scholarly journals Clinical presentation of neurofibromatosis in indigenous black Africans: Evidence for multidisciplinary team approach to diagnosis and management with emphasis on Ophthalmological perspective.

2021 ◽  
Author(s):  
Olufunmilola OGUN ◽  
Olusegun A Adediran ◽  
Gabriel Ogun
Keyword(s):  
Multidisciplinary Team ◽  
Clinical Presentation ◽  
Positive Family History ◽  
Plexiform Neurofibroma ◽  
Clinical Information ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Female Ratio ◽  
Department Of Ophthalmology ◽  
Significant Difference

Aim- To describe the pattern of clinical presentation of patients with neurofibromatosis in a homogeneous black African population with emphasis on ophthalmological presentation in a multidisciplinary management setting. Methods- Ophthalmology clinic records from the Department of Ophthalmology and database of the Department of Pathology, both of University College Hopsital, Ibadan, Nigeria were reviewed for cases of neurofibromatosis over a 10-year period (Jan 2010 and Dec 2019). Relevant demographic, clinical information, management, complications and patient follow up were extracted from the records and entered into a spreadsheet and analysed. Results - The 34 cases included in this study comprised 19 males (55.9%) and age ranged from 18 months – 60 years, with a median age of 15 years. The male to female ratio was 1.3:1 with approximately 35.3% (12 patients) in the paediatric age group. The most frequent reason for consultation was unilateral progressive painless lid swelling (plexiform neurofibroma) often associated with ptosis. There was a positive family history of neurofibromatosis in 9 out of 32 cases (28.1%). Café au laît macules were observed in 22 out of 25 (88%) of cases. Typical neurofibromas were present in 84.8% of the patients. There was no significant difference in prevalence of plexiform neurofibromas with age (p= 0.05) or sex (p= 0.79). Bone and joint abnormalities was present in 17.6% of the patients. Ophthalmic examination showed conjunctiva changes in 3 cases, prominent cornea nerves in 2 cases. Iris lisch nodules was present in 75.9% of cases that had documentation, cataract in 2 cases and optic atrophy in 6cases.Three patients had ophthalmic pathway gliomas. Patients were managed by multidisciplinary teams depending on their needs. Conclusion- Multidisciplinary team management is advocated because of the multi-system disorders these patient have and the need for holistic, patient centred care that is of good quality, and sustainable.

scholarly journals Large intramuscular plexiform neurofibroma of thigh: a multidisciplinary team approach

2020 ◽  
Vol 6 (6) ◽  
pp. 1312
Author(s):  
Aninda Mandal ◽  
Kumar Satyam ◽  
Avinash K. Sinha ◽  
Deepak Kumar ◽  
Prabhat K. Dwivedi ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Multidisciplinary Team ◽  
Positive Family History ◽  
Plexiform Neurofibroma ◽  
Neurofibromatosis Type ◽  
Operative Management ◽  
Team Approach ◽  
Muscle Involvement ◽  
Multidisciplinary Team Approach ◽  
History Of

<p>Large plexiform neurofibroma of lower extremity involving the muscle is a rare entity. In this article we present the case of plexiform neurofibroma of right thigh involving the muscular plane and entrapment of the sciatic nerve. A 28 year lady presented with a plexiform neurofibroma of right thigh of size 60 cm×30 cm×25 cm with a positive family history of neurofibromatosis type 1. MRI was done for the assessment of the tumour and the adjacent structure involvement. The neurofibroma was removed with a multidisciplinary team approach with an intensive peri operative management. The pathological diagnosis was plexiform neurofibroma with diffuse neurofibroma. We have reported a rare case of large plexiform neurofibroma of lower extremity with muscle involvement and nerve entrapment.</p>

scholarly journals Hospital based study of demography and clinical picture of vernal keratoconjunctivitis

2017 ◽  
Vol 6 (1) ◽  
pp. 65 ◽  
Author(s):  
Maneesha Sethi ◽  
Ridham Nanda ◽  
Amarjeet Singh Bali ◽  
P. Sadhotra
Keyword(s):  
Mixed Type ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Vernal Keratoconjunctivitis ◽  
Female Ratio ◽  
Northern India ◽  
Department Of Ophthalmology ◽  
Male Female Ratio ◽  
History Of ◽  
Ocular Morbidity

Background: Vernal Keratoconjunctivitis (VKC) is common cause of ocular morbidity in children living in tropical countries. Its diagnosis is based on signs and symptoms of the disease. The study was undertaken to stress upon the demography and clinical presentation of VKC.Methods: Retrospective pre-formed proforma of 155 patients of VKC, who were detected at random in the out - patient department of ophthalmology, ASCOMS, Jammu from May 2016 to April 2017, were analyzed.Results: Mean age at presentation was 10.31 years +4.05. The Male: Female ratio was 4.96:1. Majority of patients reported in the month of May. Mixed type of VKC was predominant. Personal or family history of allergy was seen in 5.8% of patients. Itching (100%) was commonest symptom and palpaberal papillae were commonest sign seen in 78.70% of patients.Conclusions: Clinical pattern of VKC seen in hot and dry climate of Northern India is like that seen in other parts of country.

scholarly journals Evaluating a Multidisciplinary Team Approach to Elder Abuse

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 273-273
Author(s):  
Carmen Morano ◽  
Erin Berical
Keyword(s):  
Multidisciplinary Team ◽  
Elder Abuse ◽  
Positive Impact ◽  
Practical Knowledge ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Preliminary Evaluation ◽  
Team Members ◽  
Face To Face ◽  
Ongoing Functioning

Abstract This paper presents findings from a University and Community-based Agency collaboration to design and implement a preliminary evaluation of the Elder Abuse Multidisciplinary Team (E-MDT) Intervention. This intervention brings professionals from a variety of fields to investigate and respond to elder abuse. Data from 22 Interviews with staff along with anonymous survey data from E-MDT team members/staff (n=312) sought to establish team successes, challenges in implementation, and ongoing functioning. Themes that emerged in creating successful teams include: Establishing Buy-In and Trust of the team members, The Benefit of sharing experience and practical knowledge with other program sites; and Recognizing the Differences related to Onboarding and Sustaining New programs versus Sustaining Existing Programs. Themes related to responding during COVID revealed challenges such as Adapting to Technology and Inconsistent Access to the Internet. It was noted that remote meetings were easier to attend than face-to-face meetings. Data from the survey found the vast majority of respondents view the E-MDTs as having a positive impact on Clients (93%); while 93% of respondents indicated a positive impact on their Approach to Practice and the service area of their agency. Approximately 80% of the respondents indicated their multidisciplinary teams were Effective. Responses to 3-Open Ended questions included in the survey echoed similar themes from the interviews, as well as comments about their Professional Development and the complexity of responding to elder abuse. The paper will close with a discussion of the strategies used to facilitate the collaboration and complete the evaluation during the COVID-19 pandemic.

scholarly journals Barriers to Comprehensive Multidisciplinary Head and Neck Care in a Community Oncology Practice

2021 ◽  
pp. 1-10
Author(s):  
Muralidhar Beeram ◽  
Andrew Kennedy ◽  
Nathan Hales
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Multidisciplinary Team ◽  
Unmet Need ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Health Care Environment ◽  
Patient Centered ◽  
Community Based

Complex, coordinated, and collaborative care of patients with head and neck cancer can be challenging yet amazingly rewarding and successful. The high symptom burden across multiple functional domains in patients with head and neck cancer, even in early stages of disease, mandates a multidisciplinary team approach that harnesses the combined contributions of physicians and ancillary providers to drive greater patient-centered care, addressing factors that heavily influence morbidity, mortality, and quality of life. Well-organized community-based multidisciplinary teams fulfill this unmet need and benefit patients with conveniently located comprehensive services that are typically found in large academic centers. Equivalent, if not superior, outcomes can be achieved in a unified community-based multidisciplinary team with shared patient-centered and outcomes-based goals. However, implementing true multidisciplinary team care in today’s complex health care environment is fraught with challenges and pitfalls. So how have some community-based practices managed to create safe and efficient programs with successful outcomes? The purpose of this review is to discuss barriers to reaching this success and emphasize practical solutions to such challenges.

Impact of Psychological Disorders on Clinical Presentation of Pediatric Patients Following a Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S21.1-S21
Author(s):  
Hannah Worrall ◽  
Shane Miller ◽  
Munro Cullum ◽  
Jane Chung
Keyword(s):  
Symptom Severity ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Psychological Disorders ◽  
Initial Presentation ◽  
Multidisciplinary Teams ◽  
Severity Scores ◽  
Significant Difference ◽  
History Of ◽  
History Of Depression

ObjectiveTo examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorders (PD) following a concussion.BackgroundLimited information exists regarding impact of pre-existing psychological disorders on initial clinical presentation in pediatric patients following concussion.Design/MethodsData were prospectively collected from participants aged 5–18 diagnosed with a concussion between August 2015 and March 2020. Demographics and clinical measures from initial presentation were reviewed, including SCAT-5 Symptom, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into 4 groups based on self-reported prior diagnosis: depression, anxiety, both, and no PD.ResultsOne thousand seven hundred seventy participants included: 50 depression, 82 anxiety, 84 both, and 1,554 no PD history. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or the anxiety and no PD group. The both group was older, had more females and prior concussions, and presented later than the no PD group. The depression, anxiety, and both groups had higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p < 0.001). Each PD group had higher symptom severity scores than the no PD group. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The both group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. All findings p = 0.001.ConclusionsDifferences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, symptom severity scores, and screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding differences at initial presentation may urge providers to engage multidisciplinary teams in facilitating patient recovery.

Van der Woude Syndrome: Clinical Presentation in 64 Patients

2007 ◽  
Vol 44 (6) ◽  
pp. 649-652 ◽  
Author(s):  
Jung-Ju Huang ◽  
Jia-Woei Hou ◽  
Ying-Chien Tan ◽  
Kuo-Ting Chen ◽  
Lun-Jou Lo ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Clinical Presentation ◽  
Cleft Lip And Palate ◽  
Positive Family History ◽  
Van Der Woude Syndrome ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Cleft Lip Palate ◽  
Isolated Cleft Palate ◽  
Male To Female

Objective: Van der Woude syndrome, characterized by lip pits and cleft lip/ palate, presents with variable expressions. This retrospective study was designed to obtain a better understanding of its clinical pattern in Taiwanese patients. Materials and Methods: Of 13,147 cleft patients treated at the Chang Gung Craniofacial Center from 1976 to 2004, there were 64 with Van der Woude syndrome. Clinical expressions and family histories were collected and analyzed. Results: The male to female ratio was 1:1. The majority had complete cleft types. Severe cleft was found among the patients, with 52% having bilateral cleft lip and palate, 31% having unilateral cleft lip and palate, and 17% having isolated cleft palate. A positive family history was found in 53.1% of the patients. The size, shape, location, and depth of the pits varied among patients. Conclusion: Clinical presentations did not always parallel those reported in the literatures. These differences warrant further investigation.

A Multidisciplinary Approach to Pediatric Feeding Disorders: Roles of the Speech-Language Pathologist and Behavioral Psychologist

2020 ◽  
Vol 29 (2S) ◽  
pp. 956-966
Author(s):  
Memorie M. Gosa ◽  
Pamela Dodrill ◽  
Maureen A. Lefton-Greif ◽  
Alan Silverman
Keyword(s):  
Psychosocial Development ◽  
Multidisciplinary Team ◽  
Accurate Diagnosis ◽  
Feeding Disorders ◽  
Complex Nature ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Pediatric Feeding Disorders ◽  
Speech Language Pathologist ◽  
Pediatric Feeding

Purpose Pediatric feeding disorders (PFDs) present as a complex clinical challenge because of the heterogeneous underlying etiologies and their impact on health, safety, growth, and psychosocial development. A multidisciplinary team approach is essential for accurate diagnosis and prompt interventions to lessen the burdens associated with PFDs. The role of the speech-language pathologist (SLP) as a member of the multidisciplinary team will be highlighted. Method This clinical focus article reviews the definition of PFDs and pertinent literature on factors that contribute to the development of PFDs, the accurate diagnosis, and current interventions for infants and children. As part of the multidisciplinary team, the SLP has an integral role in determining whether a child cannot or will not eat and working with the team to identify and carryout appropriate interventions. Collaboration between SLPs and psychologists/behavioral specialists in conjunction with the parents/caregivers as part of the multidisciplinary team is essential to the advancement of therapeutic goals. Conclusions Due to their complex nature, the successful management of PFDs is only possible with the care and expertise of a multidisciplinary team, which includes parents/caregivers. SLPs are important members of these multidisciplinary teams and provide valuable input for the accurate identification and effective remediation of PFDs.

scholarly journals Comparison of Endonasal Endoscopic Dacryocystorhinostomy with External Dacryocystorhinostomy

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Muhammad Tariq ◽  
Ahmad Zeeshan Jamil ◽  
Shahid Ali ◽  
Muhammad Khalid ◽  
Ali Akash
Keyword(s):  
Success Rate ◽  
Invasive Approach ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
Minimal Invasive Approach ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Endonasal Dcr ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Purpose:  To compare anatomical and functional success of Endonasal Dacryocystorhinostomy (DCR) with that of External Dacryocystorhinostomy. Study Design:  Quasi-experimental study. Place and Duration of Study:  Department of Ophthalmology and Otolaryngology, District Headquarter Teaching Hospital, Sahiwal, from July 2018 to July 2019. Methods:  Sixty patients with nasolacrimal duct obstruction were selected by convenient sampling technique and were divided into two groups. Group 1 underwent endonasal DCR while group 2 underwent external DCR. Detailed history with regard to symptoms and duration of the obstruction was taken. Detailed ophthalmological and otolaryngological examination was performed. Patients were followed up for three months. Chi-square test was used to compare the success between two groups. Confidence level of 95% was used and p value of less than 0.05 was considered significant. Results:  Male to female ratio was 4:11. The most common presenting symptoms was epiphora that was present in all patients. Regurgitation of lacrimal sac was present in 75%, conjunctivitis was present in 53.33% and dacryocystitis was present in 41.66% patients. Anatomical success rate for endonasal DCR was 25 (83.33%) and for external DCR was 27 (90%). Functional success rate for endonasal DCR was 23 (76.67%) and for external DCR was 22 (73.33%). There was no statistically significant difference in the short term success of surgery between the two groups. Conclusion:  Endonasal DCR offers minimal invasive approach with comparable anatomical and functional results to the external DCR. Key Words:  Conjunctivitis, Dacryocystorhinostomy, Dacryocystitis, Epiphora.

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