scholarly journals Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001297 ◽  
Author(s):  
Alwin Sebastian ◽  
Alessandro Tomelleri ◽  
Abdul Kayani ◽  
Diana Prieto-Pena ◽  
Chavini Ranasinghe ◽  
...  
Keyword(s):  
Test Performance ◽  
Fast Track ◽  
Total Population ◽  
Risk Category ◽  
Laboratory Findings ◽  
Probability Score ◽  
Percentile Score ◽  
High Risk Category ◽  
Clinical Presentations ◽  
Algorithmic Process

ObjectivesClinical presentations of giant cell arteritis (GCA) are protean, and it is vital to make a secure diagnosis and exclude mimics for urgent referrals with suspected GCA. The main objective was to develop a joined-up, end-to-end, fast-track confirmatory/exclusionary, algorithmic process based on a probability score triage to drive subsequent investigations with ultrasound (US) and any appropriate additional tests as required.MethodsThe algorithm was initiated by stratifying patients to low-risk category (LRC), intermediate-risk category (IRC) and high-risk category (HRC). Retrospective data was extracted from case records. The Southend pretest probability score (PTPS) overall showed a median score of 9 and a 75th percentile score of 12. We, therefore, classified LRC as PTPS <9, IRC 9–12 and HRC >12. GCA diagnosis was made by a combination of clinical, US, and laboratory findings. The algorithm was assessed in all referrals seen in 2018–2019 to test the diagnostic performance of US overall and in individual categories.ResultsOf 354 referrals, 89 had GCA with cases categorised as LRC (151), IRC (137) and HRC (66). 250 had US, whereas 104 did not (score <7, and/or high probability of alternative diagnoses). In HRC, US showed sensitivity 94%, specificity 85%, accuracy 92% and GCA prevalence 80%. In LRC, US showed sensitivity undefined (0/0), specificity 98%, accuracy 98% and GCA prevalence 0%. In IRC, US showed sensitivity 100%, specificity 97%, accuracy 98% and GCA prevalence 26%. In the total population, US showed sensitivity 97%, specificity 97% and accuracy 97%. Prevalence of GCA overall was 25%.ConclusionsThe Southend PTPS successfully stratifies fast-track clinic referrals and excludes mimics. The algorithm interprets US in context, clarifies a diagnostic approach and identifies uncertainty, need for re-evaluation and alternative tests. Test performance of US is significantly enhanced with PTPS.

scholarly journals Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Seon Lee ◽  
Joong-Gon Kim ◽  
Soyoung Lee
Keyword(s):  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Long Term Outcomes ◽  
Childhood Onset ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Long Term Prognosis ◽  
Digital Amputation

AbstractChildhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

scholarly journals The REDS score: a new scoring system to risk-stratify emergency department suspected sepsis: a derivation and validation study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030922 ◽  
Author(s):  
Narani Sivayoham ◽  
Lesley A Blake ◽  
Shafi E Tharimoopantavida ◽  
Saad Chughtai ◽  
Adil N Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Risk Category ◽  
Suspected Sepsis ◽  
Suspected Infection ◽  
Derivation Cohort ◽  
High Risk Category ◽  
Component Scores

ObjectiveTo derive and validate a new clinical prediction rule to risk-stratify emergency department (ED) patients admitted with suspected sepsis.DesignRetrospective prognostic study of prospectively collected data.SettingED.ParticipantsPatients aged ≥18 years who met two Systemic Inflammatory Response Syndrome criteria or one Red Flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted.Primary outcome measureIn-hospital all-cause mortality.MethodThe data were divided into derivation and validation cohorts. The simplified-Mortality in Severe Sepsis in the ED score and quick-SOFA scores, refractory hypotension and lactate were collectively termed ‘component scores’ and cumulatively termed the ‘Risk-stratification of ED suspected Sepsis (REDS) score’. Each patient in the derivation cohort received a score (0–3) for each component score. The REDS score ranged from 0 to 12. The component scores were subject to univariate and multivariate logistic regression analyses. The receiver operator characteristic (ROC) curves for the REDS and the components scores were constructed and their cut-off points identified. Scores above the cut-off points were deemed high-risk. The area under the ROC (AUROC) curves and sensitivity for mortality of the high-risk category of the REDS score and component scores were compared. The REDS score was internally validated.Results2115 patients of whom 282 (13.3%) died in hospital. Derivation cohort: 1078 patients with 140 deaths (13%). The AUROC curve with 95% CI, cut-off point and sensitivity for mortality (95% CI) of the high-risk category of the REDS score were: derivation: 0.78 (0.75 to 0.80); ≥3; 85.0 (78 to 90.5). Validation: 0.74 (0.71 to 0.76); ≥3; 84.5 (77.5 to 90.0). The AUROC curve and the sensitivity for mortality of the REDS score was better than that of the component scores. Specificity and mortality rates for REDS scores of ≥3, ≥5 and ≥7 were 54.8%, 88.8% and 96.9% and 21.8%, 36.0% and 49.1%, respectively.ConclusionThe REDS score is a simple and objective score to risk-stratify ED patients with suspected sepsis.

scholarly journals Association between Hypomagnesemia, COVID-19, Respiratory Tract and Lung Disease

2021 ◽  
Vol 15 (1) ◽  
pp. 43-45
Author(s):  
Gavino Faa ◽  
Luca Saba ◽  
Daniela Fanni ◽  
Goce Kalcev ◽  
Mauro Carta
Keyword(s):  
Renin Angiotensin System ◽  
Risk Category ◽  
Controlled Trials ◽  
Type I ◽  
Magnesium Supplementation ◽  
Angiotensin System ◽  
Old Adults ◽  
Cd8 T Lymphocytes ◽  
High Risk Category ◽  
Obesity Hypertension

The complexity of COVID-19 is also related to the multiple molecular pathways triggered by SARS-CoV-2, which is able to cause type I pneumocyte death, trigger intravascular coagulation, interfere with the renin-angiotensin system, dysregulate iron metabolism, ending with the insurgence of a cytokine storm which may lead to death. Old adults with obesity, hypertension, and diabetes are among the high-risk category groups more prone to SARS-CoV-2 infection. Magnesium has been reported to play a major role both in physiology and in pathology, particularly in elderly people, regulating cytotoxic functions of natural killer (NK) cells and CD8+ T lymphocytes. In spite of the absence of controlled trials, the possibility of magnesium supplementation for supportive treatment in patients with COVID-19 should be encouraged. This could be useful in all phases of the COVID-19 disease.

scholarly journals RUPTURED UTERUS

2010 ◽  
Vol 17 (02) ◽  
pp. 314-317
Author(s):  
YASMEEN AKHTAR
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Descriptive Study ◽  
Risk Category ◽  
Cesarean Sections ◽  
High Risk Category ◽  
Trained Personnel ◽  
Design Case ◽  
Tertiary Care Centers ◽  
Ruptured Uterus

Objective: To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with other colleagues of the specialty. Study design: Case series descriptive study. Settings: Gynae /Obstetrics Unit -I Lady Willingdon Hospital Lahore. Study Duration: Five years i.e Ist May 2004 to 30th April 2009. Material and Methods: Obstetric patients who presented with ruptured uteri. Results: Results showed that risk factor for ruptured uteri include cesarean sections (61.11%), grand multiparty (16.6%), Instrumentaldeliveries (4.44%) and undetected perforation (1.11%). Conclusion: Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus. 

scholarly journals Giant parathyroid adenoma: a case report and review of the literature

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Mohamed S. Al-Hassan ◽  
Menatalla Mekhaimar ◽  
Walid El Ansari ◽  
Adham Darweesh ◽  
Abdelrahman Abdelaal
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Neck Mass ◽  
Rare Type ◽  
Tissue Mass ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
High Calcium

Abstract Background Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East. Case presentation A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised. Conclusions Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.

scholarly journals Haemophagocytic Lymphohistiocytosis: A Case Report and Short Overview

2018 ◽  
Vol 10 (1) ◽  
pp. 51-58
Author(s):  
Md Amzad Hossain ◽  
Tahmina Akther ◽  
Md Amran Sarker ◽  
Arunava Paul ◽  
Tanzina Zannat ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Early Recognition ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Organ Damage ◽  
Clinical Syndrome ◽  
Laboratory Findings ◽  
Delay In Diagnosis ◽  
Clinical Presentations ◽  
Clinical Conditions

Haemophogocyticlymphohistiocytosis (HLH) is a rare but potentially fatal disease, which describes a clinical syndrome of hyper-inflammation resulting in uncontrolled and ineffective immune response. It appears commonly in infancy, although it has been seen in all age groups. A vast majority of cases are acquired due to secondary causes (infections, autoimmune, malignancy, metabolic disorders) but primary HLH (genetic) is also not uncommon which also gets triggered by infection as suggested by recent studies. “Hypercytokinemia” which is the hallmark of HLH can result in end organ damage and even death in some cases if there is delay in diagnosis. The pathological hallmark of this syndrome is uncontrolled activation of T lymphocytes and macrophages, together with an impaired cytotoxic function of NK cells and CD8+T lymphocytes resulting into massive cytokine release (e.g. interferon-ã, TNF-á, Interleukin-6, 8, 10, 12, 18) from this cells and overwhelming inflammation. Lymphocytes and macrophages sometimes with haemophagocytic activity accumulate in bone marrow, spleen, liver or lymph nodes. This disorder is characterized by fever, hepatosplenomegaly, lymphadenopathy, skin rash, cytopenias, hepatitis, coagulopathy, and neurological symptoms. We report a case of 55 yr. old male presenting with fever and high colored urine who developed clinical and laboratory findings consistent with diagnosis of HLH according to HLH-2004 guidelines. Unfortunately the patient died despite receiving chemotherapy. HLH has multifaceted clinical presentations with often non-specific signs and symptoms that are often found in other clinical conditions. Early recognition of HLH is critical in initiating therapy early and preventing high mortality resulting from multi-organ failure.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 51-58

Blood Alcohol and Social Drinking

1979 ◽  
Vol 19 (3) ◽  
pp. 180-185 ◽  
Author(s):  
N. G. Flanagan ◽  
G. K. Lochridge ◽  
J.G. Henry ◽  
A. J. Hadlow ◽  
P. A. Hamer
Keyword(s):  
High Risk ◽  
Food Intake ◽  
Risk Category ◽  
Blood Alcohol ◽  
Social Functions ◽  
Risk Levels ◽  
High Risk Category ◽  
Social Drinking ◽  
Blood Alcohol Levels ◽  
Considerable Individual Variation

A field study was carried out using 131 volunteers in an attempt to relate alcohol consumption at 12 social functions with actual blood alcohol levels under reasonably controlled conditions. Food, taken at 7 of these functions, caused an unpredictable delay in alcohol absorption and some subjects had blood alcohol figures approaching recently defined ‘high risk’ levels. Better correlation was found at those functions without food intake, but again there was considerable individual variation. In 36 subjects samples were taken on the following morning. About 12 per cent showed significantly raised levels but all were under the legal limit for driving. The authors are concerned that other factors in addition to the alcohol level should be considered before a driver is placed in the ‘high risk’ category.

Relationship between Oncotype DX testing and the use of chemotherapy in high-risk patients (pts).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6098-6098
Author(s):  
Winston Wong ◽  
Joseph Cooper ◽  
Steve Richardson ◽  
Bruce A. Feinberg
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Risk Groups ◽  
Oncotype Dx ◽  
Molecular Diagnostic ◽  
Risk Category ◽  
High Risk Population ◽  
Unexpected Finding ◽  
High Risk Category

6098 Background: CareFirst BlueCross BlueShield (CFBCBS) insurance network partnered with Cardinal Health Specialty Solutions (CHSS) to develop a cancer care pathway for network physicians in 2008. The program included a recommendation for molecular diagnostic testing with the Oncotype DX assay for pts with early-stage estrogen receptor-positive breast cancer. Based on NCCN guidelines, the pathway suggested adjuvant chemotherapy for all pts with Oncotype DX Recurrence Scores (RS) in the high-risk category. We aimed to determine the RS risk distribution among pts who received Oncotype DX testing and assess the patterns of care that followed. Methods: Using data from CFBCBS, CHSS proprietary claims software, and Genomic Health, we retrospectively identified a cohort of women with breast cancer who were treated on the CFBCBS clinical care pathways program from 8/2008 to 6/2011 and received Oncotype DX testing. We determined the number of pts with a RS value in the low- (RS <18), intermediate- (RS 18-30), and high-risk (RS ≥31) groups along with the number of pts who subsequently received chemotherapy in each category. Results: Of 1174 women who received Oncotype DX testing, 53% of pts were in the low-, 35% in intermediate-, and 12% in the high-risk groups. Five percent of low-, 41% of intermediate-, and 74% percent of pts in the high-risk category were treated with chemotherapy. Twenty-six percent of pts in the high-risk group did not receive chemotherapy. Conclusions: The proportionate use of chemotherapy in the low and intermediate risk groups was as expected based on adjuvant chemotherapy guidelines; however, the underuse of chemotherapy in 26% of high-risk pts was an unexpected finding. Further study is needed to determine: (1) why physicians avoided chemotherapy in 26% of high-risk pts; (2) the overall number of appropriate pts who underwent Oncotype DX testing; and, (3) the tumor characteristics that may have driven the underutilization of chemotherapy in the high-risk population.

scholarly journals MELAS: A Multigenerational Impact of the MTTL1 A3243G MELAS Mutation

2014 ◽  
Vol 41 (2) ◽  
pp. 210-219 ◽  
Author(s):  
M. Prasad ◽  
B. Narayan ◽  
A.N. Prasad ◽  
C.A. Rupar ◽  
S. Levin ◽  
...  
Keyword(s):  
Maternal Inheritance ◽  
Extended Family ◽  
Family Members ◽  
Strong Support ◽  
Radiological Findings ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
The Family ◽  
Generation Family ◽  
Pathological Material

Background:the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized.Methods:retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members.Results:there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS.Conclusions:the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.

scholarly journals Mycoplasma infection in Malaysian children: laboratory investigation and antimicrobial therapy

2015 ◽  
Vol 14 (1) ◽  
pp. 75-78
Author(s):  
Anita Sulong ◽  
Thiru Murugaan ◽  
AL Balakrishnan ◽  
Ng Li En ◽  
Noraini Mohamad Zain ◽  
...  
Keyword(s):  
Laboratory Investigation ◽  
Antimicrobial Therapy ◽  
Medical Science ◽  
Full Blood Count ◽  
Enzyme Linked Immunosorbent Assay ◽  
Laboratory Findings ◽  
P 75 ◽  
Clinical Presentations ◽  
Mycoplasma Pneumonia ◽  
Childhood Infection

Background: Mycoplasma pneumonia (M. pneumoniae) is an important causative agent of childhood infection with variable clinical presentations. The objective of the study was to evaluate the laboratory investigation and antimicrobial therapy of M. pneumoniae infection in children admitted to paediatric ward. Materials & Methods: A total of 111 children, of which 59 (53.2%) boys and 52 (46.8%) girls, with median age of 2 years (inter quartile range 1-6 years) with suspected M. pneumoniae infection were tested for IgM by enzyme-linked immunosorbent assay (ELISA). The children were classified as seropositive and seronegative. Results: Of the 111 children, 45 (40.5%) had serological evidence of M. pneumoniae infection and the remaining 66 (59.5%) were seronegative. There was significant association (p < 0.001) between age and serology response. Seropositive children were more likely to be older (median age 5.0 [interquartile range 2- 7] years, p < 0.001). Children with M. pneumoniae infection were less likely to have cough (p = 0.023) in which 55 (65.5%) patients having cough were seronegative. There was no significant association between laboratory findings of full blood count and serology. Conclusion: In addition to clinical and laboratory features, other factors like age group and absence of cough might be helpful in predicting M. pneumoniae infection.DOI: http://dx.doi.org/10.3329/bjms.v14i1.21564 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.75-78

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