scholarly journals Chronic Back Pain Suspected Sacroiliitis, Seronegative-Spondyloarthropathy related Sacroiliitis: Features and Differentials

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Dejan Spasovski
Keyword(s):  
Chronic Back Pain ◽  
Early Stage ◽  
Imaging Techniques ◽  
Positive Family History ◽  
Observational Period ◽  
Radiographic Findings ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Radiographic Changes

Introduction: Very often late diagnosis in spondylitis ankylosans (SA) in the period between 5 to 10 years is due to unstandardized diagnostic method besides established diagnostic criteria. But they are very restrictive and not practical for early diagnosis of SA, because are based on proved radiographic changes. Aim: Sacroiliitis (SI) as a sole entity rarely exists, usually is a part of a diagnostic mosaic of SA and related spondyloarthropathies (SpA). Surely proved SI clinically and radiographically means sure diagnosis of SA, especially in the early stage of the disease. Material and Methods: Highly selective group of patients with SA was followed in the period of one year: group of 23 patients (pts) with unconvincing radiographic changes for SA from 1-2° and group of 21 pts without radiographic changes i.e. 0°. Beside SA, both groups fulfilled at least another from the listed conditions: 1. Oligoarthritis; 2. Enthesitis; 3. Iridocyclitis; 4. Positive family history for SA; 5. Positive antigen HLA-B27 and 6. Elevated ESR > 30mm/h. Results: after observational period of one year in the group A 11/21 pts were with SA. In the group B only 6/23 pts were with SA; the others were transformed in different directions: 4/23 in the group of spondyloarthropathies (SpA) – 2 pts with Psoriatic spondyloarthropathy (PsSpA), 1 patient with Reiter syndrome (RS)and 1 patient with Entericspondyloarthropathy (ESpA). The others 8/22 pts were still undefined SpA. Conclusion: Our results showed that defining of SA was crucial in the diagnosis of SA. The fact that most of cases with authentic SA were in group A with minimal radiographic changes from 1-2° in comparison with group B without radiographic changes showed the necessity of using other imaging techniques (scan, MRI) for earlier detection of SI in the so called pre-radiographic stage which lasts 2-4 years, when radiographic findings are absent. Clinical (symptomatic) SI without radiographic changes according to the findings of pts in the group B gives a possibility for overlap to other entities in the group of SpA.

Comparative effectiveness assessment of a lung cancer multidisciplinary practice to improve patient care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16523-e16523
Author(s):  
Hamid R. Mirshahidi ◽  
Elvin Hernandez ◽  
Matthew Ta ◽  
Sheley M Baylon ◽  
Minh Thy Pham ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage Iv ◽  
Stage I ◽  
Tumor Board ◽  
Survival Difference ◽  
Group A ◽  
One Year ◽  
Group B

e16523 Background: Multidisciplinary focused-care teams have shown beneficial outcomes in diagnosis and treatment in cancer patients as well as assist in providing accessible, cohesive and continuous care. The multidisciplinary team specializing in thoracic cancer at our institution includes thoracic surgeons, pulmonologists, medical oncologists, radiation oncologists, pathologists, radiologists and a weekly tumor board with the inclusion of a dietician, a pharmacist, and a psych/social worker. This study examined the effectiveness of a multidisciplinary focused program in improving overall care in lung cancer patients. Methods: Lung cancer patient data between January 2000-December 2009 were abstracted from the institutional cancer registry. Patient demographics, treatment received, and survival (1-year and 2-year) were compared between Group A (January 2000-July 2005) and Group B (August 2005-December 2009) using Fisher’s exact test. Results: 1202 patients (Group A = 760; Group B = 442) were evaluated. Majority of patients were > 60 years old, male, and has stage IV adenocarcinoma. Missing stage was less in Group B (13.8% vs 17.4%). Early stage patients in Group B received more surgeries and less inappropriate treatments. More palliative chemotherapy/radiation treatments were given in Group B late stage disease. More stage II (21.1% vs 2.3%) and IIIA (12% vs 1.5%) patients in Group B were treated with wedge resection and chemotherapy. One-year survival differences were seen between 2 groups in stage I, IIIA, and IV (P <0.05). 2-year survival difference was seen in stage IV disease (P<0.05). Conclusions: Introduction of multidisciplinary lung care team between 2005-2009 was associated with an increased patients being staged and more appropriate treatments. One year survival almost doubled in stage I patients where stage IV pts experienced up to 4 times improvement in 1- and 2-year survival. The results of the present evaluation appear to confirm the value of a multidisciplinary approach to the management of patients with lung cancer.

Efficiency of cognitive control recruitment in the very early stage of multiple sclerosis: a one-year fMRI follow-up study

2008 ◽  
Vol 14 (6) ◽  
pp. 786-792 ◽  
Author(s):  
B Audoin ◽  
F Reuter ◽  
MVA Duong ◽  
I Malikova ◽  
S Confort-Gouny ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Early Stage ◽  
Random Effect ◽  
Analysis Of Covariance ◽  
Standard Pattern ◽  
Group A ◽  
One Year ◽  
Group B ◽  
The Right ◽  
The Impact

Functional magnetic resonance imaging (FMRI) studies have established that patients with multiple sclerosis show stronger activation in the lateral prefrontal cortices (LPFC) than healthy control subjects during effortful cognitive tasks. The aim of the present study was to assess the impact of these activation changes on cognitive performances. In addition to 19 controls, who were tested at a single time-point to define a standard pattern of fMRI activation during the performance of the Paced Auditory Serial Addition Task (PASAT), 13 patients with clinically isolated syndrome underwent a longitudinal fMRI examination while performing the PASAT at the beginning of the study (M0) and one year later (M12). Relative to the M0 scores, PASAT performances improved in eight patients (group A) and either decreased ( n = 4) or remained unchanged ( n = 1) (group B) in five patients at M12. Random effect analyses (SPM2; Wellcome Institute, London, England) were performed to compare intra-group time-related effects on brain activation (paired t-test between M0 and M12), and inter-group differences were also compared between the two groups of patients (analysis of covariance with PASAT performances as the covariate). Relative to group B, group A showed larger increase in activation between M0 and M12 in the right LPFC. In the whole group of patients, interaction analyses showed that the differences in the PASAT scores between M0 and M12 were correlated with the differences in activation observed in the right LPFC. This longitudinal study shows that in patients with early multiple sclerosis, the increased levels of activation in the right LPFC was associated with improved individual working memory and processing speed performances.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

2019 ◽  
Vol 6 (1) ◽  
pp. 8-13
Author(s):  
Birendra Kumar Yadav ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parish Mani Shrestha
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Operation Time ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Stone Characteristics ◽  
Negative Urine Culture ◽  
Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer

2011 ◽  
Vol 29 (7) ◽  
pp. 832-838 ◽  
Author(s):  
John K. Chan ◽  
Alexander E. Sherman ◽  
Daniel S. Kapp ◽  
Ruxi Zhang ◽  
Kathryn E. Osann ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Advanced Disease ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Lower Grade ◽  
Kaplan Meier ◽  
Group A ◽  
Advanced Stages ◽  
Staging Surgery ◽  
Group B

Purpose Despite a lack of evidence for survival benefit, the American College of Obstetrics and Gynecology has recommendations for referral to gynecologic oncologists for the treatment of endometrial cancer. Therefore, we propose to determine the influence of gynecologic oncologists on the treatment and survival of patients with endometrial cancer. Patients and Methods Data were obtained from Medicare and Surveillance, Epidemiology, and End Results (SEER) databases from 1988 to 2005. Kaplan-Meier and Cox proportional hazard methods were used for analyses. Results Of 18,338 women, 21.4% received care from gynecologic oncologists (group A) while 78.6% were treated by others (group B). Women in group A were older (age > 71 years: 49.6% v 44%; P < .001), had more lymph nodes (> 16) removed (22% v 17%; P < .001), presented with more advanced (stages III to IV) cancers (21.9% v 14.6%; P < .001), had higher-grade tumors (P < .001), and were more likely to receive chemotherapy for advanced disease (22.6% v 12.4%; P < .001). In those with stages II to IV disease, the 5-year disease-specific survival (DSS) of group A was 79% versus 73% in group B (P = .001). Moreover, in advanced-stage (III to IV) disease, group A had 5-year DSS of 72% versus 64% in group B (P < .001). However, no association with DSS was identified in stage I cancers. On multivariable analysis, younger age, early stage, lower grade, and treatment by gynecologic oncologists were independent prognostic factors for improved survival. Conclusion Patients with endometrial cancer treated by gynecologic oncologists were more likely to undergo staging surgery and receive adjuvant chemotherapy for advanced disease. Care provided by gynecologic oncologists improved the survival of those with high-risk cancers.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy

PEDIATRICS ◽  
1981 ◽  
Vol 67 (2) ◽  
pp. 222-229 ◽  
Author(s):  
A. van der Does-van den Berg ◽  
J. Hermans ◽  
J. Nagel ◽  
G. van Steenis
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
First Year ◽  
Healthy Children ◽  
Healthy Control ◽  
Antibody Titers ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Antibody Levels

Antibody titers to diphtheria, pertussis, tetanus, and poliomyelitis (types I to III) were measured in previously vaccinated children with acute lymphocytic leukemia in remission after cessation of therapy. The response to revaccination one year after therapy was stopped was also studied. The patients' antibody titers were compared with those of healthy children, matched for age and sex. Two groups of patients were studied: one group (group A, N = 30) was given two drugs (6-mercaptopurine, methotrexate); the other group (group B, N= 19) was given three drugs (6-mercaptopurine, methotrexate, and cyclophosphamide) for maintenance treatment. In general, the patients' antibody titers were lower than those of healthy children, but in most patients they were still at levels considered to be protective. No significant differences in antibody levels between the two patient groups were found. A spontaneous rise in antibody titers in the first year after termination of therapy was not observed. After revaccination the rise in antibody titers was correlated with preexisting antibody titers in the same way in patients as in healthy children, and the antibody titers in patients and in healthy control subjects were on roughly the same level.

scholarly journals What are the responsible risk factors for delay in diagnosis of acute appendicitis in children? Eleven-year research from a single institution

Folia Medica ◽  
2019 ◽  
Vol 61 (3) ◽  
pp. 389-396
Author(s):  
Katerina Kambouri ◽  
Maria Aggelidou ◽  
Savvas Deftereos ◽  
Aggelos Tsalkidis ◽  
George Vaos ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Imaging Techniques ◽  
Diagnostic Delay ◽  
Initial Examination ◽  
Delay In Diagnosis ◽  
Paediatric Surgeon ◽  
Main Effect ◽  
Logistic Regression Method ◽  
Group A ◽  
Group B

Introduction: We conducted a retrospective analysis of 602 children operated on for acute appendicitis (AA) in our department between 1/2007 and 12/2017. Aim: The aim of this study was to identify factors that are related to a delay in diagnosing AA in children. Furthermore, we’d like to strengthen our previous preliminary results by a) adding gender as a new factor and b) studying a much larger population. Materials and methods: The time that elapsed from the onset of symptoms to the surgical intervention was associated with gender, age, obesity, use of antibiotics prior to diagnosis, and the initial examination by a paediatric surgeon or another physician. Univariate and multivariate logistic regression method (backward method) was applied. Results: The diagnosis of AA was delayed by at least 48 hours in 287 patients (group A, 47.7%) and was made within 48 hours in 315 patients (group B, 52.3%). In multivariate model we noticed that boys who were examined by a paediatric surgeon and didn’t take antibiotics had decreased odds of having length of diagnostic period >48 hours, girls who received antibiotics compared to girls who do not use antibiotics are almost 12 times more likely to have length of diagnostic period >48 hours, the very young age has а main effect оn the diagnostic delay and girls who have been examined by other physician compared to females who have been examined by paediatric surgeon have decreased odds of having length of diagnostic period >48 hours. Conclusions: Therefore, physicians examining children with abdominal pain must keep in mind the multiple causes of diagnostic delay that may exist alone or in combination, and which can lead to serious complications and lengthen the hospital stay. Performing repeated examinations and asking for advice from a specialist specifically for children who are a special category of patients, in areas where it is rather impossible to use imaging techniques, could be the key to correctly diagnosing and treating AA.

scholarly journals Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial (Preprint)

2020 ◽  
Author(s):  
Aya Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Afnan Sedky Adly
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Randomized Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Early Stage ◽  
Home Based ◽  
Group A ◽  
Group B

BACKGROUND With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. OBJECTIVE The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. METHODS In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO<sub>2</sub> and PaCO<sub>2</sub>, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. RESULTS Analysis of the results showed a significant difference between the two groups (<i>P</i>&lt;.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (<i>P</i>&lt;.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. CONCLUSIONS It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. CLINICALTRIAL ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

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