scholarly journals P.143 How well can neuroradiologists localize clinical signs?

2021 ◽  
Vol 48 (s3) ◽  
pp. S60-S61
Author(s):  
C Curtis ◽  
A Pauranik
Keyword(s):  
Imaging Modality ◽  
Clinical Signs ◽  
Clinical Information ◽  
Neurological Deficits ◽  
Teaching Hospitals ◽  
Clinical Neurology ◽  
Electronic Survey ◽  
Clinical Vignettes ◽  
The Usa ◽  
American Society

Background: A basic understanding of localization for a given set of focal neurological deficits is essential for accurate acquisition and interpretation of neuroimaging. Relying on often-limited clinical information, neuroradiologists must choose the most appropriate imaging modality and tailor a study to best identify the culprit lesion to allow for accurate interpretation. Methods: A multiple-choice quiz was designed including clinical vignettes localizing to lesions within the central (CNS) and peripheral nervous systems (PNS). The quiz was pilot-tested and refined before distribution as an electronic survey to practicing neuroradiologists and fellows within newsletters from the American Society for Neuroradiology and Canadian Neurological Sciences Federation. Results: The quiz was begun by 45 neuroradiologists and completed in its entirety by 22. Most respondents were working at urban academic/teaching hospitals(81%) in the USA(42%). The majority (90%) report no clinical neurology rotation during their training. Respondents identified a high proportion (88%) of correct answers in questions about brainstem localizations. Fewer correct answers were selected in questions describing seizure semiology (44%) or flaccid weakness (59%). Conclusions: The small size of our study limits interpretation and generalizability of the findings. Identification of a potential gap in neuroradiology education relating to localization of more complex CNS and PNS presentations merits further exploration.

scholarly journals Investigation of an EHV-1 Outbreak in the United States Caused by a New H752 Genotype

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 747
Author(s):  
Nicola Pusterla ◽  
Samantha Barnum ◽  
Julia Miller ◽  
Sarah Varnell ◽  
Barbara Dallap-Schaer ◽  
...  
Keyword(s):  
Early Stage ◽  
Clinical Signs ◽  
Amino Acid Position ◽  
High Viral Load ◽  
The United States ◽  
Neurological Deficits ◽  
Diagnostic Challenge ◽  
Genotype I ◽  
Flunixin Meglumine ◽  
Nasal Secretions

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

scholarly journals Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1017
Author(s):  
Julian Zipfel ◽  
Meizer Al-Hariri ◽  
Isabel Gugel ◽  
Alexander Grimm ◽  
Volker Steger ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Signs ◽  
Complete Resection ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Surgical Interventions ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.

Assessment of the Implementation of AUC Dosing and Monitoring Practices With Vancomycin at Hospitals Across the United States

2021 ◽  
pp. 089719002110123
Author(s):  
Nicole Bradley ◽  
Yuman Lee ◽  
Muaz Sadeia
Keyword(s):  
The United States ◽  
Descriptive Statistics ◽  
Therapeutic Drug ◽  
User Friendliness ◽  
Electronic Survey ◽  
The Us ◽  
Institutional Adoption ◽  
American Society ◽  
Trough Levels ◽  
Do So

Introduction: The latest vancomycin therapeutic drug monitoring guidelines for serious MRSA infections have made a pivotal change in dosing, switching from targeting trough levels to AUC dosing. Because of these new recommendations, antimicrobial stewardship programs across the country are tasked with implementing AUC based dosing. Objectives: To assess plans for institutional adoption of vancomycin AUC dosing programs and perceptions of currently used programs in hospitals across the US. Methods: An electronic survey was distributed to members of the American College of Clinical Pharmacy IDprn Listserv and American Society of Health-System Pharmacists between May and June 2020 to assess current institutional vancomycin dosing. Institutional program use and multiple software user parameters were analyzed using descriptive statistics. Results: Two hundred two pharmacists responded to the survey with the majority practicing in institutions with 251-500 beds. Most respondents have yet to implement AUC dosing (142/202, 70.3%) with many of them planning to do so in the next year (81/142, 57.0%). Of those that already implemented AUC dosing programs, purchased Bayesian software (23/60, 38.3%) and homemade software (21/60, 35.0%) were the 2 methods most frequently utilized. Purchased Bayesian software users were more likely to recommend their software to other institutions and ranked user friendliness higher compared to non-purchased software. Conclusion: Most respondents have not made the switch to vancomycin AUC dosing, but there is a growing interest with many institutions looking to adopt a program within the next year.

Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey

2020 ◽  
Vol 36 (04) ◽  
pp. 276-280
Author(s):  
Salih Colakoglu ◽  
Seth Tebockhorst ◽  
David Woodbridge Mathes
Keyword(s):  
Clinical Investigation ◽  
The United States ◽  
Representative Sampling ◽  
Electronic Survey ◽  
Internal Review ◽  
Vascularized Composite Allograft ◽  
American Society ◽  
Question Survey ◽  
Internal Review Board

Abstract Background More than 85 patients have received over 100 hand/arm transplants and more than 35 patients have received full or partial face transplants at institutions around the world. Given over two decades of experience in the field and in the light of successful outcomes with up to 17 years follow up time, should we still consider vascularized composite allograft (VCA) as a research/clinical investigation? We present the results of a nationwide electronic survey whose intent was to gather institutional bias with regard to this question. Methods An 11 question survey that was developed by VCA advisory committee of American Society of Transplantation was sent to all identified Internal Review Board chairs or directors in the United States. Results We received a total of 54 responses (25.3%) to the survey. The majority (78%) of responses came from either the chairperson, director, or someone who is administratively responsible for an IRB. Conclusion Though certainly not an exhaustive investigation into each institution's preference, we present a representative sampling. The results of which favor VCA as an accepted clinical procedure given the appropriate setting. Further research is needed to fully ascertain practices at each individual institution.

The Black Lives Matter movement: A call to action: Acts 10:11–16, 25–28, 34–35

2017 ◽  
Vol 114 (3) ◽  
pp. 347-356 ◽  
Author(s):  
J. Alfred Smith
Keyword(s):  
Police Officers ◽  
Black People ◽  
White Supremacy ◽  
Call To Action ◽  
Black Lives Matter ◽  
The Usa ◽  
Black Life ◽  
Black Christians ◽  
American Society ◽  
Justice Movements

The Black Lives Matter movement is one of the most dynamic social justice movements currently emerging in the USA. This movement led by young Blacks unapologetically calls out the shameful, historical legacy of American racism and White supremacy while asserting the humanity and sacredness of Black lives, particularly those of unarmed persons senselessly murdered by police officers. While Black Lives Matter is a new movement, it is also an extension of the 400-year struggle of Black people in America to affirm Black dignity, equality, and human rights, even while the major institutions of American society have propagated doctrines and enforced unjust rules/laws to denigrate Black life. Black Christians have found hope and inspiration from the Gospel to claim their humanity and to struggle to gain justice for Black lives and for the lives of all oppressed people. In addition, the Black Lives Matter movement provides a helpful critique of many Black churches, challenging them to confront their biases, which label young Black males as “thugs” (the new N-word) and which cruelly demonize the LGBTQ community. The story of Peter and Cornelius in Acts 10 provides a scriptural basis for Christian introspection and responses to God’s vision for beloved community, and for the call to action from the Black Lives Matter movement.

scholarly journals Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

2017 ◽  
Vol 141 (10) ◽  
pp. 1342-1393 ◽  
Author(s):  
Daniel A. Arber ◽  
Michael J. Borowitz ◽  
Melissa Cessna ◽  
Joan Etzell ◽  
Kathryn Foucar ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Molecular Genetic ◽  
Clinical Information ◽  
Molecular Genetic Testing ◽  
Acute Leukemias ◽  
Prognostic Evaluation ◽  
The Public ◽  
American Society

Context.— A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. Objective.— To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. Design.— The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. Results.— Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. Conclusions.— The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.

Bias and `Overcall' in Interpreting Chest Radiographs in Young Febrile Children

PEDIATRICS ◽  
1992 ◽  
Vol 90 (1) ◽  
pp. 11-13
Author(s):  
Michael S. Kramer ◽  
Renée Roberts-Bräuer ◽  
Robert L. Williams
Keyword(s):  
Gold Standard ◽  
Clinical Signs ◽  
Clinical Information ◽  
Signs And Symptoms ◽  
Chest Radiographs ◽  
Pediatric Radiologist ◽  
Diagnostic Validity ◽  
Kappa Index ◽  
Hospital Emergency ◽  
Clinical Signs And Symptoms

Few studies have examined the diagnostic validity of the examining physician's interpretation of chest radiographs in young febrile children, and none (to our knowledge) the extent to which the "official" (ie, the radiologist's) reading may be biased by access to the examining physician's reading and to other clinical information. The authors studied 287 consecutive chest radiographs obtained in 286 febrile children 3 to 24 months of age without chronic cardiopulmonary disease or known asthma who presented to a children's hospital emergency department between March 1989 and August 1990. The readings by treating pediatricians, official pediatric radiologists, and a "blind" pediatric radiologist were compared. Official radiologists had access to the treating pediatricians' readings and the clinical information provided on the radiography requisition. The blind radiologist knew only that each child was 3 to 24 months of age and febrile, and he was asked to judge the presence or absence of pneumonia. Using the blind radiologist's reading as the "gold standard" for judging validity of the treating physicians' and official radiologists' readings, sensitivity (.677 vs .647), specificity (.828 vs .849), positive predictive value (PPV, .537 vs .571), and kappa index (κ, .462 vs .475) were quite similar. By contrast, agreement by the treating physicians was considerably higher with the official radiologists' readings as gold standard: sensitivity = .756, specificity = .922, PPV = .795, and κ = .688. When the treating physician's reading was positive, the official radiologists' positivity rate was much higher than the blind radiologist's (74.4% vs 51.8%, P < .005), sensitivity was high (.884) but specificity was low (.436), PPV was .663, and κ was .326. When the treating physicians' reading was negative, however, the pattern was reversed: positivity = 8.5% vs 12.8% (P not significant), sensitivity = .240, specificity = .937, PPV = .353, and κ = .205. Surprisingly, none of the three sets of readings appeared to be influenced by the reporting of clinical signs and symptoms on the radiography requisition. These results indicate that official radiologists are strongly biased by the treating physician's reading. Since such a bias can lead to unnecessary antibiotic treatment and hospital admission, strategies to reduce it should receive high priority.

scholarly journals Cerebellar peduncle abscess secondary to disseminated strangles in a six-week-old miniature foal

2011 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Brianne Henderson
Keyword(s):  
Animal Health ◽  
Clinical Signs ◽  
Acute Onset ◽  
Abscess Formation ◽  
Neurological Deficits ◽  
Post Mortem ◽  
Streptococcus Equi ◽  
The Central Nervous System ◽  
Cerebellar Peduncle ◽  
The Right

During a strangles outbreak within a herd of minature horses, a six week old foal developed acute onset clinical signs of sepsis and neurological deficits. The foal was euthanized and submitted for post-mortem at the Animal Health Laboratories, Guelph Ontario. Gross <em>post-mortem</em> examination noted severe bronchopneumonia, hypopyon of the right eye and a singular cerebellar peduncle abscess. Culture of the lungs and cerebellum produced a pure growth of <em>Streptococcus equi</em> ssp. <em>equi</em>. <em>Streptococcus equi</em> ssp. <em>equi</em>, the causative agent of equine strangles, produces an acute pyrexia, purulent lymphadenopathy of submandibular and retropharyngeal lymph nodes. Commonly, lymph node abscesses rupture and resolve without complication. Rarely, complications may include: dissemination of the bacteria with diffuse abscess formation, immune mediated disease (purpura haemorrhagica), rarely abscess formation within the central nervous system (CNS) can occur. These can be managed medically with appropriate antibiotics and drugs to reduce intra-cranial pressure, however surgical drainage and debulking of the abscess has been attempted successfully in a few cases.

scholarly journals Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

2018 ◽  
Vol 12 (3) ◽  
pp. 570-577 ◽  
Author(s):  
Jeffrey Sun ◽  
Cheuk-Kwan Sun ◽  
Cheuk-Kay Sun
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Common Hepatic Duct ◽  
Low Grade ◽  
Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

scholarly journals Viral hepatitis E: A disease of humans and animals

2012 ◽  
Vol 66 (5-6) ◽  
pp. 449-462
Author(s):  
Branislav Kureljusic ◽  
Vojin Ivetic ◽  
Bozidar Savic ◽  
Jasna Kureljusic ◽  
Nemanja Jezdimirovic
Keyword(s):  
Viral Hepatitis ◽  
Hepatitis E Virus ◽  
Clinical Signs ◽  
Hepatitis E ◽  
Developed Countries ◽  
Animal Origin ◽  
Oral Transmission ◽  
Source Of Infection ◽  
Pig Farms ◽  
The Usa

The hepatitis E virus is ubiquitous in all parts of the world where pig production exists. The infection occurs in several animal species and its course is mostly asymptomatic. Viral strains isolated from pigs and humans are genetically similar, which indicates a potential zoonotic nature of the disease, and the possibility that pigs, and perhaps also other species of animals diseased with viral hepatitis E are a source of infection to humans. The pig hepatitis E virus, which is similar to the hepatitis E virus in humans, was isolated and described for the first time in the USA in 1997. The infection of pigs with hepatitis E virus occurs through faeco-oral transmission, by ingestion of feed and water contaminated with the virus, or through direct contact between infected and healthy animals. The pathogenesis of this infection in pigs differs from its pathogenesis in humans and it has not been sufficiently examined in all its aspects. Even though viral hepatitis E in pigs has been described as a subclinical disease, some authors describe changes in the concentration of certain biochemical parameters in blood serum of the infected pigs. Histologically, a mild to moderate lymphotic-plasma cellular infiltration is observed in livers of infected pigs, as well as focal areas of hepatocyte necrosis. Viral hepatitis E is an endemic disease of humans in Asia, Africa, and Latin America. In developed countries, hepatitis E sporadically occurs in humans, but it is becoming of increasing importance in particular in Japan, North America, and Europe, because the populations of these areas travel extensively to the endemic regions or as a result of the consumption of thermally untreated meat of wild boar and products made from thermally untreated meat. Pork products can be contaminated with hepatitis E virus. Further proof that indicates the zoonotic potential of this virus and places this diseases among the group of professional diseases of farmers and veterinarians is the finding of antibodies to hepatitis E virus in farmers and veterinarians who work on pig farms without showing any clinical signs of the disease. Having in mind the fact that viral hepatitis E has been proven in pig farms in Serbia and neighboruign countries, there should be strict respect of biosecutiry measures from the episootiological and epidemiological aspects, and the principle of good production and hygiene practice should be adhered to on pig farms. This disease should in future also be included in the legal regulations of our country in order to ensure the production of products of animal origin that are safe from the aspect of hygiene.

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