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Kharsa, Dr Mhd Azhar Ibrahim. "The Most Common Ten Diseases in the Dental Department." Global Academic Journal of Dentistry and Oral Health 4, no. 1 (April 17, 2022): 1–5. http://dx.doi.org/10.36348/gajdoh.2022.v04i01.001.
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In this article the author focuses of the most common ten diseases and anomalies that come across our daily practice in the Dental Department of AHT-SA Hospital. The author depended on the statistics, cases reports and active cases of his daily practice. The most registered anomaly “considered disease” in the Orthodontic Department has been the Malocclusion. It’s found out that 94% of the patient who visited the Orthodontic Clinic of A.H. Hospital have had a sort of “Mal-Occlusion”(1). The other diseases that had been registered had been: the Dental Caries, Periodontitis, Cleft-Lip and Palate, Ectodermal Dysplasia, Dentigerous Cysts, Impacted Third Molars, Mouth breathing “and snoring”, Diabetes and its dental aftermaths and Finally Achondroplasia.
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Vakulenko, M. V. "On the casuistry of independent extraperitoneal ruptures of the bladder." Kazan medical journal 22, no. 2 (December 24, 2020): 199–200. http://dx.doi.org/10.17816/kazmj52880.
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In 1908, I described a case of spontaneous intraperitoneal rupture of the bladder. Since then, in Russian literature, I have come across only one article by Belitsky devoted to this issue. In this detailed article Belitsky describes a case of intraperitoneal rupture of the bladder, operated back in 1909 by prof. I. A. Praksin, and reports statistics of both Russian authors - including my case - and foreign ones. From the data of Naumann cited by him in the article, it is clear that in the Salgram clinic for 12 years, for 20 thousand patients, bladder ruptures were observed only in 3 cases - in 2 intraperitoneal and in 1 extraperitoneal; Rokitsky for 15 years gives 12 cases, among which in 8 there was an intraperitoneal rupture and in 4 extraperitoneal rupture.
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Pokydko, M. I., T. V. Formanchuk, О. V. Vozniuk, O. V. Honcharenko, A. N. Formanchuk, and O. O. Kirichenko. "Percutaneous minimally invasive methods as a step-up intervention in the complex treatment of fluid accumulations in patients with acute pancreatitis." Reports of Vinnytsia National Medical University 25, no. 1 (March 27, 2021): 32–39. http://dx.doi.org/10.31393/reports-vnmedical-2021-25(1)-06.
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Annotation. Analysis of recent publications on the definition of fluid accumulation in patients with complicated forms of acute pancreatitis and the possibility of their correction by minimally invasive methods according to the clinic, analysis of a clinical case that demonstrates the possibility of staged percutaneous drainage of fluid accumulation in acute infected necrotic pancreatic. The results of treatment of 622 patients who were hospitalized in the surgical department of MNPE City Clinical Hospital of Ambulance and Emergency Care during 2020 were analyzed. The mean age of patients was 48.2±2.2 years. The patient examination plan included a comprehensive clinical, laboratory and instrumental examination. Puncture and drainage of fluid accumulations were performed under local anesthesia under ultrasound control using a linear sensor with a frequency of 7.5 MHz in gray-scale mode. Statistical data processing was performed by the method of mathematical statistics with StatSoft Statistica 6.0 software and Microsoft Office Excel. It is established that the cause of acute pancreatitis in 270 (43.4%) patients was a biliary factor, in 155 (24.9%) – alcohol, 135 (21.7%) – acute pancreatitis developed on the background of triglyceridemia, in 21 (3.4%) the patient had postoperative pancreatitis, medical – in 8 (1.3%) patients and without establishing a clear etiology – in 33 (5.3%) patients. In order to eliminate fluid accumulations in 12 (1.9% of the majority of patients with acute pancreatitis and 7.6% of 157 with fluid accumulations) patients were used percutaneous puncture-drainage method under ultrasound control, among them in 5 cases the method was used to eliminate fluid accumulations due to acute peripancreatic fluid accumulation, in 2 cases – acute necrotic effusion, limited necrosis – in 2 cases, and pancreatic pseudocyst – in 3 cases. A clinical case of acute necrotic pancreatitis complicated by the development of acute necrotic effusion is presented, for the treatment of which a combination of transcutaneous minimally invasive and open surgical methods of treatment was used at different stages of the disease. So, fluid accumulations around the pancreas belong to the local complications of acute pancreatitis and are recommended for correction by conservative or minimally invasive methods. The question of choosing the optimal minimally invasive method of treatment requires an individual approach. This clinical case demonstrated the possibility of using puncture-drainage method under the ultrasound control as a “step-up” intervention in early stage of treatment and allowed to postpone the open surgery.
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Winters, Brian, Leonidas Nikolaos Diamantopoulos, Maria S. Tretiakova, Lawrence D. True, Jean H. Lee, Jing Zeng, Jay Justin Liao, et al. "Bladder Cancer Multidisciplinary Clinic (BCMC) model: Impact on imaging, pathology and treatment recommendations." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 4537. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.4537.
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4537 Background: Despite guideline-based standard of care recommendations in BC and upper tract urothelial carcinoma (UTUC), treatment remains variable across US. Experts recommend focusing BC care in tertiary centers. We hypothesized that a BCMC model, with expert central pathology and radiology review, may result in changes in corresponding reports, and, thus, treatment recommendations. Methods: Our BCMC clinic format includes simultaneous consultation with Urologic, Medical and Radiation Oncology, with real time expert genitourinary pathology and radiology review. We retrospectively assessed the concordance between outside (pre-BCMC) imaging & pathology review and BCMC review. Differences between pre- and post- BCMC recommendations on management were also assessed; descriptive statistics were used. Results: We identified 233 BC/UTUC patients (pts) referred to BCMC. Complete radiographic and pathologic data were available for 209 pts. Median age at time of evaluation was 68 (27-93) and 85% were PS ECOG 0-1. After BCMC review of outside records, 112 (53.6%) imaging and/or pathology changes were noted, with 57 (27%) pts upstaged. Overall, imaging interpretation was changed in 25% of cases, and 20% of pts were upstaged. BCMC pathology review resulted in changes in 59 (28%) pts. Among those, 42 (71%) had histologic subtype addition or change, 9 (15%) had LVI/CIS status change, and 2 (3.4%) had low to high grade conversion. In terms of pathology staging, 7 (12%) were downstaged, and 5 (8.5%) upstaged. Further diagnostic work-up was recommended in 71/209 (34%) pts, resulting in upstaging in 11/71 (15.5%) of cases. Pre- and post- BCMC-recommended treatment modality differed in 55/209 (26%) pts, while a new treatment modality was added in 28/209 (13%) pts. These recommendations were followed 91.4% of the time (191/209 pts). Conclusions: BCMC initiation at our institution resulted in imaging and/or pathology diagnostic changes in almost half of cases, with approximately a quarter of pts being upstaged. Findings reveal the importance of expert radiology and pathology review in BC. Further study is needed to confirm the proposed benefits and impact of BCMC on treatment response and outcomes.
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Walsh, Stephen, Joel Corbett, K. Meng Tan, and Simon Broadley. "111 Epileptic seizures in multiple sclerosis." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A44.1—A44. http://dx.doi.org/10.1136/jnnp-2018-anzan.110.
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IntroductionEpileptic seizures have been described in association with multiple sclerosis (MS) in both anecdotal case reports and case series. The recent identification of specific antibodies to myelin oligodendrocyte glycoprotein (MOG) protein in a small number of patients with demyelinating disease which may resemble neuromyelitis optica or acute disseminated encephalopathy, which may involve seizures, raises the possibility that anti-MOG antibody related demyelination may account for the association of epilepsy with MS.MethodsWe have undertaken a retrospective review of cases of MS diagnosed at the Gold Coast MS clinic over a 10 year period. All cases were systematically asked if they had ever had an epileptic seizure either via a patient completed questionnaire or at a clinic visit. Demographic and clinical information were also recorded. These data have been analysed using descriptive statistics and appropriate tests for significant differences between those with epilepsy and those without.Results428 cases with complete data were identified. Those with a history of epilepsy were slightly younger (median (range); 44.5 (27–64) years vs 4715–88 years), but this difference was not statistically significantly different. The gender ratio was the same for both groups (9/12 (75%) for those with epilepsy and 326/416 (78%)). There was no significant difference in age of onset, disease course, relapse frequency or level of disability. Although numbers are small, seizure appear to occur most frequently earlier in the disease course and are rarely an ongoing issue.ConclusionThese data support earlier work indicating that epilepsy occurs in people with MS who are younger. This fits with the notion that seizures arise in the context of the inflammatory stage of multiple sclerosis rather than the degenerative phase. Further work needs to be undertaken to assess any association with anti-MOG antibodies and epileptic seizures in demyelinating disease.
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Федина, N. Fedina, Ткаченко, T. Tkachenko, Дмитриев, A. Dmitriev, Гудков, and R. Gudkov. "Regional aspects of the epidemiology and clinics of syphilis in children." Journal of New Medical Technologies. eJournal 9, no. 4 (December 8, 2015): 0. http://dx.doi.org/10.12737/16783.
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The purpose of this study was clinical and epidemiological analysis of the incidence of syphilis in children and adolescents in the Ryazan region over a 12 year period. In a retrospective study the authors used the data from regional statistical reports, medical records of newborns, the data on infectious diseases of the Federal State Statistics Service. The analysis of the data for all age groups, including children and pregnant women was carried out. It was noted a substantial reduction in the number of reported cases of syphilis, including among adolescents and youth. The proportion of non-residents and rural residents in the total of patients with syphilis is increasing. In the pediatric population, the leading mode of transmission is vertical (53% of all cases). Among children born from pregnant patients with syphilis, there are 78% of the verified congenital syphilis, and only 5% the classical picture of the disease. It was established a substantial reduction of cases of congenital syphilis, the absence of cases of fetal death and postnatal mortality in recent years. However, the retention of latent forms and late detection of syphilis in pregnant women poses a threat of infection and determines the social significance of the problem. Effective control of congenital syphilis is ensured by the collaboration of obstetriciansgynecologists, dermatologists and neonatologists.
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Nowak, Nel, Michał Kotowski, Jakub Sroczyński, and Jarosław Szydłowski. "Lyell’s syndrome as a factor which escalates the risk of laryngotracheal stenosis and atresia after intubation." Polski Przegląd Otorynolaryngologiczny 8, no. 2 (September 5, 2019): 1–5. http://dx.doi.org/10.5604/01.3001.0013.4232.
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Toxic epidermal necrolysis (TEN) also known as Lyell’s Syndrome is a rare, acute hypersensitivity reaction characterized by cutaneous and mucosal necrosis. Lyell’s syndrome is self limited, but potentially recurrent disease. The mortality for toxic epidermal necrolysis is approaching to 30%.[1] Subglottic stenosis is the most common anomaly of larynx and trachea requiring tracheostomy in pediatric population. Subglottic part of larynx is the narrowest section of laryngotracheal area of airways in childhood.[5] It is estimated that most of subglottic stenosis cases is acquired and developed as a result of injury caused by long-term use of endotracheal tube. A 2-year-old patient admitted to our Clinic of Children’s Otolaryngology after long treatment for TEN because of problems with breathing without tracheostomy tube. Because of the results of bronchofiberoscopy patient has been sent to our Clinic of Children’s Otolaryngology. We performed laryngotracheoscopy which showed transglottic, subglottic and proximal part of tracheal stenosis and complete atresia of trachea above tracheostomy tube. Result of MRI examination was described as complete atresia of trachea which was 4 mm long and located above tracheostomy tube. Our patient was classified for open surgery intervention- partial cricotracheal resection with reconstruction (CTR). Latest improvements about construction of endotracheal tube and rules of procedures reduced frequency of subglottic stenosis to less than 1%.[11] There are no statistics or medical reports about tracheal atresia caused by intubation or Lyell’s syndrome. This situation forced us to recognise Lyell’s syndrome and endotracheal intubation overlapping on each other as a cause of medical state of our patient.
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Manzano, Giovanna S., Caleb R. S. McEntire, Maria Martinez-Lage, Farrah J. Mateen, and Spencer K. Hutto. "Acute Disseminated Encephalomyelitis and Acute Hemorrhagic Leukoencephalitis Following COVID-19." Neurology - Neuroimmunology Neuroinflammation 8, no. 6 (August 27, 2021): e1080. http://dx.doi.org/10.1212/nxi.0000000000001080.
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Background and ObjectivesSince the onset of the COVID-19 pandemic, a growing number of reports have described cases of acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (AHLE) following infection with COVID-19. Given their relatively rare occurrence, the primary objective of this systematic review was to synthesize their clinical features, response to treatments, and clinical outcomes to better understand the nature of this neurologic consequence of COVID-19 infection.MethodsPatients with a history of COVID-19 infection were included if their reports provided adequate detail to confirm a diagnosis of ADEM or AHLE by virtue of clinical features, radiographic abnormalities, and histopathologic findings. Cases purported to be secondary to vaccination against COVID-19 or occurring in the context of a preexisting relapsing CNS demyelinating disease were excluded. Case reports and series were identified via PubMed on May 17, 2021, and 4 additional cases from the authors' hospital files supplemented the systematic review of the literature. Summary statistics were used to describe variables using a complete case analysis approach.ResultsForty-six patients (28 men, median age 49.5 years, 1/3 >50 years old) were analyzed, derived from 26 case reports or series originating from 8 countries alongside 4 patient cases from the authors' hospital files. COVID-19 infection was laboratory confirmed in 91% of cases, and infection severity necessitated intensive care in 67%. ADEM occurred in 31 cases, whereas AHLE occurred in 15, with a median presenting nadir modified Rankin Scale score of 5 (bedridden). Anti-MOG seropositivity was rare (1/15 patients tested). Noninflammatory CSF was present in 30%. Hemorrhage on brain MRI was identified in 42%. Seventy percent received immunomodulatory treatments, most commonly steroids, IV immunoglobulins, or plasmapheresis. The final mRS score was ≥4 in 64% of patients with adequate follow-up information, including 32% who died.DiscussionIn contrast to ADEM cases from the prepandemic era, reported post–COVID-19 ADEM and AHLE cases were often advanced in age at onset, experienced severe antecedent infection, displayed an unusually high rate of hemorrhage on neuroimaging, and routinely had poor neurologic outcomes, including a high mortality rate. Findings are limited by nonstandardized reporting of cases, truncated follow-up information, and presumed publication bias.
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O’Laughlin, Kevin, Jennifer R. Cope, and Zachary A. Marsh. "354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S246. http://dx.doi.org/10.1093/ofid/ofaa439.549.
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Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures
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Das, Chhanda, Madhumita Mukhopadhyay, Srijana Subba, Ashis Kumar Saha, and Biswanath Mukhopadhyay. "Role of EGFR and HER-2/NEU Expression in Gall Bladder Carcinoma (GBC)." Journal of Laboratory Physicians 13, no. 01 (March 2021): 029–35. http://dx.doi.org/10.1055/s-0041-1726561.
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Abstract Background Gall bladder carcinoma (GBC) is the most common malignancy of the biliary tract. Being known for its geographical and racial variations, and compared with the global statistics, its incidence is higher in the Indian subcontinent, mainly in the northern and eastern regions, accounting for 80 to 95% of cases. Aims and Objectives This study was conducted to evaluate the clinic-pathological spectrum and expression of EGFR and HER-2/NEU in GBCs and to understand their relation to prognosis, paving the way for targeted therapies for better treatment outcomes and patient survival. Materials and Methods This is a prospective study performed in a tertiary care hospital in 30 resected specimens of GBC cases recorded in our Department of Pathology from November 2017 to November 2019. Clinical history including the radiological reports and demographic parameters were included in the study pro forma. Immunohistochemical (IHC) staining for EGFR and HER-2/NEU was performed on all the selected cases. Clinicopathologic parameters like age, sex, histologic type, perineural, and lymphovascular invasion were compared and correlated with EGFR and HER-2/NEU status. Results Expression of EGFR was found in 93.33% of cases, which showed a highly significant correlation with histological tumor type (p = 0.000). HER-2/NEU expression was found in 56.66% of cases, which also showed a significant correlation with histological tumour type (p = 0.021). We found most of the cases with strong EGFR immunoreactivity (3+) were poorly differentiated tumors and most of the cases showing weak immunoreactivity for EGFR (1+) were well-differentiated. Conversely, in case of HER-2/NEU immunoreactivity, strong staining (3+) was seen in well-differentiated tumors and weak staining (1+) in poorly differentiated tumors. A significant correlation was also found between EGFR and HER-2/NEU expression (p = 0.000) and between cholelithiasis and EGFR expression (p = 0.033). Conclusion EGFR is expressed in most cases of GBC. Its expression is more in poorly differentiated carcinomas as compared to the well-differentiated carcinomas, whereas HER-2/NEU expression is more in well-differentiated carcinomas. Therefore, they may serve as independent prognostic factors and also as targets for molecular therapy in GBCs.
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Kuru, Oguzhan, Ipek Betul Ozcivit Erkan, Cansu Turker Saricoban, Utku Akgor, Neslihan Gokmen Inan, and Sennur Ilvan. "The Role of Endometrial Sampling before Hysterectomy in Premenopausal Women with Abnormal Uterine Bleeding." Journal of Clinical Medicine 13, no. 13 (June 25, 2024): 3709. http://dx.doi.org/10.3390/jcm13133709.
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Background/Objectives: An endometrial sampling is recommended for patients experiencing abnormal uterine bleeding above the age of 40 or 45. Valid risk prediction models are needed to accurately assess the risk of endometrial cancer and avoid an unnecessary endometrial biopsy in premenopausal women. We aimed to assess the necessity and usefulness of preoperative endometrial sampling by evaluating premenopausal women who underwent hysterectomy for abnormal uterine bleeding after preoperative endometrial sampling at our clinic. Methods: A retrospective analysis was conducted on 339 patients who underwent preoperative endometrial sampling and subsequently underwent hysterectomy due to abnormal uterine bleeding. Detailed gynecologic examinations, patient histories, and reports of endometrial sampling and hysterectomy were recorded. Cohen’s Kappa (κ) statistic was utilized to evaluate the concordance between histopathological results from an endometrial biopsy and hysterectomy. Results: The mean age of the cohort was 47 ± 4 years. Endometrial biopsies predominantly revealed benign findings, with 137 (40.4%) cases showing proliferative endometrium and 2 (0.6%) cases showing endometrial cancer. Following hysterectomy, final pathology indicated proliferative endometrium in 208 (61.4%) cases, with 7 (2.1%) cases showing endometrioid cancer. There was a statistically significant but low level of concordance between histopathological reports of endometrial biopsy and hysterectomy results (Kappa = 0.108; p < 0.001). Significant differences were observed only in the body mass index of patients based on hysterectomy results (p = 0.004). When demographic characteristics were compared with cancer incidence, smoking status and preoperative endometrial biopsy findings showed statistically significant differences (p = 0.042 and p = 0.010, respectively). Conclusions: The concordance between the pathological findings of a preoperative endometrial biopsy and hysterectomy is low. Body mass index is an important differentiating factor between benign histopathologic findings of endometrium and endometrial neoplasia. Moreover, adenomyosis was found to be associated with endometrial cancer cases. The current approach to premenopausal women with abnormal uterine bleeding, which includes a routine endometrial biopsy, warrants re-evaluation by international societies and experts.
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Schetkin, D. S. "ABOUT PENETRATING RUPTURES OF THE VARNALS OF THE VAGINA IN GIVING WOMEN." Journal of obstetrics and women's diseases 5, no. 5 (August 7, 2020): 353–95. http://dx.doi.org/10.17816/jowd55353-395.
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Complete separation of the vagina or one of the vaults of its uterus with the release of the ovum into the peritoneal cavity belongs to the number of rare complications of the labor act; at least, the meager information that I have obtained from the literature confirms this, although, of course, at the present time it is not possible to determine with accuracy how often this complication occurs, for the reason that ruptures of the arches of the sleeves in some cases occur independently , in others - they occur because of negligence in the production of some obstetric operations. Finally, there may be confused cases in which it is completely impossible to find out what was the main reason for the vaginal tear: obstetric surgery or some other condition that contributed to its spontaneous origin. Spiegelberg, referring to the statistics of M. Clintok from the Dublin maternity hospital, says that isolated ruptures of the sleeve are fragile. Garin comes to the same conclusion on the basis of reports of our obstetric clinics and obstetric institutions.
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Burnett, D., R. Persad, and H. Q. Huynh. "A196 INCIDENCE OF PEDIATRIC EOSINOPHILIC ESOPHAGITIS IN EDMONTON ZONE AND RISK OF STRICTURING AT DIAGNOSIS." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 68–70. http://dx.doi.org/10.1093/jcag/gwz047.195.
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Abstract Background Eosinophilic esophagitis (EoE) is a common cause of esophageal dysfunction in children. A subset of children have a more severe phenotype of EoE, complicated by esophageal stricturing. Limited work has been done to characterize this phenotype. Aims To determine the incidence of EoE, and the frequency of esophageal stricturing in pediatric EoE. Methods We retrospectively identified all new cases of EoE at the Stollery Children’s Hospital from 2015–2018 using esophageal biopsy reports for the province of Alberta (CoPath database), EoE clinic lists and an OR database for esophageal dilatation at the Stollery. Electronic medical records (EMR) were reviewed to confirm EoE diagnosis. For each confirmed case, clinical data was captured from the outpatient EMR and gastroscopy/pathology reports. A review of peri-endoscopy OR/nursing charts was performed on a subset of patients (n=75) to capture scope adverse event. Statistics Canada 2016 census data was used to calculate incidence rates. Results 185 new cases of EoE were diagnosed at our center during the study period (see table). For patients < 15 years old living in Edmonton zone (n=73), the incidence over the 4 years was 11.1 cases per 100,000 person years {8.7 (0–4 year-old), 7.6 (5–9 year old), and 18.1 (10–14 year old)}. There was limited variation in incidence in the 4 years (9.1–12.1 per 100,000 person years). 8 of 185 (4%) patients had endoscopically confirmed esophageal strictures, 4 of which required mechanical dilation (mean 3.75 dilations per patient, range 1–6). 11/185 (5.9%) patients had more subtle signs of esophageal narrowing, but no strictures. No perforations or episodes of significant bleeding were reported in peri-endoscopy charts reviewed for 239 gastroscopes, including 16 dilations. Pain was reported after 15% of all scopes, including 50% of the 28 scopes with strictures and 63% of the 16 scopes involving dilations. Conclusions Edmonton zone has one of the highest incidences of EoE reported in children. In this cohort, 4% had esophageal stricture (half required dilatation) and 5.9% had more subtle narrowing. Patients with strictures were older, had more frequent food impaction and longer duration of symptoms (Table). This data will be included in an ongoing multicenter case-control study across Canada. Funding Agencies CAGWomen and Children’s Health Research Institute (Univ. Alberta)
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Brown, Nicholas J. L., and James A. J. Heathers. "The GRIM Test." Social Psychological and Personality Science 8, no. 4 (October 18, 2016): 363–69. http://dx.doi.org/10.1177/1948550616673876.
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We present a simple mathematical technique that we call granularity-related inconsistency of means (GRIM) for verifying the summary statistics of research reports in psychology. This technique evaluates whether the reported means of integer data such as Likert-type scales are consistent with the given sample size and number of items. We tested this technique with a sample of 260 recent empirical articles in leading journals. Of the articles that we could test with the GRIM technique ( N = 71), around half ( N = 36) appeared to contain at least one inconsistent mean, and more than 20% ( N = 16) contained multiple such inconsistencies. We requested the data sets corresponding to 21 of these articles, receiving positive responses in 9 cases. We confirmed the presence of at least one reporting error in all cases, with three articles requiring extensive corrections. The implications for the reliability and replicability of empirical psychology are discussed.
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Shi, Hon-Yi, Shiuh-Lin Hwang, King-Teh Lee, and Chih-Lung Lin. "In-hospital mortality after traumatic brain injury surgery: a nationwide population-based comparison of mortality predictors used in artificial neural network and logistic regression models." Journal of Neurosurgery 118, no. 4 (April 2013): 746–52. http://dx.doi.org/10.3171/2013.1.jns121130.
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Object Most reports compare artificial neural network (ANN) models and logistic regression models in only a single data set, and the essential issue of internal validity (reproducibility) of the models has not been adequately addressed. This study proposes to validate the use of the ANN model for predicting in-hospital mortality after traumatic brain injury (TBI) surgery and to compare the predictive accuracy of ANN with that of the logistic regression model. Methods The authors of this study retrospectively analyzed 16,956 patients with TBI nationwide who were surgically treated in Taiwan between 1998 and 2009. For every 1000 pairs of ANN and logistic regression models, the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow statistics, and accuracy rate were calculated and compared using paired t-tests. A global sensitivity analysis was also performed to assess the relative importance of input parameters in the ANN model and to rank the variables in order of importance. Results The ANN model outperformed the logistic regression model in terms of accuracy in 95.15% of cases, in terms of Hosmer-Lemeshow statistics in 43.68% of cases, and in terms of the AUC in 89.14% of cases. The global sensitivity analysis of in-hospital mortality also showed that the most influential (sensitive) parameters in the ANN model were surgeon volume followed by hospital volume, Charlson comorbidity index score, length of stay, sex, and age. Conclusions This work supports the continued use of ANNs for predictive modeling of neurosurgery outcomes. However, further studies are needed to confirm the clinical efficacy of the proposed model.
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Shaydullina, M. R., A. S. Sultanova, D. A. Khabibullina, and A. N. Zamalova. "The prevalence of various clinical forms of the disease and variants of CYP21A2 gene mutations in congenital adrenal cortical dysfunction in children and adolescents in the Republic of Tatarstan." Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 64, no. 5 (November 16, 2019): 165–70. http://dx.doi.org/10.21508/1027-4065-2019-64-5-165-170.
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Сongenital adrenal hyperplasia (CAH) – is one of the versions of inherited enzymopathy. If it was dedected too late, that can lead not only to some fatal consequences, but to patient’s death as well. Neonatal screening of CAH allows to detect the desease promtly and start an immediate therapy in order to prevent difficult complications of the desease and patient’s disablement.Aim: Analisys of the frequency of CAH case rate within children in the Republic of Tatarstan (RT) after neonatal screening and also prevalence rate of different clinic forms of empairments and types of gene CYP21A2’s mutations.Methods: Reports of the results of CAH screening by medicogenetic service in RT were analysed. Information about children born, detected cases of CAH was taken from statistic form № 12 “Information on the number of diseases, detected within patient residing in the service area of medical organization, Rosstat” during 2006–2018yrs. Materials for analysis of health clinic of children’s CAH were case histories of patient, observed in endocrinology department of GAUZ “Republican children clinic hospital” Ministry of Health of The Republic of Tatarstan (DRKB MZ RT). Molecular-genetic researches were conducted on the basis of Federal state budgetary institution “National medical center for endocrinology” of the Russian ministry of Health. (FGBU “NMIC of endocrinology) of The Russian ministry of Health) with the support of “Alfa Endo” program CAF charity foundation.Results: During 2007–2017 yrs. according to the results of neonatal screening 32 children with CAH were detected. The case rate ranged from 1:5054 to 1:56 598 newborn. The maximum of the disease case in RT was detected in 2016 (11 children). With 24 children molecular-genetic analysis was conducted, as a result 24 gene CYP21A2’s mutations were detected in homo- and heterozygotic state. The most widely spread mutation turned to be 12spl, which was found in 45,8% of cases.Conclusion: Conducted analysis confirms the necessity of the further study of the CAH case rate distinctions in different areas and cities of RT, and also upgrade of the organization and performance of the neonatal screening.
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Alvarado-Dela Cruz, Kristine, Madelyn Pascual, and Maria Eva Luna- Dizon. "The Clinical Profile and Outcome of Children with Dengue Encephalitis at the Philippine Children’s Medical Center: A Retrospective Study From January 2011-June 2017." Pediatric Infectious Disease Society of the Philippines Journal 20, no. 2 (December 1, 2019): 5–15. http://dx.doi.org/10.56964/pidspj20192002003.
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Background: Dengue, a mosquito-borne flavivirus, is hyperendemic in the Philippines. One of its rare complication is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. Previously known as non-neurotropic, dengue presents with an increasing incidence of neurologic manifestations. Objective: To describe the clinico-demographic profile and outcome of laboratory-confirmed dengue encephalitis patients. Methods: This is a retrospective study that used purposive sampling to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years. The clinico-demographic profiles and outcomes were collected using chart review, and variables were analyzed using descriptive statistics. Results: 14 laboratory-confirmed cases were reviewed. Most (57%) were males aged 3 days-15 years. Fever lasted 3-11 days. Following nonspecific signs and symptoms, neurological manifestations developed within 1-5 days, the most common being seizures (71%). Majority (57%) had anemia. All, except one, exhibited leukopenia and thrombocytopenia. Elevated liver enzymes, bleeding parameter derangements, electrolyte, and glucose imbalances were noted. All were seropositive for dengue IgM, and 5 dengue IgM in the CSF. Most common EEG findings showed generalized slowing. Neuroimaging reports were normal in some or showed cerebral edema in the others. Half of the patients recovered fully, 3 showing partial recovery from neurologic changes, and 3 others had neurologic sequelae. One infant expired. Conclusions and Recommendations: Dengue encephalitis should be considered in patients living in an endemic country, presenting with fever with neurologic changes or elevated liver enzymes, with a risk for developing neurologic sequelae or death.
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Gandía-González, Maria Luisa, M. Elena Kusak, Nuria Martínez Moreno, Jorge Gutiérrez Sárraga, Germán Rey, and Roberto Martínez Álvarez. "Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review of 58 cases." Journal of Neurosurgery 121, no. 5 (November 2014): 1158–65. http://dx.doi.org/10.3171/2014.5.jns131880.
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Object Jugulotympanic paragangliomas (JTPs) are rare benign tumors whose surgical treatment is usually associated with partial resection of the lesion, high morbidity, and even death. Gamma Knife radiosurgery (GKRS) has been reported as a useful treatment option. The goal of this retrospective study is to analyze the role of GKRS in tumor volume control and clinical outcomes of these patients. Methods A total of 75 patients with JTPs were treated with GKRS at the authors' center from 1995 to 2012. The authors analyzed those treated during this period to allow for a minimal observation time of 2 years. The MR images and clinical reports of these patients were reviewed to assess clinical and volumetric outcomes of the tumors. The radiological and clinical assessments, along with a group of prognostic factors measured, were analyzed using descriptive methods. The time to volumetric and clinical progression was analyzed using the Kaplan-Meier method. Prognostic factors were identified using log-rank statistics and multivariate Cox regression models. Results The mean follow-up was 86.4 months. The authors observed volumetric tumor control in 94.8% of cases. In 67.2% of cases, tumor volume decreased by a mean of 40.1% from the original size. Of patients with previous tinnitus, 54% reported complete recovery. Improvement of other symptoms was observed in 34.5% of cases. Overall, clinical control was achieved in 91.4% of cases. Previous embolization and familial history of paraganglioma were selected as significant prognostic factors for volumetric response to GKRS treatment in the univariate analysis. In multivariate analysis, no factors were significantly correlated with progression-free survival. No patient died of side effects related to GKRS treatment or tumor progression. Conclusions Gamma Knife radiosurgery is an effective, safe, and efficient therapeutic option for the treatment of these tumors as a first-line treatment or in conjunction with traditional surgery, endovascular treatment, or conventional fractionated radiotherapy.
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Shen, R. N., D. A. Hicks, and M. E. Cruickshank. "Colposcopy services provided by Genito-Urinary Medicine Clinics in the United Kingdom-British Society for Colposcopy and Cervical Pathology/National Co-ordinating Network Survey, 1993." International Journal of STD & AIDS 7, no. 2 (April 1, 1996): 98–101. http://dx.doi.org/10.1258/0956462961917456.
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Postal questionnaires were circulated to all Genito-Urinary Medicine (GUM) clinics in the UK (in parallel with questionnaires circulated to gynaecologists) on behalf of British Society for Colposcopy and Cervical Pathology (BSCCP) and National Co-ordinating Network (NCN) to audit colposcopy services. Information was sought on colposcopy workload, referral criteria, treatment method and followup, waiting times, staffing and training. A similar but less comprehensive survey of colposcopy services in GUM was undertaken in 1990 enabling direct comparison of some but not all aspects of the service in the last 3 to 4 years 1. One hundred and forty-two GUM Clinics replied. Of those who replied, 70 (49.3%) clinics provided a colposcopy service; an increase from 60 to 70 clinics since 1990. However, only 66 clinics provided detailed inform ation for analysis. Forty-six out of 66 (69.7%) clinics performed treatment for some or all of their patients and the most frequent methods of treatment used were loop excision and cold coagulation. One hundred and seventy-two (range 8-1982) patients were seen per annum with a m ean of 7 (range 1- 68) colposcopy sessions per month. Sixty-four per cent of these sessions were undertaken by consultants, 14% by training grades and the rest by Clinical Assistants and Associate Specialists. Fifty-three per cent of all patients with abnormal smears were colposcoped within 2 weeks and the maximum waiting period was less than 8 weeks for all severe dyskaryosis/malignant cells cytology reports; 1.6% of clinics admitted to having cases of invasive cervical cancer following previous treatment of cervical intraepithelial neoplasia (CIN) and 96% of clinics had a protocol in place for defaulters. The default rate was 12% both for new and follow-up patients. Thirty out of 70 (43%) clinics were com puterized and 50/66 (75.8%) of clinics collected accurate statistics.
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Hamilton, Travis, and L. Dade Lunsford. "Worldwide variance in the potential utilization of Gamma Knife radiosurgery." Journal of Neurosurgery 125, Supplement_1 (December 2016): 160–65. http://dx.doi.org/10.3171/2016.7.gks161425.
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OBJECTIVEThe role of Gamma Knife radiosurgery (GKRS) has expanded worldwide during the past 3 decades. The authors sought to evaluate whether experienced users vary in their estimate of its potential use.METHODSSixty-six current Gamma Knife users from 24 countries responded to an electronic survey. They estimated the potential role of GKRS for benign and malignant tumors, vascular malformations, and functional disorders. These estimates were compared with published disease epidemiological statistics and the 2014 use reports provided by the Leksell Gamma Knife Society (16,750 cases).RESULTSRespondents reported no significant variation in the estimated use in many conditions for which GKRS is performed: meningiomas, vestibular schwannomas, and arteriovenous malformations. Significant variance in the estimated use of GKRS was noted for pituitary tumors, craniopharyngiomas, and cavernous malformations. For many current indications, the authors found significant variance in GKRS users based in the Americas, Europe, and Asia. Experts estimated that GKRS was used in only 8.5% of the 196,000 eligible cases in 2014.CONCLUSIONSAlthough there was a general worldwide consensus regarding many major indications for GKRS, significant variability was noted for several more controversial roles. This expert opinion survey also suggested that GKRS is significantly underutilized for many current diagnoses, especially in the Americas. Future studies should be conducted to investigate health care barriers to GKRS for many patients.
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Jithendra, Thandra, and Shaik Sharief Basha. "A Hybridized Machine Learning Approach for Predicting COVID-19 Using Adaptive Neuro-Fuzzy Inference System and Reptile Search Algorithm." Diagnostics 13, no. 9 (May 6, 2023): 1641. http://dx.doi.org/10.3390/diagnostics13091641.
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This research is aimed to escalate Adaptive Neuro-Fuzzy Inference System (ANFIS) functioning in order to ensure the veracity of existing time-series modeling. The COVID-19 pandemic has been a global threat for the past three years. Therefore, advanced forecasting of confirmed infection cases is extremely essential to alleviate the crisis brought out by COVID-19. An adaptive neuro-fuzzy inference system-reptile search algorithm (ANFIS-RSA) is developed to effectively anticipate COVID-19 cases. The proposed model integrates a machine-learning model (ANFIS) with a nature-inspired Reptile Search Algorithm (RSA). The RSA technique is used to modulate the parameters in order to improve the ANFIS modeling. Since the performance of the ANFIS model is dependent on optimizing parameters, the statistics of infected cases in China and India were employed through data obtained from WHO reports. To ensure the accuracy of our estimations, corresponding error indicators such as RMSE, RMSRE, MAE, and MAPE were evaluated using the coefficient of determination (R2). The recommended approach employed on the China dataset was compared with other upgraded ANFIS methods to identify the best error metrics, resulting in an R2 value of 0.9775. ANFIS-CEBAS and Flower Pollination Algorithm and Salp Swarm Algorithm (FPASSA-ANFIS) attained values of 0.9645 and 0.9763, respectively. Furthermore, the ANFIS-RSA technique was used on the India dataset to examine its efficiency and acquired the best R2 value (0.98). Consequently, the suggested technique was found to be more beneficial for high-precision forecasting of COVID-19 on time-series data.
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Hartke, Joelle Nicole, Charuta Gavankar Furey, Anthony Michael Asher, Sreecharita Nidamanuri, Joshua Catapano, Baltazar Zavala, and Nader Sanai. "1232 Outpatient Stereotactic Needle Biopsy Is a Cost-effective Strategy for Brain Tumor Patient Decision-making That Enhances Clinical Trial Accrual." Neurosurgery 70, Supplement_1 (April 2024): 192. http://dx.doi.org/10.1227/neu.0000000000002809_1232.
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INTRODUCTION: Although neuroradiological techniques have expanded, stereotactic needle biopsy is a simple, ubiquitous,and immediate strategy for established or potential brain tumor patients with atypical clinical and/or radiographic findings. METHODS: Outpatient stereotactic needle biopsies performed by a single surgeon from August 2020 through November 2022 were retrospectively reviewed. Electronic medical records were queried for clinical, perioperative, and tumor demographics. Financial records were queried for insurance and payment reports. Descriptive statistics were used to characterize comparisons among collected variables. RESULTS: 107 consecutive stereotactic needle biopsy procedures were conducted in adult brain tumor patients. All biopsies were performed using a single needle-pass in the outpatient setting, targeting supratentorial lesions in 89.7% of cases. Tissue diagnosis was established in 96% of procedures, with glioma being the most common histology. No intraoperative or perioperative complications occurred. Four patients (3.7%) were admitted overnight due to urinary retention (n = 2) and asymptomatic tract hemorrhage (n = 2), respectively. Insurance approval was sought preoperatively from non-commercial (31.7%) and commercial (68.3%) payors and approved in all cases. Postoperatively, 30.8% of patients received an experimental therapeutic on the basis of tissue analysis. CONCLUSIONS: We report the largest experience to date with outpatient stereotactic needle biopsy in newly-diagnosed and recurrent brain tumor patients. Our findings identify this strategy as a cost-effective alternative to advanced imaging that facilitates clinical trial accrual through tissue acquisition.
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Signore, Fabrizio, Caterina Gulìa, Raffaella Votino, Vincenzo De Leo, Simona Zaami, Lorenza Putignani, Silvia Gigli, et al. "The Role of Number of Copies, Structure, Behavior and Copy Number Variations (CNV) of the Y Chromosome in Male Infertility." Genes 11, no. 1 (December 29, 2019): 40. http://dx.doi.org/10.3390/genes11010040.
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The World Health Organization (WHO) defines infertility as the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy within one year. Statistics show that the two sexes are equally at risk. Several causes may be responsible for male infertility; however, in 30–40% of cases a diagnosis of idiopathic male infertility is made in men with normal urogenital anatomy, no history of familial fertility-related diseases and a normal panel of values as for endocrine, genetic and biochemical markers. Idiopathic male infertility may be the result of gene/environment interactions, genetic and epigenetic abnormalities. Numerical and structural anomalies of the Y chromosome represent a minor yet significant proportion and are the topic discussed in this review. We searched the PubMed database and major search engines for reports about Y-linked male infertility. We present cases of Y-linked male infertility in terms of (i) anomalies of the Y chromosome structure/number; (ii) Y chromosome misbehavior in a normal genetic background; (iii) Y chromosome copy number variations (CNVs). We discuss possible explanations of male infertility caused by mutations, lower or higher number of copies of otherwise wild type, Y-linked sequences. Despite Y chromosome structural anomalies are not a major cause of male infertility, in case of negative results and of normal DNA sequencing of the ascertained genes causing infertility and mapping on this chromosome, we recommend an analysis of the karyotype integrity in all cases of idiopathic fertility impairment, with an emphasis on the structure and number of this chromosome.
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Laing, Joshua, Georgia Grant, Cecilia Harb, Elise White, Terence O’Brien, and Patrick Kwan. "130 Continuous EEG monitoring in australia: s first year audit of practice 2018–2019 of a combined hospital epilepsy program in melbourne." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A42.2—A42. http://dx.doi.org/10.1136/jnnp-2019-anzan.115.
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IntroductionContinuous EEG (cEEG) monitoring is essential for the optimal diagnosis and management of non-convulsive seizures. We audited the use of cEEG across two major metropolitan hospitals in Melbourne, Australia as part of a new combined epilepsy program. There are no reported case series of cEEG in Australia.MethodsData was collected retrospectively from consecutive patients who underwent cEEG monitoring as part of their acute inpatient care between Jan 2018 to Dec 2018 at the Alfred and Royal Melbourne Hospitals. All inpatient EEG studies over 1 hr were included. Elective cases from the epilepsy monitoring unit were excluded. Demographic and clinical information regarding their admission was collected. Descriptive statistics, and comparative analysis was performed.ResultsThere were 94 patients identified that underwent cEEG. 50% were male and 50% female, with an average age of 51.3 yrs. 45% were performed in the ICU, and 55% on the acute medical ward. The average duration of recording per patient was 86.2 hrs or 3.6 days. Of 89 of 94 available cEEG reports, seizures were seen in 55%, the majority being non-convulsive. Interictal discharges were seen in 60%. 19% (13/67 of available records) were dead at the time of the audit.ConclusionNon-convulsive seizures and non-convulsive status epilepticus is common and widely underrecognized without cEEG. We present 94 cases as part of our newly expanding cEEG program across two major Australian hospitals over a one year period, 55% with seizures which were predominantly non-convulsive. A prospective database will be designed for further quality improvement and future research.
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Spinnato, Paolo, Eugenio Rimondi, and Giancarlo Facchini. "Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes." Diagnostics 12, no. 1 (January 11, 2022): 168. http://dx.doi.org/10.3390/diagnostics12010168.
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The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction.
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Alfauri, Mohammad Abdelrazzaq, Adnan Ishaq Mohammad, Ashraf Jamil Aqel, and Majed Asad. "Trend of Chickenpox in Jordan (2013-2020)." Iproceedings 8, no. 1 (February 7, 2022): e36589. http://dx.doi.org/10.2196/36589.
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Background Chickenpox is the primary infection of varicella-zoster virus (VZV), which is a highly contagious disease. Objective The main goal of this epidemiological descriptive study was to analyze the medical chickenpox data from 2013 to 2020 in Jordan. The aim of the study was to obtain in-depth statistics for all Jordan cities comparing the year semesters for these years, with comparisons of gender and age categories. In addition, we aimed to determine the status of the epidemiological situation in Jordan with concern of the effects of Syrian refugees and the COVID-19 epidemic. Methods This was an epidemiological descriptive study focusing on children under 15 years old. Data were collected based on a clinical diagnosis by doctors. Chickenpox data were obtained from the Ministry of Health as computerized and manual weekly reports from public and private health centers and hospitals. SPSS was used to statistically analyze the data. Results The total number of chickenpox cases reported from 2013 to 2020 in Jordan was 40,988. There was an obvious rise in cases in 2014 (19.24%) with possible outbreaks due to the influx of Syrian refugees, whereas the lowest number of cases (2.44%) was reported in 2020 due to the COVID-19 pandemic and associated quarantine that occurred in Jordan, especially because of closing schools and clinics. Although the total number of chickenpox cases varied from 2013 to 2020, all years showed the same seasonal distribution, with the highest numbers in the spring (especially May), at 16.12%. Geographic distribution analysis showed that the highest numbers of cases were reported in the cities of Amman and Zarqa, with 18.15% and 12.81%, respectively, according to the highest population and gatherings. In gender distribution, there was a sustained preponderance for males over females with 54.48% of the cases reported in males. The age category of 5-9 years was the most likely to be affected by this disease, accounting for 43.34% of cases. This is because these younger children are newly entering school and starting to interact with others. However, the age category of over 20 years showed the lowest number of cases, accounting for 3.98%. There is more concern in Mafraq city (which has the greatest number of Syrian refugees), and we found that children in the age categories of 1-4 years and less than 1 year were more likely to be infected than others. Conclusions Our analysis showed a possible outbreak of chickenpox in 2014, and the lowest number of cases occurred in 2020. In addition, the spring season is the time with the highest number of infected cases. Chickenpox is a highly transmissible childhood disease that becomes more severe with age, and is especially prevalent in children 5-9 years of age in Jordan. Moreover, the gender distribution of cases throughout the years showed a sustained preponderance for males over females. Due to the high populations in Amman and Zarqa cities, these areas had the highest numbers of people infected with chickenpox.
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TJ, Farrington. "Canine Urinary Incontinence successfully treated by Homeopathic Medicine: A Real-world Clinical Evidence Panel Study." Open Access Journal of Veterinary Science & Research 7, no. 1 (2022): 1–8. http://dx.doi.org/10.23880/oajvsr-16000223.
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Background: Urinary incontinence (UI) in pets is among a group of social problems, which often leads to discomfort to the pets along with distress and financial problems to the owner. It is among the causes of requests from owners for euthanasia of their pets. The current treatments available for UI include drugs and surgery, both of which have limited efficacy, while still entailing high economic and safety concerns. Methods and Findings: This study reports the safety and effectiveness of the homeopathic medicine ‘Leaks No More’ in UI. The study reported 16 neutered dogs in an older age group with a mean age of 11.15±4.40 years and percentile of max; 64.51±19.99) with heavy body weight (44.5±37.3 lb; percentile of 109.1 ± 63.8). Most dogs were females (n=12; 75%). The median dose rate was 2 drops (range 1-6) and was given to 6 (37.5%) animals through water, to 8 (50%) animals with food and to 2 (12.5%) animals by oral administration. In all, 3 (18.75%) animals were given the medicine once a day, 5 (33.33%) were dosed twice a day and 1 (6.25%) was dosed thrice a day. All 16 animals demonstrated improvement. The median time to improvement was 3 [1 - 6.25] days with a relapse reported by 2 (12.5%) owners. This relapse may be a proving of the homeopathic medicine due to excess repetition after relief of symptoms. As the sample showed significant variety, agreement analysis (Cohen’s Kappa) was performed among the demographics and results from each breed viz. Mixed, Greyhound, Doberman, and Shih Tzu. The agreement analysis demonstrated inter-record agreement in most cases (Effect size = 0.71, p=0.12). Conclusion: In conclusion, the proof of concept established evidence of safety and efficacy of the homeopathic medicine 'Leaks No More', with statistics demonstrating the unbiasedness, impartiality, and reliability of the data, despite a small and high-variation sample
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Waite, Kristin, John Bihn, Gino Cioffi, Corey Neff, Carol Kruchko, Quinn Ostrom, Kaitlin Swinnerton, et al. "EPID-31. BRAIN TUMORS IN UNITED STATES MILITARY VETERANS." Neuro-Oncology 25, Supplement_5 (November 1, 2023): v122. http://dx.doi.org/10.1093/neuonc/noad179.0463.
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Abstract Veterans account for ~7% of the adult United States population, with half seeking care through the Veterans Health Administration (VHA). A comprehensive analysis of incidence and survival for brain tumors in the Veteran population has been lacking. Veteran data was obtained from VHA Medical Centers that diagnose and treat cancer via the VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the United States data. Cases were defined as individuals (≥18 years) with a primary brain tumor, diagnosed between 2004-2018, and identified using administrative criteria based on International Classification of Diseases for Oncology, Third Edition (ICD-O-3) topography and morphology codes. Annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100,000 population. Kaplan-Meier survival curves were generated to evaluate overall survival outcomes among Veterans. The Veteran population was primarily white (78%), male (93%), and between 60-64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18-49 years old (28%). The overall AAIR of primary brain tumors from 2004-2018 within the VA cancer registry was 11.6. Non-malignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were non-malignant pituitary tumors (AAIR:2.96), non-malignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In general, in the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. Differences between the Veteran and US population can be broadly attributed to the differences in the demographic composition of these groups. Prior to this study, there have been no reports on national level incidence rates and survival outcomes for Veterans. Statistics like these provide vital information that drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.
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Kostera, Josh, and Jose Santiago. "1532. Demographics and Population Epidemiology of Mycoplasma genitalium infection: Correlation to Co-Infection and prior STI history." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S766—S767. http://dx.doi.org/10.1093/ofid/ofaa439.1712.
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Abstract Background Despite reports in the past few years that Americans are having less sex, the US Centers for Disease Control and Prevention (CDC) recently reported in 2019 that sexually transmitted infection (STI) cases are at an all-time high in the United States. The CDC report included statistics on confirmed cases of Chlamydia trachomatis and Neisseria gonorrhoeae, but did not include data for Trichomonas vaginalis and Mycoplasma genitalium. Although Trichomonas vaginalis and Mycoplasma genitalium are generally recognized agents responsible for STI’s, there is limited prevalence data in the United States. Methods Herein we present STI prevalence and socio-demographic epidemiological data associated with patients enrolled in a multicenter STI study using the automated multiplex qualitative CE marked assay, Alinity m STI. The enrolled study population reflected a diverse number of participants with an approximately equal male to female ratio, prior STI history, single and married, education levels from primary to post-graduate, as well as different ethnicities. Results Participants in this study population who have previously been diagnosed with an STI had an overall Mycoplasma genitalium prevalence rate that was approximately double those who have not been previously diagnosed with an STI. Furthermore, the co-infection rate for Mycoplasma genitalium and Trichomonas vaginalis was as high as 2.5% for vaginal swab specimens with an overall Mycoplasma genitalium prevalence of 11.6%. The overall prevalence of Trichomonas vaginalis in women was 12.3%. Neisseria gonorrhoeae had the lowest overall prevalence in men and women at 2.4%, and Chlamydia trachomatis at had an overall prevalence of 9.8%. Conclusion Mycoplasma genitalium infections are generally asymptomatic in both men and women that contributes to up to 35% of non-chlamydial non-gonococcal urethritis in men and linked to cervicitis and pelvic inflammatory disease in women. Left untreated or not accurately diagnosed, STIs can cause significant, serious long-term health consequences including sexual, reproductive, and psychological well-being that present an extensive challenge and burden to public health in the United States. Disclosures Jose Santiago, PhD, Abbott (Employee)
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Branch-Elliman, Westyn, William O’Brien, Judith Strymish, Kamal Itani, and Kalpana Gupta. "1100. Facility Factors Are a Stronger Driver of Peri-Operative Vancomycin Use Than Patient Risk Factors." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S391. http://dx.doi.org/10.1093/ofid/ofz360.964.
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Abstract Background Prior reports suggest that the use of vancomycin for surgical prophylaxis is common and increasing. However, rates of administration and reasons for choosing vancomycin are unknown. Thus, we sought to quantify the frequency of vancomycin as a surgical prophylaxis agent and to determine drivers of use. Methods All Veteran patients undergoing major cardiac, orthopedic total joint, vascular, or colorectal procedures and entered into the VA External Peer Review Program (EPRP) database during the period from October 1, 2008 to September 30, 2013 were included. EPRP includes a manual review of surgical cases to measure type of prophylaxis, and, in the case of vancomycin, clinician-documented reasons for vancomycin use (β-lactam allergy, patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA), facility high rate of MRSA). Descriptive statistics were used to evaluate findings. Results Among 79, 058 surgical procedures at 109 different medical centers, 20,349 (25.7%) received vancomycin either alone or in combination with another agent for prophylaxis. Rates of vancomycin use were the highest for cardiac surgeries (10,455/21,396, 48.9%), followed by orthopedic total joint replacement surgeries (8,044/38,675, 20.8%), vascular surgeries (1,504/8,177, 18.4%) and colorectal surgeries (346/10,810, 3.2%). The most common reason for vancomycin use was a perceived high facility rate of MRSA (7,367, 36.2%) followed by β-lactam allergy (4,855, 23.9%) and high-risk patient (1,420/20,349, 7.0%). There was no reason documented in 5,194 (25.5%). The most common reason for vancomycin use differed by surgical type. Among cardiac and orthopedic cases, high facility rate was the most commonly reported reason, but β-lactam allergy was the most common driver among vascular and colorectal procedures. Conclusion Facility factors are a major driver of peri-operative vancomycin use, more so than β-lactam allergy or patient-level factors, particularly in cardiac and orthopedic surgery. These data suggest that facility-level interventions, such as implementation of specific guidelines, may be helpful for limiting vancomycin use in this population. Disclosures All authors: No reported disclosures.
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Bhatia, Mohit, Pradeep Kumar, Pratima Gupta, Puneet Kumar Gupta, Minakshi Dhar, and Deepjyoti Kalita. "Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study." Journal of Laboratory Physicians 11, no. 01 (January 2019): 011–16. http://dx.doi.org/10.4103/jlp.jlp_121_18.
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Abstract CONTEXT: To the best of our knowledge, there are no reports of serological evidence of human leptospirosis from Uttarakhand state in India. AIMS: The aim of this study was to screen for serological evidence of leptospirosis in patients with acute undifferentiated febrile illness at a tertiary care teaching hospital in Uttarakhand. SETTINGS AND DESIGN: A pilot study was conducted from March to November 2017. SUBJECTS AND METHODS: Fifty-three adult patients who presented in Medicine outpatient Department with a history of fever of ≥7 up to 14 days duration with or without other associated symptoms such as a headache, rashes, myalgia, arthralgia, and conjunctival suffusion were enrolled in the study using convenience sampling technique. Blood samples of these patients were collected and subjected to peripheral smear examination for malaria parasites, dengue immunoglobulin M (IgM) immunochromatographic card test, IgM Typhidot, Leptospira and Scrub typhus IgM ELISA, respectively. Aerobic blood culture was performed in 24 cases. Relevant clinico-epidemiological details were obtained as per the pro forma formulated in accordance with the modified Faine’s criteria. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The study population consisted of 50.94% of males and 49.06% of females with a mean age ± standard deviation of 34.2 ± 15.2 years. Fifty febrile patients had additional symptoms of which myalgia was the most common (81.1%) followed by arthralgia (22.6%). Peripheral smears of all patients were negative for malaria parasites. Dengue and Typhidot IgM positivity was observed in two and eight patients, respectively. Six and five patients were tested positive by leptospira and scrub typhus IgM ELISA, respectively. Salmonella Typhi was isolated from blood sample of only one patient. Serum samples of two patients showed dual positivity. All six leptospira seropositive patients satisfied modified Faine’s criteria. CONCLUSIONS: Leptospirosis is a seemingly unexplored infection in Uttarakhand and should be considered as a differential diagnosis in patients with acute undifferentiated febrile illness.
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Herr, Megan M., Paul M. Barr, David Q. Rich, and Nimish Mohile. "Clinical Features, Treatment, and Survival of Secondary Central Nervous System Lymphoma." Blood 124, no. 21 (December 6, 2014): 5389. http://dx.doi.org/10.1182/blood.v124.21.5389.5389.
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Abstract Background Secondary central nervous system lymphoma (SCNSL) is a rare complication of non-Hodgkin lymphoma (NHL) and is almost always fatal. In a review of 14 studies, SCNSL occurs in 2.3% to 10% of NHL patients and in 5% of diffuse large B-Cell lymphoma (DLBCL) patients. Median survival is 2 to 6.5 months from time of central nervous system (CNS) involvement. In this study, we sought to determine the factors that influence survival in SCNSL. Methods In a retrospective chart review with Institutional Review Board approval, all patients with SCNSL were identified from pathology reports and ICD-9 codes (198.3) using inpatient and outpatient clinic visits at the University of Rochester Medical Center, Rochester, New York from January 1st, 2005 to September 30th, 2013. Pathology reports were used to determine the total number of lymphoma patients diagnosed at URMC during this time period, which was used to calculate the incidence of SCNSL. Descriptive statistics and Kaplan-Meier curves were estimated using SAS 9.3 (Cary, NC). Results Forty-nine patients (median age = 60) developed SCNSL from DLBCL (32), transformed disease (5), marginal zone (3), Burkitts (3), lymphoplasmacytic (1), mantle cell (1), chronic lymphocytic leukemia (1), PTLD-DLBCL (1), or T-cell lymphoma (1). The cumulative incidence of secondary CNS disease in DLBCL was 3% during the study period. The majority of patients had stage IV disease (68.9%) and an elevated LDH at diagnosis. CNS prophylaxis was prescribed in 10.6% of all SCNSL patients and 12.5% in the DLBCL subset. Eighty-five percent of patients had other sites of metastases, with the majority of metastases occurring in the bone marrow, bone, lung, and liver. Patients developed CNS disease in the CSF (61%) or in the brain parenchyma (55%) or both (16%). Of the 27 patients with parenchymal involvement, 9 did not have a biopsy, but 5 had biopsy proven CSF involvement, resulting in a total of 4 unconfirmed cases, 3 of which were DLBCL. 12% of patients were asymptomatic; the other 88% presented with symptoms including headaches (33%), visual changes (29%), motor weakness (20%), cognitive problems (16%), and speech disturbances (14%). Treatment of SCNSL included a combination of treatments: methotrexate (63%), Rituxan (41%), cytarabine (39%), radiation (27%), and CHOP (20%). The median survival from diagnosis of SCNSL was 3.1 months in all patients and 2.6 months in DLBCL patients. In patients with leptomeningeal involvement only, patients that developed this involvement within 30 days of their initial NHL diagnosis were more likely to survive past 1 year (55.6%; 95% CI 0.23, 0.88) than patients who developed leptomeningeal involvement after 30 days (7.7%; 95% CI -0.07, 0.22) (p-value 0.02). Conclusion Over a period of 8.5 years, 49 NHL patients developed secondary CNS disease at a medical center in Western New York. Thirty-two out of the 49 NHL patients had DLBCL with secondary CNS disease. The cumulative incidence of secondary CNS disease in DLBCL is 3%, which is similar to what was reported in previous studies. The majority of SCNSL patients presented with neurologic symptoms. Our population closely resembles previously reported cohorts in characteristics and survival which remains poor. Disclosures No relevant conflicts of interest to declare.
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Tsang, Mazie, Kari Rabe Chaffee, Timothy G. Call, Wei Ding, Jose F. Leis, Asher Chanan-Khan, Michael Conte, et al. "Pure Red Cell Aplasia (PRCA) in Chronic Lymphocytic Leukemia (CLL): Etiology, Therapy, and Outcomes." Blood 126, no. 23 (December 3, 2015): 4169. http://dx.doi.org/10.1182/blood.v126.23.4169.4169.
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Abstract Background: PRCA is characterized by severe normochromic normocytic anemia, reticulocytopenia, and markedly reduced bone marrow erythroid precursors with intact leukocytic and megakaryocytic lineages. There is limited information about the prevalence and outcomes of PRCA in CLL, with the vast majority of information derived from case reports and small series comprising <10 patients. Here, we describe the clinical features, therapy, and outcomes of CLL patients with PRCA seen at our institution. Methods: The Mayo Clinic CLL Database includes all patients with a diagnosis of CLL evaluated at Mayo Clinic Rochester, MN between January 1995 and December 2014. We identified patients diagnosed with PRCA per the following diagnostic criteria: those who presented with normocytic anemia, had decreased erythroid precursors on bone marrow examination, and reticulocytopenia that could not be explained by any other cause besides PRCA. The baseline demographics, clinical characteristics, therapy, and outcomes were abstracted from the electronic medical records. We generated descriptive statistics and calculated overall survival (OS) from diagnosis date (PRCA, autoimmune cytopenia [AID], or CLL) to last known alive or death date. OS was plotted using Kaplan Meier curves and compared between groups using log-rank statistic. The Mayo Clinic IRB approved this study. Results: Of the 3945 CLL patients seen during the study interval, we identified 30 patients who met the diagnostic criteria of PRCA as described in the Methods section. The baseline characteristics, etiology and therapy for PRCA are shown in Table 1. The median time to PRCA from CLL diagnosis was 4.5 years (range-0.1-14 years). Of the 13 patients with IGHV results available, 12 (92%) were IGHV unmutated. Twenty-one (70%) were male and their median age at PRCA diagnosis was 67 years (range 40-81 years). Parvovirus testing was positive in 6 of 24 (25%) patients who were tested; 3 of these patients were treated with IVIG, 2 were treated with prednisone and IVIg, and 1 was treated with prednisone and rituximab. Eight patients (27%) had both PRCA and autoimmune hemolytic anemia (AIHA), and 1 patient (3%) had concomitant PRCA and immune thrombocytopenia (ITP). Of the 27 patients for whom we have treatment data, 10 required only one treatment regimen and 17 required 2-6 treatment regimens, with two patients requiring splenectomy for concomitant AIHA. The median survival of CLL patients after a diagnosis of PRCA was 4.6 years (Figure 1). There was no difference in survival between PRCA cases with and without parvovirus (p=0.92). Compared to newly diagnosed CLL Rai stage III/IV patients, there was no difference in OS (p=0.53). There was no statistically significant difference in survival from an AID cytopenia diagnosis when comparing PRCA, ITP, AIHA, and Evans syndrome (Figure 1; median 5 years for PRCA and 6 years for other groups; p=0.17). Conclusion: PRCA is a rare complication in CLL, occurring in <1% CLL patients seen at our institution over the past 20 years. Parvovirus was the etiologic factor in ~25% of patients and did not influence outcomes. There appears to be no significant difference in outcomes of PRCA patients compared to patients with other AID in CLL. Table 1. Patient Characteristics Characteristic N [range] or (%) Number of patients 30 Males 21 (70) IGHV status* · Unmutated · Mutated 12 (92) 1 (8) FISH results at CLL diagnosis* · 17p- · 11q- · Trisomy 12 · 13q- · Negative 0 (0) 1 (10) 3 (30) 3 (30) 3 (30) At PRCA Diagnosis Median age 67 [40 - 81] Median hemoglobin (gm/dL)* [normal range 12-15.5 gm/dL] 8.2 [3.5 - 10.8] Median absolute reticulocyte count (x 109/L)* [normal range: 38 - 113 x 109/L] 3.5 [0.0 - 25.3] Patients treated for CLL prior to PRCA diagnosis 25 (83) Etiology of PRCA Parvovirus (n = 24) 6 (25) Therapy-related: · Fludarabine · Alemtuzumab/rituximab · Pentostatin/cyclophosphamide/rituximab 3 (10) 1 (3) 1 (3) Autoimmune (neither therapy nor parvovirus related) 19 (63) Initial Therapy of Non-Parvovirus Related PRCA Steroids alone 2 (8) Steroids and Rituximab 3 (13) Steroids in combination with: · IVIG, Chlorambucil · Cyclosporine · Rituximab, IVIg · IVIg, splenectomy 1 (4) 2 (8) 1 (4) 1 (4) Monoclonal Ab alone · Alemtuzumab · Rituximab 1 (4) 4 (17) Cyclosporine 1 (4) Cyclophosphamide 2 (8) RCP (Rituxan, Cyclophosphamide, and prednisone) 2 (8) IVIg 1 (4) Not available 3 (13) *Not available for all patients Figure 1. Figure 1. Disclosures Ding: Merck: Research Funding. Kay:Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Research Funding; Hospira: Research Funding; Tolero Pharma: Research Funding; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Research Funding. Shanafelt:Cephalon: Research Funding; Hospira: Research Funding; Glaxo-Smith-Kline: Research Funding; Genentech: Research Funding; Jannsen: Research Funding; Celgene: Research Funding; Polyphenon E International: Research Funding; Pharmacyclics: Research Funding.
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Robertson, Charlene M. T., Lawrence W. Svenson, and Michel R. Joffres. "Prevalence of Cerebral Palsy in Alberta." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 25, no. 2 (May 1998): 117–22. http://dx.doi.org/10.1017/s0317167100033710.
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ABSTRACT:Background:In spite of scattered reports to the contrary, concern is continually expressed that the frequency of cerebral palsy has not decreased with modern perinatal/neonatal care. Overall, epidemiological information on cerebral palsy is scant. The generally accepted prevalence is 2 to 2.5 per thousand school-age children.Methods:A population-based record linkage study of a presently living cohort of 96,359 children born from April, 1985 through March, 1988 and followed over an eight-year tracking period captured the diagnostic codes for all fee-for-service physician claims, all hospital separations and individual birth data from the Department of Vital Statistics of the Government of Alberta. The ICD-9 code "343" was used to identify subjects. The childhood prevalence and frequency by birthweight- specific sub-groups of cerebral palsy were determined.Results:Two hundred and forty-eight living children with confirmed cerebral palsy after age three years (congenital, 229 [92.3%]; probable acquired 19 [7.7%]) were identified giving an overall prevalence of 2.57 per 1000. Seventy percent were diagnosed before their third birthday. Cohort prevalence of cerebral palsy for low birthweight children (< 2500 grams) was 17.7, very low birthweight (< 1500 grams), 78.5; and extremely low birthweight (< 1000 grams), 98.4. Low birthweight children made up just over one-third of cases in this study.Conclusions:Cerebral palsy continues to affect a significant number of children suggesting the prevalence of cerebral palsy has not decreased. The proportion of affected children with low birthweight in this study is less than that reported in the literature.
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van der Vegt, A. N., R. de Vries, J. Osinga, N. Grun, T. J. Postma, P. F. de Haan, M. E. van Linde, W. P. Vandertop, M. Schuur, and M. C. M. Kouwenhoven. "P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely?" Neuro-Oncology 23, Supplement_2 (September 1, 2021): ii47. http://dx.doi.org/10.1093/neuonc/noab180.163.
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Abstract BACKGROUND Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child. METHODS From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics. RESULTS The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy. CONCLUSIONS The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.
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Davidson, Anne M., Terry Burgess, Agafe Saguros, Chu Jian Ma, James McAuley, and Ryan M. Close. "451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S221—S222. http://dx.doi.org/10.1093/ofid/ofz360.524.
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Abstract Background Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical access hospital that exclusively serves an AI population in the American Southwest. Methods We identified patients hospitalized (admitted or transferred) with an SSTI from June 2017 to May 2018. Relevant cases underwent chart extraction for demographics, SSTI characteristics, laboratory and microbiologic data, relevant history and co-morbidities. All variables were summarized using descriptive statistics. Odds ratios and P-values with two-tailed tests were used to identify risk factors for multiple SSTI episodes. Results During the study period, 289 unique individuals comprised 343 SSTI hospitalizations / episodes (18% of the 1,883 total hospitalizations). The unadjusted annual rate of SSTI hospitalization was 2,018 per 100,000. There were 13 cases of necrotizing fasciitis (NF) with an unadjusted rate of 76 per 100,000 per year. Only 183 episodes (53%) had a wound culture performed, with 84% positive for a pathogenic organism, compared with 287 episodes (84%) with a blood culture performed, of which only 7% were positive for a pathogen. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive SA (MSSA)and/or Streptococcus pyogenes accounted for 74.9% (n = 125) and co-infection with these three organisms accounted for 22.2% (n = 37) of positive wound cultures (n = 167). An SSTI in the last year (49%), diabetes (41.9%), alcohol abuse (40%) and hypertension (39%) were common among all 289 individuals. Diabetes (OR 3.3, P < 0.01), hypertension (OR 2.8, P < 0.01), renal disease (OR 2.7, P < 0.05), previous SSTI (OR 3.0, P < 0.01) were associated with a higher risk of multiple SSTI hospitalizations. Conclusion The incidence rate of SSTI hospitalization in this Southwest AI population was 9-times greater than the general US population and 4-times greater than prior reports in Southwest AI. The NF rate was >10-times the general US population rate. We describe common co-morbidities among these SSTI episodes and potential risk factors for repeat hospitalization. Disclosures All authors: No reported disclosures.
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Fraiwan, Arwa, Muhammad Noman Hasan, Ran An, Amy J. Rezac, Nicholas J. Kocmich, Tolulope Oginni, Grace Mfon Olanipekun, et al. "Advancing Healthcare Outcomes for Sickle Cell Disease in Nigeria Using Mobile Health Tools." Blood 134, Supplement_1 (November 13, 2019): 2173. http://dx.doi.org/10.1182/blood-2019-131344.
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Nigeria leads the world in the number of cases of sickle cell disease (SCD). An estimated 150,000 babies are born annually in Nigeria with SCD, a heredity disorder, and 70-90% die before age 5. Only a small portion of affected infants and children in sub Saharan Africa (SSA) reach adolescence. Over 650 children die per day in sub-Saharan Africa from SCD. These dismal statistics are in sharp contrast to outcomes in high-income countries (HICs) where more than 90% of SCD patients reach adulthood. The World Health Organization (WHO) estimates that 70% of deaths could be prevented with a low cost diagnostic and treatment plan. Meaningful preventive care and treatment cannot be implemented without a structured plan for early diagnosis and patient tracking.Early diagnosis requires improved access to parents and guardians of children with SCD, and gaining this access remains a challenge in most of SSA. In 2015, Nigeria's Kano state government, with support from foreign partners, established a community-based program for newborn registration. This platform provides unique access to newborn babies in one of Nigeria's most populous cities, but still lacks a functioning patient testing, tracking, and monitoring system, which we plan to address in our ongoing study. This study will introduce mobile health in a low-income country with low literacy rate and hopefully accustom that segment of the population to more varied mobile health applications that will ultimately improve their health in the long run. Our current operational platform in Kano, Nigeria provides access to a large population with a high prevalence of SCD. We have previously completed pilot testing of 315 subjects for SCD using our microchip electrophoresis test. We are planning to test up to 4,500 additional subjects less than 5 years of age at Murtala Muhammed Specialist Hospital. The hospital staff includes 97 physicians and 415 nurses and outpatient clinics serve about 30,000 patients monthly. The maternity department has a 200-bed capacity and the antenatal clinic performs about 1,000 deliveries and serves an average of 3,000 mothers monthly. Enrollment is planned to start on September 15, 2019 and medical staff are currently being trained to run the tests. Our study is registered in the United States National Library of Medicine's ClinicalTrials.gov (Identifier: NCT03948516). Our technology is uniquely paired with an automatic reader and an Electronic Medical Record (EMR) and patient management solution to record POC test results, register new cases, and track patients for follow-up (Fig. 1). The reader enables automated interpretation of test results, local and remote test data storage, and includes geolocation (Global Positioning System) (Fig. 2). The system will generate reports for all cases of SCD, track hospital visits, appointments, lab tests, and will have mobile and dashboard applications for tracking patients and samples. The application will be installed on mobile devices provided to users. The proposed system will be compliant with the existing privacy standards to handle medical data (e.g., HIPAA in the US and GDPR in the EU). All communications between the parties will be secured via end-to-end encryption as a safeguard. We anticipate that our project will increase the rates of screening, diagnosis and timely treatment of SCD in Kano State of Nigeria. The project's broader impact will likely be the ability to track and monitor screening, disease detection, diagnosis and treatment, which can be scaled up to the whole nation of Nigeria, then to sub-Saharan Africa. The data obtained and analyzed will be the first of their kind and will be used to inform the design of programs to improve access to, and availability of, effective care for this underserved populations. The importance of increased access to diagnosis and treatment should not be underestimated - it is crucial for realizing effective management of people with SCD. The impact can be enhanced by complementing diagnosis and patient tracking with education for the families so they can provide or seek the necessary preventative treatment. Identification of the location of the patients in need would help identify the areas where family, parent, caregiver education should be provided. Disclosures Fraiwan: Hemex Health, Inc.: Equity Ownership, Patents & Royalties. Hasan:Hemex Health, Inc.: Equity Ownership, Patents & Royalties. An:Hemex Health, Inc.: Patents & Royalties. Thota:Hemex Health, Inc.: Employment. Gurkan:Hemex Health, Inc.: Consultancy, Employment, Equity Ownership, Patents & Royalties, Research Funding.
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Langlais, Blake T., Carolyn Mead-Harvey, Heidi E. Kosiorek, Gina L. Mazza, Ruben Mesa, Jeanne M. Palmer, and Amylou C. Dueck. "Analysis of Free-Text Responses in an International Myeloproliferative Neoplasms Patient Survey to Assess Impact of the COVID-19 Pandemic on Clinical Care." Blood 136, Supplement 1 (November 5, 2020): 11–12. http://dx.doi.org/10.1182/blood-2020-143172.
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Background The COVID-19 pandemic continues to challenge effective treatment delivery to hematologically-compromised patients, including those with myeloproliferative neoplasms (MPNs). MPNs are characterized by clonal proliferation of hematopoietic cell lines in bone marrow. As such, increasing reports of COVID-19 related thrombotic events highlight how MPN patients are at an increased risk in navigating potential complications during this pandemic. Mitigation strategies to lesson MPN patient exposure to COVID-19 are vital. Though, such efforts come at an inherent cost to effective healthcare delivery. Restriction of regular in-clinic treatments and reported shortages of MPN pharmacotherapies present these patients with diminishing continued care. To understand how MPN patient care has been impacted by COVID-19, an internet-based questionnaire was deployed surveying a variety of disease and pandemic related items (reported elsewhere; Palmer J et al, ASH 2020 submitted). A single free-text response item instructed respondents to: "Please tell us anything else (bad or good) about how the COVID-19 outbreak has impacted your MPN care." This qualitative analysis evaluated first-hand comments directly from patients in order to form a richer understanding of how those with MPNs have been managing disease-related care amidst this pandemic. Methods This COVID-19 survey was hosted via Mayo Clinic's secured REDCap system for online surveys and posted on MPN organizational partner websites. Surveys were completely anonymous. The free-text responses describing impacts to MPN care were each independently reviewed by 2 individuals for overall sentiment (positive, negative, both, or neutral [no impact]) and categorized for themes. The 2 reviewers were assessed for agreement. Conflicting reviews were evaluated then adjudicated by an algorithm for cases meeting selected conditions or by lead author review for all remaining cases. Descriptive statistics are reported. Results Of the 1217 consenting adult patients participating in the overall COVID-19 study, 824 provided free-text responses. Of these, respondent MPN diagnoses included, essential thrombocythemia (n=324, 39%), polycythemia vera (n=251, 30%), myelofibrosis (n=153, 19%), and other/undisclosed (96, 12%); 69% (n=567) were female; median age was 63 (range 21-93); 38% (n=313) were from the US, 38% (n=313) UK, and 24% (n=198) other/unknown. There was 89% (n=734) sentiment agreement between reviewers. Free-text responses about the impact of COVID-19 on MPN care were 49% (n=400) negative, 21% (n=177) positive, 8% (n=65) both positive and negative, and 22% (n=182) neutral/no impact. Table 1 shows a selection of MPN patient free-text responses reflecting common negative and positive sentiment themes. Negative impact (n=400): The most common negative impact involved delays or cancellations of visits or perceived inaccessibility to regular providers (n=261, 65%). Primarily this sentiment was driven by lack of clinic availability and restrictions at treatment centers or by providers. However, some respondents reported delaying or canceling visits themselves due to fear of COVID-19 exposure. Perceived health consequences from this delay were also expressed. There were 129 (32%) respondents with concern regarding changes or access to medications, including explicit drug supply shortages. Some patients resorted to self-adjusting medications and reusing single-use supplies. General anxiety, stress, and isolation were also reported (n=98, 25%). Positive impact (n=177): Availability of telemedicine comprised the majority of positive impacts of the pandemic (n=95, 54%), with many noting the reduced travel time to visits. Routine local testing coupled with follow-up telemedicine was favorable. Despite general positivity towards telemedicine, some reported preferences for in-person visits; commenting that telemedicine was impersonal, difficult to schedule or receive virtual communication, and expressed concern for lack of spleen examinations during virtual visits. Conclusion Positive and negative aspects were reported including MPN-specific issues. Healthcare systems should use such data to emerge from the COVID-19 pandemic and retain the positive impacts such as telemedicine, while developing education materials and other resources to address the reported negative impacts where possible. Disclosures Mesa: CTI BioPharma: Research Funding; Promedior: Research Funding; Novartis: Consultancy; Sierra Oncology: Consultancy; Samus Therapeutics: Research Funding; Genentech: Research Funding; AbbVie: Research Funding; Incyte: Research Funding; LaJolla Pharmaceutical Company: Consultancy; Bristol Myers Squibb: Research Funding.
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Miranda, Stephen, Daksh Chauhan, Jessica Nguyen, Eric L. Zager, and Zarina S. Ali. "142 Common Peroneal Nerve Decompression for Slimmers Palsy: A Case Series With Intraoperative Stimulation." Neurosurgery 70, Supplement_1 (April 2024): 31. http://dx.doi.org/10.1227/neu.0000000000002809_142.
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INTRODUCTION: Slimmer’s palsy refers to common peroneal nerve (CPN) entrapment neuropathy associated with rapid or significant weight loss. Indications and outcomes for CPN decompression in this population remain unclear. While there are reports documenting functional improvement after surgical decompression, there are also case series demonstrating recovery with non-operative management, including diet modification, nutritional supplementation, and rehabilitation. METHODS: Retrospective chart review was performed to identify patients (age >18) who underwent CPN decompression between 2012-2021 with documented history of weight loss >5 kg. Demographics, weight loss, operative details, electromyography findings, onset/degree of weakness by manual muscle testing (MMT), and extent of improvement were collected. Pre- and post-decompression conduction thresholds were measured intraoperatively. Descriptive statistics were performed, including paired t-tests for pre- and post-operative MMT scores and pre- and post-decompression conduction thresholds. RESULTS: Five total patients were identified. Median age was 39 years. Most were male (3/5), White (5/5), privately insured (3/5), current/former smokers (3/5), and normal weight (3/5). Mean weight loss was 27 kg (range: 5-45). Reasons for weight loss included intentional, chemotherapy-related, bariatric surgery, and one case of unexplained weight loss. Mean MMT score at time of evaluation was 2.0 + 0.45 for tibialis anterior (TA), 2.0 + 0.55 for extensor hallucis longus (EHL) and 2.2 + 0.58 for peroneus longus (PL). Time to surgery ranged from 4-6 months. Mean postoperative MMT scores were significantly improved in TA (4.6 + 0.24, p = 0.007), EHL (4.6 + 0.24, p = 0.007) and PL (4.6 + 0.24, p = 0.02) compared to baseline. Mean conduction thresholds (5.75 + 1.89) were lower after decompression (1.2 + 0.31), although not statistically significant in this sample (p = 0.12). CONCLUSIONS: In this small series, CPN decompression restored function for patients with Slimmer’s palsy. Nerve conduction block was observed intraoperatively in most cases, perhaps supporting a compressive etiology for this condition.
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Swiecicki, Paul L., Livia Hegerova, and Morie A. Gertz. "The Natural History of Cold Agglutinin Disease." Blood 120, no. 21 (November 16, 2012): 5152. http://dx.doi.org/10.1182/blood.v120.21.5152.5152.
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Abstract Abstract 5152 Introduction: Cold agglutinin disease (CAD) is a rare and poorly understood disorder accounting for 15% of patients with autoimmune hemolytic anemia. Treatment has been largely controversial with few studies addressing safety and efficacy of various treatment regimens. This study reports a single institution's experience with cold agglutinin disease, defines the clinical features, prognosis and management. Methods: A retrospective analysis of Mayo Clinic medical records since 1960 was performed to identify all cases of CAD. Initial appraisal identified 89 patients after which an in depth review of clinical notes, laboratory evaluations, and treatment regimens was performed. Statistical analysis was performed via descriptive statistics and Kaplan-Meier survival. Results: The median age at onset of symptoms was 65 years (range: 40, 82), while the median age at diagnosis was 72 (42, 91). The most common sign at presentation was anemia (38. 4%). The most common symptom during the course of disease was similarly finger discoloration (43. 8%). Over half of patients had symptoms that were triggered by a cold environment (52. 8%) and a minority (22. 5%) had exacerbations precipitated by other factors. The median time from onset of symptoms to time of disease diagnosis was 37 months (0, 374). The majority of patients had an underlying hematologic disorder (48. 3%) of which the most common was monoclonal gammopathy of undetermined significance. At diagnosis the average hemoglobin was 10. 2 (6. 2, 17. 7) with positive coombs testing in 75% of patients. All patients had documented positive cold agglutinin titers. Approximately 40% of patients received transfusions at some point during their disease course and 83% needed drug therapy at some point. The most common reason to initiate drug treatment was progressive anemia (44. 9%). In 15% of patients, CAD was able to be managed with watchful waiting. The median duration between initial symptoms to initiation of treatment was 60 months. 56. 2% and 33. 7% of patients required second and third line therapy respectively. Treatment characteristics and responses are displayed in Table 1. Rituximab showed the longest duration of response and had the lowest percentage of patients needing further treatment, while 4 out of 5 patients on prednisone required additional therapies. Median survival in all patients with CAD was 127. 5 months and 76. 9% of patients were alive at 5-years after diagnosis (Figure 1). Conclusions: This is the largest study of patients with cold agglutinin disease to date. Symptoms were frequently ill-defined resulting in delay of diagnosis. Although drug therapy was frequently indicated, many patients were successfully observed. New treatment agents including Rituximab demonstrate promising response rates compared to traditional regimens, especially in patients with underlying hematologic abnormalities. These results support consideration of CAD as part of the differential diagnosis in the setting of new onset anemia and re-enforces the importance of evaluation for underlying B Cell abnormality in this patient population. Disclosures: Off Label Use: Rituximab, Cyclophosphomide, Chlorambucil, and Prednisone will be discussed as therapy modalatities for the treatment of cold agglutinin hemolytic anemia.
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Mansouri, Alireza, Saber Ghadakzadeh, Talha Maqbool, Carolina Barnett, Karolyn Au, Paul Kongkham, Vera Bril, and Zadeh Gelareh. "Neurofibromatosis Clinic: A Report on Patient Demographics and Evaluation of the Clinic." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 5 (November 8, 2016): 577–88. http://dx.doi.org/10.1017/cjn.2016.326.
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AbstractBackground: Neurofibromatosis type 1 (NF1) is a common single-gene disorder. A multidisciplinary approach to the management of NF1 patients is necessitated by the heterogeneity of clinical manifestations. Although multidisciplinary paediatric clinics have been well established, there is a dearth of such resources for adults with NF1. Herein we report our one-year institutional experience with a multidisciplinary adult NF1 clinic. Methods: A multidisciplinary team was assembled, and an NF Patient Registry Initiative questionnaire was adapted to collect patient-reported data during clinics. Multiple databases were searched to identify publications pertaining to the experience of other multidisciplinary NF1 clinics focusing on adult patients. Data on patient epidemiology and clinical staff were compared to our data. Results: A total of 77 patients were scheduled, and 68 attended the clinic, of whom 66 completed the intake questionnaire. The demographic and clinical data from this Canadian population are mostly consistent with previous reports, with some exceptions. Clinical data related to immune system involvement such as asthma, airway/breathing-related difficulties or allergies were striking in our NF1 population. Six relevant published reports of other NF1 clinics were identified. Reports from these studies pertained to periods ranging from 10 to 38 months, and the number of adults assessed ranged from 19 to 177 patients. Conclusions: The structure of our clinic and the patient volume are comparable to those of other established centres found in the literature. Our data offer valuable cross-sectional prevalence statistics in the Canadian population. The patient-reported data concerning involvement of the immune system contribute to an emerging recognized medical concern within the NF1 population and warrant further clinical and basic investigation.
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Öfner, J. G., B. Bartl, St König, and W. F. Thumfart. "Photodynamic therapy in selected cases at the ENT Clinic, Innsbruck: case reports." Journal of Photochemistry and Photobiology B: Biology 36, no. 2 (November 1996): 185–87. http://dx.doi.org/10.1016/s1011-1344(96)07369-1.
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kler, Erdem, Zehra Erkol, and Gamze er. "Forensic Medical Evaluation of Nasal Trauma Cases." Annals of Medical Research 29, no. 6 (2022): 1. http://dx.doi.org/10.5455/annalsmedres.2021.12.652.
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Aim: The purpose of this study was to evaluate the cases for which a final report was made due to nasal trauma and to reveal the errors made in the diagnosis. Materials and Methods: Among the forensic reports prepared in the Forensic Medicine Clinic of Bolu Abant İzzet Baysal University Training and Research Hospital between 2015-2019, cases with "a history of nasal trauma" were included in the study. Result: In this study, 315 cases with a history of nasal trauma were included. Two hundred sixty-four (83.8%) of the cases were male and 51 (16.2%) are female. Two hundred thirty-one of the cases (73.3%) were injured as a result of the intentional blunt injuries. Before applying to the Forensic Medicine Clinic, 28 (8.9%) of the cases were evaluated only by physical examination, 46 (14.6%) by physical examination + direct radiography, 241 (76.5%) by physical examination + direct radiography + CT. It was evaluated that the report prepared by emergency department physicians on 203 cases (64.4%) was correct, whereas the report prepared on 112 (35.6%) cases was erroneous. It was evaluated that the reports prepared by Otorhinolaryngologists on 117 cases (80.1%) were correct, whereas the reports prepared on 29 (19.9%) cases were erroneous. Conclusion: We believe that it is more appropriate to give the final forensic report of cases with nasal trauma by a Forensic Medicine Specialist rather than Emergency Department physicians or an Otorhinolaryngologist.
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Bodecek, S., P. Jahn, O. Dobesova, and E. Vavrouchova. " Equine cyathostomosis: case reports." Veterinární Medicína 55, No. 4 (May 19, 2010): 187–93. http://dx.doi.org/10.17221/88/2010-vetmed.
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Twelve clinical cases of cyathostomosis in horses treated at the Equine Clinic University of Veterinary and Pharmaceutical Sciences in Brno, the Czech Republic, between the years 1999 and 2008 are described in this report. Six cases (50%) were hospitalized in the period from 2007 to 2008. Eleven of them were hospitalized in the period from December to March. Only one case was admitted in June, but the clinical signs had appeared for the first time in January. All horses described in these cases were younger than six years of age. Diarrhoea as a predominant clinical sign was present in four horses and colic in four horses. One horse showed both colic and diarrhoea whilst three horses had weight loss and subcutaneous oedema. Metabolic acidosis was found in three horses, eight patients had leucocytosis. Hypoproteinemia was found in four horses, hypoalbuminemia in seven horses, hypokalemia in three horses and increased alkaline phosphatase (ALP) activity in five horses. Seven horses recovered, one horse died and four horses were euthanized.
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Kumekbayeva, Saule, and Meiram Baubekov. "Estimation of Performance of Clinical Separations and Quality of Medicare of Scientific Research Institute of Traumatology and Orthopedics." Research Institute of Traumatology and Orthopedics 1, no. 51 (2020): 15–19. http://dx.doi.org/10.52889/1684-9280-2020-1-51-15-19.
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The article presents an analytical report about the activity of Scientific-research Institute of Traumatology and Orthopedics clinic for the period of 2015-2019 years. For the analysis of the in-patient clinic statistics annual report on the work of the hospital were used (Form 30), section 3 «Bedspace and its use» and the form 14 “Report on the activities of the in-patient clinic for the period of a year”, form 17 "Report on medical and pharmaceutical shots". On top of that, there were made the analysis of conjunctural reports of heads of functional departments of clinic. Except it, the analysis of quality of providing of medicare is conducted
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Sandoval-Sus, Jose D., Facundo E. Stingo, Todd C. Knepper, Lisa Nodzon, Eric Padron, Mohamed A. Kharfan-Dabaja, Julio C. Chavez, and Javier Pinilla-Ibarz. "Mutational Landscape of Chronic Lymphocytic Leukemia Using Next Generation Sequencing Technologies in the Real World Clinical Setting." Blood 128, no. 22 (December 2, 2016): 4366. http://dx.doi.org/10.1182/blood.v128.22.4366.4366.
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Abstract Background: Chronic lymphocytic leukemia (CLL) is associated with significant genomic heterogeneity that might explain its variable clinical course. Although there are established prognostic genomic features already detected by fluorescence in-situ hybridization (FISH), next generation sequencing (NGS) technologies have uncovered a myriad of novel mutations in CLL that may influence both prognosis and treatment decisions (Landau DA et al. 2015). Recently commercial NGS panels are actively used outside of the research spectrum. This study describes the mutational landscape of unselected consecutive CLL patients analyzed using commercial NGS platforms at a single academic institution as a part of routine clinical care. Materials and methods: Using Total Cancer Care (TCC) and Moffitt Cancer Center (MCC) CLL databases (N=1,267 patients) we retrospectively identified a subset of 148 subjects from January 2014 to May 2016 with confirmed CLL diagnosis and an available commercial NGS panel (Genoptix® and FoundationOne®). Molecular testing was done on bone marrow biopsies and/or peripheral blood samples either during the first clinic visit, or at time of disease progression. We used descriptive statistics to annotate demographic characteristics, disease prognostic features, mutation frequencies, and the class and type of molecular changes found in the cohort. We utilized standard statistical methods (Chi-square) to assess associations between known prognostic factors (age, CLL-IPI score, IGHV mutational status, B2M, ZAP-70 and CD38+ status, and FISH detected mutations) and identified mutations. Time to first treatment was estimated with the Kaplan-Meier method and curves compared with log-rank test. All statistical analyses where done using SPSS v24.0 Results: From our cohort of 148 CLL patients with an available commercial NGS panel, 110 and 38 were sequenced using Genoptix® and FoundationOne® panels, respectively. At the time of molecular sequencing 48 (32.3%) had high or very high CLL-IPI scores, 77 (52%) had unmutated IGHV, 22 (14.8%) harbored del11q, 19 (12.8%) had del17q and 10 (6.7%) had a complex karyotype. Seventy (47.2%) patients were treatment naïve and 59 (40%) had received CLL directed therapy before NGS testing. Of the previously treated patients, 56% received fludarabine-based regimens and 27% received at least one B-cell receptor inhibitor. The mean number of mutations in our patient cohort was 6.3 (3.1 per Genoptix® and 9.5 per FoundationOne®). Most common mutations types were missense (74.7%) and frameshift (14%). Most frequently mutated genes (≥7 cases) were: ATM (25.6%), TP53 (15.5%), NOTCH1 (15.5%), SF3B1 (14.1%), FAT1 (8.1%), BCOR (8.1%) and CREBBP (7.4%) (Figure 1). TP53 mutations had higher CLL-IPI scores (p<0.001), del17q (p<0.001), previous fludarabine based therapy (p<0.009), fludarabine resistance (p=0.016) and shorter TFT in comparison to TP53wt (16.5 vs. 64.2 months, p=0.002). Interestingly, FAT1 mutation was universally correlated with mutated IGHV status (p<0.001), and lower probability CLL-directed treatments (p=0.006). Table 1 shows correlation of general characteristics and other mutated genes. Conclusions: NGS, through validated commercial gene platforms, is readily available outside of clinical trials for CLL patients for genomic risk assessment and could accurately replicate findings of earlier reports. Challenges remains in regards of cost, adequate bioinformatics support and accessibility that restrict its availability to academic centers. Figure 1 Percentage of patients with the most common mutated genes Figure 1. Percentage of patients with the most common mutated genes Table 1 Table 1. Disclosures Nodzon: Novartis: Speakers Bureau. Chavez:Janssen: Speakers Bureau. Pinilla-Ibarz:Abbvie: Consultancy, Speakers Bureau; Pharmacyclics: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Novartis: Consultancy; Novartis: Consultancy; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Speakers Bureau; Abbvie: Consultancy, Speakers Bureau.
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Brockbank, M. J., D. Y. Veitch, and H. G. Thomson. "Cerebrospinal fluid in the rhinitis clinic." Journal of Laryngology & Otology 103, no. 3 (March 1989): 281–83. http://dx.doi.org/10.1017/s0022215100108710.
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AbstractThe Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were liagnosed. In each case long term topical steriod sprays had been prescribed and the patients had been eferred for further management of their ‘rhinitis’. Spontaneous CSF rhinorrhoea is potentially life hreatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the istula is employed.Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.
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Babushkin, Mikhail, and Ilya Bershov. "ANALYSIS OF THE ACTIVITIES OF THE INVESTIGATION BODIES OF THE STATE FIRE SUPERVISION OF THE FEDERAL FIRE-FIGHTING SERVICE FOR THE INVESTIGATION IN CASES OF FIRE IN 2023." LAW. SAFETY. EMERGENCY SITUATIONS 2024, no. 2 (July 5, 2024): 75–91. http://dx.doi.org/10.61260/2074-1626-2024-2-75-91.
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The authors show the statistics of the work of the state fire supervision authorities of the EMERCOM of Russia for 2023. The article reflects statistics on the number of accepted reports of crimes, considered reports of crimes, on the number of criminal cases on fires under articles 168, 219 and 261 of the Criminal code of the Russian Federation. Data on the number of suspended criminal cases on fires, solved criminal cases on fires, the amount of property damage in fire cases in 2023 are shown. The authors show typical violations in the investigation of criminal cases on fires.
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Call, Timothy G., Kari G. Rabe, Brewer D. Jerry, Neil E. Kay, Clive S. Zent, Susan M. Schwager, Deborah A. Bowen, et al. "Melanoma and Non-Melanoma Skin Cancer in Patients with Chronic Lymphocytic Leukemia." Blood 114, no. 22 (November 20, 2009): 1268. http://dx.doi.org/10.1182/blood.v114.22.1268.1268.
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Abstract Abstract 1268 Poster Board I-290 Purpose There are reports of an increased risk of skin cancers in patients with B-Chronic Lymphocytic Leukemia (CLL). These skin cancers include basal cell and squamous cell carcinoma. This analysis was performed to more completely define the prevalence of skin cancers in patients in the Mayo Clinic Rochester CLL database and to look for contributing factors. Methods The Mayo Clinic Rochester CLL Database includes all patients with a diagnosis of CLL since January 1995 seen in the Division of Hematology and who have signed institutional review board approved consents for research. For this study, 2240 patients were analyzed to compare differences in characteristics between CLL patients with and without skin cancer. Chi-square statistics were used to compare qualitative variables (age categories, gender, referral status, ALC categories, CD38, ZAP-70, IgVH gene mutation status, FISH categories, Rai stage), and t-tests were used for quantitative variables (age at diagnosis, ALC values). Overall survival (OS) and time to first treatment (TFT) analyses were performed with results being displayed using Kaplan-Meier curves and p-values calculated using a log-rank test. Prevalence of melanoma among CLL patients was compared to the age-adjusted prevalence of melanoma in individuals in the Iowa SEER registry. Results Median follow-up for the 2240 patients diagnosed between 1/1/1995 and 8/11/2009 was 4.6 years. In aggregate, 293 (13.1%) patients were found to have non-melanoma skin cancer (squamous cell carcinoma or basal cell carcinoma) cancer. The diagnosis of non-melanoma skin cancer occurred before the CLL diagnosis in 39% and at or after the diagnosis of CLL in 61%. There were 57 (2.5%) cases of melanoma in association with CLL. The diagnosis of melanoma occurred before the CLL diagnosis in 38% and at or after the diagnosis of CLL in 62%.The prevalence of non-melanoma skin cancer and melanoma skin cancer were both higher in non-referred (geographically regional) CLL patients than referred CLL patients (16.6% vs. 11.4%, p<0.001 for non melanoma; 2.0% vs. 3.6%, p=0.03 for melanoma). The prevalence of melanoma in CLL patients was higher than that of age-adjusted prevalence for individuals in the Iowa SEER registry (2.5% vs. 0.03%; p<0.001). We next evaluated the relationship between CLL patients with skin cancer and demographic characteristics, prognostic parameters, and CLL related treatment. The risk of non-melanoma skin cancer in CLL was found to be associated with age (median age at diagnosis with skin cancer 67.6 vs. without skin cancer 63.3, p<0.001) and with sex (males 15.1% vs females 8.9%, p <0.001). There was no statistical significant difference in frequency of non-melanoma skin cancer associated with absolute lymphocyte count (ALC), Rai stage, CD 38, Zap 70, IgVH gene mutation status, FISH, or treatment history. The risk of melanoma in CLL was found to be associated with age at diagnosis (median age with melanoma 69.9 vs. without melanoma 63.8, p=0.002) and CD38 (positive 1.3% vs negative 3.1%, p=0.03). There was no statistically significant difference associated with gender, ALC, Rai stage, Zap 70, IgVH gene mutation status, FISH, or treatment history. Since the presence of skin cancer could be a marker of immune dysregulation we hypothesized skin cancer may be associated with clinical outcome of CLL. Accordingly, we evaluated the relationship between non-melanoma skin cancer and melanoma skin cancer and TFT and OS. Contrary to our hypothesis, TFT (median 6.0 years vs. 4.9; p=0.04) and OS (median 10.8 years vs. 9.7; p=0.02) of patients with non-melanoma skin cancer were both longer than those without non-melanoma skin cancer. No differences in TFT (p=0.06) or OS (p=0.66) were observed among patients with melanoma compared to those without melanoma. Conclusions We find in our cohort of CLL patients a higher prevalence of melanoma than the general population. Risk of melanoma and non-melanoma skin cancer among patients with CLL does not appear to be related to CLL characteristics, with the exception of CD 38, or CLL outcome. The diagnosis of melanoma and non-melanoma skin cancer in patients with CLL does not appear to be a risk factor for either CLL specific outcomes (TFT) or shorter survival. Disclosures Kay: Biogenc-Idec, Celgene, Genentech, genmab: Membership on an entity's Board of Directors or advisory committees; Genentech, Celgene, Hospira, Polyphenon Pharma, Sanofi-Aventis: Research Funding. Zent:Genentech, Bayer, Genzyme, Novartis: Research Funding. Shanafelt:Genentech: Research Funding; Hospira: Membership on an entity's Board of Directors or advisory committees, Research Funding; Polyphenon E International: Research Funding; Celgene: Research Funding; Cephalon: Research Funding; Bayer Health Care Pharmaceuticals: Research Funding.
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Rodrigues Martins, Bruna, Leonor Passos Magalhães, Kaio Henrique Soares, Olga Beatriz Lopes Martins, and Cássio Roberto Rocha dos Santos. "Coronectomy: two clinical case reports." Revista Unimontes Científica 25, no. 1 (May 5, 2023): 1–11. http://dx.doi.org/10.46551/ruc.v25n1a10.
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Introduction: The lower third molar extraction is a procedure that can lead to some complications. To perform tooth extraction, the dental surgeon requests imaging exams to assess some aspects, including the proximity of the tooth to the inferior alveolar nerve. Based on these findings, the surgery can be performed or other tests can be requested, such as a cone beam computed tomography. If the proximity between such structures is confirmed through tomography, the coronectomy presents as an alternative to conventional third molar extraction or other mandibular teeth that are in close contact with the inferior alveolar nerve and, consequently, with a higher risk of damaging this structure. Objective: The present study aims to report two clinical cases of coronectomy performed at the surgery clinic of the Federal University of Jequitinhonha and Mucuri Valleys (UFVJM). Methodology: Two clinical cases were reported in this study. Discussion: Although the results of this technique are positive, it is still not widely accepted due to the lack of long term studies and the possibility of having a second surgical procedure to remove residual roots. Conclusion: In both cases, no complications were reported by the patients, such as loss of sensitivity, pain, infection or dry socket.