Main Reason For Referral Research Articles

Is there autochthonous strongyloidiasis in Spanish children?

Strongyloidiasis, a neglected helminthiasis, is more prevalent in tropical/subtropical areas. However, sporadic autochthonous cases have been described around the Mediterranean coast. We performed a retrospective descriptive study in a referral Spanish Center for Pediatric Tropical diseases. All patients below 18years of age diagnosed with probable strongyloidiasis between January 2014 and December 2019, born in Spain and with no history of travel abroad, were included. Epidemiological, clinical, and follow-up data were recorded, as well as all microbiology results. Five children met the inclusion criteria and were included in the study. Three males and two females, with a median age of 6.7years (IQR: 5.8-9.1). All patients had previous medical conditions and used to spend holidays on the Mediterranean coast of Spain. All but one were mildly symptomatic at diagnosis but only four presented peripheral eosinophilia, which was the main reason for referral. First-line treatment was ivermectin in all but one, who was treated with albendazole. Reinfection was suspected in two during follow-up. At 12months of follow-up 3/5 (60%) children presented negative serology.Conclusion: Although more prevalent in tropical areas, strongyloidiasis should be included among differential diagnosis in children presenting with eosinophilia. Screening for strongyloidiasis should be considered in all children candidate to immunosuppressive therapy. What is Known: • Strongyloidiasis is more prevalent in tropical/subtropical areas. • Strongyloidiasis can be life-threatening in immunosuppressed patients What is New: • Spanish children can be affected by autochthonous strongyloidiasis. •Screening for strongiloidiasis should be performed in all candidates to immunosuppresive therapies, including children.

Risk of True Allergy to Local Anesthetics: 10-Year Experience from an Anesthesia Allergy Clinic in China.

BackgroundLocal anesthetics (LAs) have been widely used throughout the healthcare settings, especially in local anesthesia and pain management. The incidence of allergic reactions to LAs remains uncertain. The danger of allergic reactions to the use of LAs in every day of clinical practice is a matter of great concern. Therefore, it is necessary to investigate the risk of true allergy to LAs.MethodsThis study retrospectively evaluated the medical records of patients who were referred to an anesthesia allergy clinic in China and underwent allergy tests with LAs over a 10-year period from 2009 to 2019. The following information was collected from medical records: demographics of the patients, reasons for referral, clinical features of drug hypersensitivity reaction (DHR), and test results with LAs. Skin tests combined with an in vitro method, basophil activation test (BAT), were used to investigate allergic reactions to LAs.ResultsA group of 109 patients were included in the analysis. The main reason for referral was the presence of a suspected DHR after procedures with LAs (n=68, 62%), the second most common reason for referral was a history of DHR to other drugs and the need to use LAs for upcoming procedures (n=41, 38%). Of the 68 patients with a suspected DHR to LAs, only six cases presented true allergy and showed positive results in skin tests and/or BAT. And all 41 patients who had a history of DHR to other drugs presented negative in all tests.ConclusionRisk of true allergy to LAs may be very low. However, patients with a suspected history of DHR to LAs should be considered for allergy tests. Skin tests and BAT may be useful in the investigation and diagnosis of true allergy to LAs in clinical practice.

Diagnosis in children with exercise-induced respiratory symptoms: A multi-center study.

Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. An observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46%-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonized procedures for children seen for EIS.

Characteristics of referral neonates in Sanglah Hospital: reviewed from the S.T.A.B.L.E program

The purpose of this study was to investigate the number of referral neonates that came with an unstable condition (according to a S.T.A.B.L.E program) and characteristic of unstable conditions of the referred neonates. An observational prospective study was conducted for two years from 1st January 2018 to 31st December 2019 in the Emergency Department of Sanglah Hospital, Bali, Indonesia. Referred neonates were assessed in terms of gender, gestational age, referral characteristic, and condition on arrival at the hospital according to S.T.A.B.L.E criteria. According to S.T.A.B.L.E criteria, 283 neonates (54.8%) came on unstable condition. Prematurity (42.6%) was the main reason for referral, 37.9% of them were very low birth weight. Most of them were referred from Denpasar (33.9%), the equipment of transportation was incubator transport (41.8%). T-piece resuscitator was used in 30.4% of referred neonates. Characteristics of unstable conditions were mostly hypoglycemia (33%) and 36% of unstable neonates had more than one condition of instability. This study revealed 283 neonates were unstable and the main reason of transfer neonates is prematurity. Most of them come with unstable conditions that could lead to higher mortality. This study could be a reference for improvement in the neonatal transportation system in Bali.

A medicalized hotel as a public health resource for the containment of Covid-19: more than a place for quarantining.

ABSTRACTBackgroundTo describe the implementation of a medicalized hotel in the community of Madrid as a public health resource for the containment of coronavirus disease (COVID-19) and to describe the characteristics of population benefitted.MethodsA descriptive study of the implementation of the Via Castellana Medicalised Hotel (VCMH) was conducted. The average monthly household income, educational level and occupational social class of the subjects admitted were obtained through a survey conducted during their stay.ResultsThere was no guidance for launching; however the hotel was coordinated by a tertiary referral hospital and attended the preventive medicine regulations and the decrees of legal regimes and authorization of health services in Madrid. Between 19 March and the 9 May 2020, 399 patients were admitted; 59% (235) were migrant; the main reason for referral (58%) was a lack of house conditions for quarantining, including overcrowding, which when compared with the migrant status a positive correlation was found. Some other reasons for referral were homelessness and eviction. Most of the survey participants had low monthly household income, educational level and social class.ConclusionsThis medicalized hotel provided medical care and offered housing to a subgroup of vulnerable population who could not afford a safe quarantine.

Capsule endoscopy for the study of small bowel disorders: Experience at a private institution in Mexico.

Capsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders. A retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined. A total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously. The frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.

The Nuts and Bolts of Utilizing Telemedicine in Nursing Homes – The GeriCare@North Experience

ObjectivesWe examined the demographics and the clinical profile of teleconsultations conducted between an acute geriatric medicine department and 8 nursing homes over a period of 6.5 years. DesignThis is a prospective, descriptive study. Setting and ParticipantsThis study was conducted in 8 nursing homes of Singapore. All nursing home patients referred to the program for teleconsultation between December 2010 and May 2017 were enrolled in the study. MeasuresThe unit observed and studied was the individual telemedicine consultation. Each unique patient contributed 1 or more observation points. The data collected included consultation dates, patient demographics, background medical comorbidities, reasons for referral, physical examination findings, primary diagnoses, and general management plans recommended by the doctors. ResultsThere were 1673 teleconsultations conducted with 850 unique patients. Most of these patients were categorized as having moderate to severe disability. Ninety-five percent of the consultations were scheduled. The main reasons for referral were for medication review (47.6%) and behavioral problems (22.1%). The 4 commonest comorbidities were hypertension (57.0%), dementia (40.0%), diabetes (39.0%), and hyperlipidemia (38%). The most common primary diagnosis was dementia (21.6%), of which 227 of those diagnosed (62.8%) were referred for behavioral and psychological symptoms of dementia. Conclusions and ImplicationsA telemedicine service for older patients is feasible and could be of a high quality, especially if made available in places where a high density of the latter reside, such as in the care homes and other nursing and rehabilitation facilities.

P0322OUR EXPERIENCE IN ELECTRONIC CONSULTATION FOR REDUCING WAITING LIST AND OPTIMIZING NEPHROLOGY HEALTHCARE

Abstract Background and Aims Chronic kidney disease (CKD) is recognized as a health problem in the general population; as a result, there is a growing demand for specialist services. This is especially relevant in the Spanish health system which covers the entire population free of charge. We describe our experience with new e-consultation software that allows specialists to provide clinical recommendations to primary care providers about non-subsidiary patients referred to our Nephrology Department. This system respects current protocols and is based on patient chart review without face-to-face visits, thus avoiding unnecessary time wastage in the healthcare system. Method Our Nephrology department covers the metropolitan area of Valencia with 341,972 citizens attended by 16 primary care centers. The Community IT software system allows all doctors (hospitals and primary care) to access the patient's medical records including laboratory, radiology, anthropometric data and treatments. A mailbox, developed as part of the Hospital General’s IT system, receives all proposed referrals from primary care doctors to our department. A nephrologist then decides if the e-consultation requires an in-person visit or can be answered as a non face-to-face visit. Thus, patient’s appointments are scheduled in less than one week (mean 3.8±4.5 days) and the outpatient visit in less than 14 days. The main referral criteria were: albumin/creatinine ratio> 300 mg/g, eGFR<30 ml/min/1.73 (<45 in <70 years), renal progression, resistant hypertension in CKD patients, electrolyte abnormalities and renal anemia. Patients with conditions that do not meet referral criteria are attended and given the appropriate recommendations via e-consultation. The patient is not required to present at the hospital. We describe the results of e-consultations from 1St September 2017 to 31st December 2019. Results A total of 2641 consultations were submitted between September, 2017 to December, 2019 (807 in 2017, 861 in 2018 and 903 in 2019). Of these, 285 (12%) were answered as non face-to-face visit (6% of the 2017 e-consultations, 11% from 2018 and 24% from 2019). The characteristics of the 285 non face-to-face e-consultations: mean age: 68.9 ±19.5 years, female: 61.4%, diabetics: 31.2%. The main reasons for referral were: mild/low eGFR (35%), mild albuminuria (10%), administrative questions related to treatments (10%), mild hypertension (4%), mild electrolyte disturbances (2%), subacute renal dysfunction resolved (10%) (mostly NSAIDs), non-nephrology causes (mainly urological) (8%), non-renal pathology (simple renal cysts, other) (10%) and other causes (11%). The re-consult rate was 2% within the first year. Regarding patients referred with low eGFR, the mean age was 76 ± 14 years (range: 19-98), female sex: 73.9%, eGFR: 39±11 ml/min/1.73m2, serum creatinine 1.4 ± 0.4 mg/dL. Urine alb/creat ratio: 49±127 mg/g. Thirty five percent of them were between 70-79 years and 48% were> 80 years old. For those patients referred with mild albuminuria: mean age was: 57±21 years, male sex: 61%, diabetics: 31%, eGFR: 77±18 ml/min/1.73m2, serum creatinine 0.87±0.27 mg/dL. Urine alb/creat ratio: 83 ± 54 mg/g (range 33-128). There was a 17 day waiting list to attend an outpatient nephrology clinic in 2016 (previous to the initiation of the e-consultation period). On the contrary, during the study period it was 14 days in 2017 and 4 days each in both 2018 and 2019. Conclusion Our experience shows that non-face-to-face e-consultation for patients with mild renal pathology promotes the effective management of patients who do not meet remission criteria according to established protocols. It also prevents the remission of a significant percentage of patients, reduces the waiting list and optimizes the healthcare system’s resources.

Capsule endoscopy for the study of small bowel disorders: Experience at a private institution in Mexico

Introduction and aimsCapsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders. Materials and methodsA retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined. ResultsA total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously. ConclusionsThe frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.

Risk Factors for Neonatal Mortality at St Camille Hospital in Ouagadougou, Burkina Faso

Background: Neonatal mortality remains a public health concern in developing countries such as Burkina Faso. Improving the survival rate of newborns requires a good knowledge of the current situation. This study aimed at determining the risk factors for neonatal mortality in the Neonatology Department of Saint Camille Hospital of Ouagadougou (HOSCO - Hopital Saint Camille de Ouagadougou). Materials and Methods: This was a retrospective, descriptive and analytical study that included all newborns hospitalized in the neonatology department, at St Camille Hospital, in Burkina Faso from January 1 to December 31, 2017. Total of 710 records of hospitalized newborns in 2017 were analyzed. Among them our study focused on cases of death. Results: The neonatology department registered 246 deaths out of 710 hospitalizations, representing a mortality rate of 34.6%, of whom 194 (78.8%) were preterm infants and 52 (11.2%) were term newborns. Among the deceased newborns, 88% had a low birth weight and the sex ratio was 0.8. November was the most fatal period (12.6%). Prematurity and respiratory distress were the main reasons for referral. Prematurity (76.4%), asphyxia (51.2%) and neonatal infection (27.2%) were the top 3 diagnoses at admission. The leading cause of death was respiratory distress (89.8%). All the newborns have been hospitalized within 24 hours of life and the average time to death in the unit was 3 days and 54% of deaths occurred within 72 hours of hospitalization. Conclusion: Mortality rate is higher among preterm infants while it is relatively low among full-term newborns in our facility. Prematurity, asphyxia and neonatal infection remain the main risk factors associated with neonatal mortality.

Benign breast tumors: epidemiological profile and therapeutic conduct at the escola paulista de medicina

Introduction: Breasts represent an important site for the development of diseases. It is known that 80% of the palpable masses of the breast are of benign origin. Benign breast diseases range from inflammatory to neoplastic processes. Objectives: to evaluate the clinical and epidemiological characteristics of patients diagnosed with benign breast tumor at the Mastology outpatient clinic of the Universidade Federal de São Paulo (UNIFESP). Methods: 1,532 medical records, available on the electronic platform PEP-HUHSP through the ICD D24 (benign breast cancer) and N63 (unspecified breast nodule), of patients referred to the service between July 2008 and July 2017 were reviewed. After applying exclusion criteria, 403 medical records were submitted to data collection and tabulation in Excel, followed by statistical analysis using the IBM SPSS Statistics 23 software. The study in question was approved by the Research Ethics Committee of UNIFESP (CEP UNIFESP), in the Teaching and Research Coordination of Hospital São Paulo – Hospital Universitário/UNIFESP (CoEP of HSP-HU/UNIFESP) and exempted from the application of the Informed Consent by the same organs. Results: In the 9-year period, the following results were obtained: mean age was 39.3 years. Comorbidities: smoking (16.4%), SAH (16.8%) and dyslipidemia (6.3%). Family history of breast and/or ovarian cancer accounted for 16.6%. Mean age of menarche and menopause, respectively, were 12.7 and 42.5 years. Causes of referral: "alteration in image examination" (38.3%), "lump in the breast" (33.3%), "follow-up due to previous nodules" (16.5%). Anatomopathological report: fibroadenoma (41%), breast cysts (16%), phylloid tumors (3%), and papilloma (1%). Mean number of consultations per patient until discharge or abandonment of follow-up: three. Choice behavior: expectant (85.2%). Conclusion: The epidemiological profile of patients referred to the UNIFESP tertiary mastology service was mainly composed of women of childbearing age and nulliparous women, whose main comorbidities were smoking and SAH, in the great majority with no family history of breast cancer. Regarding the consultation, the main reason for referral is the findings on imaging exams, and, specially, patients would bring their breast USG along, which surpassed mammography by 34.1%. The choice for biopsy was restricted, present in approximately 1/3 of the cases, but pointed out that the most prevalent nodule is fibroadenoma, followed by phylloid and papilloma tumors. Nevertheless, there was a predilection for expectant conduct. On average, there were regular follow-ups for 1.5 years, followed by a significant dropout rate.

Intérêt et confiance des médecins généralistes dans les tests d’allergies médicamenteuses

ObjectiveEvaluation of the interest and confidence of general practitioners in allergy testing for drug hypersensitivity, their intentions regarding the reintroduction of a drug testing negatively, and their practice in the event of suspected drug allergy. MethodsA descriptive and observational study conducted among 342 GPs in the Sarthe region of France based on responses to a questionnaire posted out in April 2019. ResultsOne hundred and seventy-three practitioners (50.6%) completed the questionnaire, 83% of whom indicated that they referred fewer than half of their patients with suspected drug hypersensitivity to an allergist. The main reasons for referral were the extent and frequency of drug use and the seriousness of the reaction. Fourteen percent of respondents did not refer their patients systematically to an allergist due to the existence of alternate drugs and to the long waiting times for an appointment. Sixty to 70% of GPs considered themselves relatively poorly informed about drug allergy testing (skin testing and challenge tests). However, 81% declared that they trust drug allergy testing, with 60 to 70% indicating their intention of reintroducing a treatment where tests have ruled out any associated drug hypersensitivity, regardless of the types of tests performed. The reasons given for prescribing a treatment once more were patient's wishes (37%), availability of alternate treatments (36%), and fear of relapse (12%). Access to an allergist and training were considered unsatisfactory. Most experienced practitioners (in term of number of years of practice) refer fewer patients to allergists. ConclusionDespite a lack of knowledge, GPs trust drug allergy testing. The number of patients referred to allergists is low, especially among more experienced GPs, with the shortage of drug-specialized allergists and their uneven geographical distribution perhaps being the two main contributing factors. Training could be improved through the use of new media sources.

78 Comparing the Management of Frailty between a Rapid Access Frailty Team and General Medical Teams at a Level Three Hospital

Abstract Background Frailty represents a particularly high risk group of geriatric patients whom require specialized care. Dedicated multidisciplinary frailty teams led by Geriatricians have been shown to provide better outcomes. The aim of this study was to compare the inpatient interventions and length of stay (LOS) between patients under the care of a dedicated Rapid Access Frailty Team (RAFT) versus general medical teams. Methods Data was collected on a total of 163 patients who were screened as frail positive using a screening tool, over a period of 10 months in 2018. Basic Statistical Analysis was used to analyse data. Results Of the 163 patients, 113 were managed by the RAFT and 50 by a medical team. 61.9% were assessed as frail immediately in the Emergency Department, while the remainder where referred to the RAFT from other medical teams. The main reasons for referral were: cognitive impairment (51.3%), poor mobility and safety awareness (70.8%), polypharmacy (82.3%), poor functioning in ADLs (76.1%) and medical reasons (77.9%). Interventions made by the frailty team included: medication rationalization (82.3%), MDT assessment (91.2%) and discharge planning (87%). 49.5% of patients seen by the RAFT had a MOCA score < 22. Of patients managed by the RAFT 100% received Physiotherapy and 96.5% were seen by Occupational Therapy, while in the medical group this was 50% and 42% respectively. The mean length of stay was 9 days in the RAFT group, and 12.4 days in general medical group. Conclusion Patients managed by the RAFT had an average LOS of 3.4 fewer days. We hypothesize that this is linked to earlier identification by the RAFT, earlier referral and more intensive intervention by allied health services, and specialized Geriatric Medical input. We aim to increase the availability of our frailty service within our hospital to optimize the management of our frail patients.

Complete denture series part 1: referrals for complete dentures – identifying the reasons

General dental practitioners (GDPs) continue to refer edentulous patients to secondary care for advice and treatment. The clinical records of edentulous patients referred to Birmingham Dental Hospital were reviewed to determine the common problems encountered by GDPs when constructing complete dentures. The main reasons for referral were resorption of the lower ridge (39%) followed by a series of ill-defined reasons (28%), looseness of either or both dentures (25%), pain (11%), immediate dentures (8%), exaggerated gag reflex (7%) and implants (7%). The reasons for referral do not always correspond to the clinical findings on the New Patient Assessment Clinics. CPD/Clinical Relevance: The findings of the article could be used as a guide for GDPs in identifying problems with problematic dentures.

SUN-LB074 Racial Distribution, Presentation and Outcome in Acromegaly and Cushing's Disease: A Tertiary Referral Center Study in 220 Patients

Background: Transsphenoidal surgery (TSS) is the primary therapy for acromegaly (ACM) and Cushing’s disease (CD) with superior outcomes at high-volume centers. According to the U.S. Central Brain Tumor Registry, African Americans (AA) have higher incidence of pituitary adenomas than non-Hispanic white (W) patients, but race-specific data in ACM and CD are not available. Our aims are to evaluate racial distribution, presentation, and long-term outcomes of adult patients who underwent TSS for these conditions at our pituitary center by a single dedicated neurosurgeon. Methods: We reviewed all cases of TSS operated between 1994-2016 and compared presentation and postoperative events (biochemical remission, recurrence, reoperation, radiation, and death) across racial demographic groups. For patients living in Metropolitan Atlanta, we used U.S. Census data to compare patient racial distribution to the demographics. Results The ACM group consisted of 112 patients (54 men and 58 women), of whom 87 were W and 13 AA. Age and gender were similar in AA and W. Main reasons for referral were physical changes (23% AA vs 44% W), headaches (38% AA vs 17% W), and pituitary incidentaloma (31% AA vs 14% W). AA had higher rates of diabetes (54% vs 16%, p 0.005) and hypertension (69% vs 42% p 0.08), lower mean IGF-1 levels (662±324 ng/ml vs 823±321 ng/ml, p 0.06), and lower median GH levels (8.6. vs 45 ng/ml p 0.002). Mean tumor diameter and cavernous sinus invasion were similar. Biochemical remission at 3 months (46% AA and 55% W) and event-free survival during follow-up (median 3.8 years) were similar in AA and W. Normal IGF-1 at last follow-up was achieved by 92% AA and 80%W after multimodality therapy. The CD group consisted of 108 patients (15 men and 93 women) of whom 70 were W and 24 AA. Age, gender, and prevalence of diabetes and hypertension were similar in AA and W. Mean urinary cortisol and ACTH levels were similar. Mean tumor diameter was similar but AA had more macroadenomas (33% AA vs 14% W). During follow-up (median 4.3 years), event-free survival was similar although AA had fewer recurrences (4.35% vs 22.0% W, p 0.06). Of the total 220 operated patients, 88% lived in Georgia and 59% in Metropolitan Atlanta. In the latter group, W represented 75% of ACM and 62% of CD patients; AA 16% ACM and 28% CD; Hispanics (H) 0% ACM and 6.5% CD; Asian 8.2% ACM and 3% CD. Census racial distribution during study period was 58-67% W, 33-34% AA, 7-10% H, and 3-5% Asians. Conclusions To our knowledge, this is the first report of race-specific patient characteristics in CD and ACM. Proportion of AA and H with ACM operated at our tertiary referral center was lower than expected, while such disparity was not seen in CD. In addition AA with ACM exhibited different clinical presentations and milder biochemical activity. Notably, the long-term outcomes of patients with ACM and CD treated at our center were similar in AA and W. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Associated clinical abnormalities among patients with Turner syndrome.

OBJECTIVE:The early diagnosis of Turner syndrome (TS) is often difficult because of the various clinical features. This study aimed to investigate clinical features and identify associated abnormalities in a group of patients with TS.METHODS:Retrospective data of presenting clinical features collected from the medical records of the 37 patients with TS. All patients were examined for associated clinical abnormalities.RESULTS:Mean age at diagnosis was 9.3±4.1 years. The main reason for referral was short stature and/or delayed puberty. All of the patients had at least one dysmorphic sign. Skeletal system abnormalities (57%) were the most common associated abnormality, which was followed by gastrointestinal system problems (40%). Cardiac defects occurred in 32%. Urinary system abnormalities occurred in 27%. Dermatological problems were detected in 32% of the patients. The pathology of the hearing was found in 19%. Autoimmune thyroid disease was detected in 24% of the patients, and celiac disease was detected in 5.4% of the patients.CONCLUSION:Phenotypic variability often leads to a delay in the diagnosis of TS. Early diagnosis can initiate effective management in patients with TS.

Spectrum of antenatally diagnosed cardiac anomalies in a tertiary referral center of North India

Background: Congenital heart disease (CHD) is the most frequent fetal anomaly seen during pregnancy. Prenatal diagnosis of CHD helps in ascertaining the prognosis of fetus and planning management. Early diagnosis and prompt intervention after delivery helps to prevent serious morbidity and mortality. Objective: To evaluate the type and pattern of fetal congenital cardiac anomalies to plan appropriate intervention. Methods: This was a retrospective study of all fetal cardiac anomalies detected on antenatal ultrasound in pregnant women at a tertiary care hospital for high-risk pregnancy in northern India. A detailed clinical evaluation and ultrasound of the fetus to look for all malformations including detailed cardiac evaluation was done in all pregnant patients. All women were thoroughly counseled regarding the malformations, possible causes, prognosis, and need for fetal karyotyping. Results: A total of 782 fetal malformations were observed during the study period, of which 211/782 (26.9%) fetuses were found to have cardiac malformation. 165/211 (78.2%) were isolated CHD and 46/211 (21.8%) had associated anomalies. The most common defect was ventricular septal defect (37/211, 17.5%) followed by fetal arrhythmias (29/211, 13.7%), hypoplastic left heart syndrome (27/211, 12.8%), tetralogy of Fallot (21/211, 9.9%), atrioventricular septal defect (18/211, 8.5%), and double outlet right ventricle (14/211, 6.6%). 96/211 (45.5%) couples opted for prenatal invasive testing, of which 14/96 (14.5%) fetuses were found to have abnormal genetic studies, most common being down syndrome. Conclusion: The problem of CHD is of profound importance, and suspected cardiac anomaly is the main reason for referral. After identification of CHD, couple should be offered genetic studies and detailed counseling, and timely cardiac intervention should be planned when indicated.

Clinical and cytogenetic features of 516 patients with suspected Turner syndrome - a single-center experience.

Clinical suspicion of Turner syndrome (TS) may be challenging. Short stature and absent puberty are not mandatory and the dysmorphic picture is widely variable. The aim of the study was to describe a representative sample of patients with suspected TS in a single center and to verify which set of features may help discriminate those with TS. This was a retrospective study of patients with suspected TS evaluated between 1989 and 2012 with the same clinical and cytogenetic protocols. Data regarding reason for referral, age and height at diagnosis, birth data, pubertal features and dysmorphisms were analyzed. TS was diagnosed in 36% of 516 patients; structural chromosome anomalies predominated (42%). Short stature was the main reason for referral of patients with and without TS. The mean age of patients at first visit, with TS or without TS was similar (11.89 and 11.35 years, respectively), however, infants and adolescents predominated in the TS group. The mean full-term birth weight was lower in patients with TS as well as height at diagnosis, but normal height z-score was found in 17% of patients. Spontaneous puberty occurred in 30% of TS patients aged 13 years or more, but most had pubertal delay. Residual lymphedema, webbed neck, cubitus valgus, hyperconvex nails, shield chest, abnormal nipples, pigmented nevi, short fourth metacarpal and shorter height were the best discriminators for girls with TS. Though short stature, pubertal delay and typical stigmata should prompt investigation of TS, lack of one of these features should not exclude this hypothesis. Dysmorphisms other than those considered "typical" should be sought on physical examination.

Avaliação da qualidade da referenciação dos CSP para a consulta de memória do hospital de Braga: um estudo descritivo

Objectives: To characterise the referrals from primary care to the memory, including the reasons for referral, the diagnostic study performed in primary care, and the time elapsed until the hospital consultation. Type of study: Observational, cross-sectional, descriptive study. Setting: Hospital de Braga. Participants: Patients referred by primary care to the memory consultation of Hospital de Braga, with first consultation taking place between May 2011 and December 2015. Methods: The study was carried out between February and June 2016. Informatic referrals of selected patients were retrieved. The variables analysed included gender, age, occupation, educational level, marital status, previous risk factors, reasons for referral, presence of cognitive impairment, previous diagnostic study, and time elapsed until referral and hospital consultation. Results: We identified 290 referrals, mostly concerning female patients (69%), mean age of 75 years (69%), pensioners (81%) and with less than 4 years of schooling (51%). Fifty eight percent of the cases were referred by loss of memory. Sixty eight percent of the referrals had a personal history of risk, 10% has a family history of dementia, 17% had a brief assessment of mental status, 51% had a previous computed tomography scan, and 32% had previous analytic investigation. In 55% of the cases, the referral took more than 24 months and the waiting time until hospital consultation took between 7-12 months. The main reason for referral is in agreement with other studies. The referrals were incomplete regarding previous risk factors, cognitive screening and previous diagnostic investigation. Both referrals and hospital responses still take place late. Conclusions: This study revealed information gaps in referrals that should be improved in order to optimise the transition between different levels of care. These results suggest that there may be limitations in approaching these patients in primary care.

Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India.

Background:The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC) strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care.Objective:This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH).Methods:An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed.Results:The referral rate was found to be 31.7%. Preterm labor (30.6%), pregnancy-induced hypertension (17%), and fetal distress (10.6%) were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank.Conclusions:The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.