Diagnosis Of Primary Disease Research Articles

Point-of-Care Diagnostics in Low-Resource Settings and Their Impact on Care in the Age of the Noncommunicable and Chronic Disease Epidemic

The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics.

Psychosocial outcome in cardiovascular rehabilitation of peripheral artery disease and coronary artery disease patients

We investigated patients with a primary diagnosis of peripheral artery disease (n = 69) and coronary heart disease (CAD; n = 520) at baseline and on changes in psychosocial risk factors (depression, anxiety, quality of life, negative and positive affect) during a cardiovascular rehabilitation program. Patients completed psychosocial questionnaires at the beginning and at discharge of a 12-week rehabilitation program. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS), positive and negative affect with the Global Mood Scale, and health-related quality of life with the SF-36 Health Survey. Patients with PAD showed improvements in anxiety (p < 0.001), negative affect (p < 0.001) and bodily pain (p < 0.001). Patients with CAD reported significant improvements in all measured dimensions (all p-values < 0.001).

Increased Risk of Chronic Liver Disease in Patients with Schizophrenia: A Population-Based Cohort Study

To investigate the prevalence and incidence of chronic liver disease in patients with schizophrenia in Taiwan. We used a random sample of 661,266 subjects aged ≥ 18 from the National Health Research Institute database in the year 2000. Subjects with at least one primary diagnosis of schizophrenia (The International Classification of Diseases, Ninth Revision, Clinical Modification: 295) in 2000 were selected. Patients with a primary or secondary diagnosis of chronic liver disease (The International Classification of Diseases, Ninth Revision, Clinical Modification: 571) were also defined. We compared the prevalence and associated factors of chronic liver disease between patients with schizophrenia and the general population in 2000. We also compared the incidence of chronic liver disease in patients with schizophrenia and the general population from 2001 through 2010. The prevalence of chronic liver disease in patients with schizophrenia (7.0%) was 1.27 times as high as that of the general population (6.1%) in 2000. The average annual incidence of chronic liver disease in patients with schizophrenia from 2001-2010 was also higher than that of the general population (2.9% vs 2.5%, risk ratio, 1.15; 95% confidence interval, 1.07-1.24). Younger patients with schizophrenia were found to have a much higher prevalence and incidence than those in the general population, and diabetes was a risk factor for patients with schizophrenia in developing chronic liver disease. Patients with schizophrenia exhibited a significantly higher prevalence and incidence of chronic liver disease than those in the general population, and younger patients with schizophrenia have a much higher prevalence and incidence than those in the general population. Co-morbidity with diabetes was the primary risk factor for patients with schizophrenia to develop chronic liver disease.

Delayed Metastasis to the Mandible of Esophageal Adenocarcinoma

Around 1% of oral cancers are metastases from distant sites. Tumor metastases to the jaw bones are uncommon and are most likely to arise from primary lung, breast, prostate or kidney tumors. Jaw bone metastases from a primary esophageal adenocarcinoma are especially rare, with only 7 reports published in the literature. Here, we describe a case of a 69year-old male patient where 7years elapsed between the diagnosis and successful treatment of a poorly differentiated, stage pT2N0 primary esophageal adenocarcinoma and re-presentation with jaw pain due to a metastatic mandibular deposit. The morphological appearance of the metastasis and immunohistochemical positivity with CK20, CK7 and CDX2 strongly supported an adenocarcinoma of upper gastrointestinal tract origin. This case is of particular interest as there is an unusually long time between the detection of the primary esophageal adenocarcinoma and diagnosis of metastatic disease. The longest period of time we have found for this in the literature is 9months, although it is also reported that some oral metastases may appear more than 10years following the primary tumor diagnosis.

PWE-134 Outcomes For Liver Disease Patients Admitted to a District General Hospital

IntroductionIn the UK, liver disease is the 5th commonest cause of death. A recent BSG commissioning report states that there were 43,694 hospital episodes due to liver disease with a...

Quantitative evaluation of vocal‐fold mucosal irregularities using GLCM‐based texture analysis

Visualization of the vocal folds is essential when reaching a primary diagnosis of laryngeal disease. However, the examination is subjective and highly dependent on the experience of the treating physician. The present study is the development of objective tools for the diagnosis of laryngeal malignancy based on laryngeal texture analysis. Texture analysis using gray-level co-occurrence matrix (GLCM) in vocal fold images of 198 patients. Vocal-fold images were subjected to texture analysis using gray-level co-occurrence matrix (GLCM)-based parameters, which were computed by a novel digital image-processing program. Patients were divided into two groups: those with benign-looking lesions and those with malignant-looking lesions. Textural irregularities were compared using GLCM-based parameters. The relationship between the texture-analysis parameters and the diagnosis was then statistically evaluated. Texture irregularity was negatively correlated with energy and the inverse difference moment (IDM) and positively correlated with entropy, variance, contrast, dissimilarity, and mean values. All of the GLCM-based parameters evaluated differed significantly according to the degree of differentiation of the benign- or malignant-looking lesion (P < 0.001). Entropy had a sensitivity of 82.9% and a specificity of 82.2% at a cutoff value of 5.94; for variance, the sensitivity was 82.9% and the specificity was 84.5% at a cutoff value of 167. GLCM-based texture analysis of vocal-fold lesions, especially in association with a differential diagnosis of benign and malignant-looking diseases, contributes to achieving an objective image-based analysis of vocal-fold lesions. In addition, this approach can be used to create algorithms permitting a reproducible classification of laryngeal pathologies.

Outcomes and Costs of Elective Surgery for Diverticular Disease

To compare outcomes and costs of elective surgery for diverticular disease (DD) with those of other diseases commonly requiring colectomy. Multivariable analyses using the Nationwide Inpatient Sample to compare outcomes across primary diagnosis while adjusting for age, sex, race, year of admission, and comorbid disease. A sample of US hospital admissions from 2003-2009. All adult patients (≥18 years) undergoing elective resection of the descending colon or subtotal colectomy who had a primary diagnosis of DD, colon cancer (CC), or inflammatory bowel disease (IBD). In-hospital mortality, postoperative complications, ostomy placement, length of stay, and hospital charges. Of the 74,879 patients, 50.52% had DD, 43.48% had CC, and 6.00% had IBD. After adjusting for other variables, patients with DD were significantly more likely than patients with CC to experience in-hospital mortality (adjusted odds ratio, 1.90; 95% CI, 1.37-2.63; P < .001), develop a postoperative infection (1.67; 1.48-1.89; P < .001), and have an ostomy placed (1.87; 1.65-2.11; P < .001). The adjusted total hospital charges for patients with DD were $6678.78 higher (95% CI, $5722.12-$7635.43; P < .001) and length of stay was 1 day longer (95% CI, 0.86-1.14; P < .001) compared with patients with CC. Patients with IBD had the highest in-hospital mortality, highest rates of complications and ostomy placement, longest length of stay, and highest hospital charges. Despite undergoing the same procedure, patients with DD have significantly worse and more costly outcomes after elective colectomy compared with patients with CC but better than patients with IBD. These relatively poor outcomes should be recognized when considering routine elective colectomy after successful nonoperative management of acute diverticulitis.

Diagnosis of Primary Glomerular Diseases

Glomerular diseases occurring in the absence of a known systemic process are called primary. This review focuses on the approach and diagnosis of primary glomerular disease. Inflammatory and/or noninflammatory insults to glomeruli results in a multiplicity of signs and symptoms of diseases, including hematuria, proteinuria, azotemia, edema, and hypertension. Patients with glomerular diseases generally present with one of the following clinical syndromes: asymptomatic urinary abnormalities, nephrotic syndrome, acute nephritic syndrome, rapidly progressive glomerulonephritis, or chronic glomerulonephritis. The urinalysis, the degree of proteinuria, the estimated glomerular filtration rate, and patient characteristics often allow the differential diagnosis of glomerular disease prior to renal biopsy. However, a renal biopsy is usually required to establish diagnosis and treatment of most glomerular disease. (Korean J Med 2013;84:6-12)

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The Use of Lufenuron to Treat Fish Lice (Argulus sp) in Koi (Cyprinus carpio)

Fish lice can cause significant morbidity and death in heavily infested fish. In addition to being a mechanical irritant when sucking blood, Argulus sp have been shown to be the vector for other fish diseases. Koi carp from a pond environment were presented with multiple raised dark spots on their dorsa and sides. The primary differential disease diagnosis was an Argulus sp. Parasites removed from the affected fish were examined under a dissection microscope, and the definitive diagnosis was determined to be Argulus sp infestation. Treatment with lufenuron (Program; Novartis, Greensboro, NC USA) was initiated with one 409.8-mg tablet per 1,000 US gallons (3,785 L) of water for a concentration of approximately 0.1 mg/L. This treatment was repeated once per week for 5 weeks. The fish have been monitored for 13 months after the initial treatment, and thus far, there has been no reappearance of Argulus sp within the aquatic environment.

Abstracts

Fish lice can cause significant morbidity and death in heavily infested fish. In addition to being a mechanical irritant when sucking blood, Argulus sp have been shown to be the vector for other fish diseases. Koi carp from a pond environment were presented with multiple raised dark spots on their dorsa and sides. The primary differential disease diagnosis was an Argulus sp. Parasites removed from the affected fish were examined under a dissection microscope, and the definitive diagnosis was determined to be Argulus sp infestation. Treatment with lufenuron (Program; Novartis, Greensboro, NC USA) was initiated with one 409.8-mg tablet per 1,000 US gallons (3,785 L) of water for a concentration of approximately 0.1 mg/L. This treatment was repeated once per week for 5 weeks. The fish have been monitored for 13 months after the initial treatment, and thus far, there has been no reappearance of Argulus sp within the aquatic environment.

Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias

A growing body of evidence demonstrates an association between vascular risk factors and Alzheimer's disease. This study investigated the frequency and severity of atherosclerotic plaques in the circle of Willis in Alzheimer's disease and multiple other neurodegenerative diseases. Semi-quantitative data from gross and microscopic neuropathological examinations in 1000 cases were analysed, including 410 with a primary diagnosis of Alzheimer's disease, 230 with synucleinopathies, 157 with TDP-43 proteinopathies, 144 with tauopathies and 59 with normal ageing. More than 77% of subjects with Alzheimer's disease had grossly apparent circle of Willis atherosclerosis, a percentage that was significantly higher than normal (47%), or other neurodegenerative diseases (43-67%). Age- and sex-adjusted atherosclerosis ratings were highly correlated with neuritic plaque, paired helical filaments tau neurofibrillary tangle and cerebral amyloid angiopathy ratings in the whole sample and within individual groups. We found no associations between atherosclerosis ratings and α-synuclein or TDP-43 lesion ratings. The association between age-adjusted circle of Willis atherosclerosis and Alzheimer's disease-type pathology was more robust for female subjects than male subjects. These results provide further confirmation and specificity that vascular disease and Alzheimer's disease are interrelated and suggest that common aetiologic or reciprocally synergistic pathophysiological mechanisms promote both vascular pathology and plaque and tangle pathology.

Cardiovascular disease burden in acute public hospitals in Ireland: estimates for 2021 and 2031

Ireland is undergoing a demographic shift to a higher proportion of older people in the population. It is expected that this demographic shift will significantly increase the burden of care on an already overstretched acute hospitals system. This study was conducted to estimate the future burden of care on acute public hospitals pertaining to 'diseases of the circulatory system' and 'procedures on cardiovascular system' in Ireland using Hospital In-Patient Enquiry (HIPE) data for 2006 and population projections for 2021 and 2031. Age-specific rates derived from HIPE data for 2006 and census figures for the same year were applied to population projections for 2021 and 2031 to get case number estimates in those years. The number of discharges with a primary diagnosis of diseases of the circulatory system is estimated to increase by 51 % by 2021 and 97 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 65 % by 2021 and 133 % by 2031 relative to 2006 case numbers. The number of procedures performed is estimated to increase by 47 % by 2021 and 82 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 63 % by 2021 and 120 % by 2031 relative to 2006 case numbers. The results reflect the aging of the Irish population. The expected increases in case numbers will pose significant burden on acute public hospitals and the cost of providing care.

Absence of the SLC22A12 gene mutation in Turkish population with primary gout disease

The aim of the study was to examine whether SLC22A12 gene mutations might be influenced in primary gout disease. We included 32 patients with diagnosis of primary gout disease and 100 healthy volunteers. DNA was purified from peripheral blood, and all exons of the SLC22A12 gene were sequenced. We did not find any mutations in the SLC22A12 gene in all of the patients, but found 5 polymorphisms in exons 1 (g.T258C, g.C246T), 2 (g.C1246T) and 8 (g.T8011C) and in intron 9 (g.C8577T). However, we have not found any significant differences in the frequency of the individual genotypes between patients with primary gout disease and control group. In addition, the polymorphisms were not associated with hyperuricemia in our patients with primary gout disease. There was no previously reported mutation/polymorphisms of SLC22A12 gene in Turkish population. Our study is the first one in Turkish population and suggests that there is no association between primary gout disease and SLC22A12 gene polymorphisms. Sequence changes in the promotor and intronic regions of SLC22A12 gene should be investigated further with larger case groups.

Brain Metastases in Breast Cancer: Analysis of the Role of HER2 Status and Treatment in the Outcome of 94 Patients

We investigated the impact of human epidermal growth factor receptor 2 (HER2) and prognostic factors in the outcome of patients with breast cancer that developed brain metastases. . The data from 94 patients who received multidisciplinary therapy from 2001 to 2007 were retrospectively reviewed. Patients were assigned according to their HER2 status, and overall survival and time to brain metastases recurrence/progression were evaluated. The prognostic value of age, presence of extracerebral metastases, recursive partitioning analysis class, hormone therapy, systemic therapy and trastuzumab was assessed. The median overall survival and time to brain disease progression were 7.1 and 6.5 months, respectively. HER2 positivity (P = 0.006), treatment with trastuzumab (P = 0.025), chemotherapy (P = 0.011) and recursive partitioning analysis class I-II (P <0.001) were associated with prolonged survival on univariate analysis. On multivariate analysis, only recursive partitioning analysis class I-II (P <0.001) and triple-negative disease (P = 0.04) remained significant for overall survival, whereas time to brain metastases progression was only associated with recursive partitioning analysis class I-II (P = 0.001). The time from the diagnosis of primary disease to brain metastasis was slightly shorter in the HER2+ patients than in HER2- patients (36 vs 39 months). Intensified local treatment of brain metastasis incorporating whole-brain radiotherapy and/or radiosurgery and neurosurgery did not affect survival. Patients with triple-negative disease presented a significantly lower survival than the rest of the cohort (4 vs 8 months; P = 0.012). Recursive partitioning analysis class I-II was found to be the strongest independent predictive factor. Treatment with trastuzumab in HER2+ patients appeared to improve overall survival, probably due to the better control of systemic metastatic disease, but did not maintain significance in multivariate analysis. The dismal prognosis of patients with triple-negative breast cancer highlights the need to develop novel therapies to improve the poor survival.

Comparative Study of ECG Classification Performance Using Decision Tree Algorithms

The electrocardiogram (ECG) signal has often been reported to play an important role in the primary diagnosis, prognosis, and survival analysis of heart diseases. Electrocardiography has brought several valuable impacts on the practice of medicine. This paper deals with the feature extraction and automatic analysis of different ECG signal waves using derivative based/ Pan-Tompkins based algorithms. The ECG signal contains an important amount of information that can be exploited in different way. It allows for the analysis of cardiac health condition. The discrimination of ECG signals using the Data Mining Decision Tree techniques is of crucial importance in the cardiac disease therapy and control of cardiac arrhythmias. Different ECG signals from MIT/BIH Arrhythmia data base are used for ECG features extraction and analysis. Two pathologies are considered: atrial fibrillation and right bundle branch block. Some decision tree classification algorithms currently in use, including C4.5, Improved C4.5, CHAID (Chi square Automatic Interaction Detector) and Improved CHAID are performed for performance analysis. Promising results have been achieved using the C4.5 classifier, with an overall accuracy of 96.87%.

VA LOVIT II: a protocol to compare low vision rehabilitation and basic low vision

To compare the effectiveness of low vision rehabilitation (LVR) and basic low vision (LV) in a single masked multicentre randomised controlled trial (RCT). Three hundred and thirty patients eligible for US. Veterans Affairs (VA) healthcare services with primary eye diagnosis (better-seeing eye) of macular disease and best-corrected distance visual acuity of 0.40-1.00 logMAR (6/15 to 6/60 or 20/50 to 20/200 Snellen) are being enrolled at seven VA facilities. All participants receive an optometric LV examination; and they are eligible to receive the same LV devices that are provided without charge. In LVR, a LV therapist dispenses devices and provides 2 or 3 (1½ to 2½ h) therapy sessions with assigned homework to teach effective use of remaining vision and LV devices. Contact time with the therapist depends upon the devices prescribed and the patient's progress in learning the skills that are taught. In basic LV, devices are dispensed by the optometrist without LV therapy. Contact time for dispensing is one hour or less depending on LV devices prescribed. The primary outcome measure is a comparison of the changes in visual reading ability (estimated from patients' difficulty ratings of reading items on the VA LV VFQ-48 questionnaire) between the treatment and control arms from pre-intervention baseline to 4 months (2 months after completion of treatment). Secondary outcome measures are changes in overall visual ability, visual ability domain scores calculated from subsets of items (mobility, visual information processing and visual motor skills), Short Form-36, and Minnesota Low Vision Reading Test scores. Cost-effectiveness analysis will be conducted using VA LV VFQ-48 scores and QALYS computed from EuroQol scores. A total of 137 patients representing 41.5% of the study target of 330 patients were randomised from October 2010 to March 2012. Among those 137 patients, mean age was 80.2 (S.D. ± 9.9) years at enrollment; 97.1% of the patients were males; 94.2% were white. Mean best corrected VA was 0.65 (S.D. ± 0.3) logMAR (approximately Snellen 6/27 or 20/90) at baseline. LOVIT II is the first multicentre RCT comparing the effectiveness and cost-effectiveness of LVR and basic LV for patients with macular diseases and near normal or moderate levels of visual impairment.

Abstract 434: The Epidemic of Hypertension Related Disease and Changing Patterns of Leading Causes of Hospitalization in Patients with Comorbid Hypertension Among US Adults Aged 35 and Older

Objective: To examine the longitudinal trend of hospitalization due to hypertension related diseases and patterns of leading causes of hospitalization in those with comorbid hypertension among US adults aged 35 and older. Method: We used sample data (n=4,598,488 thousand hospitalized cases) from 1980-2007 National Hospital Discharge Surveys to test trends of patients with 1st diagnosis of hypertension (HT) related hospitalization, and any of 2nd to 7th diagnosis of HT, and HT associated with 10 primary causes of hospitalization. Diseases were coded using ICD-9-CM criteria. Age-adjusted rates of disease were calculated using US 2000 standard population. Trends of hospitalization due to HT related disease and associations between primary cause of hospitalized diseases and HT as comorbidity were tested using multivariate logistic regression models. Results: Crude hospitalization rates due to 1st diagnosis of HT related disease significantly increased from 1.93% (2327295 / 120579000) in 1980 to 2.14% (5091906/237551000) in 2007. The corresponding age-adjusted hospitalization rates were 1.81% in 1980 and 2.17% in 2007 (test for trend, p&lt;0.01). Similarly, age-adjusted rates due to any of 2nd to 7th diagnosis of HT related diseases significantly increased from 1.23% in 1980 to 5.43% in 2007 (test for trend, p&lt;0.001). Multivariate adjusted logistic regression analysis indicates that in 2007, patients who had any of 2nd to 7th diagnosis of HT, and had primary diagnosis of renal disease had the highest significant odds ratio (OR=7.0, 95%CI: 6.70-7.32) for hospitalization, followed by diabetes (3.47, 3.34-3.59), atherosclerosis (3.10, 2.89-3.32), septicemia (2.08, 1.98-2.19), stroke (1.88, 1.83-1.92), CHD (1.85, 1.81-1.90), heart failure (1.16, 1.12-1.20), and pneumonia and influenza (1.21, 1.16-1.25) than those without these primarily diagnosed diseases, respectively. Conclusion: The study, using a nationally representative dataset, is the first to demonstrate a 28-years trend that hospitalization due to HT related diseases significantly increased from 1980 to 2007 in the US adults. The study further highlights that patients with primary diagnosis of renal disease or diabetes with comorbid HT have emerged as top causes of hospitalization.

Referral Patterns of Nonmalignant Patients to an Irish Specialist Palliative Medicine Service

Our perception is that the proportion of referrals made to the specialist palliative medicine service (SPMS) in our institution for patients with a primary diagnosis of nonmalignant disease is high and that these patients are often referred late in their illness. We aimed to review the symptom burden and referral patterns of patients with a noncancer diagnosis to the SPMS in our centre. All new non-malignant referrals to the SPMS in 2009 were included. Data were collected from patients' medical records and analyzed using Excel. Ninety-two referrals were identified: 60 (65%) female, 32 (35%) male. Mean age 76.5 years (21-92). Reasons for referral included: end-of-life care (n=55, 60%), symptom control (n=23, 25%), home care support (n=13, 14%) and psychological support (n=1, 1%). Mean time from admission to referral was 24.9 days (<1-165). Fifty-six (61%) patients were commenced on a syringe driver (CSCI), with a mean time spent on a CSCI of 2.8 days (< 1-17). Primary outcomes included: death (n=72, 78.5%), home discharge (n=9, 10%), discharge to another care institution (n=6, 6.5%), discharge from service (n=3, 3%) and hospice transfer (n=2, 2%). Mean time from referral to outcome was 4.6 days (<1-35). The proportion of noncancer patients referred to the SPMS is our institution is high. This study confirms that nonmalignant referrals are commonly sent to the SPMS when patients are actively dying or very imminently dying. Further education of colleagues is warranted in the role of the SPMS, particularly with regard to earlier referral.

A Comparison of Psychosocial Risk Factors Between 3 Groups of Cardiovascular Disease Patients Referred for Outpatient Cardiac Rehabilitation

Few studies have examined psychosocial risk factors for cardiovascular disease (CVD) between diagnostic groups of CVD patients. We compared levels of depression, anxiety, hostility, exhaustion, positive affect, and social support, and the prevalence of type D personality between patient groups with a primary diagnosis of coronary heart disease (CHD), chronic heart failure (CHF), or peripheral arterial disease (PAD). We examined 548 CHD patients, 105 CHF patients, and 79 PAD patients who completed the Hospital Anxiety and Depression Scale, the cynical hostility subscale of the Minnesota Multiphasic Personality Inventory-2, the short form of the Maastricht Vital Exhaustion Questionnaire, the type D personality questionnaire, the positive mood scale of the Global Mood Scale, and the Enhancing Recovery in CHD Social Support Inventory, all in the first week of cardiac rehabilitation. Group differences in psychosocial factors were adjusted for sociodemographic factors, previous myocardial infarction, traditional cardiovascular risk factors, and medications. Relative to patients with PAD, those with CHD and those with CHF both showed greater exhaustion (P ≤ .001) and lower positive affect (P ≤ .03). The effect sizes of these differences were clinically relevant (Cohen's d between 0.32 and 0.49). There were no significant differences in psychosocial risk factors between CHD and CHF patients. The profile of psychosocial risk factors for CVD revealed clinically relevant variability between different diagnostic groups of CVD patients. The findings imply that patients with distinct cardiac diagnosis might additionally benefit from comprehensive cardiac rehabilitation if the program includes psychosocial risk factor-specific interventions.