 81 patients, clinically suspicious of SAH in our study had a normal cranial CT and were eligible for LP 49% had an LP, which was positive in 15% and contributed 24% to the total number diagnosed with SAH. LP was not performed in 51% of eligible patients. This study reviews the varying clinical presentations of SAH and the difficulty in clinically diagnosing SAH where headache is the only symptom. We review the wide differential diagnosis on cranial CT and on discharge of patients presenting with symptoms clinically suspicious of SAH. In addition this study identfies a high proportion of patients without detailed clinical notes and discharged without a diagnosis. The study reaffirms that a significant proportion of patients are diagnosed on LP and stress the importance of performing a LP in all cases with clinically suspected SAH with a negative CT This latter point requires highlighting in the medical literature as over half of eligible patients did not have a LP performed despite this being accepted diagnostic protocol.

  1. Off-therapy headaches in pediatric brain tumor patients: a retrospective review.

    PubMed

    Johnson, Ann H; Jordan, Cathy; Mazewski, Claire M

    2009-01-01

    To determine the incidence, timing, and characteristics of headaches in a population of off-therapy pediatric brain tumor patients, a retrospective chart review was conducted on 3 subpopulations of children followed in a multidisciplinary neuro-oncology clinic in the Southeastern United States. Data collected included tumor type and location, treatment, associated symptoms, and description and timing of headaches. In all, 81 charts were reviewed from which headaches in 3 subtypes of tumors were identified (29 medulloblastomas, 36 cerebellar juvenile pilocytic astrocytomas [JPAs], and 16 craniopharyngiomas). Off-therapy headaches were noted in 6 (21%) of medulloblastomas, 10 (28%) of JPAs, and 19 (56%) of craniopharyngiomas. Almost half of those patients with prediagnosis headaches had recurrent off-therapy headaches. Given the incidence of this symptom, headache must be highlighted in posttreatment and late effects monitoring.Whether provided by the oncology team or primary care provider, headache assessment, treatment, and prevention counseling can be improved through utilization of newly developed tools and written educational materials. Experienced nurses can play key roles in this aspect of posttreatment pediatric care of brain tumor patients.

  2. Results of Goeckerman treatment for psoriasis in children: a 21-year retrospective review.

    PubMed

    Kortuem, Kimberly R; Davis, Mark D P; Witman, Patricia M; McEvoy, Marian T; Farmer, Sara A

    2010-01-01

    Goeckerman treatment has been used for the management of widespread psoriasis in children for several decades at Mayo Clinic. We aimed to review our institutional experience with the effectiveness of Goeckerman treatment for psoriasis in children. We retrospectively reviewed the records of pediatric patients who underwent Goeckerman treatment over a 21-year period (1983-2003). The main outcome measure was improvement in psoriasis. During the study period, 65 children received Goeckerman treatment for predominantly widespread, recalcitrant psoriasis. The mean age was 11.6 years (range, 3 mos to 18 yrs), and the female-to-male ratio was 2:1. Psoriasis improved in all patients: 55 patients (85%) had >80% clearance of their psoriasis. The only adverse effect was folliculitis, occurring in 27 patients (42%). Mean duration of follow-up was 2.6 years (range, 17 days-18.2 yrs); average duration of remission was 2.6 years (range, 2 mos-12.79 yrs). Goeckerman treatment is an effective treatment for widespread psoriasis in children. © 2010 The Authors. Journal compilation © 2010 Wiley Periodicals, Inc.

  3. Nasopharyngeal carcinoma in dermatomyositis patients: A 10-year retrospective review in Hospital Selayang, Malaysia

    PubMed Central

    Teoh, J.W.; Yunus, Razif M.; Hassan, Faridah; Ghazali, Norazmi; Abidin, Zainal A.Z.

    2014-01-01

    Aim The objective of our review is to investigate the association between dermatomyositis patients and nasopharyngeal carcinoma (NPC) together with the clinical presentation of the patients and their management in otorhinolaryngology. Background NPC is a malignant disease with good prognosis on early diagnosis. However, the relationship between the dermatomyositis and NPC and its management is not well defined. Materials and methods A 10-year retrospective review of case records of 21 dermatomyositis patients seen in Otorhinolaryngology Department of Hospital Selayang from January 2000 to November 2010. Results These patients ranged from 19 to 74 years old and a total of 8 (38%) out of 21 adults with dermatomyositis were detected to have malignancy. Five out of 8 patients had NPC (62.5%). The mean age of patients with NPC and dermatomyositis was 48 years. NPC is diagnosed in 4 out of 5 patients (80%) in the first year of diagnosis of dermatomyositis. The clinical findings of the examination of nasopharynx ranged from hyperemia to exophytic nasopharyngeal mass. Histologically, it is only related to NPC of WHO types II and III. Conclusions There is a strong relationship between dermatomyositis and malignancy, especially NPC. Clinicians should have a high index of suspicion for malignancy in all dermatomyositis patients. Rigid nasoendoscopies and biopsies, serum Epstein–Barr viral capsid IgA antibody and imaging studies are helpful in detecting NPC in dermatomyositis patients. PMID:25184058

  4. Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants.

    PubMed

    Elledge, R; Chaggar, J; Knapp, N; Martin, T; White, N; Evriviades, D; Edmondson, S; Parmar, S

    2017-04-01

    Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n=103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p<0.001: Kaplan-Meier survival analysis: p<0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p=0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.

  5. Patient characteristics, menopause symptoms, and care provided at an interdisciplinary menopause clinic: retrospective chart review.

    PubMed

    Sydora, Beate C; Yuksel, Nese; Veltri, Nicole L; Marillier, Justin; Sydora, Christoph P; Yaskina, Maryna; Battochio, Lori; Shandro, Tami M L; Ross, Sue

    2017-07-10

    The goal of this study was to describe the characteristics, menopause symptoms, and treatment progressions in women cared for at an interdisciplinary menopause clinic. We conducted a retrospective review of patient charts from women attending a multidisciplinary menopause clinic. Data collected from the charts included patient demographics, menopause symptoms, other concurrent medical conditions, and treatment recommendations. Data were entered into Research Electronic Data Capture database and analyzed descriptively. Generic symptom severity questionnaires were used to compare severity scores from initial to follow-up visits. Among the 198 women (mean age 52.1 y [±SD 6.3], 63.6% postmenopausal), the most common moderate/severe menopause symptoms were as follows: difficulty staying asleep or waking frequently (76.3%), tiredness (73.7%), and lack of interest in sex (60.1%). Women tended to have complex chronic medical conditions, with 54.5% suffering from four or more concurrent medical conditions. The majority of women (70.2%) were recommended various forms of hormone therapy. Women with a follow-up visit at 3 to 4 months reported a reduction in symptom severity. Our study addresses a gap in published information on patient characteristics and treatment in menopause-specific interdisciplinary clinics. The chart review highlights the variety of symptom experience and complexity of care faced in a menopausal clinic. Rigorous prospective studies including standardized data collection and follow-up are needed to help guide clinicians in managing complex menopause patients.

  6. Impact of pharmacist integration in a pediatric primary care clinic on vaccination errors: a retrospective review.

    PubMed

    Haas-Gehres, Anna; Sebastian, Sonya; Lamberjack, Kristen

    2014-01-01

    To measure the impact of ambulatory clinical pharmacist integration in a pediatric primary care clinic on vaccination error rates and to evaluate missed opportunities. A retrospective, quasi-experimental review of electronic medical records of visit encounters during a 3-month period compared vaccine error rates and missed opportunities between two pediatric residency primary care clinics. The intervention clinic has a full-time ambulatory clinical pharmacist integrated into the health care team. Pharmacy services were not provided at the comparison clinic. A vaccine error was defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended spacing from a previous dose, doses administered unnecessarily, live virus vaccination administered too close to a previous live vaccine, and doses invalid for combinations of these reasons. 900 encounters were randomly selected and reviewed. The error rate was found to be 0.28% in the intervention clinic and 2.7% in the comparison clinic. The difference in error rates was found to be significant (P = 0.0021). The number of encounters with greater than or equal to one missed opportunity was significantly higher in the comparison clinic compared with the intervention clinic (29.3% vs. 10.2%; P <0.0001). The pediatric primary care clinic with a pharmacist had reductions in vaccination errors as well as missed opportunities. Pharmacists play a key role in the pediatric primary care team to improve the appropriate use of vaccines.

  7. Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review.

    PubMed

    Selhorst, Mitchell; Fischer, Anastasia; Graft, Kristine; Ravindran, Reno; Peters, Eric; Rodenberg, Richard; Welder, Eric; MacDonald, James

    2017-05-01

    The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. Retrospective chart review. Hospital-based sports medicine clinic. The medical charts of 196 adolescent athletes (mean age = 14.3 ± 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. Patients were subgrouped based on physician referral to PT. An aggressive referral group (<10 weeks) and a conservative referral group (>10 weeks). Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.

  8. Diagnostic algorithm for unilateral sinus disease: a 15-year retrospective review

    PubMed Central

    Silva, Marianella Paz; Pinto, Jayant M.; Corey, Jacquelynne P.; Mhoon, Ernest E.; Baroody, Fuad M.; Naclerio, Robert M.

    2016-01-01

    Background Patients presenting with unilateral sinus symptoms or nasal polyps raise concerns about sinister pathology. Yet despite the relatively common occurrence of this presentation, and its potential severity, an organized diagnostic approach to unilateral sinus disease (USD) has never been defined. The purpose of this work was to propose a diagnostic algorithm for managing patients with USD based on prior experience. Methods We performed a retrospective review of the medical records of all patients with USD who underwent surgical intervention and had pathological specimens during a 15-year period at an urban academic center. Nasal endoscopy and computed tomography (CT) scan findings, demographic characteristics, presenting symptoms, medical histories, and previous treatments were analyzed. Results A total of 191 patients met the inclusion criteria, 153 of whom were initially diagnosed at our center. Among the latter group, 51 (33%) presented with a nasal mass or polyp observed by endoscopy. Inverted papilloma was present in 16% of those cases, and malignant tumors comprised 14%. In contrast, of patients without an obvious nasal polyp (n = 102), 2% had inverted papilloma and 3% had malignancies. Overall, chronic rhinosinusitis was the most common diagnosis both in patients with polyps (67%) and those without nasal polyps (69%). Conclusion Although USD is most likely to represent chronic inflammation, there exists a fair likelihood of finding malignant pathology, particularly in cases where patients have a unilateral polyp. Based on this review, we propose a strategy for the management of new presentations of USD. PMID:25880633

  9. Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

    PubMed Central

    Loff, Clara; Calado, Eulália

    2015-01-01

    Introduction Children with myelomeningocele (MMC) are usually subjected to multiple surgeries. However, the number and type of surgeries are not the same in every patient with MMC over time. This report summarizes the surgical interventions in a cohort of several ages. Materials and methods Data on all of the patients with MMC, aged from 1 year and 10 months to 21 years and 11 months, were retrospectively reviewed at the Dona Estefânia Hospital in Lisbon, Portugal. Data were collected by chart review and individual interviews. The factors analyzed were demographics, ambulatory status, neurological level of involvement, shunt status, Arnold–Chiari malformation type II, surgical history, and occurrence of fracture. The surgical interventions were categorized as neurosurgical, orthopedic, urinary, ulcer repair and others. Results A total of 84 alive were eligible and enrolled. The average age was 14 years and six months. A total of 59 patients received shunts (all but one ventriculoperitoneal). In the study group, the 84 patients required 663 surgeries. Neurosurgical interventions were the most frequent surgical procedure and predominated during the first 2 years of life. Surgical interventions related to shunts were the most common neurosurgical interventions. Orthopedic surgeries were more frequent in the age group 6–12 years. Urological surgeries were done mainly after 6 years of age. Surgical repair of pressure ulcers was more common after 12 years of age. Conclusions Our study brings to light the complexity of this condition, with multiple surgeries among patients with MMC. PMID:25029586

  10. Introduction of non‐transport guidelines into an ambulance service: a retrospective review

    PubMed Central

    Gray, J T; Wardrope, J

    2007-01-01

    Background Recent government policy has looked at improving the role of ambulance services in delivering alternative care models for patients. Objective To review the outcomes of the introduction of some specific non‐transport guidelines into an ambulance service. Methods A retrospective review was undertaken of the documentation produced from the use of these protocols in the first 4 months following introduction for appropriateness of use, and potential for risk of adverse outcome. Results Of 354 uses of the guidelines, 140 (39.5%) were considered inappropriate. A large number of these were cases where the issue was refusal of transport rather than a use of the guideline. Of the rest the more focused guidelines showed better adherence (hypoglycaemia 2/69 inappropriate, epilepsy 1/23 inappropriate) than the more non‐specific guidelines (no apparent injury 17/84 inappropriate, minor limb injury 28/58 inappropriate). Conclusions This short study suggests that focused guidelines can help support ambulance staff decision making; however, care must be taken to ensure safe practice and that these guidelines are not used to add legitimacy to poor practice. PMID:17901280

  11. Factors Associated With Infectious Laryngitis: A Retrospective Review of 15 Cases

    PubMed Central

    Thomas, Carissa M.; Jetté, Marie E.; Clary, Matthew S.

    2017-01-01

    Objectives To identify the culturable microbes associated with infectious laryngitis and outline effective treatment strategies. Methods This is a retrospective chart review of adult patients with persistent dysphonia plus evidence of laryngeal inflammation who underwent biopsy for culture at a tertiary care medical center. Demographic factors, symptoms as reported on validated patient assessment tools, past medical history, social history, culture results, and treatment duration and response were reviewed. Results Fifteen patients with infectious laryngitis were included in this study. Culture results demonstrated Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Serratia marcescens, and “normal respiratory flora.” In most patients, multiple courses of prolonged antibiotics were needed to treat MSSA or MRSA. Infections associated with other microbes resolved with a single course of antibiotics. Conclusions In this population, infectious laryngitis is defined as colonization with bacteria not found in the previously characterized laryngeal microbiome of benign vocal fold lesions. In suspected cases of infectious laryngitis, culture is recommended, by biopsy if needed. For MSSA- and MRSA-associated laryngitis, an extended course of antibiotics may be necessary for symptom improvement and resolution of laryngeal inflammation. However, the optimal treatment regimen has yet to be defined and will require larger, prospective studies. PMID:28397557

  12. Pathology of Haemonchus contortus in New World camelids in the southeastern United States: a retrospective review.

    PubMed

    Edwards, Erin E; Garner, Bridget C; Williamson, Lisa H; Storey, Bob E; Sakamoto, Kaori

    2016-03-01

    Most small ruminant farms in tropical climates are plagued by Haemonchus contortus, a hematophagous, abomasal parasite. Heavy burdens of this parasite can cause anemia, hypoproteinemia, weight loss, and mortality in susceptible animals. Haemonchus contortus is becoming a major health concern in New World camelids as well, namely llamas (Llama glama) and alpacas (Vicugna pacos), yet little research has been conducted regarding its prevalence or pathology in these species. Herein, we present a retrospective review of llamas and alpacas that were admitted to The University of Georgia Veterinary Teaching Hospital and Athens Diagnostic Laboratory between the years 2002 and 2013. Antemortem fecal egg count (FEC) estimates performed on 30 alpacas were negatively correlated with hematocrit, hemoglobin, and red blood cell count. Total protein was not significantly correlated with FEC. On postmortem examination, 55 of 198 camelids, including 2 from the aforementioned antemortem review, were infected with H. contortus, with llamas (42.6%) having a significantly higher infection rate than alpacas (22.2%). In 15.7% of the total cases, the parasite was the major cause of death. Common gross lesions included peritoneal, thoracic, and pericardial effusions, visceral pallor, subcutaneous edema, and serous atrophy of fat. Histologic lesions included centrilobular hepatic necrosis, hepatic atrophy, lymphoplasmacytic inflammation of the mucosa of the third gastric compartment (C3), extramedullary hematopoiesis in both the liver and spleen, and the presence of nematodes in C3. Our study emphasizes the importance of H. contortus diagnosis and herd monitoring in New World camelids, particularly llamas.

  13. Five-Year Retrospective Review of Blunt Renal Injuries at a Level I Trauma Center.

    PubMed

    Burns, Jessica; Brown, Megan; Assi, Zakaria I; Ferguson, Eric J

    2017-02-01

    We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality. The registry identified 48 blunt renal injury patients. Median Injury Severity Score was higher and hospital length of stay was significantly longer in those with blunt renal injury when compared with those without blunt renal injury (P < 0.001). The majority of patients with blunt renal injury were managed nonoperatively. Mortality was three out of 48 patients (5%). Nine patients underwent exploratory laparotomy. These operations were always performed for reasons other than the renal trauma (e.g., splenic injury, free fluid, free air). No patient underwent invasive renal operation. Six patients were treated using angiography with embolization. Of the six, one patient died of pulmonary septic complications. We conclude that selective nonoperative management is the mainstay of treatment for blunt renal injury. Angiography with embolization is a useful modality for cases of ongoing bleeding, and is typically preferable to nephrectomy in our experience.

  14. The impact factors on 5-year survival rate in patients operated with oral cancer

    PubMed Central

    Geum, Dong-Ho; Roh, Young-Chea; Yoon, Sang-Yong; Kim, Hyo-Geon; Lee, Jung-Han; Song, Jae-Min; Lee, Jae-Yeol; Hwang, Dae-Seok; Kim, Yong-Deok; Shin, Sang-Hun; Chung, In-Kyo

    2013-01-01

    Objectives The purpose of this study is to analyze clinical impact factors on the survival rate, and to acquire basic clinical data for the diagnosis of oral cancer, for a determination of the treatment plan with long-term survival in oral cancer patients. Materials and Methods Through a retrospective review of the medical records, the factors for long-term survival rate were analyzed. Thirty-seven patients, among patient database with oral cancer treated in the Department of Oral and Maxillofacial Surgery at Pusan National University Hospital within a period from March 1998 to March 2008, were selected within the study criteria and were followed-up for more than 5 years. The analyzed factors were gender, age, drinking, smoking, primary tumor site, type of cancer, TNM stage, recurrence of affected region, and metastasis of cervical lymph node. The 5-year survival rate on the impact factors was calculated statistically using the Kaplan-Meier method. Results By classification of clinical TNM at the 1st visit, there were 11 (29.7%) cases for stage I, 11 (29.7%) cases for stage II, 3 (8.1%) cases for stage III, and 12 (32.5%) cases for stage IV. The 5-year survival rate of total oral cancer patients after the operation were 75.7%, pathological TNM stage related 5-year survival rate were as follows: stage I 90.0%, stage II 81.8%, stage III 100% and stage IV 45.5%; in which the survival rate difference by each stage was significantly observed. The recurrence of cervical lymph node was the significant impact factor for the survival rate, because only 30.0% the survival rate in recurrent cases existed. During the follow-up, there were 15 (40.5%) patients with confirmed recurrence, and the 5-year survival rate of these patients was decreased as 46.7%. Conclusion The classification of clinical and pathological TNM stage, local recurrence after surgery, and metastasis of cervical lymph node after surgery were analyzed as the 3 most significant factors. PMID:24471047

  15. Renal amyloidosis followed more than 5 years: report of 12 cases.

    PubMed

    Kaaroud, H; Boubaker, K; Béji, S; Abderrahim, E; Moussa, F Ben; Turki, S; Goucha, R; Hedri, H; El Younsi, F; Kheder, A; Maiz, H Ben

    2004-01-01

    Renal involvement with amyloidosis is common but causes patient survival to be poor, rarely reaching 5 years. In this study, we retrospectively reviewed clinical and biological characteristics as well as treatments and outcomes of patients with renal amyloidosis followed for more than 5 years. Between 1975 and 2003, 485 patients were diagnosed with renal amyloidosis including only 12 patients who were followed more than 5 years. The six men and six women of mean age 42.4 years (range 18 to 66 years) displayed renal signs of lower limb edema in all cases; hypertension in four cases, proteinuria on urinalysis in all cases with microscopic hematuria in five cases. Biological tests showed nephrotic syndrome in 11 patients, normal renal function in nine patients, and renal failure in three patients whose mean creatinine was 481.6 micromol/L (range 294 to 726). The amyloidosis was AA type in 11 cases and non-AA in one case. An etiologic survey revealed spondylarthropathy in one patient, pulmonary tuberculosis in two patients, chronic bronchitis in three patients, hepatic hydatic cyst in one patient, Mediterranean familial fever in two patients, Crohn's disease in one patient, Hodgkin's lymphoma in one patient, and multiple myeloma in one patient. Specific treatment was initiated with colchicine in seven patients. At a 110-month mean follow-up (range 53 to 153 months), remission of nephrotic syndrome was observed in four cases, progression to chronic renal failure in two patients, and to end-stage renal failure in five cases (range 53 to 196 months), with stabilization of renal function in seven patients. In conclusion, primary amyloid disease should be optimally suppressed in patients with renal involvement. The role of this treatment in remission of renal amyloidosis is not well established. This efficacy of the treatment has been demonstrated in some patients with improved survival.

  16. Transgender voice and communication treatment: a retrospective chart review of 25 cases.

    PubMed

    Hancock, Adrienne B; Garabedian, Laura M

    2013-01-01

    People transitioning from male to female (MTF) gender seek speech-language pathology services when they feel their voice is betraying their genuine self or perhaps is the last obstacle to representing their authentic gender. Speaking fundamental frequency (pitch) and resonance are most often targets in treatment because the combination of these two voice characteristics can account for the majority of how listeners perceive a speaker's gender. Intonation, voice quality, pragmatics and non-verbal communication contribute to a lesser extent but are usually recommended in treatment guidelines. There are few examples of effective treatment with male-to-female transgender individuals in the literature. Due to a small number of reports, it remains unclear how closely clinical practice follows recommended approaches and the extent to which gains may be expected. The purpose of this study was to examine retrospectively 5 years' worth of cases of voice feminization treatment at a university clinic in order to describe a unique clinical population and report treatment techniques and outcomes. Demographic information and treatment outcome data (e.g. acoustic measures) were available for collection from 25 of the 32 cases discharged from a university clinic between 2006 and 2010. Behavioural targets of treatment goals also were examined. Clients were in various stages of male-to-female gender transitions during treatment; at discharge, 80% of them presented as female 100% of the time. A majority (88%) had a history of feminizing hormone treatment and 28% presented with a voice disorder separate from gender presentation concerns. Treatment goals included the following (listed in order of percentage of cases that addressed the topic): forward resonance, increased fundamental frequency or pitch, physical and mental relaxation, intonation, phonotraumatic behaviours, breath control, non-verbal communication, pragmatics, and vocal hygiene. After treatment, clients had increased

  17. A retrospective review of performance and utility of routine clinical pelvimetry.

    PubMed

    Blackadar, Charles S; Viera, Anthony J

    2004-01-01

    Some authorities have questioned the utility of performing clinical pelvimetry as part of routine prenatal care. This study determined the frequency with which clinical pelvimetry is still performed at two military hospitals and whether the results of pelvimetry influence the management of labor and delivery. We conducted a retrospective review of prenatal records at two military hospitals. One was an overseas hospital, and one was a family medicine teaching hospital in the United States. The records of 660 pregnant women were reviewed to identify documentation that pelvimetry was performed during prenatal care and whether there was evidence that the physician managing labor and delivery altered management based on pelvimetry results. Seventy percent (461) of the 660 records reviewed had all pelvimetry measurements documented as normal, or the provider had written "good for TOL (trial of labor)," "proven to XX pounds," or similar annotation that pelvimetry was normal. Nine percent (58 records) had no documentation of pelvimetry (pelvimetry section left blank). The remaining 21% (141 charts) had at least one pelvimetry measurement listed as abnormal on the initial prenatal exam. No admission note, progress note, or operative note recorded during labor and delivery made reference to clinical pelvimetry results. No abnormal pelvimetry result was referenced in follow-up visits or appeared to make any difference in mode of delivery or treatment in labor. Two women (one at each institution) had initial visit notes indicating the need to consider radiographic pelvimetry based on the results of clinical exam, but this test was not done in either case, and both women delivered vaginally. Our study indicates that clinical pelvimetry does not change management of pregnant patients. Current practice is to allow all women a trial of labor regardless of pelvimetry results. This makes the routine performance and recording of clinical pelvimetry a waste of time, a potential

  18. Vitamin D Levels and Monospot Tests in Military Personnel with Acute Pharyngitis: A Retrospective Chart Review

    PubMed Central

    Maloney, Sean R.; Almarines, David; Goolkasian, Paula

    2014-01-01

    Some recent studies have proposed an important role for vitamin D in reducing the risk of infection by assisting in the suppression of viruses and by controlling the inflammatory response. A low vitamin D state may have a detrimental effect on the immune system’s ability to produce activated CD8+ T cells, and it may increase the inflammatory reaction to Epstein Barr virus. The aim of this chart review was to see if serum 25 OH vitamin D3 levels in service members with acute pharyngitis were lower in those who had positive rather than negative monospot tests. A retrospective chart review was conducted on the medical records of service members who presented to sick call at Camp Lejeune, NC with acute pharyngitis from October 8, 2010 until June 30, 2011. Serum 25 OH vitamin D3 levels were compared between those with positive and negative monospot test results. Of the 25 records that were reviewed, there were 9 (36%) service members with positive results, and they were found to have lower vitamin D levels (Median = 20.80 ng/ml, Interquartile range = 10.15) than those with negative test results (Median = 30.35 ng/ml, Interquartile range = 17.05), Mann-Whitney U = 41, p = .039. Only 1 of the 9 with positive test results had a normal serum 25 OH vitamin D3 level (30 ng/ml or greater) compared with 9 of the 16 with negative test results. Optimal vitamin D stores may play a significant role in reducing the risk of developing acute mononucleosis but larger, prospective studies will be needed to verify these findings. PMID:25009977

  19. [Ocular Metastasis in Lung Cancer: a Retrospective Analysis in a Single Chinese Hospital and Literature Review].

    PubMed

    Xu, Yan; Sun, Yiduo; Zhao, Jing; Chen, Minjiang; Jiangde, Lina; Li, Longyun; Zhong, Wei; Wang, Mengzhao

    2017-05-20

    Eye is a rare site of lung cancer metastasis, and ocular metastasis is one of the largest challenges to cancer patients' quality of life (QOL). Here we present our experience on ocular metastasis of lung cancer and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. The records of 9 patients with ocular metastasis of lung cancer treated at our hospital were analyzed. A literature review identified 42 cases reported in the last 10 years and their medical records were retrospectively estimated. The median age of our patients was 51 years (range 41-61). Diagnosis of lung cancer included non-small cell lung carcinoma (NSCLC) in 7 patients, in which adenocarcinoma (ADC) were recorded in 6 patients, small cell lung carcinoma (SCLC) in 1 patient, and unknown in 1 patient. The site of ocular metastasis included choroid (n=8) and iris (n=1). In the literature review, SCLC constituted 21.4% (n=9) and ADC constituted 47.6% (n=20). Choroid presented to be the most common site for eye metastasis (66.7%, n=28). As for disease control rate, systemic chemotherapy for lung cancer patients with ocular metastasis presented to be only 28%. Meanwhile, combination of systemic treatment with ocular treatment could improve patients' eye symptoms effectively. The most common lung cancer that metastasizes to the eye is ADC. The choroid is the most common site for ocular metastasis. Ocular treatment can improve patients' eye symptoms, while the effect of systemic chemotherapy treatment is limited.

  20. Vitamin D levels and monospot tests in military personnel with acute pharyngitis: a retrospective chart review.

    PubMed

    Maloney, Sean R; Almarines, David; Goolkasian, Paula

    2014-01-01

    Some recent studies have proposed an important role for vitamin D in reducing the risk of infection by assisting in the suppression of viruses and by controlling the inflammatory response. A low vitamin D state may have a detrimental effect on the immune system's ability to produce activated CD8+ T cells, and it may increase the inflammatory reaction to Epstein Barr virus. The aim of this chart review was to see if serum 25 OH vitamin D3 levels in service members with acute pharyngitis were lower in those who had positive rather than negative monospot tests. A retrospective chart review was conducted on the medical records of service members who presented to sick call at Camp Lejeune, NC with acute pharyngitis from October 8, 2010 until June 30, 2011. Serum 25 OH vitamin D3 levels were compared between those with positive and negative monospot test results. Of the 25 records that were reviewed, there were 9 (36%) service members with positive results, and they were found to have lower vitamin D levels (Median = 20.80 ng/ml, Interquartile range = 10.15) than those with negative test results (Median = 30.35 ng/ml, Interquartile range = 17.05), Mann-Whitney U = 41, p = .039. Only 1 of the 9 with positive test results had a normal serum 25 OH vitamin D3 level (30 ng/ml or greater) compared with 9 of the 16 with negative test results. Optimal vitamin D stores may play a significant role in reducing the risk of developing acute mononucleosis but larger, prospective studies will be needed to verify these findings.

  1. When should women be recruited to intrapartum research projects? A retrospective review.

    PubMed

    Phipps, Hala; de Vries, Bradley; Kuah, Sabrina; Hyett, Jon A

    2013-11-01

    To review and describe the impact of varied recruitment processes in two intrapartum studies. Retrospective review of one prospective cohort study and one pilot randomized controlled trial. Australian tertiary referral hospital. Women with term, cephalic singleton pregnancies. Recruitment processes in one observational and one interventional study examining the management of occipitoposterior position in labor were reviewed. Data concerning recruitment and serial attrition for these studies were collected. The value of allowing consent in early labor in addition to consent in the antenatal period was assessed. Relative proportions of women participating compared with the numbers approached and recruited. One in 48 women approached about the observational study agreed to participate and then had a fetus in occipitoposterior position. One in 33 women in the intervention study were eventually randomized. Women approached in early labor were more likely to agree to participate (77% vs. 58%; p < 0.0001), more likely to have an ultrasound scan during labor (40% vs. 15%; p < 0.0001) and more likely to be randomized to intervention (4% vs. 1.5%; p = 0.02). Intrapartum research is associated with low rates of recruitment and these rates may be improved by asking women to provide informed consent during labor rather than the antenatal period. It is important to consider ways to facilitate randomized controlled trials involving women in labor to advance evidence-based care in this environment. This should include prospective research that seeks to define the best approach to patient recruitment. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review

    PubMed Central

    2012-01-01

    Background The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ. Methods We conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used. Results Out of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died. Conclusion This chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources. PMID:23234429

  3. Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review.

    PubMed

    Ahmad Hatib, Nur Adila; Chong, Chia Yin; Thoon, Koh Cheng; Tee, Nancy Ws; Krishnamoorthy, Subramania S; Tan, Natalie Wh

    2016-07-01

    Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore. A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records. Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries. Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.

  4. Breast cancer in women in their thirties (2007-2013): a retrospective review.

    PubMed

    Arleo, Elizabeth Kagan; Reichman, Melissa; Dashevsky, Brittany Zadek; Babagbemi, Kemi; Drotman, Michele

    2015-01-01

    Due to an increasing number of breast cancer diagnoses in younger women anecdotally noted at our institution, we conceived of this study %was to retrospectively review the records of women diagnosed with breast cancer under the age of 40 for potentially alterable versus unalterable risk factors in their history. Between 2007 and 2013, there were 52 patients less than 40 years of age with breast cancer at our institution: 79% (41/52) presented with a clinical abnormality (palpable mass, nipple discharge or inversion) and 21% (11/52) were asymptomatic but diagnosed on early screening mammograms. Seventy-five percent (39/52) of the cancers had an invasive component and 87% (45/52) were intermediate to high grade. Sixty percent (31/52) of subjects had stage 0 or I disease, but 40% (21/52) had later stage disease (stage II or greater). The vast majority of the cancers were ER+ (82%) and PR+ (78%). Fifty-six percent (28/50; 2 unknown) of the subjects had a documented history of hormonal contraception. Fifty-three percent (27/51; 1 unknown) of had no family history of breast cancer whatsoever, and 80% (41/51) had no family history of breast cancer in a first degree relative. Six were positive for BRCA 1, 2, or a variant (6/52 = 12%).

  5. Funding grant proposals for scientific research: retrospective analysis of scores by members of grant review panel.

    PubMed

    Graves, Nicholas; Barnett, Adrian G; Clarke, Philip

    2011-09-27

    To quantify randomness and cost when choosing health and medical research projects for funding. Retrospective analysis. Grant review panels of the National Health and Medical Research Council of Australia. Panel members' scores for grant proposals submitted in 2009. The proportion of grant proposals that were always, sometimes, and never funded after accounting for random variability arising from differences in panel members' scores, and the cost effectiveness of different size assessment panels. 59% of 620 funded grants were sometimes not funded when random variability was taken into account. Only 9% (n = 255) of grant proposals were always funded, 61% (n = 1662) never funded, and 29% (n=788) sometimes funded. The extra cost per grant effectively funded from the most effective system was $A18,541 (£11,848; €13,482; $19,343). Allocating funding for scientific research in health and medicine is costly and somewhat random. There are many useful research questions to be addressed that could improve current processes.

  6. Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases.

    PubMed

    Bertrand, Styles L; Lincoln, Eric D; Prohaska, Matthew G

    2011-12-06

    Primary pyomyositis of the pelvic musculature is a condition rarely seen in temperate climates, although its frequency has been increasing in the United States. The condition should be considered in the initial differential diagnosis of an adolescent presenting with fever, difficulty ambulating, and hip pain. This is a retrospective review of 8 cases of primary pelvic pyomyositis in patients aged 18 years or younger who were treated at the Children's Medical Center in Augusta, Georgia. The site of infection was the obturator internus in the majority of the cases (5). The site was the gluteus, iliopsoas, and iliacus in 1 case each. Four patients who were diagnosed early responded to intravenous antibiotics with no need for further intervention. Two patients required incision and drainage of an abscess combined with antibiotics. Two patients had prolonged hospital courses requiring intensive unit care and mechanical ventilation. Blood cultures were positive in 87.5% of patients, and all patients presented with elevated acute phase reactants. One of the most difficult diagnostic aspects of presentation is an inconclusive symptom profile. It is noteworthy that patients with pelvic pyomyositis may present with limited range of motion in a specific plane (the motion placing the infected muscle on stretch) vs global limited range of motion of the joint as is commonly seen in septic arthritis. Early diagnosis is essential to prevent systemic illness and complications associated with this condition. Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment.

  7. Successful Surgical Treatment of Intractable Chylous Ascites Using the Lymphatic Cable Flap: A Retrospective Review Study.

    PubMed

    Chen, Shih-Heng; Yeh, Li-Fan; Ciudad, Pedro; Chen, Hung-Chi

    2017-07-31

    For evaluation of a novel surgical procedure for the treatment of chylous ascites. Chylous ascites is a debilitating condition associated with high morbidity and mortality rates. At least one-third of patients are refractory to medical therapy and may warrant further treatment. Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging. A novel flap based on deep inferior epigastric vessels with its surrounding lymphatic fatty tissue was designed in this study and transferred into abdominal cavity, with anastomosis to the fourth jejunal vessels. Three consecutive cases with chylous ascites treated by this vascularized lymphatic cable transfer were retrospectively reviewed. All three patients recovered from chylous ascites after the lymphatic cable transfer and tolerated regular diet well, with follow-up of 3 years at least. Lymphatic cable flap based on the deep inferior epigastric vessels could be a potential option for treatment of intractable chylous ascites, with safe and successful long-term outcomes in three consecutive patients. The proposed functional mechanism of the flap is bypass of the obstructed intra-abdominal lymphatics to an extraperitoneal route as well as local lymphangiogenesis.

  8. Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review.

    PubMed

    Joyce, Christine; Witcher, Robert; Herrup, Elizabeth; Kaur, Savneet; Mendez-Rico, Elena; Silver, Gabrielle; Greenwald, Bruce M; Traube, Chani

    2015-11-01

    Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population. Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects. Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome. In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.

  9. Incidence and possible causes of nontraumatic convexal subarachnoid haemorrhage in Chinese patients: A retrospective review.

    PubMed

    Zhao, Haiyan; Han, Jintao; Lu, Ming; Zhang, Yingshuang; Fan, Dongsheng

    2016-07-07

    To explore the incidence and possible underlying pathogenic mechanisms of nontraumatic convexal subarachnoid haemorrhage (cSAH; a rarely reported condition) in a cohort of Chinese patients. Medical records from all patients with subarachnoid haemorrhage (SAH) who had been treated at Peking University Third Hospital, China, between January 2010 and December 2014 were retrospectively reviewed to identify cases of cSAH. Of 144 patients with SAH, cSAH was observed in 14 cases (9.7%). The most frequent presenting symptoms in cSAH cases were severe headache (n = 8) and a focal neurological deficit (n = 8). The parietal (10/14 patients, 71.4%) and frontal (9/14 patients, 64.3%) lobes were the most common haemorrhage sites. Cause of cSAH was identified in 11 patients: in seven cases (50.0%), significant stenosis or occlusion in the internal carotid artery system, ipsilateral to cSAH, was reported; in four cases, cSAH was caused by cerebral venous sinus thrombosis, cerebrovascular malformation, anticoagulant therapy or possible cerebral amyloid angiopathy. cSAH is an important subtype of nonaneurysmal SAH, with diverse aetiologies. In the present study, internal carotid artery system atherosclerotic stenosis was the most frequent cause of cSAH. © The Author(s) 2016.

  10. Sensory processing issues in young children presenting to an outpatient feeding clinic: A retrospective chart review

    PubMed Central

    Davis, Ann M.; Bruce, Amanda S.; Khasawneh, Rima; Schulz, Trina; Fox, Catherine; Dunn, Winifred

    2012-01-01

    Objectives To describe the relationship between sensory issues and medical complexity in a series of patients presenting to an outpatient multidisciplinary feeding team for evaluation, by a standardized measure of sensory processing abilities. Methods A retrospective chart review of all patients seen from 2004–2009 on two key variables; medical diagnostic category and Short Sensory Profile (SSP) score. Results On the SSP, 67.6% of children scored in the clinical (“Definite difference”) range. The most common diagnostic categories were Developmental (n=23), Gastrointestinal (n=16) and Neurological (n=13). Behavioral and Cardiorespiratory medical diagnostic categories were significantly related to SSP total score and SSP definite difference score. Conclusions Children who present for feeding evaluation do indeed tend to have clinically elevated scores regarding sensory processing, and these elevated scores are significantly related to certain medical diagnostic categories. Future research is needed to determine why these significant relationships exist as well as their implications for treatment of feeding related issues. PMID:22986370

  11. Cephalosporin Induced Disulfiram-Like Reaction: A Retrospective Review of 78 Cases

    PubMed Central

    Ren, Shiyan; Cao, Yuxia; Zhang, Xiuwei; Jiao, Shichen; Qian, Songyi; Liu, Peng

    2014-01-01

    Concomitant ingestion of alcohol and cephalosporin may cause a disulfiram-like reaction; however its fatal outcomes are not commonly known. We retrospectively reviewed 78 patients who had cephalosporin induced disulfiram-like reaction (CIDLR). The patients who had a negative skin test to cephalosporin prior to intravenous antibiotics were included, and those who were allergic to either alcohol or antibiotics were excluded. The average age of 78 patients was 37.8±12.2 (21–60) years. Of the 78 patients, 93.58% of the patients were males, 70.51% of the patients consumed alcohol after use of antibiotics, and 29.49% patients consumed alcohol initially, followed by intravenous antibiotics; however, no significant difference of morbidity was observed in these two groups. All patients were administered antibiotics intravenously. Five of 78 patients (6.41%) developed severe CIDLR too urgently to be rescued successfully. In conclusion, it is important for clinicians to educate patients that no alcohol should be used if one is taking cephalosporin. Also, clinicians should keep in mind that cephalosporin should not be prescribed for any alcoholics. PMID:24670024

  12. How global MS prevalence is changing: A retrospective chart review in the United Arab Emirates.

    PubMed

    Schiess, Nicoline; Huether, Katherine; Fatafta, Taghreed; Fitzgerald, Kathryn C; Calabresi, Peter A; Blair, Iain; Alsaadi, Taoufik; Szolics, Miklos

    2016-09-01

    Multiple Sclerosis (MS) is an autoimmune disorder leading to central nervous system inflammation. Traditionally, reported MS prevalence rates in the Middle East are low. Few studies include age/sex standardization giving an unreliable estimate of regional prevalence. to determine the prevalence, incidence and characteristics of MS in Abu Dhabi, United Arab Emirates. A retrospective chart review was conducted at the four largest hospitals in Abu Dhabi Emirate between 2010 and 2014. Data collected included MS type, age and symptoms at onset, expanded disability status scale, treatment, laboratory findings and family history. 510 patients were identified consisting of 318 (62.2%) Emiratis and 192 (37.6%) expatriates. Total crude prevalence rate was 18/100,000 (95% CI: 10-30/100,000). Crude prevalence rate in Emiratis was 57.09 (95% CI:50 to 63/100,000) but increased to 64.44 (95% CI: 57 to 72/100,000) when age standardized. Age-standardized incidence rate in Emiratis was 6.0 MS cases per 100,000 person-years (95% CI: 5.5 to 6.5 cases per 100,000 person-years). At 64.44/100,000, the Abu Dhabi Emirati population has one of the highest, most reliable prevalence rate on the Arab peninsula. Age/sex standardized prevalence rates, uncommonly reported in the Middle East, should be standard for all prevalence studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Morbidity associated with high gastrocnemius recession: retrospective review of 126 cases.

    PubMed

    Rush, Shannon M; Ford, Lawrence A; Hamilton, Graham A

    2006-01-01

    To evaluate morbidity associated with surgical lengthening of the gastrocnemius, medical records were reviewed retrospectively for 126 patients (mean age, 49.7 years; range, 8-78 years) who had undergone open gastrocnemius recession. Ten patients had isolated recession; 116 had gastrocnemius recession with an additional foot or ankle procedure on the ipsilateral limb. During a mean follow-up period of 19 months (range, 6-50 months), all patients were examined for any postoperative complications associated with the recession. Complications were defined as the presence of postoperative infection, wound dehiscence, nerve problems, decreased muscle strength, scar problems, or calcaneus gait (overlengthening). Uncomplicated outcome was defined as absence of all these complications and return to regular activity, both occurring during a follow-up of at least 6 months. Postsurgical complications developed in 9 (6%) of the 126 patients: 6 (4%) had scar problems, 2 (1.33%) had wound dehiscence, 2 (1.33%) had infection, 3 (2%) had nerve problems, and 1 (0.67%) developed complex regional pain syndrome. No patient complained of either a limp or gait disturbance. Neither persistent decrease in muscle strength nor calcaneus gait was seen. These data suggest that the open gastrocnemius recession procedure has low associated morbidity.

  14. A ten year retrospective review of orbital complications secondary to acute sinusitis in children.

    PubMed

    Suhaili, D N Pengiran; Goh, B S; Gendeh, B S

    2010-03-01

    Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.

  15. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study.

    PubMed

    Guner, Savas; Guner, Sukriye Ilkay; Isik, Yasemin; Gormeli, Gokay; Kalender, Ali Murat; Turktas, Ugur; Gokalp, Mehmet Ata; Gozen, Abdurrahim; Isik, Mustafa; Ozkan, Sezai; Turkozu, Tulin; Karadas, Sevdegul; Ceylan, Mehmet Fethi; Ediz, Levent; Bulut, Mehmet; Gunes, Yusuf; Gormeli, Ayse; Erturk, Cemil; Eseoglu, Metehan; Dursun, Recep

    2013-01-01

    This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma. We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome. The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively. The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

  16. Full-tendon nasal transposition of the vertical rectus muscles: a retrospective review.

    PubMed

    Dawson, Emma L M; Boyle, Natalie J; Lee, John P

    2007-01-01

    The authors report the results of a retrospective review of patients who underwent nasal transposition of the vertical rectus muscles between 1997 and 2004. Eight patients were identified, 4 males and 4 females. There was an average age at surgery of 37 years, with a range from 8 to 79 years. The aetiologies included 6 patients with trauma to their medial rectus (4 following endoscopic sinus surgery) and 2 patients with paralytic medial rectus muscles secondary to 3rd nerve palsy. All patients underwent whole tendon transposition of the superior and inferior rectus muscles, with resection of both muscles in 7 cases, before reattachment adjacent to the upper and lower borders of the medial rectus, respectively. One patient had a reduced amount of resection and this was combined with inferior oblique disinsertion and traction sutures. All patients had a reduction in deviation in the primary position and in 5 patients there was some improvement in adduction. A consequence of surgery was a degree of limitation of abduction, elevation and depression in some patients. Overall, patients were satisfied with the improvement in their appearance.

  17. Abdominal ultrasonographic findings associated with feline infectious peritonitis: a retrospective review of 16 cases.

    PubMed

    Lewis, Kristin M; O'Brien, Robert T

    2010-01-01

    The feline infectious peritonitis virus (FIPV) is a mutated form of the feline enteric coronavirus (FeCV) that can present with a variety of clinical signs. The purpose of this retrospective study was to analyze abdominal ultrasonographic findings associated with cats with confirmed FIPV infection. Sixteen cases were included in the study from a review of medical records at two academic institutions; inclusion was based either on necropsy lesions (n=13) or a combination of histopathological, cytological, and clinicopathological findings highly suggestive of FIPV infection (n=3). The liver was judged to be normal in echogenicity in 11 (69%) cats, diffusely hypoechoic in three cats, focally hyperechoic in one cat, and focally hypoechoic in one cat. Five cats had a hypoechoic subcapsular rim in one (n=3) or both (n=2) kidneys. Free fluid was present in the peritoneal cavity in seven cats and in the retroperitoneal space in one cat. Abdominal lymphadenopathy was noted in nine cats. The spleen was normal in echogenicity in 14 cats and was hypoechoic in two. One cat had bilateral orchitis with loss of normal testicular architecture. Although none of these ultrasonographic findings are specific for FIPV infection, a combination of these findings should increase the index of suspicion for FIPV infection when considered along with appropriate clinical signs.

  18. A modified technique for percutaneous dilatational tracheostomy: A retrospective review of 60 cases.

    PubMed

    Sangwan, Yashvir Singh; Chasse, Robert

    2016-02-01

    We describe a modified technique for percutaneous dilatational tracheostomy (PDT) using intermittent bronchoscopy and ultrasound (US). This method requires 1 single physician operator and no special airway adjuncts. Our aim is to reduce the complications associated with the current popular PDT technique, that is, accidental intraprocedural airway loss, intraprocedural bleeding, and hypoventilation associated with use of continuous bronchoscopy. This is a retrospective review of all PDTs performed on intensive care unit patients at a single nonacademic hospital by a pulmonologist using the modified PDT technique. Sixty consecutive PDT procedures were performed using the modified technique. Forty-five percent of the patients were considered high-risk individuals for PDT. There were no deaths from the modified PDT procedure. There were no major complications including accidental extubation, major bleeding, posterior tracheal wall laceration, pneumothorax, hemodynamic instability, severe hypoxemia, or infection. The failure rate of PDT was 1.6%. There was no puncture of the bronchoscope, endotracheal tube, or endotracheal tube balloon. All procedures were performed by 1 single physician operator. Our modified technique demonstrates a potential to reduce accidental intraprocedural airway loss and intraoperative bleeding associated with PDT while possibly improving gas exchange and saving procedural costs. This technique needs to be comparatively studied with current popular PDT technique in a prospective trial to firmly establish associated risks and benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. A 10-year retrospective review of pediatric lung abscesses from a single center

    PubMed Central

    Madhani, Kavi; McGrath, Eric; Guglani, Lokesh

    2016-01-01

    INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding response to treatments and patient outcomes. OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy. METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into two subgroups based on the need for surgical intervention. RESULTS: A total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms, and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups identified the duration of fever and abscess size as risk factors for surgical intervention. CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention. Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted. PMID:27512508

  20. Brain hemorrhages in Jacobsen syndrome: A retrospective review of six cases and clinical recommendations.

    PubMed

    Grossfeld, Paul

    2017-03-01

    Jacobsen syndrome is a rare chromosomal disorder caused by distal deletions in the long arm of chromosome 11. All patients with Jacobsen syndrome have Paris-Trousseau syndrome, a bleeding disorder that causes neonatal thrombocytopenia, and persistent platelet dysfunction. Despite that, to date there are no reported cases of hemorrhagic strokes occurring in patients with Jacobsen syndrome. In the last 6 years at least six cases of brain hemorrhages in patients with Jacobsen syndrome have occurred. In this report, we perform a retrospective review of these six cases. The analysis indicates that the etiology of brain hemorrhages in Jacobsen syndrome is likely multifactorial. A likely cause (or causes) was identified in three of the cases, and additional potential risk factors were identified. Based on these findings, clinical recommendations are provided that should aid in the identification of those individuals with Jacobsen syndrome that are at increased risk for brain hemorrhages, and will hopefully decrease the occurrence of this devastating complication in people with Jacobsen syndrome.© 2017 Wiley Periodicals, Inc.

  1. [Neonatal bronchoscopy: a retrospective analysis of 67 cases and a review of their indications].

    PubMed

    Oliveira-Santos, J A; Pereira-da-Silva, L; Clington, A; Serelha, M

    2004-01-01

    The availability of newer, more sophisticated and versatile bronchoscopes has expanded the spectrum and scope of the indications for bronchoscopy in the newborn infant both for diagnostic and therapeutic purposes. The aim of this study was to carry out a retrospective analysis of the bronchoscopies performed on newborn infants, and to review the indications of this procedure in this age group. Sixty-three patients were submitted to 67 bronchoscopies in a period of 13 years, allowing the diagnosis of 45 anomalies and malformations of the tracheo-bronchial tree, and the performance of 24 bronchoalveolar lavages. In six cases, endoscopic removal of secretions helped to resolve resistant atelectasia, while in another case, with esophageal atresia, intra-operative definition of the fistula tract was possible through catheterisation of the fistula with the bronchoscope. The flexible bronchoscope was preferred for diagnosis by direct visualisation, and the rigid bronchoscope for some diagnostic and therapeutic procedures. Stridor, unexplained cyanosis, hemoptysis, persistent or recurrent pulmonary images, difficulties in the intubation or extubation, and persistent disturbances in ventilation are among the main indications for bronchoscopy in the newborn infant. Bronchoscopy also allows the performance of subsidiary techniques, such as bronchoalveolar lavage, biopsy and laser therapy.

  2. Integrative Care Therapies and Pain in Hospitalized Children and Adolescents: A Retrospective Database Review

    PubMed Central

    Luberto, Christina M.; Bogenschutz, Lois H.; Pelley, Terri J.; Dusek, Jeffrey

    2014-01-01

    Abstract Background: Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. Methods: A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. Results: Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). Conclusions: Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents. PMID:24175871

  3. Long oblique distal osteotomy of the fifth metatarsal for correction of tailor's bunion: a retrospective review.

    PubMed

    London, Barry P; Stern, Stephen F; Quist, Mark A; Lee, Robert K; Picklesimer, Edison K

    2003-01-01

    A long-term retrospective review of a long oblique distal osteotomy of the fifth metatarsal for correction of a tailor's bunion deformity is presented. The technique, results, and follow-up of this procedure are described. The long oblique distal osteotomy was performed on 25 feet on 16 patients. Follow-up ranged from 11 to 110 months with an average of 64.4 months. The average preoperative intermetatarsal 4-5 angle and lateral deviation angle improved from 10.88 degrees and 4.24 degrees, respectively, to 5.52 degrees and -4.24 degrees postoperatively, respectively. A modified scoring scale for lesser metatarsal procedures was used, showing an average postoperative score of 94 out of 100 possible points. Subjectively, 96% (24 of 25) of feet that underwent surgery were rated as excellent or good. Complications included one patient with paresthesias, one soft-tissue infection, and 2 patients had irritation from screws. The authors conclude that the long oblique distal osteotomy is a viable alternative in the correction of tailor's bunion deformity.

  4. Clinical Features of Congenital and Developmental Cataract in East China: A Five-year Retrospective Review.

    PubMed

    Zhu, Xiangjia; Du, Yu; He, Wenwen; Sun, Ting; Zhang, Yinglei; Chang, Ruiqi; Zhang, Keke; Lu, Yi

    2017-06-26

    Congenital/developmental cataract is a significant cause of blindness in children worldwide. Full knowledge of clinical features is essential for early diagnosis and proper treatment to prevent irreversible visual impairment. We conducted a retrospective chart review on 520 congenital/developmental cataract cases based on a five-year clinical data from Eye and ENT Hospital of Fudan University, Shanghai, China. Clinical features including age at the surgery, chief complaints, interval between initial identification of cataract-related manifestations and surgery, etc. were summarized. 56.3% of children were bilateral. The age at surgery ranged from 0.25 to 17.4 years, only 9.2% receiving surgery below 1 year. Interval between initial identification of manifestations and surgery ranged from 2 days to 17 years. Concomitant congenital abnormalities were present in 67 patients, with persistent hyperplastic primary vitreous and congenital heart disease as the most frequent ocular and systemic disorders. Strabismus and nystagmus were seen in 20.6% and 11.9% of patients. In bilateral cataract patients with strabismus, axial lengths of esotropia-affected eyes were statistically shorter than exotropia-affected eyes. These findings provide information on characteristics of congenital/developmental cataract in China and may assist in achievement of comprehensive treating strategies in these cases.

  5. A retrospective review of TATRC funding for medical modeling and simulation technologies.

    PubMed

    Pugh, Carla M; Bevan, Matthew G; Duve, Rebecca J; White, Heather L; Magee, J Harvey; Wiehagen, Gene B

    2011-08-01

    In February 2000, the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC) and the U.S. Army's Simulation, Training, and Instrumentation Command cohosted an Integrated Research Team conference in Maryland. The goal of the conference was to enable end users, researchers, materiel developers, and other government agencies to present their conceptions of how modeling and simulation could and should be developed to meet military medical needs. During the past 9 years, TATRC has funded more than 175 projects relating to simulation. This study was a retrospective review of TATRC's Modeling and Simulation Training projects (N = 175). Our results show that most (>75%) of the funded projects in this study involved industry. More than 85% of the projects that involved industry focused on technology development. Industry development projects seemed to meet their deliverables in a timely fashion. However, academia projects using industry-developed technologies and prototypes were delayed largely because the technologies did not meet their needs. There seems to be a measurable gap between industry's definition of a completed product technology and academia's ability to implement and use the technology in interactive learning environments. Our findings support the need for a standardized strategic design process that involves a strong industry-academia collaboration and early end-user testing to better facilitate the development of sound requirements that guide technology development.

  6. Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review

    PubMed Central

    Sims, Laura; Kulyk, Paul; Woo, Allan

    2017-01-01

    Background Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures. Methods In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012. Patients receiving allograft with positive cultures were reviewed to identify cases of significant infection. Organisms isolated at reoperation were compared with the allograft culture taken at the time of implantation, and we performed a cost assessment. Results Of the 996 allograft bone grafts used, 43 (4.3%) had positive intraoperative cultures and significant postoperative infections developed in 2, requiring reoperation. Antibiotics based on culture results were prescribed in 24% of cases. Organisms cultured at the time of reoperation differed from those isolated initially. The cost of performing 996 allograft cultures was $169 320. Conclusion This series suggests that rates of positive intraoperative bone allograft culture are low, and subsequent infection is rare. In cases of postoperative infection, primary allograft culture and secondary tissue cultures isolated different organisms. Costs associated with performing cultures are high. Eliminating initial culture testing could save $42 500 per year in our health region. PMID:28234217

  7. Continuous subcutaneous use of levetiracetam: a retrospective review of tolerability and clinical effects.

    PubMed

    Rémi, Constanze; Lorenzl, Stefan; Vyhnalek, Birgit; Rastorfer, Karin; Feddersen, Berend

    2014-12-01

    To evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting, we conducted a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, co-administration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions, e.g., irritation or pain at the infusion site. We identified 20 patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings. Most patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. We conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.

  8. Procarbazine and antidepressants: a retrospective review of the risk of serotonin toxicity.

    PubMed

    Kraft, Shawna L; Baker, Nicole M; Carpenter, Julia; Bostwick, Jolene R

    2014-01-01

    Procarbazine is an anticancer agent that also inhibits monoamine oxidase, an enzyme responsible for the metabolism of various catecholamines, including serotonin. A retrospective chart review of lymphoma patients who were treated with both procarbazine and an antidepressant, as well as procarbazine alone, was performed to determine if signs and symptoms of serotonin toxicity were present. A total of 65 patients received procarbazine between 2004 and 2010 and were eligible to be included in the study. Twenty-six of these patients received an antidepressant in combination with procarbazine, with selective serotonin reuptake inhibitors being the most common type of antidepressant. No patients in the study were diagnosed with serotonin toxicity, nor did any meet Hunter's diagnostic criteria for serotonin toxicity. Diarrhea, tremor, and shivering were the symptoms from Sternbach's criteria that were further analyzed, with diarrhea occurring 8.54% of the time, tremor occurring 5.53% of the time, and shivering occurring 2.51% of the time in patients who received an antidepressant with their procarbazine. Despite these symptoms, the diagnosis of serotonin toxicity according to Sternbach's criteria was determined to be unlikely. In this small sample of patients treated with procarbazine plus an antidepressant (most typically SSRIs), there were no reports of serotonin toxicity, nor did any patients demonstrate symptoms consistent with serotonin toxicity. The authors urge clinicians to ensure depression is adequately managed in cancer patients who are undergoing procarbazine therapy, starting with typical first-line antidepressant agents. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Is it safe to admit patients with acute injuries to nonsurgical services? A retrospective review.

    PubMed

    Tutunjian, Alyssa M; Bugaev, Nikolay; Breeze, Janis L; Arabian, Sandra S; Rabinovici, Reuven

    2017-06-01

    Given potential safety risks when admitting injured patients to nonsurgical services (NSS), the American College of Surgeons mandates trauma centers justification. However, evidence supporting this requirement is lacking. Adult patients cleared for admission to a NSS at a level 1 trauma center between 2012 and 2014 were retrospectively reviewed. Patient demographic, injury, and outcome characteristics were compared between nonsurgical (NSA) and surgical admission patients and analyzed for predictive value. Compared with surgical admission patients, NSA patients were significantly older, had a higher number of comorbidities and/or patient and a lower Injury Severity Score, while hospital length of stay, complications, and missed injury and adjusted mortality rates were similar. NSA did not predict mortality whereas increased age, increased Injury Severity Score, and number of comorbidities and/or patient did. As all complications and mortalities were unrelated to injuries per se, admission to a NSS, after protocoled clearance by a trauma or Emergency Department attending, appears to be safe. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Predictors of Infections following Cranioplasty: A Retrospective Review of a Large Single Center Study

    PubMed Central

    Starke, Robert M.; Hann, Shannon; Bovenzi, Cory D.; Saigh, Mark P.; Schwartz, Eric W.; Kunkel, Emily S. I.; Efthimiadis-Budike, Alexandra S.; Jabbour, Pascal; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula I.

    2014-01-01

    Introduction. The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty. Method. Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed. Results. Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% (52/92) were superficial (supragaleal), 43.48% (40/92) were deep (subgaleal), and 31.52% (29/92) were present in both the supragaleal and subgaleal spaces. The predominant pathogen was coagulase-negative staphylococcus (30.43%) followed by methicillin-resistant Staphylococcus aureus (22.83%) and methicillin-sensitive Staphylococcus aureus (15.22%). Approximately 15.22% of all cultures were polymicrobial. Multivariate analysis revealed convex craniectomy, hemorrhagic stroke, and hydrocephalus to be associated with an increased risk of infection (OR = 14.41; P < 0.05, OR = 4.33; P < 0.05, OR = 1.90; P = 0.054, resp.). Conclusion. Many of the risk factors for infection after cranioplasty are modifiable. Recognition and prevention of the risk factors would help decrease the infection's rate. PMID:25401136

  11. Lightning deaths: a retrospective review of New Mexico's cases, 1977-2009.

    PubMed

    Pincus, Jennifer L; Lathrop, Sarah L; Briones, Alice J; Andrews, Sam W; Aurelius, Michelle B

    2015-01-01

    To better understand lightning deaths, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 1977 and 2009 to update and assess current risk factors. Information on demographics, circumstances, autopsy, and death certificates were collected and analyzed. Fifty-four decedents were identified, ages 2-71 years old (mean 34 years old), 42 males and 12 females. Common racial/ethnic groups were non-Hispanic Whites and American Indians (together comprising 72% of all cases). Physical findings were often related to the heat carried by the electrical current including clothing alterations (29.6%) and burning of skin (53.7%). Most deaths occurred on weekend afternoons in summer months, associated with recreational activities or agricultural work, and rural locations (77.8%). Utilizing the demographic information, clustered events, and associated outdoor activities will assist in creating public awareness and provide a framework to support targeted warnings in an attempt to prevent future deaths.

  12. Patterns of skin disease in a sample of the federal prison population: a retrospective chart review

    PubMed Central

    Gavigan, Geneviève; McEvoy, Alana; Walker, James

    2016-01-01

    Background: Dermatology in vulnerable populations is under-researched. Our objective was to analyze the most commonly referred skin diseases affecting the Correctional Service Canada inmates in Ontario. Methods: An observational, cross-sectional, retrospective chart review of inmate patients seen from 2008 until 2013 was performed. Two groups of patients were included in the analysis: those assessed in-person, and those evaluated by e-consult. Results: In the in-person patient group, the 3 most common diagnoses were acne, psoriasis and other superficial mycoses. For the e-consult group, the 3 most frequent diagnoses were acne, psoriasis and rosacea. There was a clear bias toward more inmates being seen in-person where the service was provided (Collins Bay Institution) than from other correctional institutions in Eastern Ontario. Interpretation: Most of the skin diseases that affected the incarcerated population studied were common afflictions, similar to those affecting the general population, which is in agreement with other studies. Future studies investigating skin diseases in male and female inmates across Canada would bestow more generalizable data. PMID:27398381

  13. Quality of medicines in Canada: a retrospective review of risk communication documents (2005–2013)

    PubMed Central

    Almuzaini, Tariq; Sammons, Helen; Choonara, Imti

    2014-01-01

    Objective To explore the quality and safety of medicines in Canada. Design A retrospective review of drug recalls and risk communication documents conveying issues relating to defective (ie, substandard and falsified) medicines. Setting The Health Canada website search for drug recalls and risk communication documents issued between 2005 and 2013. Eligibility criteria Drug recalls and risk communication documents related to quality defect in medicinal products. Main outcome measure Relevant data about defective medicines reported in drug recalls and risk communication documents, including description of the defect, type of formulation, year of the recall and category of the recall or the document. Results There were 653 defective medicines of which 649 were substandard. The number of defective medicines reported by Health Canada increased from 42 in 2005 to 143 in 2013. The two most frequently reported types of defects were stability (205 incidents) and contamination issues (139 incidents). Some of these defects were found to be more prominent and repetitive over other types within some manufacturers. Tablet formulation (251 incidents) was the formulation most frequently compromised. No significant differences were observed between the manufacturers and distributors in the number of substandard medicines reported under each defect type. There were only four falsified medicines reported over the 9-year period. Conclusions Substandard medicines are a problem in Canada and have resulted in an increasing number of recalled medicines. Most of the failures were related to stability issues, raising the need to investigate the root causes and for stringent preventative measures to be implemented by manufacturers. PMID:25361839

  14. Retrospective review of Contura HDR breast cases to improve our standardized procedure

    SciTech Connect

    Iftimia, Ileana; Cirino, Eileen T.; Ladd, Ron; Mower, Herbert W.; McKee, Andrea B.

    2013-07-01

    To retrospectively review our first 20 Contura high dose rate breast cases to improve and refine our standardized procedure and checklists. We prepared in advance checklists for all steps, developed an in-house Excel spreadsheet for second checking the plan, and generated a procedure for efficient contouring and a set of optimization constraints to meet the dose volume histogram criteria. Templates were created in our treatment planning system for structures, isodose levels, optimization constraints, and plan report. This study reviews our first 20 high dose rate Contura breast treatment plans. We followed our standardized procedure for contouring, planning, and second checking. The established dose volume histogram criteria were successfully met for all plans. For the cases studied here, the balloon-skin and balloon-ribs distances ranged between 5 and 43 mm and 1 and 33 mm, respectively; air{sub s}eroma volume/PTV{sub E}val volume≤5.5% (allowed≤10%); asymmetry<1.2 mm (goal≤2 mm); PTV{sub E}val V90%≥97.6%; PTV{sub E}val V95%≥94.9%; skin max dose≤98%Rx; ribs max dose≤137%Rx; V150%≤29.8 cc; V200%≤7.8 cc; the total dwell time range was 225.4 to 401.9 seconds; and the second check agreement was within 3%. Based on this analysis, more appropriate ranges for the total dwell time and balloon diameter tolerance were found. Three major problems were encountered: balloon migration toward the skin for small balloon-to-skin distances, lumen obstruction, and length change for the flexible balloon. Solutions were found for these issues and our standardized procedure and checklists were updated accordingly. Based on our review of these cases, the use of checklists resulted in consistent results, indicating good coverage for the target without sacrificing the critical structures. This review helped us to refine our standardized procedure and update our checklists.

  15. Prevalence and management of oropharyngeal dysphagia in patients with severe anorexia nervosa: A large retrospective review.

    PubMed

    Holmes, Samantha R M; Sabel, Allison L; Gaudiani, Jennifer L; Gudridge, Tricia; Brinton, John T; Mehler, Philip S

    2016-02-01

    Oropharyngeal dysphagia (OPD) refers to difficulty swallowing food or a liquid bolus from the oral and pharyngeal cavities into the esophagus and increases the risk of possibly life-threatening pneumonia. Little has been reported on OPD in adults with anorexia nervosa (AN). This study includes a description of OPD in severe AN and discusses potentially effective clinical management. Two hundred and six adults with severe AN, admitted over a five-year period to a national referral center specializing in the multidisciplinary medical stabilization of this population, were retrospectively evaluated by electronic database query and manual chart review. All patients whose initial medical assessment triggered a speech-language pathology (SLP) consultation, due to concerns for OPD, were reviewed in detail. Of the 206 total patients, 42 presented with symptoms of OPD and received SLP consultation. In the OPD cohort, 37 (88%) were women, with median age 32 years old, and mean admission weights of 57% ideal body weight (IBW) and body mass index (BMI) of 12 kg/m(2). Compared with those who did not have OPD, OPD patients had significantly lower BMI on admission (12 kg/m(2) vs. 13.1 kg/m(2), p < 0.001), longer stay (21 days vs. 14 days, p < 0.001), and were more medically compromised, including a greater incidence of refeeding hypophosphatemia (60.9% vs. 29.7%, p < 0.004). Clinical awareness of OPD may reduce the incidence of aspiration pneumonia and promote life-saving oral nutrition in patients with severe AN. Proper, timely evaluation and intervention may improve clinical outcomes. © 2015 Wiley Periodicals, Inc.

  16. Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

    PubMed Central

    Carman, Claire M.; Tobin, Chase; Chase, Serena A.; Rossmeier, Kerri A.

    2016-01-01

    Background: Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series. Methods: After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery. Results: The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05). Conclusions: In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction. PMID:27975023

  17. Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions.

    PubMed

    Schnarrs, Robert H; Carman, Claire M; Tobin, Chase; Chase, Serena A; Rossmeier, Kerri A

    2016-11-01

    Human acellular dermal matrix (HADM) is commonly used to provide coverage and support for breast reconstruction. The primary purpose of this study was to evaluate the complication rates associated with breast reconstruction procedures when performed in conjunction with multiple types of HADM in a consecutive series. After receiving institutional review board approval, medical records from a single surgeon were retrospectively reviewed for 126 consecutive patients (170 breasts and 211 procedures) who received a breast reconstruction or revision with implantation of HADM between 2012 and 2014. Patient demographics, surgical technique, and the complication profile of 4 major types of HADM were evaluated by procedure. Complication data were primarily evaluated for infection, seroma formation, necrosis, and other complications requiring additional surgery. The total complication rate was 19.4%. The complication rates were not statistically different between all 4 types of HADM: Alloderm (n = 143); Alloderm RTU (n = 19); FlexHD (n = 18); hMatrix (n = 32) (P > 0.05). Smokers and large-breasted women (≥500 g) had a significantly higher complication rate than the rest of the population (P < 0.01 and P < 0.03, respectively). The complication rates associated with all other patient cohorts analyzed (age, body mass index, comorbid conditions, cancer diagnosis, prepectoral technique) showed no influence on complication rates (P > 0.05). In characteristically similar cohorts, there was no statistically significant difference in complication rates based on type of HADM; however, certain risk factors and anatomy should be considered before HADM-assisted breast reconstruction.

  18. A Retrospective Review of Temporal Bone Imaging With Respect to Bone-Anchored Hearing Aid Placement.

    PubMed

    Baker, Aaron R; Fanelli, David G; Kanekar, Sangam; Isildak, Huseyin

    2017-01-01

    Current bone-anchored hearing aid (BAHA) guidelines recommend placement of the titanium implant 5 to 7 cm posterior to the ear canal. Previous studies show that bone conducted hearing is maximized the closer the transducer is to the cochlea. We aim to investigate the position of the sigmoid sinus with respect to BAHA implants to determine whether they may be safely placed closer to the ear canal in patients with chronic ear disease, enhancing the amplification available to the patient. We performed a retrospective review of high-resolution temporal bone computed tomographies (CTs), comparing multiple measurements between ears with chronic ear disease and normal controls. Images were obtained at a single academic medical center. Eighty patients (160 ears) with temporal bone CTs performed between 2006 and 2009 were measured. Patients with chronic ear disease were identified by international statistical classification of diseases and related health problems, revision 9 code and confirmation by review of the imaging. Measurements were made on axial CT slices from a point 1 cm posterior to the sigmoid sinus to the posterior margin of the external canal. The squamous temporal bone thickness was also measured at this point. Forty-seven patients (55 ears) had chronic ear disease. Distance from the posterior canal was significantly different between normal and diseased ears (36.3 mm versus 33.5 mm, p < 0.001). Squamous temporal bone thickness varied widely, and was similar between groups (6.9 mm versus 6.8 mm, p = 0.76). According to our data, titanium implants for bone-anchored hearing aids may be safely placed closer to the external canal than the current recommendations. This could allow for better transduction as well as sound localization in BAHA patients.

  19. Vigabatrin in the treatment of childhood epilepsy: a retrospective chart review of efficacy and safety profile.

    PubMed

    Camposano, Susana E; Major, Philippe; Halpern, Elkan; Thiele, Elizabeth A

    2008-07-01

    To review the efficacy, cognitive outcome and safety profile in children treated with vigabatrin (VGB) for infantile spasms (IS) and partial epilepsies related to tuberous sclerosis complex (TSC) and other etiologies. Retrospective review of children followed in the Pediatric Epilepsy Program of Massachusetts General Hospital for Children between May 2001 and March 2006 who were treated with VGB. Eighty-four children were treated with VGB, 68 of them were treated for IS, and 59 were treated for partial seizures (PS). Etiology (TSC or other) was the only predictive factor for IS control with VGB (p < 0.0003). IS control was achieved in 73% of children with TSC and 27% of children with other etiologies (combined 56%). Partial onset seizures were controlled in 34% of all children, (17% seizure free,17%reduction in seizure frequency >50%) and no predictive factor was found. Shorter time from seizure onset to VGB treatment (p < 0.027) and longer total time on VGB (p < 0.045) was associated with better IQ-developmental quotient (DQ) outcome in children treated for IS, but not with IS control. Adverse events were seen in 13%. Electroretinogram and/or behavioral visual field (VF) testing was done in 52%. VGB was discontinued in one case due to abnormal electroretinogram (ERG) findings. We confirm the efficacy of VGB in the treatment of IS and PS in an American population. VGB may improve cognitive outcome in the absence of complete IS control, but this finding is of uncertain clinical significance. VGB was well tolerated, and ophthalmologic side effects were uncommon.

  20. Characteristics of nontyphoidal Salmonella gastroenteritis in Taiwanese children: A 9-year period retrospective medical record review.

    PubMed

    Hung, Yeh-Ting; Lay, Chorng-Jang; Wang, Chun-Lung; Koo, Malcolm

    Nontyphoidal Salmonella is among the most common causes of acute pediatric gastroenteritis in Taiwan. It is important to study antibiotic resistance patterns in nontyphoidal Salmonella isolated from children. Therefore, the objective of this study was to investigate the prevalence of serogroups and susceptibility to antimicrobial nontyphoidal Salmonella isolated from Taiwanese children with gastroenteritis. A retrospective review of the medical records of patients aged under 18 years with a diagnosis of acute gastroenteritis at a regional hospital located in southern Taiwan from August 2000 to August 2009 was conducted. Patients whose records documented stool cultures positive for nontyphoidal Salmonella underwent serogrouping and antimicrobial susceptibility testing. Of the 1938 patients diagnosed with acute gastroenteritis, 100 (5.2%) had nontyphoidal Salmonella infections. Most of the cases of nontyphoidal Salmonella gastroenteritis occurred during the summer months of July and August. The most common Salmonella strains isolated were classified as belonging to serogroup B (51%). Three cases had blood cultures that tested positive for nontyphoidal Salmonella, all of which were classified as belonging to serogroup C2. Isolates from the stool cultures of 23 cases that occurred between 2007 and 2009 were further tested to determine their antimicrobial susceptibility profiles, and 87% of these isolates were sensitive to two common third-generation cephalosporins (cefotaxime and ceftriaxone). In conclusion, the results of this nine-year period medical record review study suggested that although extended-spectrum cephalosporins were more effective than ampicillin and ciprofloxacin in treating childhood nontyphoidal Salmonella gastroenteritis, only 87% of isolates were susceptible to these agents. Prevention through proper hygienic practices to minimize potential exposure to nontyphoidal Salmonella is clearly a better strategy than treating patients with antibiotics

  1. Neoplastic meningitis: a retrospective review of clinical presentations, radiological and cerebrospinal fluid findings.

    PubMed

    Jearanaisilp, Sorrawit; Sangruji, Tumthip; Danchaivijitr, Chotipat; Danchaivijitr, Nasuda

    2014-08-01

    To review the clinical, radiological, and laboratory presentations of patients with neoplastic meningitis. Patients with neoplastic meningitis were recruited by a retrospective search of cerebrospinal fluid (CSF) cytopathological report database of Siriraj Hospital between 1997 and 2006. Clinical information and CSF result of these patients were extracted from their medical records. Neuroimagings were reviewed by a neuroradiologist. The present study revealed 40 cases of neoplastic meningitis, which comprised of 17 cases with carcinomatous meningitis (CM) and 23 lymphoma/leukemia meningitis (LM) cases. In patients with CM, the majority (70%) had adenocarcinoma of lung or breast. Three of 17 cases with unknown primary tumor had carcinomatous meningitis as an initial presentation. In LM most of the cases (70%) were diagnosed with acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL). The most common symptom among patients with CM and LM was headache follow by cranial nerve palsy. In CM cases, CSF cytology was positive in the first specimen in 15 cases (82.35%) and in 22 from 23 cases (95.7%) in LM cases. Overall CSF showed pleocytosis in 36 cases (90%), most of which were lymphocyte predominant. The most common findings from brain imagings were leptomeningeal enhancement and hydrocephalus. The common primary sites were lung and breast cancer in the CM group and ALL and NHL in the LM group. The common symptoms were headache and cranial nerve palsy. Routine CSF examination was abnormal in virtually all cases. Positive CSF cytology was a gold standard for a diagnosis of leptomeningeal metastasis. High index of suspicious and awareness were required to avoid miss diagnosis.

  2. Safety of preoperative erythropoietin in surgical calvarial remodeling: an 8-year retrospective review and analysis.

    PubMed

    Naran, Sanjay; Cladis, Franklyn; Fearon, Jeffrey; Bradley, James; Michelotti, Brett; Cooper, Gregory; Cray, James; Katchikian, Hurig; Grunwaldt, Lorelei; Pollack, Ian F; Losee, Joseph

    2012-08-01

    Calvarial remodeling is typically associated with significant blood loss. Although preoperative erythropoiesis-stimulating agents have proven to significantly decrease the need for blood transfusions, recent data in adults have raised concerns that elevating hemoglobin levels greater than 12.5 g/dl may increase the risk of thrombotic events. This study was designed to assess the risks of erythropoietin in the pediatric population. Records were retrospectively reviewed from 2000 to 2008 at three major metropolitan children's hospitals of all children undergoing calvarial remodeling after receiving preoperative erythropoietin. Demographic and perioperative outcome data were reviewed, including transfusion reactions, pressure ulcer secondary to prolonged positioning, pneumonia, infection, deep vein thrombosis, cerebrovascular accident, pulmonary embolism, sagittal sinus thrombosis, pure red cell aplasia, and myocardial infarction. A total of 369 patients met the inclusion criteria (mean age, 0.86±1.1 years). On average, three preoperative doses of erythropoietin were administered (600 U/kg). Iron was also supplemented. No complications associated with dosing were noted, there were no thrombotic events identified, and no other major complications were seen (i.e., death or blindness). Thirty-one patients (8.40 percent) experienced one or more postoperative complications. There was no significant correlation between hemoglobin levels greater than 12.5 g/dl and the occurrence of any noted complication. With zero thrombotic postoperative complications, the authors estimate the risk of a thrombotic event in the pediatric population to be less than 0.81 percent (95 percent confidence). These data suggest that preoperative administration of erythropoietin in children undergoing calvarial remodeling does not appear to increase the incidence of thrombotic events or other significant complications. Therapeutic, IV.

  3. Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients.

    PubMed

    Gonzalez, M E; Cantatore-Francis, J; Orlow, S J

    2010-08-01

    Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population. To better characterize the causes of alopecia in a paediatric population. We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients. AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14.8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy. AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

  4. "Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda.

    PubMed

    Gupta, Neil; Kabahizi, Jules; Mukabatsinda, Constance; Walker, Timothy David; Musabeyezu, Emmanuel; Kiromera, Athanase; Van Nuil, Jennifer Ilo; Steiner, Kevin; Mukherjee, Joia; Nsanzimana, Sabin; Mbituyumuremyi, Aimable

    2017-01-01

    Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.

  5. Therapy-Related Explants After Spinal Cord Stimulation: Results of an International Retrospective Chart Review Study.

    PubMed

    Van Buyten, Jean-Pierre; Wille, Frank; Smet, Iris; Wensing, Carin; Breel, Jennifer; Karst, Edward; Devos, Marieke; Pöggel-Krämer, Katja; Vesper, Jan

    2017-08-18

    Clinical trials of spinal cord stimulation (SCS) have largely focused on conversion from trial to permanent SCS and the first years after implant. This study evaluates the association of type of SCS and patient characteristics with longer-term therapy-related explants. Implanting centers in three European countries conducted a retrospective chart review of SCS systems implanted from 2010 to 2013. Ethics approval or waiver was obtained, and informed consent was not required. The chart review recorded implants, follow-up visits, and date and reasons for any explants through mid-2016. Results are presented using Cox regression to determine factors associated with explant for inadequate pain relief. Four implanting centers in three countries evaluated 955 implants, with 8720 visits over 2259 years of follow-up. Median age was 53 years; 558 (58%) were female. Explant rate was 7.9% per year. Over half (94 of 180) of explants were for inadequate pain relief, including 32/462 (6.9%) of implants with conventional nonrechargeable SCS, 37/329 (11.2%) with conventional rechargeable and 22/155 (14.2%) with high-frequency (10 kHz) rechargeable SCS. A higher explant rate was found in univariate regression for conventional rechargeable (HR 1.98, p = 0.005) and high-frequency stimulation (HR 1.79, p = 0.035) than nonrechargeable SCS. After covariate adjustment, the elevated explant rate persisted for conventional rechargeable SCS (HR 1.95, p = 0.011), but was not significant for high-frequency stimulation (HR 1.71, p = 0.069). This international, real-world study found higher explant rates for conventional rechargeable and high-frequency SCS than nonrechargeable systems. The increased rate for conventional rechargeable stimulation persisted after covariate adjustment. © 2017 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals, Inc. on behalf of International Neuromodulation Society.

  6. Desmopressin administration in children with central diabetes insipidus: a retrospective review.

    PubMed

    Ooi, Hooi Leng; Maguire, Ann M; Ambler, Geoffrey R

    2013-01-01

    Central diabetes insipidus (DI) is a rare disorder in children caused by a deficiency of antidiuretic hormone arginine (vasopressin). Desmopressin is the first line agent in management of central DI. However, one of the side effects of desmopressin is water intoxication and hyponatraemia. This study reviews the patterns of desmopressin use and side effects in our institution. Retrospective chart review of all patients with central DI followed up in one tertiary centre between 1 January 2008 and 31 December 2010. Forty-one patients (22 males and 19 females) were included. Twelve patients (29.3%) had congenital and 29 patients (70.7%) had acquired DI, mostly as a result of intracranial tumours. Thirty-six (87.8%) patients were on oral desmopressin and the remaining on nasal formulation. The median oral dose was 9.5 (4.2-17.0) μg/kg/day with median frequency of 2.5 (2-3). The median nasal dose was 0.7 (0.4-1.4) μg/kg/day with median frequency of 2.0 (2-3.5). Fourteen patients (34.1%) were switched from nasal to oral desmopressin with the median dose conversion factor of 20.1 (10.7-31.8). Forty percent of patients on nasal desmopressin experienced hypo/hypernatraemia compared to 18.1% on oral, however, there were no significance difference between standardized hypo/hypernatraemia episodes per treatment year. Oral desmopressin is used in the majority of our patients including infants and toddlers. There is wide inter-individual variation in dose requirement and dosing intervals. Management of central diabetes insipidus remains a challenge in adipsic patients and in young children during intercurrent illness regardless of the desmopressin formulation.

  7. A retrospective review of the outcomes of migraine surgery in the adolescent population.

    PubMed

    Guyuron, Bahman; Lineberry, Kyle; Nahabet, Edward H

    2015-06-01

    Migraine surgery has been studied extensively in adult patients with refractory headaches. The purpose of this study was to review a single surgeon's outcomes following migraine surgery in an adolescent population. A retrospective review of all patients operated on by the senior author (B.G.) from 2000 to 2014 was performed. All patients aged 18 years or younger with at least 1 year of follow-up after surgery were included. Preoperative and postoperative migraine frequency, duration, severity, and migraine headache days and migraine index were analyzed for statistical significance. A total of 14 patients and 15 operations were analyzed. After an average follow-up of 38.2 months, the frequency of migraine headaches per 30-day period was reduced from 25 to 5 (p < 0.0001), the migraine headache index decreased from 148.1 to 12.4 (p < 0.0001), the duration of headaches (number of hours per 24 hours) declined from 0.71 to 0.25 (p = 0.002), severity of headaches diminished from 8.2 to 4.3 (p = 0.0004), and migraine days per month declined from 25 to 5 (p < 0.0001). Five patients remained free of any symptoms following surgery. One patient had no improvement in frequency of headaches, but did have improvement in severity and duration of headaches. No postoperative complications were noted in this group of patients. In the adolescent population with migraine headaches refractory to traditional medical management, migraine surgery may offer symptomatic improvement of migraine headache frequency, duration, and severity in patients with identifiable anatomical trigger sites. Therapeutic, IV.

  8. Victims of the Palestinian uprising (Intifada): a retrospective review of 220 cases.

    PubMed

    Emile, H; Hashmonai, D

    1998-01-01

    The purpose of this study was to review the cases of the victims of the Palestinian uprising (Intifada) and to describe the clinical presentations, the types of weapons used, and the different sites of injuries. This is a retrospective chart review study of the patients who were injured during the Palestinian uprising in the period April 1993-April 1994 and treated in the emergency department of the Barzilai Medical Center, Ashkelon, Israel. The Barzilai Medical Center is a regional level II trauma referral general hospital. Two hundred and twenty patients were injured during the Palestinian uprising and referred to our emergency department. Forty-one patients were citizens of the Gaza area, 26 patients were Israeli civilians, and 153 were Israeli soldiers. There were 55 patients (25%) injured by firearms, 10 patients (4.5%) by explosives, and 120 (54.5%) by striking stones. Seventy-three patients (33.2%) were hospitalized, and 22 patients needed surgery. The most commonly injured part of the body was the lower limb among the Gaza citizens and the head and neck among the Israeli soldiers and civilians. Striking stones was the most common means of injury used by the Palestinians, and stab wounds by knives and other sharp objects were the most common injuries among Israeli civilians. None of the patients suffered direct blast injuries. The Palestinian uprising resulted in many victims and disabled people in both nations. Terrorism did not cease after the peace treaty. It changed its face and moved from Gaza to the center of Israel. Suicidal terrorist bombing in public spaces and public buses carries more danger and more victims with much more severe injuries. We hope that the future will be brighter, and both nations will eventually be able to live in peace.

  9. Health and growth status of immigrant and refugee children in Toronto, Ontario: A retrospective chart review

    PubMed Central

    Salehi, Leila; Lofters, Aisha K; Hoffmann, Susan M; Polsky, Jane Y; Rouleau, Katherine D

    2015-01-01

    OBJECTIVE: To describe selected anthropometric and health status variables among immigrant and refugee children ≤6 years of age within an inner city clinic in Toronto, Ontario. METHODS: A retrospective chart review of patients born between January 1, 1998 and December 31, 2008, was conducted at a Toronto community health centre serving a primarily immigrant and refugee population. Outcome measures included calculated age-specific percentiles for height and weight, and the prevalence of anemia, iron deficiency, enteric parasites, elevated lead levels, HIV and hepatitis B. Postal codes were collected and used to determine the patient’s neighbourhood income quintile. RESULTS: A total of 331 patients, born between January 1, 1998 and December 31, 2008, were identified. Of these, a total of 210 charts were manually reviewed. The prevalence of height-for-age and weight-for-age under the third percentile on the Centers for Disease Control and Prevention Growth Charts were 7.2% and 11.6%, respectively, and 8.4% and 5.0%, respectively, on the WHO Growth Standards Chart. Prevalence rates were also calculated for anemia (22.8%), iron deficiency (53.3%), hepatitis B (2.5%), parasitic infections (33.6%), elevated blood lead levels (4.9%) and HIV (0%). Neighbourhood income quintiles revealed that 46.7% of patients were residing in the lowest (ie, poorest) income quintile neighbourhoods. CONCLUSION: These findings reveal a high burden of illness within the population presenting to an immigrant/refugee health clinic, and illustrate the need for further research in this area, as well as increased efforts to ensure appropriate screening within clinics serving a high volume of newcomer patients. PMID:26744562

  10. Retrospective chart review of 44 fetuses with cervicofacial tumors in the sonographic assessment.

    PubMed

    Zielinski, Rafal; Respondek-Liberska, Maria

    2015-03-01

    The aim of this retrospective study was to review and analyze ultrasonography examinations and follow-up of fetuses with cervicofacial tumors to develop bases for counseling specialist involved in perinatal treatment. The study consisted of case series with chart review of 44 fetuses with cervicofacial tumors diagnosed in utero by ultrasonography. The study was carried in Department of Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz in years 1998-2013. The analysis of the fetuses with cervicofacial tumors included assessment of fetal sonographic features, neonatal survival and in utero as well as perinatal treatments. The obtained data were analyzed by the standard statistical tests and the Pearson's Chi square test, statistical significance at p=0.05. Cervicofacial tumors were detected at mean 19±7 weeks of gestation. Eighty-two percent of the fetuses were males. Lymphatic malformations followed by teratomas were the most common fetal tumors in the cervicofacial region. In most cases, fetuses with cervicofacial tumors had other abnormalities. Mortality rate in our case series was 43%. In utero treatment was introduced in 6 fetuses. In 4 neonates prenatal sonographic assessment revealed upper airway patency and EXIT procedure (ex-utero intrapartum treatment) was introduced. Prenatal sonographic detection of cervicofacial tumor, in case of lymphatic malformations possibly as early as in the first trimester, in case of craniofacial teratomas, cervical teratomas, hemangiomas and thyroid tumors possibly as early as in the second trimester, and in case of epignathi possibly in the third trimester, permits planning further course of pregnancy as well as EXIT procedure before delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Transversus abdominis plane block in renal allotransplant recipients: A retrospective chart review

    PubMed Central

    Gopwani, SR; Rosenblatt, MA

    2016-01-01

    Context: The efficacy of the transversus abdominis plane (TAP) block appears to vary considerably, depending on the surgical procedure and block technique. Aims: This study aims to add to the existing literature and provide a more clear understanding of the TAP blocks role as a postoperative analgesic technique, specifically in renal allotransplant recipients. Settings and Design: A retrospective chart review was conducted by querying the intraoperative electronic medical record system of a 1200-bed tertiary academic hospital over a 5 months period, and reviewing anesthetic techniques, as well as postoperative morphine equivalent consumption. Materials and Methods: Fifty renal allotransplant recipients were identified, 13 of whom received TAP blocks while 37 received no regional analgesic technique. All blocks were performed under ultrasound guidance, with 20 mL of 0.25% bupivacaine injected in the transversus abdominis fascial plane under direct visualization. The primary outcome was postoperative morphine equivalent consumption. Statistical Analysis Used: Morphine consumption was compared with the two-tailed Mann–Whitney U-test. Continuous variables of patient baseline characteristics were analyzed with unpaired t-test and categorical variables with Fischer Exact Test. A P < 0.05 was considered statistically significant. Results: A statistically significant decrease in cumulative morphine consumption was found in the group that received the TAP block at 6 h (2.46 mg vs. 7.27 mg, P = 0.0010), 12 h (3.88 mg vs. 10.20 mg, P = 0.0005), 24 h (6.96 mg vs. 14.75 mg, P = 0.0013), and 48 h (11 mg vs. 20.13 mg, P = 0.0092). Conclusions: The TAP block is a beneficial postoperative analgesic, opiate-sparing technique in renal allotransplant recipients. PMID:27833477

  12. Outcomes of tympanostomy tube placement in children with Down syndrome--a retrospective review.

    PubMed

    Paulson, Lorien M; Weaver, Tyler S; Macarthur, Carol J

    2014-02-01

    Tympanostomy tubes are commonly used for treatment of chronic otitis media with effusion (COME) or recurrent acute otitis media (RAOM) in patients with Down syndrome, but hearing outcomes in this population have been mixed, and complications appear to be common. We aim to characterize outcomes and complications associated with tympanostomy tube placement in this population. Retrospective review. All patients with Down syndrome presenting to a tertiary academic pediatric otolaryngology practice over a ten year period from 2002 to 2012 who received tympanostomy tubes for COME, RAOM, or hearing loss were reviewed. Long term follow up data was obtained in 102 patients, with average follow up 4.7 years. COME was the primary indication for tube placement in 100/102 (98%). Less than half of these patients (44%) initially failed their newborn hearing screen. Post operative hearing was found to be normal or near normal for the better hearing ear in 85/99 (85.9%), and normal to near normal in bilateral ears in 71/99 (71%). A majority (63.7%) of patients required two or more sets of tubes during the follow up period. Long term complications were common and were significantly increased if the patient required three or more sets of tubes, including chronic perforation (36.6% vs 8.2%, p<0.001), atelectasis (29.3% vs 1.6%, p<0.0001), and cholesteatoma (14.6% vs 0%, p=0.003). COME is a frequent problem in Down syndrome, and the majority of patients will require two or more sets of tubes during their childhood and achieve normal postoperative hearing. Long term complications of otitis media appear to be more common in this population and appear to correlate with increasing number of tubes placed. More investigation is required to determine optimal treatment strategies for COME in patients with Down syndrome. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Morbidity and mortality in infant mountain gorillas (Gorilla beringei beringei): A 46-year retrospective review.

    PubMed

    Hassell, James M; Zimmerman, Dawn; Cranfield, Michael R; Gilardi, Kirsten; Mudakikwa, Antoine; Ramer, Jan; Nyirakaragire, Elisabeth; Lowenstine, Linda J

    2017-10-01

    Long-term studies of morbidity and mortality in free-ranging primates are scarce, but may have important implications for the conservation of extant populations. Infants comprise a particularly important age group, as variation in survival rates may have a strong influence on population dynamics. Since 1968, the Mountain Gorilla Veterinary Project (MGVP, Inc.) and government partners have conducted a comprehensive health monitoring and disease investigation program on mountain gorillas (Gorilla beringei beringei) in Rwanda, Uganda, and the Democratic Republic of the Congo. In an effort to better understand diseases in this species, we reviewed reliable field reports (n = 37), gross post-mortem (n = 66), and histopathology (n = 53) reports for 103 infants (less than 3.5 years) mountain gorillas in the Virunga Massif. Our aim was to conduct the first comprehensive analysis of causes of infant mortality and to correlate histological evidence with antemortem morbidity in infant mountain gorillas. Causes of morbidity and mortality were described, and compared by age, sex, and over time. Trauma was the most common cause of death in infants (56%), followed by respiratory infections and aspiration (13%). Gastrointestinal parasitism (33%), atypical lymphoid hyperplasia (suggestive of infectious disease) (31%), and hepatic capillariasis (25%) were the most significant causes of antemortem morbidity identified post-mortem. Identifying the causes of mortality and morbidity in infants of this critically endangered species will help to inform policy aimed at their protection and guide ante- and post-mortem health monitoring and clinical decision-making in the future. © 2017 Wiley Periodicals, Inc.

  14. Validity of Adult Retrospective Reports of Adverse Childhood Experiences: Review of the Evidence

    ERIC Educational Resources Information Center

    Hardt, Jochen; Rutter, Michael

    2004-01-01

    Background: Influential studies have cast doubt on the validity of retrospective reports by adults of their own adverse experiences in childhood. Accordingly, many researchers view retrospective reports with scepticism. Method: A computer-based search, supplemented by hand searches, was used to identify studies reported between 1980 and 2001 in…

  15. Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature.

    PubMed

    Pabaney, Aqueel H; Reinard, Kevin A; Massie, Lara W; Naidu, Padmaja K; Mohan, Yedathore S; Marin, Horia; Malik, Ghaus M

    2014-09-01

    Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature. In accordance with the Henry Ford Institutional Review Board, medical records of patients with sAVMs treated from 2000 to 2012 were reviewed. Clinical data were retrospectively collected to calculate pre- and posttreatment modified Rankin Scale scores for all patients. The authors identified 15 patients with sAVMs who received treatment. Of these, 12 were female and 3 were male, and the average age at presentation was 39.6 ± 12.94 years (± SD). Two patients (13.3%) had Spetzler-Martin Grade I lesions, 6 patients (40%) had Grade II lesions, 5 patients (33.3%) had Grade III lesions, and another 2 (13.3%) harbored Grade IV arteriovenous malformations (AVMs). According to the Sugita classification, 6 patients (40%) had medial lesions, 6 (40%) had lateral lesions, 2 (13.3%) had deep lesions, and 1 patient (6.67%) had a pure sAVM. Eight patients (53.3%) underwent stereotactic radiosurgery while 7 patients (46.7%) had microsurgical resection; 1 patient underwent surgical extirpation after incomplete response following radiosurgery. After treatment, 9 patients were unchanged from pretreatment (60%), 3 patients worsened, and 2 patients had improved functional outcome (20% and 13.3%, respectively). The authors' literature search yielded 348 patients with sAVMs, most of them harboring Spetzler-Martin Grade II and III lesions. Approximately 98% of the patients underwent resection with excellent outcomes. While the ideal choice of therapeutic modality for cerebral AVMs remains controversial in light of the recent publication of the ARUBA (A Randomized trial of Unruptured Brain AVMs) trial, a multidisciplinary treatment approach for the

  16. Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

    PubMed

    Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A

    2017-03-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions

  17. Treatment of rape-induced urogenital and lower gastrointestinal lesions among girls aged 5 years or younger.

    PubMed

    Mukwege, Denis; Alumeti, Desiré; Himpens, Jacques; Cadière, Guy-Bernard

    2016-03-01

    To evaluate outcomes after treatment of rape-induced urogenital and lower gastrointestinal lesions among young girls. In a retrospective study, data were assessed from girls aged 5 years or younger who were treated for sexual-assault-related injuries at the General Referral Hospital, Panzi, Bukavu, Democratic Republic of Congo, between 2004 and 2014. Data were obtained from review of charts, records of the mother's impressions and physical examinations, and photographic evidence. Elective surgery had been reserved for patients experiencing fecal and/or urinary incontinence. Overall, 205 girls aged 5 years or younger presented with rape injuries: 162 (79.1%) had only mucocutaneous lesions, 22 (10.7%) had musculocutaneous lesions, and 21 (10.2%) had musculocutaneous lesions complicated by fecal and/or urinary incontinence. Among the 21 girls who underwent perineal surgery, two with fecal and urinary incontinence and perforation of the peritoneum of Douglas pouch were additionally treated by laparoscopy. Among 16 patients with fecal incontinence, the continence score had improved significantly at 10.4 months after surgery (P<0.001). Concomitant urinary incontinence subsided for four of five patients but persisted for one who had a gunshot wound to the vagina. Cosmetic outcome was normal in 19 cases. For rape survivors aged 5 years or younger, a treatment strategy by which surgery is reserved for incontinent patients provided good cosmetic and functional outcomes. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Stereotactic body radiation therapy for nonmetastatic lung cancer: An analysis of 75 patients treated over 5 years

    SciTech Connect

    Beitler, Jonathan J. . E-mail: jbeitler92@alumni.gsb.columbia.edu; Badine, Edgard A.; El-Sayah, Danny; Makara, Denise; Friscia, Phillip; Silverman, Phillip; Terjanian, Terenig

    2006-05-01

    Purpose: Non-small-cell lung cancer (NSCLC) may not be medically operable even in patients with surgically resectable disease. For patients who either refuse surgery or are medically inoperable, radiation therapy may be the best therapeutic choice. Stereotactic body radiation therapy (SBRT) employs external fixation and hypofractionation to deliver a high dose per fraction of radiation to a small target volume. Methods and Materials: Retrospective review of 75 patients treated over 5 years at Staten Island University Hospital as definitive treatment for NSCLC or presumed NSCLC. Patients received a median of 5 fractions of 8 Gy per fraction over 27 days. Results: Overall 1-, 2-, and 5-year actuarial survivals were 63%, 45%, and 17%. Patients with a gross tumor volume (GTV) less than 65 cm{sup 3} enjoyed a longer median survival (25.7 vs. 9.9 months, p < 0.003), and at 5 years, the actuarial survival for the patients with GTVs less than 65 cm{sup 3} was 24% vs. 0% for those with GTVs larger than 65 cm{sup 3}. Conclusions: Stereotactic body radiation therapy as delivered was ineffective for curing the patients whose GTVs were larger than 65 cm{sup 3}. SBRT was promising for those with GTVs less than 65 cm{sup 3}.

  19. Adirondack Park incidents: a retrospective review of search and rescue reports from 2008 and 2009.

    PubMed

    Sadeghi, Rokhsanna; Konwinski, Joseph C; Cydulka, Rita K

    2015-06-01

    The Adirondack Park is a 6 million acre recreational area in northeastern New York used for activities such as hiking, camping, canoeing, hunting, fishing, snowmobiling, skiing, and rock climbing. Given the large number of people who use the Adirondacks for recreation, there exists the potential for many accidents, injuries, and illnesses to occur in areas ranging from state-operated campgrounds to remote backcountry. The aim of this study was to gain insight into the demographics of search and rescue (SAR) operations in the Adirondack Park. This study is a retrospective review of the Adirondack Park Forest Ranger SAR reports from January 1, 2008, through December 31, 2009. Epidemiologic data were gathered from the NY State Department of Environmental Conservation for each report, including victim demographics, incident, reason for injury, medical care needed, preparation of victim, and prior medical conditions. In all, 239 SAR missions were carried out involving at least 349 victims. Of all cases, 28% (66) involved an injured victim, and 9% (21) involved illness; 56% (10) of the victims had a known prior illness or medical condition; and 21% (27) of cases were due to victims exceeding their abilities. Of the search missions, 54% of victims (93) had little experience with the activity, and 9% (15) had no experience. Only 43% (62) of victims had any form of orientation equipment. This study portrays the initial demographics of SAR efforts in Adirondack Park. It will aid in educating people on preparing for wilderness activities, as well as tailoring SAR resources to the demographics of injury and illness within the park. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  20. A retrospective chart review of the features of PTEN hamartoma tumour syndrome in children.

    PubMed

    Hansen-Kiss, Emily; Beinkampen, Sarah; Adler, Brent; Frazier, Thomas; Prior, Thomas; Erdman, Steven; Eng, Charis; Herman, Gail

    2017-07-01

    It is recognised that 5% - 10 % of children with macrocephaly and autism spectrum disorder (ASD) and/or intellectual disability (ID) have a heterozygous pathogenic mutation in the PTEN tumour suppressor gene that is associated with PTEN hamartoma tumour syndrome. However, the clinical features and course in children with a pathogenic PTEN mutation are unclear and have not been well documented. We undertook a retrospective chart review of children (< 18  years) with pathogenic PTEN mutations to ascertain clinical findings, clinical course and possible outcomes. Clinical and molecular data were collected and analysed for 47 patients with PTEN mutation from 38 eligible families. Macrocephaly (average head circumference of + 5.7  SD) with developmental delay, ID and/or ASD were the most common presenting signs/symptoms (66 %). Clinical features included dermatological findings (66 %), gastrointestinal (GI) symptoms (34 %), ASD diagnosis (50 %), abnormal brain imaging (53 % of those examined) and abnormal thyroid imaging (26 %). This is the largest survey of clinical features in children with PTEN pathogenic mutations to date. It confirms earlier reports of increased rates of neurodevelopmental disorders. Dermatological, GI and thyroid abnormalities are age dependent and may not be present at the time of diagnosis, requiring regular monitoring and medical surveillance. Early paediatric diagnosis is important for institution of medical and developmental surveillance as well as for testing other at- risk family members. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review.

    PubMed

    Parks, Rachel B; Hetzel, Scott J; Brooks, M Alison

    2017-08-01

    To describe the prevalence of anemia among incoming female college athletes and to characterize the results and expenses of iron-related testing at one National Collegiate Athletic Association Division I institution. In this retrospective medical record review, hemoglobin (Hgb) and ferritin laboratory values were obtained for student-athletes at a single institution, 2002 to 2014. Laboratories were collected either as part of the preparticipation examination (PPE) for female athletes, routine screening for cross-country athletes, or as needed for medical evaluation. Anemia was defined as Hgb < 11.6 g·dL for females and < 13.6 g·dL for male athletes. Iron deficiency was defined as Fer < 20 ng·mL for both sexes. A total of 5674 laboratory draws were obtained for 2749 individuals (56% female) from 25 different teams. The prevalence of low Hgb among female athletes at PPE was 5.7% (95% confidence interval, 4.4%-6.9%). At PPE, the incidence of anemia was not significantly higher for any sport when compared with the group mean. Ferritin and Hgb were collected together in approximately one third of all blood draws from females (n = 1059) and one sixth of blood draws from males (n = 411). For female athletes, 2.2% indicated iron deficiency anemia and 30.9% indicated iron deficiency without anemia. For male athletes, 1.2% indicated iron deficiency anemia and 2.9% indicated iron deficiency without anemia. The median cost of iron testing exceeded US $20,000 annually for the institution. One in 20 incoming female athletes was identified with anemia at the PPE. Given the costs of testing, screening practices at each institution should be thoughtfully selected and routinely reassessed.

  2. Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review

    PubMed Central

    Lim, Anita WW; Landy, Rebecca; Castanon, Alejandra; Hollingworth, Antony; Hamilton, Willie; Dudding, Nick; Sasieni, Peter

    2016-01-01

    Background Cervical cancer in young women presents a diagnostic challenge because gynaecological symptoms are common but underlying disease is rare. Aim To explore the potential for using cytology as a diagnostic aid for cervical cancer in young women. Design and setting Retrospective review of primary care records and cytology data from the national cervical screening database and national audit of cervical cancers. Method Four datasets of women aged 20–29 years in England were examined: primary care records and national screening data from an in-depth study of cervical cancers; cytology from the national audit of cervical cancers; whole-population cytology from the national screening database; and general-population primary care records from the Clinical Practice Research Datalink. The authors explored the sensitivity and positive predictive value (PPV) of symptomatic cytology (earliest <12 months before diagnosis) to cervical cancer. Results The estimated prevalence of cervical cancer among symptomatic women was between 0.4% and 0.9%. The sensitivity of moderate dyskaryosis (high-grade squamous intraepithelial lesion [HSIL]) or worse in women aged 20–29 years was 90.9% to 96.2% across datasets, regardless of symptom status. The PPV was estimated to be between 10.0% and 30.0%. For women aged 20–24 years, the PPV of ‘?invasive squamous carcinoma’ was 25.4%, and 2.0% for severe or worse cytology. Conclusion Cytology has value beyond screening, and could be used as a diagnostic aid for earlier detection of cervical cancer in young women with gynaecological symptoms by ruling in urgent referral. PMID:27777232

  3. Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review.

    PubMed

    Lim, Anita Ww; Landy, Rebecca; Castanon, Alejandra; Hollingworth, Antony; Hamilton, Willie; Dudding, Nick; Sasieni, Peter

    2016-12-01

    Cervical cancer in young women presents a diagnostic challenge because gynaecological symptoms are common but underlying disease is rare. To explore the potential for using cytology as a diagnostic aid for cervical cancer in young women. Retrospective review of primary care records and cytology data from the national cervical screening database and national audit of cervical cancers. Four datasets of women aged 20-29 years in England were examined: primary care records and national screening data from an in-depth study of cervical cancers; cytology from the national audit of cervical cancers; whole-population cytology from the national screening database; and general-population primary care records from the Clinical Practice Research Datalink. The authors explored the sensitivity and positive predictive value (PPV) of symptomatic cytology (earliest <12 months before diagnosis) to cervical cancer. The estimated prevalence of cervical cancer among symptomatic women was between 0.4% and 0.9%. The sensitivity of moderate dyskaryosis (high-grade squamous intraepithelial lesion [HSIL]) or worse in women aged 20-29 years was 90.9% to 96.2% across datasets, regardless of symptom status. The PPV was estimated to be between 10.0% and 30.0%. For women aged 20-24 years, the PPV of '?invasive squamous carcinoma' was 25.4%, and 2.0% for severe or worse cytology. Cytology has value beyond screening, and could be used as a diagnostic aid for earlier detection of cervical cancer in young women with gynaecological symptoms by ruling in urgent referral. © British Journal of General Practice 2016.

  4. Alternative laronidase dose regimen for patients with mucopolysaccharidosis I: a multinational, retrospective, chart review case series.

    PubMed

    Horovitz, Dafne Dain Gandelman; Acosta, Angelina X; Giugliani, Roberto; Hlavatá, Anna; Hlavatá, Katarína; Tchan, Michel C; Lopes Barth, Anneliese; Cardoso, Laercio; Embiruçu de Araújo Leão, Emília Katiane; Esposito, Ana Carolina; Kyosen, Sandra Obikawa; De Souza, Carolina Fischinger Moura; Martins, Ana Maria

    2016-04-29

    Enzyme replacement therapy (ERT) with laronidase (recombinant human α-L-iduronidase, Aldurazyme®) is indicated for non-neurological signs and symptoms of mucopolysaccharidosis type I (MPS I). The approved laronidase dose regimen is weekly infusions of 0.58mg/kg, however, patients and caregivers may have difficulty complying with the weekly regimen. We examined clinical outcomes, tolerability, compliance, and satisfaction in a series of patients who switched to every other week infusions. This multinational, retrospective, chart review case series analyzed data from 20 patients who had undergone ERT with laronidase 0.58mg/kg weekly for more than one year, and who then switched to 1.2mg/kg every other week. The majority of patients had attenuated MPS I phenotypes (9 with Hurler-Scheie and 8 with Scheie syndromes) and 3 patients had severe MPS I (Hurler syndrome). Most patients presented with organomegaly (17/20), umbilical and/or inguinal hernia (16/20), cardiac abnormalities (17/20), musculoskeletal abnormalities (19/20), and neurological and/or developmental deficits (15/20). Following laronidase treatment, signs stabilized or improved. No deterioration or reversal of clinical outcome was noted in any patient who switched from the weekly dose of 0.58mg.kg to 1.2mg/kg every other week. There were no safety issues during the duration of every other week dosing. Patient compliance and satisfaction with the dosing regimen were greater with every other week dosing than weekly dosing. An alternative dose regimen of 1.2mg/kg laronidase every other week was well tolerated and clinically similar to the standard dose for patients who were stabilized with weekly 0.58 mg/kg for one year or more. When an individualized approach to laronidase therapy is necessary, every other week dosing may be an alternative for patients with difficulty receiving weekly infusions.

  5. A retrospective case note review of laparoscopic versus open reversal of Hartmann’s procedure

    PubMed Central

    Yeomans, NP

    2014-01-01

    Introduction First described in 1921, Hartmann’s procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18–22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. Methods This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann’s procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups. Results The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORH patients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann’s procedure. Conclusions The overall reversal rate for Hartmann’s procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH. PMID:25245735

  6. Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review.

    PubMed

    Erice, Alejo; Neira, M Inmaculada; Vargas-Prada, Sergio; Chiaraviglio, Ana; Gutiérrez-Guisado, Javier; Rodríguez de Oya, Ricardo

    2017-06-23

    Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and<30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  7. A retrospective review of the medical management of hypertension and diabetes mellitus following sleeve gastrectomy.

    PubMed

    Tritsch, Adam M; Bland, Christopher M; Hatzigeorgiou, Christos; Sweeney, Lori B; Phillips, Michael

    2015-04-01

    Bariatric surgery is being performed with increasing frequency in the USA as a definitive treatment for morbid obesity and associated comorbidities. Management strategies of type 2 diabetes mellitus (T2DM) and hypertension (HTN) medications in sleeve gastrectomy (SG) patients postoperatively are unclear, specifically in the immediate postoperative period and 6 months following surgery. From 01 June 2010 to 30 June 2011, at a single military medical facility, a retrospective review of 88 consecutive SG patients was conducted to examine the postoperative medical management of HTN and T2DM. Patient's HTN and T2DM medication regimens were evaluated for 6 months postoperatively. Categorical data was analyzed using chi-square, and continuous data was compared using the Student t test. Statistical analyses were completed with Stata, version 12. Fifty patients were prescribed an average of 2.21 HTN medications at baseline which was reduced to an average of 1.23 (p < 0.01) medications per patient at 1 month. Twenty-four patients received an average of 1.41 oral T2DM medications with a reduction to 0.70 (p < 0.01) on average at 1 month postoperatively. Medication changes persisted throughout the 6-month follow-up. Among T2DM patients requiring insulin therapy, the mean insulin dose was 42.1 units reduced to 16.8 units immediately postoperatively (p < 0.01) which persisted at 1 month. At 6 months, the mean insulin dose was 13.3 units. Medication adjustments for HTN and T2DM made immediately in the postoperative period following SG persisted throughout the 6-month follow-up period and in some patients, required further adjustments.

  8. Ambulatory postoperative ward-based epidural analgesia: a retrospective review of 1,147 cases.

    PubMed

    Duff, P; Daly, C; McCrory, C

    2013-03-01

    A retrospective review of 1,147 patients who received epidural analgesia (EA) in surgical wards from January 2008 to December 2009 to determine the prevalence of early ambulation and assess the efficacy and safety of EA for postoperative pain management. Outcome measures were the prevalence of ambulation, pain scores at rest/movement and adverse events. Patients (N = 1,147) who received postoperative EA between January 2008 and December 2009 were included. Motor function was assessed using the Bromage scale. Ambulation was defined as: Day 1: mobilisation from bed to chair, walking on the spot, taking a few steps, thereafter walks of increasing duration and distance at least twice daily. Pain scores were measured using the verbal numerical rating scale (0-10), ≤4 signifying successful analgesia. Daily assessments and data recordings were performed by clinical nurse specialists (CNSs) using standardised charts. Data collected included patient demographics, surgical procedure, ambulation achieved, pain scores at rest/movement and adverse events. The data was analysed using Microsoft Excel(®). The prevalence of ambulation was 88% and this was maintained for the duration of EA. Ninety-eight percent of patients reported pain scores of ≤4 at rest and 88% reported pain scores of ≤4 on movement. Adverse events included motor block 12%, nausea 9%, hypotension 8%, catheter dislodgement 3.8%, leakage from insertion site 1.6%, decubitus ulcers 0.58% and infection 0.001%. Mean duration of EA was 4 days. Ward-based EA facilitates early ambulation, provides excellent postoperative pain relief and is associated with low prevalence of adverse events.

  9. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    PubMed

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  10. Hypnosis for treatment of insomnia in school-age children: a retrospective chart review

    PubMed Central

    Anbar, Ran D; Slothower, Molly P

    2006-01-01

    Background The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. Methods A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7–17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. Results Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. Conclusion Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children. PMID:16914044

  11. Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

    PubMed Central

    Toro, Giuseppe; Calabrò, Giampiero; Toro, Antonio; de Sire, Alessandro; Iolascon, Giovanni

    2015-01-01

    Summary Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered ‘unsuccessfully treated’ the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 ‘unsuccessfully cases’, 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available. PMID:27134634

  12. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review.

    PubMed

    Donaldson, L H; Gill, A J; Hibbert, M

    2016-11-01

    There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates. A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%. In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high. © 2016 Royal Australasian College of Physicians.

  13. A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls.

    PubMed

    Jopling, Ellen N; Khalid-Khan, Sarosh; Chandrakumar, Shivani F; Segal, Shira C

    2016-07-21

    With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%-20% of the patients in mental health outpatient facilities and 15%-40% in mental health inpatient facilities. Further, while 75%-80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

  14. Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature

    PubMed Central

    2013-01-01

    Background Granulosa tumors were described for the first time in 1855 by Rokitansky. These tumors are malignancies with a relatively favorable prognosis. They are characterized by a prolonged natural history and a tendency to late recurrences. The aim of this study is to investigate the epidemiological and pathological characteristics of granulosa cell tumors and to investigate the prognosis factor for recurrences. Methods The clinical data of patients who were treated in the period from January 2003 to December 2010 at the National Institute of Oncology in Rabat, Morocco for adult granulosa cell tumors of the ovary were investigated retrospectively. Data for age, clinical manifestation, imaging, diagnosis and treatment of the patients were reviewed and analyzed. Post-operative histology was obtained for all patients. Results Twenty-seven cases were retrieved. The median patient age was 53 years. The most common clinical manifestations at diagnosis were abdominal pain and vaginal bleeding. Mean tumor size was 14 cm. The majority of patients had stage I (63%, n = 17), while (18,5%, n = 5) had stage III, (7.4%, n = 2) had stage IV, and (11%, n = 3) of patients had an unknown stage. In the follow-up period (median = 63.44 months), five (18.51%) patients relapsed. The median time to relapse was 41.8 months, (range: 18 to 62 months). Conclusions Granulosa cell tumor of the ovary is an uncommon neoplasm. The adult form progresses slowly and often is diagnosed in an early stage of disease. Surgery is indicated. A prolonged post-therapeutic follow-up is necessary because of the risk of recurrences, late and exceptional for the adult form. PMID:23777285

  15. Mercy for money: Torture's link to profit in Sri Lanka, a retrospective review.

    PubMed

    Block, Wendell; Lee, Jessica; Vijayasingham, Kera

    2017-01-01

    The purpose of this retrospective study is to describe the pattern of bribe taking in exchange for release from torture, during and after the decades-long war in Sri Lanka. We reviewed the charts of 98 refugee claimants from Sri Lanka referred to the Canadian Centre for Victims of Torture for medical assessments prior to their refugee hearings in Toronto between 1989 and 2013. We tallied the number of incidents in which claimants described paying cash or jewelry to end torture, and collected other associated data such as demographics, organizations of the perpetrators, locations, and, if available, amounts paid. We included torture perpetrated by both governmental and nongovernmental militant groups. Collected data was coded and evaluated. We found that 78 of the 95 subjects (82.1%) whose reported ordeals met the United Nations Convention Against Torture/International Criminal Court definitions of torture described paying to end torture at least once. 43 subjects paid to end torture more than once. Multiple groups (governmental and non-governmental) practiced torture and extorted money by doing so. A middleman was described in 32 percent of the incidents. Payment amounts as reported were high compared to average Sri Lankan annual incomes. The practice of torture and related monetary extortion was still reported after the end of the war, inclusive of 2013. Torture in Sri Lanka is unlikely to end while profit motives remain unchallenged. As well as health injuries, victims of torture and their families suffer significant economic injuries while their assailants are enriched. The frequent link between torture and impunity means multiple populations the world over are vulnerable to this abuse.

  16. Bronchoscopic foreign body extraction in a pulmonary medicine department: a retrospective review of egyptian experience.

    PubMed

    Korraa, Emad; Madkour, Ashraf; Wagieh, Khaled; Nafae, Ahmed

    2010-01-01

    Foreign body (FB) removal in our hospital was almost exclusively performed by surgeons through a rigid bronchoscope until the pulmonologists started getting involved in FB extraction. This study aimed to retrospectively review the results of 2 years of experience with 120 patients who presented or were referred to the Pulmonary Medicine Department, Ain Shams University Hospital in Cairo, Egypt, with clinical suspicion of FB aspiration during the period between December 2006 and December 2008. FBs were removed by either rigid and/or flexible bronchoscopy using either general or topical anesthesia. There were 54 male and 66 female patients with an age range between 3 months and 70 years and 68.5% of the patients were under the age of 10 years. Ninety patients (75%) presented with a definite history of FB aspiration, with a time interval between aspiration and presentation ranging between less than 6 hours and 12 months. The FB was visible on the chest x-ray in 42 cases. Aspirations were primarily into the right lung (53.2%). Seeds and scarf pins were the most common FB found, and were retrieved in 36 cases. Pulmonologists were successful in extracting 110 out of 111 (99.1%) bronchoscopically visualized FBs, and open thoracotomy was required in only 1 case for FB removal. In another 6 cases, only mucous plug was found to be the endogenous FB, whereas no FB could be found in 3 cases. No mortality or serious complications took place during or after the bronchoscopy. In conclusion, pulmonologists can extract FBs easily and safely either by using rigid and/or flexible bronchoscopes if they have the appropriate experience.

  17. Physician-Directed Heart Failure Transitional Care Program: A Retrospective Case Review

    PubMed Central

    Ota, Ken S.; Beutler, David S.; Gerkin, Richard D.; Weiss, Jessica L.; Loli, Akil I.

    2013-01-01

    Background Despite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged. Methods This is a retrospective review of 73 patients enrolled in our hospital-based, physican-directed Heart Failure Transitional Care Program (HFTCP). This study evaluated the 30- and 90- day readmission rates before and after enrollment in the program. The Transitionalist’s services focused on bedside consultation prior to hospital discharge, follow-up home visits within 72 hours of discharge, frequent follow-up phone calls, disease-specific education, outpatient intravenous diuretic therapy, and around-the-clock telephone access to the Transitionalist. Results The pre-enrollment 30-day readmission rates for acute decompensated heart failure (ADHF) and all-cause readmission was 26.0% and 28.8%, respectively, while the post-enrollment rates for ADHF and all-cause readmission were 4.1% (P < 0.001) and 8.2% (P = 0.002), respectively. The pre-enrollment 90-day all-cause and ADHF readmission rates were 69.8%, and 58.9% respectively, while the post-enrollment rates for all-cause and ADHF were 27.3% (P < 0.001) and 16.4% (P < 0.001) respectively. Conclusions Our physician-implemented HFTCP reduced rehospitalization risk for patients enrolled in the program. This program may serve as a model to assist other hospital systems to reduce readmission rates of patients with HF. PMID:23976905

  18. Physician-directed heart failure transitional care program: a retrospective case review.

    PubMed

    Ota, Ken S; Beutler, David S; Gerkin, Richard D; Weiss, Jessica L; Loli, Akil I

    2013-10-01

    Despite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged. This is a retrospective review of 73 patients enrolled in our hospital-based, physican-directed Heart Failure Transitional Care Program (HFTCP). This study evaluated the 30- and 90- day readmission rates before and after enrollment in the program. The Transitionalist's services focused on bedside consultation prior to hospital discharge, follow-up home visits within 72 hours of discharge, frequent follow-up phone calls, disease-specific education, outpatient intravenous diuretic therapy, and around-the-clock telephone access to the Transitionalist. The pre-enrollment 30-day readmission rates for acute decompensated heart failure (ADHF) and all-cause readmission was 26.0% and 28.8%, respectively, while the post-enrollment rates for ADHF and all-cause readmission were 4.1% (P < 0.001) and 8.2% (P = 0.002), respectively. The pre-enrollment 90-day all-cause and ADHF readmission rates were 69.8%, and 58.9% respectively, while the post-enrollment rates for all-cause and ADHF were 27.3% (P < 0.001) and 16.4% (P < 0.001) respectively. Our physician-implemented HFTCP reduced rehospitalization risk for patients enrolled in the program. This program may serve as a model to assist other hospital systems to reduce readmission rates of patients with HF.

  19. A 10-year retrospective review of Salmonella infections at the Children's Hospital in London, Ontario.

    PubMed

    Cellucci, Tania; Seabrook, Jamie A; Chagla, Yasmine; Bannister, Susan L; Salvadori, Marina I

    2010-01-01

    To describe Salmonella infections in children presenting to the Children's Hospital (London Health Sciences Centre, London, Ontario), to assess risk factors for infection and to examine whether younger children, particularly infants younger than 12 weeks of age, experience higher morbidity than older children. A 10-year retrospective review of children with Salmonella infections at the Children's Hospital was conducted. Patient demographics, risk factors for infection, clinical characteristics, bacteriology and outcome were collected from the hospital charts and laboratory records. Data were separated into groups based on age and recent use of antibiotics to analyze differences in outcomes. Sixty-six children with Salmonella infections presented to the Children's Hospital over a 10-year period. Common risk factors for Salmonella infection included having sick contacts, living in a rural area, recent travel, contact with pets (especially reptiles) and exposure to local water. Younger age was associated with an increased likelihood of admission to hospital, treatment with antibiotics and a longer course of antibiotic therapy. This was true when comparing older infants with those younger than 12 weeks of age. Patients recently treated with antibiotics and those with significant underlying medical conditions were more likely to be admitted. A wider knowledge of the epidemiological risk factors for Salmonella infection may improve diagnosis. Higher admission rates were expected in children younger than 12 weeks of age, those recently treated with antibiotics and those who had a significant underlying medical condition. A prospective, multicentre study is needed to further address questions regarding increased illness severity and appropriate management of Salmonella infections in children younger than 12 weeks of age.

  20. Single-Use Detergent Sacs: A Retrospective Multicenter Canadian Review of Emergency Department Cases.

    PubMed

    Rosenfield, Daniel; Eltorki, Mohamed; VandenBerg, Stephanie; Allain, Dominic; Freedman, Stephen B; Beno, Suzanne

    2016-07-12

    Single-use detergent sacs (SUDS) are widely used in North America and Europe with emerging literature on their toxicity. This is the first Canadian multicenter study aimed to quantify and compare SUDS exposures to traditional detergent exposures. A retrospective review of the Canadian Hospitals Injury Reporting and Prevention Program databases was conducted at the Hospital for Sick Children in Toronto, Alberta Children's Hospital in Calgary and the Stollery Children's Hospital in Edmonton. All exposures presenting to these 3 centers between 2009 and 2014 were identified, a case form was completed, and data were analyzed. Forty cases of SUDS exposure were identified alongside 35 cases of traditional detergent exposure during the study period resulting in an incidence of 3.16 SUDS exposures per million children per year presenting to tertiary pediatric emergency departments (EDs). In contrast, traditional detergent exposures had an incidence of 2.78 exposures per million children per year presenting to tertiary pediatric EDs over the study period. Although there was no change in incidence of exposure to traditional detergent over the study period, there was an increase in the incidence of SUDS exposures from 2010 to 2013, with a decrease seen in 2014. There was no significant difference seen in age, sex, location of exposure, transportation to hospital, morbidity, or mortality associated with SUDS exposures compared with traditional detergent exposure. Although not statistically more likely to cause long-term complications, SUDS-exposed children required more follow-up visits to health care providers than traditional detergents. This multicenter study is the first to establish the incidence of SUDS and traditional detergent exposure in 3 Canadian cities. Overall, the frequency of exposure to detergents-both traditional and SUDS-is very low. Given the increase in SUDS exposure seen from 2011 to 2013, alongside larger sales of SUDS, continued efforts are required to

  1. Risk factors for morphoea disease severity: a retrospective review of 114 paediatric patients.

    PubMed

    Pequet, M S; Holland, K E; Zhao, S; Drolet, B A; Galbraith, S S; Siegel, D H; Chiu, Y E

    2014-04-01

    Morphoea is a rare fibrosing disease of the skin and subcutaneous tissue with an unpredictable disease course, running the spectrum from mild skin involvement to severe disfigurement or extracutaneous complications. Our objective was to describe the natural history of paediatric morphoea and determine patient variables that were associated with severe disease. We conducted a retrospective chart review of patients with morphoea seen in one paediatric hospital system. Information about demographics, clinical characteristics, disease course and treatment were collected. Statistical analysis was performed using appropriate univariate tests and a multivariable model. One hundred and fourteen patients met study inclusion criteria. The female : male ratio was 2·6 : 1, and the median age of onset was 7 years old. There were 55 patients (48%) with linear morphoea, 38 patients (33%) with circumscribed morphoea, 12 patients (11%) with generalized morphoea, and nine patients (8%) with mixed morphoea. Neurological symptoms and joint involvement were present in 27 subjects (24%). Extracutaneous manifestations occurred in 38% of subjects with linear morphoea, compared with 15% with generalized morphoea and 3% with circumscribed morphoea (P = 0·0001). Thirty-six per cent of children with disease onset prior to 10 years of age and 5% of children with disease onset after 10 years of age had extracutaneous manifestations (P = 0·0002). Both linear morphoea and early-onset disease were significantly associated with extracutaneous involvement in a multivariable model. Children with linear morphoea and disease onset before 10 years of age should be monitored closely for extracutaneous manifestations and need early treatment with systemic medications to prevent disease complications. © 2013 British Association of Dermatologists.

  2. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients.

    PubMed

    Rohrich, Rod J; Leedy, Jason E; Swamy, Ravi; Brown, Spencer A; Coleman, Jayne

    2006-02-01

    In 1998, the senior author presented the intraoperative fluid ratio, defined as the volume of super-wet solution and intraoperative intravenous fluid divided by the aspiration volume, to guide resuscitation fluid volumes in super-wet liposuction. The senior author demonstrated that intraoperative fluid ratios of 2.1 for small-volume and 1.4 for large-volume liposuction were safe and did not cause volume overload sequelae. A high urine output was common and reflected a mild overresuscitation, which could have adverse consequences in patients with undiagnosed cardiopulmonary disease. The purpose of this study was to compare overresuscitation sequelae in a cohort of consecutive super-wet liposuction patients using a new fluid management formula in which replacement fluid was given after 5000 cc of lipoaspirate instead of 4000 cc, as initially described. The charts of 89 consecutive patients undergoing super-wet liposuction were retrospectively reviewed. The intraoperative fluid ratio was 1.8 for the small-volume reductions (< 5000 cc, n = 68) and 1.2 (> 5001 cc, n = 21) for the large-volume reductions. There were no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications. The average urine output in the operating room, the recovery room, and while on the floor was 1.5, 1.6, and 2.9 cc/kg/hour for the small-volume group and 1.7, 1.8, and 2.5 cc/kg/hour for the large-volume group. The super-wet subcutaneous infiltration liposuction technique for both small- and large-volume reductions is safe and can be performed without adverse cardiopulmonary sequelae. Given the high urine outputs, the intraoperative fluid ratio can be further improved by possibly eliminating the replacement fluid altogether.

  3. Range Environmental Vulnerability Assessment 5-Year Review, MCAS Cherry Point

    DTIC Science & Technology

    2012-02-01

    MCAS Cherry Point is located within the  Neuse  and White Oak  River  basins.  The subwatersheds  at Cherry Point Main Station consist of dry...ecological receptor exposure  points include tidal creeks and the near‐shore marine environment (e.g., Hancock and Slocum  creeks,  Neuse   River ...1 Water ranges are defined as ranges containing any surface water body such as a stream, creek  river , pond, lake, sea

  4. 75 FR 66724 - Endangered and Threatened Species; 5-Year Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... sawfish should remain listed as endangered species because it is in danger of extinction throughout its.... The list is published at 50 CFR 17.11 (for animals) and 17.12 (for plants). Section 4(c)(2) of the...

  5. Parotid mass: a 5-year review of parotid surgery.

    PubMed

    Chew, Y K; Noorizan, Y; Khir, A; Brito-Mutunayagam, S

    2007-12-01

    This study is to analyze the incidence of facial nerve paralysis after parotidectomy and the type of pathologic condition involved in Hospital Pakar Sultanah Fatimah, Muar between 2002 and 2006. There were 20 parotidectomies done on 20 patients over this period of time. Fourteen were done for tumour and six for inflammatory conditions. The pathology involved were pleomorphic adenoma 9 (45%) cases, Kimura disease 2 (10%) cases, carcinoma 5 (25%) cases and inflammatory condition 4 (20%) cases. Out of 20 parotidectomies done (13 for superficial and 7 for total), 4 (20%) patients had complication of facial nerve paralysis, 2 Malignant tumour, 1 benign tumor and 1 was inflammatory condition. In conclusion, preservation of the facial nerve and its function, wherever possible, is very important to reduce social and functional morbidity.

  6. 5-year review of Metal Hydride Center of Excellence.

    SciTech Connect

    Keller, Jay O.; Klebanoff, Leonard E.

    2010-05-01

    The purpose of the DOE Metal Hydride Center of Excellence (MHCoE) is to develop hydrogen storage materials with engineering properties that allow the use of these materials in a way that satisfies the DOE/FreedomCAR Program system requirements for automotive hydrogen storage. The Center is a multidisciplinary and collaborative effort with technical interactions divided into two broad areas: (1) mechanisms and modeling (which provide a theoretically driven basis for pursuing new materials) and (2) materials development (in which new materials are synthesized and characterized). Driving all of this work are the hydrogen storage system specifications outlined by the FreedomCAR Program for 2010 and 2015. The organization of the MHCoE during the past year is show in Figure 1. During the past year, the technical work was divided into four project areas. The purpose of the project areas is to organize the MHCoE technical work along appropriate and flexible technical lines. The four areas summarized are: (1) Project A - Destabilized Hydrides, The objective of this project is to controllably modify the thermodynamics of hydrogen sorption reactions in light metal hydrides using hydride destabilization strategies; (2) Project B - Complex Anionic Materials, The objective is to predict and synthesize highly promising new anionic hydride materials; (3) Project C - Amides/Imides Storage Materials, The objective of Project C is to assess the viability of amides and imides (inorganic materials containing NH{sub 2} and NH moieties, respectively) for onboard hydrogen storage; and (4) Project D - Alane, AlH{sub 3}, The objective of Project D is to understand the sorption and regeneration properties of AlH{sub 3} for hydrogen storage.

  7. Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients.

    PubMed

    Assi, Maha A; Sandid, Mohamad S; Baddour, Larry M; Roberts, Glenn D; Walker, Randall C

    2007-05-01

    To our knowledge, an institutional review of systemic histoplasmosis has not been conducted in the United States since the major outbreaks in Indianapolis in 1978-4982. We conducted a retrospective review of all patients with systemic histoplasmosis diagnosed at Mayo Clinic over a 15-year period. The case definitions employed were based on an international consensus statement by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/IFICG) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG). One hundred eleven patients with systemic histoplasmosis were identified between January 1, 1991, and December 31, 2005. Of these, 78 patients had disseminated histoplasmosis and 55 patients had Histoplasma capsulatum fungemia. The mean age of patients was 55 years, 66% were male, and 98% were white. Fifty-nine percent of patients were immunocompromised. Fever was the most frequently reported symptom (63%), followed by respiratory complaints (43%) and weight loss (37%). The peripheral white blood cell count was <3000 cells/mm in 28%, hemoglobin was <10 g/dL in 29%, and platelet count was <150,000 cells/mm in 41% of patients. Liver enzymes were elevated (alanine aminotransferase >60 U/L in 39%, aspartate aminotransferase >60 U/L in 27%), alkaline phosphatase was >200 U/L in 55%, and albumin was <3.5 g/dL in 70%. Serologic and histopathologic examinations were each positive in 75% of cases, Histoplasma urine antigen screening was positive in 80%, and H. capsulatum was culture positive in 84%. Forty-seven percent of patients were sequentially treated with an amphotericin B-containing product followed by itraconazole, 31% received itraconazole alone, and 7% received an amphotericin B-containing product only. Another 13% of patients did not receive antifungal treatment, and the remaining 2% did not have treatment data available. Sixty percent of patients required hospitalization, and in

  8. A retrospective review of 911 calls to a regional poison control center.

    PubMed

    Bosak, Adam; Brooks, Daniel E; Welch, Sharyn; Padilla-Jones, Angie; Gerkin, Richard D

    2015-01-01

    There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings. Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08-12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission. A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2-68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1-6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9-3.0). The ORs for several other predictive variables are also reported. When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility.

  9. Abuse potential of carisoprodol: a retrospective review of Idaho Medicaid pharmacy and medical claims data.

    PubMed

    Owens, Christopher; Pugmire, Brooke; Salness, Ty; Culbertson, Vaughn; Force, Rex; Cady, Paul; Steiner, Joseph

    2007-10-01

    Carisoprodol is a muscle relaxant indicated as adjunctive therapy in acute, painful musculoskeletal conditions. Case reports of drug-seeking behavior and utilization of carisoprodol in combination with opioids have suggested abuse potential. We undertook a retrospective review of claims data to identify and characterize potential indicators of abuse in long-term users of carisoprodol and to determine any continued use of the drug by former long-term users following prior authorization implementation. The Idaho Medicaid pharmacy and medical claims database was queried from January 1 to December 31, 2005, to identify long-term users of muscle relaxants. Use of concomitant opioids and coded diagnoses relating to past drug abuse were analyzed and compared between patients who used carisoprodol and patients who used other muscle relaxants. Data from 11 of 30 surveys mailed to pharmacies filling prescriptions for long-term users of carisoprodol were also collected to determine the frequency of self-pay-continued use after Medicaid coverage of the drug was discontinued. Long-term users of carisoprodol (n = 340) and other skeletal muscle relaxants (SMRs) (n = 453) were identified from among 130,000 individuals in the Idaho Medicaid pharmacy and medical claims database in calendar year 2005. Patients in both groups were similar in terms of mean age (~47 years) and sex (71.5% female). Patients using carisoprodol used concomitant opioids more frequently (81.5% vs 59.8%; P < 0.01), more commonly had past diagnoses indicating other drug abuse (34.1% vs 21.4%; P < 0.01), and in 80% of reported cases, continued to pay out of pocket for carisoprodol when third-party coverage was discontinued. Taken together, these findings are consistent with published case reports suggesting the abuse potential of carisoprodol. The results from this review suggest that, compared with long-term users of other SMRs, carisoprodol patients utilized concomitant opioids more frequently and concomitant

  10. The impact of tubal ectopic pregnancy in Papua New Guinea – a retrospective case review

    PubMed Central

    2013-01-01

    Background Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. Methods We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. Results A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. Conclusions Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment

  11. Metabolic effects of antipsychotics in prepubertal children: a retrospective chart review.

    PubMed

    Ebert, Tanya; Midbari, Yael; Shmilovitz, Ronen; Kosov, Ira; Kotler, Moshe; Weizman, Abraham; Ram, Anca

    2014-05-01

    Antipsychotics, especially atypical ones, are in common use in children and adolescents with psychotic or affective spectrum disorders, as well as in various other psychopathologies. The adverse effects of atypical antipsychotics in children and adolescents are similar to those seen in adults, and include weight gain, elevated blood glucose levels, and hyperlipidemia. In this retrospective chart review, we compared these adverse events in children who were treated with typical, atypical, or no antipsychotic treatment. The medical charts of 72 children, 65 boys and 7 girls, were reviewed. All children were 6-13 years old (mean age 9.5±1.7 years). In total, 48 children received antipsychotic treatment, and 24 children were in the control group. Data were extracted from the medical charts, including weight, height, body mass index (BMI), blood pressure, aspartate transaminase (AST), alanine transaminase (ALT), triglycerides, total cholesterol, and glucose blood levels. We examined the values in the beginning of the antipsychotic treatment and at release from the hospital in the study group, and at admission and in the end of the drug-free period or at release from the hospital (a duration of at least 4 weeks) in the control group. The average weight gain was 3.9±3.8 kg in the atypical antipsychotic treatment (AAT) group, 1.1±4.4 kg in the typical antipsychotic treatment (TAT) group, and 0.23±2.9 kg in the control group. The average increase in BMI was 15.1±22.0 percentiles in the AAT group, 6.4±14.2 percentiles in the TAT group, and 1.6±12.5 percentiles in the control group. No statistically significant difference was found in the increase in height percentile. There were no significant differences in the rates of elevated values of serum triglycerides, cholesterol, AST, ALT, or fasting blood glucose. We found a significant increase in both absolute weight gain and BMI percentile following atypical antipsychotic treatment. In contrast, typical

  12. Tuberculosis retreatment 'others' in comparison with classical retreatment cases; a retrospective cohort review.

    PubMed

    Nabukenya-Mudiope, Mary G; Kawuma, Herman Joseph; Brouwer, Miranda; Mudiope, Peter; Vassall, Anna

    2015-09-02

    Many of the countries in sub-Saharan Africa are still largely dependent on microscopy as the mainstay for diagnosis of tuberculosis (TB) including patients with previous history of TB treatment. The available guidance in management of TB retreatment cases is focused on bacteriologically confirmed TB retreatment cases leaving out those classified as retreatment 'others'. Retreatment 'others' refer to all TB cases who were previously treated but with unknown outcome of that previous treatment or who have returned to treatment with bacteriologically negative pulmonary or extra-pulmonary TB. This study was conducted in 11 regional referral hospitals (RRHs) serving high burden TB districts in Uganda to determine the profile and treatment success of TB retreatment 'others' in comparison with the classical retreatment cases. A retrospective cohort review of routinely collected National TB and Leprosy Program (NTLP) facility data from 1 January to 31 December 2010. This study uses the term classical retreatment cases to refer to a combined group of bacteriologically confirmed relapse, return after failure and return after loss to follow-up cases as a distinct group from retreatment 'others'. Distribution of categorical characteristics were compared using Chi-squared test for difference between proportions. The log likelihood ratio test was used to assess the independent contribution of type of retreatment, human immunodeficiency virus (HIV) status, age group and sex to the models. Of the 6244 TB cases registered at the study sites, 733 (11.7%) were retreatment cases. Retreatment 'others' constituted 45.5% of retreatment cases. Co-infection with HIV was higher among retreatment 'others' (70.9%) than classical retreatment cases (53.5%). Treatment was successful in 410 (56.2%) retreatment cases. Retreatment 'others' were associated with reduced odds of success (AOR = 0.44, 95% CI 0.22,0.88) compared to classical cases. Lost to follow up was the commonest adverse outcome (38

  13. Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience.

    PubMed

    Razminia, Mansour; Willoughby, Michael Cameron; Demo, Hany; Keshmiri, Hesam; Wang, Theodore; D'Silva, Oliver J; Zheutlin, Terry A; Jibawi, Hakeem; Okhumale, Paul; Kehoe, Richard F

    2017-04-01

    Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations on our patients for over 5 years. We present a retrospective analysis of the safety, efficacy, and feasibility data from 500 consecutive patients who underwent nonfluoroscopic catheter ablation, targeting a total of 639 arrhythmias, including atrioventricular reciprocating tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT), atrial fibrillation (AF), premature ventricular contractions (PVCs), and ventricular tachycardia (VT). We perform fluoroless ablations using intracardiac electrograms, electroanatomic mapping, and for most cases intracardiac echocardiography. Our experience includes exclusively endocardial cardiac ablations. The mean follow-up was 20.5 months. Recurrence rate for AVRT was 6.5%, for AVNRT 2.5%, for macro-reentrant AT 6.4%, for focal AT 5.4%, for AF 22.6%, for PVC 6.7%, and for VT 21.4%. Major complications occurred in five patients (1.0%); minor complications occurred in three patients (0.6%). No deaths occurred. Fluoroscopy was used in one instance, for 0.3 minutes, to confirm venous access. Completely fluoroless catheter ablations may be routinely performed for all endocardial ablations without compromising safety, efficacy, or procedural duration. © 2017 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  14. The acquired cardiac disease domain: the next 5 years.

    PubMed

    Pepper, John R

    2013-01-01

    At a recent in-house meeting at the European Association for Cardiothoracic Surgery (EACTS) headquarters in Windsor, the Chairs of the four domains were asked by the President to present their perception of the next 5 years in their respective domains. This review represents a distillation of our discussions on adult cardiac surgery. Advances in technology and imaging are having a radical effect on the working lives of surgeons. In clinical practice, the growth of heart teams and the breaking down of artificial barriers between specialities are altering the way we practice for the better. We see the development of hybrid approaches to many areas such as coronary artery surgery and operations on the thoracic aorta. These changes require careful analysis to ensure that they produce better outcomes that are also cost-effective. All health-care systems are at breaking point, and it is our responsibility to harness new technology to benefit our patients. This is all part of placing the patient at the centre of our activities. Hence, we see the involvement of patients in the design and analysis of clinical trials, which also require great mutual trust and cooperation between surgeons in different countries. Because of the dramatic changes in the pattern of working, we have had to alter our patterns of training and education, and we will continue to make significant innovations in the future. These are exciting challenges that will keep us all busy for the next 5 years at least.

  15. Musculoskeletal pain: prescription of NSAID and weak opioid by primary health care physicians in Sweden 2004–2008 – a retrospective patient record review

    PubMed Central

    Brattwall, Metha; Turan, Ibrahim; Jakobsson, Jan

    2010-01-01

    Purpose: To study the prescription of oral analgesics for musculoskeletal pain by primary care physicians over a 5-year period in Sweden. Design: A retrospective automatic database review of patient records at four primary health care centers. All prescriptions of NSAIDs, weak opioids, and coprescriptions of gastroprotecting medications to patients with musculoskeletal were retrieved for the period January 1, 2004 to November 11, 2008. Results: A total of 27,067 prescriptions prescribed to 23,457 patients with musculoskeletal pain were analyzed. Of all prescriptions, NSAIDs were the most commonly prescribed analgesic comprising 79%, tramadol was the second most commonly prescribed analgesic comprising 9%, codeine the third most (7%), and dextropropoxyphene the fourth (5%). The proportion of NSAIDs and weak opioids and the proportion of the different weak opioids prescribed showed no change over time. The proportion of nonselective and selective NSAIDs prescribed changed; Coxib prescriptions decreased from 9% to 4% of all analgesics prescribed in 2004–2007 with no change in 2008. Conclusion: NSAIDs were found to be the dominant class of analgesic prescribed by primary care physicians to patients diagnosed as musculoskeletal pain. No change was observed in the proportion of NSAID and weak opioid prescription over the period studied. Prescription of selective Coxibs decreased and was less than 4% in 2008. The impact on gastrointestinal and cardiovascular adverse effects associated with the extensive prescription of NSAIDS for musculoskeletal pain warrants further analysis. PMID:21197316

  16. Long-lasting effects of anti-VEGF/photodynamic combination therapy in the treatment of exudative age-related macular degeneration: a retrospective chart review

    PubMed Central

    Silva-Garcia, Rosemary; McLellan, Colleen; Shaya, Fadi S; Small, Kent W

    2014-01-01

    Purpose To examine the potential long-term benefit of an anti-VEGF/photodynamic therapy (PDT) combination on patients treated for wet age-related macular degeneration (AMD). Methods A retrospective chart review was conducted on 29 eyes (subjects) from 26 patients (eight male and 18 female) that showed sustained, positive response to combination therapy for exudative AMD for a minimum of 1 year. Collected data included: visual acuity, central retinal thickness, intraocular pressure and history of glaucoma, wet AMD onset and treatment history, concomitant use of anticoagulants and past history or development of cerebrovascular or cardiovascular disease while receiving combination therapy. Results Subjects underwent an average of five injections and two PDT treatments in total over 16 months before the choroidal neovascular membrane (CNVM) stabilized and became inactive for at least 1 year. Prior to the effective anti-VEGF/PDT combination therapy the median Snellen visual acuity ranged from 20/200 to 20/250 and presented at no worse than 20/200 at 1 year after treatment. Some subjects were followed for up to 5 years and remained inactive. Conclusion Combination therapy can cause long-lasting closure of the CNVM, even with advanced disease resistant to anti-VEGF monotherapy. PMID:25548512

  17. Epidemiology of pediatric burns requiring hospitalization in China: a literature review of retrospective studies.

    PubMed

    Kai-Yang, Lv; Zhao-Fan, Xia; Luo-Man, Zhang; Yi-Tao, Jia; Tao, Tan; Wei, Wei; Bing, Ma; Jie, Xiong; Yu, Wang; Yu, Sun

    2008-07-01

    This review was an effort to systematically examine the nationwide data available on pediatric burns requiring hospitalization to reveal burn epidemiology and guide future education and prevention. The China Biomedical Disk Database, Chongqing VIP Database, and China Journal Full-Text Database were searched for articles reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of pediatric burns requiring hospitalization in China. Twenty-eight articles met the inclusion criteria, all of which were retrospective analyses. For each study included, 2 investigators independently abstracted the data related to the population description by using a standard form and included the percentage of patients with burn injury who were <15 years old; gender and distributi