scholarly journals Misdiagnosis of bradyarrhythmias in clinical practice in Iraq

2021 ◽  
Vol 25 (2) ◽  
pp. 567-576
Author(s):  
Amar Alhamdi
Keyword(s):  
Clinical Practice ◽  
Electrophysiological Study ◽  
Final Diagnosis ◽  
Case Definition ◽  
Vertebrobasilar Insufficiency ◽  
Standard Case ◽  
Pacemaker Therapy ◽  
Study Results ◽  
Missed Diagnosis ◽  
Definition Of

Background and objective: Bradyarrhythmias are one of the many causes of syncope, pre-syncope, and dizzy spells. Missing the diagnosis of bradyarrhythmias, an underlying etiology of those symptoms, may lead to serious complications and even mortality. This study aimed to set a standard case definition of bradyarrhythmias, which will improve patient survival. Methods: Patients presented with partial or total loss of consciousness, who were misdiagnosed as other non-arrhythmic etiologies and later diagnosed as bradyarrhythmia, were included in this study. Diagnosis of bradyarrhythmias was reached by either 12 leads electrocardiography, Holter monitor, or electrophysiological study. Results: A total of 150 patients who fulfilled the definition of missed diagnosis of bradyarrhythmias were included. A total of 100 males and 50 females were collected over 10 years. The pre arrhythmic over-diagnosis included transient ischemic attacks in 35 patients, vertebrobasilar insufficiency in 40 patients, vertigo in 30 patients, and other nonspecific diagnoses in 45 patients. The final diagnosis of bradyarrhythmias was reached by electrocardiogram only in 45, Holter recording in 75, and electrophysiological study in 30. All the diagnosed cases of bradyarrhythmias received permanent pacemaker therapy. Conclusion: Misdiagnosis of bradyarrhythmias in patients presenting with syncope is not uncommon in clinical practice in Iraq, which may have a bad impact on patients' morbidity and mortality. Understanding the causative factors for the missed diagnosis can help set up an educational program to minimize this problem. Keywords: Misdiagnosis; Bradyarrhythmia; Syncope; Dizzy spells.

scholarly journals Detection of brucellosis through active surveillance, Armenia, 2014

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Liana Torosyan ◽  
Lilit Avetisyan ◽  
Artavazd Vanyan
Keyword(s):  
Animal Husbandry ◽  
Raw Milk ◽  
Case Definition ◽  
Main Risk Factor ◽  
Standard Case ◽  
Vulnerable Households ◽  
Serious Disease ◽  
Definition Of ◽  
Favorable Conditions ◽  
Cattle Farms

ObjectiveIn the spring of 2014, people from vulnerable households in allmarzes of Armenia were examined with the aim of active surveillance.IntroductionBrucellosis is a serious disease caused by bacteria of the Brucellagenus. It principally affects ruminants but may be transmitted tohumans. Registration of cases in cattle farms causes considerableeconomic losses and creates favorable conditions for mass infectionamong humans. In Armenia the expansion of animal industries andurbanization are the main reasons for occurrence and developmentof brucellosis.MethodsBlood was sampled from people on farms reported as havinginfected animals. Blood samples were tested by the Wright-Huddleston method. The standard case definition of brucellosis wasused for diagnosis. A questionnaire-based interview was carried outamong the population to identify the form of contact with animals andto analyze epidemiological links. During the investigation provisionswere followed in governmental decree RA 19.01.2006 N480-Nand brucellosis prevention, epidemiology, diagnosis, treatment,preventive measures.ResultsA total of 11160 people from 1054 households were enrolled in thestudy, of which 3625 (32.5%) underwent a laboratory examination.Nearly 6% (641) refused to be tested. Over 6% of those tested (226)were positive for antibodies to Brucellae. Of these, 129 (3.5%) hadchronic brucellosis. Those testing positive for brucellosis were treatedappropriately. These included 203 (90%) adults and 23 (10%) below14 years old; 147 (65%) were male and 79 (35%) were female.Of those diagnosed with brucellosis, working in animal husbandryaccounted for 46.6% (106), while those who harvested milk accountedfor 37.6% (85) and those using raw milk made up 15.4% (35).ConclusionsCases were most frequently reported among people 20-55 years ofage; the highest percentage of positives were among 41-45 year oldmales who had contact with infected animals. The main risk factor foracquiring brucellosis is animal husbandry.

scholarly journals How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study

2019 ◽  
Author(s):  
Christopher Lowbridge ◽  
Soraya A. M. Fadhil ◽  
Gayathri D. Krishnan ◽  
Emma Schimann ◽  
Raman Muthu Karuppan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Diagnostic Tests ◽  
Prospective Cohort ◽  
Intestinal Tuberculosis ◽  
Final Diagnosis ◽  
Case Definition ◽  
Tissue Samples ◽  
Standard Case

Abstract Gastrointestinal tuberculosis (TB) is diagnostically challenging; therefore, many cases are treated presumptively. We aimed to describe features and outcomes of gastrointestinal TB, determine whether a clinical algorithm could distinguish TB from non-TB diagnoses, and calculate accuracy of diagnostic tests. Methods We conducted a prospective cohort study of hospitalized patients in Kota Kinabalu, Sabah, Malaysia, with suspected gastrointestinal TB. We recorded clinical and laboratory characteristics and outcomes. Tissue samples were submitted for histology, microscopy, culture and GeneXpert MTB/RIF®. Patients were followed for up to two years. Results Among 88 patients with suspected gastrointestinal TB, 69 were included in analyses; 52 (75%) had a final diagnosis of gastrointestinal TB; 17 had a non-TB diagnosis. People with TB were younger (42.7 versus 61.5 years, p=0.01) and more likely to have weight loss (91% versus 64%, p=0.03). An algorithm using age <44, weight loss, cough, fever, no vomiting, albumin >26 g/L, platelets >340 x109/L and immunocompromise had good specificity (96.2%) in predicting TB, but very poor sensitivity (16.0%). GeneXpert® performed very well on gastrointestinal biopsies (sensitivity 95.7% versus culture 35.0% against a gold standard case definition of confirmed TB). Most patients (79%) successfully completed treatment and no treatment failure occurred, however adverse events (21%) and mortality (13%) among TB cases were high. We found no evidence that six months of treatment was inferior to longer courses. Conclusions The prospective design provides important insights for clinicians managing gastrointestinal TB. We recommend wider implementation of high-performing diagnostic tests such as GeneXpert® on extra-pulmonary samples.

Emotion Dysregulation: A Review of the Concept and Implications for Clinical Practice

2016 ◽  
Vol 33 (S1) ◽  
pp. S528-S529
Author(s):  
A. D’Agostino ◽  
S. Covanti ◽  
M. Rossi Monti ◽  
V. Starcevic
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorders ◽  
Emotion Dysregulation ◽  
Emotional Reactivity ◽  
Emotional Awareness ◽  
Future Research ◽  
Competing Interest ◽  
Expression Of Emotions ◽  
Psychology Literature ◽  
Definition Of

IntroductionOver the past decade, emotion dysregulation has become a very popular term in the psychiatric and clinical psychology literature and it has been described as a key component in a range of mental disorders. For this reason, it has been recently called the “hallmark of psychopathology” (Beauchaine et al., 2007). However, many issues make this concept controversial.ObjectivesTo explore emotion dysregulation, focusing on problems related to its definition, meanings and role in many psychiatric disorders.AimsTo clarify the psychopathological core of emotion dysregulation and to discuss potential implications for clinical practice.MethodsA literature review was carried out by examining articles published in English between January 2003 and June 2015. A search of the databases PubMed, PsycINFO, Science Direct, Medline, EMBASE and Google Scholar was performed to identify the relevant papers.ResultsAlthough, there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in different proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions.ConclusionsThis review highlights a discrepancy between the widespread clinical use of emotion dysregulation and inadequate conceptual status of this construct. Better understanding of the various dimensions of emotion dysregulation has implications for treatment. Future research needs to address emotion dysregulation in all its multifaceted complexity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Facets of Cultural Competence

2001 ◽  
Vol 29 (6) ◽  
pp. 842-849 ◽  
Author(s):  
Lisa A. Suzuki ◽  
Mary B. McRae ◽  
Ellen L. Short
Keyword(s):  
Clinical Practice ◽  
Cultural Competence ◽  
Counseling Psychology ◽  
Past Research ◽  
Current Clinical Practice ◽  
Multidimensional Model ◽  
Proposed Model ◽  
Innovative Thinking ◽  
Definition Of

Sue’s proposed model is based on a critique of the Eurocentric assumptions underlying current clinical practice and reflects his innovative thinking and unique synthesis of past research. The specific areas addressed in this article focus on an examination of the multidimensional model of cultural competence (MDCC) and issues related to the definition of competence and its measurement. Areas of needed elaboration in the model include complexities related to power hierarchies (i.e., authority, authorization, and leadership) and implications for training and practice. Particular emphasis is placed on the complexities of cultural competence and the important contributions of Sue’s MDCC as an important step in making cultural competence a reality in the practice of counseling psychology.

DISC HERNIA - DIFFERENTIAL DIAGNOSTICS, OPTION OF PSEUDOTUMOROUS FLOW

Vestnik ◽  
2021 ◽  
pp. 97-101
Author(s):  
М.А. Алиев ◽  
М.Ж. Мирзабаев ◽  
В.С. Караваев
Keyword(s):  
Clinical Medicine ◽  
Clinical Symptoms ◽  
Final Diagnosis ◽  
Herniated Disc ◽  
General Definition ◽  
Differential Diagnostics ◽  
Common Disease ◽  
Physical And Mental Health ◽  
Imaging Results ◽  
Definition Of

Грыжа диска (ГД) является распространенным заболеванием и наносит большой вред как физическому, так и психическому здоровью пациентов, страдающих этим заболеванием. Главным этиологическим фактором заболевания служит дегенерация диска. В настоящее время общее определение грыжи межпозвонкового диска в клинической медицине довольно запутанно. В настоящее время общее определение грыжи межпозвонкового диска в клинической медицине довольно запутанно. Окончательный диагноз ГД основывается на совокупности анамнеза, клинических симптомов и результатах визуализации. Herniated disc is a common disease and causes great harm to both the physical and mental health of patients suffering from this disease. The main etiological factor of the disease is disc degeneration. Currently, the general definition of a herniated disc in clinical medicine is quite confusing. Currently, the general definition of a herniated disc in clinical medicine is quite confusing. The final diagnosis of HD is based on a combination of anamnesis, clinical symptoms, and imaging results.

Diagnostic and Therapeutic Knowledge and Practices in the Management of Congenital Syphilis by Pediatricians in Public Maternity Hospitals in Brazil

2017 ◽  
Vol 49 (2) ◽  
pp. 322-342 ◽  
Author(s):  
Raquel Rodrigues dos Santos ◽  
Roberta Pereira Niquini ◽  
Francisco Inácio Bastos ◽  
Rosa Maria Soares Madeira Domingues
Keyword(s):  
Congenital Syphilis ◽  
Cross Sectional Study ◽  
Case Definition ◽  
Educational Work ◽  
Correct Treatment ◽  
Cross Sectional ◽  
Treatment Protocols ◽  
Missed Opportunities ◽  
Maternity Hospitals ◽  
Definition Of

The study aimed to assess conformity with Brazil’s standard protocol for diagnostic and therapeutic practices in the management of congenital syphilis by pediatricians in public maternity hospitals. A cross-sectional study was conducted in 2015 with 41 pediatricians working in all the public maternity hospitals in Teresina, the capital of Piauí State, Northeast Brazil, through self-completed questionnaires. The study assessed the conformity of knowledge and practices according to the Brazilian Ministry of Health protocols. The study has made evident low access to training courses (54%) and insufficient knowledge of the case definition of congenital syphilis (42%) and rapid tests for syphilis (39%). Flaws were observed in the diagnostic workup and treatment of newborns. Requesting VDRL (88%) and correct treatment of neurosyphilis (88%) were the practices that showed the highest conformity with standard protocols. Low conformity with protocols leads to missed opportunities for identifying and adequately treating congenital syphilis. Based on the barriers identified in the study, better access to diagnostic and treatment protocols, improved recording on prenatal cards and hospital patient charts, availability of tests and medicines, and educational work with pregnant women should be urgently implemented, aiming to reverse the currently inadequate management of congenital syphilis and to curb its spread.

EVALUATION OF A CLINICAL CASE-DEFINITION OF ACQUIRED IMMUNODEFICIENCY SYNDROME IN AFRICA

The Lancet ◽  
1987 ◽  
Vol 329 (8531) ◽  
pp. 492-494 ◽  
Author(s):  
Robert Colebunders ◽  
Henry Francis ◽  
Lebughe Izaley ◽  
Kanyinda Kabasele ◽  
Nzila Nzilambi ◽  
...  
Keyword(s):  
Acquired Immunodeficiency Syndrome ◽  
Clinical Case ◽  
Case Definition ◽  
Acquired Immunodeficiency ◽  
Definition Of ◽  
Immunodeficiency Syndrome ◽  
Clinical Case Definition

A SIMPLIFIED SURVEILLANCE CASE DEFINITION OF AIDS DERIVED FROM EMPIRICAL CLINICAL DATA

1992 ◽  
Vol 5 (12) ◽  
pp. 1212???1223 ◽  
Author(s):  
Bruce G. Weniger ◽  
Eleonora Pati Quinh??es ◽  
Andrea Borges Sereno ◽  
Maur??cio Andrade de Perez ◽  
John W. Krebs ◽  
...  
Keyword(s):  
Clinical Data ◽  
Case Definition ◽  
Definition Of

scholarly journals SARS-COV-2 INFECTION IN PRIMARY CARE: A SINGLE-CENTERED, RETROSPECTIVE, OBSERVATIONAL STUDY

2021 ◽  
Author(s):  
Pilar Galicia ◽  
Juan Jose Gutierrez Cuevas ◽  
Fang Fang Chen Chen ◽  
Laura Santos Larregola ◽  
Alberto Manzanares Briega ◽  
...  
Keyword(s):  
Primary Care ◽  
Arterial Hypertension ◽  
Clinical Characteristics ◽  
Care Center ◽  
Case Definition ◽  
Living Conditions ◽  
Primary Care Center ◽  
Predictive Role ◽  
Definition Of

Purpose: to describe the clinical characteristics of patients with confirmed SARS-CoV-2 infection in primary care and to analyze the predictive role of different risk factors on prognosis, especially living conditions. Methods: Retrospective longitudinal observational retrospective study by reviewing medical records from a primary care center since March 1 to April 30, 2020. Case definition of confirmed SARS-CoV-2 infection, sociodemographic data, clinical characteristics, comorbidity and living conditions were collected. The statistical analysis consisted in description of the sample, comparison of prognosis groups and analysis of prognostic factors. Results. A sample of 70 patients with confirmed SARS-CoV-2 infection was obtained, with comorbidity mainly related to arterial hypertension, overweight/obesity, hypercholesterolemia, diabetes and chronic pulmonary pathology. Pneumonia was present in 66%. Exitus occurred in 14% of the sample. Factors associated with mortality were advanced age (84 vs 55; p<0.0001), arterial hypertension (78% vs 41%; p=0.040), asthma-COPD (56% vs 13%; p=0.008) and atrial fibrillation (56% vs 5%; p=0.001). Conclusions. The study reflects the clinical practice of a primary care center. This kind of studies are essential to strengthen and reorganize the Health System and to try to anticipate the medium- to long-term consequences of COVID-19 on global health.

scholarly journals The Expression of Chromogranin A, Syanptophysin and Ki67 in Detecting Neuroendocrine Neoplasma at High Grade Colorectal Adenocarcinoma

2021 ◽  
Vol 9 (A) ◽  
pp. 1142-1147
Author(s):  
W. A. Gusti Deasy ◽  
M. Husni Cangara ◽  
Andi Alfian Zainuddin ◽  
Djumadi Achmad ◽  
Syarifuddin Wahid ◽  
...  
Keyword(s):  
Chromogranin A ◽  
Colorectal Adenocarcinoma ◽  
Final Diagnosis ◽  
Neuroendocrine Neoplasm ◽  
Neuroendocrine Neoplasms ◽  
High Grade ◽  
Neuroendocrine Markers ◽  
Study Results ◽  
Cell Neoplasm ◽  
Sample Characteristics

BACKGROUND: Neuroendocrine neoplasm (NEN) is an epithelial cell neoplasm that can give a histopathological appearance resembling high-grade colorectal adenocarcinoma. Immunohistochemical assays with specific neuroendocrine markers of chromogranin A and synaptophysin are required to establish a definite diagnosis of NEN. AIM: This study aimed to determine whether there was an expression of chromogranin A, synaptophysin and Ki67 which indicated the presence of neuroendocrine neoplasms in samples that have been diagnosed as high-grade colorectal adenocarcinoma. MATERIALS AND METHODS: A study of the expression of chromogranin A, synaptophysin and Ki67 in paraffin blocks was carried out as a result of biopsy and tissue surgery of 70 samples of colorectal tumor specimens diagnosed with colorectal adenocarcinoma. Descriptive analyses were used to assess the study results of the amount of chromogranin A, synaptophysin, and sample characteristics. RESULTS: We discovered that eight (8) samples (11.4%) were NEN from 70 previously diagnosed samples as high-grade colorectal adenocarcinoma using immunohistochemical assay with neuroendocrine markers, namely chromogranin A and synaptophysin. CONCLUSION: The final diagnosis obtained from 8 samples diagnosed as NEN were Neuroendocrine tumor (NET) G1, G2, and G3, respectively 1.4% and LCNEC 7.1% based on the specific neuroendocrine markers of chromogranin A, synaptophysin and Ki67.

Sign in / Sign up

Export Citation Format

Share Document