Frequent Clinical Diagnosis Research Articles

Identifying Drivers of Multiple Readmissions After Pulmonary Lobectomy

Readmissions after pulmonary lobectomy for lung cancer are important markers of healthcare quality for surgeons and hospitals. The implications on resources and quality are magnified when examining patients who require multiple readmissions within the perioperative period. The Nationwide Readmission Database between 2013 and 2014 was investigated for patients with a primary diagnosis of lung cancer who underwent pulmonary lobectomy. Using adjusted hierarchical regression models, demographic and clinical factors during the index hospitalization were investigated for associations with single and multiple readmissions during the 90-day postoperative period. First and second readmissions during this period were compared for the primary diagnosis at the time of readmission using Clinical Classification Software codes. Of the 41,576 lobectomies during the study period 7,030 patients (16.9%) were readmitted. Among this group 1,554 patients (3.7%) had at least two readmissions. After adjustment for other factors, postoperative arrhythmia (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.25-1.83; p < 0.0001), postoperative infection (OR, 1.55; 95% CI, 1.11-2.17; p= 0.01), and postoperative sepsis (OR, 1.70; 95% CI, 1.08-2.67; p= 0.02) during the index hospitalization were associated with an increased risk ofatleast two readmissions. The most frequent Clinical Classification Software diagnosis for first readmissions was "postoperative complications" (892, 12.7%) and for second readmissions was heart disease (173, 11.2%). Approximately one-fifth of patients readmitted after pulmonary lobectomy would go on to be readmitted two or more times within 90 days. Although first readmissions were most likely to present with postoperative infection or complication, second readmissions were most likely to present with heart disease.

Vaginal colonization and vulvovaginitis by Candida species in pregnant women from Northern of Colombia

Objective: identify the vaginal colonizing Candida species and VVC species, predisposing factors and susceptibility against fluconazole in pregnant women attending gynecological outpatient of a maternal clinic in Cartagena (Colombia). Vulvovaginal candidiasis (VVC) is a common infection that affects a large proportion of women of childbearing age. It is estimated that about 75% of healthy women have had at least one episode of VVC in her life. Vaginal colonization by Candida spp. can vary from 10 to 17% and this is increased by 35% during pregnancy. The epidemiological behavior of Candida in VVC tends to be variable and this will depend on the level of vaginal estrogens, conditions of immunosuppression or chronicity of the process. Materials and Methods: the laboratory study included the direct examination of vaginal swabs, by fresh and differential staining of smears and cultures. The isolated species were identified by phenotypic tests and by multiplex PCR and CLSI M27-A3 microdilution method was used to evaluate susceptibility to fluconazole. Results: the frequent clinical diagnosis of bacterial vaginosis, did not correspond with the laboratory diagnosis in which predominated the intermediate biota. The results showed Candida albicans as the most common isolated species, followed by Candida tropicalis and Candida krusei. Candida colonization occurred in 71.4% and 28.6% of the population was diagnosed with vaginal candidiasis. All isolates were susceptible to fluconazole. Conclusion: The most common factors for colonization were related to clothing and for vaginal candidiasis to the use of vaginal lubricants.

Argyrophilic Grain Pathology in Frontotemporal Lobar Degeneration: Demographic, Clinical, Neuropathological, and Genetic Features.

Frontotemporal lobar degeneration (FTLD) is a clinically, pathologically, and genetically heterogeneous group of disorders that affect the frontal and temporal lobes of the brain. FTLD classification distinguishes three main neuropathological groups: FTLD-tau, FTLD-TDP, and FTLD-FUS. As a four-repeat tauopathy, argyrophilic grain disease (AGD) is included in the FTLD-tau group. AGD may also appear in association with other neuropathological disorders. We describe the demographic, clinical, neuropathological, and genetic characteristics of a series of FTLD cases presenting with AGD. For this purpose, a clinico-pathological study of 71 autopsy-confirmed FTLD cases from different tissue banks was performed. AGD was found in 52.1% of FTLD cases. The presence of AGD increased with the increasing age (up to 88.9% in cases older than 80 years; p < 0.001) and was associated with higher ages at onset (p < 0.001) and death (p < 0.001). In AGD cases, progressive supranuclear palsy (PSP) was the most frequent clinical diagnosis (29.7%) and gait disturbance was the most common symptom (64.5%); behavioral and language symptoms were less frequent as compared with non-AGD cases (p = 0.055; p = 0.012). PSP was the most frequent neuropathological diagnosis among cases with AGD (32.4%). This group also showed less brain atrophy (p = 0.094) and higher prevalence of Alzheimer (p = 0.002) and vascular pathology (p = 0.047) as compared to the non-AGD group. We also observed that H1/H1 genotype was overrepresented in AGD cases (p = 0.018) and that there was no association with any specific APOE allele. A subanalysis of PSP cases according to the AGD status was carried out, yielding no significant differences.

Les facteurs de rémission du trouble de l’adaptation : la parole aux patients. Une étude qualitative

BackgroundAdjustment disorder (AD) is a frequent clinical diagnosis defined by the patient's reaction to an external factor and reversibility. While it is known that the prevalence of AD varies depending on setting and diagnostic tools utilized, the literature is rather scarce when it comes to AD's investigation or remission factors. Unlike other psychiatric disorders, the fact that there is a factor triggering AD makes it especially suitable to learn more about triggering elements, reversibility and factors of remission. ObjectivesTo study the evolution of AD, to identify and categorize AD remission factors from the patient's perspective. MethodsWe interviewed by means of semi-structured approach patients (n=11) who consulted the emergency and crisis psychiatric unit of Lausanne University Hospital (CHUV) for an AD and who presented a positive evolution in the following four months. Interviews were transcribed and then analyzed to identify and categorize the remission factors evoked by the patients; categorization was then confirmed by a consensus within the research group. ResultsWe identified three main categories of remission factors (aggregated from 11 subcategories and 101 items) based on the interviews: (i) relational factors (5 subcategories, 46 items), (ii) personal factors (5 subcategories, 36 items) and (iii) factors related to life events (3 subcategories, 19 items). No patient explained his remission by factors of one single category. On the contrary, our study reveals that a variety of remission factors exists, with 4 to 14 different factors having been reported to play a crucial role in remission of AD. ConclusionsRelationships play an important role in remission of AD, but personal and life events also contribute in a complex way. According to the patients, mental health professionals are part of a favorable evolution of AD, especially by means of their containing presence, their neutrality and their invitation to “think with the patient”. Our observations call for a therapeutic intervention with a particular focus on the therapeutic relationship – therapeutic alliance – in which the clinician is aware that remission of AD is multifactorial and dynamic.

Slowly progressive dementia caused by MAPT R406W mutations: longitudinal report on a new kindred and systematic review

BackgroundThe MAPT c.1216C > T (p.Arg406Trp; R406W) mutation is a known cause of frontotemporal dementia with Parkinsonism linked to chromosome 17 tau with Alzheimer’s disease-like clinical features.MethodsWe compiled clinical data from a new Swedish kindred with R406W mutation. Seven family members were followed longitudinally for up to 22 years. Radiological examinations were performed in six family members and neuropathological examinations in three. We systematically reviewed the literature and compiled clinical, radiological, and neuropathological data on 63 previously described R406W heterozygotes and 3 homozygotes.ResultsFor all cases combined, the median age of onset was 56 years and the median disease duration was 13 years. Memory impairment was the most frequent symptom, behavioral disturbance and language impairment were less common, and Parkinsonism was rare. Disease progression was most often slow. The most frequent clinical diagnosis was Alzheimer’s disease. R406W homozygotes had an earlier age at onset and a higher frequency of behavioral symptoms and Parkinsonism than heterozygotes. In the new Swedish kindred, a consistent imaging finding was ventromedial temporal lobe atrophy, which was evident also in early disease stages as a widening of the collateral sulcus with ensuing atrophy of the parahippocampal gyrus. Unlike previously published R406W carriers, all three autopsied patients from the novel family showed neuropathological similarities with progressive supranuclear palsy, with predominant four-repeat (exon 10+) tau isoform (4R) tauopathy and neurofibrillary tangles accentuated in the basal-medial temporal lobe. Amyloid-β pathology was absent.ConclusionsDominance of 4R over three-repeat (exon 10−) tau isoforms contrasts with earlier reports of R406W patients and was not sufficiently explained by the presence of H1/H2 haplotypes in two of the autopsied patients. R406W patients often show a long course of disease with marked memory deficits. Both our neuropathological results and our imaging findings revealed that the ventromedial temporal lobes were extensively affected in the disease. We suggest that this area may represent the point of origin of tau deposition in this disease with relatively isolated tauopathy.

Clinical Profile of Obstetric Patients Getting Admitted to ICU in a Tertiary Care Center Having HDU Facility: A Retrospective Analysis.

The critically ill obstetric patient represents a challenge that usually requires a multidisciplinary approach. Lack of awareness and the absence of regular antenatal care make the critically ill patients to be referred late and sometimes in moribund conditions. The objective of the present study is to determine the incidence, predictors and outcome of obstetric ICU admissions. This retrospective study was conducted over a period of 2 year from July 2015 to June 2017 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. Out of a total of 4986 deliveries, 756 patients underwent HDU admission, while 92 obstetric patients were admitted to ICU during this study period. Maximum number of patients (73.91%) were in the age-group of 20-35years, 64.13% of patients constitute lower socioeconomic status group, 68.47% of patients reside in rural area and there was inadequacy in receiving antenatal care in case of 60.86% of patients. Maximum number of patients were admitted for a period of 4-7days. Blood transfusion (64.1%), the use of inotropic drugs (45.6%), central line placement (44.5%) and mechanical ventilation (26.08%) were the major interventions performed in ICU. Obstetric hemorrhage was found to be the most frequent clinical diagnosis leading to ICU admission (31.5%) followed by hypertensive disorders (25%). In addition to timely referral, health education and training of health professionals may improve clinical outcome and better obstetric practice, especially in countries like India. Obstetric ICU dedicated for the management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill women.

Different clinical picture of cytomegalovirus neuroinfection – diagnostic and treatment results

Objective: Presentation of different clinical cases of human cytomegalovirus (HCMV) neuroinfection in children Methods: In 42 children (25 females, 17 males) at the age of from one month to 14 years with different clinical symptoms and signs, DNA cytomegalovirus was found in cerebrospinal fluid (CSF) by PCR method. Serological tests as well as quantitative PCR method were used to establish number of viral copies in blood and urine. Antiviral treatment with intravenous ganciclovir (GCV) and also oral valganciclovir (VGC) were administered. Results: Symptomatic epilepsy was the most frequent (37 children) clinical diagnosis in HCMV neuroinfecion. Central nervous system malformations (pachygyria/polimicrogyria) were diagnosed in six patients with epilepsy. Three infants with HCMV neuroinfection and epileptic seizures had severe sensorineural hearing loss. Five infants with drug resistant West syndrome were treated antivirally (ganciclovir) before simultaneous regimen with GCV and synthetic ACTH. One male adolescent had optic neuritis, one 12 year old girl had ADEM. Both were successfully (full recovery) treated with intravenous ganciclovir. In all infants, GCV regimen for at least three weeks was effective and control CSF examination was negative for HCMV DNA. The elimination of HCMV DNA from CSF was also achieved in one patient with congenital cytomegalovirus neuroinfection and persistent neutropenia treated with oral 3-week, valganciclovir course. The elimination was achieved later than in other patients. After the antiviral treatment, this girl, who, at the age of 7 months, had the highest number of HCMV viral copies excreted in urine (10 000 000/1ml), at the age of one year, had no neurological signs. Her psychomotor development is normal. In 14 (29.7%) children, antiepileptic drugs were withdrawn without recurrence of epileptic seizures during ten year follow-up period. Conclusion: Cytomegalovirus neuroinfection in immunocompetent children at different ages has various, severe neurological symptoms and signs, but could be treated efficiently.

Disease Characteristics and Rheumatoid Arthritis Development in Patients with Early Undifferentiated Arthritis: A 2-year Followup Study.

To examine the 2-year disease course in patients with undifferentiated arthritis (UA) focusing on fulfillment of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria. Data were provided by the Norwegian Very Early Arthritis Clinic study, which included patients presenting with ≥ 1 swollen joint of ≤ 16 weeks' duration. UA was defined as patients not fulfilling the 2010 ACR/EULAR RA criteria and who did not have a clinical diagnosis other than RA at baseline. The main outcome was fulfillment of the 2010 RA criteria. Secondary outcomes were disease-modifying antirheumatic drug (DMARD) use, resolution of synovitis without use of DMARD during followup, and final clinical diagnosis. We included 477 patients with UA of whom 47 fulfilled the 2010 ACR/EULAR RA criteria during followup (UA-RA) and 430 did not (UA-non-RA). Of the UA-RA patients, 70% fulfilled the criteria within the first 6 months. UA-RA patients were older, more often positive for rheumatoid factor and anticitrullinated protein antibodies, female, and ever smokers, and they more often presented with polyarticular arthritis, small joint involvement, and a swollen shoulder joint. During followup, 53% of UA-RA patients vs 13% of UA-non-RA patients used DMARD (p < 0.001). Overall, 71% of patients with UA achieved absence of clinical synovitis at final followup without use of DMARD. The most frequent final clinical diagnosis was UA (61%). Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD.

Validation of the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for systemic sclerosis in patients from a capillaroscopy clinic.

To validate the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) in patients from a capillaroscopy clinic. All patients attended in a capillaroscopy clinic were included. Sociodemographic and SSc-related variables were collected. Using as gold standard for SSc the clinical judgement, the performance (sensitivity, specificity, predictive values, and likelihood ratios) of the 2013 ACR/EULAR criteria were analyzed. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were calculated for the global score and individual items, and the best cutoffs were obtained. We included 327 patients (84% women, mean age at capillaroscopy 48 years). Main reasons for capillaroscopy referral were Raynaud's phenomenon (39%) and SSc evaluation (27%). The most frequent final clinical diagnosis were SSc (32.4%) and primary Raynaud's phenomenon (25.7%). The 2013 ACR/EULAR SSc classification criteria were met by 116 patients (35.5%). Sensitivity and specificity of the new criteria were 98.1% and 94.6%, respectively, and positive and negative predictive values were 89.7% and 99.1%. The individual variables with the best sensitivity were Raynaud's phenomenon (99.1%) and abnormal nailfold capillaries (81.1%). All the individual variables, except Raynaud's phenomenon, puffy fingers and sclerodactily showed high specificity values, over 90%. The best cutoffs of the total score were ≥8, ≥9, and ≥10, and the AUC = 0.993. We validated the new ACR/EULAR classification criteria for SSc in unselected patients from a capillaroscopy clinic. Global score and individual items included in the new criteria show high diagnostic accuracy and discriminatory capacity.

Human parainfluenza virus types 1-4 in hospitalized children with acute lower respiratory infections in China.

Human parainfluenza viruses (HPIVs) are an important cause of acute lower respiratory tract infections (ALRTIs). HPIV‐4, a newly identified virus, has been associated with severe ALRTIs recently. A total of 771 nasopharyngeal aspirate samples were collected from hospitalized children between March 2010 and February 2011. HPIVs were detected by Nest‐PCR, and other known respiratory viruses were detected by RT‐PCR and PCR. All amplification products were sequenced. HPIVs were detected in 151 (19.58%) patients, of whom 28 (3.63%) were positive for HPIV‐4, 12(1.55%) for HPIV‐1, 4 (0.51%) for HPIV‐2, and 107 (13.87%) for HPIV‐3. Only three were found to be co‐infected with different types of HPIVs. All HPIV‐positive children were under 5 years of age, with the majority being less than 1 year. Only the detection rate of HPIV‐3 had a significant statistical difference (χ2 = 29.648, P = 0.000) between ages. HPIV‐3 and HPIV‐4 were detected during the summer. Sixty (39.74%) were co‐infected with other respiratory viruses, and human rhinovirus (HRV) was the most common co‐infecting virus. The most frequent clinical diagnosis was bronchopneumonia, and all patients had cough; some patients who were infected with HPIV‐3 and HPIV‐4 had polypnea and cyanosis. No significant difference was found in clinical manifestations between those who were infected with HPIV‐4 and HPIV‐3. Two genotypes for HPIV‐4 were prevalent, although HPIV‐4a dominated. HPIV‐4 is an important virus for children hospitalized with ALRTIs in China. HRV was the most common co‐infecting virus. Two genotypes for HPIV‐4 are prevalent, HPIV‐4a dominated. J. Med. Virol. 88:2085–2091, 2016. © 2016 Wiley Periodicals, Inc.

Prevalence of respiratory virus in symptomatic children in private physician office settings in five communities of the state of Veracruz, Mexico.

BackgroundAcute respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Many studies have described the frequency of viruses in hospitalized patients, but studies describing the prevalence of viruses in the community setting are limited, particularly in developing countries, where most of the deaths from serious respiratory diseases occur. The aim of this study was to evaluate the diversity of respiratory viruses in the community setting using molecular diagnostic tools, as well as the clinical characteristics of respiratory viral infections in the general pediatric practice in Mexico.MethodsChildren with respiratory tract infections attending private pediatric practices during a 10-month period in five cities of the state of Veracruz were included. Nasal swabs were taken and processed by a multiplex detection kit for 15 respiratory viruses.Results525 children were included from July 2011 to May 2012; 44% were female, mean age was 45 months. The 3 most frequent clinical diagnosis were: rhinopharyngitis 68%, pharyngitis 18%, and 3.3% influenza-like illness. 71.5% of the samples were positive for virus. The five most frequent pathogens were respiratory syncycitial virus in 18.3% of the children, rhinovirus in 17.5%, influenza A 9.1%, adenovirus 7.2%, and enterovirus 3.4%, although all 15 viruses were detected; there were viral coinfections in 14.1%, and 28.5% of the samples were negative.ConclusionsA large proportion of respiratory infections in the community setting in Mexico was associated to viruses. Although testing for common respiratory pathogens in children with acute respiratory tract infections may lead to a better understanding of the role of viral pathogens in, and eventually to improvement in the management of, individual patients, additional prospective studies are required to study the need of routinely using such tests in general pediatric practices in resource-limited countries.

Pattern of Dermatophytes Isolated in the Medical Microbiology Laboratory of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Dermatophytoses are the most common dermatological conditions but they are however not life threatening or debilitating hence medical care is sought usually due to aesthetic reasons and chronicity of the lesions despite several self-medications. The purpose of this study was to determine the distribution pattern of dermatophytes isolated in the medical microbiology laboratory of University of Port Harcourt teaching hospital (UPTH). This is a 5-year desk review of the Dermatophytes isolated in the medical microbiology laboratory of UPTH. Relevant Patients’ data were retrieved and analyzed. A total of seventy (70) dermatophytes were isolated over the five-year period as follows: Trichophyton species accounted for 55 (79%), Epidermophyton species were 8 (11%) and Microsporum species 7 (10%). The peak age range of patients from which dermatophytes were isolated was 31 - 40 years with a male to female ratio of 1:1.7. The majority of patients being 49 (70%) were referred from the dermatology outpatient clinic (DOPC) and the most frequent clinical diagnosis was Tinea corporis. Trichophyton species were the commonest cause of dermatophytoses in adult patients in Port Harcourt where the most common clinical presentation was Tinea corporis.

Genetic diversity and clinical impact of human rhinoviruses in hospitalized and outpatient children with acute respiratory infection, Argentina

BackgroundHuman rhinoviruses (HRV) are recognized as a cause of upper and lower acute respiratory infections (ARI). The circulating species and their clinical impact were not described in Argentina. ObjectivesTo describe the molecular epidemiology of HRV in children and to determine the association of HRV species with outcome and severity.Study design: Hospitalized and outpatients children <6 years old with ARI without comorbidities (n=620) were enrolled (2008–2010). Demographic, clinical data and outcome were analyzed. HRV were identified by RT-PCR. Phylogenetic analysis and demographic reconstruction for HRV were performed in selected samples. ResultsHRV were detected in 252/620 (40.6%) of children; 8.5% in viral coinfection. Bronchiolitis (55%) and pneumonia (13%) were the most frequent clinical diagnosis. Of 202 inpatients with HRV: 72% required oxygen supplementation, 11% intensive care unit and 3% mechanical ventilation. HRV were identified as a risk factor for hospitalization (OR: 2.47).All three HRV species were detected being HRV-A (55%) and HRV-C (43%) the most frequent; HRV-B was infrequent (2%). Of 44 sequenced HRV, 30 genotypes were detected. Seven of them were the most prevalent and circulated during limited periods of time. The demographic reconstruction revealed a constant population size and a high turnover rate of genotypes. Demographic and clinical outcome were similar for HRV-A and HRV-C infections. ConclusionThis study highlights the clinical impact of HRV in children without comorbidities as a cause of lower ARI and hospitalization. The high frequency of HRV infections may be associated with the simultaneous circulation of genotypes and their high turnover rate.

Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

BackgroundAlthough malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.MethodsChildren with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.ResultsAmong the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.ConclusionsThese data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

Prevalence and risk factors of onychomycosis in primary school children living in rural and urban areas in Central Anatolia of Turkey

Onychomycosis is a world-wide public health concern in children, requiring epidemiological data for different regions for control and prevention. The aim of this study was to evaluate the predominant pathogens and risk factors for onychomycosis in school children living in Kayseri, Turkey. This study included 8122 school children, aged 5-16 years, living in the rural and urban areas around Kayseri. Onychomycosis was clinically classified as distal and lateral subungual (DLSO), proximal subungual, superficial white, endonyx and totally dystrophic onychomycosis. Nail samples from children with clinically diagnosed onychomycosis were collected, examined by direct microscopy and inoculated for culture study. The demographic features and possible risk factors were recorded and assessed by logistic regression models. We clinically diagnosed onychomycosis in 152 out of 8,122 (0.18%) school children. DLSO was the most frequent clinical diagnosis (120/152, 78.9%). Culture-positive onychomycosis was detected in 27/152 (17.7%) children. The prevalence of culture-positive onychomycosis was determined as 0.33%. All culture-positive samples were only from toenails. The onychomycosis causative agents were dermatophytes in 17/27 cases (62.9%), including Trichophyton rubrum 12 (44.4%), Trichophyton mentagrophytes 1 (3.7%), Trichophyton tonsurans 1 (3.7%) and Trichophyton spp. 3 (11.1%) and yeasts in 10/27 cases (37.1%), including Candida glabrata 4 (14.8%), Candida parapsilosis 1 (3.7%), Trichosporon 2 (7.4%) and Rhodotorula 3 (11.1%). Age, father's occupation, number of siblings and rooms were statistically associated with the frequency of onychomycosis. Although to be prevalence of onychomycosis in school children in central Anatolia of Turkey seems very low degree, pediatric onychomycosis is a growing public health concern all over the world. Children having more siblings or unemployed fathers and children living in small house as well as older children should be examined carefully for onychomycosis.

Meralgia Paresthetica After Bariatric Surgery in Iranian Patients

Meralgia paresthetica (MP) is a benign clinical syndrome of entrapment of the lateral cutaneous nerve in the thigh. Among the complications of bariatric sur-gery, neurologic complications are not uncommon and of these complications, MP is a frequent clinical diagnosis. Thus, knowing the clinical risk factors of MP is of great im-portance as they help with the differential diagnoses of MP from other serious disorders.

Análisis de las sentencias judiciales en la práctica de la cardiología resueltas en segunda instancia en España entre 1992 y 2007

Introduction and objectivesThe increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. MethodsWe analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. ResultsThere were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. ConclusionsDespite cardiology being a “low-risk discipline” compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty.Full English text available from:www.revespcardiol.org

Analysis of Judgments in the Practice of Cardiology Resolved on Appeal in Spain Between 1992 and 2007

Introduction and objectivesThe increase in the prosecution of health issues in Spain has increased the interest in legal claims against physicians. Our objective is to analyze the judgments issued in relation to cardiology practice in Spain in recent years. MethodsWe analyzed the 1899 sanitary judicial sentences issued in Spain in the second instance or later during the period 1992 to 2007. The data sheet includes 25 administrative, clinical, and judicial variables. In addition to a descriptive study, comparative analysis was performed on selected variables. ResultsThere were 32 sentences in the field of cardiology, 31% decided for the plaintiff and with an award amount never exceeding 365 000 euros. The most frequent clinical diagnosis is coronary syndrome (50%). There is a significant statistical relationship (P<.004) between physician specialty and reason for the claim: the most frequent causes (misdiagnosis and malpractice) affected predominantly noncardiologists, while defects in information or informed consent (9.5% of cases) affected cardiologists exclusively. Patient death occurred in 75% of cases. ConclusionsDespite cardiology being a “low-risk discipline” compared to others, the litigant activity has increased dramatically in recent years. Causes for the claims are related to the specialty of the involved physician; misdiagnosis and/or malpractice and defects in information should be emphasized, the former for its frequency and the latter for its novelty.

Impulse Control Disordersedited by AboujaoudeElias, M.D., and KoranLorrin M., M.D. New York, Cambridge University Press, 2010, 328 pp., $95.00.

Impulse Control Disordersedited by AboujaoudeElias, M.D., and KoranLorrin M., M.D. New York, Cambridge University Press, 2010, 328 pp., $95.00.

¿Qué es la hiperactividad y cómo ven el problema los padres?: Análisis de los motivos de consulta y las estrategias de afrontamiento del TDAH en una muestra de estratos socioeconómicos altos de Bogotá

IntroductionThe most frequent clinical diagnosis in psychiatric child services in different societies is attention deficit hyperactivity disorder (ADHD). Classically, the core symptoms and the main objective of different therapeutic strategies are the triad hyperactivity, attention deficit, and impulsivity. However, the chief complaints that patients and families state are diverse due to the relevant impact of the symptoms on school and social dynamics. ObjectiveTo learn how the chief complaints are expressed in the context of Bogotá (Colombia). Methods366 surveys of parents of children with ADHD were analyzed. They participated in the monthly meeting of the “HIDEA Parent's School”, which specializes in ADHD. Surveys summarized the complaints and confrontation strategies used to improve these inconveniences. ResultsThe most frequent complaints were disobedience, defying authority, and low school performance. To help the children the parents turned mainly to occupational therapy as suggested by the school. ConclusionsWe observed that parents perceived the problem as linked to social annoyance consequences instead of clinical symptoms of ADHD. Paradoxically a relative weakness of confrontation approaches was also evident, involving deep changes in child rearing patterns and social interactions.