Comprehensive Arthritis Referral Study — Phase 2: Analysis of the Comprehensive Arthritis Referral Tool

2014 ◽  
Vol 41 (10) ◽  
pp. 1980-1989 ◽  
Author(s):  
Andrew E. Thompson ◽  
Sara L. Haig ◽  
Nicole G.H. LeRiche ◽  
Gina Rohekar ◽  
Sherry Rohekar ◽  
...  
Keyword(s):  
Referral And Consultation ◽  
Study Phase ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Included Patient ◽  
Patient Reported ◽  
History Of ◽  
Early Inflammatory Arthritis ◽  
Duration Of Disease ◽  
Referral Tool

Objective.Rheumatologists triage referrals to assess those patients who may benefit from early intervention. We describe a referral tool and formally evaluate its sensitivity for urgent and early inflammatory arthritis (EIA) referrals.Methods.All referrals received on a standardized referral tool were reviewed by a rheumatologist and, based on the information conferred, assigned a triage grade using a previously described triage system. Each referral was also dichotomized as suspected EIA or not. After the initial rheumatologic assessment, the diagnosis was recorded and a consultation grade, blinded to referral grade, was assigned to each case. Agreement between referral and consultation grades was assessed. A regression analysis was performed to determine factors that predicted truly urgent referrals including EIA.Results.We evaluated 696 referrals. A total of 210 (30.2%) were categorized as urgent at the time of consultation. The referral tool was able to successfully detect 169 of these referrals (sensitivity 80.5%, specificity 79.4%). EIA occurred in 95 (13.6%); of those referrals, 86 were correctly classified as urgent at the time of triage (sensitivity 90.5%, specificity 69.6%). Items that helped correctly discriminate urgent or EIA referrals included patient age < 60, duration of disease, morning stiffness, patient-reported joint swelling, a personal or family history of psoriasis, urgency as rated by referring physician, prior assessment by a rheumatologist, elevated C-reactive protein, and a positive rheumatoid factor.Conclusion.A 1-page referral tool that includes parts completed by the referring physician and patient has good sensitivity to detect urgent referrals including EIA.

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

scholarly journals Synchronous cytomegalovirus infection in a newly diagnosed ulcerative colitis patient

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Jin Yu Chieng ◽  
Yasotha Sugumaran ◽  
Sellymiah Adzman ◽  
Pan Yan
Keyword(s):  
Ulcerative Colitis ◽  
Medical Illness ◽  
C Reactive Protein ◽  
Colitis Patient ◽  
Intravenous Ganciclovir ◽  
Reactive Protein ◽  
Chronic Medical Illness ◽  
History Of ◽  
Cmv Colitis

A 61-year-old Punjabi female patient presented with six months history of mild abdominal discomfort with bloody diarrhea. She did not have underlying chronic medical illness; she neither took steroid nor immunosuppressant. She was found anemic, thrombocytosis, and elevated C-reactive protein. Colonoscopy showed moderate left sided colitis, with histopathology evidence of ulcerative colitis (UC) with cytomegalovirus (CMV) infection. Her serum anti-CMV IgM antibody was detected. She was treated with intravenous ganciclovir, together with 5-ASA and tapering dose of steroid. Anemia was corrected. Subsequent clinic reviews and follow up endoscopies showed dramatically improvement. CMV colitis should be considered for the patients presenting with moderate to severe UC. Early prescription of antiviral would be beneficial in the treatment of flare of UC.

scholarly journals Angioedema severity and impacts on quality of life: chronic histaminergic angioedema versus chronic spontaneous urticaria

2021 ◽  
Author(s):  
Marina Sabate-Bresco ◽  
Nuria Rodríguez-Garijo ◽  
JULIÁN AZOFRA ◽  
María L. Baeza ◽  
Carmen Diaz Donado ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Activity ◽  
Chronic Spontaneous Urticaria ◽  
C Reactive Protein ◽  
Prospective Multicenter Study ◽  
Reactive Protein ◽  
Female Predominance ◽  
Patient Reported ◽  
Considerable Impact

Background: Chronic histaminergic angioedema (CHA) is defined as recurrent episodes of isolated angioedema (without hives) of unknown cause that respond to the same treatment as chronic spontaneous urticaria (CSU). Quality of life (QoL) studies have not been performed for CHA, except those carried out in the context of CSU associated with angioedema attacks (CSU-AE). Moreover, biomarkers for monitoring disease activity in CHA have not been identified. We aim to describe the burden of CHA and impact on patient QoL, compare the findings to those in CSU-AE patients, and investigate biomarker associations with disease severity and QoL parameters. Methods: We performed a prospective multicenter study that included 68 patients with CHA and 63 patients with CSU-AE. Demographic and clinical variables were collected. Validated patient-reported questionnaires were employed to analyze the quality of life and disease activity. Blood and serological parameters, including blood cell count, C-reactive protein, D-dimer and total IgE, were also analyzed. Results: Angioedema disease activity was significantly higher in CSU-AE patients (median AAS7, IQR: 1, [0–1]) than CHA patients (0, [0–1]; p= 0.022). A considerable impact on QoL was found in both groups, although significantly worse values were found for CSU-AE (median AEQoL, IQR: 37, [10–65]; p=0.005). CHA patients were older than CSU-AE patients, and female predominance was not observed. Conclusions: Angioedema severity and QoL impacts are significantly worse in CSU than in chronic histaminergic angioedema. Angioedema should be included in severity urticaria scores (UAS) as well as in specific quality of life urticaria scales.

scholarly journals An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Seisuke Ota ◽  
Toshio Noguchi ◽  
Tomoya Takao ◽  
Takumi Sakamoto ◽  
Yuichiro Kanie ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Transverse Colon ◽  
Surgical Intervention ◽  
C Reactive Protein ◽  
Fluid Level ◽  
Hernia Sac ◽  
Reactive Protein ◽  
Free Air ◽  
History Of ◽  
Cold Extremities

There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

The characteristics associated with alcohol co-ingestion in patients visited to the emergency department with deliberate self-poisoning: retrospective study

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Self Report ◽  
C Reactive Protein ◽  
Alcohol Group ◽  
Reactive Protein ◽  
History Of

Objective: The aim of this study was to investigate the characteristics associated with alcohol co-ingestion by measuring blood alcohol concentration in patients visited to the emergency department with deliberate self-poisoning. Also, it was to evaluate the accuracy of self-reported alcohol ingestion. Methods: The initial assessment forms, medical records and laboratory tests of patients visited to the ED after DSP between March 2017 and June 2020 were retrospectively reviewed. Based on the patients’ BAC, two groups were formed: the non-alcohol group and the alcohol group. Results: This study included 286 patients (56.6%, n = 162) in the non-alcohol group and 43.4% (n = 124) in the alcohol group. In multivariate logistic analysis, alcohol co-ingestion was independently associated with no history of psychiatric admission (Odds Ratio = 6.222, 95% Confidence Interval = 1.148-33.716, P = 0.034), lactate (mg/dL)(Odds Ratio = 1.961, 95% Confidence Interval = 1.274-3.019, P = 0.002), and C-reactive protein level (mg/dL) (Odds Ratio = 0.003, 95% Confidence Interval = 0.000-0.897, P = 0.046). The receiver operating characteristics analysis of lactate value for the association with alcohol co-ingestion showed a cutoff value of 1.45, with 88.1% sensitivity, 71.6%specificity, and an area under the curve of 0.845. There was no statistically significant difference in emergency department disposition between the two groups. Using the 261 subjects who completed the self-report of alcohol co-ingestion, self-report resulted in 77.6% sensitivity and 76.6% specificity for the assessment of alcohol co-ingestion. The positive and negative predictive values for self-reporting were 72.6% and 81.0%, respectively. Conclusions: Alcohol co-ingestion was associated with no history of psychiatric ward admission, high lactate levels, and low C-reactive protein values in patients who visited the emergency department with deliberate self-poisoning. This study showed that self-reported alcohol co-ingestion was not a substitute for the blood alcohol concentration test.

scholarly journals Management of community-acquired pneumonia: essential tips for the physician on call

2020 ◽  
Vol 81 (5) ◽  
pp. 1-9 ◽  
Author(s):  
Malcolm Avari ◽  
Jeremy S Brown
Keyword(s):  
Clinical Problem ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Care Bundle ◽  
Clinical Markers ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Acute Hospitals ◽  
History Of ◽  
Short Courses

Community-acquired pneumonia is a common clinical problem requiring admission to hospital, with a particularly high incidence in the elderly population and those with significant comorbidities. Diagnosis is made on the combination of a short history of respiratory symptoms and systemic ill-health with new examination and/or radiological features of consolidation. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5–17% of cases. The CURB-65 score can identify patients with community-acquired pneumonia with a higher risk of mortality, but is insensitive at identifying patients requiring intensive care support and needs to be combined with clinical markers of potential severity. Both high admission levels of C-reactive protein and the failure of levels of C-reactive protein to decline by >50% by day 4 after admission are associated with higher risk of complications, need for ventilation or inotropic support, and mortality. Empirical antibiotic therapy for most patients admitted to hospital is combination of a ß-lactam and a macrolide. Short courses of antibiotics do not result in significantly different outcomes to longer courses unless the patient has developed complications such as a complex parapneumonic effusion. Implementation of a community-acquired pneumonia care bundle into clinical practice reduces mortality, and should be a high priority for all acute hospitals.

scholarly journals Association of Testosterone, Insulin-Like Growth Factor-I, and C-Reactive Protein with Metabolic Syndrome in Chinese Middle-Aged Men with a Family History of Type 2 Diabetes

2005 ◽  
Vol 90 (12) ◽  
pp. 6418-6423 ◽  
Author(s):  
Peter C. Y. Tong ◽  
Chung-Shun Ho ◽  
Vincent T. F. Yeung ◽  
Maggie C. Y. Ng ◽  
Wing-Yee So ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Family History ◽  
Total Testosterone ◽  
C Reactive Protein ◽  
Middle Aged ◽  
Reactive Protein ◽  
Igf I ◽  
History Of ◽  
Hs Crp

Context: Age-related declines in testosterone and IGF-I are associated with deposition of visceral fat, a component of the metabolic syndrome (MES). Objective: Testosterone and IGF-I may interact with familial disposition to diabetes mellitus to increase the association with MES. Design: We conducted a cross-sectional cohort study. Setting: The study was conducted in a university teaching hospital. Subjects: Study subjects included 179 middle-aged men with a family history of diabetes (FH) (aged 39.1 ± 8.1 yr) and 128 men without FH (aged 43.8 ± 8.5 yr). Main Outcome Measures: Clinical characteristics, frequency of MES using the World Health Organization criteria with Asian definitions of obesity (body mass index ≥ 25 kg/m2), and serum levels of total testosterone, IGF-I, and high-sensitive C-reactive protein (hs-CRP) were measured. Results: Men with FH had higher frequency of MES than those without FH [39.1 vs. 23.4% (P = 0.004)]. On multivariate analysis, smoking (former and current smokers), low total testosterone, and IGF-I but elevated hs-CRP levels explained 35% of the MES variance in men with FH. The frequency of MES increased with declining tertiles of total testosterone and IGF-I but increasing tertiles of hs-CRP. After adjustment for age and smoking history, subjects with all three risk factors had a 13-fold increase in risk association with MES compared with those without hormonal and inflammatory risk factors. These risk associations were not found in men without FH in whom only smoking (ex and current) and low total testosterone level were independent predictors for MES, which explained 14% of the variance. Conclusions: Clustering of FH, hormonal abnormalities, and high hs-CRP is associated with MES in Chinese middle-aged men.

Development of Prothrombotic Repertoire with Progressive HIV Disease: Data from the Women’s Interagency HIV Study (WIHS).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1057-1057
Author(s):  
Alexandra M. Levine ◽  
Cheryl Vigen ◽  
Jay Gravink ◽  
Howard A. Liebman
Keyword(s):  
Factor Viii ◽  
Lupus Anticoagulant ◽  
Protein S ◽  
Hiv Disease ◽  
C Reactive Protein ◽  
Factor Viii Activity ◽  
Functional Protein ◽  
Reactive Protein ◽  
History Of ◽  
Hiv Negative

Abstract HIV infected patients may be at increased risk for VTE, as shown by case reports, and a recent retrospective, longitudinal medical record review of approximately 42,000 HIV-infected individuals (Sullivan, 2000). There is a well documented association between acute and chronic inflammation and activation of the hemostatic system. Inflammatory cytokines such as TNF alpha, IL-1 and IL-6 have been shown to activate coagulation via the Tissue Factor pathway. Inflammation can also result in a decrease in functional Protein S, and in an increase in Factor VIII coagulant protein. We hypothesized that the inflammatory state associated with more advanced HIV disease would be associated with hemostatic activation, and clinical development of VTE over time. Methods: We assayed plasma for factor VIII activity levels, functional protein S activity, presence of lupus anticoagulant, and C reactive protein levels in a group of 96 HIV infected women and 50 HIV negative women from the Women’s Interagency HIV Study (WIHS). All assays were performed blinded to subjects HIV status. This cross sectional sample of WIHS participants from the Los Angeles site were studied at their second study visit (1994-5). The sample was selected to represent the following groups: (1) History of clinical AIDS, CD 4&lt; 200; (2) CD4 &lt; 200, no clinical AIDS; (3) HIV positive, CD4 &gt; 200; HIV-negative. Pts were excluded if they were taking any hormones or contraceptives; had been pregnant within 6 weeks of study; had any acute, active infection at the time of study visit. Hemostatic data were correlated with HIV viral load, CD4 cell count, history of clinical AIDS, history of anti-retroviral and other medication use, and levels of serum and plasma C reactive protein (CRP). Results are depicted below for median (inter-quartile range) values, adjusted for age: Group Protein S Factor VIII Serum CRP# 1. Clinical AIDS, CD4 &lt; 200 46* (40,65) 212* (174,253) 2.0 (0.5,4.8) 2. No Clinical AIDS, CD4 &lt; 200 62^ (55,67) 196+ (150, 234) 0.8 (0.7,2.7) 3. HIV+, No Clinical AIDS, CD4 &gt; 200 67.5 (59,83) 154^ (111,202) 0.9 (0.4, 3.3) 4. HIV Negative 75.5 (66,85) 116.5 (97,154) 1.85 (0.8, 5.1) Models were adjusted for age. Groups are significantly different from HIV negative participants (group 4) at the indicated p-values, determined using Scheffe adjustment * p&lt;0.0001 ^p&lt;.05 + p&lt;.001 # CRP Medians are not significantly different for the different groups. No patient or control was found to have a positive assay for the Lupus anticoagulant. We conclude: (1) Increasing progression of HIV disease, from asymptomatic, to immunologic (CD 4&lt; 200) and then clinical AIDS, is associated with progressive increase in factor VIII activity, and decrease in functional protein S; (2) This progressive hemostatic changes were not associated with elevated CRP levels, suggesting that IL-6 is not involved in this process; (3) An increase in VTE is biologically plausible in the setting of HIV infection; (4) Further prospective study is warranted to determine the full range of hemostatic abnormalities associated with HIV, and to determine any correlation between these abnormalities and development of VTE in time.

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