instruction
stringlengths 246
3.98k
| input
stringlengths 11
329
| output
stringlengths 43
2.08k
| text
stringlengths 110
2.16k
|
|---|---|---|---|
Answer the question based on the following context: The relationship between giant cell lesions (GCLs) of the maxillofacial (MF) skeleton and those of the axial/appendicular (AA) skeleton has been long debated. The present study compared the clinical and radiographic characteristics of subjects with MF and AA GCLs. This was a retrospective cohort study of patients treated for GCLs at Massachusetts General Hospital from 1993 to 2008. The predictor variables included tumor location (MF or AA) and clinical behavior (aggressive or nonaggressive). The outcome variables included demographic, clinical, and radiographic parameters, treatments, and outcomes. Descriptive and bivariate statistics were computed, and P<or= .05 was considered significant. The sample included 93 subjects: 45 with MF (38 with aggressive and 7 with nonaggressive) and 48 with AA (30 with aggressive and 18 with nonaggressive). Comparing the patients with MF and AA GCLs, those with MF lesions presented younger (P<.001), and the lesions were more commonly asymptomatic (P<.001), smaller (P<.001), and managed differently (P<.001) than AA lesions. When stratified by clinical behavior, aggressive tumors were diagnosed earlier than nonaggressive tumors (P<.001). Controlling for location and clinical behavior, patients with MF aggressive lesions were younger (P<.001) than those with AA aggressive lesions. MF nonaggressive lesions were more commonly asymptomatic (P = .04), smaller (P = .05), and less commonly locally destructive (P = .05) than AA nonaggressive lesions. | Maxillofacial and axial/appendicular giant cell lesions: unique tumors or variants of the same disease? | These results suggest that MF and AA GCLs represent a similar, if not the same, disease. Comparing the aggressive and nonaggressive subgroups, more similarities were found than when evaluating without stratification by clinical behavior. The remaining differences could be explained by the likelihood that MF tumors are diagnosed earlier than AA tumors because of facial exposure and dental screening examinations and radiographs. | Question: Maxillofacial and axial/appendicular giant cell lesions: unique tumors or variants of the same disease?
Answer: These results suggest that MF and AA GCLs represent a similar, if not the same, disease. Comparing the aggressive and nonaggressive subgroups, more similarities were found than when evaluating without stratification by clinical behavior. The remaining differences could be explained by the likelihood that MF tumors are diagnosed earlier than AA tumors because of facial exposure and dental screening examinations and radiographs. |
Answer the question based on the following context: To gain insight into the professional characteristics of radiologists in Switzerland and to determine how to enhance the attractiveness of radiology to medical graduates as a specialty. Data from 262 members of the Swiss Society of Radiology (m:f = 76:24%) obtained in a questionnaire survey were analysed regarding socio-demographic variables, working status, specialty, main fields of interest, career success, mentoring and reasons for the shortage of radiologists. 35 (56.4%) female and 85 (45.5%) male radiologists were aged ≤ 45 years. 228 (87%) were board-certified; 44 (17.9%) had completed a sub-specialisation. Men worked part-time mostly just before retirement, while women worked part-time at a younger age. As reasons for specialty choice, the wide range of clinical work and the combination of technology and medicine were ranked highest. Women reported significantly less career success and support. To improve the attractiveness of radiology to graduates, radiology should be visible on medical school curricula. | Specialising in radiology in Switzerland: still attractive for medical school graduates? | In Switzerland, more female radiologists work part-time than male ones, and there is less career success and support for women. In order to make radiology more attractive to medical graduates as a specialty, structured residency programmes and reliable gender-respecting career support are needed. | Question: Specialising in radiology in Switzerland: still attractive for medical school graduates?
Answer: In Switzerland, more female radiologists work part-time than male ones, and there is less career success and support for women. In order to make radiology more attractive to medical graduates as a specialty, structured residency programmes and reliable gender-respecting career support are needed. |
Answer the question based on the following context: In the winter of 2001, we found several cases of transient hyperphosphatasemia (TH) in patients with respiratory syncytial virus (RSV) infection. Therefore, we tried to verify that RSV was one of the causative agents for TH. From November 2001 to January 2002, we diagnosed 94 cases of RSV infection with the detection of virus antigens in the nasal mucus. Among these cases, we found six cases (6.4%) of TH, and all six patients were over one year of age. There were 55 cases of RSV infection in patients over one year of age, and the rate of TH with RSV infection was estimated to be 10.9% in this age group. This rate of TH (6.4%) was significantly higher than rates reported in previous studies (0.33% to 1.5%, p = 0.0145 to p<0.0001). | Is respiratory syncytial virus one of the causative agents for transient hyperphosphatasemia? | We conclude that RSV is one of the causative agents for TH. | Question: Is respiratory syncytial virus one of the causative agents for transient hyperphosphatasemia?
Answer: We conclude that RSV is one of the causative agents for TH. |
Answer the question based on the following context: Biliary tract cancer is uncommon, but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection. We report a patient who developed recurrence 8 years after resection of cholangiocarcinoma. Descriptions of late recurrence after excision of cholangiocarcinoma are reviewed. Few long-term survivors with biliary tract cancer have been reported. The survivors tend to have well differentiated or papillary tumors. The present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation, invasion through the muscle wall and perineural invasion. It has been suggested that tumor cells left after the first operation grow and present as late recurrence. There is a need to differentiate a new primary and field change from recurrence of the previous tumor. | Late recurrence after surgery for cholangiocarcinoma: implications for follow-up? | Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs. The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6% to 43% in different series. Early detection of local recurrence may give an opportunity for further surgical resection. | Question: Late recurrence after surgery for cholangiocarcinoma: implications for follow-up?
Answer: Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs. The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6% to 43% in different series. Early detection of local recurrence may give an opportunity for further surgical resection. |
Answer the question based on the following context: Our aim was to evaluate therapeutic consequences of preoperative staging with Chest X-ray (CXR) in patients with a primary melanoma planned for sentinel node biopsy (SNB). From a prospective database, 248 medical records of patients treated for primary melanoma were extracted. CXRs were made prior to SNB, and examined by radiologists. Results were classified as follows: no metastasis, inconclusive, or suspect for metastasis. Furthermore, changes in planned treatment were recorded. CXR was performed in 227 (92%) cases. In 95% of these patients, the CXR showed no metastasis. In 5%, the CXR was inconclusive; all of these CXR results appeared to be false-positive after complementary radiodiagnostic imaging and/or follow-up. All patients received a SNB. | Is there an indication for routine chest X-ray in initial staging of melanoma? | Preoperative CXR did not identify pulmonary metastasis and did not change planned treatment strategies. We suggest that CXR has no added value in the routine workup of patients with a primary melanoma. | Question: Is there an indication for routine chest X-ray in initial staging of melanoma?
Answer: Preoperative CXR did not identify pulmonary metastasis and did not change planned treatment strategies. We suggest that CXR has no added value in the routine workup of patients with a primary melanoma. |
Answer the question based on the following context: Biocompatible circuits (BCC) are intended to decrease the activation of blood to the artificial cardiopulmonary bypass (CPB) surface. Typically, the coatings are made of various inert substances or molecules physiologically similar to endothelium. Thromboelastography (TEG) graphically represents clot formation, strength of clotting and fibrinolysis. TEG analysis was undertaken to determine if coagulation could be preserved by the BCC. Five different BCC were studied in clinical applications. These five coated circuits were then compared to an identical circuit where only the oxygenator was coated. A pre- and post-bypass TEG was done for comparison. Six well-studied parameters of TEG analysis were compared: R time, angle, K, maximum amplitude (MA), LY30% and Clot Index (CI). Postoperative bleeding and transfusion requirements were compared to TEG results for comparison. All postoperative TEG results were significantly different from preoperative parameters except LY30%. No BCC circuit was able to prevent the significant disruption of the observed TEG coagulation parameters R, K, angle, MA and CI. Of note, the postoperative TEG parameters resulting from the Control and Trillium groups--which had the same type of oxygenator - were practically identical. The oxygenator, which represents the largest surface area in the CPB circuit, is the single most important factor influencing coagulation. | Are any biocompatible coatings capable of attenuating the deleterious effects of cardiopulmonary bypass? | While not harmful, BCC are ineffective in preserving TEG coagulation parameters post CPB. Clinical findings support laboratory TEG results in that there were no differences in bleeding or transfusion requirements between groups. | Question: Are any biocompatible coatings capable of attenuating the deleterious effects of cardiopulmonary bypass?
Answer: While not harmful, BCC are ineffective in preserving TEG coagulation parameters post CPB. Clinical findings support laboratory TEG results in that there were no differences in bleeding or transfusion requirements between groups. |
Answer the question based on the following context: Despite successful surgical correction, morbidity of patients with coarctation of the aorta is increased. It is well known that these patients have impaired elastic properties of the prestenotic arteries. To find out whether these abnormalities are primarily present or develop later, we studied 17 newborns before and early after surgical repair. Aortic wall stiffness index and distensibility were calculated using ascending and abdominal aortic diameters determined by M-mode echocardiography and noninvasive estimation of aortic pulse pressure in the right arm and leg. Seventeen patients with aortic coarctation (mean age, 20+/-26 days) were compared with 17 normal neonates (mean age, 13+/-7 days) preoperatively and postoperatively (10+/-6 days after surgery). Ascending aortic distensibility in patients was significantly reduced preoperatively (79+/-58 versus 105+/-36; P=0.03) and postoperatively (65+/-24 versus 105+/-36; P<0.005). Preoperative and postoperative ascending aortic stiffness index was higher in patients (preoperative, 5.2+/-4.4 versus 2.7+/-0.9; P=0.04; postoperative, 4.0+/-1.6 versus 2.7+/-0.9; P<0.005). Elastic properties of the descending aorta did not differ preoperatively or postoperatively compared with those in normal subjects. | Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? | Elastic properties of the prestenotic aorta of patients with coarctation seem to be impaired primarily, even in neonates, and remain unchanged early after successful operation. Surgical correction does not resolve inborn pathology of the prestenotic aortic vascular bed. | Question: Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries?
Answer: Elastic properties of the prestenotic aorta of patients with coarctation seem to be impaired primarily, even in neonates, and remain unchanged early after successful operation. Surgical correction does not resolve inborn pathology of the prestenotic aortic vascular bed. |
Answer the question based on the following context: Little is known about whether more experience with an electronic health record (EHR) makes it easier for providers to meaningfully use EHRs. To assess whether the length of time that small practice providers have been using the EHR is associated with greater ease in performing meaningful use-related tasks and fewer EHR-related concerns.DESIGN/ We administered a web-based survey to 400 small practice providers in medically underserved communities in New York City participating in an EHR implementation and technical assistance project. We used logistic regression to estimate the association between the length of time a provider had been using the EHR (i.e., "live") and the ease of performing meaningful use-related tasks and EHR-related concerns, controlling for provider and practice characteristics. Compared to providers who had been live 6 to 12 months, providers who had been live 2 years or longer had 2.02 times greater odds of reporting it was easy to e-prescribe new prescriptions (p < 0.05), 2.12 times greater odds of reporting it was easy to e-prescribe renewal prescriptions (p < 0.05), 2.02 times greater odds of reporting that quality measures were easy to report (p < 0.05), 2.64 times greater odds of reporting it was easy to incorporate lab results as structured data (p < 0.001), and 2.00 times greater odds of reporting it was easy to generate patient lists by condition (p < 0.05). Providers who had been live 2 years or longer had 0.40 times lower odds of reporting financial costs were a concern (p < 0.001), 0.46 times lower odds of reporting that productivity loss was a concern (p < 0.05), 0.54 times lower odds of reporting that EHR unreliability was a concern (p < 0.05), and 0.50 times lower odds of reporting that privacy/security was a concern (p < 0.05). | Does it get easier to use an EHR? | Providers can successfully adjust to the EHR and over time are better able to meaningfully use the EHR. | Question: Does it get easier to use an EHR?
Answer: Providers can successfully adjust to the EHR and over time are better able to meaningfully use the EHR. |
Answer the question based on the following context: Prediction and management of drug safety is a global regulatory issue. Safety-related regulatory actions (SRRAs) are taken mostly when unexpected adverse drug reactions occur. Currently, Japan is reconciled to delayed access to new drugs (ie, launch delay compared to Western countries), but may have been benefiting by free-riding on safety data accumulated in other countries prior to Japanese launch. To identify factors that are significantly associated with SRRAs, and to discuss the challenges that Japan might have to face with increasing access to new drugs. The SRRAs of 135 new drugs approved from January 2000 to December 2005 were analyzed to investigate association with launch lag, company and drug characteristics, market size, submission data, and regulatory status. SRRAs were measured in terms of the number of emergency safety information notifications and official safety instructions issued by the Japanese regulatory agency within 3 years after approval. A negative binomial distribution model was used for regression analysis. Longer launch lags and presence of drugs with similar modes of action were associated with fewer SRRAs. Bridging strategy showed increased SRRAs. No significant association was observed between SRRAs and the subject number in clinical data packages. Occurrence of SRRAs was varied among development strategy, preceding products, and regional regulations. | Analysis of pharmaceutical safety-related regulatory actions in Japan: do tradeoffs exist between safer drugs and launch delay? | The occurrence of SRRAs was associated with the accumulation of both foreign and domestic postmarketing evidence rather than with clinical trial data upon launch. Considering the paradigm shift to simultaneous global drug development and filing for regulatory approval, this study indicates the importance of intensive data collection in the early postmarketing phase and use of safety information in early markets. However, even if we would be sufficiently cautious about safety risks of new drugs, a population that enjoys first-in-class drugs probably has to bear the risks. | Question: Analysis of pharmaceutical safety-related regulatory actions in Japan: do tradeoffs exist between safer drugs and launch delay?
Answer: The occurrence of SRRAs was associated with the accumulation of both foreign and domestic postmarketing evidence rather than with clinical trial data upon launch. Considering the paradigm shift to simultaneous global drug development and filing for regulatory approval, this study indicates the importance of intensive data collection in the early postmarketing phase and use of safety information in early markets. However, even if we would be sufficiently cautious about safety risks of new drugs, a population that enjoys first-in-class drugs probably has to bear the risks. |
Answer the question based on the following context: Gastroesophageal reflux disease (GERD) is very common in patients with chronic lung diseases. We evaluated the incidence of GERD in young patients with cystic fibrosis (CF) and defined the characteristics of gastroesophageal reflux episodes analyzed by pH-multichannel intraluminal impedance (pH-MII) and esophagogastric scintigraphy. Since 2010, 31 patients with CF underwent pH-MII. Scintigraphy and upper endoscopy were performed in positive GERD patients. Forced expiratory volume in 1 second (FEV1%) predicted was detected. pH-MII was positive in 17/31 (54.8%) patients (mean age: 12.4 years; range: 4-17 years). pH monitoring detected an average of 64.6 acid reflux events 4.4 episodes>5 minutes in duration. The DeMeester score was 38.5. Impedance identified a mean number of reflux episodes of 66 (65.2% acid; 32% weakly acidic; 2.8% nonacidic), 28% of which reached the proximal esophagus. Esophageal transit and gastric emptying were delayed in 6/13 (46.1%) and in 5/15 (33.3%) cases, respectively. No differences were found in lung function between positive and negative GERD patients (P=0.88). | Cystic fibrosis: a surgical matter? | Pediatric patients with CF have a high incidence of GERD with acidic events. These patients should be investigated with pH-MII and scintigraphy in order to make an early diagnosis and determine the most appropriate follow-up. | Question: Cystic fibrosis: a surgical matter?
Answer: Pediatric patients with CF have a high incidence of GERD with acidic events. These patients should be investigated with pH-MII and scintigraphy in order to make an early diagnosis and determine the most appropriate follow-up. |
Answer the question based on the following context: Percutaneous liver biopsy is the gold standard in the diagnosis and staging of a wide variety of hepatic disorders. Complications, post-procedure monitoring, and recovery time have limited the ability for liver biopsies to be performed in a busy gastroenterology community practice. The aim of this study was to determine whether ambulatory patients requiring percutaneous liver biopsy can be safely discharged after a short recovery time period. All ambulatory patients undergoing a percutaneous liver biopsy at the University of Florida between February 1995 and June 2004 were evaluated in this study. A 15-gauge Jamshidi needle was used after percussion (before February 2002) or ultrasound guidance (starting February 2002). Major complications were defined as those events that required either immediate or delayed hospitalization or resulted in death within 2 weeks after the liver biopsy. Three thousand two hundred fourteen outpatient liver biopsies were performed at our institution from March 1995 to June 2004. During this time, our recovery time was gradually decreased from 6 hours before 1997 to 1 hour in 2002. The majority of the complications occurred within 1 hour of the observation period or within 24 hours after discharge. The major complication rate was<or =1.7%, regardless of the observation period. | Short recovery time after percutaneous liver biopsy: should we change our current practices? | A shorter observation time after ambulatory percutaneous liver biopsy is safe and might facilitate the physician's ability to optimally utilize procedural space and ancillary staff in a busy ambulatory care unit. | Question: Short recovery time after percutaneous liver biopsy: should we change our current practices?
Answer: A shorter observation time after ambulatory percutaneous liver biopsy is safe and might facilitate the physician's ability to optimally utilize procedural space and ancillary staff in a busy ambulatory care unit. |
Answer the question based on the following context: The influence of end-stage kidney failure on the progression of liver disease in patients infected with hepatitis C virus and treated with hemodialysis is still controversial. Liver histology of 154 hepatitis C virus infected non-uremic patients was compared with liver histology of 13 hepatitis C virus infected uremic patients treated with hemodialysis. In either group of altogether 167 patients, no normal liver histology was found. Each patient had at least a low-grade lobular and/or portal inflammation. However, statistically significant differences were observed between hepatitis C virus infected uremic and non-uremic patients in the extent of intralobular changes, portal inflammation, and degree of fibrosis. | Does end-stage kidney failure influence hepatitis C progression in hemodialysis patients? | Non-uremic hepatitis C virus infected patients appear to have more active and progressive liver disease than hepatitis C virus infected patients on hemodialysis. Regular follow-up of uremic patients, associated with earlier detection of hepatitis C virus infection, so as suggested uremia-associated impaired immunoreactivity and increased levels of hepatocyte growth factor described recently, might be implicated in a more favorable course of hepatitis C virus infection in uremic patients. In addition, due to the absence of normal liver histology in either group of hepatitis C virus infected patients, we propose liver biopsy to be mandatory in all these patients, provided that no contraindications exist clinically. | Question: Does end-stage kidney failure influence hepatitis C progression in hemodialysis patients?
Answer: Non-uremic hepatitis C virus infected patients appear to have more active and progressive liver disease than hepatitis C virus infected patients on hemodialysis. Regular follow-up of uremic patients, associated with earlier detection of hepatitis C virus infection, so as suggested uremia-associated impaired immunoreactivity and increased levels of hepatocyte growth factor described recently, might be implicated in a more favorable course of hepatitis C virus infection in uremic patients. In addition, due to the absence of normal liver histology in either group of hepatitis C virus infected patients, we propose liver biopsy to be mandatory in all these patients, provided that no contraindications exist clinically. |
Answer the question based on the following context: The 1997 National Asthma Education and Prevention Program (NAEPP) recommends a severity classification scheme to optimize the use of anti-inflammatory therapy for persistent asthma. Physician documentation of asthma severity is often used as a quality assurance measure. To test the hypothesis that physician documentation of asthma severity is associated with appropriate use of anti-inflammatory therapy. inner-city academic health center. First, we reviewed a consecutive sample of charts of scheduled pediatric patients. Then, we administered a structured parent survey regarding the child's asthma symptoms and current asthma therapy. We used NAEPP guidelines to classify patients' severity of asthma. The main outcome measure was appropriate use of anti-inflammatory therapy. Appropriate therapy was defined as: (1) mild persistent asthmatics using anti-inflammatory therapy, and (2) moderate-severe persistent asthmatics using inhaled steroids. Chart classification of asthma severity was compared with the NAEPP-applied classification. Of 784 charts, 214 (27%) were asthmatic. Of these, 176 (82%) were surveyed. The mean age was 7.4 years; 61% were males. Severity classification was documented in 77% of charts. Chart documentation differed significantly from survey classification for the same patients: (mild intermittent 54% vs. 40%, mild persistent 21% vs. 14%, moderate persistent 24% vs. 36%, severe persistent 1% vs. 10%; all p<.001). Correctly classified patients were more likely to be on appropriate therapy. | Documenting asthma severity: do we get it right? | Physicians underestimated the severity classification of asthmatic patients. Incorrect classification was associated with inappropriate asthma therapy. These findings have implications for the institution of asthma quality improvement programs. | Question: Documenting asthma severity: do we get it right?
Answer: Physicians underestimated the severity classification of asthmatic patients. Incorrect classification was associated with inappropriate asthma therapy. These findings have implications for the institution of asthma quality improvement programs. |
Answer the question based on the following context: Some authorities are concerned that the use of complementary and alternative medications (CAM) may replace recommended preventive health practices. This study was done to determine if users of individual types of CAM were less likely to receive recommended immunizations. We used data from the 2007 National Health Interview Survey of over 23,000 adult, non-institutionalized U.S. citizens using bivariate and multivariate analysis to determine if users of individual types of CAM were less likely to receive influenza and/or pneumococcal vaccinations. Using a weighted logistic regression analysis, we found that respondents who used chiropractic care were less likely to receive flu shots (OR=0.68, CI=0.55,0.83, p<0.001). There was a mildly positive trend toward receiving the pneumococcal vaccine in users of deep breathing exercises and toward not receiving both in followers of qi gong. Prayer use was prevalent and had a positive impact on receiving immunizations, especially in Blacks and those in poor health. Regular exercise, having a primary care provider and more frequent office visits were also positively associated with receiving immunizations. | Are those who use specific complementary and alternative medicine therapies less likely to be immunized? | Chiropractic users are less likely to get flu shots, perhaps reflecting their national body's attitude, which could affect morbidity and mortality. Providers should be aware of their patients' CAM use and encourage accepted primary care practices. | Question: Are those who use specific complementary and alternative medicine therapies less likely to be immunized?
Answer: Chiropractic users are less likely to get flu shots, perhaps reflecting their national body's attitude, which could affect morbidity and mortality. Providers should be aware of their patients' CAM use and encourage accepted primary care practices. |
Answer the question based on the following context: Previous studies have indicated that the startle reflex is potentiated by phasic, but not by tonic, heat pain, although the latter is seen as more strongly associated with emotional responses and more similar to clinical pain. The threat value of pain might be a decisive variable, which is not influenced alone by stimulus duration. This study aimed at comparing startle responses to tonic heat pain stimulation with varying degrees of threat. We hypothesized that the expectation of unpredictable temperature increases would evoke higher threat and thereby potentiate startle compared with the expectation of constant stimulation. Healthy, pain-free subjects (n = 40) underwent painful stimulation in two conditions (low/high threat) in balanced order. The only difference between the two conditions was that in the high-threat condition 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle tones were presented prior to this temperature increase still in the phase of anticipation. We observed startle potentiation in the high-threat compared with the low-threat condition, but only in those participants who took part first in the high-threat condition. Habituation could not account for these findings, as we detected no significant decline of startle responses in the course of both conditions. | Modulation of the startle reflex by heat pain: does threat play a role? | Our results suggest that subjective threat might indeed be decisive for the action of pain on startle; the threat level appears not only influenced by actual expectations but also by previous experiences with pain as threatening or not. | Question: Modulation of the startle reflex by heat pain: does threat play a role?
Answer: Our results suggest that subjective threat might indeed be decisive for the action of pain on startle; the threat level appears not only influenced by actual expectations but also by previous experiences with pain as threatening or not. |
Answer the question based on the following context: Conventional wisdom regarding exposures to persistent organic chemicals via breast-feeding assumes that concentrations decline over the course of lactation and that the mother's body burden reflects her cumulative lifetime exposure. Two important implications stemming from these lines of thought are, first, that assessments of early childhood exposures should incorporate decreasing breast milk concentrations over lactation; and, second, that there is little a breast-feeding mother can do to reduce her infant's exposures via breast-feeding because of the cumulative nature of these chemicals. We examined rates of elimination and milk/serum partition coefficients for several groups of persistent organic chemicals. We collected simultaneous milk and blood samples of 10 women at two times postpartum and additional milk samples without matching blood samples. Contrary to earlier research, we found that lipid-adjusted concentrations of polybrominated diphenyl ethers, polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins and furans, and organochlorine pesticides in serum and milk do not consistently decrease during lactation and can increase for some women. Published research has also suggested an approximate 1:1 milk/serum relationship (lipid adjusted) on a population basis for 2,3,7,8-tetrachlorodibenzo-p-dioxin; however, our results suggest a more complex relationship for persistent, lipophilic chemicals with the milk/serum relationship dependent on chemical class. | Do human milk concentrations of persistent organic chemicals really decline during lactation? | Decreases in concentration of lipophilic chemicals on a lipid-adjusted basis during lactation should no longer be assumed. Thus, the concept of pumping and discarding early milk as means of reducing infant exposure is not supported. The hypothesis that persistent lipophilic chemicals, on a lipid-adjusted basis, have consistent concentrations across matrices is likely too simplistic. | Question: Do human milk concentrations of persistent organic chemicals really decline during lactation?
Answer: Decreases in concentration of lipophilic chemicals on a lipid-adjusted basis during lactation should no longer be assumed. Thus, the concept of pumping and discarding early milk as means of reducing infant exposure is not supported. The hypothesis that persistent lipophilic chemicals, on a lipid-adjusted basis, have consistent concentrations across matrices is likely too simplistic. |
Answer the question based on the following context: To assess criterion validity of a survey that uses contingent valuation to elicit estimates of client willingness-to-pay (WTP) higher prices for family planning and reproductive health services in three developing countries. Criterion validity was assessed at the individual client level and at the aggregate service level. Individual-level validity was assessed using a longitudinal approach in which we compared what women said they would do with their actual utilization behavior following a price increase. Aggregate-level validity was assessed using predictions derived from cross-sectional surveys and comparing these with actual utilization data. Phi coefficients and correlation statistics were calculated for individual and aggregate-level analyses, respectively. None of the three individual-level cohorts exhibited statistically significant relationships between predicted and actual WTP. Approximately 70% of clients returned for follow-up care after the price increase, regardless of their responses on the WTP survey. For the aggregate analysis the correlation coefficient between predicted and actual percentage change in demand was not significant. Many clinics experienced higher demand after prices increased, suggestive of shifting demand curves. | Predicting impact of price increases on demand for reproductive health services: can it be done well? | A validated technique for predicting utilization subsequent to a price increase would be highly useful for program managers. Our individual and aggregate-level results cast doubt on the usefulness of WTP surveys for this purpose. | Question: Predicting impact of price increases on demand for reproductive health services: can it be done well?
Answer: A validated technique for predicting utilization subsequent to a price increase would be highly useful for program managers. Our individual and aggregate-level results cast doubt on the usefulness of WTP surveys for this purpose. |
Answer the question based on the following context: To study the efficacy of pattern deviation (PD) values in the estimation of visual field compensating the influence of cataract in eyes with glaucoma. The study subjects comprised of 48 eyes of 37 glaucoma patients. Mean total deviation value (mTDs) on Humphrey Field Analyzer after cataract surgery was compared with mean PD (mPD) before the surgery. Visual field measurements were carried out ≤6 months before (VF(pre)) and following (VF(post)) successful cataract surgery. The difference between the mPD or mTD values in the VF(pre) and mTD values in the VF(post) (denoted as εmPD/ΔmTD) was calculated, and the influence of the extent of 'true' glaucomatous visual field damage or cataract (as represented by εmPD and ΔmTD, respectively) on this difference was also investigated. There was a significant difference between mTD in the VF(pre) and mTD in the VF(post) (p<0.001, repeated measures analysis of variance). There was not a significant difference between mPD in the VF(pre) and mTD in the VF(post) (p=0.06); however, εmPD was significantly correlated with the mTD in VF(post) and also ΔmTD (R(2)=0.56 and 0.27, p<0.001, Pearson's correlation). The accurate prediction of the mTD in the VF(post) can be achieved using the pattern standard deviation (PSD), mTD and also visual acuity before surgery. | Do pattern deviation values accurately estimate glaucomatous visual field damage in eyes with glaucoma and cataract? | Clinicians should be very careful when reviewing the VF of a patient with glaucoma and cataract since PD values may underestimate glaucomatous VF damage in patients with advanced disease and also overestimate glaucomatous VF damage in patients with early to moderate cataract. | Question: Do pattern deviation values accurately estimate glaucomatous visual field damage in eyes with glaucoma and cataract?
Answer: Clinicians should be very careful when reviewing the VF of a patient with glaucoma and cataract since PD values may underestimate glaucomatous VF damage in patients with advanced disease and also overestimate glaucomatous VF damage in patients with early to moderate cataract. |
Answer the question based on the following context: In Pakistan approximately 5.7 million people suffer from tuberculosis, with 260 000 new cases occurring every year. This study was conducted in an outpatient hospital setting in Karachi. To explore the level of awareness about tuberculosis amongst patients and their families, and recommend strategies for increasing understanding of the disease. Descriptive cross-sectional survey based on a structured questionnaire using convenience sampling. Of the 203 patients interviewed, 131 were males. Nearly 82% knew that tuberculosis is contagious and 78% were aware that lungs are commonly affected. Almost half knew that it spreads by droplets and causes cough and that treatment is long and costly. With regard to commonly affected age and sex, however, respectively only 43% and 23% had the correct knowledge. Less than one third could identify appropriate risk factors and ways to cure and limit spread. Almost half considered tuberculosis to be a social stigma. Media emerged as the main source of information. Respondents with more than 12 years of formal education were more likely to have better knowledge. | Tuberculosis: do we know enough? | Further population-based studies are recommended. Misconceptions about tuberculosis need to be removed through focused health education messages. The importance of complete and appropriate treatment needs to be emphasised. | Question: Tuberculosis: do we know enough?
Answer: Further population-based studies are recommended. Misconceptions about tuberculosis need to be removed through focused health education messages. The importance of complete and appropriate treatment needs to be emphasised. |
Answer the question based on the following context: Intrahepatic biliary strictures or parenchymal infarcts may occur after liver transplantation as a complication of ischemic damage to the graft. In some selected cases the lesions appear to be confined to a part of the liver. We report our experience with partial graft resection in this setting. From January 1984 to December 1991, 286 liver transplantations were performed in 257 recipients. Seven patients, three children and four adults, underwent partial hepatectomy 3 to 218 weeks after liver transplantation of a full-size graft. The clinical presentation included septic parenchymal infarcts (n = 4) and nonanastomotic biliary strictures (n = 3) complicating (n = 5) artery thrombosis or not (n = 2). There were four left hepatectomies, two left lobectomies, and one right hepatectomy. In four instances partial hepatectomy was performed after failed attempt at biliary reconstruction (n = 2) or arterial revascularization (n = 2). Partial graft resection was performed extrafascially without Pringle's maneuver and mobilization of the remnant liver to preserve its vascularization. No surgical complications occurred, and none of the patients experienced acute hepatic failure during the postoperative period. All patients were discharged home 10 to 96 days (median, 23 days) after liver resection. Two patients had recurrent ischemic cholangitis. One patient underwent successful regrafting for recurrent Budd-Chiari syndrome; one patient died of tumor recurrence. Six patients were alive with a follow-up ranging from 12 to 45 months. | Partial hepatic resection for ischemic graft damage after liver transplantation: a graft-saving option? | These results suggest that partial graft resection is a safe and graft-saving option after liver transplantation in selected patients with localized ischemic damage of the graft. | Question: Partial hepatic resection for ischemic graft damage after liver transplantation: a graft-saving option?
Answer: These results suggest that partial graft resection is a safe and graft-saving option after liver transplantation in selected patients with localized ischemic damage of the graft. |
Answer the question based on the following context: The Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has been published in 2008 as the successor of the original UPDRS. The MDS-UPDRS organizing team developed guidelines for the development of official non-English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new MDS-UPDRS and its validation process into Hungarian. Two independent groups of neurologists translated the text of the MDS-UPDRS into Hungarian and subsequently back-translated into English. After the review of the back-translated English version by the MDS-UPDRS translation administration team, cognitive pretesting was conducted with ten patients. Based on the results of the initial cognitive pretesting, another round was conducted. For the large field testing phase, the Hungarian official working draft version of MDS-UPDRS was tested with 357 patients with Parkinson's disease (PD). Confirmatory factor analyses (CFA) determined whether the factor structure for the English-language MDS-UPDRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥ 0.90 compared to the English-language version. For all four parts of the Hungarian MDS-UPDRS, the CFI was ≥ 0.94. | VALIDATION OF THE HUNGARIAN MDS-UPDRS: WHY DO WE NEED A NEW PARKINSON SCALE? | The overall factor structure of the Hungarian version was consistent with that of the English version based on the high CFIs for all the four parts of the MDS-UPDRS in the CFA; therefore, this version was designated as the "OFFICIAL GUNGARIAN VERSION OF THE MDS-UPDRS'. | Question: VALIDATION OF THE HUNGARIAN MDS-UPDRS: WHY DO WE NEED A NEW PARKINSON SCALE?
Answer: The overall factor structure of the Hungarian version was consistent with that of the English version based on the high CFIs for all the four parts of the MDS-UPDRS in the CFA; therefore, this version was designated as the "OFFICIAL GUNGARIAN VERSION OF THE MDS-UPDRS'. |
Answer the question based on the following context: Mastectomy with axillary lymph node dissection (ALND) represents the gold standard in the treatment of male breast carcinoma. Recently, data have emerged supporting that sentinel lymph node biopsy (SNB) may be feasible in selected patients. The aim of this study was to analyze the safety and prognostic reliability of SNB in male patients with breast carcinoma and clinically negative axilla. During a 10-year period (2000-2010), 11 men with mean age 66.1 years (range 34-84) diagnosed with breast carcinoma were retrospectively included to our study. All patients underwent SNB. Regardless of the SNB results, completion axillary clearance was conducted in all cases. SNB detection rate was 100%, while the mean number of sentinel nodes removed was 1.5 +/- 0.7 (range 1-2). Frozen section analysis revealed a negative sentinel node in four out of 11 patients (36.4%). Independently of these results, all patients underwent completion ALND. The overall false-negative rate, defined as the percentage of all node-positive tumors in which the SNB was negative, was 0%. | Sentinel node biopsy in male breast carcinoma: is the "female" approach justified? | The current study indicates that SNB may be feasible in selected male individuals with breast carcinoma. The technique may reduce the morbidity related to dissection of the axilla; prospective multicenter trials are needed in order to define the exact criteria for wider application of this technique. | Question: Sentinel node biopsy in male breast carcinoma: is the "female" approach justified?
Answer: The current study indicates that SNB may be feasible in selected male individuals with breast carcinoma. The technique may reduce the morbidity related to dissection of the axilla; prospective multicenter trials are needed in order to define the exact criteria for wider application of this technique. |
Answer the question based on the following context: Parks are important for providing opportunities for physical activity among youth. Apart from engaging in physical activity whilst visiting a park, active transportation (e.g. walking or cycling) to parks is potentially an additional source of physical activity. Previous research has shown that a major barrier to young people visiting parks is their inability to visit parks unaccompanied by an adult. It is not known; however, whether young people who have greater independent mobility and territorial range (ability to move around their neighbourhood alone or with friends, unaccompanied by an adult) are more likely to visit parks. This study examined park visitation and travel mode to parks and whether independent mobility and territorial range were associated with park visitation among youth living in disadvantaged areas of Victoria, Australia. In 2010-11, 311 youth aged 8-16 years self-reported their park use, active transport, independent mobility to parks, and territorial range. Logistic regression models determined the odds of park visitation (once per week or more) according to independent mobility and territorial range, adjusting for key covariates. Overall, 75% of participants reported visiting parks, and 37% visited their 'usual' park at least once per week. Of those who reported visiting parks, 87% travelled to the park they usually visited using active transport: 57% walked, 22% cycled, and 8% used a scooter/skateboard. Just 15% and 13% of youth regularly walked or cycled alone to parks/playgrounds respectively, and 25% and 19% regularly walked or cycled with friends or siblings (no adults) respectively. For the 84% who reported having parks/playgrounds within walking distance from home, those who regularly walked alone to parks (OR 3.61; CI=1.67, 7.80), and regularly walked (OR 2.27; CI=1.14, 4.55) or cycled (OR 3.38; CI=1.73, 6.62) with friends to parks, were significantly more likely to visit a park at least once per week, compared to others. | Are independent mobility and territorial range associated with park visitation among youth? | This study showed that active transport is frequently used by this sample of young people to travel to parks. Findings also highlight the potential importance of providing opportunities for youth aged 8-16 years to visit local parks independent of an adult. | Question: Are independent mobility and territorial range associated with park visitation among youth?
Answer: This study showed that active transport is frequently used by this sample of young people to travel to parks. Findings also highlight the potential importance of providing opportunities for youth aged 8-16 years to visit local parks independent of an adult. |
Answer the question based on the following context: Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS. The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as "no improvement", "worse" or "much worse" on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported "a little improvement", "improved" and "very much improved" on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared. A total of 236 women were identified for the study. Of these, 24 women (10.2 %) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm H2O, which was significantly lower in group 1 (poor outcome 37.05 cm H2O) compared with a mean MUCP of 50.6 cm H2O in group 2 (good outcome; p = 0.005). | Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? | We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure. | Question: Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence?
Answer: We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure. |
Answer the question based on the following context: We compared prostate cancer detection rates for the 2 most commonly used transrectal ultrasound prostate biopsy probes, end fire and side fire, to determine whether the probe configuration affects detection rates. We evaluated 2,674 patients who underwent initial prostate biopsy between 2000 and 2008 with respect to prostate specific antigen, biopsy technique and pathological findings. Patients were divided into 1,124 in whom biopsies were performed with an end fire probe and 1,550 in whom biopsies were performed with a side fire probe. There was a significant difference in the overall cancer detection rate in the end vs side fire arms (45.8% vs 38.5%, p<0.001). In the subsets of patients with prostate specific antigen greater than 4 to 10 ng/ml or less and greater than 10 ng/ml a significant difference persisted (46.4% vs 38.9% and 61.7% vs 49.1%, p<0.004 and<0.015, respectively). There was also a significant difference in detection rates between probes in those who underwent 8 to 19 biopsy cores (p<0.009). Biopsies of greater than 20 cores failed to attain statistical significance (p>0.105). We also found that prostate volume, patient age, prostate specific antigen and hypoechoic findings were independent variables for predicting cancer detection on multivariate analysis (p<0.001). | Does transrectal ultrasound probe configuration really matter? | The type of probe significantly affects the overall prostate cancer detection rate, particularly in patients with prostate specific antigen greater than 4 ng/ml and/or nonsaturation (8 to 19 cores) prostate biopsy. This may be because the end fire probe allows better mechanical sampling of the lateral and apical regions of the peripheral zone, where cancer is most likely to reside. We set the stage for a randomized, controlled trial to confirm our observations. | Question: Does transrectal ultrasound probe configuration really matter?
Answer: The type of probe significantly affects the overall prostate cancer detection rate, particularly in patients with prostate specific antigen greater than 4 ng/ml and/or nonsaturation (8 to 19 cores) prostate biopsy. This may be because the end fire probe allows better mechanical sampling of the lateral and apical regions of the peripheral zone, where cancer is most likely to reside. We set the stage for a randomized, controlled trial to confirm our observations. |
Answer the question based on the following context: Flexible flatfoot, as the most prevalent foot deformity in pediatric population still has no standardized strategy for its management hence some orthopedic surgeons have the tendency to use orthotic devices. The objective of this study is to evaluate whether orthotic shoes effect the natural course of the developing medial longitudinal arch in children diagnosed with moderate flexible flatfoot. Fourty-five children (33 boys and 12 girls) with moderate flexible flatfoot were enrolled in this study. They were followed up for 34.6 ± 10.9 months (24-57 months). Patients in group 1 were treated with corrective shoes whereas group 2 was left untreated. Patients were evaluated according to; general joint laxity, arch index, lateral talo-first metatarsal (TM), talo-horizontal (TH), calcaneal pitch (CP), lateral and anterior talocalcaneal (TC) angles. Although there was a significant decrease in general laxity in both groups, decrease of laxity percentage was not significant between groups (p = 0.812). TM, TH and anterior TC angles were found to be decreased in groups whereas there was no difference between group 1 and 2. The arch index was found to be correlated with TM and TH angles in both groups (p = 0.004, p = 0.013). | Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet? | Corrective shoes for flexible flatfoot was found not effective on development of foot arches. Therefore, they should be limited only for selected cases. | Question: Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet?
Answer: Corrective shoes for flexible flatfoot was found not effective on development of foot arches. Therefore, they should be limited only for selected cases. |
Answer the question based on the following context: The authors would like to present the problem of performing bedside tracheotomy in the Intensive Care Unit. The tracheotomy have been done in the highly specific group in poor or fatal general condition, so the complication rate according to the general status of the patients is discussed. 92 patients were treated with tracheotomy between I 2003-XII 2005 and in this number 13 complications occurred. The general status of the patients (shock, stroke, sepsis, pneumonia, hypoalbuminemy) in the time of procedure was taken into consideration. In early complications dominated the bleeding--in 7 patients (7.9%) and wound infections--in 4 patients. Tracheal strictures, the only late complication found in our group, were stated during the follow up period in 2 patients (1.1%). The time of performing the tracheotomy i.e. day of the intubation (range from 0-13; mean--5.7) and day of the decaniulation (range from 3-65; mean--16) were analyzed. | Tracheotomy as a bedside procedure in the Intensive Care Unit: is it safe? | Tracheotomy performed in the Intensive Care Unit as a bedside procedure is safe, quick and effective. Complication rate in the group of patients in poor general condition is comparable both to the average population and to the percutaneous technique. | Question: Tracheotomy as a bedside procedure in the Intensive Care Unit: is it safe?
Answer: Tracheotomy performed in the Intensive Care Unit as a bedside procedure is safe, quick and effective. Complication rate in the group of patients in poor general condition is comparable both to the average population and to the percutaneous technique. |
Answer the question based on the following context: Dedifferentiation of thyroid cancer leads to an inability of thyroid cells to concentrate iodine. In these cases, imaging methods that allow an accurate detection of recurrence and/or metastases at an early stage are essential for an adequate management of patients. Positron emission tomography using [18F]-2-fluoro-2-deoxy-d-glucose and a dedicated (dPET-FDG) or non-dedicated (nPET-FDG) camera has been suggested as a potential tool for the detection of tumour foci. This prospective study was undertaken to evaluate nPET-FDG in 51 consecutive patients (18 men, 33 women) with differentiated thyroid cancer (33 papillary, 11 follicular, four insular and three oncocytic (Hurthle-cell) thyroid carcinomas). Selection criteria were high thyroglobulin (Tg) levels (>10 ng/ml off-levothyroxine treatment) and no detectable radioiodine uptake, on a whole body scan performed with a high dose, in the absence of iodine contamination. Results were interpreted in terms of assumed presence of tumoral tIssue. Sensitivity of nPET-FDG was similar to that of conventional imaging modalities (67%). False negative nPET-FDG (n=16) were observed mostly in cases of micro-lesions (lymph nodes or lung metastases). Conversely, nPET-FDG identified new tumoral sites in 11 cases. Better sensitivity was found for nPET-FDG in patients with Tg levels higher than 15 microg/l (P<0.05). On a patient basis, results of nPET-FDG were equivalent to that of dPET-FDG. Finally, nPET-FDG changed treatment strategy in seven patients. | Is [18F]-2-fluoro-2-deoxy-d-glucose (FDG) scintigraphy with non-dedicated positron emission tomography useful in the diagnostic management of suspected metastatic thyroid carcinoma in patients with no detectable radioiodine uptake? | nPET-FDG has a high sensitivity for the detection of tumour sites in patients when pathological iodine uptake cannot be demonstrated and appears to be a useful method in patients with elevated Tg levels, especially when dedicated PET is either unavailable or impractical. | Question: Is [18F]-2-fluoro-2-deoxy-d-glucose (FDG) scintigraphy with non-dedicated positron emission tomography useful in the diagnostic management of suspected metastatic thyroid carcinoma in patients with no detectable radioiodine uptake?
Answer: nPET-FDG has a high sensitivity for the detection of tumour sites in patients when pathological iodine uptake cannot be demonstrated and appears to be a useful method in patients with elevated Tg levels, especially when dedicated PET is either unavailable or impractical. |
Answer the question based on the following context: To evaluate the effectiveness of the self-expanding Wallstent in the treatment of benign biliary strictures. Twenty patients with benign biliary strictures were included in this retrospective study. Seven patients had chronic pancreatitis, two had fibrous papillary stenosis, one had primary sclerosing cholangitis, and 10 had postsurgical strictures, including four who had a stenosed bilidigestive anastomosis. Primary and secondary patency of the stents and clinical outcome after stent insertion were evaluated. Stent placement was successful in all patients. At the end of the observation period, which lasted 3-78 months (mean, 31.2 months +/- 4.5 [standard error]), 10 patients were alive. Median primary patency was 32 months +/- 8.7. In 10 patients, patency was preserved during the observation period (two with secondary patency). Six patients had a good clinical result. Among the other four patients, one had recurrent cholangitis, one had a biliary abscess, and two had stent revisions. In the other patients, stents became occluded after 3-55 months. The reason for stent occlusion was a stone in one patient; in the others, the causes were not proved. | Benign biliary obstruction: is treatment with the Wallstent advisable? | Results of stent placement for treatment of benign biliary strictures are not encouraging. However, the patient population is too limited to allow final conclusions. | Question: Benign biliary obstruction: is treatment with the Wallstent advisable?
Answer: Results of stent placement for treatment of benign biliary strictures are not encouraging. However, the patient population is too limited to allow final conclusions. |
Answer the question based on the following context: Our goal was to determine whether spleen or muscle can be used as a qualitative standard of reference for diagnosing fatty infiltration of liver on contrast-enhanced CT. Qualitative visual comparisons and quantitative region-of-interest measurements of liver, spleen, and muscle were made on scans of 96 patients who underwent dynamic CT before and after injection of intravenous contrast material. As the standard of reference, the portion of liver assessed was considered fatty if its attenuation measured less than spleen on noncontrast CT. In 16 (17%) scans, the portion of liver assessed was fatty on noncontrast CT. After contrast material administration, the attenuation of that portion of liver measured less than splenic attenuation in 93 (97%) of 96 cases (including all 16 fatty livers). Only four (25%) fatty livers, and no nonfatty livers, were visually judged to be less attenuating than muscle after contrast material; these four were the most fatty shown on noncontrast CT. Comparing hepatic and splenic attenuation on postcontrast CT resulted in a specificity of 30% and a positive predictive value of 20%; comparing hepatic and muscle attenuation on postcontrast CT yielded corresponding values of 100 and 100% but a sensitivity of 25%. | Qualitative assessment of liver for fatty infiltration on contrast-enhanced CT: is muscle a better standard of reference than spleen? | For the visual assessment of fatty liver, spleen is not an accurate reference standard on contrast-enhanced CT. However, fatty liver can be diagnosed on contrast-enhanced CT if liver appears less attenuating than muscle-a situation that occurs only if fatty infiltration is pronounced. | Question: Qualitative assessment of liver for fatty infiltration on contrast-enhanced CT: is muscle a better standard of reference than spleen?
Answer: For the visual assessment of fatty liver, spleen is not an accurate reference standard on contrast-enhanced CT. However, fatty liver can be diagnosed on contrast-enhanced CT if liver appears less attenuating than muscle-a situation that occurs only if fatty infiltration is pronounced. |
Answer the question based on the following context: Six health districts selected from a total of 53 in Burkina Faso. To evaluate the performance of the health services in identifying infectious pulmonary tuberculosis (PTB) cases in Burkina Faso. Retrospective review of initial consultation registers in the first level health centres and the laboratory and treatment registers kept at the Centres for TB Diagnosis and Treatment (CDTs) in 2001. The rate of detection of sputum-positive cases of PTB was 11.7 cases per 100000 population. Cough was the reason for consulting for 10.6% of 248,730 adults; 1.1% had chronic cough. Among patients with chronic cough, 66% had been referred for smear microscopy, 69.7% of whom were registered at the CDT to which they were referred. A positive diagnosis was made in 22.5% of the suspects referred and traced to the CDT. Among those with a positive diagnosis, 87.1% were put on treatment in the same CDT. | Are patients who present spontaneously with PTB symptoms to the health services in Burkina Faso well managed? | The PTB case detection rate in Burkina Faso is low, due to the loss of cases at each of the stages leading to the diagnosis of TB. Case detection depends on the operational effectiveness of the staff working in the health services, as well as the referral of suspect patients to the CDT. | Question: Are patients who present spontaneously with PTB symptoms to the health services in Burkina Faso well managed?
Answer: The PTB case detection rate in Burkina Faso is low, due to the loss of cases at each of the stages leading to the diagnosis of TB. Case detection depends on the operational effectiveness of the staff working in the health services, as well as the referral of suspect patients to the CDT. |
Answer the question based on the following context: The present study aimed at evaluating the prognostic value of transcranial Doppler ultrasonography (TCD) in the acute phase of ischemic stroke, when major therapeutic decisions must be made. Seventy-three patients with a first-ever ischemic hemispheric stroke underwent neurological assessment according to the Unified Neurological Stroke Scale, clinical subgrouping according to the criteria of Bamford, CT scan, cervical duplex sonography, and TCD, all within 12 hours from stroke onset. TCD was repeated on days 2 and 7. Patients were followed for 90 days, during which we calculated the fatality rate and then assessed clinical outcome. Emergency TCD revealed middle cerebral artery (MCA) no-flow in 24 cases and MCA asymmetry in 30 subjects. Serial TCD showed early (<24 hours) MCA recanalization in 6 patients. After 90 days, no patient with MCA occlusion at admission was autonomous, while 17 of 19 patients (89.5%) with a normal baseline TCD were independent. The fatality rate at 3 months was 21% but was 46% in patients with MCA occlusion and 61% in patients without signs of early MCA recanalization. Total anterior circulation infarct and abnormal TCD were significantly correlated (P:<0.001) with higher mortality rate and worse outcome (Barthel Index score</=60), whereas early CT ischemic signs and severe carotid disease were not. Furthermore, TCD identified within the total anterior circulation infarct subgroup 2 prognostic clusters according to MCA patency at admission (P:<0.001). Logistic regression selected normal baseline TCD as an independent predictor of good long-term outcome and MCA no-flow as an independent predictor of disability or death. | The quest for early predictors of stroke evolution: can TCD be a guiding light? | TCD findings play an important role in the early prognosis of anterior circulation stroke, providing possible guidance for therapeutic interventions. | Question: The quest for early predictors of stroke evolution: can TCD be a guiding light?
Answer: TCD findings play an important role in the early prognosis of anterior circulation stroke, providing possible guidance for therapeutic interventions. |
Answer the question based on the following context: To evaluate the presence of lymphocyte aggregates in synovial tissue of patients with early arthritis in relationship to clinical outcome and to determine whether this is a stable feature over time. Arthroscopic synovial biopsy samples were collected in a prospective cohort of disease-modifying antirheumatic drug-naïve patients with early arthritis (<1 year's disease duration) at baseline (n=93) and, if rheumatoid arthritis was suspected, after 6 months of follow-up (n=17). After 2 years of follow-up, definitive diagnosis and clinical outcome were assessed. Size of synovial lymphocyte aggregates was graded (score 1-3). Lymphoid neogenesis (LN) was defined by the presence of grade ≥2 aggregates and subclassified based on the presence of follicular dendritic cells (FDCs). LN was present in 36% of all patients and FDCs in 15% of patients with LN. Presence of lymphocyte aggregates differed over time. LN was associated with the degree of synovial inflammation. There was no relationship between the presence of lymphocyte aggregates at baseline and definitive diagnosis or clinical outcome after follow-up. | Presence of lymphocyte aggregates in the synovium of patients with early arthritis in relationship to diagnosis and outcome: is it a constant feature over time? | Presence of lymphocyte aggregates is a dynamic phenomenon related to the degree of synovitis and can be detected in different forms of early arthritis. This feature does not appear to be related to clinical outcome. | Question: Presence of lymphocyte aggregates in the synovium of patients with early arthritis in relationship to diagnosis and outcome: is it a constant feature over time?
Answer: Presence of lymphocyte aggregates is a dynamic phenomenon related to the degree of synovitis and can be detected in different forms of early arthritis. This feature does not appear to be related to clinical outcome. |
Answer the question based on the following context: To assess the outcome of men presenting with lower urinary tract symptoms (LUTS) associated with large postvoid residual urine volumes (PVR). The study included men presenting with LUTS and a PVR of>250 mL who, because of significant comorbidity, a low symptom score or patient request, were managed conservatively and prospectively, and were followed with symptom assessment, serum creatinine levels, flow rates and renal ultrasonography. Patients were actively managed if there was a history of previous outflow tract surgery, prostate cancer, urethral strictures, neuropathy, elevated creatinine or hydronephrosis. In all, 93 men (mean age 70 years, range 40-84) with a median (range) PVR of 363 mL (250-700) were included in the study and followed for 5 (3-10) years. At presentation, the median maximum flow rate was 10.2 (3-30) mL/s and the voided volume 316 (89-714) mL. The measured PVR remained stable in 47 (51%), reduced in 27 (29%) and increased in 19 (20%) patients; 31 patients (33%) went on to transurethral resection of the prostate after a median of 30 (10-120) months, because of serum creatinine elevation (two), acute retention (seven), increasing PVR (eight) and worsening symptoms (14). Of 31 patients 25 were available for evaluation after surgery; their median PVR was 159 (0-1000) mL, flow rate 18.4 (4-37) mL/s and voided volume 321 (90-653) mL. Symptoms were improved in all but five men. There was no difference in initial flow rate, voided volume or PVR between those who developed complications or went on to surgery and those who did not. Urinary tract infections (UTIs) occurred in five patients and two developed bladder stones. | Is the conservative management of chronic retention in men ever justified? | Complications such as renal failure, acute retention and UTIs are uncommon in men with large, chronic PVRs. Conservative management for this group of patients is reasonable but outpatient review is prudent. There were no factors that could be used to predict those patients who eventually required surgery. | Question: Is the conservative management of chronic retention in men ever justified?
Answer: Complications such as renal failure, acute retention and UTIs are uncommon in men with large, chronic PVRs. Conservative management for this group of patients is reasonable but outpatient review is prudent. There were no factors that could be used to predict those patients who eventually required surgery. |
Answer the question based on the following context: Perhexiline, originally used as a first-line prophylactic antianginal agent, is now regarded primarily as a treatment for otherwise refractory myocardial ischemia. Recent studies have also demonstrated its short-term utility in heart failure, hypertrophic cardiomyopathy, and inoperable aortic stenosis. Its benefits on myocardial energetics state are potentially counter-balanced by risk of hepatotoxicity and peripheral neuropathy during long-term treatment if drug accumulation occurs. Since perhexiline exhibits complex pharmacokinetics with wide inter-individual variability, its long-term use requires regular plasma concentration monitoring. In this study, the risk of neuro- and hepato-toxicity during long-term perhexiline therapy in relation to the intensity of therapeutic drug monitoring was investigated. Furthermore, determinants of mortality during perhexiline treatment were evaluated. In 170 patients treated with perhexiline for a median of 50 months (interquartile range: 31-94 months), outcomes and relationship to plasma drug concentrations were documented. Rationale for treatment with perhexiline included myocardial ischemia in 88% and severe systolic heart failure in 38%. Plasma concentrations were within the therapeutic range of 150-600 ng/mL on 65% of assay occasions and toxic levels accounted for 8.8% of measurements. No patient developed hepatotoxicity attributable to perhexiline while 3 developed peripheral neuropathy possibly induced by treatment. Actuarial 5-year survival rate was 83% overall, and 76.3% in patients with associated systolic heart failure. | Can Perhexiline Be Utilized Without Long-Term Toxicity? | This first audit of a large population treated long-term perhexiline demonstrates the following: (1) Although the frequency of monitoring is less than ideal, therapeutic drug monitoring effectively limits occurrence of toxic drug concentrations and virtually eliminates long-term hepato- and neuro-toxicity and (2) Mortality rates during long-term therapy, notably for patients with concomitant heart failure, are surprisingly low. | Question: Can Perhexiline Be Utilized Without Long-Term Toxicity?
Answer: This first audit of a large population treated long-term perhexiline demonstrates the following: (1) Although the frequency of monitoring is less than ideal, therapeutic drug monitoring effectively limits occurrence of toxic drug concentrations and virtually eliminates long-term hepato- and neuro-toxicity and (2) Mortality rates during long-term therapy, notably for patients with concomitant heart failure, are surprisingly low. |
Answer the question based on the following context: To explicate whether mixed connective tissue disease (MCTD) is a distinct disease and evaluate the reliability of three different diagnostic criteria proposed by Sharp, Alarcon-Segovia and Kasukawa respectively. Clinical follow-up of 50 MCTD patients lasted 2-8 years (80%>5 years). HLA-A, -B as well as -DR typing was performed by complemently dependent cytotocity assay. Autoantibody profile was detected by counterimmune electrophoresis (CIE). Thirteen (26.0%) of the 50 MCTD patients subsequently developed other connective tissue disease (OCTD), including 7 systemic lupus erythematosis (SLE), and 6 progressive systemic scleroderma (PSS). Among 23 of the MCTD patients fulfilling Sharp's criteria, 1 (4.3%) developed PSS, but among 23 of the patients fulfilling Kasukawa's, not Sharp's, 7 (30.4%) developed OCTD and among 27 of the patients fulfilling Alarcon-Segovia's, not Sharp's, 12 (44.4%) developed OCTD. In the frequencies of DR4 and DR5, there were significant differences between patients fulfilling Sharp's (60.9%, 56.5%) and controls (24.3%, P<0.005, RR = 4.7 and 21.4%, P<0.005, RR = 4.6%), but there were no significant differences between the patients not fulfilling Sharp's and normal control (P>0.05). | Mixed connective tissue disease: a disease entity? | MCTD is a distict rheumatic disease. Sharp's criteria is the most reliable for diagnosis of MCTD. | Question: Mixed connective tissue disease: a disease entity?
Answer: MCTD is a distict rheumatic disease. Sharp's criteria is the most reliable for diagnosis of MCTD. |
Answer the question based on the following context: The purpose of this study was to analyze whether, and by whom sexuality is discussed in amputation departments. The focus was on whether professionals received questions about sexuality from their patients with a lower limb amputation and whether they addressed sexuality themselves, as well as on the knowledge and comfort level, approach and attitudes toward sexuality of these professionals. An online questionnaire, including questions on self-perceived sexological competence and the Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale. Seventy-eight percent of the professionals had not received questions about sexuality from their patients and 67% had not addressed sexuality. Self-perceived knowledge about sexuality and self-perceived ability to recognize sexual problems increased the odds of receiving a question about sexuality and the odds of addressing this issue. | Sexuality in people with a lower limb amputation: a topic too hot to handle? | Sexuality is rarely discussed by professionals in the amputation department. It is, however, the responsibility of the professional to do so. By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Therefore, the professionals' self-perceived sexological competence and feeling of comfort with the topic of sexuality need to be increased. Implications for Rehabilitation Sexuality is rarely discussed by professionals in the amputation department, even though sexual problems do occur in patients with a lower limb amputation (LLA). By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Our study shows that self-perceived knowledge about sexuality and self-perceived ability to recognize sexual problems increases the odds of receiving a question about sexuality and the odds of addressing this issue. Investing in courses that focus on increasing the knowledge and feeling of comfort concerning sexuality of professionals working with people with a LLA is therefore of important value. | Question: Sexuality in people with a lower limb amputation: a topic too hot to handle?
Answer: Sexuality is rarely discussed by professionals in the amputation department. It is, however, the responsibility of the professional to do so. By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Therefore, the professionals' self-perceived sexological competence and feeling of comfort with the topic of sexuality need to be increased. Implications for Rehabilitation Sexuality is rarely discussed by professionals in the amputation department, even though sexual problems do occur in patients with a lower limb amputation (LLA). By addressing sexuality in a systematic way and discussing this as a common topic professionals "give permission" to patients and other team members to discuss eventual sexual problems or concerns. Our study shows that self-perceived knowledge about sexuality and self-perceived ability to recognize sexual problems increases the odds of receiving a question about sexuality and the odds of addressing this issue. Investing in courses that focus on increasing the knowledge and feeling of comfort concerning sexuality of professionals working with people with a LLA is therefore of important value. |
Answer the question based on the following context: Little is known about the impacts of class attendance and learning preferences on academic performance in dermatology. This study was designed to examine the effects of medical student class attendance and learning preferences on students' academic performance in an introductory dermatology course. A total of 101 second-year medical students enrolled in a required introductory dermatology course were surveyed regarding their learning preferences. Records of class attendance and scores on the final examination were reviewed. The most frequently cited reason for attending classes was social expectation (96%), whereas the least cited was learning well in a classroom-type setting (65%). The top reasons cited by students for not attending classes were availability of lectures online (35%), preference for individual study outside the classroom setting (26%), and the inconvenience of traveling to class (24%). Multivariate analysis found no statistically significant relationship between class attendance and performance on the final examination (estimate -0.074, standard error 0.12; P = 0.54) after adjusting for sex, age, Medical College Admission Test (MCAT) score, having children at home, and reason for attending class. Those who prefer to learn by watching online videos scored significantly higher on the final examination (prefer online videos: 87 ± 5.5; neutral: 86 ± 5.9; do not prefer online videos: 82 ± 2.6 [P = 0.049]). | Does class attendance matter? | Class attendance was not associated with improved academic performance in a dermatology course. Those who preferred to learn by watching online videos demonstrated a higher level of performance than those who did not prefer to learn this way. | Question: Does class attendance matter?
Answer: Class attendance was not associated with improved academic performance in a dermatology course. Those who preferred to learn by watching online videos demonstrated a higher level of performance than those who did not prefer to learn this way. |
Answer the question based on the following context: Effective fetal growth requires adequate maternal nutrition coupled to active transport of nutrients across the placenta, which, in turn requires ATP. Epidemiological and experimental evidence has shown that impaired maternal nutrition in utero results in an adverse postnatal phenotype for the offspring. Placental mitochondrial function might link maternal food intake to fetal growth since impaired placental ATP production, in response to poor maternal nutrition, could be a pathway linking maternal food intake to reduced fetal growth. We assessed the effects of maternal diet on placental water content, ATP levels and mitochondrial DNA (mtDNA) content in mice at embryonic (E) day 18 (E18). Females maintained on either low- (LPD) or normal- (NPD) protein diets were mated with NPD males. Fetal dry weight and placental efficiency (embryo/placental fresh weight) were positively correlated (r = 0.53, P = 0.0001). Individual placental dry weight was reduced by LPD (P = 0.003), as was the expression of amino acid transporter Slc38a2 and of growth factor Igf2. Placental water content, which is regulated by active transport of solutes, was increased by LPD (P = 0.0001). However, placental ATP content was also increased (P = 0.03).
To investigate the possibility of an underlying mitochondrial stress response, we studied cultured human trophoblast cells (BeWos). High throughput imaging showed that amino acid starvation induces changes in mitochondrial morphology that suggest stress-induced mitochondrial hyperfusion. This is a defensive response, believed to increase mitochondrial efficiency, that could underlie the increase in ATP observed in placenta. | Is Placental Mitochondrial Function a Regulator that Matches Fetal and Placental Growth to Maternal Nutrient Intake in the Mouse? | These findings reinforce the pathophysiological links between maternal diet and conceptus mitochondria, potentially contributing to metabolic programming. The quiet embryo hypothesis proposes that pre-implantation embryo survival is best served by a relatively low level of metabolism. This may extend to post-implantation trophoblast responses to nutrition. | Question: Is Placental Mitochondrial Function a Regulator that Matches Fetal and Placental Growth to Maternal Nutrient Intake in the Mouse?
Answer: These findings reinforce the pathophysiological links between maternal diet and conceptus mitochondria, potentially contributing to metabolic programming. The quiet embryo hypothesis proposes that pre-implantation embryo survival is best served by a relatively low level of metabolism. This may extend to post-implantation trophoblast responses to nutrition. |
Answer the question based on the following context: The introduction of the classification of chronic kidney disease (CKD) by NKF KDOQI guidelines in 2002, including the staging and risk assessment of this disease, was a landmark event. The division of CKD into stages 1-5 turned out to be very useful and sensitive tool in the hands of both scientists and clinical practitioners; it established common nomenclature pertaining to CKD all over the world. This stratification profoundly changed the approach to CKD, transforming it from a somewhat neglected clinical problem to the phenomenon named "the epidemic of CKD". However, after a short period if clinical experience a heated debate was initiated in the literature, indicating the shortcomings of the adopted classification. The most questionable areas included methodological issues as well as dissimilar prognoses for patients depending on the cause of kidney dysfunction, the presence of proteinuria and comorbidities.AIM: The aim of this study was to evaluate the prevalence of CKD and the risk factors based on NKF KDOQI classification of 2002 in the population of Ostróda administrative district. In total 437 individuals (F 277, M 160) aged 52.7±18.0 were examined. The study was conducted in Ostróda among randomly selected inhabitants of Ostróda adminstrative district. Serum creatinine was determined by a modified Jaffe method and eGFR was calculated (MDRD formula) for each individual. The correlations between serum creatinine and eGFR, gender and age were studied. Additionally, 326 of the examined participants were interviewed to establish CKD risk factors: kidney disease in the family, being overweight and/or obese, arterial hypertension, diabetes, smoking, heart attack, stroke. 58.6% of the examined individuals demonstrated abnormal eGFR values (<90 ml/min/l.73 m2), whereas serum creatinine above the laboratory norm was found in 1.3% of patients. Significant CKD risk factors included an increased prevalence of obesity (78.3%), arterial hypertension (38.6%), and smoking (26.8%); 23.9% reported kidney disease in the family. | Was it necessary to modify the classification of chronic kidney disease stages designed by NKF KDOQI? | Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice. | Question: Was it necessary to modify the classification of chronic kidney disease stages designed by NKF KDOQI?
Answer: Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice. |
Answer the question based on the following context: There are limited data on the night-to-night variability of childhood sleep-related disordered breathing (SDB). We aim to assess for the presence of first-night effect (FNE) and to examine whether a single-night sleep study is adequate in the assessment of childhood SDB. In a case-control study investigating whether obesity is a risk factor for childhood SDB, the night-to-night variability of sleep and respiratory variables were studied. Forty-six obese children from a pediatric obesity clinic and 44 age- and sex-matched normal weight control subjects from local schools. All subjects underwent two consecutive overnight polysomnographic studies. An obstructive apnea index (OAI)>/= 1/h was considered diagnostic of SDB. The mean age of the children was 11.21 years (SD 2.21). Forty-four obese children and 43 control subjects completed the 2-night study. Based on the criterion of the worst OAI over the 2 nights, 13 subjects were found to have SDB, 12 subjects were primary snorers, and 62 were normal subjects. In all subjects, the sleep efficiency improved and sleep-onset latency was reduced on the second night. While there was a rebound of rapid eye movement sleep with the associated worsening of respiratory indexes (mainly accounted for by an increase in central apneas and hypopneas) evident in normal subjects, there was a significant improvement of respiratory disturbances in the SDB group on the second night. The first-night polysomnography would have correctly identified 84.6% of cases as defined by the criteria of the worst OAI over the 2 nights. All cases missed by the first-night study had only borderline OAI. | Is a 2-night polysomnographic study necessary in childhood sleep-related disordered breathing? | The phenomenon of FNE in children was well demonstrated in our study. We proposed that a single-night sleep study is adequate and more cost-effective in assessing for childhood SDB. | Question: Is a 2-night polysomnographic study necessary in childhood sleep-related disordered breathing?
Answer: The phenomenon of FNE in children was well demonstrated in our study. We proposed that a single-night sleep study is adequate and more cost-effective in assessing for childhood SDB. |
Answer the question based on the following context: To compare patients' functional ability in the 24-hour postoperative period following a remifentanil compared to a hypnotic-fentanyl-treated anesthesia regimen using a 24-Hour Functional Ability Questionnaire. Prospective, 1:1 single-blind, randomized, controlled effectiveness study. Multicenter study including 156 hospitals and ambulatory surgery facilities. 2438 patients (1496 outpatients and 942 inpatients) 18 years of age or older, scheduled for elective surgeries under general endotracheal anesthesia, with an expected duration of unconsciousness of>or =30 minutes. Patients were randomized to receive either intravenous remifentanil (0.5 microg/kg/min for induction and intubation; with the infusion rate decreased to 0.25 microg/kg/min after intubation) or fentanyl (administered according to anesthesiologists' usual practice) as the opioid during surgery. Concomitant hypnotic drugs were propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was given in the remifentanil patients and at the discretion of the anesthesiologists in the fentanyl patients. A validated set of measurements of functional ability, rather than more traditional clinical psychological methods, to compare the recovery of patients from remifentanil- and fentanyl-treated anesthetic regimens up to 24 hours after surgery. Remifentanil was statistically superior to fentanyl for the four functional assessments evaluated: walking without dizziness, thinking clearly, concentration, and communicating effectively. These differences reflect events occurring within the first 24 hours after anesthesia and surgery. | Does functional ability in the postoperative period differ between remifentanil- and fentanyl-based anesthesia? | A remifentanil-treated anesthetic demonstrated earlier return to some functions than a fentanyl-treated technique. Although functional assessment is a field that is still in its infancy, a questionnaire to assess functional ability during the 24 hours after anesthesia may provide more practical information about anesthetic recovery than previously used, traditional psychomotor evaluations. | Question: Does functional ability in the postoperative period differ between remifentanil- and fentanyl-based anesthesia?
Answer: A remifentanil-treated anesthetic demonstrated earlier return to some functions than a fentanyl-treated technique. Although functional assessment is a field that is still in its infancy, a questionnaire to assess functional ability during the 24 hours after anesthesia may provide more practical information about anesthetic recovery than previously used, traditional psychomotor evaluations. |
Answer the question based on the following context: Health care reform is dramatically changing the practice and delivery of medical care. The goal of this investigation was to examine gastroenterology trainees' outlook on the impact of health care reform on training programs. A 24-question survey was mailed in February 1996 to 780 GI fellows obtained from the comprehensive American College of Gastroenterology (ACG) database. A total of 362 fellows responded (46%): 85% were male, 57% Caucasian, 75% married, and 86% were university-based. Ninety-six percent of fellows believed that health care reform is adversely affecting the quality of health care and 94.1% felt that it was adversely affecting fellowship training. Eighty-eight percent expressed concern over the impact of health care reform on practice opportunities. Only 9% of fellows reported that their training program had established a specific educational program addressing health care reform, whereas 83% of fellows felt that their program should do so. | The impact of health care reform on gastroenterology fellows: are training programs preparing them for the future? | Gastroenterology fellows are concerned about the impact of health care reform on the quality of care and the quality of their fellowship training. Trainees believe that programs are not providing sufficient education to help them respond to the changes in health care. | Question: The impact of health care reform on gastroenterology fellows: are training programs preparing them for the future?
Answer: Gastroenterology fellows are concerned about the impact of health care reform on the quality of care and the quality of their fellowship training. Trainees believe that programs are not providing sufficient education to help them respond to the changes in health care. |
Answer the question based on the following context: Practicing physicians underutilize U.S. Department of Health and Human Services evidence-based approaches to nicotine addiction and treatment. Few studies have assessed medical student knowledge in this area. This study examined New York City fourth-year medical students' knowledge of tobacco cessation and treatment of nicotine addiction. The authors conducted a Web-based survey, comprising 27 closed- and open-ended questions, of six of seven New York City medical schools in the spring of 2004. They drew questions from international, national, and local surveys on tobacco and health, U.S. Department of Health and Human Services tobacco treatment guidelines, and prior studies. Primary outcome measures were knowledge of the epidemiology of smoking, benefits of cessation and treatment of nicotine addiction, clinical cessation practices, and students' use of tobacco and intentions to stop smoking. Of 943 fourth-year medical students, 469 (50%) completed an online survey. Students had good knowledge of the epidemiology of smoking, including its prevalence and health effects, with most responding correctly to relevant questions (mean correct response 79%; SD = 9.4). Students demonstrated a fair understanding of the benefits of cessation (mean correct response, 67%; SD = 19.2) and treatment of nicotine addiction (mean correct response, 61%; SD = 13.2). Three hundred students (64%) rated their own preparation to assist patients to quit as less than adequate. | Do medical students know enough about smoking to help their future patients? | Fourth-year medical students at the participating schools in New York City understood the harms of smoking but needed more information on the benefits of stopping smoking and treatment of nicotine addiction. | Question: Do medical students know enough about smoking to help their future patients?
Answer: Fourth-year medical students at the participating schools in New York City understood the harms of smoking but needed more information on the benefits of stopping smoking and treatment of nicotine addiction. |
Answer the question based on the following context: We sought to determine the percentage of patients presenting with code stroke who would be excluded from computed tomography angiography, computed tomography perfusion, or both based on their emergency department laboratory results (creatinine and glomerular filtration rate) and the incidence of contrast-induced nephropathy in patients with code stroke who receive contrast. We conducted a retrospective analysis of our prospective code stroke database. The study took place in an emergency department at a university medical center. A total of 131 consecutive patients with code stroke were identified. Of these, 11 (8.4%) would not have received contrast based on a creatinine level greater than 1.5 mg/dL on initial evaluation. However, 10 of these 11 patients (91%) had a history of renal disease. A total of 3% of patients who received contrast developed contrast-induced nephropathy. | Reducing the delay in thrombolysis: is it necessary to await the results of renal function tests before computed tomography perfusion and angiography in patients with code stroke? | Our findings suggest that the use of contrast agents in patients with code stroke before availability of renal function tests appears safe in patients who do not have a known history of renal disease. | Question: Reducing the delay in thrombolysis: is it necessary to await the results of renal function tests before computed tomography perfusion and angiography in patients with code stroke?
Answer: Our findings suggest that the use of contrast agents in patients with code stroke before availability of renal function tests appears safe in patients who do not have a known history of renal disease. |
Answer the question based on the following context: The aim of this study was to assess the relationship between clinical, radiological and histopathological findings in nasal polyposis. This was a retrospective study of 85 patients with nasal polyposis who were treated by endoscopic sinus surgery between the years of 2005 and 2010. All patients underwent preoperative paranasal sinus Computerized Tomography scan in the coronal plane and these images was evaluated with Lund-Mackay scores. The biopsy materials diagnosed as nasal polyp were identified by archive scanning at the pathology department. The Haematoxylin-Eosin stained preparations of the biopsy materials were re-evaluated. All of the results were analyzed by using the SPSS 13.0 soft ware program. Statistical significance was determined as p-value<0.05. When the patients with (16.4%) and without (83.6%) bronchial asthma were compared regarding the eosinophil, lymphocyte, neutrophil, macrophage, mast cells and goblet cells/ epithelial cell rate, no statistical significance was found (p>0.05). There was a positive relationship between the preoperative complaint durations and the total Lund-Mackay scores (r=0.270, p=0.012). The neutrophil amount (16.53 ± 19.87) on the preparations of the patients with metaplasia was higher than the neutrophil amount (8.71 ± 23.98) on the preparations of the patients without metaplasia (p=0.001). Radiologically, there was a positive correlation between the infiltration of anterior-posterior sinuses by the polyp tissues and the Lund-Mackay score of the nasal cavity. | Is there any relationship between the clinical, radiological and histopathologic findings in sinonasal polyposis? | There was a positive correlation between preoperative complaint duration and squamous metaplasia; and there was also a positive correlation between the preoperative complaint duration and the total Lund-Mackay score. There was no histopathological difference between the polypoid infiltration of the front and rear group sinuses. | Question: Is there any relationship between the clinical, radiological and histopathologic findings in sinonasal polyposis?
Answer: There was a positive correlation between preoperative complaint duration and squamous metaplasia; and there was also a positive correlation between the preoperative complaint duration and the total Lund-Mackay score. There was no histopathological difference between the polypoid infiltration of the front and rear group sinuses. |
Answer the question based on the following context: To compare pregnancy outcomes in women diagnosed as having class A1 gestational diabetes with those of a group with a normal 3-hour glucose tolerance test (GTT) to assess morbidities attributable to glucose intolerance. Selective 50-g GTT identified pregnant women who received a 3-hour GTT. Over a 16-month period, 159 women were diagnosed as having class A1 gestational diabetes according to the National Diabetes Data Group criteria. During the latter 12 months of this time period, 151 women who had a normal GTT result were identified for comparison. There were statistically significant differences in age and the development of peripartum hypertension in women with class A1 gestational diabetes compared with the normal 3-hour GTT group. There were no significant differences in any neonatal outcome variable, including percent delivering large for gestational age (LGA) neonates in women with A1 diabetes compared to controls. Overall, 111 (36%) of the 310 neonates were classified as LGA, a rate more than double that in the singleton population in our hospital. Maternal weight, parity, and a history of a previous macrosomic infant were significantly associated with LGA outcome. Mean maternal weight was the same in the two GTT groups, implying an independent effect on fetal size. Obstetric interventions were not significantly different between the groups, so differences in intervention could not account for the lack of difference in outcome variables. The impact of dietary counseling in the class A1 diabetic women is also an unlikely explanation for the lack of differences in outcome. Within the normal-GTT group, women with one abnormal 3-hour value had a frequency of LGA infants similar to that of women with all normal 3-hour GTT values. These results suggest that there is a selection effect of screening for glucose intolerance that may relate more to other risk factors for LGA outcome than to glucose intolerance. Maternal obesity is an independent and more potent risk factor for large infants than is glucose intolerance. | Class A1 gestational diabetes: a meaningful diagnosis? | The diagnosis of class A1 gestational diabetes is not significantly associated with obstetric and perinatal morbidities. A nondiscriminating diagnostic test undermines the validity of population screening for glucose intolerance. | Question: Class A1 gestational diabetes: a meaningful diagnosis?
Answer: The diagnosis of class A1 gestational diabetes is not significantly associated with obstetric and perinatal morbidities. A nondiscriminating diagnostic test undermines the validity of population screening for glucose intolerance. |
Answer the question based on the following context: Desmoid tumor (DT) is a rare myofibroblastic proliferative neoplasm, but can occur in up to 26% of patients with familial adenomatous polyposis (FAP). Therefore, DT may be an extraintestinal manifestation of FAP that precedes the development of advanced malignancies. The aim of this study was to identify the incidence of polyps in DT patients and investigate value of colonoscopy for diagnosis of FAP in DT patients without gastrointestinal symptoms. The records of patients diagnosed with DT were retrospectively reviewed using the clinical data warehouse (CDW) system. Clinical data, including location of tumor, type(s) of treatment, and colonoscopic findings, were collected. Sixty-five patients were diagnosed with DT during the study period; 10 patients received colonoscopies before diagnosis of DT, and 20 patients received colonoscopies after diagnosis of DT. The mean age at diagnosis of DT was 41.9 ± 16.7 years old (range 17-74). Most tumors were extra-abdominal (n = 24, 80.0%), and fewer were intra-abdominal (n = 4, 13.3%) or in an abdominal wall (n = 2, 6.7%). The colonoscopy results revealed one or two tubular adenomas in 11 patients (36.6%), although none of the patients had colorectal polyposis or colorectal cancer. | Does routine colonoscopy help diagnose familial adenomatous polyposis in patients presenting with desmoid tumors but no gastrointestinal symptoms? | None of the patients in our study population had colorectal polyposis. Routine colonoscopy of DT patients without gastrointestinal symptoms seems to have low diagnostic yield for detection of FAP. | Question: Does routine colonoscopy help diagnose familial adenomatous polyposis in patients presenting with desmoid tumors but no gastrointestinal symptoms?
Answer: None of the patients in our study population had colorectal polyposis. Routine colonoscopy of DT patients without gastrointestinal symptoms seems to have low diagnostic yield for detection of FAP. |
Answer the question based on the following context: Functional outcome has recently become of interest for cross-diagnostic subphenotype approaches in psychiatric genetics. Therefore, it is crucial to know about clinical, demographic and psychosocial variables that correlate with long-term functioning. Unfortunately, there is a lack of studies that directly compare the importance of correlates for functional outcome between different disorders. Applying regression models to samples of patients with schizophrenia (SZ, n = 238), bipolar disorder (BD, n = 533) and major depressive disorder (MDD, n = 398), we compared the magnitude of association of potential correlates with functional outcome, measured by the Global Assessment of Functioning (GAF) score. Shared correlates for worse functional outcome were poor premorbid functioning, insidious illness onset and poor premorbid work or social adjustment in all three disorders, and negative symptomatology in SZ and BD. Disorder-specific correlates for SZ were longer duration of illness, lower functioning during episodes and being life-time single, for BD substance abuse and suicidality, and for MDD premorbid unemployment and having a premorbid personality disorder. | Functional outcome in major psychiatric disorders and associated clinical and psychosocial variables: A potential cross-diagnostic phenotype for further genetic investigations? | We found different patterns of correlates for long-term functioning in SZ, BD and MDD. Knowledge of these patterns may improve the quality of genetic investigations focussing on functional outcome. | Question: Functional outcome in major psychiatric disorders and associated clinical and psychosocial variables: A potential cross-diagnostic phenotype for further genetic investigations?
Answer: We found different patterns of correlates for long-term functioning in SZ, BD and MDD. Knowledge of these patterns may improve the quality of genetic investigations focussing on functional outcome. |
Answer the question based on the following context: A limited number of studies have investigated the impact of gender on renal function and clinical outcomes after ST-segment elevated myocardial infarction (STEMI), and these studies have provided discrepant results. This study was based on a retrospective cohort, the Korean Acute Myocardial Infarction Registry (KAMIR). Patients (n = 7,679) with a discharge diagnosis of STEMI were analyzed to investigate association of gender with renal function and clinical outcomes. Compared to men, women were older and exhibited more comorbidity, including impaired renal function. Women showed higher mortality compared to men (1-month mortality,5.6% in men vs. 12.6% in women, p<0.001; 1-year mortality, 6.8% in men vs. 14.4% in women, p<0.001). The risk of death proportionally increased as estimated glomerular filtration rate (eGFR) decreased in both genders. After adjusting for potential confounders, hazard ratios for women did not significantly differ from those for men at each eGFR level.The interaction test showed no significant interaction between gender and eGFR in 1-month mortality and 1-year mortality. | Does gender influence the impact of impaired renal function on prognosis after ST-segment elevated myocardial infarction? | Impaired renal function was an independent prognostic factor after STEMI in both genders, and the impact of impaired renal function on prognosis after STEMI did not significantly differ between genders. | Question: Does gender influence the impact of impaired renal function on prognosis after ST-segment elevated myocardial infarction?
Answer: Impaired renal function was an independent prognostic factor after STEMI in both genders, and the impact of impaired renal function on prognosis after STEMI did not significantly differ between genders. |
Answer the question based on the following context: Phototherapy has a time-honoured place in the treatment of variety of skin diseases in adults. The use of this modality in children is limited mainly due to concerns about long-term carcinogenic potential. Only a few clinical trials have been performed on the efficacy and safety of phototherapy in children. To determine the efficacy and safety of NB-UVB phototherapy in children with atopic dermatitis (AD) and psoriasis. This is a retrospective review of the treatment outcomes of 129 children with psoriasis and AD, who were treated with NB-UVB between 1998 and 2006 at our institute. Fifty per cent of the psoriatic patients and 25% of patients with AD achieved clearance by the end of the treatment. NB-UVB phototherapy was well-tolerated, with no serious adverse effects except one doubtful case of melanoma in situ. | Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis? | NB-UVB may be considered as a viable therapeutic option in children with psoriasis and AD. Children who are treated by phototherapy should remain under annual dermatologic observation. To determine true carcinogenic risk of UV therapy, longer follow-up is essential. | Question: Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis?
Answer: NB-UVB may be considered as a viable therapeutic option in children with psoriasis and AD. Children who are treated by phototherapy should remain under annual dermatologic observation. To determine true carcinogenic risk of UV therapy, longer follow-up is essential. |
Answer the question based on the following context: Evidence from developing countries regarding the association between gender inequity and intimate partner violence (IPV) victimization in women has been suggestive but inconclusive. Using nationally representative population-based data from Bangladesh, we examined the association between multidimensional aspects of gender inequity and the risk of IPV. We used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 4,467 married women. The main explanatory variable was gender inequity, which reflects the multidimensional aspects of women's autonomy and the relationship inequality between women and their partner. The experience of physical and/or sexual IPV was the main outcome variable of interest. Over 53% of married Bangladeshi women experienced physical and/or sexual violence from their husbands. In the adjusted models, women who had a higher level of autonomy (adjusted odds ratio [AOR] 0.48; 99% confidence interval [CI]0.37-0.61), a particularly high level of economic-decision-making autonomy (AOR 0.12; 99% CI 0.08-0.17), and a higher level of non-supportive attitudes towards wife beating or raping (AOR 0.61; 99% CI 0.47-0.83) were less likely to report having experienced IPV. Education level, age at marriage, and occupational discrepancy between spouses were also found to be significant predictors of IPV. | Does gender inequity increase the risk of intimate partner violence among women? | In conclusion, dimensions of gender inequities were significant predictors of IPV among married women in Bangladesh. An investigation of the causal link between multidimensional aspects of gender inequity and IPV will be critical to developing interventions to reduce the risk of IPV and should be considered a public health research priority. | Question: Does gender inequity increase the risk of intimate partner violence among women?
Answer: In conclusion, dimensions of gender inequities were significant predictors of IPV among married women in Bangladesh. An investigation of the causal link between multidimensional aspects of gender inequity and IPV will be critical to developing interventions to reduce the risk of IPV and should be considered a public health research priority. |
Answer the question based on the following context: Neoadjuvant chemotherapy (NAC) has been administered since the 1990s and is now one of the major treatments for breast cancer. It can achieve extremely positive results in some patients. Whether NAC affects immediate breast reconstruction (IBR) using an expander, however, remains unclear. A retrospective study was performed at Tokyo Medical and Dental University (TMDU) hospital. Seventy-five cases of immediate breast reconstruction using an expander were performed in 69 patients between January 2001 and January 2007. The patients were evaluated for tumor size, histological type, sites of invasion, staging, lymph node metastasis, NAC regimen, response to NAC, type of immediate breast reconstruction (IBR), complications, and prognosis. In patients treated with an expander, there was no significant difference in the complication rate between those who underwent NAC and those who did not. | Does neoadjuvant chemotherapy for breast cancer increase complications during immediate breast reconstruction? | NAC did not increase the complication rate after IBR using an expander. However, for reconstruction using autologous tissue, more data are needed. | Question: Does neoadjuvant chemotherapy for breast cancer increase complications during immediate breast reconstruction?
Answer: NAC did not increase the complication rate after IBR using an expander. However, for reconstruction using autologous tissue, more data are needed. |
Answer the question based on the following context: B type natriuretic peptide (BNP) is a hormone released in response to stretching of the ventricular wall. The role of BNP as a biomarker of bronchopulmonary dysplasia (BPD) has not been clarified. To determine if plasma BNP concentrations correlate with the severity of BPD. This prospective observational case control study included 60 preterm infants (≤32 weeks); 27 infants had no/mild BPD, 19 had moderate and 14 had severe BPD. BNP levels were measured at 36 ± 2 weeks PMA or within a week of discharge home. Groups were compared using Mann-Whitney's U-test, Kruskal-Wallis, and bivariate regression. Median (IQR) plasma levels of BNP in infants with moderate/severe BPD infants (n = 33) were higher as compared to those with no/mild BPD (n = 27); 27.1 (12.1-43.5) pg/ml versus 9.3 (6-18.5) pg/ml; P < 0.05 (Mann Whitney U). Median (IQR) BNP levels in infants with severe BPD (n = 14), 43.5 (28.4-189) pg/ml differed significantly from levels in those with moderate (n = 19), 22.8 (10.3-27.7) pg/ml; mild (n = 16), 11.5 (6.6-44.5 pg/ml); or no (n = 11), 8.1 (5-12.6 pg/ml) BPD (P < 0.001 Kruskal-Wallis). Based on receiver operating characteristic curves, BNP > 24.4 pg/ml at 36 ± 2 weeks PMA or discharge home was 85.7% sensitive and 76.1% specific for severe BPD. | B-type natriuretic peptide levels in preterm neonates with bronchopulmonary dysplasia: a marker of severity? | An elevation in plasma BNP was significantly associated with severe BPD. We speculate that plasma BNP measurement in infants with BPD may aid in risk-stratification and further targeted therapies. | Question: B-type natriuretic peptide levels in preterm neonates with bronchopulmonary dysplasia: a marker of severity?
Answer: An elevation in plasma BNP was significantly associated with severe BPD. We speculate that plasma BNP measurement in infants with BPD may aid in risk-stratification and further targeted therapies. |
Answer the question based on the following context: No studies have compared ventilator-associated pneumonia (VAP) and non-VAP following cardiac surgery (CS). The aim of this study was to assess the incidence, clinical and microbiologic features, treatment characteristics and prognosis of postoperative pneumonia following CS with a special focus on non-VAP. This was a retrospective cohort study based on a prospectively collected database. We compared cases of non-VAP and VAP following CS observed between January 2005 and December 2012. Statistical analysis consisted of bivariate and multivariate analysis. A total of 257 (3.5%) of 7,439 consecutive CS patients developed postoperative pneumonia, including 120 (47%) cases of non-VAP. Patients with VAP had more frequent history of congestive heart failure (31% vs. 17%, P = 0.006) and longer duration of cardiopulmonary bypass (105 vs 76 min, P < 0.0001), than patients with non-VAP. No significant differences were observed between the 2 groups in terms of the types of microorganisms isolated with high proportions of Enterobacteriaceae (35%), Pseudomonas aeruginosa (20.2%) and Haemophilus spp (20.2%), except for a lower proportion of Methicillin-susceptible S. aureus in the non-VAP group (3.2% vs 7.9%, P = 0.03). In the intensive care unit, patients with non-VAP had lower sequential organ failure assessment scores than patients with VAP (8 ± 3 versus 9 ± 3, P = 0.004). On multivariate analysis, in-hospital mortality was similar in both groups (32% in the non-VAP group and 42% in the VAP group, adjusted Odds Ratio (aOR): 1.4; 95% confidence intervals (CI): 0.7-2.5; P = 0.34) and appropriate empiric antibiotic therapy was associated with a reduction of in-hospital mortality (aOR: 0.4; 95% CI: 0.2-1; P = 0.05). Piperacillin/tazobactam or imipenem monotherapy constituted appropriate empiric therapy in the two groups, with values reaching 93% and 95% with no differences between VAP and non-VAP cases. | Postoperative pneumonia following cardiac surgery in non-ventilated patients versus mechanically ventilated patients: is there any difference? | Intensive care patients with VAP are more severely ill than non-VAP patients following CS. Nevertheless, patients with non-VAP and VAP following CS have similar outcomes. This study suggests that the empiric antibiotic regimen in patients with pneumonia following CS should include at least a broad-spectrum antibiotic targeting non-fermenting Gram-negative bacilli, regardless of the type of pneumonia, and targeting S. aureus in VAP patients. | Question: Postoperative pneumonia following cardiac surgery in non-ventilated patients versus mechanically ventilated patients: is there any difference?
Answer: Intensive care patients with VAP are more severely ill than non-VAP patients following CS. Nevertheless, patients with non-VAP and VAP following CS have similar outcomes. This study suggests that the empiric antibiotic regimen in patients with pneumonia following CS should include at least a broad-spectrum antibiotic targeting non-fermenting Gram-negative bacilli, regardless of the type of pneumonia, and targeting S. aureus in VAP patients. |
Answer the question based on the following context: To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. MAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. | Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone? | MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. | Question: Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone?
Answer: MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. |
Answer the question based on the following context: This research conducted a face validation study of patient responses to the application of an HRQOL assessment research tool in a comprehensive community cancer program setting across a heterogeneous cohort of cancer patients throughout the natural history of diagnosed malignant disease, many of whom would not be considered candidates for clinical research trial participation. Cancer registries at two regional cancer treatment centers identified 11072 cancer patients over a period of nine years. The EORTC QLQ-C30 was administered to patients at the time of their initial clinical presentation to these centers. To determine the significance of differences between patient subgroups, two analytic criteria were used. The Mann-Whitney test was used to determine statistical significance; clinical relevance defined a range of point differences that could be perceived by patients with different health states. Univariate analyses were conducted across stratification variables for population, disease severity and demographic characteristics. The largest differences were associated with cancer diagnosis and recurrence of disease. Large differences were also found for site of origin, mortality and stage; minimal differences were observed for gender and age. Consistently sensitive QoL scales were appetite loss, fatigue and pain symptoms, and role (work-related), social and physical functions. | Can quality of life assessments differentiate heterogeneous cancer patients? | 1) The EORTC QLQ-C30 collected meaningful patient health assessments in the context of non-research based clinical care, 2) patient assessment differences are manifested disparately across 15 QoL domains, and 3) in addition to indicating how a patient may feel at a point in time, QoL indicators may also reveal information about underlying biological responses to disease progression, treatments, and prospective survival. | Question: Can quality of life assessments differentiate heterogeneous cancer patients?
Answer: 1) The EORTC QLQ-C30 collected meaningful patient health assessments in the context of non-research based clinical care, 2) patient assessment differences are manifested disparately across 15 QoL domains, and 3) in addition to indicating how a patient may feel at a point in time, QoL indicators may also reveal information about underlying biological responses to disease progression, treatments, and prospective survival. |
Answer the question based on the following context: Recently, psychological status, patient-centered outcomes, and health-related quality of life (HRQoL) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized. The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated.QUESTIONS/ The primary objective of this study was to investigate changes in psychological status (depression, anxiety, insomnia) and HRQoL after rotator cuff repair. The secondary objective was to assess whether preoperative depression, anxiety, and insomnia predict clinical outcome after rotator cuff repair. Forty-seven patients who underwent rotator cuff repair prospectively completed the visual analog scale (VAS) pain score, the UCLA Scale, the American Shoulder and Elbow Surgeons' Scale (ASES), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality-of-life Scale Abbreviated Version (WHOQOL-BREF) before surgery and at 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements. The chi-square test was also used to compare preoperative and postoperative prevalence of depression, anxiety, and insomnia. Finally, multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome. With surgery, depression, anxiety, and insomnia decreased, whereas quality of life increased. The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3, 4.3 ± 4.3, and 6.6 ± 3.6, respectively, before surgery to 2.1 ± 2.3, 1.4 ± 2.4, and 4.2 ± 3.3, respectively, at 12 months after surgery (HADS-D mean difference 1.6 [95% confidence interval {CI}, 0.6-2.6], p = 0.003; HADS-A mean difference 2.9 [1.5-4.4], p<0.001; PSQI mean difference 2.4 [1.3-3.4], p<0.001). The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery (mean difference -7.0 [95% CI, -10.7 to -3.4], p<0.001). At 12 months after surgery, there were decreases in the prevalence of depression (six of 47 [22.8%] versus three of 47 [6.4%], p = 0.002), anxiety (11 of 47 [23.4%] versus two of 47 [4.3%], p = 0.016), and insomnia (33 of 47 [70.2%] versus 20 of 47 [42.6%], p = 0.022). Preoperative HADS-depression, HADS-anxiety, and PSQI scores did not correlate with the VAS pain score, UCLA, or ASES scores at 12 months after surgery. | Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear? | Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery. Preoperative depression, anxiety, and insomnia did not predict poor outcome after rotator cuff repair. Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL. | Question: Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear?
Answer: Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery. Preoperative depression, anxiety, and insomnia did not predict poor outcome after rotator cuff repair. Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL. |
Answer the question based on the following context: A retrospective assessment of coronal, sagittal, and axial correction using convex lumbar pedicle screw constructs compared with hook constructs in patients with idiopathic scoliosis. To determine if pedicle screw constructs can improve coronal, sagittal, and axial correction without increased complications and therefore warrant their use in the lumbar spine. Although hooks have been the traditional fixation choice for posterior scoliosis correction of the lumbar spine, pedicle screws may offer advantages for improved correction of lumbar spinal deformity. Twenty-two patients constituted Group A (hooks), in which 17 were double major and five were King Type IV curves. These patients had a minimum follow-up period of 2 years and an average of one hook per lumbar fusion segment. Twenty-two patients constituted Group B (screws), in which 20 were double major and two were King Type IV curves. These patients had a minimum follow-up period of 2 years, and screw configuration consisted of pedicle fixation on the convex side for correction and at times on the concave side for fixation. Pedicle screw fixation constructs had improved lumbar Cobb correction (P<0.05), lowest instrumented vertebra tilt (P<0.05), lowest instrumented vertebra translation (P<0.01), and segmental sagittal alignment from T12 to lowest instrumented vertebra (P<0.01). There was no significant change in axial rotation using either surgical method. | The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted? | The use of pedicle screw fixation on the convex portion of the lumbar spine in patients with double major idiopathic scoliosis allows for improved correction of the lumbar Cobb measurement, horizontalization and translation of the lowest instrumented vertebra, and improved segmental lordization over the instrumented levels without increased complications. | Question: The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted?
Answer: The use of pedicle screw fixation on the convex portion of the lumbar spine in patients with double major idiopathic scoliosis allows for improved correction of the lumbar Cobb measurement, horizontalization and translation of the lowest instrumented vertebra, and improved segmental lordization over the instrumented levels without increased complications. |
Answer the question based on the following context: Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease. A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue. A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime. | Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention? | Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital. | Question: Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?
Answer: Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital. |
Answer the question based on the following context: By the comparison between most used tumor marker trend (cancer antigen 125: CA 125 and human epididymal secretory protein E4: HE4) before and after laparoscopic surgery, the aim of the present study was to assess HE4 usefulness in ovarian benign cyst and endometrioma diagnosis. Thirty-eight patients were enrolled in this prospective study: 25 women underwent unilateral endometriosis ovarian cyst excision, 13 underwent benign ovarian cyst incision, and 26 were healthy controls. CA 125 and HE4 serum levels were estimated before surgery (in the early proliferative phase of the cycle) and one month after surgery. A statistically significant decrease of CA 125 serum level was found after an endometrioma surgical excision but no decreases in HE4 serum level. | Is HE4 a useful endometrioma marker? | In patients with endometrioma, no alteration was found in HE4 serum levels before and after surgery, while CA125 serum levels decreased after surgery. HE4 may better distinguish a malign cyst from benign one, but it is not useful in the diagnosis of low risk endometrioma. | Question: Is HE4 a useful endometrioma marker?
Answer: In patients with endometrioma, no alteration was found in HE4 serum levels before and after surgery, while CA125 serum levels decreased after surgery. HE4 may better distinguish a malign cyst from benign one, but it is not useful in the diagnosis of low risk endometrioma. |
Answer the question based on the following context: The aim of the study was to determine the prevalence of hyper and hypo-parathyroid state in prevalent dialysis patients. The second part of the study was to look for the prevalence of vascular calcification (abdominal aortic) and factors predicting calcification in these patients. All adult patients, who were more than 1 month on dialysis, were included in the study. A total of 68 patients, of which 75% were on hemodialysis and 25% on peritoneal dialysis, were finally studied. Patients' parathyroid status was defined as per target recommendation of KDOQI--hypoparathyroid with iPTH<or = 150 pg/ml and hyperparathyroid with iPTH>300 pg/ml. Vascular calcification was determined by X ray of lateral lumbar spine to look for abdominal aortic calcification (AAC). The AAC was scored as validated. The prevalence of hyper- and hypoparathyroidism in dialysis patients was determined as percentage of total dialysis patients. The prevalence of AAC and factors predicting it was analyzed by 'univariate' and 'multiple logistic regression analyses. The mean age of patients was 50.04 +/- 14.15 years, 58.82% were males and 42.64% were diabetics. Mean duration of dialysis was 22.36 +/- 19.17 months. Hyperparathyroidism was seen in only 27.94% of all dialysis patients, while hypoparathyroidism was in 45.58%. Abdominal aortic calcification was seen in 79.41% of overall patients and 13.23% had significant calcification (score 7-24). On univariate analysis, age (0.000) and iPTH (0.03) were the only variables predicting AAC and on logistic regression analysis, age was the only independent predictor of abdominal aortic calcification (p = 0.002, OR 1.11, CI 1.038-1.186). | Are we overconcerned about secondary hyperparathyroidism and underestimating the more common secondary hypoparathyroidism in our dialysis patients? | Hypoparathyroidism is more common (46%) in our dialysis patients as compared to hyperparathyroidism (28%). There is high prevalence of vascular (abdominal aortic) calcification (80%) in our dialysis patients. | Question: Are we overconcerned about secondary hyperparathyroidism and underestimating the more common secondary hypoparathyroidism in our dialysis patients?
Answer: Hypoparathyroidism is more common (46%) in our dialysis patients as compared to hyperparathyroidism (28%). There is high prevalence of vascular (abdominal aortic) calcification (80%) in our dialysis patients. |
Answer the question based on the following context: The aim of this study was to measure the temperature generated by light sources in conjunction with angulated endoscopes and to analyze whether the heat generated at the endoscopes' tips harbors potential damage to mucosa or highly sensitive structures like the optic nerve or brain when in direct contact, considering a beginning necrosis of human protein starting at 40°C. Laboratory setting, prospective. Brand new 4-mm, 0° and 30° rigid nasal endoscopes were measured each with halogen, xenon, and light-emitting diode (LED) light sources, respectively, at different power levels for tip contact temperature. The highest temperatures were reached with a xenon light source at a maximum of 44.3°C, 65.8°C, and 91.4°C at 33%, 66%, and 100% power levels, respectively, for 4-mm, 0° endoscopes. For 30° endoscopes, temperatures of 47.0°C, 75.1°C, and 95.5°C were measured at 33%, 66%, and 100% power levels (P<.001; 0° vs. 30°), respectively. At 5-mm distance from the tip, temperatures were below body temperature for all light sources (<36°C) at all power settings. Within 2 minutes after switching off light sources, temperatures dropped to room temperature (22°C). | Heat development at nasal endoscopes' tips: danger of tissue damage? | Xenon light sources have the greatest illumination potential; however, at only 33% power level, potentially harmful temperatures can be reached at the tips of the endoscopes. Power LED and halogen have the highest safety; however, only LED has very good illumination. In narrow corridors, direct contact to tissues or vital structures should be avoided, or endoscopes should be cooled during surgical procedures. | Question: Heat development at nasal endoscopes' tips: danger of tissue damage?
Answer: Xenon light sources have the greatest illumination potential; however, at only 33% power level, potentially harmful temperatures can be reached at the tips of the endoscopes. Power LED and halogen have the highest safety; however, only LED has very good illumination. In narrow corridors, direct contact to tissues or vital structures should be avoided, or endoscopes should be cooled during surgical procedures. |
Answer the question based on the following context: To describe 6 patients with hybrid cysts of the eyelid that demonstrated follicular and apocrine differentiation. Clinicopathologic series of 6 cases obtained from review of 1,099 cases of hidrocystoma diagnosed at the New York Eye and Ear Infirmary from 1990 to 2006. Six patients, aged 38 years to 85 years (mean 66.5 years), was examined for cystic eyelid lesions. Histopathologic evaluation revealed cystic structures, lined by a combination of apocrine, infundibular (epidermoid), and trichilemmal-type epithelia. Luminal contents consisted of variable amounts of lamellated and compact keratin, and serous material. Contiguity with a hair follicle was demonstrated in 4 of 6 lesions. Immunohistochemical evaluation showed intense immunoreactivity of the entire cyst lining in all lesions for high molecular weight cytokeratin and variable immunoreactivity for low molecular weight cytokeratin. All cystic structures displayed immunoreactivity for carcinoembryonic antigen. Weak focal immunoreactivity for S-100 protein and gross cystic disease fluid protein-15 was observed in most lesions. | Hybrid cysts of the eyelid with follicular and apocrine differentiation: an under-recognized entity? | Hybrid cysts can show apocrine, trichilemmal, and infundibular differentiation, suggestive of their origin at the junction of keratinizing squamous and glandular epithelia of the hair follicle. Although, to our knowledge, only 1 such lesion has been described in the eyelid skin, it is likely that hybrid cysts of the eyelid are not an infrequent finding. | Question: Hybrid cysts of the eyelid with follicular and apocrine differentiation: an under-recognized entity?
Answer: Hybrid cysts can show apocrine, trichilemmal, and infundibular differentiation, suggestive of their origin at the junction of keratinizing squamous and glandular epithelia of the hair follicle. Although, to our knowledge, only 1 such lesion has been described in the eyelid skin, it is likely that hybrid cysts of the eyelid are not an infrequent finding. |
Answer the question based on the following context: Medical patients are often screened for distress in the clinic using a questionnaire such as the Hospital Anxiety and Depression Scale (HADS) while awaiting their consultation. However, might the context of the clinic artificially inflate the distress score ? To address this question we aimed to determine whether those who scored high on the HADS in the clinic remained high scorers when reassessed later at home. We analysed data collected by a distress and depression screening service for cancer out-patients. All patients had completed the HADS in the clinic (on computer or on paper) prior to their consultation. For a period, patients with a high score (total of>or = 15) also completed the HADS again at home (over the telephone) 1 week later. We used these data to determine what proportion remained high scorers and the mean change in their scores. We estimated the effect of ‘ regression to the mean’ on the observed change. Of the 218 high scorers in the clinic, most [158 (72.5 %), 95% confidence interval (CI) 66.6–78.4] scored high at reassessment. The mean fall in the HADS total score was 1.74 (95% CI 1.09–2.39), much of which could be attributed to the estimated change over time (regression to the mean) rather than the context. | Screening medical patients for distress and depression: does measurement in the clinic prior to the consultation overestimate distress measured at home? | Pre-consultation distress screening in clinic is widely used. Reassuringly, it only modestly overestimates distress measured later at home and consequently would result in a small proportion of unnecessary further assessments. We conclude it is a reasonable and convenient strategy. | Question: Screening medical patients for distress and depression: does measurement in the clinic prior to the consultation overestimate distress measured at home?
Answer: Pre-consultation distress screening in clinic is widely used. Reassuringly, it only modestly overestimates distress measured later at home and consequently would result in a small proportion of unnecessary further assessments. We conclude it is a reasonable and convenient strategy. |
Answer the question based on the following context: The population consisted of infants born to HIV-infected women in South Africa who were participating in a vitamin A intervention trial to prevent MTCT of HIV. Women chose to breastfeed or formula feed their infants according to UNAIDS guidelines. Actual feeding practices and morbidity were recorded at clinic follow-up visits at I wk, 6 wk, 3 mo and every 3 mo thereafter until 15 mo of age or cessation of breastfeeding. The infant's HIV status was assessed according to a predetermined algorithm. HIV-infected infants who were never breastfed had a poorer outcome than those who were breastfed; 9 (60%) of those who were never breastfed had 3 or more morbidity episodes compared with 15 (32%) of breastfed children [odds ratio (OR) 4.05, 95% confidence interval (95% CI) 0.91-20.63, p = 0.05]. During the first 2 mo of life, never-breastfed infants (regardless of HIV status) were nearly twice as likely to have had an illness episode than breastfed infants (OR 1.91, 95% CI 1. 17-3.13, p = 0.006). | Morbidity in children born to women infected with human immunodeficiency virus in South Africa: does mode of feeding matter? | The significant extra morbidity experienced in the first few months by all never-breastfed infants and at all times by HIV-infected infants who are not breastfed needs to be considered in all decisions by mothers, health workers and policy makers so as not to offset any gains achieved by decreasing HIV transmission through avoiding breastfeeding. | Question: Morbidity in children born to women infected with human immunodeficiency virus in South Africa: does mode of feeding matter?
Answer: The significant extra morbidity experienced in the first few months by all never-breastfed infants and at all times by HIV-infected infants who are not breastfed needs to be considered in all decisions by mothers, health workers and policy makers so as not to offset any gains achieved by decreasing HIV transmission through avoiding breastfeeding. |
Answer the question based on the following context: To realize safe radiotherapy treatment, processes must be stabilized. Standard operating procedures (SOP's) were expected to stabilize the treatment process and perceived task importance would increase sustainability in compliance. This paper presents the effects on compliance to safety related tasks of a process redesign based on lean principles. Compliance to patient safety tasks was measured by video recording of actual radiation treatment, before (T0), directly after (T1) and 1.5 years after (T2) a process redesign. Additionally, technologists were surveyed on perceived task importance and reported incidents were collected for three half-year periods between 2007 and 2009. Compliance to four out of eleven tasks increased at T1, of which improvements on three sustained (T2). Perceived importance of tasks strongly correlated (0.82) to compliance rates at T2. The two tasks, perceived as least important, presented low base-line compliance, improved (T1), but relapsed at T2. The reported near misses (patient-level not reached) on accelerators increased (P<0.001) from 144 (2007) to 535 (2009), while the reported misses (patient-level reached) remained constant. | Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized? | Compliance to specific tasks increased after introducing SOP's and improvements sustained after 1.5 years, indicating increased stability. Perceived importance of tasks correlated positively to compliance and sustainability. Raising the perception of task importance is thus crucial to increase compliance. The redesign resulted in increased willingness to report incidents, creating opportunities for patient safety improvement in radiotherapy treatment. | Question: Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized?
Answer: Compliance to specific tasks increased after introducing SOP's and improvements sustained after 1.5 years, indicating increased stability. Perceived importance of tasks correlated positively to compliance and sustainability. Raising the perception of task importance is thus crucial to increase compliance. The redesign resulted in increased willingness to report incidents, creating opportunities for patient safety improvement in radiotherapy treatment. |
Answer the question based on the following context: There is controversy as to whether PTSD can develop following a brain injury with a loss of consciousness. However, no studies have specifically examined the influence of the memories that the individuals may or may not have on the development of symptoms. To consider how amnesia for the traumatic event effects the development and profile of traumatic stress symptoms. Fifteen hundred case records from an Accident and Emergency Unit were screened to identify 371 individuals with traumatic brain injury who were sent questionnaires by post. The 53 subsequent valid responses yielded three groups: those with no memory (n = 14), untraumatic memories (n = 13) and traumatic memories (n = 26) of the index event. The IES-R was used as a screening measure followed by a structured interview (CAPS-DX) to determine caseness and provide details of symptom profile. Groups with no memories or traumatic memories of the index event reported higher levels of psychological distress than the group with untraumatic memories. Ratings of PTSD symptoms were less severe in the no memory groups compared to those with traumatic memories. | Post-traumatic stress disorder symptoms following a head injury: does amnesia for the event influence the development of symptoms? | Psychological distress was associated with having traumatic or no memories of an index event. Amnesia for the event did not protect against PTSD; however, it does appear to protect against the severity and presence of specific intrusive symptoms. | Question: Post-traumatic stress disorder symptoms following a head injury: does amnesia for the event influence the development of symptoms?
Answer: Psychological distress was associated with having traumatic or no memories of an index event. Amnesia for the event did not protect against PTSD; however, it does appear to protect against the severity and presence of specific intrusive symptoms. |
Answer the question based on the following context: Deficits in executive functioning (EF) are implicated in neurobiological and cognitive-processing theories of depression. EF deficits are also associated with Attention-deficit/hyperactivity disorder (ADHD) in adults, who are also at increased risk for depressive disorders. Given debate about the ecological validity of laboratory measures of EF, we investigated the relationship between depression diagnoses and symptoms and EF as measured by both rating scales and tests in a sample of adults referred for evaluation of adult ADHD. Data from two groups of adults recruited from an ADHD specialty clinic were analyzed together: Adults diagnosed with ADHD (N=146) and a clinical control group of adults referred for adult ADHD assessment but not diagnosed with the disorder ADHD (N=97). EF was assessed using a rating scale of EF deficits in daily life and a battery of tests tapping various EF constructs. Depression was assessed using current and lifetime SCID diagnoses (major depression, dysthymia) and self-report symptom ratings. EF as assessed via rating scale predicted depression across measures even when controlling for current anxiety and impairment. Self-Management to Time and Self-Organization and Problem-Solving showed the most robust relationships. EF tests were weakly and inconsistently related to depression measures. Prospective studies are needed to rigorously evaluate EF problems as true risk factors for depressive onset. | Does executive functioning (EF) predict depression in clinic-referred adults? | EF problems in everyday life were important predictors of depression. Researchers and clinicians should consistently assess for the ADHD-depression comorbidity. Clinicians should consider incorporating strategies to address EF deficits when treating people with depression. | Question: Does executive functioning (EF) predict depression in clinic-referred adults?
Answer: EF problems in everyday life were important predictors of depression. Researchers and clinicians should consistently assess for the ADHD-depression comorbidity. Clinicians should consider incorporating strategies to address EF deficits when treating people with depression. |
Answer the question based on the following context: The incidence of residual paralysis, i.e., a mechanomyographic train-of-four (TOF) ratio (T4/T1) less than 0.9, remains frequent. Routine acceleromyography has been proposed to detect residual paralysis in clinical practice. Although acceleromyographic data are easy to obtain, they differ from mechanomyographic data, with which they are not interchangeable. The current study aimed to determine (1) the acceleromyographic TOF ratio that detects residual paralysis with a 95% probability, and (2) the impact of calibration and normalization on this predictive acceleromyographic value. In 60 patients, recovery from neuromuscular block was assessed simultaneously with mechanomyography and acceleromyography. To obtain calibrated acceleromyographic TOF ratios in group A, the implemented calibration modus 2 was activated in the TOF-Watch S; to obtain uncalibrated acceleromyographic TOF ratios in group B, the current was manually set at 50 mA (n = 30 for each). In addition, data in group B were normalized (i.e., dividing the final TOF ratio by the baseline value). The agreement between mechanomyography and acceleromyography was assessed by calculating the intraclass correlation coefficient. Negative predictive values were calculated for detecting residual paralysis from acceleromyographic TOFs of 0.9, 0.95, and 1.0. : For a mechanomyographic TOF of 0.9 or greater, the corresponding acceleromyographic TOF was 0.95 (range, 0.86-1.0), and the negative predictive values for acceleromyographic TOFs of 0.9, 0.95, and 1.0 were 37% (95% CI, 20-56%), 70% (95% CI, 51-85%), and 97% (95% CI, 83-100%), respectively. Group B: Without normalization, an acceleromyographic TOF of 0.97 (range, 0.68-1.18) corresponded to a mechanomyographic TOF of 0.9 or greater, with negative predictive values for acceleromyographic TOFs of 0.9, 0.95, and 1.0 being 40% (95% CI, 23-59%), 60% (95% CI, 41-77%), and 77% (95% CI, 58-90%), respectively. After normalization, an acceleromyographic TOF of 0.89 (range, 0.63-1.06) corresponded to a mechanomyographic TOF of 0.9 or greater, and the negative predictive values of acceleromyographic TOFs of 0.9, 0.95, and 1.0 were 89% (95% CI, 70-98%), 92% (95% CI, 75-99%), and 96% (95% CI, 80-100%), respectively. | Can acceleromyography detect low levels of residual paralysis? | To exclude residual paralysis reliably when using acceleromyography, TOF recovery to 1.0 is mandatory. | Question: Can acceleromyography detect low levels of residual paralysis?
Answer: To exclude residual paralysis reliably when using acceleromyography, TOF recovery to 1.0 is mandatory. |
Answer the question based on the following context: The main purpose of this study is to assess the achievements and barriers to advancement for Saudi women in a medical academic setup. We studied the career progression of female medical graduates, who were appointed an academic position in King Faisal University, Dammam, Kingdom of Saudi Arabia (KSA) between 1982 and 2003 and compared it to the male counterpart. The information was collected from the Dean's ship of admission and registration, employees and faculty affairs administration office, self completed and telephone surveys. The percentage of medical graduates who were appointed on an academic post in the University was 4.4% for females and 4% for males. The females specialized in various fields and progressed equitably with the males in their postgraduate studies. Academic promotion to higher ranks was slower for females in comparison to males. This was related to various reasons related to family responsibilities, social strains, lack of family friendly policies in the institutions, lack of mentoring relationship, and bias against females. | Saudi women in academic medicine. Are they succeeding? | Saudi women in academic medicine have succeeded at the junior level. They specialized in various fields and excelled. Their further academic progression needs the support of senior academic staff, the chairs and the institution administration. | Question: Saudi women in academic medicine. Are they succeeding?
Answer: Saudi women in academic medicine have succeeded at the junior level. They specialized in various fields and excelled. Their further academic progression needs the support of senior academic staff, the chairs and the institution administration. |
Answer the question based on the following context: Federal initiatives continue to provide strong support for community antidrug coalitions, but whether this approach actually reduces substance abuse is not clear. This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effects. Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were also ranked by site. Using rank order correlation, three directional hypotheses compared strategy dose to outcomes. None of the hypotheses were supported. Strategies aimed at either youth or community/prevention outcomes showed no effects, while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show any superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes. | Fighting back against substance abuse: are community coalitions winning? | Comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered. Efforts to evaluate implementation processes as well as to correlate strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research. | Question: Fighting back against substance abuse: are community coalitions winning?
Answer: Comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered. Efforts to evaluate implementation processes as well as to correlate strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research. |
Answer the question based on the following context: To determine the chronic complication rate of anterior hypospadias repair and to explore whether the practice of placing the neomeatus at the tip of the penis should be applicable to all cases in our community where urination is in a sitting/squatting position. Over a 10-year period commencing 1st September 1987, 312 patients had hypospadias repair of whom 72% had anterior hypospadias. The meatus was advanced to the tip of the penis in all repairs. The location of the meatus was also determined in 281 non-complaining men with a straight penis and normal sexual and reproductive functions. Following prior information that anterior hypospadias was not associated with sexual and reproductive dysfunction, 51 patients were given a choice between repair or no repair. Urethrocutaneous fistula occurred in 5% of patients, urethral stricture in 3% and meatal retraction in 3%, with 92% of patients having no complications. Forty six percent of non-complaining men had the meatus in locations other than the tip of the penis. Of 51 patients with the benefit of informed consent, 73% opted for no repair. | Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position? | Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies. | Question: Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position?
Answer: Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies. |
Answer the question based on the following context: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. | Do guidelines for the diagnosis and monitoring of diabetes mellitus fulfill the criteria of evidence-based guideline development? | The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine. | Question: Do guidelines for the diagnosis and monitoring of diabetes mellitus fulfill the criteria of evidence-based guideline development?
Answer: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine. |
Answer the question based on the following context: Poor mental health may influence people's decisions about, and ability to, keep working into later adulthood. The identification of factors that drive retirement provides valuable information for policymakers attempting to mitigate the effects of population ageing. This study examined whether mental health predicts subsequent retirement in a general population sample, and whether this association varied with the timing of retirement. Longitudinal data from 2,803 people aged 45-75 years were drawn from five waves of the Household Income and Labour Dynamics in Australia (HILDA) survey. Discrete-time survival analyses were used to estimate the association between mental health and retirement. Mental health was measured using the Mental Health Index (MHI-5). The relative influences of other health, social, financial, and work-related predictors of retirement were considered to determine the unique contribution of mental health to retirement behaviour. Poor mental health was associated with higher rates of retirement in men (hazard rate ratio, HRR 1.19, 95% CI 1.01-1.29), and workforce exit more generally in women (HRR 1.14, 95% CI 1.07-1.22). These associations varied with the timing of retirement and were driven by early retirees specifically. Physical functioning, income, social activity, job conditions (including job stress for women and job control for men), and aspects of job satisfaction also predicted subsequent retirement. | Is poor mental health a risk factor for retirement? | Poor mental and physical health predict workforce departure in mid-to-late adulthood, particularly early retirement. Strategies to accommodate health conditions in the workplace may reduce rates of early retirement and encourage people to remain at work into later adulthood. | Question: Is poor mental health a risk factor for retirement?
Answer: Poor mental and physical health predict workforce departure in mid-to-late adulthood, particularly early retirement. Strategies to accommodate health conditions in the workplace may reduce rates of early retirement and encourage people to remain at work into later adulthood. |
Answer the question based on the following context: Skeletal muscle atrophy and decreased expression of slow fibers contribute to exercise capacity limitation in Chronic Heart Failure (CHF). Pro-inflammatory cytokines and free radicals worsen muscle damage. In CHF sarcomeric proteins are oxidized with reduction of muscle twitch efficiency, and VO(2)-max. Beta-blockers with anti-oxidative capacity such as carvedilol have been shown to prevent contractile protein oxidation in CHF rats. Recently a new class of beta-blockers with NO donor activity has been introduced and approved for the treatment of CHF. Since a clinical clear superiority of a beta-blocker has never been shown, we compared nebivolol, that possesses NO donor activity, with bisoprolol, looking at possible differences in skeletal muscle that may have an impact on muscle function and exercise capacity in humans. We therefore studied skeletal muscle apoptosis and wastage, sarcomeric protein composition and oxidation, and muscle efficiency. In the monocrotaline rat model of CHF we compared nebivolol a beta-blocker with vasodilative properties mediated by NO production, with bisoprolol. Nebivolol prevented protein oxidation, while bisoprolol did it only partially, as demonstrated by the oxyblot analysis (Oxy/RP values) (0.90+/-0.14 Controls.; 1.7+/-0.14 CHF; 1.1+/-0.05 bisoprolol; 0.82+/-0.17 nebivolol low; 0.62+/-0.10 nebivolol high). Only nebivolol improved twitch force production and relaxation. Nebivolol prevented fibers shift towards fast isoforms, atrophy, decreased apoptosis and sphingosine levels. | Skeletal muscle proteins oxidation in chronic right heart failure in rats: can different beta-blockers prevent it to the same degree? | Nebivolol seems better than bisoprolol in CHF by decreasing apoptosis and cytokines induced muscle wastage, preventing fibers shift and protein oxidation. Nebivolol by stimulating NO generation may have prevented protein oxidation. It could be speculated that ROS release, pro-inflammatory cytokines production and NF-kappa-B activation may play a key role. These positive changes could produce a favorable impact on exercise capacity in man. | Question: Skeletal muscle proteins oxidation in chronic right heart failure in rats: can different beta-blockers prevent it to the same degree?
Answer: Nebivolol seems better than bisoprolol in CHF by decreasing apoptosis and cytokines induced muscle wastage, preventing fibers shift and protein oxidation. Nebivolol by stimulating NO generation may have prevented protein oxidation. It could be speculated that ROS release, pro-inflammatory cytokines production and NF-kappa-B activation may play a key role. These positive changes could produce a favorable impact on exercise capacity in man. |
Answer the question based on the following context: Abstract Purpose: To determine whether one vs two 24-hour urine collections is optimal in the metabolic evaluation of nephrolithiasis. We retrospectively reviewed all 24-hour urine collections performed at our tertiary stone clinic from July 1997 to February 2012. We identified patients with two 24-hour urine collections performed ≤10 days apart. Samples were analyzed by an outside laboratory for the standard urinary parameters. For each parameter, pairwise t tests were performed and Pearson correlation coefficients were calculated to compare samples 1 and 2. In addition, the number of cases that changed from normal to abnormal or vice versa was also evaluated for each parameter and the Kappa statistic was calculated. A total of 813 subjects submitted two 24-hour urine collections ≤10 days apart. Mean age was 53.2 years, and mean body mass index was 28.8 kg/m(2). Based on creatinine 24/kg, subset analysis was performed for all properly collected samples (n=236). Using pairwise t test, 24-hour urine volume (P=0.0365) and phosphorus (P=0.0387) showed a statistically significant difference between samples 1 and 2. None of the other urinary parameters demonstrated a statistically significant difference when means were compared (pairwise t test, P>0.05), (range 0.061-0.9983). Pearson correlation demonstrated a high degree of correlation between two 24-hour urines for all variables (r=0.66-0.95, each P<0.0001). Depending on the urinary parameter assessed, 5.5% to 44.9% of patients changed from normalcy to abnormality, or vice versa. | 24-hour urine collection in the metabolic evaluation of stone formers: is one study adequate? | A single 24-hour urine collection may have changed clinical decision making in up to 45% of patients. Therefore, we recommend two collections to optimize the diagnostic yield and appropriately target stone prevention strategies. | Question: 24-hour urine collection in the metabolic evaluation of stone formers: is one study adequate?
Answer: A single 24-hour urine collection may have changed clinical decision making in up to 45% of patients. Therefore, we recommend two collections to optimize the diagnostic yield and appropriately target stone prevention strategies. |
Answer the question based on the following context: Studies indicate that ovarian cancer patients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice. One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model. There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked (<or = 2 cm residual disease) than UK patients [corrected] (71.3% v 58.4%, respectively; P<.001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy. | Does aggressive surgery only benefit patients with less advanced ovarian cancer? | Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients. | Question: Does aggressive surgery only benefit patients with less advanced ovarian cancer?
Answer: Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients. |
Answer the question based on the following context: Nodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations. We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes. Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities. | Is the glass half full or half empty? | Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome. | Question: Is the glass half full or half empty?
Answer: Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome. |
Answer the question based on the following context: Recently, a number of studies have reported positive results from the nonoperative management of fistula-in-ano in infancy, although it has not been of use in all patients. The purpose of this study was to discern the effective treatment methods of fistula-in-ano in infants. A retrospective review was done of 310 children who required operative management for fistula-in-ano or perianal abscess between January 1991 and July 2000. Eighteen patients displayed an onset of symptoms at less than 1 year of age and a duration of symptoms longer than 12 months. The authors analyzed these patients' medical records. All patients were boys. The mean duration of the symptoms was 26.6 +/- 27.5 months. Fourteen patients had shown an onset of symptoms at less than 6 months of age. The longest duration was 10 years. The patients showed conservative periods of over 12 months because their parents did not want them to undergo surgery. The disease in these patients followed 2 patterns. One (6 patients) was an onset of symptoms followed by a silent fistula-in-ano state. The other (12 patients) was an onset of symptoms followed by an intermittent relapse of inflammation. All patients underwent fistulotomy, and none of them had recurrent fistula during the follow-up period. | Fistula-in-ano in infants: is nonoperative management effective? | Although the advantages of a nonoperative management of fistula-in-ano in infants include the avoidance of general anesthesia and surgical intervention, the lesions cannot be cured by a period of conservation. Surgical management is more effective in respect to the time factor. | Question: Fistula-in-ano in infants: is nonoperative management effective?
Answer: Although the advantages of a nonoperative management of fistula-in-ano in infants include the avoidance of general anesthesia and surgical intervention, the lesions cannot be cured by a period of conservation. Surgical management is more effective in respect to the time factor. |
Answer the question based on the following context: There is an expectation that interns can perform the core procedural skill of male catheterisation; however, it is unclear if our medical graduates are competent to do so, because there is no formal practical skills exit assessment in our current programme.AIM: We sought to investigate the level of experience, the self-reported confidence, and measured competency of our pre-intern (PRINT) students to perform the procedural skill of male catheterisation. We asked 100/147 (68%) PRINT students to complete a questionnaire to elucidate their experience and confidence prior to being practically assessed on a plastic manikin, using a faculty member validated 26-item checklist. Students were also invited to attend focus groups to help identify factors that had contributed to their practical performance. Between 2010 and 2012, 100/147 (68%) PRINT students completed a questionnaire prior to being formatively assessed. The mean score for self-reported confidence was 78.3/100 (95% CI 74.8-81.8), and the mean performance score was 85.6/100 (95% CI 83.2-87.9); however, the correlation coefficient between the confidence score and performance score was weak (r = 0.18). Three focus groups were conducted, with a total of 12/100 (12%) students attending. Although students reported that they had sound knowledge of the skill, the lack of opportunity to perform the skill in the clinical setting had led to mediocre performance outcomes. | Pre-interns: ready to perform? | We found no significant correlation among the level of experience, the self-reported ability and actual performance when students were assessed under direct observation. | Question: Pre-interns: ready to perform?
Answer: We found no significant correlation among the level of experience, the self-reported ability and actual performance when students were assessed under direct observation. |
Answer the question based on the following context: Some studies find that parents of children with Down's syndrome may experience symptoms of depression, while other studies find that parents adapt well. This study aimed to clarify this variability in adaptive strength by investigating a stress-coping model to explain depressive symptoms and positive affect. Questionnaires were completed by 553 parents of children (aged 0-18) with Down's syndrome, containing measures of goal disturbance, cognitive coping, social support, partner bonding, and coping self-efficacy. Different models for positive affect and depressive symptoms were found. The coping strategies of self-blame and rumination were positively related to depressive symptoms, and positive reappraisal was positively related to positive affect. Partner bonding characteristics played relevant roles in both models, as did coping self-efficacy and goal disturbance. Social support seemed mainly relevant in explaining positive affect. | Down or up? | Different psychological factors were related to depressive symptoms and positive affect in parents of children with Down's syndrome. Implications are discussed. | Question: Down or up?
Answer: Different psychological factors were related to depressive symptoms and positive affect in parents of children with Down's syndrome. Implications are discussed. |
Answer the question based on the following context: In order to evaluate the permissiveness of current bioequivalence requirements for antiepileptic drugs we investigated how accurate Cmax and AUC0-t of generic antiepileptic drugs approved in Brazil are in comparison to reference products. Data collected from assessment reports of approved bioequivalence studies archived in the Brazilian regulatory agency in 2007-2012 were: geometric mean ratios and 90% confidence intervals (CI) for Cmax and AUC0-t, intra-subject variability (CV) of Cmax and AUC0-t and number of subjects. The average difference in Cmax and AUC0-t between generic and reference products was 5% and 3%, respectively. Maximum deviation from 1.00 of the CI of Cmax can achieve 15-20% (demonstrated in 27% of studies); for AUC0-t, 25% of studies showed the deviation can be>10%. All studies that used adequate number of subjects for a 90% CI of 0.90-1.11 complied with it for AUC0-t, except one of carbamazepine, but only 33% complied with it for both AUC0-t and Cmax. The CV was strongly correlated to the maximum CI deviation for AUC0-t (CV of approximately 15% corresponding to deviation of 10%). Studies that presented maximum CI deviation ≤ 10 % together with CV ≤ 15% for AUC0-t represented 65% of the total. Weaker correlation was observed for Cmax and no correlation was seen between maximum CI deviation and number of subjects. | Assessing bioequivalence of antiepileptic drugs: are the current requirements too permissive? | Modification in legislation for bioequivalence of antiepileptic drugs is suggested, not only with constraint of AUC0-t 90% CI to 0.90-1.11, but also with limitation of the CV to 15%, as to assure similar variance in pharmacokinetics and diminish the risk of critical plasma-level fluctuation when switching between generic and reference formulations. Although most generics presented differences ≤ 10% in AUC0-t compared to their references, some narrow therapeutic index drugs displayed differences that could be clinically significant after product substitution. | Question: Assessing bioequivalence of antiepileptic drugs: are the current requirements too permissive?
Answer: Modification in legislation for bioequivalence of antiepileptic drugs is suggested, not only with constraint of AUC0-t 90% CI to 0.90-1.11, but also with limitation of the CV to 15%, as to assure similar variance in pharmacokinetics and diminish the risk of critical plasma-level fluctuation when switching between generic and reference formulations. Although most generics presented differences ≤ 10% in AUC0-t compared to their references, some narrow therapeutic index drugs displayed differences that could be clinically significant after product substitution. |
Answer the question based on the following context: To investigate the clinical course of untreated patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia) (IPF/UIP). Forty-three patients with IPF/UIP, divided into two groups. Group I consisted of 29 patients treated at diagnosis, while Group II comprised 14 patients who did not receive treatment. The indication of treatment was established whenever patients referred to a significant progression of the degree of dyspnea during the year prior to diagnosis. At diagnosis, patients from Group I had lower FVC (mean +/- SEM, 56+/-3% vs 73+/-3%) (p = 0.0004) and a greater extent of ground glass pattern in high resolution CT scan (18+/-4% vs 4+/-1%) (p = 0.004) than those from Group II. In group I, a follow-up study was carried out on 26 patients for 24+/-4 months. Thirteen of these 26 patients (50%) died 11+/-4 months after the initial assessment. Serial pulmonary functional tests were performed on 19 patients. Thirteen patients from Group II were followed up for 23+/-3 months. Seven of these 13 patients were treated 12+/-3 months after the diagnosis because of progression of the disease. The remaining 6 patients remained untreated and with the disease stable at the end of the follow-up, representing 15% (6 out of 39) of the whole study group. No patients from this group died during the follow-up. At the end of the follow-up, there were no differences in lung function changes between treated patients (19 from Group I and 7 from Group II), and the 6 untreated patients. | Is it necessary to treat all patients with idiopathic pulmonary fibrosis? | Some patients with IPF/UIP remain stable for extended periods of time without treatment. | Question: Is it necessary to treat all patients with idiopathic pulmonary fibrosis?
Answer: Some patients with IPF/UIP remain stable for extended periods of time without treatment. |
Answer the question based on the following context: To investigate and compare the level of light touch-pressure sensation as tested via the Semmes Weinstein monofilament (SWM) test with the level of functional hand ability. Twenty-seven persons with isolated sensory deficit due to leprosy and 31 healthy controls were tested in the Occupational Therapy department of a hospital for patients with Hansen's disease. Palmar light touch thresholds were determined by SMW testing. Functional hand ability was tested via the Jebsen-Taylor Hand Function Test (JTHFT) and the Functional Dexterity Test (FDT). All participants were measured by manual muscle testing (MMT) to exclude any motor impairment. Data analysis compared sensory thresholds and level of functional hand ability between the two groups and examined the relationship between the variables. In the group with sensory deficit, the sensory thresholds were significantly higher than in the control group. Significant correlations were found between the sensory thresholds measured by the SWM test and the FDT and JTHFT scores, with higher correlations found for tasks entailing manipulation of small objects. | Is there a relationship between light touch-pressure sensation and functional hand ability? | The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests. | Question: Is there a relationship between light touch-pressure sensation and functional hand ability?
Answer: The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests. |
Answer the question based on the following context: We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants were 1,523 general practitioners/family physicians (568 from England and Wales, 453 from the United States and 502 from The Netherlands). Our main outcome measures were the perceived importance of the types of continuity of care and doctor or practice characteristics that may influence attitudes toward personal continuity of care. The response rates were England and Wales 60% (568/946), United States 47% (453/963) and Netherlands 76% (502/660). The doctors in all 3 countries felt strongly that personal continuity remained an important aspect of good-quality care to their patients. Within a given health care system, doctors' personal and practice characteristics explained only a small part of the variance in attitudes toward the provision of personal continuity of care (England and Wales and The Netherlands r2 = 0.04, United States r2 = 0.01). The doctors in all 3 countries felt that they were currently able to provide all 3 types of continuity of care, although doctors in England and Wales were least positive about the provision of informational and management continuity across the primary-secondary care divide. | Continuity of care: is the personal doctor still important? | General practitioners/family physicians from 3 differing health care systems all place high value on being able to provide personal continuity of care to patients. Personal continuity of care remains a core value of general practice/family medicine and should be taken account of by policy makers when redesigning health care systems. | Question: Continuity of care: is the personal doctor still important?
Answer: General practitioners/family physicians from 3 differing health care systems all place high value on being able to provide personal continuity of care to patients. Personal continuity of care remains a core value of general practice/family medicine and should be taken account of by policy makers when redesigning health care systems. |
Answer the question based on the following context: We investigated the possibility of determining organ confinement of prostate cancer using multiple nuclear texture features determined by fully automated high resolution image analysis combined with preoperative serum PSA levels. The study population consisted of 145 patients (61 organ confined and 84 non-organ-confined cases). Nuclear texture features were determined using single cell preparations of radical prostatectomy specimens. Nuclear texture features were extracted and analyzed by multivariate logistic regression analysis in order to build a classifier for distinguishing between organ confined and non-organ-confined tumors. The classifier was designed in a cell by cell model and tested on a case by case analysis. The predictive probability of the trained classifier in the cell by cell analysis had a sensitivity of 63%, a specificity of 53%, a positive predictive value of 75% and a negative predictive value of 38% and an area under the ROC curve of 0.58. In the case by case analysis the sensitivity was 70%, the specificity was 54%, positive predictive value 78%, negative predictive value 74%, area under the ROC curve 0.62. When preoperative PSA was included in the algorithm, sensitivity raised to 80%, specificity to 60%, the positive predictive value raised to 79%, the negative predictive value to 52% and the area under the ROC curve to 0.70. | Are nuclear texture features a suitable tool for predicting non-organ-confined prostate cancer? | In contrast to former studies using tissue sections, our results suggest that nuclear texture features extracted from single cell preparations cannot be used as a reliable parameter for the determination of organ confinement in prostatic adenocarcinomas. | Question: Are nuclear texture features a suitable tool for predicting non-organ-confined prostate cancer?
Answer: In contrast to former studies using tissue sections, our results suggest that nuclear texture features extracted from single cell preparations cannot be used as a reliable parameter for the determination of organ confinement in prostatic adenocarcinomas. |
Answer the question based on the following context: The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). | Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? | Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. | Question: Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?
Answer: Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. |
Answer the question based on the following context: Early referral is a major goal in chronic kidney diseases; however, loss to follow-up, potentially limiting its advantages, has never been studied.MATERIAL/ In order to assess the prevalence and causes of loss to follow-up, a telephone inquiry was performed in a renal outpatient unit, mainly dedicated to early referral of diabetic patients. Patients were considered to be in follow-up if there was at least one check-up in the period February 2001-February 2002, and lost to follow-up if the last check-up had occurred in the previous year. The reasons for loss to follow-up were related to typical clinical-biochemical parameters to define a "drop-out profile". 195 patients were on follow-up: median creatinine 1.4 mg/dL, age 64, 76.9% diabetics. 81 patients were lost to follow-up: creatinine 1.4 mg/dL, age 70, 73.8% diabetics. A telephone number was available in 87.6% of the cases; 25 were not found, 7 had died, 24 were non-compliant, 1 was bed-ridden, 12 had changed care unit, 2 had started dialysis. Renal care was shorter in those lost to follow-up; among the latter, serum creatinine and age were significantly lower in non-compliant patients. A logistic regression model confirmed the significance of lower serum creatinine at last check-up in non-compliant patients (p=0.018). | Lost to follow-up: the bottleneck of early referral to renal units? | Loss to follow-up is a problem in nephrology; lack of awareness probably causes the higher drop-out rate at lower creatinine levels. The initial period of care may be crucial for long-term compliance. Further studies are needed to tailor organizational and educational interventions. | Question: Lost to follow-up: the bottleneck of early referral to renal units?
Answer: Loss to follow-up is a problem in nephrology; lack of awareness probably causes the higher drop-out rate at lower creatinine levels. The initial period of care may be crucial for long-term compliance. Further studies are needed to tailor organizational and educational interventions. |
Answer the question based on the following context: States need data on live births resulting from unintended pregnancies in order to assess the need for family planning services; however, many states do not collect such data. Some states may use extrapolated rates from other states. Pregnancy Risk Assessment Monitoring System (PRAMS) data were assessed to explore the feasibility of extrapolating data on the percentage of live births resulting from unintended pregnancies from states that collect these data to states that do not. Data on women who had live births between 1993 and 1995 were examined for eight states: Alabama, Florida, Georgia, Michigan, New York (excluding New York City), Oklahoma, South Carolina and West Virginia. Logistic regression was used to determine state variation in the odds of delivering a live birth resulting from an unintended pregnancy after adjustment for maternal race, marital status, age, education, previous live birth and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The percentage of live births resulting from unintended pregnancy ranged from 33% in New York to 49% in Alabama, Georgia and South Carolina. Compared with women in Alabama, women in Oklahoma were more likely to deliver a live birth resulting from an unintended pregnancy (odds ratio of 1.2, confidence interval of 1.1-1.3) and women in New York State were less likely (odds ratio of 0.7, confidence interval of 0.6-0.8) to have such a birth. However, unmarried white women in New York had lower odds of having a live birth resulting from an unintended pregnancy and married black women in Michigan had higher odds of having a live birth resulting from unintended pregnancy than their counterparts in Alabama. Although the percentages varied, in all eight states women who were black, were unmarried, were younger than 20 years of age, had less than 12 years of education or had more than one child had higher percentages of live births resulting from unintended pregnancy than women with other demographic characteristics. | Live births resulting from unintended pregnancies: is there variation among states? | Data on which women have the greatest risk of delivering a live birth resulting from an unintended pregnancy may be extrapolated from one state to another, but the rate of such births may overestimate or underestimate the problem from one state to another. | Question: Live births resulting from unintended pregnancies: is there variation among states?
Answer: Data on which women have the greatest risk of delivering a live birth resulting from an unintended pregnancy may be extrapolated from one state to another, but the rate of such births may overestimate or underestimate the problem from one state to another. |
Answer the question based on the following context: Desmoid tumors associated with familial adenomatous polyposis show variable behavior; about 10% grow relentlessly, resulting in severe morbidity or mortality. Investigations that could identify the minority of desmoid tumors that behave aggressively would allow these tumors to be treated early and spare the majority of patients who have more benign disease from unnecessary intervention. The aim of this study was to investigate whether imaging the tumor metabolic-vascular phenotype by modern methods predicts growth. This is a prospective case series study. The study was conducted at a tertiary center specializing in familial adenomatous polyposis and desmoid disease. Nine patients with familial adenomatous polyposis (4 male, mean age 39 years) with desmoid tumor underwent 18F-FDG-PET and dynamic contrast-enhanced MRI. Standard MRI was repeated a year later to assess tumor growth. The primary outcome measured was the correlation between 18F-FDG-PET and dynamic contrast-enhanced MRI parameters and subsequent desmoid growth. Failed intravenous access precluded dynamic contrast-enhanced MRI in 1 female patient. Thirteen desmoid tumors (4 intra-abdominal, 2 extra-abdominal, 7 abdominal wall; mean area, 68 cm) were analyzed in the remaining 8 patients. Two patients died before follow-up MRI. Five tumors decreased in size, 3 increased in size, and 3 remained stable after a year. Significant correlation (Spearman rank correlation, significance at 5%) existed between maximum standardized uptake value and k(ep) (r = -0.56, p = 0.04), but not with other vascular parameters (K(trans) (r = -0.47, p = 0.09); v(e) (r = -0.11, p = 0.72); integrated area under the gadolinium-time curve at 60 seconds (r = -0.47, p = 0.10)). There was no significant difference in the maximum standardized uptake value or dynamic contrast-enhanced MRI parameters (K(trans), v(e), k(ep), integrated area under the gadolinium-time curve at 60 seconds) between the tumors that grew or decreased in size or between the tumor sites. However, vascular metabolic ratio (maximum standardized uptake value/K(trans)) was significantly different for tumor site (p = 0.001) and size (p = 0.001, 1-way ANOVA). This investigation is limited because of its exploratory nature and small patient numbers. | Can combined 18F-FDG-PET and dynamic contrast-enhanced MRI predict behavior of desmoid tumors in patients with familial adenomatous polyposis? | Although not predictive for tumor behavior, some correlations existed between dynamic contrast-enhanced MRI and 18F-FDG-PET parameters. Vascular metabolic ratio may provide further information on tumor behavior; however, this needs to be evaluated with further larger studies. | Question: Can combined 18F-FDG-PET and dynamic contrast-enhanced MRI predict behavior of desmoid tumors in patients with familial adenomatous polyposis?
Answer: Although not predictive for tumor behavior, some correlations existed between dynamic contrast-enhanced MRI and 18F-FDG-PET parameters. Vascular metabolic ratio may provide further information on tumor behavior; however, this needs to be evaluated with further larger studies. |
Answer the question based on the following context: Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb. We asked whether a constraint-induced movement (CIM) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity (UE) therapies during this period. Twenty-three persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies. A blinded observer rated the primary end point, the Action Research Arm Test (ARA). Inclusion criteria were the following: ischemic stroke within 14 days, persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response. Differences between the groups were compared by using Student's t tests, ANCOVA, and Mann-Whitney U: tests. Twenty subjects completed the 14-day treatment. Two adverse outcomes, a recurrent stroke and a death, occurred in the traditional group; 1 CIM subject met rehabilitation goals and was discharged before completing 14 inpatient days. The CIM treatment group had significantly higher scores on total ARA and pinch subscale scores (P:<0.05). Differences in the mean ARA grip, grasp, and gross movement subscale scores did not reach statistical significance. UE activities of daily living performance was not significantly different between groups, and no subject withdrew because of pain or frustration. | Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke? | A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies. | Question: Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?
Answer: A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies. |
Answer the question based on the following context: Trauma centres have been shown to reduce the number of preventable deaths from serious injuries. This is due largely to the rapid response of surgeons and health care teams to resuscitate, evaluate, and operate if necessary. Less is known about the effectiveness of trauma centre care on those patients who have not incurred immediate life-threatening problems and may not be as critically injured. The purpose of this study was to review the use of physician and hospital resources for this patient population to determine whether trauma team and trauma centre care is helpful or even needed. This was a retrospective study of consecutive trauma patients (n=1592) admitted from 1998 to 2002 to the trauma service of an urban level I trauma centre and recorded in the hospital trauma registry. Patients were triaged in a tiered response to more or less severely injured. All patients' care was directed by trauma surgeons. Of the 1592 patients, 398 (25%) received a full trauma team response (Class I), 1194 were less seriously injured (Class II). The ISS for the Class I patients was 19+/-18 and for Class II patients 10+/-10. Nineteen percent of Class II patients had an ISS>15. Overall mortality in Class II patients was 2% including 20 unexpected deaths. Four hundred and three Class II patients (34%) had multisystem injuries. Of the Class II patients 423 (35%) were sent to the ICU or OR from the ED, 106 of whom required an immediate operation and 345 required an operation prior to discharge. Complications developed in 129 patients (11%), the majority of which were pulmonary. | Is trauma centre care helpful for less severely injured patients? | A large proportion of those patients thought initially to be less severely injured required resources available in a trauma centre, including specialty care, intensive care, and operating room accessibility. Over one-third of these patients had multisystem injuries and almost 20% were considered major trauma, needing prioritisation of care and expertise ideally found in a trauma centre environment. Complications developed in a sizable number of patients. This patient population, because of its heterogeneity and propensity for critical illness, deserves the resources of a trauma centre. | Question: Is trauma centre care helpful for less severely injured patients?
Answer: A large proportion of those patients thought initially to be less severely injured required resources available in a trauma centre, including specialty care, intensive care, and operating room accessibility. Over one-third of these patients had multisystem injuries and almost 20% were considered major trauma, needing prioritisation of care and expertise ideally found in a trauma centre environment. Complications developed in a sizable number of patients. This patient population, because of its heterogeneity and propensity for critical illness, deserves the resources of a trauma centre. |
Answer the question based on the following context: Many developing countries are undergoing a nutrition transition with rising rates of overweight and obesity. This nutrition transition coincides with a rapid expansion of supermarkets. The objective of the present research is to study whether supermarkets directly contribute to overweight and other changes in nutritional status. This research builds on cross-sectional observational data. Household- and individual-level data were collected in Kenya using a quasi-experimental survey design. Instrumental variable regressions were employed to analyse the impact of supermarket purchase on nutritional status. Causal chain models were estimated to examine pathways through which supermarkets affect nutrition. Small towns in Central Province of Kenya with and without supermarkets. A total of 615 adults and 216 children and adolescents. Controlling for other factors, buying in a supermarket is associated with a significantly higher BMI (P=0·018) and a higher probability of overweight (P=0·057) among adults. This effect is not observed for children and adolescents. Instead, buying in a supermarket seems to reduce child undernutrition measured by height-for-age Z-score (P=0·017). Impacts of supermarkets depend on many factors including people's initial nutritional status. For both adults and children, the nutrition effects occur through higher food energy consumption and changes in dietary composition. | Do supermarkets contribute to the obesity pandemic in developing countries? | Supermarkets and their food sales strategies contribute to changing food consumption habits and nutritional outcomes. Yet the types of outcomes differ by age cohort and initial nutritional status. Simple conclusions on whether supermarkets are good or bad for nutrition and public health are not justified. | Question: Do supermarkets contribute to the obesity pandemic in developing countries?
Answer: Supermarkets and their food sales strategies contribute to changing food consumption habits and nutritional outcomes. Yet the types of outcomes differ by age cohort and initial nutritional status. Simple conclusions on whether supermarkets are good or bad for nutrition and public health are not justified. |
Answer the question based on the following context: Effective interventions to prevent, delay, or remit diabetes are currently available. However, their impact on the prevalence of diabetes at the population level is unknown. This study aimed to estimate the impact of a range of diabetes interventions on the population prevalence of diabetes for Australian adults between 2010 and 2025. We used the Australian Diabetes Projection Model to estimate the impact of a population-wide strategy, high-risk prevention, surgical diabetes treatment, and a combination strategy on the future population prevalence of diabetes and to estimate the number of diabetes cases that could be potentially prevented in the year 2025. We estimate that a population-wide strategy would reduce the number of diabetes cases by 60,000-85,000 in 2025 from an estimated 2 million cases under the status quo scenario. A high-risk prevention strategy would result in 106,000 to 150,000 fewer cases of diabetes in 2025, and surgically induced weight loss would result in 3,000-6,000 fewer cases. No single intervention, or combination of interventions, reversed the increasing trend in diabetes prevalence over the next 15 years. | Diabetes prevention and treatment strategies: are we doing enough? | To reverse upward trends in diabetes prevalence in future years, it is essential that current approaches to diabetes prevention and treatment are optimized and implemented and that alternative approaches to reduce the prevalence of diabetes at a population level are developed. | Question: Diabetes prevention and treatment strategies: are we doing enough?
Answer: To reverse upward trends in diabetes prevalence in future years, it is essential that current approaches to diabetes prevention and treatment are optimized and implemented and that alternative approaches to reduce the prevalence of diabetes at a population level are developed. |
Answer the question based on the following context: Dengue is a reportable disease in Brazil; however, pregnancy has been included in the application form of the Brazilian notification information system only after 2006. To estimate the severity of maternal dengue infection, the available data that were compiled from January 2007 to December 2008 by the official surveillance information system of the city of Rio de Janeiro were reviewed. During the study period, 151,604 cases of suspected dengue infection were reported. Five hundred sixty-one women in their reproductive age (15-49 years) presented with dengue infection; 99 (18.1%) pregnant and 447 (81.9%) non-pregnant women were analyzed. Dengue cases were categorized using the 1997 WHO classification system, and DHF/DSS were considered severe disease. The Mann-Whitney test was used to compare maternal age, according to gestational period, and severity of disease. A chi-square test was utilized to evaluate the differences in the proportion of dengue severity between pregnant and non-pregnant women. Univariate analysis was performed to compare outcome variables (severe dengue and non-severe dengue) and explanatory variables (pregnancy, gestational age and trimester) using the Wald test. A multivariate analysis was performed to assess the independence of statistically significant variables in the univariate analysis. A p-value<0.05 was considered statistically significant. A higher percentage of severe dengue infection among pregnant women was found, p = 0.0001. Final analysis demonstrated that pregnant women are 3.4 times more prone to developing severe dengue (OR: 3.38; CI: 2.10-5.42). Mortality among pregnant women was superior to non-pregnant women. | Is pregnancy associated with severe dengue? | Pregnant women have an increased risk of developing severe dengue infection and dying of dengue. | Question: Is pregnancy associated with severe dengue?
Answer: Pregnant women have an increased risk of developing severe dengue infection and dying of dengue. |
Answer the question based on the following context: To describe an association between continuous simple partial seizures and independent right and left partial seizures in children with benign childhood epilepsy with centrotemporal spikes (BCECTS). Three children with BCECTS and episodes of continuous simple partial seizures are described. All three children had a history of typical rolandic seizures occurring on the right and left sides of the body on different occasions. | Partial status epilepticus in benign childhood epilepsy with centrotemporal spikes: are independent right and left seizures a risk factor? | The occurrence of independent right and left rolandic seizures in children with BCECTS may be a predisposing factor for the development of partial status epilepticus. | Question: Partial status epilepticus in benign childhood epilepsy with centrotemporal spikes: are independent right and left seizures a risk factor?
Answer: The occurrence of independent right and left rolandic seizures in children with BCECTS may be a predisposing factor for the development of partial status epilepticus. |
Answer the question based on the following context: The aim of the study was to examine the prevalence of HIV infection in patients presenting in primary care with glandular fever (GF)-like illness. Samples from primary care submitted for a GF screen between April 2009 and June 2010 were identified. Samples without an HIV request were anonymized and retrospectively tested using a 4th-generation HIV antigen/antibody screening test. Reactive samples were further confirmed by an HIV antibody only test, with or without a p24 antigen assay. Antibody avidity testing based on the Recent HIV Infection Testing Algorithm (RITA) was used to identify individuals with evidence of recent acquisition (within 4-5 months). Of 1046 GF screening requests, concomitant HIV requests were made in 119 patients. Excluding one known positive patient, 2.5% (three of 118) tested HIV positive. Forty-five (4.3%) had a subsequent HIV test through another consultation within 1 year; of these, 4.4% (two of 45) tested positive. Of the remaining 882 patients, 694 (78.7%) had samples available for unlinked anonymous HIV testing, of which six (0.9%) tested positive. The overall HIV prevalence was 1.3% (11 of 857), with 72.7% (eight of 11) of cases missed at initial primary care presentation. Four of the nine (44.4%) available positive samples had evidence of recent acquisition, with three (75.0%) missed at initial primary care presentation. | Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection? | Low levels of HIV testing in patients presenting in primary care with GF-like illness are resulting in a significant number of missed HIV and seroconversion diagnoses. Local policy should consider adopting an opt-out strategy to include HIV testing routinely within the GF-screening investigation panel. | Question: Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection?
Answer: Low levels of HIV testing in patients presenting in primary care with GF-like illness are resulting in a significant number of missed HIV and seroconversion diagnoses. Local policy should consider adopting an opt-out strategy to include HIV testing routinely within the GF-screening investigation panel. |
Answer the question based on the following context: Homocystinuria due to cystathionine beta-synthase deficiency and familial hypercholesterolemia are inherited disorders of metabolism that are associated with premature development of cardiovascular disease. This study addresses the possibility that different patterns of carotid wall damage and cerebral blood flow hemodynamics are present in these two metabolic diseases. Twelve patients with homocystinuria due to cystathionine beta-synthase deficiency (mean age, 24 years), 10 patients with homozygous familial hypercholesterolemia (mean age, 26 years), and 11 healthy control subjects (mean age, 26 years) underwent a vascular examination by noninvasive methods. B-mode ultrasound imaging was used to obtain measurements of intima-media thickness of common carotid, bifurcation, and internal carotid arteries as an index of atherosclerosis. Cerebral blood flow velocity was estimated from vascular examination of the middle cerebral artery by transcranial Doppler. Systolic, diastolic, and mean velocities were measured. Pulsatility index, a possible indicator of vascular resistance in the cerebral circulation, was also calculated. Mean maximum intima-media thickness was 1.4 mm in patients with familial hypercholesterolemia, 0.6 mm in patients with homocystinuria, and 0.6 mm in control subjects. The difference between hypercholesterolemic and homocystinuric patients or control subjects was statistically significant (P<.001). Diastolic blood flow velocities were significantly reduced in the middle cerebral arteries of hypercholesterolemic patients compared with homocystinuric patients or control subjects (P<.05), whereas systolic or mean velocities did not differ. The pulsatility index, a possible indicator of vascular resistance in the cerebral circulation, was significantly higher in hypercholesterolemic patients compared with homocystinuric patients or healthy control subjects (P<.01). A direct relation was demonstrated between pulsatility index of the middle cerebral artery and mean maximum intima-media thickness of carotid arteries on the same side (P<.001). | Premature carotid atherosclerosis: does it occur in both familial hypercholesterolemia and homocystinuria? | Familial hypercholesterolemia is responsible for diffuse and focal thickening of carotid arteries and possibly also for hyperlipidemic endothelial dysfunction extending to small resistance arteries and leading to a disturbed cerebral blood flow. Patients with homocystinuria due to homozygosis for cystathionine beta-synthase deficiency seldom have plaques in their carotid arteries. They are similar to healthy control subjects with regard to both intima-media thickness and blood flow velocity in the middle cerebral artery. Therefore, it is unlikely that typical atherosclerotic lesions precede thrombotic events in homocystinuria. However, it is possible that arterial dilatations caused by medial damage lead to thrombosis in homocystinuric patients. | Question: Premature carotid atherosclerosis: does it occur in both familial hypercholesterolemia and homocystinuria?
Answer: Familial hypercholesterolemia is responsible for diffuse and focal thickening of carotid arteries and possibly also for hyperlipidemic endothelial dysfunction extending to small resistance arteries and leading to a disturbed cerebral blood flow. Patients with homocystinuria due to homozygosis for cystathionine beta-synthase deficiency seldom have plaques in their carotid arteries. They are similar to healthy control subjects with regard to both intima-media thickness and blood flow velocity in the middle cerebral artery. Therefore, it is unlikely that typical atherosclerotic lesions precede thrombotic events in homocystinuria. However, it is possible that arterial dilatations caused by medial damage lead to thrombosis in homocystinuric patients. |
Answer the question based on the following context: Dermatitis palmaris sicca (DPS) is a common dry-fissured palmar dermatitis in Asian women. It may be an irritant contact dermatitis, but the immunophenotype of the cells in its infiltrate is unknown. The aim of this study was to evaluate the role of inflammatory cells in the pathogenesis of DPS. Patch testing was done in 68 patients with DPS, 87 subjects with hand eczema, and 31 healthy subjects. Immunophenotyping of cutaneous inflammatory cells was performed in 8 patients with DPS, 10 subjects with hand eczema, and 8 healthy individuals. Positive patch rates were higher in patients with DPS and those with hand eczema compared with healthy controls, but strong positive (++ or +++) reactions in DPS were fewer compared with hand eczema. Density of CD3, CD4, CD8, and CD68 cells in skin lesions of DPS and hand eczema was significantly higher than that in normal skin. Sparse CD20 cells were present only in hand eczema. Compared with hand eczema, the number of CD3, CD8, CD68, and dermal CD1a cells decreased, but epidermal CD1a cells and CD4/CD8 ratio increased in DPS. | Is dermatitis palmaris sicca an irritant contact dermatitis? | The absolute lack of CD20 cells and relative scarcity of dermal CD8 and CD1a cells in skin lesions might be insufficient to induce contact hypersensitivity, so DPS may be an irritant but not allergic contact dermatitis. | Question: Is dermatitis palmaris sicca an irritant contact dermatitis?
Answer: The absolute lack of CD20 cells and relative scarcity of dermal CD8 and CD1a cells in skin lesions might be insufficient to induce contact hypersensitivity, so DPS may be an irritant but not allergic contact dermatitis. |
Subsets and Splits