Routine Medical History Research Articles

To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis in relation to operative and histopathological findings

Background: Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas. Aims: 1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis. Methods: A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS & RF under various surgical units from November 2018 to October 2020 were selected. Results: In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study. Conclusion: This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room.

Impulse Control Disorders in the Polish Population of Patients with Parkinson's Disease.

Background and Objectives: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the world. It is characterized by the presence of not only typical motor symptoms but also several less known and aware non-motor symptoms (NMS). The group of disorders included in the NMS is Impulse Control Disorders (ICDs). ICDs are a group of disorders in which patients are unable to resist temptations and feel a strong, pressing desire for specific activities such as gambling, hypersexuality, binge eating, and compulsive buying. The occurrence of ICDs is believed to be associated primarily with dopaminergic treatment, with the use of dopamine agonists (DA), and to a lesser extent with high doses of L-dopa. The aim of our study was to develop a profile of Polish ICDs patients and assess the frequency of occurrence of ICDs, as well as determine the risk factors associated with these disorders against the background of the PD population from other countries. Materials and Methods: Our prospective study included 135 patients with idiopathic PD who were hospitalized between 2020 and 2022 at the Neurological Department of University Central Hospital in Katowice. In the assessment of ICDs, we used the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Other scales with which we assessed patients with PD were as follows: MDS-UPDRS part III and modified Hoehn-Yahr staging. Clinical data on age, gender, disease duration and onset, motor complications, and medications were collected from electronic records. Results: ICDs were detected in 27.41% of PD patients (binge eating in 12.59%, hypersexuality in 11.11%, compulsive buying in 10.37%, and pathological gambling occurred in only 5.19% of patients. In total, 8.89% had two or more ICDs). The major finding was that ICDs were more common in patients taking DA than in those who did not use medication from this group (83.78% vs. 54.07%, respectively; p = 0.0015). Patients with ICDs had longer disease duration, the presence of motor complications, and sleep disorders. An important finding was also a very low detection of ICDs in a routine medical examination; only 13.51% of all patients with ICDs had a positive medical history of this disorder. Conclusions: ICDs are relatively common in the population of Polish PD patients. The risk factors for developing ICDs include longer duration of the disease, presence of motor complications, sleep disorders, and use of DA and L-dopa. Due to the low detectability of ICDs in routine medical history, it is essential for physicians to pay more attention to the possibility of the occurrence of these symptoms, especially in patients with several risk factors. Further prospective studies on a larger group of PD patients are needed to establish a full profile of Polish PD patients with ICDs.

Quantification of ectopic fat storage in the liver and pancreas using six-point Dixon MRI and its association with insulin sensitivity and β-cell function in patients with central obesity.

To assess the association of ectopic fat deposition in the liver and pancreas quantified by Dixon magnetic resonance imaging (MRI) with insulin sensitivity and β-cell function in patients with central obesity. A cross-sectional study of 143 patients with central obesity with normal glucose tolerance (NGT), prediabetes (PreD), and untreated type 2 diabetes mellitus (T2DM) was conducted between December 2019 and March 2022. All participants underwent routine medical history taking, anthropometric measurements, and laboratory tests, including a standard glucose tolerance test to quantify insulin sensitivity and β-cell function. The fat content in the liver and pancreas was measured with MRI using the six-point Dixon technique. Patients with T2DM and PreD had a higher liver fat fraction (LFF) than those with NGT, while those with T2DM had a higher pancreatic fat fraction (PFF) than those with PreD and NGT. LFF was positively correlated with homeostatic model assessment of insulin resistance (HOMA-IR), while PFF was negatively correlated with homeostatic model assessment of insulin secretion (HOMA-β). Furthermore, using a structured equation model, we found LFF and PFF to be positively associated with glycosylated hemoglobin via HOMA-IR and HOMA-β, respectively. In patients with central obesity, the effects of LFF and PFF on glucose metabolism. were associated with HOMA-IR and HOMA-β, respectively. Ectopic fat storage in the liver and pancreas quantified by MR Dixon imaging potentially plays a notable role in the onset ofT2DM. We highlight the potential role of ectopic fat deposition in the liver and pancreas in the development of type 2 diabetes in patients with central obesity, providing valuable insights into the pathogenesis of the disease and potential targets for intervention. • Ectopic fat deposition in the liver and pancreas is associated with T2DM. • T2DM and prediabetes patients had higher liver and pancreatic fat fractions than normal individuals. • The results provide valuable insights into pathogenesis of T2DM and potential targets for intervention.

Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart?

This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. The average patient age was 57.8years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p=0.003 and -0.237 for the left eye, p=0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. NCT04233619.

Diagnostic efficacy of deep learning-based prediction of origin for patients with cancers of unknown primary.

e13560 Background: Despite of routine medical history inquiry, laboratory analysis, histopathological analyses, endoscopy and imaging methods, 3-5% of metastatic cancers are diagnosed with unknown primary (CUP). It poses a considerable challenge as modern therapeutic options for patients with CUP are mainly limited to empirical chemotherapy (paclitaxel, carboplatin, etc.), leading to an overall poor prognosis. In current clinical trials (CUPISCO trial, PACET-CUP trial) targeting CUP for precision therapy, genomic data suggest that only 31% of CUP patients could be matched for at least one targeted or immune agent. The determination of primary tumor origin and genetic mutations could probably provide more therapeutic choices and help to significantly improve the outcome in CUP patients. Methods: To identify the primary lesion of CUP, we built a weighted ensemble model by Automated machine learning, including 13 models ( XGBoost, RandomForestGini, ExtraTreesGini, etc.), using genetic and clinical datasets containing 22,018 patients of 28 tumor types, enrolled between 2016-2021. Our genetic and clinical datasets contained 10 features including age, tumor site, gene alteration, TMB, etc. Among them, 813 sites related to tumor were covered by gene alteration. The 5-fold Cross-Validation method was used to estimate the accuracy of our diagnosis models. Results: The models were evaluated using top-k differential diagnosis accuracy, which measured how frequently the top-k predictions capture any of the primary diagnoses in the reference standard. Our diagnostic model was then performed on 8 CUP patients. All of them were successfully confirmed their diagnosis of primary origin tumor. Among these patients, 2/8 CUP patients have begun relevant systemic therapy based on the confirmed diagnosis: 1 patient with diagnosis of esophageal squamous cell carcinoma receiving the immune combination TP Regimen (Albumin paclitaxel plus cisplatin) and achieved a 9-month PFS; another patient diagnosed as colorectal cancer achieved a 2-month PFS after treatment with Oxaliplatin-based chemotherapy regimen. Preliminary results of our study demonstrated the efficiency of this Artificial Intelligence model for the diagnosis in CUP patients. Conclusions: We developed a diagnostic model on CUP using deep learning based on genomic and clinical data and preliminarily applied in clinic. Genetic characterization of CUP patients contributes to the selection of targeted therapies under unclear diagnosis, whereas our diagnosis model could equally adjust more proper precision treatment for CUP patients. In CUP patients, the combined strategy of deep learning-predicted diagnosis and genetic mutations-based therapy could help to maximize the clinical benefit in a clinical setting and optimize the clinical development of innovative therapies.

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study.

BackgroundThis study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago.MethodsPatients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables.ResultsOne hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051).ConclusionsSignificantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease.Trial registration numberNCT04774861.

Correlation between thyroid autoantibodies and cardiovascular disease in patients with stages 3-5 chronic kidney disease.

BackgroundChronic kidney disease (CKD) is associated with thyroid disease and cardiovascular disease (CVD). To date, little is known about the association of thyroid autoantibodies with renal function or cardiac function in patients with CKD.MethodsThis is a descriptive cross-sectional study. Patients diagnosed with stages 3–5 CKD from January 2015 to May 2019 at our department were recruited. Routine medical history, general clinical data, and laboratory test indexes were collected for all patients. Echocardiography was performed by a trained echocardiographer to measure E in early diastole and A, E/A ratio, E’ in early diastole, A’ in end-diastole, E/E’ ratio, and E’/A’ ratio.ResultsA total of 1,164 patients with stages 3–5 CKD were included. Thyrotropin receptor antibody (TRAb) was significantly positively correlated with C-reactive protein (r=0.206, P<0.001). Thyroid peroxidase antibody (TPOAb) and TGAb titers in male diabetic patients were higher (r=0.137, P=0.023; r=0.159, P=0.011). In female patients, both TPOAb and TGAb were significantly negatively correlated with hemoglobin (r=–0.213, P=0.018; r=–0.188, P=0.019). The E/E’ of patients who were TPOAb positive was higher than that in patients with TPOAb negative (r=0.181, P<0.001). LVEF in patients who were TPOAb positive was higher than that in patients with TPOAb negative (r=0.159, P=0.007). In addition, LVEF was significantly negatively correlated with TRAb (r=–0.112, P=0.026).ConclusionsIn patients with stages 3–5 CKD, AITD may increase the risk of CVD in CKD patients by affecting triglycerides levels, increasing the risk of anemia, and promoting micro-inflammation. Attention should be paid to female patients with high TPOAb and TGAb titers. The mean of E/E’ in patients with stage 5 CKD was 16.89 in the present study. Women with TPOAb positive may be more likely to develop diastolic heart failure.

Pessary use in patients diagnosed with short cervix and cervical insufficiency

Objective The aim was to evaluate the effectiveness of Arabin pessary use in patients with cervical insufficiency or short cervix before the 24th week of gestation and the impact of cervical examination findings prior to pessary application on the outcome in terms of the gestational week. Materials and methods In our study, among the pregnancies between the 12th and 24th gestational weeks, 60 pregnant women with a preterm delivery history and/or cervical length less than 25 mm were included. Among these 60 patients, 43 of them had a short cervix, 17 of them had cervical insufficiency. Routine medical and obstetric history was obtained. In the vaginal examination, the cervix was evaluated in terms of patency, dilatation, and position. Cervical length, presence of debris, and funneling were evaluated by transvaginal ultrasound. After receiving patients’ approval a cervical pessary was applied to patients. Pessaries of pregnant women with 37 weeks of gestation were removed. Before reaching the 37th gestation week, pessaries were withdrawn in patients who had ongoing vaginal bleeding, premature rupture of membranes, and preterm contractions unresponsive to tocolytic treatment. Results Thirty-one pregnant women (51.7%) out of 60 pregnant women who underwent pessary, delivered at 37 weeks and below. Delivery rates in the short cervical measurement group and cervical insufficiency group at ≤28 weeks, ≤34 weeks and ≤37 weeks were respectively (n = 21) 34.8% vs 36.3% (p = 0.976), (n = 29) 41.8% vs 64.7% (p = 0.111), (n = 31) 44.2% vs 70.6% (p = 0.888). The presence of cervical funneling before pessary application shows a statistically significant difference in terms of patient’s giving birth before or after 28 weeks (p = 0.033). In patients with cervical funneling, there was a significant increase in a birth before 28 weeks. Depending on whether or not patients applying with pain need for tocolysis, it shows the statistically meaningful difference in terms of the patients giving birth before or after 34 weeks (p = 0.001) (OR 7, 61, 95% GA 2.4–24.6). In the group without the need for tocolysis, there is a meaningful increase in birth after 34 weeks. Conclusions Our findings showed that, alongside the defined cervical risk factors, cervical funneling and the need for tocolysis are remarkable prognostic variables in pessary application.

Woes of follow-up patients: A stumbling block, every cardiologist needs to intervene

Sir, “My doctor has lost interest in me, nowadays he hardly examines me, I don't feel like going for follow-up visits.” These are the few utterances of several patients who turn up for regular follow-up visits after the cardiac interventional procedures. Their grievance is that, the cardiologist who used listen to them so patiently, hardly spends anyquality time with them during follow-up visits. The perceived woe is that their doctor just checks the medical reports, simply says everything is fine, and the session simply ends by the issue of the next appointment date. They perceive that their follow-up visits are simply waste of time and money. Follow-up visits are the important part of the medical care of the patients following the discharge from the hospital. These visits give an ample opportunity for the treating doctor to have an insight into the overall recovery and improvement of the patients from an ailment and replan the treatment regimen.[1] These visits ensure the patient safety, and in addition, the patient gets reassured that they are recovering and being cared for. Any shortcomings here will have farfetched repercussions in the overall medical care and outcome of the patient's management. It is possible that the treating doctors could be overpleased by the good outcome of their medical procedures and get carried away a bit. This could also make the doctors to get complacent and take their patients for granted. They fail to perceive and understand the expectations and emotions of their patients, who are otherwise doing fine. The end result is that the treating doctors would go easy on their patients who report to them with normal functional status and cardiac evaluation reports. The patients who are used to the detailed examination and long chat with their doctors during the acute phase of their illness, do expect the same warmth and enthusiasm from their doctors during every follow-up visits. They may feel let down, disappointed, and disillusioned, if the follow-up visits do not meet their expectations. A failure to pick up this kind of sentiments of the patients and a small communication gap of this sort could take a big toll on the patient–doctor relationship. It could well snow ball into a totally wrong decision from the patients, they may decide not to follow-up with the treating doctor. God saves them if these patients if they land up with wrong hands and all the good medical care would simply go in vain. The patient engagement strategies for the follow-up visits, which is in fact applicable to all the medical professionals, should include spending quality time with them. The interaction and conversation should include enquiry about their physical functional status, family, and professional life, other than the routine medical history taking. This act of human touch would definitely make them feel better and cared for. The stethoscope, a magic wand in the hands of the doctors, should be used liberally and could make a world of difference for the patient if not for the cardiologist. Thus, all the efforts should be made to make the follow-up visits of the patients, more meaningful and above all medically valuable from patient point of view. A well planned follow-up visits could definitely prevent the re-admissions by timely identification of the impending complications.[2] A contended patient is always a good ambassador and asset for the professionals as well as the medical profession at large. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of Preoperative and Postoperative Sexual Dysfunction in Male Patients with Lumbar Disc Herniation.

To compare preoperative and postoperative sexual dysfunction in male patients diagnosed with lumbar disc herniation (LDH). This study was conducted in a single group with a pretest?posttest design. The sample included 32 male patients with LDH admitted to the neurosurgery outpatient clinic of a state hospital between August 1, 2019 and November 1, 2020 and who were about to undergo operation. The data were collected using a questionnaire form developed by the researchers, the Golombok?Rust Inventory of Sexual Satisfaction (GRISS), and the Visual Analogue Scale (VAS). Descriptive statistical methods, Mann?Whitney U test, Wilcoxon test, and Spearman correlation analysis were used to evaluate the data. Significance was evaluated at the level of p < 0.05. Before LDH surgery, male patients had problems with sub-dimensions of sexual function, such as frequency, communication, avoidance, touching, impotence, and premature ejaculation. A significant improvement was achieved after the operation in the communication sub-dimension and pain levels. The mean preoperative and postoperative VAS scores of the patients were 8.18 ± 1.20 and 1.28 ± 1.08, respectively. Lumbar disc surgery has a positive effect on sexual function and reduces pain levels. Since there is a strong relationship between LDH and sexual dysfunction, taking sexual history from patients should be part of routine medical history, and psychiatric care and consultation should be offered if necessary.

Epidemiological profile of patients utilizing dental public health services in the eThekwini and uMgungundlovu districts of KwaZulu-Natal province, South Africa

INTRODUCTION: Oral conditions such as dental caries, periodontal diseases, tooth loss and trauma affect millions of people globally. These conditions can be prevented when detected early, thereby avoiding adverse outcomes. The prevalence of oral conditions has been reported in most provinces. However, there is a paucity of data in KwaZulu-Natal. AIM AND OBJECTIVE: This study aimed to determine the prevalence of oral conditions at public health facilities in two health districts in KwaZulu-Natal, South Africa. MATERIALS AND METHODS: A cross-sectional analytical study design was used to determine the nature of oral conditions treated in dental facilities in the eThekwini and uMgungundlovu districts, in KwaZulu-Natal. The study was conducted over a 5-month period (November 2018 - April 2019). After clinicians examined the patients they entered the data in the patients clinical records and selected information (routine medical history questions as well as 16 possible diagnosis codes) were entered into a data extraction template. The data were analyzed using statistical software SPSS. RESULTS: Dental caries was the most prevalent oral condition at 66.4% followed by periodontal disease at 11.7%, trauma at 7.3% and lastly tooth loss at 5.9% CONCLUSION: These findings contribute to knowledge on the prevalence of these oral conditions found in the province.

Analysing cardiovascular risk factors and related outcomes in a middle-aged to older adults population in Iran: a cohort protocol of the Shiraz Heart Study (SHS)

IntroductionThe significant increase in the rate of morbidity and mortality due to cardiovascular diseases has become a health challenge globally. Lack of enough knowledge on the underlying causes in Iran...

Technology-enabled examinations of cardiac rhythm, optic nerve, oral health, tympanic membrane, gait and coordination evaluated jointly with routine health screenings: an observational study at the 2015 Kumbh Mela in India

ObjectivesTechnology-enabled non-invasive diagnostic screening (TES) using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for the primary care screening of patients.DesignDental conditions, cardiac...

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country.

Background:Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor–patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor–patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan.Materials and Methods:The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data.Results:The study revealed four emerging themes: (1) Lack of doctor–patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients’ concern with their improvement in health and doctor's demeanor.Conclusion:The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.

Usefulness of trans-thoracic echocardiography (TTE) in patients with acute ischaemic strokes and normal clinical cardiac examination

Introduction: Stroke is one of the leading causes of disability and mortality in Sri Lanka. Cardiac sources of embolism account for 15 - 30% of ischaemic strokes. For optimal treatment aiming at secondary prevention it is crucial to identify the source of the embolism.We aimed to assess the influence of routine echocardiography in the management of patients with ischaemic strokes who have no evidence of cardiac abnormality on routine medical history, physical examination or 12-lead ECG. Methods: Transthoracic echocardiography (TTE) was performed in patients admitted to Professorial Medical Unit, Teaching Hospital Karapitiya with an acute ischaemic stroke and normal clinical cardiac evaluation including a 12-lead ECG. The echo findings were categorized as therapeutically significant or insignificant by the cardiologist who performed the echo and the treating physician. Results: Of the 110 patients with acute ischaemic stroke with normal clinical cardiac evaluation, 14.5% had therapeutically significant echo findings; left ventricular systolic dysfunction with ejection fraction Conclusions: In this study, TTE revealed cardiac abnormalities that need specific treatment in 16 (14.5%) patients with acute ischaemic stroke with normal clinical cardiac evaluation. TTE should be considered an essential test in the evaluation of all ischaemic stroke patients regardless of the clinical findings.

Peripheral blood mononuclear cells from severe asthmatic children release lower amounts of IL-12 and IL-4 after LPS stimulation

IntroductionAsthma is an inflammatory disorder of the airways associated with bronchial hyperresponsiveness, airway obstruction, and increased mucus production, with a predominance of type 2 immune response (Th2). According to the hygiene hypothesis, exposure to environmental bacterial lipopolysaccharide (LPS) may induce a type 1 immune response (Th1), modulating the development of asthma. ObjectiveIn this study we investigated cytokine production by peripheral blood mononuclear cells (PBMC) from children and adolescents with severe asthma, in response to LPS stimulation in vitro. Materials and methods26 children were selected: 13 severe asthmatics and 13 healthy controls, aged between 5 and 18 years. They were evaluated through routine medical history, physical examination and lung function test to diagnose severe asthma. Allergy status was confirmed by skin prick test and specific IgE assay. We collected blood samples to analyse in vitro LPS-induced cytokines release by PBMC. ResultsPBMC from severe asthmatic children produced lower levels of IL-12p70 in basal conditions and after 12 and 24h stimulation with LPS compared to healthy controls. PBMC from severe asthmatic children produced lower levels of IL-4 after 24h LPS stimulation compared to healthy controls. PBMC from severe asthmatic children produced more levels IL-17 and IL-10 after stimulus with LPS compared to healthy controls. The release of IFN-γ, IL-5 and TNF-α by PBMC from severe asthmatic children was similar to healthy controls. ConclusionOur results demonstrate that LPS directly influence the cytokine profile of PBMC in children with severe asthma. These observations may be potentially helpful in developing new treatment strategies.

AN ANONYMOUS ONLINE SURVEY OF THE VIEWS AND ATTITUDES OF MEDICAL STUDENTS AND JUNIOR DOCTORS TOWARDS PHYSICAL ACTIVITY (PA) TEACHING AND PROMOTION

BackgroundPhysical inactivity is the fourth leading cause of mortality globally according to the WHO. Several recent studies have highlighted that physical activity (PA) is inadequately covered during UK medical school...

The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study

Familial lichen sclerosus (LS) has been described in only 37 families. We feel that the association is under-reported. To determine the percentage of patients with LS who have a positive family history. A large observational-cohort study of a total of 1052 females at vulval clinics within a University Hospital with a diagnosis of LS of the vulva (clinical diagnosis was confirmed in 80% of cases by histology). Patients were questioned as to family history of LS or balanitis xerotica obliterans; male circumcision for medical reasons; vulval cancer; and routine medical and family history. The outcome was the presence or absence of personal or family history of LS, autoimmune disorder or vulval cancer. In total 1052 patients were investigated. Of these, 126 (12%) had a positive family history of LS. These patients belonged to 95 families. Vulval cancer was significantly increased in those with a family history of LS compared with those without (4.1% vs. 1.2%, P < 0.05). There was more associated autoimmune disease in familial LS than in sporadic LS, although this was not statistically significant. (7% vs. 5%, P > 0.2). Our data from a large cohort of patients with LS provide evidence of an increased risk for family members to develop LS. This indicates a likely genetic component in the aetiology of LS.

Factors influencing heartworm, flea, and tick preventative use in patients presenting to a veterinary teaching hospital

The introduction of modern heartworm, flea, and tick preventatives has provided a safe and effective means of controlling companion animal endoparasites, but achieving good owner compliance remains an ongoing challenge for the veterinary profession. Based on a sample of patients from the veterinary teaching hospital at the University of Pennsylvania, this study retrospectively examined factors associated with preventative use and areas of potential weakness in client communication. Between 1999 and 2006, records of 5276 canine and 1226 feline patients were searched for signalment, survey results for heartworm, flea, and tick preventative use, date of visit, presenting complaint, vaccination history, and owner zip code. Data were analyzed using bivariate and multivariate techniques. Overall, only 13–23% of patients were questioned about heartworm, flea, or tick preventative use during routine medical history taking. Patients with a prior history of parasites, younger patients, or those presenting with signs of cardiac disease were no more likely to be questioned about preventative use than healthy animals. Patients presenting to a specialty service were also less likely to be questioned. Approximately 74–79% of dogs and 12–38% of cats in the sample were on preventative products at any given time. There was a distinct seasonality to preventative use corresponding to the heartworm transmission season from June through November in the northeastern United States. Only 50% of patients seen for a yearly physical examination in winter were reported to be using preventative products when surveyed later in the year, compared to the roughly 85% on patients in heartworm preventatives when they received their routine physical examination in spring. Month of presentation and neuter status were the only signalment factors significantly ( P < 0.05) associated with preventative use in the multivariate analysis. Findings from this study emphasize target areas for increasing owner compliance.

Routine electrocardiogram and medical history in syncope: a simple approach can identify most high-risk patients

Syncope accounts for 3–5% Emergency Department visits and for 1–6% of urgent hospital admissions each year.1 In the USA, between 1 and 2 million patients are evaluated annually for syncope. Despite the updated clinical guidelines and the development of diagnostic algorithms over recent years, the cost associated with hospitalization and clinical management of syncope is still overwhelming. One of the problems is that syncope is not a disease per se , but a symptom related to an extensive range of differential diagnoses, which could span from cardiac to neurological to psychiatric conditions. Furthermore, up to 47% of patients presenting with syncope may be discharged without the diagnosis1 and, even if their outcome is generally benign, the 1-year mortality rate in syncope of cardiac origin could reach 18–33%.2 Overall, these data point towards the importance of identifying which are the most useful clinical tools that physicians could use in their practice to correctly differentiate between syncopal events with benign vs. those with serious outcome. When analysis of the substrate of transitory loss of consciousness is narrowed to a population of children or young adults, the importance in selecting which episodes are associated with a malignant prognosis becomes even more evident. As a matter of fact, most of these episodes may be situational or vasovagal syncope, therefore benign events. However, syncope is the main symptom also in inherited channelopathies, such as long QT syndrome (LQTS), Brugada … *Corresponding author. Tel: +39 0382 592040, Fax: +39 0382 592094, Email: silvia.priori{at}fsm.it