Unmet needs in bullous pemphigoid: definition of accurate and combined diagnostic criteria.

Author(s):  
LM Nieto‐Benito ◽  
R Suárez‐Fernández
Author(s):  
Waldemar Pluta ◽  
Wioleta Dudzińska ◽  
Anna Lubkowska

Disorders of metabolic obesity with normal body weight (MONW) are widely recognized risk factors for the development of cardiovascular diseases and type 2 diabetes. Despite this, MONW is not diagnosed in clinical practice. There is no consensus on the definition of MONW, and measuring the degree of insulin resistance or obesity among apparently healthy, non-obese patients is not widely applicable. The awareness of the relationship between metabolic disorders such as MONW and a higher risk of mortality from cardiovascular causes and other related diseases prompts the need for action to be taken aimed at creating appropriate diagnostic models that will allow for the effective detection of those with metabolic abnormalities among people with normal body weight. Such actions are decisive in the prevention and treatment of diseases. Therefore, the purpose of this article is to review the MONW diagnostic criteria used over the years.


1998 ◽  
Vol 37 (3) ◽  
pp. 206-210 ◽  
Author(s):  
George Ch. Chaidemenos MD ◽  
Efstratios Maltezos MD ◽  
Fotis Chrysomallis MD ◽  
Konstantinos Kouskoukis MD ◽  
Evangelos Kapetis MD ◽  
...  

2017 ◽  
Vol 34 (4) ◽  
pp. 330-341 ◽  
Author(s):  
Jürgen Rehm ◽  
Robin Room

Aims: To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples. Design: Narrative review. Results: There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder. Conclusions: Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.


2021 ◽  
Vol 12 ◽  
Author(s):  
Yingying Sun ◽  
Yile Zhang ◽  
Xueshan Ma ◽  
Weitong Jia ◽  
Yingchun Su

BackgroundThe definition of recurrent implantation failure (RIF) differs clinically, one of the most controversial diagnostic criteria is the number of failed treatment cycles. We tried to investigate whether the two implantation failure could be included in the diagnostic criteria of RIF.MethodsA retrospective analysis of the clinical data of patients (N=1518) aged under 40 years with two or more implantation failure, recruited from the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2019.ResultsAfter adjusting for confounding factors by using binary logistic regression, the results showed that partial general information and: distribution of associated factors were significant differences such as maternal age (aOR=1.054, P=0.001), type of cycle (aOR=2.040, P<0.001), stage of embryos development (aOR=0.287, P<0.001), number of embryos transferred (aOR=0.184, P<0.001), female factor (tubal pathology) (aOR=0.432, P=0.031) and male factor (aOR=1.734, P=0.002) between the groups with two and three or more unexplained implantation failure. And further explored whether these differential factors had a significant negative impact on pregnancy outcome, the results showed that: for patients who had three unexplained implantation failure, in the fourth cycle of ET, the live birth rate decreased significantly with age (aOR=0.921, P<0.001), and the live birth rate of blastocyst transfer was significantly higher than that of cleavage embryo transfer (aOR=1.826, P=0.007). At their first assisted pregnancy treatment after the diagnosis of RIF according to these two different definitions, there were no significant difference in the biochemical pregnancy rate, clinical pregnancy rate, ectopic pregnancy rate and abortion rate (P>0.05), but the live birth rate (35.64% vs 42.95%, P=0.004) was significantly different. According to the definition of ‘two or more failed treatment cycles’, the live birth rate of the first ET treatment after RIF diagnosis was significantly lower than that of patients according to the definition of ‘three or more failed treatment cycles’.ConclusionFor patients with unexplained recurrent implantation failure, two implantation failure cannot be included in the diagnostic criteria of RIF. This study supports the generally accepted definition of three or more failed treatment cycles for RIF.


2020 ◽  
pp. 55-60
Author(s):  
O. V. Boyko ◽  
Yu. V. Volkova ◽  
P. N. Zamiatin ◽  
V. O. Litvishko ◽  
O. Yu. Tkachuk ◽  
...  

Abstract. Purpose of work. Study of sources of domestic and world literature on the problem of diagnosing post-traumatic disorders in patients with concomitant thoracic trauma. According to the literature, the features of the diagnosis of post-traumatic disorders and the possibility of using various methods when using laboratory and instrumental studies in patients with concomitant thoracic trauma were determined. Materials and methods. A review of the authors’ references on the bases of literary sources on laboratory and instrumental studies in patients with concomitant thoracic trauma is carried out. Conclusions. To improve the results of reducing the level of possible complications and their correction, it is necessary to develop complex clinical, instrumental and laboratory differential diagnostic criteria with the definition of biochemical markers, as well as their pathogenetic justification for improving tactics and increasing the effectiveness of intensive therapy in patients of this category.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ola Wallengren ◽  
Ingvar Bosaeus ◽  
Kerstin Frändin ◽  
Lauren Lissner ◽  
Hanna Falk Erhag ◽  
...  

Abstract Background The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores. Methods Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model. Results Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P <  0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P <  0.001) in the 70-year-olds and 17.8% (P <  0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P <  0.05) but not at T-score − 2.0. Conclusions The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition.


2014 ◽  
pp. 1-6
Author(s):  
B. VELLAS ◽  
R. FIELDING ◽  
R. MILLER ◽  
Y. ROLLAND ◽  
S. BHASIN ◽  
...  

In May 2012, a Sarcopenia Consensus Summit was convened by the Foundation of the National Institutes of Health (FNIH), National Institute of Aging (NIA), and the U.S. Food and Drug Administration (FDA); and co-sponsored by five pharmaceutical companies. At this summit, sarcopenia experts from around the world worked to develop agreement on a working definition of sarcopenia, building on the work of previous efforts to generate a consensus. With the ultimate goal of improving function and independence in individuals with sarcopenia, the Task Force focused its attention on people at greatly increased risk of muscle atrophy as a consequence of hip fracture. The rationale for looking at this population is that since hip fracture is a recognized condition, there is a clear regulatory path forward for developing interventions. Moreover, patients with hip fracture may provide an appropriate population to advance understanding of sarcopenia, for example helping to define diagnostic criteria, develop biomarkers, understand the mechanisms that underlie the age-related loss of muscle mass and strength, and identify endpoints for clinical trials that are reliable, objective, and clinically meaningful. Task Force members agreed that progress in treating sarcopenia will require strengthening of partnerships between academia, industry, and government agencies, and across continents to reach consensus on diagnostic criteria, optimization of clinical trials design, and identification of improved treatment and preventive strategies. In this report, the main results of the Task Force discussion are presented.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Fera ◽  
M Di Ciano ◽  
G Gorgoni

Abstract The EU Coordination and Support Action, under Horizon 2020 “Innovation in Healthcare”, aims at the adoption of innovation in health and care systems and advancing procurement of innovation practices. In response to this initiative, a consortium of 25 leading organizations in procurement and health care has been created. Among the project partners, AReSS Puglia, in collaboration with InnovaPuglia (public provider of Apulian system), analysed and exploited the best integrated solution to adopt in the Health and Care system. The EURIPHI project has successfully contributed to address common unmet needs and shortcomings in the current care delivery by using value-based innovation procurement for Public Procurement of Innovation Solutions and Pre-Commercial Procurement in the field of rapid-diagnosis of infectious diseases and integrated care. Regions, providers and procurers joined the effort to map the unmet needs and to have a broader view on demands for innovative solutions for rapid diagnosis for infectious disease and integrated care. After the definition of unmet needs and, therefore of procurement objectives, the EURIPHI consortium organized two Open Market Consultations with the industry, one in the field of rapid diagnosis and in integrated care. Two ecosystems have been created to ensure the sustainability of the project's results the EURIPHI Health & Social Care Regions Network and Value Based Procurement Community of Practice. Puglia Region is at the forefront of the two, together with other relevant healthcare stakeholders across Europe. The needed reform of health and care systems in Europe requires the adoption of innovation and integrated solutions. One way forward is to rethink procurement policies. A positive transformation in this area definitively is to elevate procurement practices towards an approach that awards the value offered by innovation or integrated solution.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2138-2138
Author(s):  
Sarah A. Hyatt ◽  
Wei Wang ◽  
Bryce A. Kerlin ◽  
Sarah H. O’Brien

Abstract Background: Although type 1 von Willebrand disease (VWD) is the most common bleeding disorder seen by pediatric hematologists, making a definitive diagnosis continues to be a challenge in clinical practice. Both the International Society on Thrombosis and Haemostasis (ISTH) and the Hospital for Sick Children in Toronto (HSC) have proposed diagnostic criteria for type 1 VWD. These include abnormal laboratory values, significant mucocutaneous bleeding, and/or a positive family history. Most recently, the ISTH published updated recommendations, which differed only in the requirement of more abnormal laboratory results (VWF:Ag 5–20 IU/ml). We applied ISTH and HSC criteria, as well as updated ISTH criteria, to a large population of pediatric patients diagnosed with type 1 VWD. We hypothesized that a substantial number of patients would not meet either HSC or ISTH diagnostic criteria. Methods: We performed a retrospective medical record review of all type 1 VWD patients at our Hemostasis and Thrombosis Center. We evaluated each record for bleeding history, family history, and laboratory values. Frequencies of fit for HSC, ISTH and updated ISTH criteria were calculated. Mean VWF:Ag, VWF:RCo, and bleeding scores (Rodeghiero et al, J Thromb Haemost, 2006) were compared across populations meeting each proposed criteria. Results: Of 201 patients, 33.9% met the HSC definition of “definitive” type 1 VWD, 4.5% met ISTH definition, and 0% met updated ISTH definition. An additional 56.2% (HSC), 15.4% (ISTH), and 6% (updated ISTH) met definitions of “possible” type 1 VWD. For each proposed definition, criteria for significant mucocutaneous bleeding were most likely to be met, while criteria for abnormal laboratory values were least likely. In fact, 74% of patients had significant bleeding as defined by the HSC (56% as defined by ISTH). We did find significant clinical and laboratory differences between patients labeled as definite, possible, and normal by ISTH and HSC criteria. For example, patients meeting criteria for definite disease by HSC criteria had a mean bleeding score of 3.5 and mean VWF:Ag of 31 IU/ml, compared to 2.6 and 47 IU/ml in patients labeled as possible, and 2.2 and 68 IU/ml in patients labeled as normal (p=0.001 bleeding score, &lt;0.001 mean VWF:Ag). Regardless of whether they met any set of criteria, most patients (94%) received some type of medical intervention (pre-operative or therapeutic desmopressin or VWF replacement). Discussion: We found that the majority of our pediatric type 1 VWD patients did not meet the original ISTH definition of definite or even possible type 1 VWD, thus confirming in a larger population the findings of HSC investigators (Dean et al, Thromb Haemost, 2000). In addition, we have demonstrated that the new ISTH criteria are even more inappropriate for clinical practice in a pediatric population, with 0% of patients meeting criteria for definite disease. Therefore, these criteria failed to identify a substantial number of children and adolescents who presented to medical attention, had significant mucocutaneous bleeding, and required therapeutic interventions. The new ISTH criteria may be an excellent scientific tool for identifying a narrow, severely affected population of patients likely to have autosomal dominant VWD mutations. However, they do not appear to have clinical validity in the pediatric setting.


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