scholarly journals Evaluation of Malignant Mesothelioma in Central Anatolia: A Study of 67 Cases

2004 ◽  
Vol 11 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Inci Gulmez ◽  
Levent Kart ◽  
Hakan Buyukoglan ◽  
Ozlem Er ◽  
Suleyman Balkanli ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Mesothelioma ◽  
Environmental Control ◽  
Public Health Problem ◽  
Central Anatolia ◽  
Major Public Health Problem ◽  
Pleural Thickening ◽  
Chest X Ray ◽  
Fibrous Mineral

BACKROUND:Malignant mesothelioma (MM) is a fatal neoplasm which frequently results from exposure to asbestos or erionite.METHOD:Sixty-seven patients with MM were seen between 1990 and 2001. Their clinical and radiological features, as well as the therapy, were retrospectively evaluated.RESULTS:In 51 patients (76.1%), the MM was confined to the pleura, in 14 patients it was exclusively peritoneal and in two patients, it involved both areas. Of the 67 cases, 35 (52.2%) were women. The mean (± SD) age for all cases was 57.6±11.5 years. Dyspnea (67.2%), cough (55.2%) and chest pain (50.7%) were the most frequent symptoms of onset. Pleural effusion (92.4%) was the most common chest x-ray finding, whereas pleural effusion (60.8%), pleural nodules (34.7%) and pleural thickening (34.7%) were the most common computed tomography findings in pleural MM patients. The histological subtypes of MM were determined as epithelial in 60 patients (89.5%), sarcomatous in four patients (5.9%) and mixed in three patients (4.4%). Although 50.7% and 25.4% of the cases were exposed to erionite and asbestos, respectively, 23.9% of the cases recalled no exposure to asbestos or erionite. Exposures were environmental as opposed to occupational. Thirty-five patients (52.2%) were administered chemotherapy, and follow-up data were available for 22 patients. For these patients, the two-year survival rate was 22% and the two-year progression-free interval was 15.7%. There were no differences between patients with asbestos and erionite exposure.CONCLUSION:MM should be considered when exudative pleural effusion is detected in a patient who has been exposed to asbestos or erionite. MM is a major public health problem in parts of Turkey and compulsory environmental control of fibrous mineral should be considered.

scholarly journals Justification and active guideline implementation for spine radiography referrals in primary care

2016 ◽  
Vol 58 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Pirita Tahvonen ◽  
Heljä Oikarinen ◽  
Jaakko Niinimäki ◽  
Esa Liukkonen ◽  
Seija Mattila ◽  
...  
Keyword(s):  
Primary Care ◽  
Lumbar Spine ◽  
Guideline Implementation ◽  
Public Health Problem ◽  
Further Education ◽  
Major Public Health Problem ◽  
Spine Radiography ◽  
Cervical Spine Radiography ◽  
Active Implementation

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

scholarly journals Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion

2019 ◽  
Vol 7 (1) ◽  
pp. 1
Author(s):  
Sandeepa H. S. ◽  
Narendra U. ◽  
Gajanan S. Gaude ◽  
Supriya Sandeepa
Keyword(s):  
Pleural Effusion ◽  
Total Duration ◽  
Control Group ◽  
Study Group ◽  
Pigtail Catheter ◽  
Catheter Drainage ◽  
Female Ratio ◽  
Tuberculous Pleural Effusion ◽  
Pleural Thickening

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36±0.49mm vs 9.28±1.50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

scholarly journals Co-Existence of TB & Leprosy in the same patient – A Case Report

2010 ◽  
Vol 23 (1) ◽  
pp. 103-105
Author(s):  
Md Azraf Hossain Khan ◽  
Samir C Majumder
Keyword(s):  
Bacterial Load ◽  
Public Health Problem ◽  
Lepromatous Leprosy ◽  
Major Public Health Problem ◽  
Health Issues ◽  
Common Infectious Disease ◽  
Positive Smear ◽  
Chest X Ray ◽  
Nodular Lesions ◽  
One Year

Leprosy is one of the more serious health issues in a number of developing countries. Although it seldom kills, leprosy is nonetheless a deforming, disabling and stigmatizing disease.1, 2 Tuberculosis is also a major public health problem affecting nearly one third of the global population. Though leprosy and tuberculosis are common infectious disease, yet co-infection of Mycobacterium leprae and Mycobacterium tuberculosis is rare possibly due to cross-immunity. A male patient of about 70 years presented with widespread shinny hypesthetic nodular lesions symmetrically located mainly in upper extremities, trunk and a little in lower extremities about 3 years back. Slit skin smear and histopathology studies showed significant amount of bacterial load which suggested lepromatous leprosy. About after one year of starting MDT treatment, the patient developed type-2 reaction of intermittent variety. During the episodic attacks of this reaction, the patient developed pulmonary TB supported by positive smear of sputum and patchy opacities of chest x-ray about 2½ years back TAJ 2010; 23(1): 103-105

scholarly journals Study of association and prognostic correlation of cardiac troponin I estimation in acute decompensated heart failure patients

2020 ◽  
Vol 8 (1) ◽  
pp. 26
Author(s):  
Sunil Kumar Tripathi ◽  
Vikas A. Mishra ◽  
Amit B. Kinare ◽  
Vishwa Deepak Tripathi ◽  
Ravi Shankar Sharma
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Acute Decompensated Heart Failure ◽  
Public Health Problem ◽  
Decompensated Heart Failure ◽  
Major Public Health Problem ◽  
Positive Group ◽  
Medical College ◽  
Follow Up Study

Background: Heart failure is a major public health problem since last few decades affecting significant number of people worldwide. Acute decompensated heart failure is a major cause of hospitalization in elderly people with a high mortality rate. Heterogeneity and non-specificity of symptoms makes diagnosis of heart failure by clinical presentation alone more challenging. Aim of current study was to investigate troponin biomarkers in diagnosis, prognosis and management of acute decompensated heart failure.  Methods: Present study was a prospective observational study conducted on 100 patients at Department of Cardiology, Superspeciality hospital, NSCB medical college Jabalpur and Department of cardiology Superspeciality hospital, SS medical college Rewa from October 2019 to August 2020. Patients were investigated for clinical, echocardiographic parameters and NYHA classification. Cardiac functions were analyzed by color doppler echocardiography. Results: According to study findings, 65.2% of TnI positive patients were males whereas 34.8% were females. Mean age of TnI positive group was observed to be higher. Majority of troponin positive patients were in NYHA class IV. Recurrent hospitalization was observed more in TnI positive group. Logistic regression analysis depicted systolic blood pressure reduced significantly (p<0.001) on follow up study in TnI positive patients, FBS was significantly more in TnI positive patients (131.4+42.9 mg/dl) (p=0.049). LVID was significantly more in TnI positive patients (p=0.022). Reduction in EF was statistically significant (p=0.03) at the three months follow up study.  Conclusions: A positive prognostic correlation was established between ADHF and troponin positivity, large prospective randomized trials are necessary to recommend quantitative troponin I determination in all patients of acute decompensated heart failure for prognosis and guiding therapy.

scholarly journals System Delay in Breast Cancer Diagnosis in Gaza Strip, Palestine

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Samira S. Abo Al-Shiekh ◽  
Yasser S. Alajerami ◽  
Bothyna B. Etewa ◽  
Aymen M. Elsous
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Gaza Strip ◽  
Diagnostic Delay ◽  
Public Health Problem ◽  
Diagnostic Tools ◽  
Major Public Health Problem ◽  
Related Factors ◽  
The Gaza Strip

Background. Breast cancer is a major public health problem and the first leading cause of cancer deaths among females in Palestine. Early diagnosis of breast cancer contributes to reduction of morbidity and mortality rates. This study aimed to explore system-related factors affecting the timely diagnosis of breast cancer in the Gaza Strip. Method and Materials. A mixed method, sequential explanatory design was employed. A quantitative study was conducted first, and it was cross-sectional in nature, followed by a qualitative study. An interviewed questionnaire and an abstraction sheet were used to collect necessary quantitative data among 122 females diagnosed with breast cancer. A purposive sample of five medical specialists were selected for in-depth interview. Descriptive and inferential analyses were used to find differences between variables. Odds ratio and confidence interval at 95% were presented, and P<0.05 was considered statistically significant. Results. Around 12.3% of women experienced diagnostic delay for 3 months and more, and 6.6% reported a delay in referral for more than 2 weeks. Regarding imaging delay, around 8.2% and 2.7% of women had reported a delay in performing mammography and ultrasound, respectively. Moreover, one-fourth reported delay in performing biopsy for more than 14 days, and 46.3% reported delay more than 14 days in getting histopathology report. In addition, 9% missed the follow-up after benign findings of the previous breast imaging and no national protocols are available for the diagnosis of breast cancer in the Gaza strip. Conclusion. There is a long appointment time for diagnostic tools especially in biopsy. The nonmalignant findings from mammography or ultrasound could affect diagnosis time. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health.

First-episode psychosis

2020 ◽  
pp. 122-131
Author(s):  
Merete Nordentoft ◽  
Nikolai Albert
Keyword(s):  
Public Health Problem ◽  
Convincing Evidence ◽  
Community Treatment ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Major Public Health Problem ◽  
Clinical Effects ◽  
Long Run ◽  
Follow Up Studies

Psychosis in the schizophrenia spectrum constitutes a major public health problem. There is convincing evidence for positive effects of 2-year specialized early intervention programs with intensive care, assertive outreach, and family involvement. Follow-up studies indicate a risk of loss of positive clinical effects after termination of specialized programs, but clinical effects can be sustained or even improved with prolonged specialized treatment or transfer to standard treatment, including assertive community treatment (ACT) for the most disabled patients. Long-term studies show substantial heterogeneity in clinical and functional outcomes, resulting in a very diverse picture. Ten-year follow-up studies of the OPUS and the AESOP cohort indicate that more than half of the patients will achieve stable remission of psychotic symptoms and that half of those patients can maintain remission in the long run without antipsychotic medication.

scholarly journals A Clinical Audit on Management of Hypertension

2019 ◽  
Vol 18 (1) ◽  
pp. 49-51
Author(s):  
AK Fazlul Haque ◽  
Faruque Uddin ◽  
Farzana Hamid
Keyword(s):  
Clinical Audit ◽  
Combined Treatment ◽  
Public Health Problem ◽  
Hypertensive Encephalopathy ◽  
Smoking History ◽  
Daily Routine ◽  
Major Public Health Problem ◽  
Cvd Risk ◽  
Hypertensive Patients

Background : Hypertension is a major public health problem globally in both the developed and developing countries and it leads to cardiovascular diseases, stroke and kidney failure. The aim of this study was to identify the deficiency of management and to know the overall approach both by physician and cardiologist in daily routine OPD setting. Materials and methods : The patients’ mean age was 54.9±9.9years, 53.2% were male and 46.8% were female. In history taking important symptoms, family history and smoking history were poorly recorded (51.2%). Results : Of the hypertensive patients, 78.4% were well controlled (BP<140/90). Out of 80 patients, 44 patients needed combined treatment either at the beginning or during follow up. Hypertension preceded before the onset of many newly detected diabetic subjects in our series. About 70% did have LVH and notably ACS were noted in 7.5% cases. 8.3% were obese. TIA/Hypertensive encephalopathy/CVD were detected in 6.2% cases. CCR or eGFR measurement done in only <1% of subjects routinely when we noted renalinsufficiency in 14% and interestingly some were having erectile dysfunction. Conclusion : A significant number (20%) of patients discontinued their BP check. At OPD setting Framingham 10 year CVD risk evaluated in <1% cases only. Refractory or Secondary HTN is seen in only 2 cases. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 49-51

scholarly journals Pleural Effusion Related to Chronic Hepatitis B Virus Reactivation: A Rare Association

2021 ◽  
Author(s):  
Ana Oliveira ◽  
Diana Valadares ◽  
Filipe Nery
Keyword(s):  
Hepatitis B Virus ◽  
Pleural Effusion ◽  
Hepatitis B ◽  
Antiviral Treatment ◽  
Public Health Problem ◽  
Hbv Infection ◽  
Viral Reactivation ◽  
Major Public Health Problem ◽  
Chronic Hepatitis B Virus ◽  
B Virus

Despite worldwide vaccination campaigns, hepatitis B virus (HBV) infection remains a major public health problem. The natural history ranges from asymptomatic infection to severe liver injury or failure, chronic complications or reactivation episodes. The effects of HBV on the organism are immunomediated, possibly triggering extrahepatic manifestations. Since 1971, only a few cases of pleural effusion related to HBV infection have been described. We report HBV-associated pleural effusion occurring during a viral reactivation episode. Antiviral treatment directed towards pleural effusion related to HBV infection should be dictated by underlying liver disease severity and not pleural effusion severity.

scholarly journals Esophageal Cancer and Treatment Modalities

2020 ◽  
Vol I (1) ◽  
pp. 1-3
Author(s):  
Takalkar Unmesh Vidyadhar
Keyword(s):  
Esophageal Cancer ◽  
Public Health Problem ◽  
Diagnostic Techniques ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Major Public Health Problem ◽  
Minimally Invasive Surgical ◽  
Predominant Type ◽  
Modal Treatment

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients.

scholarly journals Pathological Approach to Pleural Malignant Mesothelioma

2022 ◽  
pp. 14
Author(s):  
◽  
◽  
Keyword(s):  
Malignant Mesothelioma ◽  
Latency Period ◽  
The United States ◽  
Initial Exposure ◽  
Pleural Thickening ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Night Sweats ◽  
Chest X Ray ◽  
Pleural Malignant Mesothelioma

Exposure to asbestos can lead to asbestosis or malignancy 10-40 years after initial exposure [1]. Although its use has been banned in multiple countries, past occupational exposure leads to most cases that we see in present time. Malignant mesothelioma is an insidious and rare neoplasm that can arise from mesothelial surface cells, being Malignant Pleural Mesothelioma (MPM) the most common type. Lifetime risk of developing mesothelioma among asbestos workers can be as high as 10 percent and latency period is approximately 30-40 years since time of exposure to development of disease [2]. Annual incidence in the united states is approximately 3,300 cases per year [3]. Median overall survival of patients with advanced unresectable disease is approximately 12 months [4]. Clinical suspicion should arise in patients with previous exposure to asbestos who present with pleural thickening and/or effusion with associated respiratory symptoms. Most symptoms are nonspecific such as chest pain, dyspnea, cough and night sweats. Initial evaluation includes chest x-ray, contrast enhanced CT of the chest to find pleural abnormalities, thoracentesis and closed pleural biopsy. However, difficulties establishing diagnosis have been illustrated on studies where thoracentesis and pleural fluid cytology only yields diagnosis in 26% of cases. The diagnosis, then, is established by morphologic and immunohistochemistry findings of cytologic and surgical specimens.

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