Cardinal Criteria Research Articles

Hypopigmented Skin Lesions with Doubtful/Minimal Sensory Impairment: A Histopathology-Based Analysis.

Cardinal criteria proposed by the World Health Organisation (WHO) lack sensitivity to diagnose indeterminate leprosy. To estimate the frequency of hypopigmented skin lesions with doubtful/minimal sensory impairment showing histopathology features of indeterminate leprosy. To compare between the histopathology findings noted in specimens showing features suggestive of indeterminate leprosy and those showing a non-specific dermatitis pattern. Data on patients who attended our department with hypopigmented patches with doubtful/minimal sensory impairment from January 2018 to December 2019 and who underwent a skin biopsy were collected. A pathologist blinded to the clinical findings reviewed the histopathology specimens using a pre-set questionnaire. We studied sixteen biopsy specimens from 14 patients. Eight specimens (50%) showed histopathology suggestive of indeterminate leprosy and the remaining eight showed a non-specific dermatitis pattern. A higher percentage of patients with indeterminate pattern showed mast cells (87.5% vs 25%) and fibrosis around nerve twig or sweat duct (75% vs 12.5%) when compared to those who showed a non-specific dermatitis pattern. Small sample size and retrospective study design were the limitations. We found histopathology features of indeterminate leprosy in 50% of the skin biopsy specimens from hypopigmented lesions with doubtful/minimal sensory impairment. The present study highlights the need to improve the diagnostic definition of indeterminate leprosy.

World Health Organization Classification of Odontogenic Tumors and Imaging Approach of Jaw Lesions.

Tumors of the jaws represent a heterogeneous group of lesions that are classified histologically in the World Health Organization Classification of Odontogenic Tumors (2017). This article provides an update of the current nomenclature. The main role of imaging is to describe the precise location and extent of these lesions. Although characterization of imaging is often difficult due to overlapping characteristics, imaging is helpful to define which lesions should be referred for histologic examination and subsequent treatment planning. Location and density are the cardinal criteria for potential characterization on imaging. Radiologically, lesions may be radiolucent, radiopaque, or of mixed density. Additional criteria include lesion demarcation, morphology, cortical breakthrough, periosteal reaction, and adjacent soft tissue changes. Final lesion characterization is only definitive after interdisciplinary discussion and radiopathologic correlation. Correct diagnosis is obtained by a combination of the patient's age, lesion location, and clinical and radiologic presentation. It is important that all physicians use a uniform nomenclature.

Are children safe from complications of leprosy? A study from North Kerala

Objectives:The aims of the study were (1) to document the demography and clinical profile of patients with leprosy at a tertiary referral center from 2009 to 2018. (2) To compare the disease manifestation in children aged 12 years/below and the same in patients above 12 years.Materials and Methods:Case records of all patients diagnosed to have leprosy as per the World Health Organization cardinal criteria at our tertiary referral center from 2009 to 2018 were included in this study. The findings recorded in those aged 12 years/below were compared with those above 12 years using Pearson’s Chi- square test.Results:A total of 705 patients who attended our institution during the 10 year period were diagnosed to have leprosy. Six hundred and sixty-four (94.2%) were above 12 years of age and 41 patients (5.8%) were aged 12 years or below. Lepromatous spectrum cases, pure neuritic cases, Grade 2 disability, and lepra reactions were not documented in any of the patients aged 12 years or below which were contrary to the observations in those above 12 years. The differences were found to be statistically significant.Limitations:Retrospective design and small number of childhood cases were the main limitations of the study.Conclusion:Clinical presentation of leprosy in children differs from that in adults. Detection of disease in childhood offers an opportunity to cure the disease with less risk of developing some of the important disease and therapy-related complications.

SAPEVO-M: A GROUP MULTICRITERIA ORDINAL RANKING METHOD

ABSTRACT This paper proposes a new ordinal method to rank alternatives with multiple criteria and decision makers (DMs). This is a decision group ordinal method called SAPEVO-M, an acronym for Simple Aggregation of Preferences Expressed by Ordinal Vectors Group Decision Making. SAPEVO-M method allows for the aggregation of DM preference rankings into a consensus ranking and expresses the DM degrees of importance in the form of a rank order. It was developed for dealing with purely ordinal criteria and it is also applicable to situations in which ordinal and cardinal criteria are intermixed. A free version of the method was made available on the internet.

Factors Influencing Development of Depressive Illness among Parkinson’s Disease Patients

Background: Depressive illness is present among Parkinson’s disease (PD) patients.
 Objective: The purpose of the present study was to see the influencing factors of development of depressive illness among Parkinson’s disease patients.
 Methodology: This comparative cross-sectional study was carried out in the Department of Neurology and Department of Psychiatry at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2009 to June 2011 for a period of two (2) years. Parkinson’s disease patients who were attended at the movement disorder clinic and general OPD of Department of Neurology and in-patient department of Neurology at BSMMU, Dhaka were selected as study population. Patients with Parkinson’s plus syndrome, with dementia or other causes of parkinsonism like vascular or drug induced parkinsonism were excluded from this study. Data were collected by filling structured clinical questionnaire, then filling up of ‘structured clinical interview for DSM-IV Axis I disorders’ (SCID-CV) and self-reported ‘Depression scale` questionnaire. Parkinson disease was diagnosed by neurologist by the presence of two or more of the four cardinal criteria namely tremor, rigidity, bradykinesia and postural instability. Then patients were screened for depression by a psychiatrist of Department of Psychiatry at BSMMU, Dhaka.
 Result: A total of 100 Parkinson’s disease patients were interviewed and 80 patients ultimately participated in the study. The mean age of total Parkinson’s disease patients was 57.71±12.36 years ranging from 35 to 82 years with highest percentage (35%) had age group 65 years or above, 28.7% in 55 to 64 years, 22.5% in 45 to 54 years and lowest percentage (13.8%) in age group less than 45 years. Among 80 Parkinson’s disease patients, depression was present in 34 (42%) patients and was absent in 46 (58%) patients. Diabetes mellitus (p=0.125), hypertension (p=0.097), hypothyroidism (p=1.000), other illness (p=0.595), family history of PD (p=0.758) and levodopa use (p=0.661) were not significantly associated with the development of depressive illness in Parkinson’s disease.
 Conclusion: Diabetes mellitus (DM), hypertension (HTN), hypothyroidism, other illness, family history of PD and levodopa use do not significantly influence in the development of depressive illness among the Parkinson’s disease.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 106-110

A 10-year Retrospective Descriptive Study on Pure Neuritic Leprosy from a Tertiary Referral Centre.

Context:Pure neuritic leprosy is a risk factor for grade 2 disability owing to the early nerve damage.Aims:To study the clinical patterns of neuritic leprosy, to determine the percentage of patients manifesting grade 2 disability at the time of diagnosis and to identify any risk factors for the same.Settings and Design:Retrospective descriptive study from previous case records of pure neuritic leprosy patients who attended a tertiary centre from 1st July 2007 to 30th June 2017.Subjects and Methods:Data on patients who satisfied the World Health Organization (WHO) cardinal criteria for diagnosis of leprosy, who had no skin lesion of leprosy and had acid-fast bacilli negative status on skin smears were collected using a pre-set proforma.Statistical Analysis Used:The Chi-square test was used to assess statistical significance and logistic regression model was applied to avoid the effects of confounding factors.Results:A diagnostic delay of >1 year was observed in 44% patients. At the time of diagnosis, grade 2 disability was documented in 60 (80%) of patients. No statistically significant risk factor was identified for grade 2 disability.Limitations:Retrospective nature and the study conducted in a tertiary care centre not reflecting the status in the community were the limitations.Conclusions:Grade 2 disability noted in 80% of patients points to the inherent nature of disease to cause early nerve damage. Diagnostic delay of >1 year documented in 44% of patients underscores the diagnostic challenges in the absence of skin lesions.

A Mathematical Programming Approach for Strategy Ranking

Before working out their final strategic plan, managers must consider several feasible alternatives and contemplate various factors behind each of them. It is a very complicated task to rank the strategies. The objective of this paper is to propose a method that allows strategy to be evaluated on both ordinal and cardinal criteria on the one hand, and on the other hand is to use a method for ranking strategies without relying on weight assignment by decision makers. A numerical example demonstrates the application of the proposed method.

Medial temporal lobe epilepsy associated with hippocampal sclerosis is a distinctive syndrome.

Epileptic syndromes are distinctive disorders with specific features, which when taken together, permit a specific diagnosis. There is actually a debate on that medial temporal lobe epilepsy with hippocampal sclerosis is an epileptic syndrome. To address this issue, we searched for discriminative semiological features between temporal lobe epilepsy patients with hippocampal sclerosis (TLE-HS patients or group 1), TLE patients with medial structural lesion other than hippocampal sclerosis or in MRI-negative cases with medial onset on further investigations (group 2) and lateral TLE patients (LTLE or group 3). We retrospectively collected data from medical and EEG-video records of 523 TLE patients, referred for surgery to the Pitié-Salpêtrière Epileptology Unit between 1991 and 2014. We identified 389 patients belonging to group 1, 61 patients belonging to group 2, and 73 patients belonging to group 3 and performed a comparative analysis of their clinical data and surgical outcomes. TLE-HS patients (group 1): (1) began epilepsy earlier (11±9 vs. 20±10 vs. 15±9years); (2) exhibited more frequently early febrile convulsions (FC) (59 vs 7 vs 5%); (3) presented more: ictal gestural automatisms (90 vs 54 vs 67%), dystonic posturing (47 vs 20 vs 23%), and secondary generalized tonic-clonic seizures (GTCS) (70 vs 44% vs 48%) as compared to both groups 2 and 3 patients (all p<0.001). With respect to auras, abdominal visceral auras were more reported by TLE-HS than by LTLE patients (49 vs 16%). Three cardinal criteria correctly classified 94% of patients into TLE-HS group: history of FC, dystonic posturing, and secondary GTCS. Postoperative outcome was significantly better in TLE-HS group than in the two other groups (p=0.03 and 0.003). Our study demonstrates that cardinal criteria are reliably helpful to distinguish patients with TLE-HS from those with other TLE and may allow considering TLE-HS as a distinctive syndrome.

Autoimmune pancreatitis: An update

Autoimmune pancreatitis (AIP) is a rare disease, the pathophysiological understanding of which has been greatly improved over the last years. The most common form, type 1 AIP belongs to the IgG4-related diseases and must be distinguished from type 2 AIP, which is a much rarer entity associated with chronic inflammatory bowel disease. Clinically, there is an overlap with pancreatic cancer. Imaging and further criteria, such as serological and histological parameters are utilized for a differentiation between both entities in order to select the appropriate therapy and to avoid the small but ultimately unnecessary number of pancreatectomies. The diagnostics of AIP are complex, whereby the consensus criteria of the International Association of Pancreatology have become accepted as the parameters for discrimination. These encompass five cardinal criteria and one therapeutic criterion. By applying these criteria AIP can be diagnosed with a sensitivity of 84.9%, a specificity of 100% and an accuracy of 93.8%. The diagnosis of AIP is accomplished by applying several parameters of which two relate to imaging. As for the routine diagnostics of the pancreas these are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Important for the differential diagnosis is the exclusion of signs of local and remote tumor spread for which CT and MRI are established. The essential diagnostic parameter of histology necessitates sufficient sample material, which cannot usually be acquired by a fine needle biopsy. CT or MRI are the reference standard methods for identification of the optimal puncture site and imaging-assisted (TruCut) biopsy. In patients presenting with unspecific upper abdominal pain, painless jaundice combined with the suspicion of a pancreatic malignancy in imaging but a mismatch of secondary signs of malignancy, AIP should also be considered as a differential diagnosis. As the diagnosis of AIP only partially relies on imaging radiologists also have to be aware of the clinical, serological and histological parameters for AIP in order to guide clinicians towards the correct diagnosis. Only in this way can the highly efficient steroid therapy be initiated and otherwise possibly severe forms of therapy be avoided.

Is there a need to redefine Parkinson’s disease?

Parkinson's disease (PD) is classically defined by its cardinal motor features and current clinical diagnostic criteria require the presence of bradykinesia and at least one additional motor symptom out of tremor, rigidity or postural instability. However, converging evidence from clinical, neuropathological, imaging and genetic research suggests initiation of PD-specific pathology prior to appearance of classical motor signs. This is of particular relevance in relation to the development of disease-modifying or neuroprotective therapies which would require intervention at the earliest stages of disease. A key challenge in PD research, therefore, is to better characterize markers for the 'preclinical' stages of the illness. Development of PD criteria by combining such markers allowing for an early diagnosis and intervention could pave the way for the design and implementation of future disease modification trials.

Ophthalmological assessment of children with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder, caused by mutations in the NF1 gene, located on chromosome band 17q11.2. In 1988, the National Institutes of Health created specific criteria for the diagnosis of NF1. Four cardinal criteria are assessed through ophthalmological screening: Lisch nodules, optic pathway glioma, a distinctive osseous lesion (sphenoid dysplasia), and the (orbital) plexiform neurofibroma. NF1 patients are prone to the development of central and peripheral nervous system tumors. Especially young children are at risk for growing optic pathway gliomas that can threaten their sight. From an early age, children with NF1 undergo regular ophthalmological examinations. Little is known about the natural progress of these clinical features and the guidelines for screening and follow-up are controversial. Several questions remain unanswered. Most of these questions could be solved by better understanding of the natural history of optic pathway gliomas. There is a tendency towards using vision as a primary objective in clinical treatment trials; this way we can evaluate new treatment strategies and focus specifically on visual evolution so we will be able to select even more carefully which patient would benefit treatment. For future clinical trials, a standardized visual acuity assessment protocol is therefore mandatory.

Supplier evaluation in manufacturing environment using compromise ranking method with grey interval numbers

Article history: Received 1 June 2011 Received in revised form November, 26, 2011 Accepted 14 December 2011 Available online 20 December 2011 Evaluation of proper supplier for manufacturing organizations is one of the most challenging problems in real time manufacturing environment due to a wide variety of customer demands. It has become more and more complicated to meet the challenges of international competitiveness and as the decision makers need to assess a wide range of alternative suppliers based on a set of conflicting criteria. Thus, the main objective of supplier selection is to select highly potential supplier through which all the set goals regarding the purchasing and manufacturing activity can be achieved. Because of these reasons, supplier selection has got considerable attention by the academicians and researchers. This paper presents a combined multi-criteria decision making methodology for supplier evaluation for given industrial applications. The proposed methodology is based on a compromise ranking method combined with Grey Interval Numbers considering different cardinal and ordinal criteria and their relative importance. A ‘supplier selection index’ is also proposed to help evaluation and ranking the alternative suppliers. Two examples are illustrated to demonstrate the potentiality and applicability of the proposed method. © 2012 Growing Science Ltd. All rights reserved

Genotype–phenotype analysis of the branchio‐oculo‐facial syndrome

Branchio-oculo-facial syndrome (BOFS; OMIM#113620) is a rare autosomal dominant craniofacial disorder with variable expression. Major features include cutaneous and ocular abnormalities, characteristic facies, renal, ectodermal, and temporal bone anomalies. Having determined that mutations involving TFAP2A result in BOFS, we studied a total of 30 families (41 affected individuals); 26/30 (87%) fulfilled our cardinal diagnostic criteria. The original family with the 3.2 Mb deletion including the TFAP2A gene remains the only BOFS family without the typical CL/P and the only family with a deletion. We have identified a hotspot region in the highly conserved exons 4 and 5 of TFAP2A that harbors missense mutations in 27/30 (90%) families. Several of these mutations are recurrent. Mosaicism was detected in one family. To date, genetic heterogeneity has not been observed. Although the cardinal criteria for BOFS have been based on the presence of each of the core defects, an affected family member or thymic remnant, we documented TFAP2A mutations in three (10%) probands in our series without a classic cervical cutaneous defect or ectopic thymus. Temporal bone anomalies were identified in 3/5 patients investigated. The occurrence of CL/P, premature graying, coloboma, heterochromia irides, and ectopic thymus, are evidence for BOFS as a neurocristopathy. Intrafamilial clinical variability can be marked. Although there does not appear to be mutation-specific genotype-phenotype correlations at this time, more patients need to be studied. Clinical testing for TFAP2A mutations is now available and will assist geneticists in confirming the typical cases or excluding the diagnosis in atypical cases.

Health care reform in Chile: 2005 to 2009

Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specified, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.

Démence à corps de Lewy atypique révélée par une glossodynie et des troubles pseudo-psychiatriques

Among the degenerative diseases of the nervous system, Lewy body disease has the most psychiatric symptoms especially hallucinations, delusion and identification disorders. We report a case of Lewy body disease that started with a burning mouth syndrome for three year as the only symptom before the development of a pseudo-psychiatric syndrome (melancholy and Capgras). None of the usual cardinal criteria were present. MRI, cerebrospinal fluid, and DAT scan findings enabled the diagnosis. The dopaminergic hypothesis put forward in some cases of burning mouth syndrome might explain this symptom in Lewy body disease.

Multiple-Criteria Sorting Using Case-Based Distance Models With an Application in Water Resources Management

A case-based distance model to solve sorting problems in multiple-criteria decision analysis (MCDA) is developed, and its application in water resources management is presented. The sorting problem in MCDA is to arrange a set of alternatives into ordered groups. MCDA is introduced as consequence-based preference aggregation, whereby consequence and preference expressions (values and weights) are defined and combined in a sequence of steps. Then, sorting problems are defined, and some properties are explained. Based on weighted Euclidean distance, two case-based distance models are developed for sorting using weights and group thresholds obtained by assessment of a case set provided by a decision maker (DM). This case-based method can elicit the DM's preferences more expeditiously and accurately than direct inquiry. Case-based sorting model I is designed for cardinal criteria, while its extension, i.e., case-based sorting model II, can handle both cardinal and ordinal criteria. Optimization programs are employed to find the most descriptive weights and group thresholds. A case study in which Canadian municipalities are sorted according to water usage is presented.

Dermatologic Manifestations of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive-aged women and is one of the most common endocrine disorders in women. The disorder is commonly characterized by elevated levels of androgen and insulin. Women with PCOS may present with a range of signs and symptoms, and face increased risks of reproductive, metabolic, cardiovascular, psychologic, and neoplastic sequelae, particularly if the condition is left unrecognized or untreated. The clinical definition of PCOS has changed in recent years and includes as one of its cardinal criteria the dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinemia, may also be present. These dermatologic features may provide early clinical clues to recognition of PCOS, and treatment of these cutaneous conditions may improve the patient's quality of life and psychologic well-being. The effects of androgen on pilosebaceous units in the skin can vary by anatomic location, producing pathophysiologic effects on hair growth and differentiation, sebaceous gland size and activity, and follicular keratinization. Treatment modalities may include hormonal therapy intended to modulate androgen production and action as well as non-hormonal therapies directed toward specific dermatologic conditions.

Neurofibromatosis Type 1 in a Pediatric Population: Ste-Justine's Experience

To date, few pediatric series of neurofibromatosis type 1 (NF-1) have been described in the literature even though it is the most frequently encountered phakomatosis. We reviewed 987 charts of pediatric patients with a presumptive diagnosis of NF-1 who were evaluated at Ste-Justine hospital from January 1, 1991 to July 31, 2002. Patients who presented with two or more cardinal criteria were diagnosed with NF-1. Clinical and laboratory data were retrospectively collected, including: demographics, neuroimaging and presence or absence of associated symptoms or signs of NF-1. A total of 279 patients were diagnosed with NF-1. The mean age at diagnosis was 3.4 years. Ninety-nine percent of the patients had café au lait spots and 47% had a first degree relative with NF-1. Almost 60 percent (59.6%) of those seen by an ophthalmologist had Lisch nodules. Optic glioma was found in in 14.7%, cutaneous neurofibromas in 38.4%, plexiform neurofibromas in 24.7%, neurofibrosarcoma in 1.8%, learning disabilities in 39%, attention deficit disorder in 40.5%, osseous dysplasias in 7.2%, pseudoarthrosis in 3.6%, precocious puberty in 3.2% and short stature in 17.9%. Magnetic resonance, when performed, showed hyperintense T2 lesions in 87.1% of cases. The mean period of follow-up was 7.4 years. Neurofibromatosis type 1 is a multisystemic disorder associated with increased risk of malignancy. It can be diagnosed at a very young age and clinical follow-up is advised. To our knowledge, this is the largest single center study of NF-1 in a pediatric population.

Assessment of learning with multiple-choice questions

Nurse educators aspire to learning outcomes that will produce competent practitioners. Assessment strategies should be consistent with desired learning outcomes [Manogue, M., Kelly, M., Bartakova Masaryk, S., Brown, G., Catalanotto, F., Choo-Soo, T., Delap, E., Godoroja, P., Murio, I., Rotgans, J., Saag, M., 2002. Evolving methods of assessment. European Journal of Dental Education 6 (3) 53-66] and there is a requirement to diversify approaches. Objective testing, specifically multiple-choice questions (MCQ's) are one of the approaches that may diversify the assessment approach in Irish undergraduate nursing education. In this paper, Quinn's [Quinn, F.M., 2000. The Principles and Practice of Nurse Education, fourth ed., Stanley Thorne (Publishers) Ltd, Cheltenham] cardinal criteria of assessment, practicality, reliability, validity and discrimination provide a useful framework to discuss the issues associated with the implementation of this type of assessment strategy. MCQ examinations that are consistent with educational outcomes can be used to effectively assess aspects of student performance and can facilitate timely feedback and contribute to the process of self-learning. Significant commitment is required to prepare MCQ test items and examination formats that are reliable and consistent with curriculum objectives. Appropriately constructed MCQ examinations are efficient, objective, capable of discrimination and can be combined with other assessment strategies to contribute to a comprehensive student assessment strategy for use in nursing education.

Integration of ordinal and cardinal information in multi-criteria ranking with imperfect compensation

The method presented in this paper is a MCDA method, which outranks a certain number of choice options that are evaluated on a mixture of cardinal and ordinal judgement criteria. Characteristics of the method are a theoretically sound integration of cardinal and ordinal information and a decision-makers' preference structure that allows for less than perfect compensation between criteria. The method is based on a pairwise comparison of choice-options. It belongs to the family of decomposed scaling methods: the assessment of the relative importance of the criteria on one hand and the assessment of the scores (cardinal criteria) and rankings (ordinal criteria) on the other hand are performed separately. The assessment of the scores and rankings is realised by means of (marginal) value functions in such a way that the ordinal information is fully comparable with the cardinal information. Essentially, the ordinal information is translated into stochastical information without imposing any assumption on the probability distributions attached to the ordinal data. The relative importance of the judgement criteria is represented by a set of cardinal weights or by a ranking of weights. The final ranking of the choice options is based upon an overall value function that is some kind of weighed aggregation of the marginal value functions. In order to allow for less-than-perfect-compensation between criteria, the method uses a convex combination of two different CES-type value functions. The paper ends with an empirical application, on the planning of public transport systems in The Netherlands.