scholarly journals Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Gang Liu ◽  
Yingying Su ◽  
Yifei Liu ◽  
Mengdi Jiang ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Inclusion Criteria ◽  
Group 6 ◽  
Stroke Group ◽  
Predicting Outcome ◽  
Poor Outcomes ◽  
Electrical Stimuli

Objective. To test the value of quantifiable electrical stimuli as a reliable method to assess electroencephalogram reactivity (EEG-R) for the early prognostication of outcome in comatose patients.Methods. EEG was recorded in consecutive adults in coma after cardiopulmonary resuscitation (CPR) or stroke. EEG-R to standard electrical stimuli was tested. Each patient received a 3-month follow-up by the Glasgow-Pittsburgh cerebral performance categories (CPC) or modified Rankin scale (mRS) score.Results. Twenty-two patients met the inclusion criteria. In the CPR group, 6 of 7 patients with EEG-R had good outcomes (positive predictive value (PPV), 85.7%) and 4 of 5 patients without EEG-R had poor outcomes (negative predictive value (NPV), 80%). The sensitivity and specificity were 85.7% and 80%, respectively. In the stroke group, 6 of 7 patients with EEG-R had good outcomes (PPV, 85.7%); all of the 3 patients without EEG-R had poor outcomes (NPV, 100%). The sensitivity and specificity were 100% and 75%, respectively. Of all patients, the presence of EEG-R showed 92.3% sensitivity, 77.7% specificity, 85.7% PPV, and 87.5% NPV.Conclusion. EEG-R to quantifiable electrical stimuli might be a good positive predictive factor for the prognosis of outcome in comatose patients after CPR or stroke.

scholarly journals Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Carola Pilone ◽  
Federico Verdone ◽  
Roberto Rossi ◽  
Davide Bonasia ◽  
Federica Rosso
Keyword(s):  
Prognostic Factors ◽  
Regression Model ◽  
High Tibial Osteotomy ◽  
Womac Score ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Inclusion Criteria ◽  
Opening Wedge

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]

scholarly journals Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

2013 ◽  
Vol 35 (5) ◽  
pp. E6 ◽  
Author(s):  
William C. Gump ◽  
Ian S. Mutchnick ◽  
Thomas M. Moriarty
Keyword(s):  
Cerebral Palsy ◽  
Spinal Cord Injuries ◽  
Spastic Diplegia ◽  
Inclusion Criteria ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Common Diagnosis

Children with spastic diplegia from cerebral palsy (CP) experience measurable improvement in their spasticity and motor function following selective dorsal rhizotomy (SDR). The role of this operation in the treatment of other spasticity causes is less well defined. A literature review was undertaken to survey outcomes from SDRs performed outside the CP population. Multiple sclerosis was the most common diagnosis found, accounting for 74 of 145 patients described. Selective dorsal rhizotomies have also been reported in patients with traumatic brain and spinal cord injuries, ischemic and hemorrhagic stroke, neurodegenerative disease, hypoxic encephalopathy, and other causes of spasticity. Outcomes from surgery are generally described as favorable, although postoperative assessments and follow-up times are not standardized across reports. Long-term outcomes are sparsely reported. Larger numbers of patients and more detailed outcomes data have the potential to form a basis for expanding the inclusion criteria for SDR.

Psychiatry’s ethical involvement in gender-affirming care

2018 ◽  
Vol 26 (5) ◽  
pp. 460-463 ◽  
Author(s):  
Roberto D’Angelo
Keyword(s):  
Gender Dysphoria ◽  
Poor Quality ◽  
Medline Search ◽  
Gender Reassignment ◽  
The Subject ◽  
Poor Outcomes ◽  
Physical Treatments

Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term “transsexualism” or “gender dysphoria” and “outcome” or “follow-up” in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals.

scholarly journals Changing the course of schizophrenia - predictors of treatment outcome revisited

2007 ◽  
Vol 13 (1) ◽  
pp. 5 ◽  
Author(s):  
R Emsley ◽  
P Oosthuizen ◽  
D Niehaus ◽  
L Koen ◽  
B Chiliza
Keyword(s):  
Treatment Outcome ◽  
Treatment Response ◽  
Predictive Value ◽  
Analysis Model ◽  
Antipsychotic Therapy ◽  
Early Treatment Response ◽  
Research Findings ◽  
Predicting Outcome ◽  
Predicting Treatment Outcome

<p>Multiple factors play a role in determining the outcome of schizophrenia. However, the role of these factors is poorly understood, and research findings so far have been inconclusive and sometimes contradictory. Various demographic and baseline clinical factors have been reported to be associated with treatment outcome. Also, early symptom reduction after initiation of antipsychotic therapy is closely related to later treatment response. However, associations as such do not necessarily imply predictive value, and none of these factors can be regarded as clinically useful in predicting treatment outcome. This article discusses selected aspects of treatment outcome and its prediction in schizophrenia, focusing particularly on early treatment response, ethnicity, neurological soft signs, and the predictive value of a discriminant functional analysis model utilising a combination of putative predictors. Such a model holds promise, and it is to be hoped that future refinements will lead to a clinically useful model for predicting outcome.</p>

scholarly journals The role of rebound tenderness in acute appendicitis and appendicular perforation

2017 ◽  
Vol 4 (2) ◽  
pp. 725
Author(s):  
Yashwant R. Lamture ◽  
Varsha P. Gajbhiye
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Study Data ◽  
Rebound Tenderness ◽  
Important Sign ◽  
Male Patients ◽  
Rule Out

Background: Acute appendicitis is the most common surgical emergency. Inspite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, rebound tenderness is very important sign with controversial views regarding it in available literature. Hence this study was undertaken to prove its efficacy of it related to rule out appendicular perforations.Methods: This study was conducted in 418 patients with 186 female and 251 male. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by data statistic software.Results: The sensitivity and specificity of rebound tenderness to diagnose acute appendicitis is 65% and 73.6% respectively whereas the sensitivity and specificity of rebound tenderness to diagnose appendicular perforation was 94% and23.3% respectively with positive predictive value is 5 and negative predictive value is 99.Conclusions: Hence it indicates that rebound tenderness is very important to rule out complications like perforation or peritonitis and to support diagnosis of acute appendicitis. It has minimal significance to diagnose perforation of appendix as positive predictive value is less.

scholarly journals The Effect of Mulaka Beejadi Lepa and Pruthu Nimba Panchaka Churna in the Management of Vicharchika W.S.R. to Eczema 

2018 ◽  
Vol 9 (3) ◽  
pp. 185-190
Author(s):  
Divya V ◽  
Ragamala K C
Keyword(s):  
Diagnostic Criteria ◽  
Skin Diseases ◽  
Age Group ◽  
Inclusion Criteria ◽  
External Application ◽  
Before And After ◽  
Pro Forma ◽  
Great Advance

According to Ayurveda, Vicharchika is a major problem in skin diseases.  All Kusthas are having Tridoshaja origin.The disease Vicharchika to a greater extent resembles eczema/dermatitis.  Despite of great advance in dermatology and the advent of powerful antibiotics, antifungal as well as steroids, Eczema continues to defy the best effect of dermatologists. Hence it is the need of the hour to find out safe and effective medicine for Vicharchika and here comes the role of Ayurveda. The involvement of Vata results in dry, blackish lesion of eczema, itching in those affected areas is due to Kapha and Pitta is responsible for Srava. In classical texts, Ayurveda Acharyas emphasizes shodhana and shamana therapy as the line of treatment at various contexts. So, the study aimed to evaluate efficacy of Mulaka beejadi lepa and Pruthu nimba panchaka churna in vicharchika, 30 children aged 3-16years who were fulfilling the inclusion criteria and diagnostic criteria were selected from Kaumarabhritya OPD and IPD of S.V.Ayurvedic College & Hospital, Tirupati.  Patients were given Mulaka beejadi lepa as external application  and vati prepared with Pruthu nimba panchaka churna 250mg BID  in 3-10years age group and 500mg BID in 11-16yrs age group children for 30days and called for follow up after 15days to note any recurrence.The cases were recorded as per the case Pro forma and observations were recorded. Symptoms were scored and statistically analysed for any change before and after treatment. Mulaka Beejadi lepa as external application and Pruthu Nimba panchaka churna internally are very effective in the management of vicharchika.  

The sensitivity and specificity of TOF-MRA compared with DSA in the follow-up of treated intracranial aneurysms

2021 ◽  
pp. neurintsurg-2020-016788
Author(s):  
Sishi Xiang ◽  
Fu Fan ◽  
Peng Hu ◽  
Kun Yang ◽  
Xiaodong Zhai ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Intracranial Aneurysms ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Interventional Therapy ◽  
Flow Diverter ◽  
Tof Mra ◽  
Specificity And Sensitivity

BackgroundTime-of-flight magnetic resonance angiography (TOF-MRA) is widely used in detecting intracranial aneurysms (IA), but it is limited and controversial for use during follow-up to assess the outcome of interventional coiling or clipping surgery.MethodsTo evaluate the specificity and sensitivity of using TOF-MRA as an imaging follow-up for IA with different treatments. A total of 280 patients with 326 treated IA underwent simultaneous TOF-MRA and digital subtraction angiography (DSA) as follow-up imaging on the same day. All images were independently reviewed by two neurosurgeons and two radiologists. The consensus evaluation of intra-arterial DSA as a reference test was used to evaluate the result of aneurysm occlusions. The aneurysmal embolization status was assessed with two ratings involving complete or incomplete occlusions. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value of three-dimensional-TOF-MRA to investigate the diagnostic performance.ResultsOverall sensitivity and specificity of TOF-MRA for diagnosing the remnant were 83.3% and 95.2%, respectively. The sensitivity and specificity of interventional therapy was 90.0% and 94.2%, respectively, while the clipping group showed sensitivity and specificity of 50.0% and 100%, respectively. For additional groups, involving coil only, stent-assisted, and flow diverter, the analysis of interventional therapy showed sensitivities and specificities of 100.0% and 90.1%, 66.7% and 95.1%, and 91.7% and 100%, respectively.ConclusionsTOF-MRA can be used as a first-line noninvasive imaging modality during follow-up, especially for the patients treated with a pipeline embolization device and coils only. But it may not be enough for clipped aneurysms.

FDG-PET in Peripheral T-Cell Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5499-5499
Author(s):  
Joanna M. Quigley ◽  
Shrinivas Bishu ◽  
Jordan H. Hankins ◽  
James O. Armitage
Keyword(s):  
T Cell ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Cell Lymphoma ◽  
Diagnostic Methods ◽  
Physical Exam ◽  
World Health ◽  
Anaplastic Lymphoma ◽  
Average Maximum

Abstract The sensitivity and specificity of fluorine-18 fluoro-deoxy-glucose positron emission tomography (PET) in the evaluation of peripheral T cell lymphomas (PTCL) is not well established. In this abstract, we describe our experience utilizing PET in the diagnostic evaluation of PTCL. A retrospective review of 2768 PET examinations conducted at our institutionbetween the years 1999–2006 produced twenty-six examinations among twenty-two patients with a biopsy proven diagnosis of PTCL. All patients underwent staging of their disease using both conventional diagnostic methods and PET. Their therapeutic status was also taken into consideration when interpreting PET examinations. PTCL were classified by World Health Organization (WHO) criteria and included: PTCL-unclassified (PTCL-U), anaplastic lymphoma kinase positive (+) and negative (−) anaplastic large cell lymphoma, gioimmunoblastic (AITL n=1), and natural killer T-cell nasal type (NK/T n=1). PET results for each patient were compared against a standard of reference, and the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PET) of PET were calculated. PET had an overall sensitivity of 55% and specificity of 100% in PTCL-U. PET had an overall sensitivity of 83% and specificity of 100% in ALCL. PET had an overall sensitivity of 13% and specificity of 0% in cutaneous PTCL. Among patients with non-cutaneous PTCL-U, the sensitivity and specificity were 83% and 100% respectively. Among patients with non-cutaneous ALCL, the sensitivity and specificity were 100% respectively. Excluding those patients with cutaneous PTCL, PET correlated with clinical outcome in 87% of PTCL-U 100% of ALCL patients. The average maximum standard uptake value (g/mL) of abnormal foci demonstrated greater intensity in patients with ALCL (13.1) than those with PTCL-U (8.87) (Figure 1). PET had excellent correlation with CT, physical examination and clinical follow-up at both nodal and extra-nodal sites, but poor correlation at cutaneous sites (Figure 2). The PPV and NPV of restaging PET in PTCL-U were 75% and 100% respectively. In ALCL, the PPV and NPV of restaging PET were 66% and 100% respectively. PET is useful for staging and restaging patients with nodal and non-cutaneous extra-nodal involvement in PTCL-U and ALCL. It demonstrates a comparatively low sensitivity in cutaneous PTCL. Average Maximum SUV (gm/ml) of Abnormal Foci in PTCL-U and ALCL Average Maximum SUV (gm/ml) of Abnormal Foci in PTCL-U and ALCL Positivity (%) of PET vs. Site of Disease by CT, Physical Exam and/or Clinical Follow Up Positivity (%) of PET vs. Site of Disease by CT, Physical Exam and/or Clinical Follow Up

Operative Treatment of Ingrown Toenail by Nail Fold Resection Without Matricectomy

2015 ◽  
Vol 105 (4) ◽  
pp. 295-301 ◽  
Author(s):  
Michael B. DeBrule
Keyword(s):  
Operative Procedure ◽  
Inclusion Criteria ◽  
Operative Techniques ◽  
Recurrence Rates ◽  
Ingrown Toenail ◽  
Satisfactory Outcome ◽  
Skin Excision ◽  
Ingrown Toenails

Background Many operative techniques have been studied for correction of ingrown toenails, yet the role of nail fold resection without matricectomy is poorly defined. Current literature on this topic is sparse, and previous systematic reviews are absent. Methods A MEDLINE/Cumulative Index to Nursing and Allied Health Literature/Scopus search was performed and a systematic review was undertaken for articles discussing surgical treatment of ingrown toenail by nail fold resection without matricectomy. Outcome measures were systematically reported, and variations in operative technique were identified. Results Of the 14 articles that fit the inclusion criteria, 2 were level V evidence, 11 were level IV, and 1 was level III. Minimum follow-up time and the criteria for a satisfactory outcome were not consistently defined. Recurrence rates varied from 0% to 20%. The postsurgical infection rate was 0% for all nine studies reporting infection. Ten different operative techniques were identified. Three studies used partial or total nail avulsion as an adjunctive operative procedure. Triangular-, crescent-, elliptical-, semi-elliptical–, and radical-shaped skin excision strategies were identified. Primary and secondary intentions were used for closure. Conclusions Operative algorithms for the treatment of ingrown toenail are still unclear regarding nail fold resection without matricectomy and are supported by almost entirely level IV evidence. Future prospective comparative studies and randomized trials are necessary to support and strengthen current practice.

ICHD-II Diagnostic Criteria for Tolosa—Hunt Syndrome in Idiopathic Inflammatory Syndromes of the Orbit and/or the Cavernous Sinus

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 577-584 ◽  
Author(s):  
S Colnaghi ◽  
M Versino ◽  
E Marchioni ◽  
A Pichiecchio ◽  
S Bastianello ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Response To Treatment ◽  
High Dose ◽  
Inclusion Criteria ◽  
Resonance Imaging ◽  
Hunt Syndrome ◽  
Magnetic Resonance Imaging Mri

A bibliographical search was conducted for papers published between 1999 and 2007 to verify the validity of International Classification of Headache Disorders (ICHD)-II criteria for the Tolosa-Hunt syndrome (THS) in terms of (i) the role of magnetic resonance imaging (MRI); (ii) which steroid treatment should be considered as adequate; and (iii) the response to treatment. Of 536 articles, 48, reporting on 62 patients, met the inclusion criteria. MRI was positive in 92.1% of the cases and it normalized after clinical resolution. There was no evidence of which steroid schedule should be considered as adequate; high-dose steroids are likely to be more effective both to induce resolution and to avoid recurrences. Pain subsided within the time limit required by the ICHD-II criteria, but signs did not. We conclude that THS diagnostic criteria can be improved on the basis of currently available data. MRI should play a pivotal role both to diagnose and to follow-up THS.

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