scholarly journals The prevalence of cross-reactivity of cephalosporin in penicillin-allergic patients: A cross-sectional study in Thailand

2018 ◽  
Vol 26 (3) ◽  
pp. 151-155
Author(s):  
Panadda Aiyaka ◽  
Win Techakehakij
Keyword(s):  
Clinical Decision Making ◽  
Asian Population ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Cross Reactivity ◽  
Type I ◽  
Cross Sectional ◽  
First Choice ◽  
History Of

Background: Cross-reactivity between penicillin and cephalosporin is of crucial concern among patients who have had a previous allergic reaction to penicillin, and cephalosporin is the first choice for their diseases. There is very little evidence concerning the prevalence of cross-reactivity in the Asian population. Objectives: This study aims to explore the cross-reactivity between penicillin and cephalosporin in the Asian population. Methods: This study included patients who were registered at Lampang Hospital from January 2011 to January 2018. Only patients who were prescribed penicillins and cephalosporins at least once as recorded in the electronic medical records (EMR), were included. Patients having penicillin and cephalosporin allergies were defined as those who were diagnosed in the EMR as allergic to drugs in the penicillin/ cephalosporin groups, in either the probable or definite categories with respect to the Naranjo’s algorithm. Cross-reactivity is defined as patients who were diagnosed as being allergic to both penicillin and cephalosporin. Data about characteristics and types of allergic reactions (type I & IV) were obtained from the EMR. Results: A total of 13,959 patients were included in the study. Of these, 99 penicillin-allergic and 13,860 non-penicillin-allergic patients were identified. The prevalence of cross-reactivity among patients with a history of penicillin allergy was 8.1%. Results showed high cross-reactivity rates among patients with type 1 (16.7%) and type 4 (13.3%) hypersensitivity, in relation to other allergic manifestations (3.4%). Conclusions: This study raises the possibility that cross-reactivity reported in previous research may differ from that in the Asian population. More Asian-based studies are needed to evaluate this cross-reaction so that this information can further assist medical professionals in clinical decision-making.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Clinical Problem Solving: Decreased Level of Consciousness and Unexplained Hydrocephalus

2022 ◽  
pp. 194187442110567
Author(s):  
Naomi Niznick ◽  
Ronda Lun ◽  
Daniel A. Lelli ◽  
Tadeu A. Fantaneanu
Keyword(s):  
Decision Making ◽  
Differential Diagnosis ◽  
Clinical Decision Making ◽  
Clinical Problem ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Clinical Problem Solving ◽  
Level Of Consciousness ◽  
History Of

We present a clinical reasoning case of 42-year-old male with a history of type 1 diabetes who presented to hospital with decreased level of consciousness. We review the approach to coma including initial approach to differential diagnosis and investigations. After refining the diagnostic options based on initial investigations, we review the clinical decision-making process with a focus on narrowing the differential diagnosis, further investigations, and treatment.

scholarly journals Impact of 123I-MIBG Scintigraphy on Clinical Decision-Making in Pheochromocytoma and Paraganglioma

2019 ◽  
Vol 104 (9) ◽  
pp. 3812-3820 ◽  
Author(s):  
Dipti Rao ◽  
Anouk van Berkel ◽  
Ianthe Piscaer ◽  
William F Young ◽  
Lucinda Gruber ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Mibg Scintigraphy ◽  
Cross Sectional ◽  
First Choice ◽  
Cross Sectional Imaging ◽  
The Cost ◽  
The Impact

Abstract Context Cross-sectional imaging with CT or MRI is regarded as a first-choice modality for tumor localization in patients with pheochromocytoma and paraganglioma (PPGL). 123I-labeled metaiodobenzylguanidine (123I-MIBG) is widely used for functional imaging but the added diagnostic value is controversial. Objective To establish the virtual impact of adding 123I-MIBG scintigraphy to CT or MRI on diagnosis and treatment of PPGL. Design International multicenter retrospective study. Intervention None. Patients Two hundred thirty-six unilateral adrenal, 18 bilateral adrenal, 48 unifocal extra-adrenal, 12 multifocal, and 26 metastatic PPGL. Main Outcome Measures Patients underwent both anatomical imaging (CT and/or MRI) and 123I-MIBG scintigraphy. Local imaging reports were analyzed centrally by two independent observers who were blinded to the diagnosis. Imaging-based diagnoses determined by CT/MRI only, 123I-MIBG only, and CT/MRI combined with 123I-MIBG scintigraphy were compared with the correct diagnoses. Results The rates of correct imaging-based diagnoses determined by CT/MRI only versus CT/MRI plus 123I-MIBG scintigraphy were similar: 89.4 versus 88.8%, respectively (P = 0.50). Adding 123I-MIBG scintigraphy to CT/MRI resulted in a correct change in the imaging-based diagnosis and ensuing virtual treatment in four cases (1.2%: two metastatic instead of nonmetastatic, one multifocal instead of single, one unilateral instead of bilateral adrenal) at the cost of an incorrect change in seven cases (2.1%: four metastatic instead of nonmetastatic, two multifocal instead of unifocal and one bilateral instead of unilateral adrenal). Conclusions For the initial localization of PPGL, the addition of 123I-MIBG scintigraphy to CT/MRI rarely improves the diagnostic accuracy at the cost of incorrect interpretation in others, even when 123I-MIBG scintigraphy is restricted to patients who are at risk for metastatic disease. In this setting, the impact of 123I-MIBG scintigraphy on clinical decision-making appears very limited.

scholarly journals Perception and Usage of Point of Care Devices: A Cross-sectional Study Targeting Residents and Trainers in Oman

2021 ◽  
Vol 36 (1) ◽  
pp. e213-e213
Author(s):  
Amna Al Harrasi ◽  
Laila Mohammed Al Mbeihsi ◽  
Abdulhakeem Al Rawahi ◽  
Mohammed Al Shafaee
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Mobile Technologies ◽  
Handheld Devices ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Impact

Objectives: The use of mobile technologies and handheld computers by physicians has increased worldwide. However, there are limited studies globally regarding training physicians on the use of such devices in clinical practice. In addition, no studies have been conducted previously in Oman addressing this issue among postgraduate medical trainees and trainers. The present study explores the practice and perception of resident doctors and trainers towards the use of mobile technologies and handheld devices in healthcare settings in Oman. Methods: This cross-sectional study was conducted using a validated questionnaire disseminated via email to all residents and trainers in five major training programs of the Oman Medical Specialty Board (OMSB). The questionnaire explored three main areas; perception, usage, and perceived barriers of handheld devices. Results: Overall, 61.4% of the residents and 28.3% of the trainers responded to the questionnaire. Both types of participants agreed that the use of such devices positively affects clinical decision-making. In total, 98.8% of the participating residents and 86.7% of the trainers frequently used handheld devices. Both OMSB residents and trainers agreed that lack of time, training, and applications were the most common factors limiting the use of these devices. Participants emphasized the need for constructive training regarding the use of handheld devices as healthcare resources. Conclusions: Point-of-care devices are positively perceived and frequently used by OMSB trainees and trainers. However, constructive training on the effective usage of these devices in clinical decision-making is needed. Further future studies to evaluate the impact of using such devices in patient care should be conducted.

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients

2018 ◽  
Vol 128 (08) ◽  
pp. 493-498 ◽  
Author(s):  
Marino Vilovic ◽  
Tina Ticinovic Kurir ◽  
Anela Novak ◽  
Mladen Krnic ◽  
Josip Andelo Borovac ◽  
...  
Keyword(s):  
Diabetes Management ◽  
Statistical Significance ◽  
Severe Hypoglycemia ◽  
Cross Sectional Study ◽  
Hospital Environment ◽  
Diabetic Patients ◽  
Hypoglycemic Episode ◽  
Cross Sectional ◽  
First Choice ◽  
History Of

Abstract Background First choice of therapy for severe hypoglycemia outside hospital environment is glucagon injection, an undertaught and underused remedy. Aim of this study was to investigate knowledge about glucagon therapy, possession rate and usage rate in insulin-treated diabetic patients, with special emphasis on history of hypoglycemia and severe hypoglycemia episodes. Methods In this cross-sectional study, 300 insulin-treated diabetic patients (146 males and 154 females, mean age 61.1±16.4 years) were recruited from comprehensive Diabetes Center in Croatia. Specialized self-administered, 13-item questionnaire regarding glucagon therapy and history of hypoglycemia was obtained from each patient, as well as data collected from medical history documentation. Results Experience of hypoglycemic episode was reported by 233 (77.7%), and severe hypoglycemia by 73 (24.3%) patients. Participants with experience of hypoglycemia have significantly longer diabetes duration (17.2±11.2 vs. 11.9±8.5 years, P<0.001) and lower BMI values (26.38±3.97 vs. 31.11±7.17 kg/m2, P<0.001). Knowledge about glucagon therapy had 55.3% patients, 44.7% obtained it from the pharmacy, while glucagon was used in 35.6% cases of severe hypoglycemia. Glucagon knowledge was better in patients that attended at least one diabetes lecture (P=0.038), while educational level showed no statistical significance (P=0.286). Main significant positive predictor of glucagon knowledge was history of severe hypoglycemia (OR 4.71, 95% CI 1.38 – 16.02, P=0.013). Conclusions Glucagon therapy was underused in treating severe hypoglycemia. It is highly important to emphasize value of quality education as one of the fundamentals of good diabetes management.

scholarly journals Outcomes Bronchoscopic Evaluation in A University Hospital

2016 ◽  
Vol 55 (204) ◽  
pp. 51-54 ◽  
Author(s):  
Ram Hari Ghimire ◽  
Narendra Bhatta ◽  
Puru Koirala ◽  
Bides Bista ◽  
Deebya Raj Misra ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Patient Care ◽  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Fiberoptic Bronchoscopy ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Clinical Profile ◽  
University Hospital ◽  
Cross Sectional

Introduction: Study of clinical profile of the patients and diagnostic yield of the selected bronchoscopic procedures gives us important information in clinical decision making and better patient care. There are hardly very few studies regarding these entities. Therefore, we decided to study clinical characteristics and outcomes of the patients who underwent bronchoscopic evaluation in our setting. Methods: This was a cross-sectional study the consecutive patients who underwent bronchoscopy from 1st May 2013- 30th April 2015 in division of pulmonary, critical care and sleep medicine. The main procedure performed was bronchoalveolar lavage. Results: The mean age was 54.71 years with 76 (76%) males. Recurrent hemoptysis in 58 (58%) patients were the commonest indication. Total 95 (95%) patients have chest X-ray abnormalities. The commonest bronchoscopic finding was bronchiectasis 23 (23%) of patients followed by chronic bronchitis in 18 (18%) and endobronchial tuberculosis in 16 (16%). Total 10 (71%) of the 14 bronchoscopically suspected lung cancer patients have intraluminal lesions. Bronchoalveolar lavage culture for tuberculosis showed growth in 46 (46%), positive for malignancy in 7 (7%) positive Ziehl Neelson stain for tuberculosis in 6 (6%).Conclusions: Bronchoscopic evaluation of patients with pulmonary diseases gives us a lot of information that may help us in better patient care and bronchoalveolar lavage has high diagnostic yield in diagnosing pulmonary tuberculosis.Keywords: bronchoalveolar lavage;clinical profile;fiberoptic bronchoscopy. | PubMed

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients 

2021 ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection.Methods: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19.Results: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥ 2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28).Conclusion: The combination of ≥ 2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation <93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease.Trial registration: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

scholarly journals Prevalence and Associated Factors of Diabetic ketoacidosis among Patients Living with Type 1 Diabetes in Makkah City

2021 ◽  
Author(s):  
Raghad Alhajaji ◽  
Khalid Almasodi ◽  
Afaf Alhajaji ◽  
Ahamd Alturkistani ◽  
Mayada Samkari
Keyword(s):  
Diabetic Ketoacidosis ◽  
Hba1c Level ◽  
Past History ◽  
Postgraduate Education ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Patients ◽  
History Of ◽  
Associated Risk Factors

Objective: To assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors. Methods: A cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City, Saudi Arabia. Results: Among participants, 59.3% were males, 44.1% were diabetic for more than 5 years, while 70.8% reported past history of DKA. The main causes of DKA were first presentation of the disease (40.9%), and discontinued treatment (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). Out of them, 9 (5.4%) suffered complications. Female patients were more likely to suffer from episodes of DKA than males (76% and 68.3%, respectively). Most patients whose parents' highest education was primary level had DKA more frequently than those whose parents' had postgraduate education. Patients with unemployed fathers had significantly higher frequency of DKA (p=0.004). Ketoacidosis was significantly more frequent among patients with parents' consanguinity (p<0.001). Patients who had their current HbA1c level exceeding 9% had positive history of DKA compared to those with HbA1c level 7% (87.9% and 28.6%, respectively, p<0.001). Conclusion: Most type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives.

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