Cause Of Consultation Research Articles

The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome

Abstract Introduction Home apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory-related sleep disturbances in children has not been demonstrated, as was originally thought. Objective To describe the type of patients being monitored, for how long and their outcome. Material and methods A retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. Results During the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). Conclusions Suspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the paediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments.

Actualización en el tratamiento médico de los síntomas del tracto urinario inferior en el varón

Lower urinary tract symptoms (LUTS) are a frequent cause of consultation in Primary Care, especially in men>40 years of age.Benign prostatic hyperplasia (BPH) has been recognized as the most common cause of bothersome LUTS, causing significant interference with everyday activities and quality of life.The purpose of this study is to provide an update on recent developments regarding the medical management of male LUTS.

Patología prostática no tumoral. Hiperplasia prostática benigna. Prostatitis

Benign pathology of the prostate is one of the most important causes of consultation in urological offices. It is a disease with high prevalence, whose potential complications are very important and have an important impact on the quality of life of patients. Diagnostic techniques have not undergone major changes in recent years, but the therapeutic armamentarium is gradually increasing. The arrival of new drugs and new technologies have changed the treatment of medical and surgical treatment of benign prostatic hiperplasia and the symptoms associated with prostatitis. We present an updated version of this pathology with emphasis on recent therapeutic advances available to treat this pathology.

Infecciones vaginales por Cándida: Diagnóstico y tratamiento

Las infecciones vaginales son un motivo importante de consulta. Ya sea como única molestia o acompañante a otros problemas de diferente relevancia. Dependiendo de las series de investigación, la candidiasis suele encontrarse disputando el primer o segundo lugar en el diagnóstico diferencial de las diferentes causas de molestias vulvovaginales y flujo. En el presente artículo se hace una revisión de la epidemiología, los diferentes factores de riesgo, métodos de diagnóstico y del manejo y tratamiento.

Prevalence of hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage.

Subconjunctival hemorrage (SCH) is a frequent, mild bleeding manifestation and a common cause of consultation. Hemostatic alterations are possible causes of SCH but their role and prevalence is unknown. We assessed the prevalence of hemostatic abnormalities in patients with spontaneous, recurrent SCH to clarify the role of the hemostasis laboratory in this clinical setting. A total of 105 SCH patients (21-78 years, 65 females) with no identifiable cause (hypertension-trauma-conjunctivitis) or concomitant treatments (NSAIDs- aspirin-oral anticoagulants-antiplatelet agents) and 53 age and sex-matched healthy controls (HCs) (22-72 years, 29 females) were evaluated for skin bleeding time, PFA-100®, blood clotting screening, platelet count, light transmission aggregomery, VWF:Ag, VWF:RCo, RIPA, FVIII activity, FXIII antigen and activity and ISTH Bleeding Severity Score (BSS). Prevalence of hemostatic abnormalities was not higher in the SCH population than in HCs BSS was 0.83 (95% CI 0.62-1.06) in SCH and 0.66 (0.37-0.95) in HC (p=NS). Type I Von Willebrand disease was diagnosed in one SCH and none HC patients, a prevalence not significantly different (p=NS by χ2). The prevalence of hemostatic alterations in patients with recurrent, spontaneous SCH is not different from the general population; hemostatic screening or second level tests are of no use in patients with recurrent SCH and no other bleedings.

Efficacy and safety of Gantong Granules in the treatment of common cold with wind-heat syndrome: study protocol for a randomized controlled trial

BackgroundAlthough the common cold is generally mild and self-limiting, it is a leading cause of consultations with doctors and missed days from school and work. In light of its favorable effects of relieving symptoms and minimal side-effects, Traditional Chinese Medicine (TCM) has been widely used to treat the common cold. However, there is a lack of robust evidence to support the clinical utility of such a treatment. This study is designed to evaluate the efficacy and safety of Gantong Granules compared with placebo in patients with the common cold with wind-heat syndrome (CCWHS).Methods/DesignThis is a multicenter, phase IIb, double-blind, placebo-controlled and randomized clinical trial. A total of 240 patients will be recruited, from 5 centers across China and randomly assigned to the high-dose group, medium-dose group, low-dose group or placebo control group in a 1:1:1:1 ratio. All subjects will receive the treatment for 3 to 5 days, followed by a 7-day follow-up period. The primary outcome is the duration of all symptoms. Secondary outcomes include the duration of primary symptoms and each symptom, time to fever relief and time to fever clearance, change in TCM symptom score, and change in Symptom and Sign Score.DiscussionThis trial will provide high-quality evidence on the efficacy and safety of Gantong Granules in treating CCWHS, and help to optimize the dose selection for a phase III clinical trial.Trial registrationThe registration number is ChiCTR-TRC-14004255, which was assigned by the Chinese Clinical Trial Registry on 12 February 2014.

A comprehensive review of randomized placebo-controlled pharmacological clinical trials in children with functional abdominal pain disorders.

Abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are the most common cause of consultation to pediatric gastroenterology; however, no medications have been approved to treat this group of disorders in children. The Food and Drug Administration have published recommendations for clinical trials on AP-FGIDs in adults but not in children. The lack of methodological guidelines and accepted primary endpoints for clinical trials in children hampers the progress of the field, making the approval of new medications difficult. A necessary first step to determine the feasibility of clinical trials in children and provide recommendations on the best design for future trials is to review the methods, ability to recruit, attrition rate, and results of previous clinical trials. We designed a comprehensive review of pharmacological clinical trials in AP-FGIDs in children focused on study design. Study eligibility was randomized controlled trials (RCTs) evaluating the efficacy of pharmacological interventions compared with that of placebo in children and adolescents with AP-FGIDs. There is no evidence to support the use of most commonly used drugs in children. Only 7 pharmacological RCTs on AP-FGIDs in children were found. Most studies were single center based and had a small sample size. The methods and outcomes were heterogeneous. Primary endpoints varied widely among studies. Many of the RCTs did not show a consistently significant benefit of the drug over placebo in some or all of the outcomes. We found a considerable risk of bias in most studies. None of the studies have considered minimal clinically important differences in their selection of primary endpoints. Few randomized clinical trials have been conducted. Most studies have methodological limitations and small sample size. There is an urgent need for well-designed randomized clinical trials using age-appropriate validated outcome measures.

Protocolo diagnóstico de las alteraciones sensitivas asimétricas

Sensitive disturbances with asymmetric distribution are frequent cause of consultation. Their differential diagnosis is wide, from mild peripheral mononeuropathies to chronic diseases of central nervous system (CNS). In young patients, multiple sclerosis is a common cause of sensitive disease with asymmetric distribution as well as the main early-onset with prevalence up 77% along disease. In order to guide the differential diagnostic topographic diagnosis is indispensable, which is based on a detailed clinical history, careful neurological examination with particular emphasis on distribution pattern and the anatomical knowledge of the sensitive branches.

Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante

IntroductionHome apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory -related sleep disturbances in children has not been demonstrated, as was originally thought. ObjectiveTo describe the type of patients being monitored, for how long and their outcome. Material and methodsA retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. ResultsDuring the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). ConclusionsSuspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the pediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments.

Morbilidad postoperatoria en pacientes con hidatidosis hepática complicada

Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

Analysis of psychiatric consultations in a multidisciplinary hospital patients.

AIM : The aim of the research is the analysis of psychiatric consultations conducted in the multi-disciplinary hospital, establishing the cause of the consultations according to ICD-10 and the analysis of psychiatric consultations regarding their number on particular wards. Retrospective analysis of medical documentation concerning given consultations in the multidisciplinary hospital in Tarnowskie Góry in the years 2002-2010 has been conducted. In the statistics studies Shapiro-Wilk test, Kruskal-Wallis test, Mann-Whitney U test, Chi-square test of independence and the others have been used. In the analyzed years, 3,672 consultations have been done, the mean age of the consulted patients has been 46.9 years. Taking into consideration the sex of the consulted patients, 41.99% of them were female and 58.01% were male. The main diagnoses of all consultations present as follows: F00-F09: 18.82%, F10-F19: 29.58%, F20-F29: 17.70%, F30-F39: 10.29%, F40-F48: 13.83%, F50-F59: 0.16%, F60-F69: 3.21%, F70-F79: 1.77%, F80-F89: 0%, F90-F98: 1.01%, other: 3.62%. The consultations most often have taken place on the following wards: Hospital Admitting Department (13.21%), Hospital Emergency Service (6.97%), Surgery Department (8.42%), Internal Medicine Department (6.51%), Neurology Department (4.82%). The most frequent causes of consultation were addictions, the next were organic and psychotic disorders, neurotic and affective disorders. Consultations most often have taken place at the Hospital Admitting Department/Hospital Emergency Service, Surgery Department, Internal Medicine Department and Neurology Department.

Quality Control of Selected Antimalarials Sold in the Illicit Market: An Investigation Conducted in Porto-Novo City (Republic of Benin)

Malaria is a parasitic disease caused by the bite of female Anopheles mosquito and particularly affects the tropical areas of the world. According to national statistics it is the leading cause of consultations and hospitalizations. Nowadays, despite the surveillance systems for efficient malaria control and access to generic drugs, Benin is witnessing an increased development of illicit drug markets with a large part of the population going towards such markets. However, this is not without adverse impact on the health of individuals, as well as, the economic status of the country. Therefore, the situation needs to be seriously considered by policy makers at various levels, health professionals but also the entire international community in order to thwart this scourge.Regarding the aforementioned situation, the current study was undertaken aiming to perform a quality control of selected antimalarial drugs of the illegal market in Porto-Novo city. Therefore, 40 antimalarial batches were randomly collected in the illicit drug market and submitted to analytical tests such as: macroscopic examination (a visual and critical examination); mass uniformity test; disintegration test; identification test and active ingredients’ content measurement. At the end of the study, the percentages of non-compliance is 97.5%, 5%, 15% and 27.5%, respectively for the content uniformity tests, disintegration, identification and assay. Over-all, 42.5% of noncompliance was recorded. The findings of this study prove that street vended drugs offer no guarantee of good quality and pose a threat to the health of populations. Also, the rate of non-compliance denotes a flaw in the security of the drug distribution system.

Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

BackgroundThe purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients’ reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany.MethodsWe conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework.ResultsThree interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions.ConclusionsFuture PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

Antidote use in a paediatric emergency department

Abstract Introduction Poisoning is an infrequent cause of consultation in a paediatric emergency department (PED), but it can be potentially serious. Paediatricians should know how to use the available antidotes properly. Objectives To analyse the use of antidotes in a PED and to assess the suitability of their indications. Materials and methods A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and consultation for suspicious poisoning by a substance that could be treated with an antidote. The adequacy of antidote indication was based on the recommendations of the Spanish Society of Paediatric Emergencies (SSPE). Results A total of 1728 consultations for suspicious poisoning (0.4% of the total visits in the PED) were recorded. In 353 cases (20.4%) the involved poison could be treated with an antidote. Sixty-seven patients received an antidote (3.9% of consultations for suspicious poisoning), and a total of 69 administrations of an antidote were made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3), deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In three cases there was no indication for administration: flumazenil without respiratory depression, and vitamin K following coumarin exposure. As side effects, agitation was noted after the use of flumazenil, and a decrease in the prothrombin time during infusion of N-acetylcysteine. Conclusions The administration of antidotes in this PED is uncommon and, mainly, in accordance with the SSPE recommendations, and without serious side effects. The use of flumazenil needs to be limited to the cases with a clear indication and without any contraindication.

Demographic and clinical profiles in patients with acute urticaria

BackgroundUrticaria is a common cause for consultation in general and specialised medical practices. There is scarce information on the characteristics of patients suffering acute urticaria in Latin America. ObjectivesTo investigate demographic and clinical features of patients with acute urticaria attending two allergy clinics in Caracas, Venezuela. MethodsA prospective study of all new patients who consulted during a three-year period because of acute urticaria. Information on age, gender, symptom duration, previous medical history, body distribution of wheals and angio-oedema, laboratory investigations, skin prick tests, and pharmacological treatment, was collected. Patients were classified according to their age as children/adolescents and adults. ResultsTwo hundred and forty eight patients (177 adults and 71 children) were studied. Acute urticaria was more frequent in middle-aged atopic female patients. Lesions more often involved upper and lower limbs and head, and 31% of patients exhibited generalised urticaria. Laboratory investigations, performed only in selected cases, did not contribute to the final diagnosis. Most frequent subtypes of acute urticaria were spontaneous, dermographic, papular, and drug-induced urticaria. Most patients were treated with non-sedating antihistamines, with increased use of cetirizine and levocetirizine in children, while 5.6% of children and 20.3% of adults required the addition of short courses of systemic corticosteroids. ConclusionsAcute urticaria is a frequent cause of consultation for allergists, affecting more often middle-aged female atopic patients. The use of extensive complementary tests does not seem to be cost-effective for this clinical condition. Spontaneous, dermographic, papular and drug-induced urticaria are the most common subtypes.

Nail disorders in infants and children.

Nail diseases in infants and children are an uncommon cause of consultation and are often difficult to diagnose and to manage. This review will cover nail diseases that are most commonly seen in clinical practice, including congenital and hereditary disorders and inflammatory, infective, and neoplastic nail diseases. The purpose of the review is to help the reader to recognize nail disorders at an early age and to manage them appropriately. Two recent large studies have reported the clinical findings of genetic disorders involving the nails, that is, pachyonychia congenita and epidermolysis bullosa. Only a few articles gave a comprehensive review of a disease, as occurred for onychomycosis, while the majority of the reports published in the recent literature involve single cases. Nail diseases in children and neonates are not easy to diagnose by nonexperts. Basic knowledge of the anatomy and biology of the nail facilitates their diagnosis as the understanding of their pathophysiology. This review gives hints at the most common nail diseases that affect infants and children.

Efficacy and safety of ultrasound-guided saphenous nerve block in patients with chronic knee pain

IntroductionKnee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. ObjectiveTo establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methodsDescriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p<0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. ConclusionsInterventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients.

Eficacia y seguridad del bloqueo del nervio safeno guiado por ultrasonido en pacientes con dolor crónico de rodilla

IntroductionKnee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. ObjectiveTo establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methodsDescriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p < 0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. ConclusionsInterventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients.

The high frequency of genetic diseases in hypotonic infants referred by neuropediatrics

Neonatal hypotonia is a relatively common cause of consultation in daily pediatric practice. It is part of the clinical presentation of a large group of heterogeneous diseases, many of which have an important and classifiable genetic background. Identification of the specific disorder can help optimize the management and treatment of the patient and inform genetic counseling for the family, and therefore input from clinical geneticists is critical at the earliest stages of medical management. Here we present 30 patients with hypotonia of unknown etiology referred by a neuropediatrician to clinical genetics. Clinical, genetic, and molecular evaluation of each patient was performed. Sixty-nine percent of the patients included in the study had a genetic disease, including eight with Prader-Willi syndrome, three with spinal muscular atrophy, one with Rett syndrome, and one with Sotos syndrome harboring a previously undescribed mutation. Our data demonstrate that a multidisciplinary approach used from the outset that includes molecular analysis can help improve diagnosis and management of hypotonic infants.

Role of Insulin Resistance and Diabetes in the Pathogenesis and Treatment of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is now a frequent cause of consultation for hepatologists and other health care providers. To a significant extent, this is because the metabolic abnormalities associated with obesity and type 2 diabetes mellitus (T2DM) promote liver disease and are more prevalent than ever before. Clinicians must be aware that insulin resistance and hyperglycemia are believed to worsen the natural history of NAFLD, fueling inflammation, hepatocyte injury (ballooning) and fibrosis. End-stage liver disease and hepatocellular carcinoma (HCC) develop more often in this setting. Interventions that reverse insulin resistance and hyperglycemia, may halt or ameliorate the disease process. Therefore, a comprehensive approach is needed for the successful management of these patients that addresses both, the liver-specific and the associated metabolic conditions. This review focuses on the mechanisms by which insulin resistance, and both lipo- and glucotoxicity, are believed to contribute to the development of NAFLD, and on the treatments tested in obese patients with T2DM and NAFLD, as a means to assist practitioners managing these complex patients.