Optic Nerve Drusen Is Highly Prevalent Among Children With Pseudotumor Cerebri Syndrome

Introduction: The clinical presentation of pseudotumor cerebri syndrome (PTCS) usually includes headache, nausea, and vomiting with normal physical examination apart from papilledema and diplopia. However, pseudopapilledema, which can be caused by optic nerve drusen, may lead to misdiagnosis. The prevalence of optic nerve drusen in the general population is 0.5–2%. The purpose of our study was to evaluate the prevalence and risk factors of optic nerve drusen among patients with PTCS.Materials and Methods: Medical records of children evaluated in the pediatric department at Bnai Zion Medical Center due to PTCS between 2008 and 2020 were assessed. Inclusion criteria were children age under 18 years with a PTCS diagnosis and ophthalmic B-mode ultrasonography (US). Exclusion criteria were secondary intracranial hypertension.Results: Thirty-four children were included with a mean age 10.1 years which included 50% boys. A majority of the patients, 24 (72.4%), complained of headaches, while 15 (45.5%) complained of transient visual obscuration, and 9 (26.5%) of vomiting. Visual acuity on presentation was normal (20/20–20/30) in 23 of the children (67%), moderately diminished (20/40–20/80) in 9 (26%), and showing profound loss (20/200) in 2 (7%). Five patients (14.7%) were diagnosed with optic nerve drusen via B-mode ophthalmic ultrasonography (US). However, they still fulfilled the diagnostic criteria for PTCS, and disc swelling improved after treatment. There were no statistically significant differences between the group with optic nerve drusen and the rest of the patients.Conclusions: Optic nerve drusen are common among pediatric patients with PTCS. Diagnosis of optic nerve drusen should not rule out the presence of increased intracranial pressure.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

Diseases of the Esophagus ◽

10.1093/dote/doz047.42 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

I P Aanen ◽

B Pullens ◽

J van Rosmalen ◽

R M H Wijnen

Keyword(s):

Sensitivity And Specificity ◽

Esophageal Atresia ◽

Surgical Intervention ◽

Medical Center ◽

Primary Repair ◽

Demographic Data ◽

P Value ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

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Prevalence of orofacial trauma in soccer players of a Brazilian club

Journal of Health Sciences ◽

10.17532/jhsci.2019.795 ◽

2019 ◽

Author(s):

Barbara Capitanio de Souza ◽

Larissa Leci Fernandes ◽

Debora Magalhaes Barreto ◽

Cornelis Robert Springer

Keyword(s):

Soft Tissue ◽

Medical Records ◽

Soccer Player ◽

Soccer Players ◽

Inclusion Criteria ◽

Anatomic Site ◽

Exclusion Criteria ◽

Male And Female ◽

The Face ◽

Record Type

Introduction: The objectives of the study were to evaluate the prevalence of orofacial injuries in soccer players of a Brazilian club, considering the category, the position in the field, and the most affected anatomic site, through medical records. Methods: A total of 126 charts of players from the base categories (sub-15, sub-17, and sub-20) and male and female professional categories from 2016 to 2018 were evaluated. It was considered inclusion criteria to be a soccer player hired by a club in the indicated period. The exclusion criteria of the study correspond to the medical records registered after the chronological date stipulated or that did not have the correct registry of the occurred trauma. Results: The data analyzed presented a moderate value in relation to the orofacial traumas prevalence, and 64.3% of the athletes of the club have some record type of trauma in the face. We observed that soft-tissue lacerations of the lips and dental fractures present the highest frequencies (73% and 27%, respectively). The positions of defender, striker, and midfield are the most susceptible to injuries (31%, 24%, and 23%, respectively). Conclusion: Dental and orofacial trauma are a problem commonly encountered in sports, being present also in collective sports, such as football. It was observed a moderate prevalence of injuries on the face, especially among the athletes who are ahead of the attack line, with lip lacerations and dental fractures being the most common events.

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The Rationality of Using Diclofenac in Outpatient Cases of Osteoarthritis of RSUP MH Palembang Period January-March 2018

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i1.12 ◽

2021 ◽

Vol 2 (1) ◽

pp. 67-74

Author(s):

Dara Prameswari ◽

M. Totong Kamaluddin ◽

Nita Parisa

Keyword(s):

Medical Records ◽

Sampling Technique ◽

Outpatient Setting ◽

Common Disease ◽

Low Back ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Cross Sectional ◽

Drug Of Choice ◽

History Of

Rationality of Diclofenac Use in Osteoarthritis Outpatient Case at RSUP MH Palembang in January-March 2018. Osteoarthritis (OA) is the most common disease in joints that affects people in their middle until late years. In Indonesia the prevalence of OA is relatively high and disturbs their daily activity. Diclofenac is one of the drug of choice in treating OA. To avoid multiple side effects from Diclofenac use, the usage must be in accordance to rationality indicators which are correct dose, correct frequency, and correct length of use. This study is aimed to know the rationality of Diclofenac use in Osteoarthritis outpatient cases at RSUP Mohammad Hoesin Palembang. This study is a descriptive observational with a cross-sectional approach to know the rationality of Diclofenac use in outpatient cases of osteoarthritis at RSUP Mohammad Hoesin Palembang. Samples were medical records of OA patients in outpatient setting from January to March 2018 which fulfilled the inclusion and exclusion criteria. Sampling technique used was total sampling. The amount of samples fulfilling the inclusion criteria were 201 patients, with the most were aged 46-65 years (60.2%), female (55.7%), and has a history of comorbidity which includes low back pain (22.8%). The result of this study shows pattern of Diclofenac use with dosage of 2 x 25mg (73.6%), length of use about <7 days (57.2%). In combination with other drugs there were no interaction to be found (84.4%), or synergistic interaction (8.5%) and antagonistic interaction (7.1%). The use of diclofenac in osteoarthritis cases at outpatient setting in RSUP Dr Mohammad Hoesin Palembang is rational and needs to be maintained.

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Association between Fever during Admission and Outcome of Treatment in Tuberculous Meningitis Patients in Hasan Sadikin General Hospital Bandung

Journal Of Medicine & Health ◽

10.28932/jmh.v2i3.1233 ◽

2019 ◽

Vol 2 (3) ◽

Author(s):

Regita A Kuswanto ◽

Ahmad Rizal ◽

R Raspati C Koesoemadinata

Keyword(s):

Tuberculous Meningitis ◽

Medical Records ◽

Retrospective Cohort ◽

Inflammatory Process ◽

Common Type ◽

Limited Data ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Factors Associated

Tuberculous meningitis (TBM) is the most common type of meningitis with a highmortality rate (20-41%). There are limited data on factors associated with outcome oftreatment, especially in Indonesia. Fever is a common inflammatory process in meningitispatients. This study aims to investigate the association between fever during admission andoutcome of treatment in TBM patients treated in the In-patient Neurology Department at HasanSadikin Hospital Bandung. This is an observational retrospective cohort study conducted byusing medical records from 2017. The inclusion criteria of this study were all medical recordsof inpatients who were diagnosed as TBM and ?18 years old, while the exclusion criteria wereincomplete medical records. The variables in this study were age, gender, body temperature,classification of TBM, and Glasglow Outcome Scale (GOS). There were 125 medical recordswhich fulfilled the inclusion criteria. Kruskal- Wallis test showed that fever was notsignificantly associated with GOS (p=0.193). In conclusion, fever during admission was notassociated with GOS in TBM patients.Keywords: tuberculous meningitis, fever, Glasglow Outcome Scale, outcome

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Perbandingan Nilai Risk Malignancy Index Kanker Ovarium Tipe Serosum dan Musinosum RSUP Dr. M. Djamil Padang pada Tahun 2017

JOURNAL OBGIN EMAS ◽

10.25077/aoj.4.1.87-94.2020 ◽

2020 ◽

Vol 4 (1) ◽

pp. 87-94

Author(s):

Frita Dwi Luhuria ◽

Defrin Defrin ◽

Andi Friadi

Keyword(s):

Ovarian Cancer ◽

Medical Records ◽

Age Distribution ◽

Mean Value ◽

Common Type ◽

Ca 125 ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Serous Ovarian Carcinoma ◽

The Mean

The Risk Malignancy Index (RMI) is one of the simplest assessments that can assist in diagnosing and determining the prognosis of benign and malignant adnexa masses. Epithelial carcinoma is the most common type of about 90% of ovarian cancers. As many as 35-40% of the epithelial type are serous and 6-10% are musinosum.This study aims to compare the picture of RMI value on the incidence of ovarian cancer serosum and musinosum type. This study was cross sectinal comparative study from medical records of ovarian cancer patients at obstetrics and gynecology section in DR M Djamil Hospital Padang from January 1st, 2017 until December 31st, 2017. The population was found one hundred and forty of patients with ovarian cancer and only one hundred and twenty nine of patients met the inclusion criteria and there were no exclusion criteria. Next RMI value is calculated based on RMI 1 formula, result is described in tabular form and data processing with SPSS program. Conclucion of this study is there were no differences in age distribution, ascites occurrence and age of menopause in serous and musinosum ovarian cancer. There is a difference in Ca, 125 levels in serous with musinosum ovarian cancer which also contribute to the high value of RMI. The mean value of patients‘s RMI in serous type ovarian cancer is higher than the mean value of RMI in patients with type Musinosum ovarian cancer. Keywords: index of risk malignancy, menopause, ultrasonography, anatomic pathology, serous ovarian carcinoma

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Hipertensi pada Pasien Kanker Kolorektal Metastatik dengan Terapi Bevacizumab di RSUP Dr. Kariadi

Medica Hospitalia : Journal of Clinical Medicine ◽

10.36408/mhjcm.v7i2.502 ◽

2020 ◽

Vol 7 (2) ◽

pp. 388-392

Author(s):

Bayu Prio Septiantoro ◽

Dyah Aryani Perwitasari ◽

Imaniar Noor Faridah ◽

Indra Pradipta

Keyword(s):

Colorectal Cancer ◽

Medical Records ◽

Chemotherapy Regimen ◽

Combination Regimen ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Keywords Colorectal Cancer ◽

Colorectal Cancer Patients ◽

Level 2 ◽

Initial Cycle

Latar belakang: Kanker kolorektal saat ini sudah menjadi penyebab utama ketiga kematian akibat kanker di dunia, penyakit ini membutuhkan terapi yang progresif dimana salah satu terapinya adalah bevacizumab. Namun diketahui bevacizumab dapat menimbulkan hipertensi pada sebagian pasien. Penelitian ini bertujuan untuk untuk mengetahui onset terjadinya hipertensi akibat bevacizumab dengan rejimen kemoterapi apa yang digunakan. Metode: Penelitian ini merupakan sebuah tinjauan deskriptif restrospektif yang dilakukan di RSUP Dr. Kariadi, Semarang. Kriteria inklusi terdiri dari pasien kanker kolorektal metastatik yang berusia ? 18 tahun dengan hipertensi tingkat ?2 berdasarkan NCI CTCAE version 5.0 setelah diberikan terapi bevacizumab 5 mg/kg berat badan di RSUP Dr. Kariadi. Pengambilan data dalam 1 tahun (bulan April 2018 hingga April 2019) melalui peninjauan dari rekam medis, laporan penggunaan obat bevacizumab dan laporan penggunaan obat kardiovaskuler instalasi farmasi. Kriteria ekslusi dalam penelitian ini yaitu hipertensi tingkat ?2 berdasarkan NCI CTCAE version 5.0 yang muncul setelah ?4 kali waktu paruh bevacizumab (t 1/2 = 20 hari) dari kemoterapi yang terakhir. Hasil: Total 95 pasien sesuai kriteria, sebanyak 24 pasien (25,26%) teridentifikasi mengalami hipertensi tingkat ? 2 berdasarkan NCI CTCAE version 5.0. Dengan 20 pasien (83,33%) pasien mendapatkan kemoterapi rejimen FOLFOX4, sedangkan sisanya (16,66%) dengan rejimen de Gramont. Hipertensi ini muncul sebagian besar pada siklus III, diikuti siklus ke II, ke I dan ke VI. Tidak satupun pasien dengan kombinasi FOLFIRI yang terdeteksi mengalami hipertensi ini. Kesimpulan: Penelitian ini menunjukkan onset munculnya hipertensi tingkat ?2 NCI CTCAE version 5.0 paling banyak adalah pada siklus awal terapi yaitu I-III dan dengan rejimen kombinasi FOLFOX4 + bevacizumab. Kata Kunci: Kanker kolorektal, bevacizumab, hipertensi Background: Colorectal cancer nowadays is the third leading cause of cancer deaths in the world, this disease requires progressive therapy where one of the treatments is bevacizumab. But it is known that bevacizumab can cause hypertension in some patients. This study aims to determine the onset of the hypertension with chemotherapy regimen used. Method: This research is a retrospective descriptive review conducted at Dr. Kariadi General Hospital, Semarang. Inclusion criteria consisted of metastatic colorectal cancer patients aged ?18 years old with hypertension level ?2 based on NCI CTCAE version 5.0 after being given bevacizumab therapy dose 5 mg/kg body weight. Retrieval of data in 1 year (April 2018 to April 2019) through a review of medical records, reports on the use of bevacizumab drugs and reports on the use of cardiovascular drugs in Department of Pharmacy. The exclusion criteria in this study were hypertension level on NCI CTCAE version 5.0 which appeared after 4 times the half-life of bevacizumab (t 1/2 = 20 days) from the last chemotherapy. Result: Total 95 patients according to the criteria, 24 patients (25.26%) were identified as having hypertension level ? 2 based on NCI CTCAE version 5.0. With 20 patients (83.33%) patients received FOLFOX4 regimen, while the rest (16.66%) with de Gramont regimen. This hypertension occurs mostly in cycle III, followed by cycle II, to I and to VI. None of the patients with a combination of FOLFIRI. Conclusion: This research shows that the onset of hypertension level ?2 NCI CTCAE version 5.0 mostly in the initial cycle of therapy (I-III) with the FOLFOX4 + bevacizumab combination regimen. Keywords: Colorectal cancer, bevacizumab, hypertension

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Abnormal Optic Nerves Signals in Orbital MRI: a Rare Sign in Idiopathic Intracranial Hypertension

10.21203/rs.2.11621/v1 ◽

2019 ◽

Author(s):

Zhonghua Ma ◽

Hanqiu Jiang ◽

Jiawei Wang

Keyword(s):

Optic Nerve ◽

Intracranial Hypertension ◽

Diagnostic Criteria ◽

Medical Records ◽

Idiopathic Intracranial Hypertension ◽

Radiological Examination ◽

Inclusion Criteria ◽

Optic Nerves ◽

Nerve Signal ◽

Optic Nerve Involvement

Abstract Background It is recognized that radiological examination is essential for the diagnosis of Idiopathic intracranial hypertension (IIH). The present study demonstrated a rare sign of IIH in optic nerves on MRI images. Methods Review the medical records and MRI images of 82 the patients with IIH referred to our neurology department from January 2017 to December 2018. Inclusion criteria were: 1) accorded with the IIH diagnostic criteria adapted from Friedman et al. [1], 2) abnormal optic nerve signal with enhancement on orbital MRI, 3) no better explanation for the optic nerve involvement. Results 12 patients are enrolled. The age of patients ranged from 16 to 55 years, median age 32.91±14.36 years, two patients were male and ten were female. The CSF opening pressures (OP) of all patients were all above 30 cmH2O. Enhancement of optic nerves sheaths (ONS) in retrobulbar segments were observed in all affected eyes showed on coronal orbital MRI gadolinium (Gd)-enhanced T1WI sequence. Conclusions Enhancement of ONS on MRI is a rare sign of IIH that clinicians should recognize in order to avoid misdiagnosis and mistreatment. Keywords: Idiopathic intracranial hypertension, Optic nerves sheaths, Orbital MRI

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Update in Pediatric Pseudotumor Cerebri Syndrome

Seminars in Neurology ◽

10.1055/s-0040-1708847 ◽

2020 ◽

Vol 40 (03) ◽

pp. 286-293

Author(s):

Shannon J. Beres

Keyword(s):

Surgical Treatment ◽

Intracranial Hypertension ◽

Pediatric Population ◽

Age Groups ◽

Rare Condition ◽

Pseudotumor Cerebri ◽

Significant Morbidity ◽

Increased Intracranial Pressure ◽

Pseudotumor Cerebri Syndrome ◽

Eye Exams

AbstractPseudotumor cerebri syndrome (PTCS) is a rare condition in children presenting with headache and papilledema from increased intracranial pressure that can cause significant morbidity. This can be idiopathic, also known as idiopathic intracranial hypertension or primary intracranial hypertension, or can be secondary to medications and associated medical conditions. Given the threat to vision, early detection and treatment is needed in all age groups. However, identifying papilledema or pseudopapilledema in children presents unique challenges sometimes as a result of differences between prepubertal and postpubertal children, further elucidating the complex pathophysiology. Management requires brain imaging, lumbar puncture, and frequent eye exams with medical and rarely surgical treatment. Visual outcomes in children are favorable if caught early and management can be prolonged over years. Pediatric PTCS is different from adult PTCS in many ways, and this review will focus on the most updated definitions of the disease, theories of pathophysiology, management, and treatment in the pediatric population.

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Protocol description of the HOVON 141/VISION trial: a prospective, multicentre, randomised phase II trial of ibrutinib plus venetoclax in patients with creatinine clearance ≥30 mL/min who have relapsed or refractory chronic lymphocytic leukaemia (RR-CLL) with or without TP53 aberrations

BMJ Open ◽

10.1136/bmjopen-2020-039168 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039168

Author(s):

Mark-David Levin ◽

Arnon Kater ◽

Mattias Mattsson ◽

Sabina Kersting ◽

Juha Ranti ◽

...

Keyword(s):

Chronic Lymphocytic Leukaemia ◽

Lymphocytic Leukaemia ◽

Residual Disease ◽

Medical Center ◽

Progression Free Survival ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Free Survival ◽

Informed Consent Form ◽

Registration Number

IntroductionLiterature is scarce on the combination treatment of ibrutinib and venetoclax (IV) is scarce in relapsed or refractory chronic lymphocytic leukaemia (RR-CLL). Especially, the possibility of stopping ibrutinib in RR-CLL patients in deep remission is unclear.Methods and analysisIn the HOVON 141/VISION trial, patients with RR-CLL are treated with 12 cycles of IV after a short induction with ibrutinib. Patients reaching undetectable minimal residual disease (uMRD) after 12 cycles of IV are randomised 1:2 to continue ibrutinib or stop treatment. The persistence of uMRD after stopping IV is studied. In addition, in patients who become positive for MRD again after stopping, IV treatment is reinitiated. The efficacy of this approach with regard to progression-free survival 12 months after randomisation is the primary endpoint of the study.Ethics and disseminationThis protocol respects the Helsinki declaration and has been approved by the ethical committee of the Amsterdam Medical Center. Study findings will be disseminated through peer-reviewed papers. All patients who fulfil the inclusion criteria and no-exclusion criteria, and have signed the informed consent form are included in the study.Trial registration numberClinicalTrials.gov Registry (NCT03226301).

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