Diagnostic Outcomes Of Patients Research Articles

O079 Investigating Hypersomnolence Disorders in South Australia: A Retrospective Audit of Multiple Sleep Latency tests

Abstract Introduction This study aims to evaluate the characteristics of patients with Narcolepsy Type 1 (NT1), Narcolepsy Type 2 (NT2), and Idiopathic Hypersomnolence (IH) along with diagnostic outcomes in patients referred for a multiple sleep latency test (MSLT) at an Australian hospital. Methods A retrospective audit was performed of all patients who completed an MSLT between January 2018 to January 2023. Results 431 participants (62.4% female; mean±SD age 40.2±16.4 years; BMI 28.6±7.4 kg/m²) who completed MSLTs were included. 95 participants (22%) had a positive MSLT of ≤ 8 minutes, of which 87% (n=83) had a prior night total sleep time on polysomnography of > 6 hours. Gender, age, and BMI did not vary significantly between participants with a mean sleep latency (MSL) ≤ 8 versus >8 minutes (p=0.9, p>0.9, p=0.1 0, respectively). Participants with an MSL ≤ 8 minutes had higher Epworth Sleepiness Scale scores 14.6 ± 5.1 vs 12.5 ± 5.0 (p < 0.001), with more sleep onset REM periods (SOMREPs) 0.82 ± 1.35 vs 0.14 ± 0.49 compared to those with MSL >8 minutes. Further data collection is in progress, but to date, diagnoses were available for 34 participants with MSL ≤ 8 minutes (6 NT1, 8 NT2, 8 IH, 12 Other [i.e., shiftwork disorder, sleep restriction, medication-induced]). Discussion This study seeks to estimate diagnostic frequency and characteristics of patients presenting for evaluation of hypersomnolence. The prevalence of MSL < 8 minutes (22.0%) is consistent with prior studies1,2. Analysis of diagnostic outcomes is pending further data collection in progress.

The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

Prognostic and diagnostic significance of circRNAs expression in lung cancer.

Circular RNAs (circRNAs) have spurred considerable interest in numerous tumors. We aimed to investigate the clinical, prognostic, and diagnostic roles of circRNAs in human lung cancer. We systematically searched PubMed, Web of Science, EMBASE, Scopus, CBM, and the Cochrane Library databases up to July 24, 2018. Eligible studies about the relationship between circRNAs expression and clinical, prognostic, and diagnostic outcomes in patients with lung cancer were in our study. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were to investigate clinical parameters, and hazard ratios (HRs) and 95% CIs to estimate overall survival (OS). A total of 23 relevant studies were eligible, with 15 on clinicopathological features, 14 on prognosis, and six on diagnosis. For clinical features, high expression of oncogenic circRNAs was remarkably related to poor clinical parameters. Whereas, the results of tumor-suppressor circRNAs were the complete opposite. For the prognostic roles, oncogenic circRNAs had an unfavorable impact on overall survival (OS: HR = 3.24, 95% Cl: 2.70-3.77), and elevated level of tumor-suppressor circRNAs was correlated with longer survival (OS: HR = 0.57, 95% Cl: 0.43-0.70). For the diagnostic values, the pooled result showed an area under the curve (AUC) of 0.86, with 77% sensitivity and 81% specificity in distinguishing patients with lung cancer from healthy ones. The above results suggested that circRNAs have the potential to be novel indicators for prognostic and diagnostic evaluation of patients with lung cancer.

Phenotypic characteristics and diagnostic outcomes of patients presenting with and without seizure-related neurocysticercosis: A cross-sectional analysis of tertiary hospital episodes in Qatar (2015–2018)

Background: In resource-poor settings, neurocysticercosis (NCC) is a common cause of acute presentation with seizures. There remains an uncertainty regarding its changing epidemiology in resource-rich settings such as Qatar. Patients and Methods: We carried out a retrospective review of case notes and electronic records of 2450 patients presenting to an acute admissions unit with suspected NCC between January 2015 and May 2018. Results: Of the 2450 records reviewed, 26 cases satisfied the Del Brutto criteria for NCC. The mean age at presentation was 31 ± 9.74 years, made up of an entirely male population. There was a higher proportion of patients (n = 20) presenting with seizures 76.9%, of which the most dominant subtype was generalized tonic–clonic seizures 73.7% (n = 14). Advancing age and intracerebral calcifications were associated with an increased risk of having seizures (confidence interval [CI]: 1.18–18.8, P = 0.019, and CI: 0.034–0.9, P = 0.036, respectively). Conclusion: The migrant population in Qatar continues to account for the preponderance of NCC morbidity with seizure, in its various phenotypes, the most common mode of presentation. To our knowledge, this is the most up-to-date account of this disease with interesting and changing demographics in this part of the world.

Elevated fecal levels of eosinophil granule proteins predict collagenous colitis in patients referred to colonoscopy due to chronic non-bloody diarrhea

Objective: Colonoscopy with biopsy sampling is often performed to detect collagenous colitis (CC) and lymphocytic colitis (LC) in patients with chronic non-bloody diarrhea. However, the diagnostic yield is low and incurs high costs. Fecal calprotectin (FC) and myeloperoxidase (MPO) indicate intestinal inflammation in ulcerative colitis (UC) and Crohn’s disease (CD). In CC, elevated fecal levels of eosinophil protein X (EPX) and eosinophil cationic protein (ECP) have been reported. We aimed to evaluate if F-EPX, F-ECP, FC, and F-MPO could predict the diagnostic outcome in patients with chronic non-bloody diarrhea referred to colonoscopy. We also evaluated serum (S) EPX and ECP in this regard.Methods: Of 67 included patients, 63 (94%) underwent colonoscopy with biopsy sampling. Fecal EPX, F-ECP, FC, F-MPO, S-EPX, and S-ECP were analyzed.Results: Diagnostic outcome: normal: n = 46 (73%), CC: n = 9 (14%), LC: n = 4 (6%), UC: n = 2 (3%), CD: n = 2 (3%). Higher levels of F-EPX and F-ECP were found in CC compared to a normal diagnostic outcome (p = 0.01). No change was noted in any of the fecal markers in LC. When all of the fecal markers were normal the probability of a normal diagnostic outcome was 92%. We found no differences in S-EPX and S-ECP between the groups.Conclusion: Elevated F-EPX and F-ECP could predict CC. None of the fecal markers predicted LC. Serum-EPX and S-ECP are not useful for the diagnosis of CC, LC, UC, or CD. With normal levels in all of the analyzed fecal markers, there is a low probability of a pathologic diagnostic outcome.

Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery - A case series.

BackgroundOxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP.Patients and methods18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred.ResultsBelow the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications.ConclusionDuring 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients.

Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis.

It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2-45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis.

PWE-172 Does salivary pepsin measurement change diagnostic outcome in patients investigated by 24h ph monitoring?

Introduction Pepsin, a gastric enzyme, has been proposed as a marker of gastro-oesophageal reflux disease (GORD) when present in saliva.1 In contrast to routine diagnostic methods, quantification of salivary pepsin is rapid and non-invasive. Furthermore, 24h pH-monitoring has limited sensitivity.2We aimed to evaluate the impact of salivary pepsin measurement on diagnosis of GORD in patients undergoing 24h pH-monitoring. Method Patients referred for 24h pH-monitoring (off medication) were invited to take part in the study. Eligible participants complained of heartburn, regurgitation, chest pain or acid in the mouth and were referred for testing by a gastroenterologist, upper gastrointestinal surgeon or respiratory consultant. Presence of additional atypical symptoms was assessed by questionnaire (Reflux Symptom Index). Patients underwent high resolution oesophageal manometry and catheter-based 24h pH-monitoring. During the monitoring period, participants collected up to three saliva samples at the time of experiencing their predominant symptom (s). Pepsin concentration of samples was quantified using a lateral flow device (Peptest) where at least one sample containing >25ng/ml pepsin was indicative of reflux disease. Diagnostic outcome by pepsin measurement and 24h pH-monitoring (>4.2% of time pH Results 100 participants recruited; 80 participants included in final analysis (exclusions: corrupt pH study (n = 1), no pepsin samples collected (n = 19)). 81% of participants returned at least one positive pepsin sample. 39/80 (49%) patients were classified as having reflux disease based on 24h-pH monitoring (mean%time pH Conclusion A higher proportion of the total population was found to have GORD based on pepsin measurement (81% vs 49% using pH), which may reflect the poor sensitivity of 24h pH-monitoring. Measurement of salivary pepsin changed the diagnostic outcome when compared to 24h pH-monitoring in 44% of symptomatic reflux patients. Further studies should explore the relationships between pepsin concentration and symptoms of reflux. This study may support the use of salivary pepsin measurement to prevent false-negative diagnosis based on 24h pH-monitoring alone. Disclosure of interest A. Rasijeff: None Declared, W. Jackson: None Declared, J. Burke: None Declared, P. Dettmar Shareholder of: RD Biomed Limited. References Hayat JO, et al. Gut 2015;64:373–380 Dent J, et al. Gut 2010;59:714–721

Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

Histopathologic Diagnosis Associated with Delayed Diagnosis of Inferior Turbinate Pathology

Background and ObjectivesZZConditions of inferior turbinate other than hypertrophy are rare and its morphology of inferior turbinate is variable. Therefore, the diagnosis of this fatal disease is often delayed. In the present study, histopathologic characteristics of inferior turbinate lesions associated with delayed diagnosis are determined by reviewing the clinical and diagnostic outcomes in patients with inferior turbinate lesions. Materials and MethodZZThe medical records of patients who underwent endoscopic inferior turbinate biopsy following histopathologic evaluation from 2002 to 2013 were retrospectively reviewed, including the previous medical history, physical examination, radiologic findings, histopathologic results, therapy, and follow-up examination. ResultsZZA total 21 patients were included. The most common primary symptoms were nasal obstruction and frequent epistaxis. Diagnosed were 9 benign tumors, 7 malignant tumors, 2 infectious lesions, and 3 autoimmune lesions. Six of 21 patients visited more than three different hospitals before visiting our hospital. One-third of the cases with delayed diagnosis were malignant tumors, which included mucosal melanoma and natural killer/T cell lymphoma. ConclusionZZIn patients with nasal obstruction unresponsive to multiple therapeutic attempts, inferior turbinate neoplasia should be suspected to avoid delaying diagnosis and proper treatment.

Encephalitis of unclear origin diagnosed by brain biopsy: a diagnostic challenge.

Brain biopsy specimens that exhibit encephalitis without specific histopathologic features pose a diagnostic challenge to neuropathologists and neurologists. Such cases are generally referred to pathologically as encephalitis, not otherwise specified (ENOS). A systematic approach to diagnostic evaluation in such patients is challenging, and currently there is no generally accepted algorithm. To examine ultimate diagnostic outcomes in patients with ENOS diagnosed by brain biopsy. This retrospective case series at the University of California, San Francisco, Medical Center, a tertiary care urban neurosciences center, studied patients with encephalitis diagnosed by brain biopsy from January 1, 1983, through December 31, 2011. Brain biopsy. Clinical and neuropathologic diagnosis. Among 58 patients who met the inclusion criteria for the study, the original pathologic diagnosis was ENOS in 49 patients (84%). The median age was 40 years (interquartile range, 27-53 years), 35 patients were male, and 13 had known human immunodeficiency virus or AIDS. Median time from onset of symptoms to brain biopsy was 66 days (interquartile range, 18-135 days). For the 29 patients in whom material for pathologic analysis was still available, additional neuropathologic review led to a more specific categorization in 10 (34%). Clinical detail and follow-up information was available for 42 patients, and a specific diagnosis was reached with the help of ancillary testing and/or clinical follow-up in 12 patients. Despite a comprehensive neuropathologic review with additional studies and information, 27 patients still had to be classified in the ENOS category at the end of the study. ENOS is the most common initial type of encephalitis diagnosed by brain biopsy. In such patients, it may be worth having the biopsy materials reviewed again in a comprehensive fashion by a neuropathologist because additional review led to a more specific categorization in one-third of our cases. Ancillary testing, clinical correlation, and clinical follow-up establish more specific diagnoses in some patients. ENOS still remains a diagnostic challenge after all these efforts in many cases. Current algorithms are of limited value. More advanced methods and better diagnostic algorithms are needed to characterize these patients.

EPA-0882 - Prediction of diagnosis of early-onset schizophrenia spectrum disorders using support vector machines

Diagnosis of schizophrenia spectrum disorders (SSD) may be difficult in clinical practice, particularly during the first episodes of early-onset psychosis (FE-EOP). To develop a Support Vector Machine (SVM) algorithm as a predictive tool for diagnostic outcome in patients with FE-EOP, based on clinical and biomedical data at the emergence of the illness. Two-year, prospective longitudinal study, where 81 patients (9-17 years of age) with a FE-EOP and stable diagnosis at follow-up and 41 age and sex-matched healthy controls (HC) were included. Structured diagnostic interviews, clinical and cognitive scales, a MRI scan and biochemical tests were conducted at baseline. Three SVM classification algorithms were developed (SSD vs HC group, non-SSD vs HC group, and SSD vs non-SSD group). Jackknifing was used to validate the algorithms and to calculate performance estimates. Enhanced-Recursive Feature Elimination was performed in order to gain information about the predictive weight for diagnosis of each variable. The SSD-versus-non-SSD classifier achieved an overall accuracy of 83.1%, sensitivity of 86.6% and specificity of 77.8%. The variables during a FE-EOP with higher predictive value for a diagnosis of SSD were clinical variables such as negative symptoms preceding or during the psychotic onset, poor insight and duration of illness until first psychiatric contact. Biochemical, neuroimaging, and cognitive variables at baseline did not provide any additional predictive value. SVM may serve as a predictive tool for early diagnosis of SSD during a FE-EOP. The most discriminative variables during a FE-EOP for a future diagnosis of SSD are clinical variables.

Weighted registration of 123I‐FP‐CIT SPECT images improves accuracy of binding potential estimates in pathologically low striatal uptake

To test whether the use of a striatum weighted image may improve registration accuracy and diagnostic outcome in patients with parkinsonian syndromes (PS), weighted images were generated by increasing signal intensity of striatal voxels and used as intermediate dataset for co-registering the brain image onto template. Experimental validation was performed using an anthropomorphic striatal phantom. (123)I-FP-CIT SPECT binding ratios were manually determined in 67 PS subjects and compared to those obtained using unsupervised standard (UWR) and weighted registered (WR) approach. Normalized cost function was used to evaluate the accuracy of phantom and subjects registered images to the template. Reproducibility between unsupervised and manual ratios was assessed by using intra-class correlation coefficient (ICC) and Bland and Altman analysis. Correlation coefficient was used to assess the dependence of semi-quantitative ratios on clinical findings. Weighted method improves accuracy of brain registration onto template as determined by cost function in phantom (0.86 ± 0.06 vs. 0.98 ± 0.02; Student's t-test, P = 0.04) and in subject scans (0.69 ± 0.06 vs. 0.53 ± 0.06; Student's t-test, P < 0.0001). Agreement between manual and unsupervised derived binding ratios as measured by ICC was significantly higher on WR as compared to UWR images (0.91 vs. 0.76). Motor UPDRS score was significantly correlated with manual and unsupervised derived binding potential. In phantom, as well as in subjects studies, correlations were more significant using the WR method (BPm: R(2) = 0.36, P = 0.0001; BPwr: R(2) = 0.368, P = 0.0001; BPuwr: R(2) = 0.300, P = 0.0008). Weighted registration improves accuracy of binding potential estimates and may be a promising approach to enhance the diagnostic outcome of SPECT imaging, correlation with disease severity, and for monitoring disease progression in Parkinsonian syndromes.

SAT0080 Ankle synovitis and its prognostic implications in a very early arthritis cohort

BackgroundAnkle synovitis occurs in over a third of early inflammatory arthritis patients and may be present in isolation. However, the clinical outcomes associated with ankle involvement in this population are...

Ultrasonography in early assessment of elderly patients with polymyalgic symptoms: a role in predicting diagnostic outcome?

Objective: To study the usefulness of ultrasonography (US) in predicting the diagnostic outcome in patients with polymyalgic symptoms.Methods: Sixty-one elderly patients with polymyalgic syndrome were recruited in a secondary care setting and followed up in a prospective way. Clinical, laboratory, and US data obtained at onset were re-evaluated after 1 year when diagnostic outcome was defined.Results: A diagnostic shift was observed in 32 polymyalgic patients (52%). Calcium pyrophosphate deposition disease (CPDD) was diagnosed in nine patients, elderly-onset rheumatoid arthritis (EORA) in 18, and elderly-onset spondyloarthritis (EOSpA) in five. In polymyalgia rheumatica (PMR) patients US demonstrated synovitis in 90% of cases, in both proximal (90%) and peripheral joints (41%). The best predictive US model for the definitive diagnosis of PMR comprised: the presence of subacromial-subdeltoid bursitis [odds ratio (OR) 5.603, p = 0.003], low frequency of wrist (OR 0.074, p < 0.001), metacarpophalangeal (OR 0.052, p < 0.001), and metatarsophalangeal effusion/synovitis (OR 0.107, p < 0.027), low frequency of knee menisci chondrocalcinosis (OR 0.091, p = 0.013), tendinous calcaneal calcifications (OR 0.078, p = 0.006), and Achilles enthesitis (OR 0.107, p = 0.027), and low power Doppler US (PDUS) scores at wrist (OR 0.052, p < 0.001).Conclusions: US and PDUS can be useful in distinguishing, at onset of disease, pure PMR from other diseases mimicking this condition.

Limitations of helical CT for the diagnosis of pulmonary thromboembolism during pregnancy and the puerperium

THROMBOEMBOLISM DURING PREGNANCY AND THE PUERPERIUM FRANCIS NUTHALAPATY, MONIQUE HO, SATINDER SINGH, HRUDAYA NATH, JOHN OWEN, JOHN HAUTH, University of Alabama at Birmingham, Obstetrics & Gynecology, Birmingham, Alabama, University of Alabama at Birmingham, Radiology, Birmingham, Alabama OBJECTIVE: To determine the diagnostic outcomes of patients evaluated for pregnancy-associated pulmonary thromboembolism (PTE) using Helical Computed Tomography (HCT). STUDY DESIGN: We retrospectively reviewed the medical records of all women who underwent HCT between January 1, 1999 and March 31, 2004 for evaluation of possible pregnancy-associated PTE. Subjects were identified from hospital discharge and radiology procedure records. Patient characteristics and diagnostic test outcomes were abstracted. RESULTS: Our case series consisted of 68 gravidas, with a mean age of 27 G 7 years, of whom 49% (33/68) underwent antenatal evaluation at a mean gestational age of 30 G 7 weeks. Postpartum evaluation occurred in 51% (35/ 68) of the cohort, of whom 37% delivered vaginally and 63% by cesarean. Sixtythree percent (43/68) of the HCT studies were interpreted as negative, 15% (10/ 68) as positive, and 22% (15/68) as indeterminate for PTE. Regardless of the HCT-PTE interpretation, 45% of all HCT reports included a qualifier that the study was either inadequate for interpretation (n = 3), or technically limited/ suboptimal (n = 27) due to poor contrast infusion, motion artifact, or large body habitus. Important additional pulmonary findings including pneumonia, effusions, and edema, were noted in 74% (50/68) of all HCT studies. Confirmatory pulmonary angiography (PA) was requested in 6 women who had compelling clinical evidence of PTE. Three had strong HCT support for PTE and anticoagulation, while 3 had either an indeterminant or negative study. All 6 women had normal PA. No apparent false negative tests occurred. CONCLUSION: The diagnosis of PTE during pregnancy and the peurperium using HCT is associated with an appreciable incidence of quality limiting factors and a worrisome positive predictive value. Our findings suggest that when HCT results indicate PTE, a definitive diagnostic evaluation (pulmonary arteriogram) should be performed prior to instituting long-term anticoagulation. 293 IS THERE A DIFFERENCE IN OBSTETRICAL OUTCOME BETWEEN MILD AND SEVERE RENAL DISEASE? ALISA MODENA, MATTHEW HOFFMAN, JORGE TOLOSA, Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, Pennsylvania, Christiana Hospital, Newark, Delaware OBJECTIVE: An initial serum creatinine (SC) of greater or less than 1.4 mg/dL differentiates severe chronic renal disease (CRD) from mild. Perinatal outcome is considered to be significantly worse in severe CRD. Our objective is to determine if this concept remains accurate with current clinical management of these patients during pregnancy. STUDY DESIGN: We conducted a retrospective population based study at two institutions from 1990-2002. ICD-9 codes identified pregnancies complicated by chronic renal disease. A retrospective review of charts was undertaken. Data was analyzed with SPSS. RESULTS: There were 82 patients with chronic renal disease, SC range 0.411.3 mg/dL, of these 46 (57%) had severe CRD and 35 (43%) had mild CRD. The cause of CRD was: 49 (60%) chronic hypertension, 23 (28%) diabetes mellitus, 17 (20%) lupus, 6 (7%) membrano-proliferative glomerulonephritis, 4 (5%) polycystic kidney disease, 3 (4%) Post-streptococcal GN, 3 (4%) focal glomerulosclerosis, 2 (3%) sickle cell disease, 1 (1%) IgA nephropathy, 18 (22%) other causes. 16/82 (20%) patients had at least one renal transplant, and 11/82 (14%) were on dialysis during their pregnancy. There was no difference between the two groups in rates of preeclampsia (OR 0.66 CI .26-1.7, P =.55), IUGR (0.45, CI .09-2.1, P = .57) or neonatal mortality (OR 1.9, CI .5-7.4, P = .56). Patients with mild CRD delivered at a mean gestational age 33.6, those with severe CRD delivered at a mean gestational age of 31.4 (OR 2.7, CI .9-8, P = .11). CONCLUSION: There is no significant increased risk of adverse perinatal outcome in women with severe CRD compared to women with mild disease. A reevaluation of prognosis in these patients is warranted.

Diagnostic outcome in patients with dyspepsia. A preliminary report.

The main indication for upper endoscopy in outpatients with dyspepsia is to find an illness causing the symptoms. Frequently there is no abnormal findings at endoscopy in this group of patients who are therefore often left without an explanation for their symptoms unless further efforts are made to find out the origin of their dyspepsia.