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Appropriate Screening (appropriate + screening)
Selected AbstractsDetection of Leishmania infantum by real-time PCR in a canine blood bankJOURNAL OF SMALL ANIMAL PRACTICE, Issue 7 2008M. D. Tabar Objectives: Risk for transmission of Leishmania infantum from blood products has been largely demonstrated in human and veterinary literature. Appropriate screening of canine blood donors is important especially in an endemic area such as Barcelona (Spain). The purpose of this study was to evaluate the presence of L infantum DNA parasites by real-time quantitative PCR in our canine blood bank. Methods: Samples from blood products obtained from 92 canine blood donors were assayed for L infantum by means of real-time PCR amplification and quantification. Results: The prevalence of quantitative PCR-positive blood samples among healthy seronegative blood donors was 19·6 per cent. Clinical Significance: The results of this study show that L infantum infection is common in canine blood donors and their blood products in an endemic area, despite a negative commercial serological screening for infectious diseases. Therefore, screening by PCR should be included in an integrated approach to evaluate L infantum infection among potential blood donors. [source] Retinal photography for diabetic retinopathy screening in Indigenous primary health care: the Inala experienceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Geoffrey K. P. Spurling Abstract Objective: We aimed to determine the impact of clinic based retinal photography on access to appropriate screening for diabetic retinopathy (DR). Design, setting and participants: We opportunistically recruited patients undergoing their annual diabetic cycle of care over a two year period in the urban Indigenous primary health care clinic. Data were collected on retinal outcomes, health variables and referral patterns. Main outcome measures: Access to appropriate screening and ophthalmic follow up, prevalence of DR, acceptability and feasibility of clinic-based retinal photography were the main outcome measures of this study. Results: One hundred and thirty-two of a possible 147 patients consented to participate. 30% of participants had DR. Appropriate screening and ophthalmic follow up increased six fold, from 20 to 124 participants, following the introduction of the retinal camera. Most participants felt very positive about DR screening. Conclusions: Primary care DR screening using retinal photography can improve access to DR screening for indigenous patients, reduce the burden on busy outpatient departments and should reduce visual loss. Policy-makers could contribute to screening sustainability by funding a medicare item-number for primary care based DR screening associated with the annual diabetic cycle of care. An upfront Practice Incentive Program (PIP) payment could offset set up costs. [source] Segmental testicular ischaemia: presentation, management and follow-upINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2009D. Gianfrilli Summary Segmental infarction of the testis is a rare event. Less than 40 cases have been reported in the literature and its aetiology remains largely unknown. The diagnosis is challenging and its identification crucial as partial ischaemia is frequently confused with testicular tumours and unnecessarily treated with orchiectomy. The objectives of this study are to: (i) raise awareness of this rare condition, (ii) provide the distinctive clinical and radiological features enabling pre-operative diagnosis, (iii) promote appropriate screening of causative factors and (iv) propose an alternative management approach to avoid surgery and preserve fertility. We describe three cases of partial testicular ischaemia in men presenting with reduced sperm quality. The cases demonstrate the ultrasound and magnetic resonance imaging appearance of testicular ischaemia. The surveillance strategy adopted for these lesions indicates that over 2 years of follow-up, marginal changes in the lesions can occur. Histology revealed that infiltration by stromal cells, leucocytes and macrophages is responsible for the remodelling of these lesions. Screening of risk factors for thromboembolism revealed that all patients carried a methylenetetrahydrofolate reductase 677C,T (MTHFR) mutation in a gene involved in folate metabolism, and either borderline or elevated homocysteine levels. Distinctive features permit the pre-operative diagnosis of segmental testicular ischaemia. There are sufficient data to assert that a surveillance strategy is safe and feasible. We speculate that the defects in folate metabolism may pre-dispose individuals to the development of testicular infarction and infertility. [source] Should children at risk for familial adenomatous polyposis be screened for hepatoblastoma and children with apparently sporadic hepatoblastoma be screened for APC germline mutations?,PEDIATRIC BLOOD & CANCER, Issue 6 2006Stefan Aretz MD Abstract Background Hepatoblastoma (HB) is the most frequent liver tumor in childhood, occurring in the first few years of life. Surgery combined with chemotherapy has resulted in dramatic improvements in prognosis. However, even today, about one quarter of affected children do not survive the disease. Compared to the general population, the risk of HB is 750,7,500 times higher in children predisposed to familial adenomatous polyposis (FAP), an autosomal-dominant cancer predispostion syndrome caused by germline mutations in the tumor suppressor gene APC. Only limited data exist about the frequency of APC germline mutations in cases of apparently sporadic HB without a family history of FAP. Procedure In our sample of 1,166 German FAP families, all known cases of HB were registered. In addition, 50 patients with apparently sporadic HB were examined for APC germline mutations. Results In the FAP families, seven unrelated cases of HB are documented; three had been detected at an advanced stage. In patients with apparently sporadic HB, germline mutations in the APC gene were identified in 10%. Conclusions These data raise the issue of the appropriate screening for HB in children of FAP patients. To date, the efficiency of surveillance for HB is unclear. In Beckwith,Wiedemann syndrome (BWS), recent studies suggest an earlier detection of both Wilms tumor and HB by frequent screening. We discuss the rationale and implications of a screening program; besides the examination procedure itself, screening for HB in children of FAP patients would have important consequences for the policy of predictive testing in FAP. In a substantial fraction of sporadic HB, the disease is obviously the first manifestation of a de novo FAP. These patients should be identified by routine APC mutation screening and undergo colorectal surveillance thereafter. Pediatric Blood Cancer 2006;47:811,818. © 2005 Wiley-Liss, Inc. [source] Modest Impact of a Brief Curricular Intervention on Poor Documentation of Sexual History in University-Based Resident Internal Medicine ClinicsTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Danielle F. Loeb MD ABSTRACT Introduction., Providers need an accurate sexual history for appropriate screening and counseling. While curricula on sexual history taking have been described, the impact of such interventions on resident physician performance of the sexual history remains unknown. Aims., Our aims were to assess the rates of documentation of sexual histories, the rates of documentation of specific components of the sexual history, and the impact of a teaching intervention on this documentation by Internal Medicine residents. Methods., The study design was a teaching intervention with a pre- and postintervention chart review. Participants included postgraduate years two (PGY-2) and three (PGY-3) Internal Medicine residents (N = 25) at two university-based outpatient continuity clinics. Residents received an educational intervention consisting of three 30-minute, case-based sessions in the fall of 2007. Main Outcome Measures., We reviewed charts from health-care maintenance visits pre- and postintervention. We analyzed within resident pre- and postrates of sexual history taking and the number of sexual history components documented using paired t -tests. Results., In total, we reviewed 369 pre- and 260 postintervention charts. The mean number of charts per resident was 14.8 (range 8,29) pre-intervention and 10.4 (range 3,25) postintervention. The mean documentation rate per resident for one or more components of sexual history pre- and postintervention were 22.5% (standard deviation [SD] = 18.1%) and 31.7% (SD = 20.4%), respectively, P < 0.01. The most frequently documented components of sexual history were current sexual activity, number of current sexual partners, and gender of current sexual partner. The least documented components were history of specific sexually transmitted infections, gender of sexual partners over lifetime, and sexual behaviors. Conclusion., An educational intervention modestly improved documentation of sexual histories by Internal Medicine residents. Future studies should examine the effects of more comprehensive educational interventions and the impact of such interventions on physician behavior or patient care outcomes. Loeb DF, Aagaard EM, Cali SR, and Lee RS. Modest impact of a brief curricular intervention on poor documentation of sexual history in university-based resident internal medicine clinics. J Sex Med 2010;7:3315,3321. [source] Strongyloides stercoralis hyperinfection: difficulties in diagnosis and treatmentANAESTHESIA, Issue 3 2010N. M. Feely Summary Immunocompromised patients who are infected with Strongyloides stercoralis may develop a potentially fatal auto-infection syndrome characterised by non-specific pulmonary and gastrointestinal symptoms and Gram negative sepsis. We present the case of one such patient who underwent a negative laparotomy for a presumed intra-abdominal surgical catastrophe with a subsequent protracted stay on the intensive care unit. Once the diagnosis of strongyloidiasis was made, the patient was successfully treated with subcutaneous antihelminthic drugs. With appropriate screening for and eradication of strongyloides in those with immune compromise, or in those about to start immunosuppressive therapy, potentially fatal episodes of hyperinfection could be avoided. In the absence of screening, severe strongyloidiasis should be suspected in immunosuppressed individuals who have travelled to or resided in an endemic area and present with the characteristic features. Awareness of the signs of hyperinfection amongst those involved in acute care could prevent unnecessary morbidity and mortality in these patients. [source] Pseudoxanthoma elasticum-like lesions in association with thalassaemia majorAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2009Shirley Yu ABSTRACT A 33-year-old woman with a background of thalassaemia major presented with a 3-month history of yellowish plaques on the back of her neck bilaterally and alterations in the texture of the skin in both axillae. Examination of these lesions showed yellowish cobblestone plaques and coalescing papules in both axillae. Pseudoxanthoma elasticum (PXE)-like lesions were confirmed histopathologically. PXE-like lesions in association with thalassaemia major are an uncommon occurrence. Due to the increase in the survival rate of thalassaemia major patients on treatment, the development of these lesions is likely to increase. The histopathological manifestation of these lesions mimics that of hereditary PXE and is associated with severe vascular complications. This case highlights the importance of recognising this rare disorder and the role dermatologists have in establishing the diagnosis and advising on appropriate screening for complications. [source] | ||||||||||