scholarly journals Cutaneous Amyloidosis: A Pilot Study at a Teaching Hospital in New Delhi

2017 ◽  
Vol 19 (1) ◽  
pp. 35-39
Author(s):  
Zeeba S Jairajpuri ◽  
Safia Rana ◽  
Shaan Khetrapal ◽  
Pooja Arora ◽  
Sujata Jetley
Keyword(s):  
Pilot Study ◽  
Congo Red ◽  
Polarized Light ◽  
New Delhi ◽  
Histologic Diagnosis ◽  
Systemic Involvement ◽  
Extracellular Compartment ◽  
Macular Amyloidosis ◽  
Skin Biopsies ◽  
One Year

Background: Amyloidosis is characterized by the deposition of polymeric fibrillar proteins in the extracellular compartment in tissues and organs ultimately leading to damage with functional compromise. Cutaneous amyloidosis is clinically classified into more common macular, papular, and the rarer nodular form. The present study was undertaken with the aim to histopathologically analyze and characterize clinically diagnosed amyloid cases.Methods:The present study was a retrospective analysis of skin biopsies conducted over a one year period. Data on the age and presenting clinical features were retrieved from the accompanying laboratory request forms or patients records wherever available. All skin biopsies with a histologic diagnosis of amyloid were retrieved and reviewed, the pattern of amyloid deposition identified and classified. Special stains including Congo Red stain was done in all the cases.Results: Histopathological confirmation of cutaneous amyloidosis was seen in nine out of fourteen cases and was confirmed by positive Congo-red stain under polarized light. Out of this seven were females and two were males. Majority of the lesions were of macular type. In all the nine cases, family history was negative and no evidence of systemic involvement was noted, either clinically or based upon the lab investigations.Conclusions: In this pilot study of 9 cases, histologically diagnosed as cutaneous amyloidosis we noted a female preponderance in young and middle-aged persons. Macular amyloidosis was the most common form and the most common site of involvement, the upper extremity and the inter-scapular/back region.J MEDICINE Jan 2018; 19 (1) : 35-39

scholarly journals A clinicopathological study of primary localised cutaneous amyloidosis

2017 ◽  
Vol 3 (4) ◽  
pp. 470 ◽  
Author(s):  
Vinitha V. Panicker ◽  
Soumya Jagadeesan ◽  
Gopikrishnan Anjaneyan ◽  
Lekshmi S. ◽  
Malini Eapen ◽  
...  
Keyword(s):  
Congo Red ◽  
Amyloid Fibrils ◽  
Immunofluorescence Microscopy ◽  
Cultural Practices ◽  
Diagnostic Yield ◽  
Polarized Light ◽  
Published Data ◽  
Polarized Microscopy ◽  
Congo Red Staining ◽  
Macular Amyloidosis

<p class="abstract"><strong>Background:</strong> Amyloidosis is defined as extracellular deposits of heterogenic, misfolded proteins, amyloid fibrils, in various tissues. The term primary cutaneous amyloidosis (PLCA) usually includes macular amyloidosis (MA), lichen amyloidosis (LA) and nodular amyloidosis. Primary cutaneous amyloidosis is very common in Kerala probably due to socio-cultural practices. There has been no published data on PLCA from Kerala thus we undertook this study. The objectives of the study were to correlate clinical features of primary localized cutaneous amyloidosis with histopathologic findings; to evaluate the sensitivity of Congo red staining with polarized light in histopathologically proven primary localized cutaneous amyloidosis)</p><p class="abstract"><strong>Methods:</strong> We undertook an observational analysis for a period of 2 years from May 2012 to April 2014 in the Department of Dermatology, Amrita Institute, Cochin. All cases clinically diagnosed as cutaneous amylodosis were included in the study. After informed consent, skin biopsy was taken. The histopathologic sections were stained with Congo red and seen under polarized microscopy for apple green birefrengance.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 70 patients were included in the study. Of the 70 cases, there were 20 males and 50 females. The most common clinical type was lichen amylodosis observed in 32 patients followed by macular amylodosis (28) and biphasic amyloidosis (10) cases. Histopathological compatibility was seen in 71% of MA and 89% cases of LA. Congored positivity was seen in 53.8%. Congored stain under immunofluorescence microscopy was done for 30 patients which gave a positivity of 85% which indicates that it is more sensitive that polarizing microscopy.</p><p><strong>Conclusions:</strong> Our study showed that the most common type is lichen amylodosis. Histopathology and congo red staining with polarized light is a valuable aid in diagnosis. Congo red stain under immunofluorescence microscopy has greater sensitivity and improves the diagnostic yield. </p>

scholarly journals Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Amudha Palanisamy ◽  
Paul Persad ◽  
Patrick P. Koty ◽  
Laurie L. Douglas ◽  
Robert J. Stratta ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Hematologic Malignancy ◽  
Deceased Donor ◽  
Myeloid Sarcoma ◽  
Kidney Transplant Recipients ◽  
Systemic Involvement ◽  
Transplant Patients ◽  
Single Donor ◽  
Allograft Nephrectomy ◽  
One Year

We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescencein situhybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.

scholarly journals A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study (Preprint)

2019 ◽  
Author(s):  
Linn Nathalie Støme ◽  
Tron Moger ◽  
Kristian Kidholm ◽  
Kari J Kværner
Keyword(s):  
Pilot Study ◽  
Home Care ◽  
Rate Ratio ◽  
Care Service ◽  
Behavioral Data ◽  
Home Care Service ◽  
Early Assessment ◽  
Web Based ◽  
Digital Platform ◽  
One Year

BACKGROUND Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; <italic>P</italic>=.10), unnecessary trips (rate ratio=1.37; <italic>P</italic>=.26), and phone calls (rate ratio=1.24; <italic>P</italic>=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

scholarly journals A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study

10.2196/14780 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e14780
Author(s):  
Linn Nathalie Støme ◽  
Tron Moger ◽  
Kristian Kidholm ◽  
Kari J Kværner
Keyword(s):  
Pilot Study ◽  
Home Care ◽  
Rate Ratio ◽  
Care Service ◽  
Behavioral Data ◽  
Home Care Service ◽  
Early Assessment ◽  
Web Based ◽  
Digital Platform ◽  
One Year

Background Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. Objective This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. Methods Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. Results Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. Conclusions Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

scholarly journals Intra-operative uterine scar condition and fetomaternal outcome in patients of previous lower segment caesarean section (LSCS) with scar tenderness

2017 ◽  
Vol 5 (11) ◽  
pp. 4911
Author(s):  
Nidhi Gupta ◽  
Renuka Sinha
Keyword(s):  
Signs And Symptoms ◽  
Caesarian Section ◽  
New Delhi ◽  
Lower Segment ◽  
Average Hospital ◽  
Lower Segment Caesarean Section ◽  
Uterine Scar ◽  
Nicu Admission ◽  
One Year ◽  
A Prospective Study

Background: During past few years, there is increasing trend in trial of labor in cases of previous lower segment caesarian section (LSCS). It needs vigilant approach in identifying signs and symptoms of giving way of previous scar. This study is to see the intra-operative uterine scar condition and feto-maternal outcome in patients of previous LSCS with scar tenderness.Methods: This is a prospective study done in Safdarjung hospital, New Delhi. It includes 120 patients of previous lower segment caesarian section with scar tenderness operated as emergency cases over a period of one year. It excludes elective repeat LSCS.Results: During this period repeat emergency LSCS was done in 862 cases and scar tenderness was seen in 120 cases (13.92 %). Out of 120 cases enrolled for the study intra-operative scar was intact in 69 cases (57.5%). Scar was thinned out in 27 cases (22.5%). Scar dehiscence was found in 21 cases (17.5%). Rupture occurred in 3 cases (2.5%) out of which 2 were Fresh still births. NICU admission was done in 11 cases (9.17%). 1 neonatal death occurred. No maternal death was recorded. Average hospital stay was 6 days. Blood transfusion was needed in 23 cases (19.2%).Conclusions: Scar tenderness is a very important tool for predicting scar integrity. All cases of previous LSCS should have institutional delivery.

scholarly journals Ekspressiv skriving som egenterapeutisk verktøy ett år etter brystkreftdiagnosen - resultater fra en norsk pilotstudie

2015 ◽  
Vol 10 (2) ◽  
pp. 45
Author(s):  
Birgitta Haga Gripsrud ◽  
Håvard Søiland ◽  
Kirsten Lode
Keyword(s):  
Breast Cancer ◽  
Pilot Study ◽  
Expressive Writing ◽  
Breast Cancer Diagnosis ◽  
Design Data ◽  
Illness Experiences ◽  
Electronic Writing ◽  
Scientific Context ◽  
One Year ◽  
The Mind

<p>Expressive writing as a self-help tool one year after the breast cancer diagnosis – results from a Norwegian pilot study</p><p>The article presents findings from a pilot study on expressive writing, a therapeutic method undescribed in a Norwegian scientific context. Objective: 1. Gain qualitative data on breast cancer women’s experiences with expressive writing. 2. Evaluate the intervention’s feasibility, based on participants’ experiences of the instruction, procedure, and circumstances for writing. Method &amp; design: The study has an exploratory descriptive design. Data collection was achieved through in-depth interviews, followed by experiential thematic analysis of transcripts. Results: Two women enrolled, participating in writing/interviews. Analysis revealed three themes: "The experience of the writing process", "Writing as working through and work to clear the mind", "Strength and vulnerability in relation to others". Conclusion: Findings reveal that expressive writing was experienced as achievable for two breast cancer women, one year after diagnosis. Writing provided an opportunity to work through, and sort out, feelings and thoughts connected to participants’ lives and illness experiences. The instruction was evaluated as easy to understand and inspiring. The women became absorbed in electronic writing in their own homes. They both recommended expressive writing for other women with breast cancer, especially in the period after initial diagnosis.</p>

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