scholarly journals An epidemiologic overview of a tertiary referral practice for male paediatric lichen sclerosus

2019 ◽  
Vol 25 (4) ◽  
pp. 241-245
Author(s):  
Dylan Thomas Hoare ◽  
Peter Metcalfe
Keyword(s):  
Primary Outcome ◽  
Descriptive Analysis ◽  
Lichen Sclerosus ◽  
Paediatric Population ◽  
Tertiary Referral ◽  
Chief Complaints ◽  
Changing Patterns ◽  
Clinically Significant ◽  
Significant Disease ◽  
Referral Practice

Abstract Within the paediatric population, changing patterns of circumcisions have confounded the epidemiology and presentation of lichen sclerosus (LS). We sought to evaluate the incidence, demographics, and clinical features of patients presenting to a single Albertan paediatric urologist with LS. This retrospective descriptive analysis evaluated all paediatric patients referred for phimosis to a single paediatric urologist in Edmonton, Alberta. Chief complaints/symptoms, date of birth, and date of circumcision were identified. The primary outcome of interest was the proportion of circumcisions with pathologically confirmed LS. From July 2006 to March 2016, 4,163 patients were seen for phimosis of the approximate 12,000 new referrals. Hundred phimosis patients had clinically suspected LS. Of those adequately reported, 81 (81/83) were microscopically confirmed to be LS with a mean age of 9.6 years and median age of 8.9 years (range 4.1 to 16.1 years). This cohort represented 2.0% of phimosis referrals and approximately 0.7% of all referrals to our paediatric urologist. When compared to physiologic phimosis, these patients had higher rates of dysuria (n=28, 34.6% versus n=1, 1.0%, P<0.0001) and urinary retention (n=18, 22.2% versus n=1, 1.0%, P<0.0001) as presenting complaints. LS of the paediatric male genitalia is an uncommon, albeit clinically significant disease entity. The clinical diagnosis for the trained practitioner is very accurate.

scholarly journals Cryptococcus Species Other Than Cryptococcus neoformans and Cryptococcus gattii: Are They Clinically Significant?

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Edison J Cano ◽  
Zachary A Yetmar ◽  
Raymund R Razonable
Keyword(s):  
Cryptococcus Neoformans ◽  
Opportunistic Infections ◽  
Descriptive Analysis ◽  
Laboratory Data ◽  
Invasive Disease ◽  
Cryptococcus Gattii ◽  
Cryptococcus Laurentii ◽  
Cryptococcus Species ◽  
Clinically Significant ◽  
Cryptococcus Spp

Abstract Background Cryptococcus spp is a major cause of opportunistic infections in immunocompromised patients, primarily due to Cryptococcus neoformans and Cryptococcus gattii. There are occasional reports of other Cryptococcus species causing invasive human disease. However, their epidemiology and clinical significance are not fully defined. We sought to describe cases with cultures positive for Cryptococcus species other than C neoformans and C gattii. Methods A retrospective descriptive analysis of clinical and laboratory data of patients with cultures growing Cryptococcus species other than C neoformans and C gattii from November 2011 to February 2019 was performed. Three Mayo Clinic sites in Arizona, Florida, and Minnesota were included. Results From 176 cases with a culture growing Cryptococcus spp, 54 patients (30%) had a culture for Cryptococcus other than C neoformans and C gattii in the study time frame. The most common species were Cryptococcus magnus, Cryptococcus laurentii, and Cryptococcus ater. The organisms were isolated and identified in culture of bronchoalveolar lavage (11), skin (11), urine (7), oral (4), sinus (3), intraoperative soft tissue (3), sputum (2), synovial fluid (2), cerebrospinal fluid (2), and intravenous catheter (2), among others (7). Only 8 (15%) cases were considered to be potentially pathogenic, with 1 case of invasive disease. Antifungal treatment was fluconazole, itraconazole, and griseofulvin, for a mean systemic antifungal duration of 42 days. Conclusions This large series of patients with Cryptococcus spp other than C neoformans and C gattii suggests that these species rarely cause clinically significant infection in humans. Only 1 case of invasive disease was found.

scholarly journals Applying Machine Learning to Predict the Exportome of Bovine and Canine Babesia Species That Cause Babesiosis

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 660
Author(s):  
Stephen J. Goodswen ◽  
Paul J. Kennedy ◽  
John T. Ellis
Keyword(s):  
Machine Learning ◽  
Severe Disease ◽  
Economic Loss ◽  
Babesia Bovis ◽  
Training Data ◽  
Babesia Bigemina ◽  
Bovine Babesiosis ◽  
Canine Babesiosis ◽  
Clinically Significant ◽  
Significant Disease

Babesia infection of red blood cells can cause a severe disease called babesiosis in susceptible hosts. Bovine babesiosis causes global economic loss to the beef and dairy cattle industries, and canine babesiosis is considered a clinically significant disease. Potential therapeutic targets against bovine and canine babesiosis include members of the exportome, i.e., those proteins exported from the parasite into the host red blood cell. We developed three machine learning-derived methods (two novel and one adapted) to predict for every known Babesia bovis, Babesia bigemina, and Babesia canis protein the probability of being an exportome member. Two well-studied apicomplexan-related species, Plasmodium falciparum and Toxoplasma gondii, with extensive experimental evidence on their exportome or excreted/secreted proteins were used as important benchmarks for the three methods. Based on 10-fold cross validation and multiple train–validation–test splits of training data, we expect that over 90% of the predicted probabilities accurately provide a secretory or non-secretory indicator. Only laboratory testing can verify that predicted high exportome membership probabilities are creditable exportome indicators. However, the presented methods at least provide those proteins most worthy of laboratory validation and will ultimately save time and money.

scholarly journals Evaluation of Prescribing Indicators in a Paediatric Population Seen in an Outpatient Consultation at the Gaspard Kamara Health Centre in 2019 (Senegal)

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 113
Author(s):  
Oumar Bassoum ◽  
Mouhamadou Faly Ba ◽  
Ndèye Marème Sougou ◽  
Djibril Fall ◽  
Adama Faye
Keyword(s):  
Descriptive Analysis ◽  
Health Centre ◽  
Paediatric Population ◽  
Essential Medicines ◽  
World Health ◽  
Bivariate Analysis ◽  
Prescribing Indicators ◽  
Outpatient Consultation ◽  
International Nonproprietary Name ◽  
Health Organization

Introduction: Data on drug use in paediatrics are scarce in Senegal. The objective of this study was to assess the prescribing indicators in a paediatric population seen in an outpatient consultation at a Health Centre in Dakar, Senegal. Methods: A retrospective and analytical study was conducted. The study population consisted of prescriptions for children aged 0 to 14 years who were seen in ambulatory consultation between 1 June and 30 November 2019. The sample size was 600 prescriptions. The systematic survey was then conducted. Five prescription indicators recommended by the World Health Organization were calculated. The R software was used for descriptive analysis, bivariate analysis and binomial logistic regression. Results: The average number of drugs per prescription was 2.56. The proportion of drugs prescribed under the International Nonproprietary Name (INN) was 18.9%, while the proportion of drugs on the National Essential Medicines List (NEML) was 41.3%. The proportions of prescriptions with at least one antibiotic and one injectable product were 41.5% and 1.3%, respectively. Conclusions: This study showed that prescribing habits were inadequate. Thus, it would be necessary to move towards continuing training of prescribers in the wise use of medicines.

Validation and adaptation of the Spanish version of the systemic lupus activity questionnaire (S-SLAQ) in an Argentinean population

Lupus ◽  
2021 ◽  
pp. 096120332110610
Author(s):  
Cecilia Catoggio ◽  
Alejandro Martínez Muñoz ◽  
Rafael Chaparro del Moral ◽  
Diana S Klajn ◽  
Silvia B Papasidero ◽  
...  
Keyword(s):  
Disease Activity ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Internal Consistency ◽  
Intraclass Correlation ◽  
Systemic Lupus ◽  
Cronbach's Alpha ◽  
Clinically Significant ◽  
Significant Disease ◽  
Activity Questionnaire

Objectives To validate the systemic lupus activity questionnaire (SLAQ) in Spanish language. Methods The SLAQ questionnaire was translated and adapted in Spanish. Consecutive SLE patients from 8 centers in Argentina were included. A rheumatologist completed a Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, and a physician’s assessment. Reliability was assessed by internal consistency (Cronbach’s alpha), stability by test–retest reliability (intraclass correlation coefficient), and construct validity by evaluating the correlation with clinically relevant scores. Sensitivity and specificity for clinically significant disease activity (SLEDAI ≥6) of different S-SLAQ cut-off points were evaluated. Results We included 97 patients ((93% female, mean age: 40 years (SD14.7)). Internal consistency was excellent (Cronbach’s alpha = 0.84, p < 0.001), and the intraclass correlation coefficient was 0.95 ( p < 0.001). Mean score of S-SLAQ was 8.2 (SD 7.31). Correlation of S-SLAQ was moderate with Patient NRS (r= 0.63 p< 0.001), weak with SLAM-no lab ( r = 0.42, p <0.001) and SLAM ( r = 0.38, p < 0.0001), and very weak with SLEDAI-2K ( r = 0.15, p =0.1394). Using the S-SLAQ cutoff of five points, the sensitivity was 72.2% and specificity was 37.9%, for clinically significant disease activity. Conclusions The S-SLAQ showed good validity and reliability. A good correlation, similar to the original instrument, was observed with patient´s global disease activity. No correlation was found between S-SLAQ and gold standard disease activity measures like SLEDAI-2K and SLAM. The S-SLAQ cutoff point of 5 showed a good sensitivity to identify the active SLE population and therefore could be an appropriate screening instrument for disease activity in clinical and epidemiological studies.

scholarly journals Micrometastases: are they clinically significant disease?

Gut ◽  
1997 ◽  
Vol 40 (4) ◽  
pp. 555-556 ◽  
Author(s):  
H J Andreyev ◽  
D Cunningham
Keyword(s):  
Clinically Significant ◽  
Significant Disease

Risks of post-colonoscopic polypectomy bleeding and thromboembolism with warfarin and direct oral anticoagulants: a population-based analysis

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323600
Author(s):  
Louis HS Lau ◽  
Cosmos LT Guo ◽  
Terry CF Yip ◽  
Joyce WY Mak ◽  
Sunny H Wong ◽  
...  
Keyword(s):  
Lower Risk ◽  
Thromboembolic Event ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Colonic Polyps ◽  
Population Based ◽  
Limited Data ◽  
Thromboembolic Risk ◽  
Clinically Significant

BackgroundThere were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and warfarin users in a population-based cohort.MethodsWe performed a territory-wide retrospective cohort study involving patients in Hong Kong from 2012 to 2020. Patients who received an oral anticoagulant and had undergone colonoscopy with polypectomy were identified. Propensity-score models with inverse probability of treatment weighting were developed for the warfarin-DOAC and between-DOAC comparisons. The primary outcome was clinically significant delayed PPB, defined as repeat colonoscopy requiring haemostasis within 30 days. The secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event.ResultsApixaban was associated with lower PPB risk than warfarin (adjusted HR (aHR) 0.39, 95% CI 0.24 to 0.63, p<0.001). Dabigatran (aHR 2.23, 95% CI 1.04 to 4.77, adjusted p (ap)=0.035) and rivaroxaban (aHR 2.72, 95% CI 1.35 to 5.48, ap=0.002) were associated with higher PPB risk than apixaban. In subgroup analysis, apixaban was associated with lower PPB risk in patients aged ≥70 years and patients with right-sided colonic polyps.For thromboembolic events, apixaban was associated with lower risk than warfarin (aHR 0.22, 95% CI 0.11 to 0.45, p<0.001). Dabigatran (aHR 2.60, 95% CI 1.06 to 6.41, ap=0.033) and rivaroxaban (aHR 2.96, 95% CI 1.19 to 7.37, ap =0.013) were associated with higher thromboembolic risk than apixaban.ConclusionsApixaban was associated with a significantly lower risk of PPB and thromboembolism than warfarin, dabigatran and rivaroxaban, particularly in older patients with right-sided polyps.

Loan sharking: changing patterns in, and challenging perceptions of, an abuse of deprivation

2019 ◽  
Author(s):  
Patrick Saunders
Keyword(s):  
Consumer Credit ◽  
Descriptive Analysis ◽  
Credit Unions ◽  
Predatory Lending ◽  
Financial Health ◽  
Social Interventions ◽  
Causative Factors ◽  
Changing Patterns ◽  
Negative Impacts ◽  
Political Economic

Abstract Background Illegal high interest lending or ‘loan sharking’ exploits the vulnerable and has profound negative impacts on individuals and communities. The 2008 UK financial crash and subsequent austerity programme coupled with changes in the consumer credit market have fuelled an increase in predatory lending. Methods The study is a descriptive analysis of demographic, financial, health and behavioural data on 753 victims (2011–2017). A review of the causative factors and potential political, economic and public health responses is analysed. Results Most victims were female but males were considerably more indebted. Illegal loans are largely taken out for routine living expenses and over 70% of victims reported other serious debts. Victims are disproportionately poor, unemployed and on benefits but fewer than half have had financial or benefits advice. Despite 90% reporting they would not borrow illegally again, 30% had previously done so from the same shark and over half considered them a friend. Conclusions The increase in loan sharking has coincided with the withdrawal of traditional sub-prime lenders and local welfare assistance schemes, and the low penetration of Credit Unions in many areas. Conventional perceptions of loan sharks and their relationships with victims are largely incorrect. A range of coordinated financial, political and social interventions is required.

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