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Insulin Resistance: Is it Prevalent in Egyptian Patients with Rheumatoid Arthritis?
No full textAim: to determine the prevalence of insulin resistance in a group of RA patients and to clarify the association between IR and the various disease parameters and the subclinical vascular pathology in those patients. Subjects and Methods: The present study included 40 patients with RA in addition to 20 healthy age and sex matched controls. The study participants were subjected to careful history taking, thorough clinical examination and laboratory investigations including CRP, RF, ESR and insulin resistance. VAS and Disease activity score were calculated for all patients. Ultrasound assessment of carotid arteries was also performed.Results: The study included 40 RA patients. The patients comprised 31 females (77.5 %) and 9 males (22.5 %) with a mean age of 42.7 ± 8.3 years and BMI of 28.6 ± 3.2 Kg/m2. Patients had significantly higher CIMT when compared with controls. Also, it was found that patients had significantly higher HOMA-IR when compared with control. HOMA-IR was significantly correlated with BMI and CIMT.Conclusions: Insulin resistance is prevalent in RA patients and significantly contributes to the development of subclinical atherosclerosis in those patients
Long Term Outcomes with Selective Drug Eluting Stent Use in STElevation Myocardial Infarction in an Australian Urban Population
No full textAim: To evaluate the safety and effect on long-term outcomes of an approach that selectively uses drug-eluting stent (DES) only in ST elevation myocardial infarction (STEMI) that meet criteria for high risk of in-stent restenosis (ISR).Methods: Consecutive patients (n=1832) presenting with STEMI to a single large centre between April 2004 and January 2012 were managed according to an algorithm in which those with pre-specified criteria indicating they were at high risk for ISR received DES (46%, n=847), and otherwise received bare metal stents (BMS) (54%, n=985). High risk criteria included: vessel diameter £2.5mm (£3.0mm in diabetic patients); lesion length >18mm; previous ISR; saphenous vein graft lesions; ostial lesions; bifurcation lesions; left main coronary artery lesions; and multi-vessel disease. The two groups were compared for primary composite outcome of major adverse cardiac events (MACE) including death, repeat MI and TVR; and secondary outcomes of target lesion revascularisation (TLR) and stent thrombosis (ST).Results: Over a median period of 24 months there was no significant difference (DES vs BMS) in MACE (13.6% vs 18.1%, p=0.074), mortality (7.6% vs 10.5%, p=0.327) or definite stent thrombosis (2.6% vs 1.6%, p=0.094). Patients who received DES had a lower rate of clinically driven TLR (1.6% vs 3.9%, p=0.032).Conclusion: An approach of selectively using DES in STEMI patients at high risk of ISR provides satisfactory long-term outcomes while limiting the number of patients exposed to DES costs
Diagnosis and Management of Renal Infarction in the Emergency Department: A Review
No full textRenal infarction is a rare and often misdiagnosed condition. The goal of this review article is to evaluate the causes, presentation, and treatment of this elusive condition
Measuring Early Communication in Spanish Speaking Children: The Communication Complexity Scale in Peru.
No full textBackground: There is a great need in the United States to develop presymbolic evaluation tools that are widely available and accurate for individuals that come from a bilingual and/or multicultural setting. The Communication Complexity Scale (CCS) is a measure that evaluates expressive presymbolic communication including gestures, vocalizations and eye gaze. Studying the effectiveness of this tool in a Spanish speaking environment was undertaken to determine the applicability of the CCS with Spanish speaking children.Methods & Procedures: In 2011-2012, researchers from the University of Kansas and Centro Ann Sullivan del Perú (CASP) investigated communication in a cohort of 71 young Spanish speaking children with developmental disabilities and a documented history of self-injurious, stereotyped and aggressive behaviors. Communication was assessed first by parental report with translated versions of the Communication and Symbolic Behavior Scales (CSBS), a well-known assessment of early communication, and then eleven months later with the CCS.Hypothesis: We hypothesized that the CCS and CSBS measures would be significantly correlated in this population of Spanish speaking children.Outcomes & Results: The CSBS scores from time 1 with a mean participant age of 41 months were determined to have a strong positive relationship to the CCS scores obtained at time 2 with a mean participant age of 52 months.Conclusions & Implications: The CCS is strongly correlated to a widely accepted measure of early communication. These findings support the validity of the Spanish version of the CCS and demonstrate its usefulness for children from another culture and for children in a Spanish speaking environment
Prevalence, Risk Factors & Survival of Hepatocellular Carcinoma in Sudanese Patients
No full textBackground: Hepatocellular carcinoma (HCC) is among the 10 most common cancers worldwide. Although several studies were conducted in Sudan, the survival of these patients remains unknown.Aim and Settings: Single centre, prospective cohort analysis of patients presenting with HCC. Outcome measures: The clinical presentation, risk factors and patients survival.Method: We prospectively studied 102 patients diagnosed as HCC referred to the NCGLD in the period from January 2003 to January 2005.Results: The mean age of the study group was 44 years with 80% males, 51% were positive for HBsAg and 25% were positive for HCV-Ab. 92% of the patients were Okuda stage II and III, with overall mean survival of five months for Okuda III and six months for Okuda II patients in this study.Conclusion: Hepatitis B and C viruses are the main risk factors for HCC in Sudan. Majority of the patients present at a late stage with poor survival outco
Treatment of Venous Lake with Intralesional Diathermy
No full textVenous lake is a fairly common change that can often be seen on the lower lip. Venous lake can cause bleeding and be a cosmetic nuisance. Here we describe a quick and simple treatment technique using intralesional monopolar diathermy.Background: We describe a simple and effective treatment for patients with venous lakes.Materials and methods: The article is based on non-systematic research found in PubMed and the authors’ own experience.Results: Intralesional diathermy was found to result in a good cosmetic outcome in a patient with venous lake on their upper lip.Interpretation: We describe a simple, fast and safe technique for the removal of venous lakes using intralesional diathermy. The procedure takes a short time and the equipment is less expensive than lasers or surgical interventions. It provides a good cosmetic result. The technique can be an alternative to wedge excisions and it avoids scarring
Mental Health Service Utilization by Referrals from a Helpline for Suicide Prevention in Mumbai, India
No full textBackground: Suicide is a global health problem which is highly underreported and under treated. Though suicide intervention helplines have been studied the pattern of utilization of a suicide helplines by those referred to the facility has not been studied.Methodology: In the present study we have studied the pattern of utilization of a helpline in a community mental health clinic in the city of Mumbai. The study sample was patients who called the helpline and later attended the out patient facility of the clinic. Data was collected in semi-structured format and statistically analyzed using computer software.Results: 15149 calls were received by the helpline. Of the 1391 patients reporting suicidal ideation (59.42%) only 718 opted for psychiatric evaluation. 18.3% of patients with suicidal ideas had a past suicidal attempt while 82.6% had a psychiatric diagnosis. Majority of patients were belonging to psychotic and mood disorder categories. Financial and educational stressors were reported as the main stressors leading to suicidal ideas.Conclusions: A helpline offers definite advantage for patients with suicidal ideation to access mental health services. A helpline is an economical service that serves as a contact point to bring more people at an early stage to mental health care facilities
HBsAg Serconversion is Important but not Sufficient for Clearance of HBV Infection –A Time To Re-Think: A Case Report & Review of Literature.
No full textHepatitis B viral infection is a worldwide problem. About 95% adult recovers from acute infection naturally. Anti HBs is a marker of recovery from acute hepatitis B. Anti HBs is a usually consistent with decline of cccDNA in hepatocytes. However there may be situations where viral rebound occurs due to persistence of cccDNA. This case report depicts such a picture. Measurement of cccDNA is perhaps essential before cure from hepatitis B infection can be declared
Percutaneous Endoscopic Gastro-Jejunostomy (PEGJ): Could Drug Administation be the Only Indication for Insertion? The Levodopa/Carbidopa Infusion Treatment Experience. A Retrospective Evaluation of the Method
No full textEnteral feeding is the preferred means of nutritional support in patients unable to eat normally. Percutaneous endoscopic gastro-jejunostomy (PEGJ) is widely used in such cases. It is also accepted that medication will be administered through the tube. In patients with severe Parkinson’s disease, a continuous delivery system of levodopa/carbidopa, formulated as a gel suspension (Duodopa®), reaches the small intestine through a jejunostomy and represents an alternative treatment method. The continuous release results in less variability in levodopa serum concentrations and fewer motor fluctuations and dyskinesias compared to oral administration. The method requires a very good collaboration between neurologists and gastroenterologists and is used in specializing centers in patients as mentioned with severe disease. A modified percutaneous endoscopic gastrostomy (PEG) kit is placed under sedation. This allows the passage of a pig tail catheter which is advanced to the jejunum and a portable pump is attached on it through a specially designed tubing system. This is the only case, known to us, where PEGJ is inserted for drug administration. We present our experience of nine cases (7 males, 2 females, mean age 72.4 years) with a follow up of up to five years. In three patients the tubing system had to be changed; the first it was accidentally pulled out, the second because of bezoar formation around the intragastric part of the tube and the third because of knot formation at the intragastric part of the jejunal tube. At the end of this five year period, all patients agreed that the neurological benefit was welcome and they had all come in terms with the undoubted difficulties the procedure causes
Prevalence of Psychiatric and Medical Comorbidities in HIVPositive Middle-Aged and Older Adults: Findings From a Nationally Representative Survey
No full textObjective: In order to better serve older individuals with HIV, more information is needed regarding the prevalence of medical and psychiatric comorbidities, and its influence on quality of life within a nationally representative sample. The aims of this study were to assess associations of HIV among middle-aged and older Americans with lifetime Axis I and II psychiatric disorders and suicide attempts, past-year Axis I psychiatric disorders, past-year medical conditions, obesity, and health-related quality of life.Method: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which included 15,456 adults aged 50 and older.Results: Respondents with self-reported HIV were more likely than those without to report any lifetime Axis I disorder, any lifetime anxiety disorder, any lifetime substance and drug use disorder, any past-year Axis I and substance use disorders, hypertension, diabetes, and arthritis. HIV infection was also associated with poorer physical health-related quality of life.Discussion: Middle-aged and older adults with HIV have an increased risk of psychiatric disorders and a number of medical conditions that impair physical but not mental health-related quality of life. Comprehensive and integrated medical treatment should be designed and delivered to this underappreciated but growing group of patients