scholarly journals Implementation of Ultraportable Echocardiography in an Adolescent Sudden Cardiac Arrest Screening Program

2014 ◽  
Vol 8 ◽  
pp. CMC.S15779 ◽  
Author(s):  
Thomas E. Vanhecke ◽  
James E. Weber ◽  
Matthew Ebinger ◽  
Kimberly Bonzheim ◽  
Frank Tilli ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Large Scale ◽  
Screening Program ◽  
Sudden Cardiac Arrest ◽  
Structural Abnormality ◽  
Screening Programs ◽  
Structural Abnormalities ◽  
Echocardiographic Examination ◽  
Medical History Questionnaire

Background Over a 12-month period, adolescent heart-screening programs were performed for identifying at-risk adolescents for sudden cardiac death (SCD) in our community. Novel to our study, all adolescents received an abbreviated, ultraportable echocardiography (UPE). In this report, we describe the use of UPE in this screening program. Methods and Results Four hundred thirty-two adolescents underwent cardiac screening with medical history questionnaire, physical examination, 12-lead electrocardiogram (ECG), and an abbreviated transthoracic echocardiographic examination. There were 11 abnormalities identified with uncertain/varying clinical risk significance. In this population, 75 adolescents had a murmur or high ECG voltage, of which only three had subsequent structural abnormalities on echocardiography that may pose risk. Conversely, UPE discovered four adolescents who had a cardiovascular structural abnormality that was not signaled by the 12-lead ECG, medical history questionnaire, and/or physical examination. Conclusions The utilization of ultraportable, handheld echocardiography is feasible in large-scale adolescent cardiovascular screening programs. UPE appears to be useful for finding additional structural abnormalities and for risk-stratifying abnormalities of uncertain potential of adolescents’ sudden death.

scholarly journals Echocardiographic assessment of suspicious clinical and electrocardiogram findings of healthy young male military aspirants: a cross sectional observational study

2018 ◽  
Vol 14 (2) ◽  
pp. 92-97
Author(s):  
Navaraj Paudel ◽  
Vijay Madhav Alurkar
Keyword(s):  
Physical Examination ◽  
Sinus Bradycardia ◽  
Pulmonary Stenosis ◽  
Young Male ◽  
Physical Exertion ◽  
Cross Sectional Study ◽  
Structural Abnormality ◽  
Cross Sectional ◽  
Structural Abnormalities ◽  
Apparently Healthy

ABSTRACTBackground: Heavy exercise is associated with multiple physiological changes in cardiovascular system. Individuals who otherwise are healthy and asymptomatic are also found to have cardiac abnormalities. The aim of study is to find prevalance of structural abnormalities in apparently healthy males who are found to have abnormal/ suspicious clinical/electrogram findings during routine screening. Materials and Methods:A cross-sectional study was done in the department of cardiology within Manipal Teaching Hospital, Pokhara over a period of 3 years (December 2013 to December 2016). The study population included all the participants who were apparently healthy young males competing for military recruitment. After the initial screening, those who had abnormal/suspicious findings in the physical examination or in ECG were subjected for trans-thoracic echocardiogram to assess for any structural abnormality Results: Out of 1950 individuals, who underwent physical examination and ECG, 165 had abnormal physical findings and 261 had abnormal ECG findings (21.84% of total had any form of abnormality). 72 (43%) had grade 2 short systolic murmur in the pulmonary area followed by pansystolic murmur in apex. Only 1.8% had diastolic murmur in aortic area. Most common ECG abnormality found was LVH followed by sinus bradycardia and Tinversion in III . Almost 7% of individuals with abnormal ECG findings. Only 16 (0.82% of the total screened/ 4.38% of suspicious findings) had structural abnormalities in echocardiography: 12 had RHD (MR-7, AR-3, R+AS+MR=2); 1 had ASD, 1 had VSD, 1 had Ebstein’s anomaly and 1 had mild valvular pulmonary stenosis (congenital). Conclusion: Individuals who are otherwise healthy and asymptomatic were found to have cardiac abnormality (almost 1.7% had serious electrical or structural abnormality). Cardiovascular screening of all the individuals seeking jobs requiring intense physical exertion is essential to prevent serious cardiovascular outcomes.Keywords: echocardiography; electrocardiography; intense exercise; physical cardiac findings.

scholarly journals DNA-based carrier screening in primary healthcare: screening for aspartylglucosaminuria mutations in maternity health offices

1996 ◽  
Vol 42 (9) ◽  
pp. 1398-1404 ◽  
Author(s):  
M Hietala ◽  
P Aula ◽  
A C Syvänen ◽  
A Isoniemi ◽  
L Peltonen ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Large Scale ◽  
Solid Phase ◽  
Screening Program ◽  
Low Cost ◽  
Carrier Screening ◽  
Screening Programs ◽  
One Step ◽  
Laboratory Technology ◽  
Maternity Health

Abstract Large-scale genetic screening programs are complex enterprises in which ethical, technical, medical, and socioeconomic aspects have to be handled with professional expertise. Establishment of automated, relatively robust, and inexpensive laboratory techniques is one step of this path. Here a pilot carrier-screening program for the mutations causing aspartylglucosaminuria was carried out for pregnant women in primary care maternity health offices. Women (1975) were tested before their 12th week of pregnancy, and 31 heterozygotes were detected. The sampling was based on dried blood strips, facilitating convenient handling and inexpensive mailing to the laboratory. The mutation detection technique, solid-phase mini-sequencing simplified by the use of scintillation microplates and automated equipment, proved to be rapid, simple, inexpensive, and reliable, with a low repeat rate (2.5%). In conclusion, we found that good collaboration between the primary healthcare unit, the laboratory, and counseling experts, combined with modern laboratory technology, facilitate reliable low-cost genetic testing.

scholarly journals Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience

2020 ◽  
Vol 37 (3) ◽  
pp. 321-324 ◽  
Author(s):  
José María Remes-Troche ◽  
Gabriela Hinojosa-Garza ◽  
Priscilla Espinosa-Tamez ◽  
Arturo Meixueiro-Daza ◽  
Peter Grube-Pagola ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Potential Benefit ◽  
Large Scale ◽  
Screening Program ◽  
Preliminary Evidence ◽  
Premalignant Lesions ◽  
Middle Income ◽  
Screening Programs ◽  
Crc Screening ◽  
Middle Income Countries

Abstract Background In middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico. Objective Since there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico. Methods We conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results >100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy. Results Of 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed >100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT >100 ng haemoglobin/ml for premalignant lesions was 33%. Conclusion These results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

Unrecognized Cardiovascular Abnormalities Detected Through a Community Cardiovascular Screening Program

2020 ◽  
Vol 36 (3) ◽  
pp. 234-242
Author(s):  
S. Michelle Bierig ◽  
Anita Arnold ◽  
Lynne C. Einbinder ◽  
Eric Armbrecht ◽  
Thomas Burroughs
Keyword(s):  
Large Scale ◽  
Screening Program ◽  
Ankle Brachial Index ◽  
Positive Test ◽  
Screening Tests ◽  
Early Detection Of Disease ◽  
Screening Programs ◽  
Cardiovascular Screening ◽  
Subclinical Disease ◽  
Screening Protocol

Objective: Self-referral community cardiovascular screening programs (CCSPs) have a potential to reduce outcome events through early detection of disease. This study evaluated the characteristics of a population that could predict a positive test. Materials and Methods: Participants who completed a cardiovascular screening protocol were compared. The screening protocol included a blood pressure (BP), Doppler ankle brachial index (ABI) testing, a limited carotid sonogram, a limited aortic sonogram, electrocardiogram (ECG), and limited transthoracic echocardiogram (TTE). Results: Screenings were performed on 205 participants (58% female, 68 ± 9 years of age). Sixty-seven (34%) participants were abnormal in at least one of the following screening tests: ABI (2%), carotid sonogram (6%), aortic sonogram (3%), ECG (11%), and TTE (22%). Although 60.5% of the participants reported recent symptoms, there were no differences in normal or abnormal results of participants presenting with or without symptoms ( P = .06). Income was not a predictor of abnormal test results (odds ratio, 0.76; 95% confidence interval, 0.55–0.97; P = .19). Multivariate analysis demonstrated, when controlling for age greater than 75 years, that participants taking BP medication was the only variable that predicted a positive test result. Conclusion: One-third of patient results were abnormal, regardless of symptoms or lack thereof, suggestive of subclinical disease. Further large-scale studies would demonstrate the role of CCSPs in risk stratifying participants.

scholarly journals Implementing a Large-Scale Systematic Tuberculosis Screening Program in Correctional Facilities in South Africa

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Vincent Zishiri ◽  
Salome Charalambous ◽  
Maunank R. Shah ◽  
Violet Chihota ◽  
Liesl Page-Shipp ◽  
...  
Keyword(s):  
South African ◽  
Large Scale ◽  
Screening Program ◽  
High Volume ◽  
Treatment Costs ◽  
Correctional Facilities ◽  
Tuberculosis Screening ◽  
Pulmonary Tb ◽  
Screening Programs ◽  
The Cost

Abstract Background.  Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates. Methods.  We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates. Results.  During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880). Conclusions.  We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.

A new multisystem inflammatory syndrome temporally associated with SARS-CoV-2 in a 6-year-old boy

2020 ◽  
Vol 16 (3) ◽  
pp. 295-300
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
◽  
Milena Wronecka ◽  
Natalia Panasiuk ◽  
Karolina Kasiak ◽  
...  
Keyword(s):  
Child Health ◽  
Physical Examination ◽  
Medical History ◽  
Royal College ◽  
New Disease ◽  
Imaging Findings ◽  
Inflammatory Syndrome ◽  
And Child Health

In December 2019, China reported cases of infections caused by a new zoonotic coronavirus, which gradually developed into a pandemic. The disease was initially believed to be mild in children. In April 2020, a possible relationship between a new paediatric multisystem inflammatory syndrome and SARS-CoV-2 was found. In May, the Royal College of Paediatrics and Child Health published the criteria for the diagnosis of this new disease. We present a case of a 6-year-old boy retrospectively diagnosed with SARS-CoV-2-related multisystem inflammatory syndrome based on medical history, physical examination, laboratory and imaging findings, as well as the available literature.

Human Papillomavirus Selected Properties and Related Cervical Cancer Prevention Issues

2020 ◽  
Vol 26 (18) ◽  
pp. 2073-2086
Author(s):  
Saule Balmagambetova ◽  
Andrea Tinelli ◽  
Ospan A. Mynbaev ◽  
Arip Koyshybaev ◽  
Olzhas Urazayev ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Prevention ◽  
Screening Program ◽  
Hpv Infection ◽  
Cervical Cancer Prevention ◽  
Point Of View ◽  
Prevention Strategies ◽  
Middle Income ◽  
Screening Programs

High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.

The Swiss Prison Study (SWIPS): Protocol for Establishing a Public Health Registry of Prisoners in Switzerland (Preprint)

2020 ◽  
Author(s):  
Thomas Gaisl ◽  
Naser Musli ◽  
Patrick Baumgartner ◽  
Marc Meier ◽  
Silvana K Rampini ◽  
...  
Keyword(s):  
Public Health ◽  
Medical History ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
Disease Prevalence ◽  
Vulnerable Population ◽  
International Classification ◽  
Classification Of Diseases ◽  
Health Registry

BACKGROUND The health aspects, disease frequencies, and specific health interests of prisoners and refugees are poorly understood. Importantly, access to the health care system is limited for this vulnerable population. There has been no systematic investigation to understand the health issues of inmates in Switzerland. Furthermore, little is known on how recent migration flows in Europe may have affected the health conditions of inmates. OBJECTIVE The Swiss Prison Study (SWIPS) is a large-scale observational study with the aim of establishing a public health registry in northern-central Switzerland. The primary objective is to establish a central database to assess disease prevalence (ie, International Classification of Diseases-10 codes [German modification]) among prisoners. The secondary objectives include the following: (1) to compare the 2015 versus 2020 disease prevalence among inmates against a representative sample from the local resident population, (2) to assess longitudinal changes in disease prevalence from 2015 to 2020 by using cross-sectional medical records from all inmates at the Police Prison Zurich, Switzerland, and (3) to identify unrecognized health problems to prepare successful public health strategies. METHODS Demographic and health-related data such as age, sex, country of origin, duration of imprisonment, medication (including the drug name, brand, dosage, and release), and medical history (including the International Classification of Diseases-10 codes [German modification] for all diagnoses and external results that are part of the medical history in the prison) have been deposited in a central register over a span of 5 years (January 2015 to August 2020). The final cohort is expected to comprise approximately 50,000 to 60,000 prisoners from the Police Prison Zurich, Switzerland. RESULTS This study was approved on August 5, 2019 by the ethical committee of the Canton of Zurich with the registration code KEK-ZH No. 2019-01055 and funded in August 2020 by the “Walter and Gertrud Siegenthaler” foundation and the “Theodor and Ida Herzog-Egli” foundation. This study is registered with the International Standard Randomized Controlled Trial Number registry. Data collection started in August 2019 and results are expected to be published in 2021. Findings will be disseminated through scientific papers as well as presentations and public events. CONCLUSIONS This study will construct a valuable database of information regarding the health of inmates and refugees in Swiss prisons and will act as groundwork for future interventions in this vulnerable population. CLINICALTRIAL ISRCTN registry ISRCTN11714665; http://www.isrctn.com/ISRCTN11714665 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23973

The Clinical Method and Subjectivity in Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Record ◽  
Chronic Conditions ◽  
Process Of Care ◽  
Clinical Method ◽  
Functional Assessments ◽  
Contemporary Medicine

The clinical method is defined as the means by which doctors gather information about their patients, think about and evaluate these medical facts, and enter the facts into their process of care. Its key components are the medical history, including the process by which it is acquired from patients and its subsequent documentation in the medical record, as well as the physical examination. Characteristics, such as the reproducibility and accuracy of various components, are discussed with a reference to prevailing opinions of subjectivity and objectivity in medicine. It is argued that as a consequence of a shift in the prevalence of illness, from acute to chronic conditions, a misalignment exists between the clinical method currently taught and contemporary medicine. It is suggested that a renewed and repurposed clinical method must incorporate enhanced strategies for functional assessments.

scholarly journals Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

2021 ◽  
Vol 11 (6) ◽  
pp. 497
Author(s):  
Yoonsuk Jung ◽  
Eui Im ◽  
Jinhee Lee ◽  
Hyeah Lee ◽  
Changmo Moon
Keyword(s):  
Colorectal Cancer ◽  
Large Scale ◽  
Screening Program ◽  
Antiplatelet Agents ◽  
Population Based ◽  
Small Sample ◽  
Antithrombotic Agents ◽  
Predictive Values ◽  
Prescription Rates ◽  
Small Sample Sizes

Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78–0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83–0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61–0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.

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