Organization Criteria (organization + criterion)

Distribution by Scientific Domains

Kinds of Organization Criteria

  • health organization criterioN
  • world health organization criterioN

  • Selected Abstracts

    The metabolic syndrome in type 2 diabetes: When does it matter?

    J. Wong
    Aims:, Young adults with type 2 diabetes (T2Dm) present the clinician with the problem of when to start therapies for the primary prevention of vascular disease and how to identify those at most vascular risk. We examine whether the metabolic syndrome (MetS) can be a useful clinical tool to stratify vascular risk in this context. Methods:, Data were collected from 5928 subjects with T2Dm, and subjects were categorized as having MetS by World Health Organization criteria (body mass index criteria modified for Asians using >23 kg/m2). The prevalence of macrovascular disease was examined by MetS status and age. Results:, The overall MetS prevalence was 72.3%. MetS was associated with an increased prevalence of ischaemic heart disease (IHD) (17.2% MetS vs. 11.6% no MetS, p < 0.0001), coronary artery bypass graft (7.6 vs. 4.7%, p < 0.0003), peripheral vascular disease (PVD) (4.7 vs. 3.7%, p = 0.08) and stroke (6 vs. 3.9%, p = 0.002) across all age groups. MetS subjects had an IHD prevalence equivalent to that seen in subjects who were one decade older without MetS. The most significant impact of MetS was for the age group of 40,49 years with much lesser impact seen with progressively increasing age [odds ratio (OR) = 2.1 for IHD in MetS compared with no MetS at age 40,50 years, p < 0.05; falling progressively to OR = 1.5 at age >70 years, p > 0.05]. Similar trends were seen for coronary artery by-pass graft (CABG) and PVD. There was a strong relationship between the number of MetS risk factors and IHD prevalence (r = 0.99, p = 0.0001). Conclusions:, These data suggest that MetS is particularly useful in stratifying vascular risk in younger T2Dm patients and in those with a high number of MetS components. For patients with MetS, especially those with a full house of MetS risk factors, commencing risk-lowering interventions 10 years earlier than their MetS-free counterparts could be considered. [source]

    Validation of an algorithm combining haemoglobin A1c and fasting plasma glucose for diagnosis of diabetes mellitus in UK and Australian populations

    DIABETIC MEDICINE, Issue 2 2009
    S. E. Manley
    Abstract Aim, To determine whether glycated haemoglobin (HbA1c) can be used in combination with fasting plasma glucose (FPG) for the diagnosis of diabetes in patients with impaired fasting glucose (IFG) and in a broader spectrum of patients. Methods, An algorithm was derived from oral glucose tolerance test (OGTT) capillary samples in 500 consecutive UK patients with IFG by World Health Organization criteria. It was validated in a further 500 UK patients and, with venous specimens, in 1175 unselected Australian patients. Results, The derivation cohort was aged 61 years (50,69 years) (median IQ range) with 52% male and 12% South Asian. Diabetes Control and Complications Trial-aligned HbA1c was 6.2% (5.8,6.6%) (reference interval < 6.0%) and FPG 6.7 mmol/l (6.3,7.2 mmol/l). FPG was in the diabetes range in 36% of patients, with an OGTT identifying a further 12% with diabetes. The derived algorithm, (HbA1c , 6.0% with FPG < 7.0 mmol/l) identified those patients requiring an OGTT to diagnose diabetes. When applied to the UK validation cohort, sensitivity was 97% and specificity 100%. The algorithm was equally effective in the unselected group, aged 59 years (49,68 years) and 54% male, with sensitivity 93% and specificity 100%. HbA1c was 6.0% (5.6,6.6%) and FPG 6.0 mmol/l (5.3,6.8 mmol/l), with 26% having IFG. Use of the algorithm would reduce the number of OGTTs performed in the UK validation cohort by 33% and by 66% in the Australian patients studied. Conclusions, Use of this algorithm would simplify procedures for diagnosis of diabetes and could also be used for monitoring pre-diabetes. Validation is now required in other populations and patient groups. [source]

    Caries and dental fluorosis in a western Saharan population of refugee children

    José Manuel Almerich-Silla
    The aim of this study was to investigate the relationship between dental fluorosis and dental caries among western Saharan refugee children. The western Saharan child population is characterized by adverse living conditions, an unbalanced diet, poor oral hygiene habits, and a concentration of fluoride in the drinking water of around 2 p.p.m. (2 mg l,1). A sample consisting of 360 children, 6,7 yr of age, and 212 children, 11,13 yr of age, was obtained from four refugee camps (Smara, Awsard, El-Aaiun, and 27-February) situated in the vicinity of Tindouf (southern Algeria). The children were examined using the World Health Organization criteria for caries diagnosis and Dean's index for fluorosis. The decayed, missing or filled teeth (DMFT) score was 0.48 in the 6,7-yr-old children and 1.69 in the 11,13-yr-old children, with a caries prevalence (DMFT > 0 or decayed and filled primary teeth (dft) > 0) of 47.2% and 63.2%, respectively. Among the 6,7 yr-old children examined, 36.9% were free of fluorosis, 15.6% presented moderate fluorosis, and 7.8% presented severe fluorosis. Among 11,13 yr-old children, only 4.2% were free of fluorosis, 30.2% exhibited moderate fluorosis, and 27.4% presented severe fluorosis. The mean DMFT, decayed permanent teeth (DT), and caries prevalence (DMFT > 0 and DMFT or dft > 0) scores were significantly higher among the children affected by severe fluorosis, suggesting that severe fluorosis might increase the susceptibility to dental caries. [source]

    Do Diabetic Patients Have Higher In-hospital Complication Rates When Admitted from the Emergency Department for Possible Myocardial Ischemia?

    Peter B. Richman MD
    Abstract Objective: To compare in-hospital complication rates for diabetic and nondiabetic patients admitted from the emergency department (ED) for possible myocardial ischemia. Methods: This was a prospective, observational study of consecutive consenting patients presenting to a suburban university hospital ED during study hours with typical and atypical symptoms consistent with cardiac ischemia. Demographic, historical, and clinical data were recorded by trained research assistants using a standardized, closed-question, data collection instrument. Inpatient records were reviewed by trained data abstractors to ascertain hospital course and occurrence of complications. Final discharge diagnosis of acute myocardial infarction (AMI) was assigned by World Health Organization criteria. Categorical and continuous data were analyzed by chi-square and t-tests, respectively. All tests were two-tailed with alpha set at 0.05. Results: There were 1,543 patients enrolled who did not have complications at initial presentation; 283 were diabetic. The rule-in rate for AMI was 13.8% for nondiabetic patients and 17.7% for diabetic patients (p = 0.09). Times to presentation were similar for nondiabetic vs diabetic patients [248 minutes (95% CI = 231 to 266) vs 235 minutes (95% CI = 202 to 269); p = 0.32]. Nondiabetic patients tended to be younger [56.6 years (95% CI = 55.8 to 57.4) vs 61.6 years (95% CI = 60.2 to 63.1); p = 0.001] and were less likely to be female (34.3% vs 48.1%; p = 0.001). The two groups had similar prevalences for initial electrocardiograms diagnostic for AMI (5.5% vs 7.4%; p = 0.21). There was no significant difference between nondiabetic and diabetic patients for the occurrence of the following complications after admission to the hospital: congestive heart failure (1.3% vs 1.1%, p = 0.77); nonsustained ventricular tachycardia (VT) (1.3% vs 1.2%, p = 0.93); sustained VT (1.2% vs 1.1%, p = 0.85); supraventricular tachycardia (1.7% vs 3.2%, p = 0.12); bradydysrhythmias (1.9% vs 1.1%, p = 0.33); hypotension necessitating the use of pressors (0.9% vs 1.1%, p = 0.76); cardiopulmonary resuscitation (0.2% vs 0.7%, p = 0.10); and death (0.3% vs 0.7%, p = 0.34). One or more complications occurred with similar frequencies for patients in the two groups (6.3% vs 5.7%; p = 0.70). Conclusions: No statistically significant difference was found in the post-admission complication rates for initially stable diabetic vs nondiabetic patients admitted for possible myocardial ischemia. Based on these results, the presence or absence of diabetes as a comorbid condition does not indicate a need to alter admitting decisions with respect to risk for inpatient complications. [source]

    Osteoprotegerin and bone turnover markers in heavily pretreated HIV-infected patients

    HIV MEDICINE, Issue 3 2005
    E Seminari
    Objectives To characterize osteoprotegerin (OPG) levels, bone remodelling and bone mineral density (BMD) in heavily pretreated HIV-infected patients on antiretroviral therapy, and to evaluate the clinical factors associated with bone density decline. Methods Heavily pretreated (>5 years) HIV-positive patients were enrolled in this cross-sectional, observational study, which was based on a total body bone densitometry examination and a comprehensive evaluation of bone and mineral parameters. Results Sixty-eight patients (55 male and 13 female) with a median age of 41 years (range 25,60 years) were included in the study. Their antiretroviral treatment lasted for 82 months. On the basis of the World Health Organization criteria, nine patients (13.2%) were osteoporotic [T-score<,2.5 standard deviation (SD)] and 19 patients (27.9%) were osteopenic (T-score between,1 and,2.5). The principal outcomes associated with the presence of a low BMD were high OPG and lysylpyridinoline/creatinine ratio (Dpd) values. Most of the patients (39 of 48; 81.25%) showed vitamin D insufficiency [Vitamin D (25(OH)D)<18 ng/mL] with secondary hyperparathyroidism (13 of 50 patients: 26%), which proved to be correlated to osteocalcin (BGP) levels [parathyroid hormone (PTH) vs. BGP: r=0.34; P<0.01]. There was an inverse correlation between T-scores and serum osteocalcin and alkaline phosphatase (AP) levels, on one hand, and Dpd, on the other. High AP and Dpd values were associated with relative risks of 4.1 [95% confidence interval (CI)=1.01,17.6] and 7.2 (95% CI=1.67,31.03), respectively, of a pathological T-score. Multivariate analysis revealed that the factors associated with the presence of osteopenia or osteoporosis were older age and lower body mass index. Conclusions About 40% of our heavily pretreated subjects with advanced HIV infection had a low BMD, and 56% (24 of 44 patients) showed a high bone turnover rate with marked osteoclast activation. High OPG levels may protect against bone resorption. [source]

    Dental caries and associated factors in 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India

    J. DAVID
    Summary Objectives. The aims of the present study were to describe the dental health status of 12-year-old schoolchildren in Thiruvananthapuram, Kerala, India, and to identify sociodemographic factors, oral health behaviours, attitudes and knowledge related to dental caries experience. Methods. The study took the form of a cross-sectional survey of 838 children in upper primary schools. A two-stage cluster sampling technique was used. Dental caries was measured using World Health Organization criteria. Sociodemographic factors, oral health behaviours, attitudes and knowledge were assessed by a self-administered questionnaire. Results. The prevalence of dental caries in the permanent dentition was 27%. The mean number of decayed, missing and filled teeth was 0·5 (SD = 0·9). The decayed component (D) constituted 91% of the total number of decayed, missing and filled teeth (DMFT). Multiple logistic regression analysis showed that children had a higher risk of having dental caries if they lived in urban area [OR = 1·5, 95% confidence interval (CI) = 1·1,2·1], had visited a dentist (OR = 1·6, 95% CI = 1·2,2·2), did not use a toothbrush (OR = 1·9, 95% CI = 1·2,2·9), consumed sweets (OR = 1·4, 95% CI = 1·0,1·9) or performed poorly in school (OR = 1·7, 95% CI = 1·0,2·3). Conclusions. The prevalence of caries in this sample of 12-year-old schoolchildren was low compared to that in other developing countries. The present study indicated that urban living conditions were associated with more dental caries. Since urbanization is rapid in India, oral health promotion at the present time would be valuable to prevent increased caries prevalence. [source]

    Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

    Linus Okeke
    Objective: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. Methods: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999,November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4,6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P , 0.05 was considered significant. Results: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5,7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of ,20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) Conclusion: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy. [source]

    The Association Between Obesity and the Frailty Syndrome in Older Women: The Women's Health and Aging Studies

    Caroline S. Blaum MD
    Objectives: To determine whether obesity is associated with the frailty phenotype and, if so, whether comorbid conditions or inflammatory markers explain this association. Design: Cross-sectional analysis of baseline data from the Women's Health and Aging Studies I (1992) and II (1994), complementary population-based studies. Setting: Twelve contiguous ZIP code areas in Baltimore, Maryland. Participants: Five hundred ninety-nine community-dwelling women aged 70 to 79 with a body mass index (BMI) greater than 18.5 kg/m2. Measurements: The dependent variables were the frailty syndrome, including prefrailty, defined as presence of one or two of five frailty indicators (weakness, slowness, weight loss, low physical activity, exhaustion), and frailty, defined as three or more indicators. Independent variables included BMI, categorized using World Health Organization criteria as normal (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (,30 kg/m2); chronic diseases; C-reactive protein; and serum carotenoids. Results: Being overweight was significantly associated with prefrailty, and obesity was associated with prefrailty and frailty. In all frail women, regardless of BMI group, a similar pattern of three defining frailty indicators was found: slowness, weakness, and low activity (with the addition of weight loss in the normal weight group.) In multinomial regression models, obesity was significantly associated with prefrailty (odds ratio (OR)=2.23, 95% confidence interval (CI)=1.29,3.84) and frailty (OR=3.52, 95% CI=1.34,9.13), even when controlling for covariates. Conclusion: Obesity is associated with the frailty syndrome in older women in cross-sectional data. This association remains significant even when multiple conditions associated with frailty are considered. Prospective studies are needed to confirm this finding. [source]

    MRI of sporadic Creutzfeldt,Jakob disease

    A Kong
    Summary The key MRI findings in five cases of sporadic Creutzfeldt,Jakob disease (CJD) are illustrated with four ,definite' and one ,probable' according to World Health Organization criteria. Close attention to fluid-attenuation inversion recovery and diffusion-weighted imaging sequences are important for diagnosis, noting especially restricted diffusion in cortical and deep grey matter. Our study and those of others show predominant cortical, caudate and thalamic involvement. This pattern is highly sensitive and specific for the diagnosis. Fluid-attenuation inversion recovery and diffusion-weighted imaging signal abnormality becomes progressively more extensive and bilateral as disease progresses, but may become less pronounced in end-stage disease because of atrophy. [source]

    Hypo-osmotic swelling test and unexplained repeat early pregnancy loss

    Sudhindra M. Bhattacharya
    Abstract Aim:, To study the relationship of various sperm characteristics and hypo-osmotic swelling test (HOS test) with repeat unexplained early pregnancy loss. Methods:, Semen samples from husbands of 74 couples with a history of repeat early pregnancy loss (group A) were analyzed according to World Health Organization criteria, and a HOS test was performed in each case. Semen samples from 65 husbands with proven fertility (group B) were also studied for comparison. Results:, No statistically significant differences were noted in the age of the husbands, sperm concentration, sperm morphology and percent motile sperm between groups A and B. The mean HOS test scores of the two groups were significantly different (group A: 60.4%; group B: 76.9%; P = 0.01 [normal value: >60%]). In group A, 33.8% of cases (25/74) and in group B, 12.3% of cases (8/65) showed low HOS test scores. Conclusion:, The sperm HOS test may be helpful to screen for any paternal factor associated with repeat embryonic or early fetal loss and in a resource-poor setting, and may be utilized in any clinical laboratory. [source]

    Screening Trauma Patients With the Alcohol Use Disorders Identification Test and Biomarkers of Alcohol Use

    ALCOHOLISM, Issue 6 2009
    Tim Neumann
    Background:, Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. Methods:, The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. Results:, There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. Conclusions:, Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers. [source]

    A Comparison of Dental Caries Levels in Two Communities with Different Oral Health Prevention Strategies Stratified in Different Social Classes

    Darius Sagheri PhD
    Abstract Objectives: To compare dental caries levels of schoolchildren stratified in different social classes whose domestic water supply had been fluoridated since birth (Dublin) with those living in an area where fluoridated salt was available (Freiburg). Methods: A representative, random sample of twelve-year-old children was examined and dental caries was recorded using World Health Organization criteria. Results: A total of 699 twelve-year-old children were examined, 377 were children in Dublin and 322 in Freiburg. In Dublin the mean decayed, missing, and filled permanent teeth (DMFT) was 0.80 and in Freiburg it was 0.69. An examination of the distribution of the DMFT score revealed that its distribution is highly positively skewed. For this reason this study provides summary analyses based on medians and inter-quartile range and nonparametric rank sum tests. In both cities caries levels of children in social class 1 (highest) were considerably lower when compared with the other social classes regardless of the fluoride intervention model used. The caries levels showed a reduced disparity between children in social class 2 (medium) and 3 (lowest) in Dublin compared with those in social class 2 and 3 in Freiburg. Conclusions: The evidence from this study confirmed that water fluoridation has reduced the gap in dental caries experience between medium and lower social classes in Dublin compared with the greater difference in caries experience between the equivalent social classes in Freiburg. The results from this study established the important role of salt fluoridation where water fluoridation is not feasible. [source]

    Evaluation of zeta and HA-binding methods for selection of spermatozoa with normal morphology, protamine content and DNA integrity

    ANDROLOGIA, Issue 1 2010
    S. H. Razavi
    Summary Sperm selection parameters based on morphology and motility for ICSI might not be relevant to chromatin integrity. Thus sperm selection based on sperm characteristics has been suggested. Therefore, the aim of this study was to evaluate the efficiency of the zeta and hyaluronic acid (HA) sperm selection procedures with neat semen, for recovering spermatozoa with normal morphology, protamine content and DNA integrity in infertile men. Semen samples from 77 infertile couples were assessed during this study. Semen analysis was carried out according to World Health Organization criteria. Protamine content, DNA integrity and sperm morphology were assessed by chromomycin A3, sperm chromatin dispersion and Papanicolaou staining respectively. The results show that both HA and zeta methods were efficient to recover spermatozoa with normal morphology and protamine content. In terms of the latter parameters, there was no superiority between the two procedures. However, in terms of DNA integrity, the zeta method was more efficient compared with the control and HA procedure and no significant difference was observed between HA and the controls. Therefore, the zeta method appears to be a suitable procedure to recover spermatozoa with normal DNA integrity. [source]

    Association between freezing agent and acrosome damage of human spermatozoa from subnormal and normal semen

    ANDROLOGIA, Issue 6 2001
    M. E. Hammadeh
    Summary. This experimental study compares the effects of human sperm preservation medium (HSPM) with TEST,yolk buffer (TYB) as cryoprotectants of human spermatozoa with respect to the integrity of the acrosome after the freeze,thawing procedure. Fifty-six semen samples were included in this study; 18 were subnormal (G1) and 38 were normal (G2) based on World Health Organization criteria, except for morphology, which was evaluated according to strict criteria. Each semen sample was divided into two parts: the first part was prepared for cryopreservation by the addition of HSPM (1:1) and the second by addition of TYB (1:1). Freezing was performed in liquid nitrogen vapour. Smears were made before freezing and after the thawing process for evaluation of acrosome integrity using fluorescent-lectin labelling. The mean percentage of spermatozoa with intact acrosomes in the subnormal group was 77.0 ± 7.2% before freezing and decreased significantly (P < 0.001) after thawing: to 63.7 ± 8.2% with the use of HSPM and 66.8 ± 8.7% with the use of TYB. The corresponding values in the normal semen samples were 83.4 ± 9.2%, 76.0 ± 8.8% and 77.9 ± 9.2%, respectively. It is obvious that the decrease in the mean percentage of spermatozoa with intact acrosome was significantly higher when using HSPM in comparison with TYB, not only for G1 (,14.9 ± 1.9% versus ,11.8 ± 1.4%) but also for G2 samples (,13.8 ± 1.5% versus ,11.9 ± 1.3%). In conclusion, TYB should be recommended for freeze,thawing of human spermatozoa as the first-choice cryoprotectant, for normal as well as subnormal semen samples, in order to protect the sperm acrosome from the deleterious effects of the freeze,thawing procedure. [source]

    Oral lichenoid reactions associated with amalgam: improvement after amalgam removal

    A. Dunsche
    Summary Background The pathogenetic relationship between oral lichenoid reactions (OLR) and dental amalgam fillings is still a matter of controversy. Objectives To determine the diagnostic value of patch tests with amalgam and inorganic mercury (INM) and the effect of amalgam removal in OLR associated with amalgam fillings. Methods In 134 consecutive patients 467 OLR were classified according to clinical criteria. One hundred and fifty-nine biopsies from OLR lesions were histologically diagnosed according to the World Health Organization criteria for oral lichen planus (OLP) and compared with 47 OLP lesions from edentulous patients without amalgam exposure. One hundred and nineteen patients were patch tested with an amalgam series. In 105 patients (357 of 467 lesions) the amalgam fillings were removed regardless of the patch test results and OLR were re-examined within a follow-up period of about 3 years. Twenty-nine patients refused amalgam removal and were taken as a control group. Results Eleven patients with OLR (8·2%) had skin lesions of lichen planus (LP). Histologically, the lesions in the OLR group could not be distinguished from those seen in the OLP group. Thirty-three patients (27·7%) showed a positive patch test to INM or amalgam. Amalgam removal led to benefit in 102 of 105 patients (97·1%), of whom 31 (29·5%) were cured completely. Of 357 lesions, 213 (59·7%) cleared after removal of amalgam, whereas 65 (18·2%) did not improve. In the control group without amalgam removal (n = 29) only two patients (6·9%) showed an improvement (P < 0·05). Amalgam removal had the strongest impact on lesions of the tongue compared with lesions at other sites (P < 0·05), but had very little impact on intraoral lesions in patients with cutaneous LP compared with patients without cutaneous lesions (P < 0·05). Patients with a positive patch test reaction to amalgam showed complete healing more frequently than the amalgam-negative group (P < 0·05). After an initial cure following amalgam removal, 13 lesions (3·6%) in eight patients (7·6%) recurred after a mean of 14·6 months. Conclusions Of all patients with OLR associated with dental amalgam fillings, 97·1% benefited from amalgam removal regardless of patch test results with amalgam or INM. We suggest that the removal of amalgam fillings can be recommended in all patients with symptomatic OLR associated with amalgam fillings if no cutaneous LP is present. [source]

    Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients

    CANCER, Issue 5 2010
    Seunggu J. Han BS
    Abstract BACKGROUND: Primary gliosarcoma (PGS) is a rare central nervous system tumor with limited experience reported in the literature. In the current study, the authors present a modern series of confirmed PGS cases treated in the era of magnetic resonance imaging (MRI), after the accepted glioblastoma management of resection, radiation, and temozolomide. METHODS: Using a retrospective review, patients with confirmed PGS were identified (1996-2008). Cases were determined to be PGS by central pathology review using the 2007 World Health Organization criteria. Extensive chart review was performed to gather clinical and pathologic data on these cases. RESULTS: All but 1 patient had undergone a preoperative MRI, with 1 patient receiving a computed tomography scan due to a cardiac pacemaker. A total of 10 patients received radiotherapy with concurrent and adjuvant temozolomide chemotherapy, and 8 patients received radiotherapy alone or in combination with other chemotherapeutic agents. In 2 patients, the history of adjuvant treatment could not be confirmed. The overall median survival was 13.9 months (range, 2.2-22.9 months). Patients with gliosarcomas resembling meningioma were found to have a significantly prolonged median survival compared with patients harboring gliosarcoma resembling glioblastoma multiforme (16 months vs 9.6 months; P = .011). However, no difference in survival was noted between patients who received concurrent radiotherapy and temozolomide compared with those who did not (10.4 months vs 13.9 months; P = .946). CONCLUSIONS: The results of the current study support previous hypotheses that there are 2 distinct types of PGS. The type mimicking the appearance of a meningioma appears to carry a significantly more favorable prognosis, most likely due to an increased chance at achieving macroscopic total resection. Cancer 2010. © 2010 American Cancer Society. [source]

    Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia,

    CANCER, Issue 4 2006
    A Gynecologic Oncology Group study
    Abstract BACKGROUND Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75,80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH). METHODS This prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses. RESULTS Between November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens. CONCLUSIONS The prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma. Cancer 2006. © 2006 American Cancer Society. [source]

    Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid

    CANCER, Issue 1 2005
    Chiara Pilatrino M.D.
    Abstract BACKGROUND The authors investigated the efficacy and safety of the histone deacetylase inhibitors valproic acid (VPA) and all-trans retinoic acid (ATRA) as differentiation agents in a cohort of older, poor-risk patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). METHODS Twenty older patients with recurrent or refractory AML or MDS were treated in a Phase II protocol with sequential VPA and ATRA therapy. VPA was started at a dose of 10 mg/kg per day and then escalated to achieve the serum concentration of 45,100 ,g/mL. ATRA was added at 45 mg/square meters (sm) per day when VPA reached the target serum concentration. Only patients treated continuously for , 2 months were considered evaluable. RESULTS Hematologic improvement, according to World Health Organization criteria, was observed in 6 of 20 patients enrolled in the protocol but in 6 of 11 considered evaluable. In five patients, a major platelet response was observed, achieving platelet transfusion independence. Three of these five patients also exhibited a minor erythroid response. A sixth patient showed both a minor erythroid response and a platelet response. The median duration of response was 189 days (range, 63,550 days). No significant reduction in the blast count was observed. Grade 3 neurocortical toxicity was observed in four patients. Severe bone pain was experienced by 4 patients (2 Grade 4 and 2 Grade 3) and was associated with an increase in the peripheral blast cell count. Treatment with ATRA did not modify the response observed with VPA alone. CONCLUSIONS Differentiation therapy with VPA was of clinical benefit in approximately 30% of elderly patients with AML and MDS of the refractory anemia with excess of blast type with unfavorable prognostic features. A striking platelet transfusion independence lasting several months may be obtained in some patients, reducing the burden of palliative care and improving the quality of life. Cancer 2005;. © 2005 American Cancer Society. [source]

    Small cell astrocytoma: An aggressive variant that is clinicopathologically and genetically distinct from anaplastic oligodendroglioma

    CANCER, Issue 10 2004
    Arie Perry M.D.
    Abstract BACKGROUND Small cell glioblastoma (GBM) is a variant with monomorphous, deceptively bland nuclei that often is misdiagnosed as anaplastic oligodendroglioma. METHODS To elucidate its clinicopathologic and genetic features, the authors studied 71 adult patients (median age, 57 years), including 22 patients who were identified from a set of 229 GBMs (10%) that had been characterized previously by epidermal growth factor receptor (EGFR)/EGFR-vIII variant immunohistochemistry. Tumors also were analyzed by fluorescence in situ hybridization for 1p, 19q, 10q, and EGFR copy numbers. RESULTS Radiologically, 37% of tumors that were not selected for grade showed minimal to no enhancement. Similarly, 33% of tumors had no endothelial hyperplasia or necrosis histologically, qualifying only as anaplastic astrocytoma (Grade III) using World Health Organization criteria. Nevertheless, such tumors progressed rapidly, with mortality rates that were indistinguishable from their Grade IV counterparts. The median survival for 37 patients who were followed until death was 11 months. Oligodendroglioma-like histology included chicken-wire vasculature (86%), haloes (73%), perineuronal satellitosis (58%), and microcalcifications (45%), although mucin-filled microcystic spaces were lacking. No small cell astrocytomas had 1p/19q codeletions, whereas EGFR amplification and 10q deletions were present in 69% and 97% of small cell astrocytomas, respectively. The tumors expressed EGFR and EGFR-vIII more commonly than nonsmall cell GBMs (83% vs. 35% [P < 0.001]; 50% vs. 21% [P < 0.001] respectively). CONCLUSIONS Small cell astrocytoma is an aggressive histologic variant that behaved like primary GBM, even in the absence of endothelial hyperplasia and necrosis. Despite considerable morphologic overlap with anaplastic oligodendroglioma, clinicopathologic and genetic features were distinct. Fifty percent of small cell astrocytomas expressed the constitutively activated vIII mutant form of EGFR, and molecular testing for 10q deletion improved the diagnostic sensitivity over EGFR alone. Cancer 2004. © 2004 American Cancer Society. [source]

    Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study

    Fausto Medeiros Mendes
    Mendes FM, Braga MM, Oliveira LB, Antunes JLF, Ardenghi TM, Bönecker M. Discriminant validity of the International Caries Detection and Assessment System (ICDAS) and comparability with World Health Organization criteria in a cross-sectional study. Community Dent Oral Epidemiol 2010; 38: 398,407. © 2010 John Wiley & Sons A/S Abstract,,, Objectives:, The aim of this cross-sectional study in preschool children was to assess the ability of International Caries Detection and Assessment System (ICDAS) in discriminating socioeconomic factors associated with the presence of caries lesions at both noncavitated and cavitated thresholds and to compare with the standard World Health Organization (WHO) criteria. Methods:, The study was carried out in Amparo, Brazil, during the National Day of Children's Vaccination including 252 children aged 36,59 months. The same child was independently examined by two calibrated examiners, one using the ICDAS and the other using WHO criteria. Socioeconomic information was also recorded. Associations between socioeconomic factors and presence of caries assessed as binary (caries prevalence) and count outcome (actual dmfs values) obtained by WHO criteria and by ICDAS at noncavitated and cavitated thresholds were evaluated by Poisson regression analysis with robust variance. Results:, Some covariates were significantly associated with the presence of caries evaluated by the WHO criteria and by ICDAS (using score 3 as cut-off point). When noncavitated scores of ICDAS were used to calculate the presence of caries, the discriminant power decreased. When dmfs values were used as outcome, no differences in the associations were observed between two systems or using noncavitated caries lesions. Conclusion:, Cavitated scores of ICDAS present similar discriminant validity compared with WHO criteria when presence of caries is used as outcome; however, when actual dmfs values are used, no differences are observed in using noncavitated or cavitated caries lesions. [source]

    Salt fluoridation and dental caries in Jamaica

    Saskia R. Estupiñán-Day
    Abstract ,Purpose: In 1987, Jamaica initiated a comprehensive island-wide salt fluoridation program. A survey was conducted in 1995 to monitor the impact of salt fluoridation among children in Jamaica. Methods: Dental examinations of 1120 children aged 6,8, 12, and 15 years were conducted according to World Health Organization criteria to assess dental caries, fluorosis, the presence of and need for dental sealants, and Community Periodontal Treatment Needs (CPI). Results: Age specific DMFT means observed in 1995 were 0.2 at age 7, 0.4 at age 8, 1.1 at age 12 and 3.0 at age 15. The mean DMFT scores in children 6, 12 and 15 years of age were dramatically lower than the corresponding scores of 1.7, 6.7 and 9.6 obtained at the baseline examination in 1984 for children of the same age groups, respectively (baseline data for 7- and 8-year-olds were not collected). The mean percentage of sound permanent teeth for all age groups was 90% in 1995. The percentage of children caries-free at baseline was 27.6% for 6 years, 2.8% for 12 years and 0.3% for 15 years of age. In 1995, the percentage of caries-free children (permanent teeth) was 61%. In 1984, 23 children were scored as having very mild or mild fluorosis. In 1995, five children were scored in the same categories of fluorosis, using Dean's criteria; thus, fluorosis remained at negligible levels in 1995. Conclusions: The oral health survey conducted in Jamaica in 1995 indicated a significant decline in dental caries compared with findings in 1984. The major change in Jamaica during the interval was the introduction of salt fluoridation in 1987. Dental fluorosis was low in the 1995 survey. [source]