Huge Vulval Elephantiasis of Filarial Origin: Diagnosis by Exclusion

2021 ◽  
Author(s):  
Sunita Samal ◽  
Prithiv Raj ◽  
Seetesh Ghose
Keyword(s):  
Diagnosis By Exclusion

scholarly journals Applying the concept of uncertainty to the sFlt-1/PlGF cut-offs for diagnosis and prognosis of preeclampsia

2021 ◽  
Vol 59 (4) ◽  
pp. 681-686
Author(s):  
Pacifique Lévy ◽  
Safouane Hamdi ◽  
Jean Guiboudenche ◽  
Marie Clothilde Haguet ◽  
Sophie Bailleul ◽  
...  
Keyword(s):  
Quality Control ◽  
Growth Factor ◽  
Tyrosine Kinase ◽  
Error Propagation ◽  
Placental Growth Factor ◽  
Internal Quality ◽  
Diagnosis And Prognosis ◽  
Diagnosis By Exclusion ◽  
Using Data ◽  
Plgf Ratio

Abstract Objectives Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) assays and the corresponding ratios (sFlt-1/PlGF) have been proposed to aid in the diagnosis by exclusion and/or prognosis of preeclampsia (PE). A method for evaluating ratio uncertainties (RUs), based on the theory of error propagation, was applied to the sFlt-1/PlGF ratio. Methods RUs were calculated using data derived from sFlt-1 and PlGF Internal Quality Control (IQC) results collected from four centers using Elecsys (Roche) or Kryptor (Thermo Fisher) sFlt-1 and PlGF assays. The corresponding ratio uncertainties were defined for each ratio value. Results The RUs increased linearly with the sFlt-1/PlGF ratio values. The Elecsys RUs were lower than the Kryptor RUs. Although RUs cannot eliminate differences in ratio values observed among various immunoassays, it can affect interpretation of the sFlt-1/PlGF ratio, especially when results are within the range of predefined PE diagnosis or prognosis cut-offs. Conclusions Since RUs are only a function of PlGF and sFlt-1 precision, they can be calculated for each assay from each laboratory to adjust the interpretation of sFlt-1/PlGF ratio results in the context of PE.

scholarly journals Hyperactive bladder: concept of disease and paradigms in the treatment

2021 ◽  
pp. 121-126
Author(s):  
G. G. Krivoborodov ◽  
E. I. Tur ◽  
D. A. Shirin
Keyword(s):  
Large Scale ◽  
Lifestyle Changes ◽  
Diagnosis By Exclusion ◽  
Step Algorithm ◽  
Detrusor Hyperactivity ◽  
Large Groups ◽  
Current Guidelines ◽  
Global Population ◽  
Methods Of Treatment ◽  
Adrenergic Receptor Agonist

World studies have shown that the mean prevalence of overactive bladder (OAB) ranges today from 11 to 16% of the global population and is common in both men and women. In addition, OAB is a diagnosis by exclusion. The article discusses two large groups of the causes of pathology: neurological and non-neurological. The former includes various diseases and conditions that lead to a complex abnormality in the urinary mechanism, namely, involuntary detrusor contractions and increased intravesical pressure. Spinal trauma, brain strokes and spinal strokes, multiple sclerosis, Parkinson’s disease, etc. are the most common of them. Unidentified factors constitute the second group of causes resulting in urgent frequent urination, and what is meant here is idiopathic detrusor hyperactivity (IDH). In this case, a patient may have these symptoms amidst full health without any neurological history. According to the available current guidelines, the treatment of OAB includes a three-step algorithm and suggests lifestyle changes, drug therapy and, finally, minimally invasive methods of treatment. Historically, M-anticholinergics are the main drugs for the treatment of OAD symptoms. However, administration of drugs from this group may often be impossible due to prominent side effects, which are more commonly reported among elderly patients. Unlike M-anticholinergics, Mirabegron is the only β3-adrenergic receptor agonist today that has shown a high efficacy and safety profile based on the results of large-scale placebo-controlled clinical trials.

scholarly journals Is This Rapid Destructive Hip Osteoarthritis ?

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Tung HO Sheung ◽  
Yip Kan Yeung ◽  
Ming Yu Chiu ◽  
Yeung IP Hoi
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Septic Arthritis ◽  
Hip Arthroplasty ◽  
Frozen Section ◽  
Hip Osteoarthritis ◽  
Rapid Progression ◽  
Total Hip ◽  
Diagnosis By Exclusion ◽  
Rapid Destruction

Rapid destructive hip osteoarthritis is a diagnosis by exclusion. It should be differentiated from septic arthritis, osteonecrosis, neuropathic arthritis and other aetiologies causing rapid bone resorption or destruction around the hip. The present study aims to review the incidence of rapid destructive hip osteoarthritis among those patients who request total hip arthroplasty for end stage arthrosis. A retrospective review of radiographs of all patients who scheduled for total hip arthroplasty from January 2010 to March 2019 were analysed by 3 orthopaedic fellows. Of 174 hips of 146 patients, 35 hips of 29 patients were considered by at least 2 orthopaedic fellows to have rapid destructive hip osteoarthritis based on radiographic criteria of rapid joint space narrowing or rapid destruction of femoral head with or without acetabular involvement. Clinical history and physical finding, blood biochemistry, cultures and pathology with or without frozen section are reviewed. Early total hip arthroplasty, rather than routine operation in the long waiting list, is recommended for rapid destructive hip osteoarthritis to prevent technical difficulty in dealing with the bone loss or defect associated with rapid destructive hip osteoarthritis. However, one must exclude septic arthritis before proceeding to total hip arthroplasty. In clinically highly suspected cases, staged total hip arthroplasty was done despite of normal initial blood investigationsand negative hip aspiration with equivocal frozen section on table. In one such patient, the culture was initially negative, but became positive only after extended period of culture. On the other hand, rapid destruction of acetabulum requiring impaction bone grafting and acetabular augmentation for total hip arthroplasty was needed in one patient. Malignancy was suspected in another patient, but there was no evidence of malignancy or infection in the femoral head and tissue obtained by excisional arthroplasty of hip. One patient with hip pain and bilateral hip involvement was found to have Charcot joint. Rapid destruction hip osteoarthritis represents an uncommon subset of arthrosis with rapid progression. A delicate balance between correct diagnosis and timely early operation should be exercised to prevent rapid loss of bone stock making delayed total hip arthroplasty become technical difficult with possible compromised outcomes.

scholarly journals MON-111 Plasma Insulin Measured with a Sensitive Immunoassay May Establish the Diagnosis of Congenital Hyperinsulinism Without Further Testing

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Julie Siersbæk ◽  
Annette R Larsen ◽  
Mads Nybo ◽  
Henrik Boye Thybo Christesen
Keyword(s):  
Detection Limit ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Plasma Insulin ◽  
Diagnostic Testing ◽  
Congenital Hyperinsulinism ◽  
Operating Characteristics ◽  
Diagnosis By Exclusion ◽  
Hypoketotic Hypoglycaemia ◽  
L 14

Abstract Background: The diagnosis of congenital hyperinsulinism (CHI) is often hampered by a plasma insulin (p-insulin) detection limit of 2-3 mU/L (14-21 pmol/L) by RIA methods. Objective: To evaluate the diagnostic performance of a sensitive immunoassay for p-insulin and to find the optimal p-insulin cut-off for CHI versus other conditions with hypoglycaemia. Design: Single centre retrospective cohort study. Methods: Diagnostic tests with no medication, no i.v. glucose and under fasting conditions were performed in children with a clinical diagnosis of CHI. P-insulin concentrations determined at simultaneous p-glucose concentrations at least <3.2 mmol/L (57.5 mg/dL) were included in the analysis (n=61). The diagnosis of CHI was either clinical (n=61) or by gold standard criteria: hypoketotic hypoglycaemia plus disease-causing genetic mutations and/or diffuse, focal or atypical pancreatic histopathology (n=57). Samples from 15 children with idiopathic ketotic hypoglycaemia (IKH, diagnosis by exclusion, p-ketones >1.5 mmol/L during hypoglycaemia) were used as controls. P-insulin was measured by the high-sensitive assay (Cobas e411 immunoassay analyzer); lower detection limit 1.4 pmol/L (0.2 mU/L); normal range 18-173 pmol/L (2.57-24.7 mU/L). Concentrations <18 pmol/L were considered suppressed; ≥18 pmol/L un-suppressed. Receiver operating characteristics (ROC) curves with determination of area under the curve (AUC) values were performed for the diagnostic performance of p-insulin in the diagnosis of CHI. Results: In the 61 samples from CHI patients, the median (range) p-insulin was un-suppressed in all diagnostic samples [90; 20-758 pmol/L (12.9; 2.9-109.1 mU/L)], while p-insulin was suppressed in all 15 samples from IKH patients [1.5; 1.5-9 pmol/L (0.21; 0.21-1.3 mU/L)]. The ROC AUC was 1.0 (95%CI. 1.0-1.0) for the diagnosis of CHI defined both by the clinic and by gold standard. The optimal p-insulin cut-off was 14.5 pmol/L (2.1 mU/L) or 12.5 pmol/L (1.8 mU/L), for CHI patients by use of a simultaneous p-glucose cut-off of <3.2 mmol/L (57.5 mg/dL; n=61), or 3.0 mmol/L (55 mg/dL; n=49), respectively. Conclusions: The sensitive insulin assay performed excellent in diagnosing CHI with a ROC AUC of 1.0. The use of a p-insulin cut-off of 13 pmol/L (1.86 mU/L) during a diagnostic hypoketotic hypoglycaemia test may establish the diagnosis of CHI without further diagnostic testing.

scholarly journals Tolosa-Hunt: Case Report

2021 ◽  
Author(s):  
Lília Tereza Diniz Nunes ◽  
Flávia S. Silva ◽  
Karyme G. Aota ◽  
Maria Beatriz Miranda S. B. de Assis ◽  
João Fellipe B. Bento ◽  
...  
Keyword(s):  
Case Report ◽  
Cavernous Sinus ◽  
Clinical Care ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Unknown Etiology ◽  
Specific Diagnosis ◽  
Hunt Syndrome ◽  
Diagnosis By Exclusion ◽  
History Of

Context: Tolosa-Hunt Syndrome (STH) is a rare condition with unknown etiology, it affects both genders equally. It is manifested by inflammation of the cavernous sinus and involvement of some cranial nerves pairs. Case report: MSR, 39 years, male, diver in the mining zone, history of recurrent otitis with acute pain and gradual hearing loss that progressed. He was admitted to the General Hospital of Palmas with symptoms of retrorbital headache. After physical exams it was found an ophthalmoplegia with right amaurosis and ipsilateral pain. The neurological examination showed a right eye with loss of photomotor reflex and presence of consensual reflex and eyelid ptosis. After 38 days in hospital, a probable septic thrombosis of the cavernous sinus was found, antibiotic and corticosteroids therapy was initiated. The patient also reports significant improvement in headache and partially in vision, he is currently hospitalized with clinical care and antibiotic therapy, awaiting results of the image examination report. Conclusions: Painful ophthalmoplegia in most cases is not diagnosed as STH. The differential diagnosis for this pathology is most often through brain magnetic ressonance and the ICHD-3 beta diagnostic criteria, STH should be suspected, but it is still necessary to close the diagnosis by exclusion, due to the lack of a specific diagnosis.

Discussing First Aid Training Issues of Psychiatric Emergencies

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Tsopelas ◽  
F. Kapsali ◽  
S. Tsetsou ◽  
K. Kardaras ◽  
D. Oikonomou ◽  
...  
Keyword(s):  
Web Search ◽  
Treatment Guidelines ◽  
Psychiatric Treatment ◽  
Diagnostic Procedures ◽  
Psychiatric Emergencies ◽  
Medical Databases ◽  
Diagnosis By Exclusion ◽  
First Aid Training ◽  
Usual Clinical Practice ◽  
Medical Emergencies

Aims:Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.Methods:Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.Results:There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.Conclusions:Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.

scholarly journals Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 168
Author(s):  
Victoria Strassheim ◽  
Julia L. Newton ◽  
Tracy Collins
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Lived Experience ◽  
Chronic Fatigue ◽  
Severe Form ◽  
Myalgic Encephalomyelitis ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Fatigue Syndrome ◽  
Diagnosis By Exclusion ◽  
Health Burdens

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a rare disease with no known etiology. It affects 0.4% of the population, 25% of which experience the severe and very severe categories; these are defined as being wheelchair-, house-, and bed-bound. Currently, the absence of biomarkers necessitates a diagnosis by exclusion, which can create stigma around the illness. Very little research has been conducted with the partly defined severe and very severe categories of CFS/ME. This is in part because the significant health burdens experienced by these people create difficulties engaging in research and healthcare provision as it is currently delivered. This qualitative study explores the experiences of five individuals living with CFS/ME in its most severe form through semi-structured interviews. A six-phase themed analysis was performed using interview transcripts, which included identifying, analysing, and reporting patterns amongst the interviews. Inductive analysis was performed, coding the data without trying to fit it into a pre-existing framework or pre-conception, allowing the personal experiences of the five individuals to be expressed freely. Overarching themes of ‘Lived Experience’, ‘Challenges to daily life’, and ‘Management of the condition’ were identified. These themes highlight factors that place people at greater risk of experiencing the more severe presentation of CFS/ME. It is hoped that these insights will allow research and clinical communities to engage more effectively with the severely affected CFS/ME population.

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