scholarly journals IgG Anti-Toxoplasma pada Cairan Otak Pasien Terinfeksi HIV dan AIDS dengan Meningitis

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Yunilda Andriyani ◽  
Agnes Kurniawan ◽  
Ika Puspa Sari ◽  
Retno Wahyuningsih
Keyword(s):  
Clinical Diagnosis ◽  
Predictive Value ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Aids Patients ◽  
Significant Difference ◽  
Life Threatening ◽  
History Of ◽  
Weak Negative Correlation ◽  
End Stage

Toksoplasmosis diperkirakan telah menginfeksi sepertiga populasi dunia dan dapat mengancam jiwa pasien dengan imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii yang sering terjadi pada pasien AIDS, terutama stadium akhir. Untuk menegakkan diagnosis pasti pada pasien AIDS dengan kelainan SSP sangatlah sulit. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respon terhadap terapi yang diberikan. Pemeriksaan kadar IgG dari cairan organ masih jarang dilakukan. Sampel cairan otak diperoleh dari 50 pasien HIV dan AIDS yang dikumpulkan sejak Januari 2013 hingga 2014 di Laboratorium Parasitologi FKUI. Kadar CD4+, gejala klinis, hasil radiologi, diagnosis klinis, riwayat terapi profilaksis ko-trimoksazol, dan analisis cairan otak, diperoleh dari rekam medik.Dari 50 sampel, diperoleh hasil 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, terdapat 5 (20,83%) dengan kadar tinggi, dan 19 (79,17%) dengan kadar IgG rendah. Tidak ada perbedaan bermakna antara kadar IgG antiToxoplasma dengan hasil radiologi, diagnosis klinis, maupun riwayat terapi profilaksis ko-trimoksazol. Diperoleh korelasi negatif antara kadar CD4+ dan IgG anti-Toxoplasma, walaupun kekuatannya sangat lemah. Berdasarkan hasil radiologi, diperoleh sensitivitas 56%, spesifisitas 57%, nilai duga positif 41%, dan nilai duga negatif 71%. Toxoplasmosis is estimated to infect a third of the world's population and can be life-threatening to human immunocompromised system . Toxoplasma Encephalitis (TE) is caused by reactivation of latent T. gondii infection that often occurs in AIDS patients especially those with end-stage . To establish a definite diagnosis in AIDS patients with Central Nervous System (CNS)disorders is very difficult. The diagnosis of TE is only based on the assumptions of clinical symptoms, radiological features, and responses to the therapy given. Examination of IgG levels from organ fluids is still rare. CSF samples were taken from 50 HIV/AIDS patients collected from January 2013 to 2014 at the Parasitology Laboratory at FKUI (Medical Departement of University of Indonesia). CD4 levels, clinical symptoms, radiological results, clinical diagnosis, history of co-trimoxazole prophylaxis, and SCF analysis were obtained from medical records. The results showed that IgG-anti Toxoplasma was positive in 24 patients (48%) and negative in 26 patients (52%). From the positive IgG, there were 5 patients(20.83%) with high IgG levels, and 19 patients(79.17%) with low IgG levels. There was no significant difference between the levels of IgG anti-toxoplasma and the results of radiology, clinical diagnosis, and a history of co-trimoxazole prophylactic therapy. There was a weak negative correlation between CD4 + and IgG anti-Toxoplasma levels, The results of radiology showed values of sensitivity 56%, specificity 57%, positive predictive value 41%, and negative predictive value 71%.

Assessing the Positive Predictive Value of Architectural Distortion Detected with Digital Breast Tomosynthesis in BI-RADS 4 Cases

2020 ◽  
Vol 2 (6) ◽  
pp. 552-560
Author(s):  
Eda Dou ◽  
Martha Ksepka ◽  
Katerina Dodelzon ◽  
Prapti Y Shingala ◽  
Janine T Katzen
Keyword(s):  
Multivariate Analysis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Medical Records ◽  
Digital Breast Tomosynthesis ◽  
Architectural Distortion ◽  
Breast Tomosynthesis ◽  
Institutional Review ◽  
Significant Difference ◽  
History Of

Abstract Objective The purpose of this study was to evaluate the positive predictive value of biopsy (PPV3) of architectural distortion (AD) detected on digital breast tomosynthesis (DBT) in BI-RADS 4 cases, where suspicion for malignancy remains broad. Methods This Institutional Review Board-approved, retrospective study included screening and diagnostic mammograms performed from August 2015 to December 2017 with DBT and digital mammography (DM) revealing suspicious AD with a BI-RADS 4 assessment. Medical records were reviewed for clinical data, imaging, and pathology results. Malignancy rate was assessed by lesion visibility on DM and DBT. Multivariate analysis was performed to assess the odds ratio (OR) of malignancy. Results A total of 63/179 cases were malignant, yielding a PPV3 of 35%. No significant difference in PPV3 was found by race, personal or family history of breast cancer, presence of microcalcifications, or mammogram type. Architectural distortion was more likely to be malignant when an US correlate was present (PPV3 49% vs 19%; P < 0.0001). Multivariate analysis demonstrated a 3-fold increased OR for malignancy with an US correlate present (P = 0.005). Lesion visibility analysis revealed a higher PPV3 for AD visible on DM-DBT compared with DBT alone (44% vs 26%; P = 0.01) and when an US correlate was present (DM-DBT 54% vs 30%, P = 0.02; DBT-only 43% vs 11%, P < 0.001). Conclusions Tomosynthesis-detected BI-RADS 4 AD are malignant in 35% of cases and are more likely to be malignant if an US correlate is present and if visible on both DM and DBT.

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A406-A406
Author(s):  
Juan Ibarra Rovira ◽  
Raghunandan Vikram ◽  
Selvi Thirumurthi ◽  
Bulent Yilmaz ◽  
Heather Lin ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Ct Scans ◽  
Wall Thickening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

scholarly journals Unusual dyspnea in a hemodialysis patient: A case report

10.3823/2607 ◽  
2019 ◽  
Vol 12 ◽  
Author(s):  
Ching-Hsiang Wang ◽  
Jenq-Shyong Chan ◽  
Chung-Chi Yang ◽  
Po-Jen Hsiao
Keyword(s):  
Hemodialysis Patient ◽  
Pleural Cavity ◽  
Middle Age ◽  
Clinical Symptoms ◽  
Rapid Development ◽  
Previous History ◽  
Final Diagnosis ◽  
Spontaneous Hemothorax ◽  
Life Threatening ◽  
History Of

The typical clinical symptoms of hemothorax include a rapid development of chest pain or dyspnea, which may be life-threatening without immediate management. As we know, spontaneous hemothorax, a collection of blood within the pleural cavity without previous history of trauma or other cause, which usually onsets suddenly. The early and accurate diagnosis of spontaneous hemothorax is imperative in clinical practice. We reported a middle-age male undergoing regular hemodialysis was referred to our emergency department due to unknown cause of dyspnea and acute respiratory failure. Chest radiography revealed bilateral patchy infiltration of lung. Pleural tap analysis showed exudative pleural effusion with numerous red blood cells. Video-assisted thoracic surgery (VATS) were performed and confirmed the final diagnosis of spontaneous hemothorax. He was then successfully treated with the surgery of VATS combined chest tube thoracostomy.

Laryngeal cancer in acquired immunodeficiency syndrome

2009 ◽  
Vol 20 (8) ◽  
pp. 582-584 ◽  
Author(s):  
S Shushan ◽  
U Cinamon ◽  
D Levy ◽  
M Sokolov ◽  
Y Roth
Keyword(s):  
Combined Therapy ◽  
Head And Neck Carcinoma ◽  
Curative Treatment ◽  
Aids Patients ◽  
Alcohol Abusers ◽  
Neck Carcinoma ◽  
Life Threatening ◽  
History Of ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

With improved survival, more AIDS patients, especially heavy smokers and alcohol abusers, may be confronted with laryngeal squamous cell carcinoma. Since curative treatment may require aggressive combined therapy, these patients, often suffering from immunosupression and poor general condition, present unique therapeutic challenges. The objective of the study was to describe treatment dilemmas. This case report presents a detailed description of an AIDS patient with carcinoma of the larynx. A patient with T3N0M0 laryngeal carcinoma and AIDS underwent tracheotomy and biopsy, followed by severe neck and pulmonary infection. After convalescence, radiotherapy was administered, with no evidence of a disease during a 3.5-year follow-up. During his remaining life, the patient developed severe psychoaffective disorder, his immune state deteriorated until he demised from sepsis. In conclusion, patients with HIV infection, especially having a history of tobacco or alcohol abuse, should be carefully examined for head and neck carcinoma that is likely to be more aggressive. Following surgery, AIDS patients may have worse wound healing and a greater tendency to contract infections. Radiotherapy and especially chemotherapy may cause life-threatening complications. Although early detection may increase survival, curative treatment should involve many disciplines and extra caution.

scholarly journals Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections

2019 ◽  
Vol 24 (17) ◽  
Author(s):  
Nicklas Sundell ◽  
Leif Dotevall ◽  
Martina Sansone ◽  
Maria Andersson ◽  
Magnus Lindh ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Previous History ◽  
Contact Tracing ◽  
Measles Outbreak ◽  
History Of ◽  
Measles Vaccination

In an outbreak of measles in Gothenburg, Sweden, breakthrough infections (i.e. infections in individuals with a history of vaccination) were common. The objective of this study was to compare measles RNA levels between naïve (i.e. primary) and breakthrough infections. We also propose a fast provisional classification of breakthrough infections. Medical records were reviewed and real-time PCR-positive samples genotyped. Cases were classified as naïve, breakthrough or vaccine infections. We compared clinical symptoms and measles RNA cycle threshold (Ct) values between breakthrough and naïve infections. Sixteen of 28 confirmed cases of measles in this outbreak were breakthrough infections. A fast provisional classification, based on previous history of measles vaccination and detectable levels of measles IgG in acute serum, correctly identified 14 of the 16 breakthrough infections, confirmed by IgG avidity testing. Measles viral load was significantly lower in nasopharyngeal samples from individuals with breakthrough compared with naïve infections (median Ct-values: 32 and 19, respectively, p < 0.0001). No onward transmission from breakthrough infections was identified. Our results indicate that a high risk of onward transmission is limited to naïve infections. We propose a fast provisional classification of breakthrough measles that can guide contact tracing in outbreak settings.

scholarly journals Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Tolia ◽  
M Khan ◽  
S Khan ◽  
D Alexander ◽  
M Soltys ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Ischemic Cardiomyopathy ◽  
Circulatory Support ◽  
Complication Rates ◽  
Number Of Patients ◽  
Significant Difference ◽  
History Of ◽  
End Stage Heart Failure ◽  
End Stage

Abstract Background Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy. Methods We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p&lt;0.05 was considered statistically significant. Results Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value &lt;0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p&lt;0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table). Conclusion Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Impact of IL28B genetic variant's and viral genotype on treatment outcome of hepatitis C infected patients

2018 ◽  
Vol 12 (09) ◽  
pp. 762-770
Author(s):  
Mosin S Khan ◽  
Abid Shoukat ◽  
Syed Mudassar ◽  
Zaffar Kawoosa ◽  
Altaf H Shah ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hepatitis C ◽  
Virological Response ◽  
Rapid Virological Response ◽  
Viral Genotype ◽  
Genotype 1 ◽  
Genotype 3 ◽  
Significant Difference ◽  
History Of ◽  
End Stage

Introduction: Viral genotype and variation in host genes involved in the immune response may predict the treatment response in patients infected with HCV. The present study was designed to determine the distribution pattern of HCV and host genotypes in Chronic Hepatitis C (CHC) patients and their association with virological response and other risk factors. Methodology: Two hundred and fifty (n = 250) HCV positive patients were included in the study. HCV and Interleukin 28B (IL28B) genotyping was carried out by PCR-RFLP. Results: Viral genotype 3 was the predominant genotype seen in 187 (74.8%) patients. Wild genotype predominated in rs12979860, rs12980275 and rs8099917 SNP of IL28B gene. A significant difference was found in end stage virological response (EVR) between HCV genotype 1 infected patients with wild and variant genotype for rs12980275 and rs8099917 SNPs respectively (P < 0.05). On multivariate analysis all the SNPs were found to be associated with each other (P < 0.05) with rs12980275 SNP associated with history of Jaundice (P < 0.05). Viral genotype 3 was significantly associated with age (< 50 years) and rapid virological response (RVR) while as viral genotype 1 was significantly associated with history of surgery on multivariate analysis (P < 0.05). Conclusions: The viral genotype and IL28B polymorphisms are important factors to personalize antiviral therapy of patients with CHC.

Vascular calcifications and calciphylaxis in a patient on concurrent haemodialysis and Coumadin therapy

2021 ◽  
Vol 14 (3) ◽  
pp. e240310
Author(s):  
Jack Schnur ◽  
Hadeer Sinawe ◽  
Athina Lidia Yoham ◽  
Damian Casadesus
Keyword(s):  
Pulmonary Oedema ◽  
Wound Care ◽  
Sodium Thiosulfate ◽  
High Morbidity ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Haemodialysis Treatment

Calciphylaxis is a rare life-threatening condition, with calcification of small and medium-sized vessels leading to skin necrosis. It has a high morbidity and mortality, and most of the patients die from wound superinfection and sepsis. A 48-year-old man with a history of end-stage renal disease on haemodialysis and Coumadin therapy for venous thromboembolism presented with pulmonary oedema after missing two haemodialysis treatment. At examination, he had bilateral lower extremity dark brown, possibly necrotic, painful ulcers. He was diagnosed with calciphylaxis and treated with sevelamer hydrochloride, low calcium dialysate and sodium thiosulfate with haemodialysis. He received daily wound care with topical collagenase. After daily wound care treatment for 4 months, the patient’s ulcers completely healed. The patient had been followed for 8 months, which included 29 additional readmissions, 3 admissions related to bacteraemia and 26 admissions with the diagnosis of pulmonary oedema and hyperkalaemia requiring haemodialysis.

A computerized algorithm to capture patient’s past preeclampsia and eclampsia history from prenatal clinical notes

2018 ◽  
Vol 25 (4) ◽  
pp. 1299-1313 ◽  
Author(s):  
Fagen Xie ◽  
Theresa Im ◽  
Darios Getahun
Keyword(s):  
Electronic Medical Records ◽  
Predictive Value ◽  
Medical Records ◽  
Past History ◽  
Rule Based ◽  
High Performing ◽  
Clinical Notes ◽  
Sentence Level ◽  
Risk Patients ◽  
History Of

Prenatal clinical notes in electronic medical records contain a wealth of information on pregnancy complications and outcomes. Extracting this critical information provides a unique opportunity for risk assessment to identify at-risk patients who may benefit from early monitoring and intervention. We developed and validated a rule-based computerized algorithm called PregHisEx to characterize past obstetrical history (preeclampsia/eclampsia) by mining prenatal clinical notes for women delivered in 2012 within a large healthcare maintenance organization. The algorithm successfully identified cases with past history of preeclampsia/eclampsia: 2984 definite and 479 probable cases at sentence level; 2419 definite and 348 probable cases at note level; and 762 definite and 82 probable cases at pregnancy episode level. Validation conducted on a random sample of 200 notes using PregHisEx yielded 88.0 percent sensitivity, 98.9 percent specificity, 91.7 percent positive predictive value, 98.3 percent negative predictive value, and F-score of 0.90. The high-performing PregHisEx can be applied for other prenatal conditions.

Clinicopathological features and comorbidities of cats with mild, moderate or severe hyperthyroidism: a radioiodine referral population

2018 ◽  
Vol 20 (12) ◽  
pp. 1130-1137 ◽  
Author(s):  
Natalie Watson ◽  
Jane K Murray ◽  
Sonja Fonfara ◽  
Angie Hibbert
Keyword(s):  
Medical Records ◽  
Serum Biochemistry ◽  
Clinicopathological Features ◽  
Dietary Management ◽  
Incidental Diagnosis ◽  
Curative Therapy ◽  
Cardiac Abnormalities ◽  
Significant Difference ◽  
Total Thyroxine ◽  
History Of

Objectives This study sought to explore the clinicopathological features and comorbidities of cats with mild, moderate and severe hyperthyroidism in a radioiodine referral population. Methods Medical records were reviewed, along with results of serum biochemistry, urinalysis, systolic blood pressure and diagnostic imaging performed at the time of radioiodine referral. Cats were grouped by total thyroxine (TT4) levels as mildly (TT4 60.1–124.9 nmol/l), moderately (TT4 125–250 nmol/l) or severely (TT4 >250 nmol/l) hyperthyroid at the time of diagnosis and referral. Results Thirty percent (42/140) of the cats were <10 years old at diagnosis. In 24.3% (34/140), hyperthyroidism was diagnosed incidentally. The time between diagnosis and referral for radioiodine was significantly longer in cats with severe hyperthyroidism at the time of referral ( P = 0.004). An increase in severity group between the time of diagnosis and referral occurred in 38.6% (54/140) of cats. At referral, 54.3% (25/46) of cats with mild, 66.7% (42/63) with moderate and 80.6% (25/31) with severe hyperthyroidism were unstable despite ongoing medical or dietary management. The prevalence of cardiac abnormalities was significantly increased in cats with severe hyperthyroidism ( P = 0.014) compared with those with mild or moderate hyperthyroidism. There was no significant difference in the likelihood of renal disease ( P = 0.708) or hypertension ( P = 0.328) between the groups. Conclusions and relevance Incidental diagnosis of hyperthyroidism occurs commonly, potentially owing to increased disease screening. Cats with severe hyperthyroidism at referral were more likely to be chronically hyperthyroid with a history of poor stabilisation. This subset of patients was significantly more likely to have cardiac abnormalities. Thyrotoxic cardiomyopathy may ultimately affect patient suitability for curative treatments (radioiodine or thyroidectomy) owing to higher anaesthetic risks and potential for decompensation into congestive heart failure with the stress of travel and hospitalisation. Curative therapy should be considered before the development of severe hyperthyroidism.

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