Common Specific Diagnoses Research Articles

Performance Characteristics of Incisional and Core Needle Biopsies for Diagnosis in Parotid Gland: Single-Institutional Experience and Assessment of the Value of a Milan System for Reporting Salivary Gland Cytopathology-Like Risk Stratification Model.

Unlike parotid fine-needle aspiration biopsy, standardized reporting for core needle biopsy (CNB) and incisional biopsy (IB) is not established. To examine the value of risk stratification by a Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)-like classifier for parotid CNB/IB. Five hundred ninety-two parotid biopsy records (CNB = 356, IB = 236) were retrieved (1994-2022) along with clinicopathologic data. Diagnoses were transformed to an MSRSGC-like classifier and compared with end points including risk of malignancy. Over time, CNB was progressively more used compared with IB. Overall malignancy call rate was 223 of 592 (37.7%). Common specific diagnoses included Warthin tumor, lymphoma subtypes, and metastatic squamous cell carcinoma for CNB and IB, in addition to pleomorphic adenoma for CNB. Descriptive diagnoses were still frequent. Nondiagnostic rates were higher in CNB (26 of 356; 7.30%) than IB (5 of 236; 2.12%; P <.001). Tissue volumes significantly influenced CNB adequacy, with minimum and optimal volumes of 4.76 mm³ (J index, receiver operating characteristic curve) and 12.92 mm³ (95th percentile of distribution), respectively. One hundred forty-four patients (112 CNBs) had follow-up resections; diagnoses were concordant for 66 of 73 adequate CNBs (90.41%). Our restructured risk grouping of MSRSGC categories performed robustly in terms of risk of malignancy (sensitivity = 85.5%, specificity = 100%, accuracy = 92.3%, area under the curve = 0.9677). Although CNB and IB are amenable to a risk stratification system, there are some differences as compared with fine-needle aspiration biopsy, particularly given the high baseline prevalence of malignancy. Specific diagnoses are often feasible and concordant with resection. CNB tissue volume can inform optimal and minimal sampling recommendations for adequacy.

Using telehealth to support antimicrobial stewardship at four rural VA medical centers: Interim analysis

Background: Healthcare settings without access to infectious diseases experts may struggle to implement effective antibiotic stewardship programs. We previously described a successful pilot project using the Veterans Affairs (VA) telehealth system to form a Videoconference Antimicrobial Stewardship Team (VAST) that connected multidisciplinary teams from rural VA medical centers (VAMCs) with infectious diseases experts at geographically distant locations. VASTs discussed patients from the rural VAMC, with the overarching goal of supporting antibiotic stewardship. This project is currently ongoing. Here, we describe preliminary outcomes describing the cases discussed, recommendations made, and acceptance of those recommendations among 4 VASTs. Methods: Cases discussed at any of the 4 participating intervention sites were independently reviewed by study staff, noting the infectious disease diagnoses, recommendations made by infectious diseases experts and, when applicable, acceptance of those recommendations at the rural VAMC within 1 week. Discrepancies between independent reviewers were discussed and, when consensus could not be reached, discrepancies were discussed with an infectious diseases clinician. Results: The VASTs serving 4 different rural VAMCs discussed 96 cases involving 92 patients. Overall, infection of the respiratory tract was the most common syndrome discussed by VASTs (Fig. 1). The most common specific diagnoses among discussed cases were cellulitis (n = 11), acute cystitis (n = 11), wounds (n = 11), and osteomyelitis (n = 10). Of 172 recommendations, 41 (24%) related to diagnostic imaging or laboratory results and 38 (22%) were to change the antibiotic agent, dose, or duration (Fig. 2). Of the 151 recommendations that could be assessed via chart review, 122 (81%) were accepted within 1 week. Conclusions: These findings indicate successful implementation of telehealth to connect clinicians at rural VAMCs with an offsite infectious diseases expert. The cases represented an array of common infectious syndromes. The most frequent recommendations pertained to getting additional diagnostic information and to adjusting, but not stopping, antibiotic therapy. These results suggest that many of the cases discussed warrant antibiotics and that VASTs may use the results of diagnostic studies to tailor that therapy. The high rate of acceptance suggests that the VASTs are affecting patient care. Future work will describe VAST implementation at 4 additional VAMCs, and we will assess whether using telehealth to disseminate infectious diseases expertise to rural VAMCs supports changes in antibiotic use that align with principles of antimicrobial stewardship.Disclosures: None

Analysis of hospitalizations of patients with Kaposi sarcoma: A national population-based study.

e18821 Background: Kaposi sarcoma (KS) is a type of soft tissue sarcoma due to infection with human herpes virus 8 (HHV-8) and can be associated with acquired immunodeficiency syndrome [AIDS]. Recent national population data are scarce on reasons for hospitalizations, epidemiology, and hospitalization outcomes of patients with KS in the United States (U.S). Methods: Data were abstracted from the National Inpatient Sample (NIS) Database. This database is the largest collection of inpatient admission data in the U.S. It is a 20-percent stratified sample of all discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The numbers in the databases are weighted to optimize national estimates. Hospitalizations for patients with KS were obtained by searching for hospitalizations that contained ICD-10 code “C46” as a principal or secondary diagnosis. The principal diagnosis is the main reason for the admission, while any other diagnosis other than the principal, are secondary diagnosis. The reason for hospitalization (or principal diagnosis) was recorded in descending order of frequency based on the ICD-10 code organ system category and specific principal diagnosis. The total number of KS discharges, baseline demographic characteristics, hospital length of stay (LOS), and total hospital charges were recorded. STATA 16 was used for analysis. Since NIS contains de-identified data, Institutional Review Board (IRB) review was waived. Results: There were 32 million discharges included in the 2020 NIS database. Of those, 2,785 hospitalizations were for patients aged ≥18 years, who had either a principal or secondary ICD 10 code for KS. Patients were mainly males (91%), black (40%), mean age of 48 years, inpatient mortality of 9.3%, mean LOS of 9 days, and mean total hospital charge of 132,476 U.S dollars. The 5 most common reasons for hospitalization by ICD 10 code categories were infections (52.4%), cardiovascular (6.5%), respiratory (6.1%), neoplasm and hematologic (5.6%), and skin (5.6%). The 5 most common specific principal diagnoses for hospitalizations were Human immunodeficiency virus [HIV] disease (29.1%), sepsis (12.7%), left leg cellulitis (2.7%), pneumonia (2.2%), and Acute kidney injury (1.8%). Conclusions: Hospitalizations for KS patients are mostly black middle-aged men, with high inpatient mortality, long LOS, and significant hospital charges. Infections and HIV were the most common reasons for hospitalizations. Management of underlying HIV and measures for prevention, early detection, and prompt treatment of infections in the outpatient setting are important in preventing hospitalizations of these patients.

Analysis of hospitalizations of patients with penile cancer: A national population-based study.

e17033 Background: Penile cancer (PC) is a rare malignancy that is more common in developing countries. However, recent studies have shown rising incidence-based mortality in the United States (U.S). National population data is scarce on reasons for hospitalizations, epidemiology, and hospitalization outcomes of patients with PC. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2020 Database. T≥his database is the largest collection of inpatient admission data in the U.S. It is a 20-percent stratified sample of all discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The numbers in the databases are weighted to optimize national estimates. Hospitalizations for patients with PC were obtained by searching for hospitalizations that contained the International Classification of Diseases (ICD)-10 code “C60” as a principal or secondary diagnosis. The principal diagnosis is the main reason for the admission, while any other diagnosis other than the principal, are secondary diagnosis. The reason for hospitalization (or principal diagnosis) was recorded in descending order of frequency based on the ICD-10 code organ system category and specific principal diagnosis. The total number of PC discharges, baseline demographic characteristics, hospital length of stay (LOS), and total hospital charges were recorded. STATA 16 was used for analysis. Since NIS contains de-identified data, Institutional Review Board (IRB) review was waived. Results: There were 32 million discharges included in the 2020 NIS database. Of those, 2,785 hospitalizations were for patients aged ≥18 years, who had either a principal or secondary ICD 10 code for PC. Patients were predominantly white (65.9%), mean age of 66.5 years, inpatient mortality of 4.7%, mean LOS of 6.1 days, and mean total hospital charge of 71,447 U.S dollars. The 7 most common reasons for hospitalization by ICD 10 code categories were neoplasm and hematological (35.9%), nonspecific (17.3%), infections (12.6%), injury &amp; poisoning (7.1%), cardiovascular (6.4%), and Genito-urinary (4.3%). The 5 most common specific principal diagnoses for hospitalizations were malignant neoplasm of the penis (29.1%), admission for chemotherapy (12.7%), sepsis (2.7%), Malignant neoplasm of the glans penis (2.2%), secondary neoplasm of inguinal and lower limb nodes (1.8%). Conclusions: Hospitalized PC patients are mostly elderly white men. Infections, chemotherapy, and PC were the most common reasons for hospitalizations. Optimal management of underlying malignancy, prevention, and prompt treatment of infections in the outpatient is important in reducing hospitalizations of these patients.

Demography and disorders of English Cocker Spaniels under primary veterinary care in the UK

BackgroundThe English Cocker Spaniel (ECS) is a common family dog in the UK. This study aimed to describe demography, morbidity, and mortality in ECS under primary veterinary care in the UK during 2016 using data from the VetCompass™ Programme. This study hypothesised that the prevalence of aggression is higher in male than female ECS, and higher in solid-coloured than bi-coloured ECS.ResultsEnglish Cocker Spaniels comprised 10,313/336,865 (3.06%) of dogs under primary veterinary care during 2016. The median age was 4.57 years (inter-quartile range (IQR) 2.25–8.01) and the median adult bodyweight was 15.05 kg (IQR 13.12–17.35). The annual proportional birth rate was relatively stable between 2.97–3.51% from 2005–2016. The most common specific diagnoses were periodontal disease (n = 486, prevalence 20.97%, 95% confidence interval (CI): 19.31–22.62), otitis externa (n = 234, 10.09%, 95% CI: 8.87–11.32), obesity (n = 229, 9.88%, 95% CI: 8.66–11.09), anal sac impaction (n = 187, 8.07%, 95% CI: 6.96–9.18), diarrhoea (n = 113, 4.87%, 95% CI: 4.00–5.75), and aggression (n = 93, 4.01%, 95% CI: 3.21–4.81). The prevalence of aggression was higher in males (4.95%) than in females (2.87%) (P = 0.015) and in solid-coloured (7.00%) than in bi-coloured dogs (3.66%) (P = 0.010). The median age at death was 11.44 years (IQR 9.46–13.47) and the most common grouped causes of death were neoplasia (n = 10, 9.26%, 95% CI: 3.79–14.73), mass-associated disorders (n = 9, 8.33%, 95% CI: 4.45–15.08), and collapse (n = 8, 7.41%, 95% CI: 3.80–13.94).ConclusionsPeriodontal disease, otitis externa, and obesity are identified as the most common health issues for ECS, and neoplasia and mass-associated disorders as the most common reasons for death. The prevalence of aggression was higher in males and solid-coloured dogs. The results can aid veterinarians in giving evidence-based health and breed choice information to dog owners and highlights the importance of thorough oral examination and body condition score evaluation during routine veterinary examination of ECS.

Admission and Mortality Patterns in Intensive Care Delivery at Enugu State University of Science and Technology Teaching Hospital: A Three-Year Retrospective Study.

BackgroundThe intensive care unit (ICU) provides critical care to high-risk patients to prevent morbidity and mortality. This requires closer monitoring and better management than the care provided to patients in normal admission wards and non-critical care units. Mortality rates in ICUs in developing countries are remarkably high compared to rates in more developed countries. Evaluating outcomes of treatment is a way to improve the quality of care. Therefore, this study was conducted to review the pattern of admission and outcome in the ICU of Enugu State University of Science and Technology Teaching Hospital (ESUT-TH).MethodologyThis study was a three-year retrospective, descriptive review of all patients admitted to the ICU of ESUT-TH between January 1, 2019, and December 21, 2021. Data were collected from admissions and discharge registers of the ICU ward. Data were analyzed and expressed as frequencies and percentages. Categorical parameters were compared using the chi-squared test, and the significance level was set at p < 0.05.ResultsA total of 179 patients were admitted in the three-year period. Of them, 49.2% were postoperative patients while 21.2% were admitted from the accident and emergency unit. There were a total of 74 (41.3%) medical cases and 81 (45.3%) surgical cases, and the rest were unspecified. Among surgical cases, 19% were from the general surgery department followed by obstetrics and gynecology (18.4%) and neurosurgery (16.8%). Cerebrovascular accidents and traumatic brain injury were the most common specific diagnoses recorded among ICU admitted patients. The most common reason for admission was close monitoring of high-risk patients. The mortality rate during the studied period was 34.1%, and this was significantly associated with patient age and type of illness at presentation (p < 0.05). Stratified by year of admission, the highest rate of mortality was noted in the year 2020 (46.7%).ConclusionThere is a high level of mortality among ICU admissions in our center. This calls for the improvement of intensive care delivery in the healthcare facility, including training and retraining of manpower and provision of essential facilities for high-quality healthcare delivery.

Persistent Shoulder Pain After Vaccine Administration Is Associated with Common Incidental Pathology: A Systematic Review.

Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine. Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve? In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively. A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period. The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology. Level IV, therapeutic study.

Gestational age and birth growth parameters as early predictors of fetal alcohol spectrum disorders

To investigate gestational age and growth at birth as predictors of fetal alcohol spectrum disorders (FASD). The sample analyzed here comprises 737 randomly selected children who were assessed for growth, dysmorphology, and neurobehavior at 7years of age. Maternal interviews were conducted to ascertain prenatal alcohol exposure and other maternal risk factors. Birth data originated from clinic records and the data at 7years of age originated from population-based, in-school studies. Binary linear regression assessed the relationship between preterm birth, small for gestational age (SGA), and their combination on the odds of a specific FASD diagnosis or any FASD. Among children diagnosed with FASD at 7years of age (n=255), a review of birth records indicated that 18.4% were born preterm, 51.4% were SGA, and 5.9% were both preterm and SGA. When compared to non-FASD controls (n=482), the birth percentages born preterm, SGA, and both preterm and SGA were respectively 12.0%, 27.7%, and 0.5%. Mothers of children with FASD reported more drinking during all trimesters, higher gravidity, lower educational attainment, and older age at pregnancy. After controlling for usual drinks per drinking day in the first trimester, number of trimesters of drinking, maternal education, tobacco use, and maternal age, the odds ratio of an FASD diagnosis by age 7 was significantly associated with SGA (OR=2.16, 95% CI: 1.35 to 3.45). SGA was also significantly associated with each of the 3most common specific diagnoses within the FASD continuum: fetal alcohol syndrome (FAS; OR=3.1), partial FAS (OR=2.1), and alcohol-related neurodevelopmental disorder (OR=2.0). SGA is a robust early indicator for FASD in this random sample of children assessed at 7years of age.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Ice Hockey: 2014-2015 Through 2018-2019.

The National Collegiate Athletic Association has supported men's ice hockey, a distinct sport that mandates high-velocity gamesmanship, since 1974. Injury surveillance systems are designed to identify evolving injury trends and their temporal qualities. Continual monitoring of collegiate men's ice hockey athletes remains essential. Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRR) were used to examine differential injury rates. The overall injury rate was 7.65 per 1000 athlete-exposures. Injuries from competition occurred at a rate nearly 7 times that from practice injuries (IRR = 6.54, 95% CI = 6.08, 7.04). The most common specific injury diagnoses were concussions (9.6%), acromioclavicular sprains (7.3%), and medial collateral ligament tears (3.7%). Injury rates by event type and season segment were higher than previously reported. Contusions accounted for nearly a quarter of all injuries, and acromioclavicular sprain rates increased notably across the study period.

Medical Encounters in a 90-km Ultramarathon Running Event: A 6-year Study in 103 131 Race Starters-SAFER XVII.

To determine the incidence and nature of illness-related medical encounters (MEs) at a 90-km, ultramarathon, mass, community-based, endurance running event. Retrospective, descriptive epidemiological study. Comrades Marathon (90 km), South Africa. One lakh three thousand one hundred thirty-one race starters over 6 years (2014-2019). Incidence of moderate and serious/life-threatening MEs. All MEs were recorded by race medical doctors on race day each year. Medical encounters were recorded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidences (I: per 1000 starters; 95% confidence intervals) were calculated for MEs. There were 1971 illness-related MEs, with an overall incidence of 19.1 (range, 18.3-20.0). The incidence for serious/life-threatening MEs was 1.8 (range, 1.6-2.1). Incidences of MEs by organ systems affected were as follows: fluid/electrolyte (8.8; 8.3-9.4), central nervous system (4.0; 3.7-4.5), and gastrointestinal system (2.9; 2.6-3.2). Dehydration (I = 7.5: 7.0-8.1) and exercise-associated muscle cramping (I = 3.2: 2.9-3.6) were the 2 most common specific diagnoses. The incidence of MEs in the 90-km Comrades Marathon was one of the highest incidences of MEs reported in an endurance running event (1 in 52 starters and 1 in 556 starters for serious/life-threatening MEs). Preventative measures to reduce MEs are needed, and further investigations into the risk factors associated with MEs could assist in managing the risk and better prepare athletes, race organizers, and medical directors.

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

Survey of 138 Conjunctival Tumors in the Dominican Republic

ABSTRACT Purpose To report the frequency of conjunctival tumors in the Dominican Republic. Methods Retrospective noninterventional case series. One hundred thirty-eight consecutive patients with a conjunctival mass evaluated at two tertiary referral centers from 2010 to 2018. Main outcome measures were frequency of tumors by diagnosis and distribution of tumors relative to patients’ age and gender. Results The mean age at presentation was 41.2 years (median, 42 years; range 10 days – 91 years). There were 83 male patients (60%) and 55 female patients (40%). The three most common specific diagnoses were junctional, compound, and subepithelial naevi (47 [34%]), squamous cell carcinoma (SCC) (26 [19%]) and conjunctival squamous intraepithelial neoplasia (CIN) (17 [12%]). The mean age at detection was 36.5 years for non-malignant tumors and 56.3 years for malignant tumors (p < .001), with a mean difference of 19.8 years at time of diagnosis (95% CI, 10.7–28.8). Benign tumors were more common in children and young adults; malignant and premalignant tumors were more common in mid and older adults (p = .009). Malignant tumors were more common in males (73%) than in females (27%) (p = .04). Conclusion In the Dominican Republic, conjunctival tumors are benign (63%), premalignant (13%) and malignant (24%). Malignant tumors are more common in older adults and men.

Indications, risk factors, and outcomes of 30-day readmission after infrarenal abdominal aneurysm repair

ObjectiveReducing readmissions is an important target for improving patient care and enhancing health care quality and cost-effectiveness. The aim of this study was to assess rates, risk factors, and indications of 30-day readmission after open aortic repair (OAR) and endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs). MethodsA retrospective analysis of the Premier Healthcare Database from 2009 to 2015 was performed. Indications for readmission after the index procedure, risk factors, and outcomes of the index admission and rehospitalization were evaluated. Multivariate logistic models were used to assess the association between 30-day readmission and different patient and hospital factors. ResultsA total of 33,332 AAA repair procedures were identified: 27,483 (82.5%) EVAR and 5849 (17.5%) OAR. The overall rate of 30-day readmission was 8.1%, and it was greater after OAR (12.9% vs 7.1% in EVAR; P < .001). In general, the most common specific readmission diagnoses were infectious complications (16.1%), followed by respiratory and cardiac complications (11.8% and 11.3%, respectively). After multivariate adjustment, OAR was associated with higher 30-day readmission compared with EVAR (adjusted odds ratio, 1.11; 95% confidence interval, 1.0-1.2; P = .04). Other risk factors of 30-day readmission included female gender, emergency and urgent procedures, certain patient comorbidities (dyslipidemia, congestive heart failure, history of transient ischemic attack, previous cardiac surgery, chronic obstructive pulmonary disease, asthma, chronic kidney disease, peripheral vascular disease, and history of malignant disease), and hemorrhage/shock/bleeding occurring during the index admission as well as nonhome discharge. Readmitted patients had an overall in-hospital mortality of 3.6% and paid a median rehospitalization cost of $7757. ConclusionsOur study shows that around 8.1% of patients undergoing infrarenal AAA repair were readmitted within 30 days. Because many readmissions are unrelated to the index procedure or caused by factors that are nonmodifiable or nonidentifiable at discharge, efforts should focus on discharge planning and improving the decision process regarding discharge destination as well as postdischarge coordination of care for high-risk patients.

Pattern of Uveitis in a Referral Hospital in Bangladesh

ABSTRACTPurpose: To report the pattern of uveitis in a tertiary eye care center in Bangladesh.Methods: Retrospective analysis of all uveitis cases visiting uveitis clinic of Bangladesh Eye Hospital between January, 2009 and April, 2015.Results: In total, 652 patients (mean age 32.3 years, female 47.8%) were included in the study. Uveitis was bilateral in 42.6% of cases. Anterior uveitis was the most common (39.2%) case, closely followed by intermediate uveitis (22.2%), posterior uveitis (22%), and panuveitis (16.4%). Specific diagnosis was established in 53.3% of patients. The three most common specific diagnoses were ocular tuberculosis (10.7%), followed by HLA-B27-related uveitis (10.1%) and Vogt–Koyanagi–Harada disease (VKHD; 8.4%).Conclusion: Ocular tuberculosis remained an important cause of uveitis in Bangladesh while HLA-B27 and VKHD were found to be the most common non-infectious uveitic entity.

Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic.

IntroductionGhana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic.MethodsWe conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014.ResultsAmong the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed.ConclusionOur study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.

Changes in patterns of uveitis at a tertiary referral center in Northern Italy: analysis of 990 consecutive cases

PurposeThe role of uveitis, an uncommon ocular disease, is often neglected in research and treatment of autoimmune conditions. The study described the spectrum of uveitis at a referral center in North Italy, and compared that to a previously published series of patients.MethodsWe reviewed all patients with uveitis diagnosed from 2013 to 2015 at the Immunology Eye Unit, Arcispedale S. M. Nuova-IRCCS, Reggio Emilia, Italy. We examined patient characteristics, disease spectrum, and etiologies.ResultsIn total, 990 cases of uveitis were identified, who were mostly female (59%) with a median age at presentation of 44 years (interquartile range = 29–57). Anterior uveitis was most frequent (53.5%), followed by panuveitis (22.8%), posterior (16.2%), and intermediate uveitis (5.5%). Anterior herpetic uveitis (15.6%), Fuchs uveitis (9.7%), and HLA-B27 positive anterior uveitis (7.7%) were the most common specific diagnoses. Compared with the previous series, we observed an increased incidence of uveitis, and a different pattern of diagnoses. Rates of herpetic, HLA-B27 positive uveitis, and presumed ocular tuberculosis were higher, but Fuchs uveitis was less frequent.ConclusionsThe pattern of uveitis appears to be changing, very likely due to population-level increases in infectious diseases, to the availability of new diagnostic tests and to the interdisciplinary approach used in patient diagnosis.

Reasons for referral and diagnostic concordance between physicians/surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India.

Background:Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams.Aim:This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team.Materials and Methods:Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team.Results:In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655).Conclusions:The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.

Serial Frequencies and Clinical Features of Uveitis in Hokkaido, Japan

ABSTRACTPurpose: Environmental and lifestyle changes influence the clinical features of uveitis. This study reviewed the epidemiologic trends of uveitis in the Japanese population.Methods: A retrospective review of the past 80 years of reports from Hokkaido University Hospital.Results: In the 1930s, tuberculosis accounted for 46% and syphilitic uveitis for 31% of cases. The frequency of these diseases decreased to 12% in the 1950s; 8% in 1969; 0.6% in the 1990s; and 0.8% in the 2000s, while the rate of non-infectious uveitis increased. The three most common specific diagnoses were: sarcoidosis, Vogt–Koyanagi–Harada disease, and Behçet disease. Although Behçet disease was the most frequent non-infectious uveitis until the 1980s, sarcoidosis is now the most frequent cause of newly diagnosed non-infectious uveitis.Conclusions: The etiology of uveitis has changed with the times. Tubercular and syphilitic cases have greatly decreased, and sarcoidosis is the most frequent type of uveitis today.

Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation

ABSTRACTObjective: We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders.Methods: In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version.Results: The mean age of the study subjects (n = 209) was 45.96 ± 11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n = 25, 16.9%) and generalised anxiety disorder (n = 19, 12.8%).Conclusions: Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.

Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration.

BackgroundThe causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities.MethodsWithin the International epidemiological Database to Evaluate AIDS (IeDEA) - West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d’Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever > 38°5C, Karnofsky index < 70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale.ResultsFrom December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study.ConclusionsThis study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0910-3) contains supplementary material, which is available to authorized users.