Liver Tuberculosis Presenting as an Uncommon Cause of Pyrexia of Unknown Origin: Positron Emission Tomography/Computed Tomography Identifies the Correct Site for Biopsy

Objective

To identify the correct site to biopsy in a case of pyrexia of unknown origin (PUO) caused by hepatic tuberculosis (TB).

Clinical Presentation and Intervention

A 58-year-old man who developed hepatic TB presented with PUO. Ultrasonography (US) and computed tomography (CT) of the abdomen showed only calcifications in the liver, and positron emission tomography (PET)/CT showed diffuse increased metabolic activity in addition to focal areas of increased activity. A diagnosis of hepatic TB was confirmed by histological examination of liver tissues and interferon-γ release assays (IGRAs of T-SPOT/TB). The patient was treated with 4 anti-tubercular therapies (rifampicin, isoniazid, ethambutol and pyrazinamide). At the 3-month follow-up, the patient was disease free as confirmed by abdominal US.

Conclusion

PET/CT was helpful in identifying a site to biopsy that led to the correct diagnosis.Key Words: Hepatic tuberculosis, Positron emission tomography, Computed tomography, Pyrexia of unknown origin     

Sixty-Four-Slice Multidetector Computerized Tomography in the Evaluation of Transmesenteric Internal Hernias following Roux-en-Y Bariatric Surgery

Objective

To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients.

Subjects and Methods

This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration.

Results

Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively.

Conclusion

The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.Key Words: Internal hernia, Bariatric surgery, Computerized tomography, Roux-en-Y, Gastric bypass     

Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients

Objective

To determine the long-term follow-up of the various operations for lumbar disc herniation in a large patient population.

Subjects and Methods

Patients who had operations for lumbar disc herniation (microdiscectomy, endoscopic microdiscectomy and the ‘classical operation’, i.e. laminectomy/laminotomy with discectomy) were collected from the world literature. Patients who had follow-ups for at least 2 years were analyzed relative to the outcome. The outcome was graded by the patients themselves, and the operative groups were compared to one another.

Results

39,048 patients collected from the world literature had had lumbar disc operations for disc herniations. The mean follow-up period was 6.1 years, and 30,809 (78.9s%) patients reported good/excellent results. Microdiscectomy was performed on 3,400 (8.7s%) patients. The mean follow-up was 4.1 years with 2,866 (84.3s%) good/excellent results, while 1,101 (3.6s%) patients had endoscopic microdiscectomy. There, the mean follow-up was 2.9 years with 845 (79.5s%) good/excellent results. The classical operation was performed on 34,547 (88.5s%) patients with a mean follow-up period of 6.3 years, and 27,050 (78.3s%) patients had good/excellent results. These results mirror those with discectomy and the placement of prosthetic discs.

Conclusions

The analysis of 39,048 patients with various operations for lumbar disc herniation revealed the same pattern of long-term results. Patients who had microdiscectomy, endoscopic microdiscectomy or the classical operation (laminectomy/laminotomy with discectomy) all had approximately 79s% good/excellent results. None of the operative procedures gave a different outcome.Key Words: Lumbar disc herniation, Lumbar disc surgery, Long-term follow-up, Lumbar disc operations, Operations for lumbar disc herniation, Results of lumbar disc surgery     

Potassium Abnormalities in Current Clinical Practice: Frequency,Causes, Severity and Management

Objective

We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients.

Subjects and Methods

Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records.

Results

Of the 9,045 hospitalized patients, 1,265 (14.0s%) had a serum potassium abnormality; 604 (6.7s%) patients had hypokalemia and 661 (7.30s%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8s%) patients and renal losses in 252 (41.7s%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8s%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4s%) patients, followed by renal failure in 191 (28.8s%). Two hundred and ninety-eight (45.0s%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0s%) were normokalemic at hospital discharge.

Conclusion

This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.Key Words: Hypokalemia, Hyperkalemia, Potassium     

Clinical Factors Associated with Negative Urinary Antigen Tests Implemented for the Diagnosis of Community-Acquired Pneumococcal Pneumonia in Adult Patients

Objective

This study investigated clinical factors associated with negative urinary antigen tests (UAT) implemented for the diagnosis of pneumococcal community-acquired pneumonia (CAP) in adult patients.

Subjects and Methods

We reviewed the medical records of 755 adult patients who completed the UAT in our hospital between 2009 and 2012. Of these, we evaluated 63 patients with bacteriologically confirmed definite pneumococcal CAP (33 were UAT-positive, and 30 were UAT-negative).

Results

There was no significant difference between the UAT-positive and the UAT-negative patients regarding age, dehydration, respiratory failure, orientation, blood pressure (ADROP) score (the CAP severity score proposed by the Japanese Respiratory Society), gender, white blood cell counts, liver/kidney function tests, or urinalysis. However, serum C-reactive protein (CRP) concentrations were 31s% lower in the UAT-negative patients than in the UAT-positive patients (p = 0.02). Furthermore, the prothrombin time-international normalized ratio was 50s% higher in the UAT-negative patients than in the UAT-positive patients, although the difference did not reach statistical significance (p = 0.06). The prevalence of comorbidities was similar in both UAT-positive and UAT-negative patients. However, warfarin had been prescribed in 8 (27s%) of the UAT-negative patients compared to only 1 (3s%) of the UAT-positive patients (odds ratio = 11.6; p = 0.01).

Conclusions

These results suggested that low serum CRP concentrations and the use of warfarin increased the possibility with which false-negative UAT results occurred in these patients with pneumococcal CAP.Key Words: Urinary antigen test, Community-acquired pneumonia, Streptococcus pneumoniae, Anticoagulation therapy     

The Morbidity Rate of Chronic Disease among Chinese Rural Residents: Results from Liuyang Cohort

Objective

To study the health status and explore the putative risk factors of chronic diseases among a Chinese rural population.

Subjects and Methods

Face-to-face interviews were carried out to collect the information of social characteristics, health status and related risk factors of 11,909 families comprised of 49,383 subjects in the rural area of Liuyang, Hunan province during 2007. Chronic disease was diagnosed according to the diagnosis certification from the town clinic or superior level hospital.

Results

The morbidity rate of chronic disease among Liuyang rural residents in 2007 was 19.22s%. The prevalence of the top 10 chronic disorders was as follows: hypertension: 3.65s%; urolithiasis: 1.03s%; chronic obstructive pulmonary disease: 0.92s%; ischemic heart disease: 0.92s%; chronic gastritis: 0.91s%; cerebrovascular disease: 0.71s%; lumbar disk disease: 0.61s%; chronic viral hepatitis: 0.55s%; gallstones: 0.54s%, and diabetes: 0.54s%. Age, gender, educational level, occupation, marital status, type of housing, source of drinking water, smoking, underweight and overweight were factors associated with chronic disease. We also noticed that 14.2s% of the residents were underweight and 29.7s% are still using unsafe sources of drinking water.

Conclusions

The prevalence of chronic disease in Liuyang area was severe both in communicable and noncommunicable chronic disease. Unhealthy lifestyles such as tobacco usage and overweight partially contributed to the high prevalence of chronic disease.Key Words: Chronic disease, Epidemiology, Risk factors, Prevalence rate, Rural residence, China     

Can Appropriate Diagnosis and Treatment of Childhood Asthma Reduce Excessive Antibiotic Usage?

Introduction

This study compared the frequency of antibiotic usage and the number of asthma episodes before and after the diagnosis and treatment of pediatric asthma patients who were followed up by specialists.

Subjects and Methods

Included in this study were 334 patients (211 males and 123 females) of 2–16 years of age who were diagnosed with asthma and followed up for at least 1 year in our clinic. The frequency of antibiotic usage and the number of asthma episodes in the year prior to diagnosis and treatment were compared to these same variables after 1 year of follow-up by specialists.

Results

The median age was 84 months (range: 24–192) and 212 (63s%) children were at school or in day care centers. Atopy and a family history of asthma were present in 200 (60s%) of the patients, and 137 (41s%) reported that at least one member of their household smoked. Antibiotics were used a median number of 7 times [interquartile range (IQR) = 6] in the year before the asthma diagnosis, and 2 times (IQR = 3) during the year after treatment (p < 0.001). The mean number of asthma episodes before diagnosis, i.e. 4 (IQR = 8) was reduced to 0 (IQR = 2) in the year after treatment when the patients were followed up by specialists (p < 0.001).

Conclusion

This study shows that appropriate diagnosis and treatment of childhood asthma significantly reduce the frequency of antibiotic usage and the number of asthmatic episodes.Key Words: Childhood, Asthma, Antibiotic usage     

A Retrospective Radiographic Study of Coronal-Periapical Status and Root Canal Filling Quality in a Selected Adult Turkish Population

Objective

To investigate the oral health (with regard to the periapical status, quality of root fillings and coronal restorations) in an urban adult Turkish subpopulation using digital panoramic radiographs.

Materials and Methods

One thousand digital panoramic radiographs involving 28,000 teeth were selected from the archive of the Public Oral and Dental Health Center of Isparta. Coronal status (the type of restoration, signs of marginal leakage or decay), root filling quality (length and lateral seal) and periapical status (according to Periapical Index, PAI) were evaluated. Correlations between apical periodontitis (AP) and the quality of root fillings or coronal restorations were statistically analyzed using the χ² test.

Results

Of the 28,000 teeth evaluated, 22,380 (80.0s%) were sound, 4,732 (16.9s%) were missing, 753 (2.6s%) were filled and 135 (0.5s%) were decayed. Of the 753 coronal restorations, 400 (53.1s%) were radiographically acceptable. Of the 23,268 teeth, 601 (2.6s%) were root filled and 247 root fillings were adequate. Ninety-five (15.8s%) root-filled teeth had AP (PAI 3–5). Out of the total, the AP prevalence was 0.4s% in root-filled teeth and 0.8s% in teeth without root fillings. The presence of AP was significantly correlated with inadequate coronal restorations and root canal fillings (p = 0.000).

Conclusion

Tooth type, quality and type of coronal restorations, and length and homogeneity of root fillings significantly affected periapical status.Key Words: Coronal status, Digital panoramic radiography, Periapical index, Periapical status, Root canal filling quality     

Occupational Injuries Prone to Infectious Risks amongst Healthcare Personnel in Kuwait: A Retrospective Study

Objective

The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents.

Subjects and Methods

An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included.

Results

The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7s% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7s%), followed by doctors: 35 (14.1s%), technicians: 26 (10.4s%) and housekeeping personnel: 22 (8.8s%). Needle stick injury was the most common type of exposure, in 189 (75.9s%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7s%), were caused by hollow-bore needles. Exposure to blood represented 96.8s%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4s%)] and when performing surgical interventions [56 (22.6s%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6s%)] and garbage collection [21 (8.4s%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1s%)] and operating theaters [56 (22.6s%)]. Among the exposed HCP, 130 (52.2s%) had been fully vaccinated against hepatitis B virus (HBV).

Conclusion

Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.Key Words: Occupational exposure, Blood-borne viruses, Healthcare personnel, Kuwait     

Characteristics of Symptom Presentation and Risk Factors in Patients with Erosive Esophagitis and Nonerosive Reflux Disease

Objective

The aim of this study was to investigate the effect of gender on symptom presentation and quality of life of patients with erosive esophagitis (EE) and nonerosive reflux disorder (NERD).

Subjects and Methods

Medical records from patients with gastroesophageal reflux disease (GERD) between January and December 2009 were reviewed. The patients were assigned to either the EE or the NERD group. The general demographic data, the modified Chinese GERDQ scores and the Short Form (SF)-36 life quality questionnaire scores of the two groups of patients were compared.

Results

Of the 261 patients, 87 (33.3s%), 86 (33.0s%) and 88 (33.7s%) patients were classified into the EE, the NERD and the control groups, respectively. The patients in the EE group were significantly older (48.94 ± 17.38 vs. 43.34 ± 12.67 years), were predominately male (58.6 vs. 39.5s%), had more frequently hiatal hernia (34.5 vs 17.4s%), had a higher body weight (67.57 ± 15.13 vs. 61.06 ± 11.08 kg) and a higher body mass index (24.09 ± 4.61 vs. 22.68 ± 3.12) than those in the NERD group. The GERD-specific symptom scores and the general life quality scores of the EE and the NERD groups were similar, and both groups had lower life quality scores than the control group did. The female patients with NERD had a higher frequency of GERD symptoms and lower quality of life scores. Gender had no effect on symptom scores or life quality scores in the EE group.

Conclusion

The GERD-specific symptom severity and general quality of life scores of the EE and the NERD patients were similar. Gender had a great influence on symptom presentation and quality of life in patients with NERD, but not in those with EE.Key Words: Erosive esophagitis, Gastroesophageal reflux disease, Gender, Quality of life, Nonerosive reflux disease     

Investigating pulmonary embolism in the emergency department with lower limb plethysmography: the Manchester Investigation of Pulmonary Embolism Diagnosis (MIOPED) study

Objectives

To measure the diagnostic accuracy of computerised strain gauge plethysmography in the diagnosis of pulmonary embolism (PE).

Methods

Two researchers prospectively recruited 425 patients with pleuritic chest pain presenting to the emergency department (ED). Lower limb computerised strain gauge plethysmography was performed in the ED. All patients underwent an independent reference standard diagnostic algorithm to establish the presence or absence of PE. A low modified Wells'' clinical probability combined with a normal D‐dimer excluded PE. All others required diagnostic imaging with PIOPED interpreted ventilation perfusion scanning and/or computerised tomography (CT) pulmonary angiography. Patients with a nondiagnostic CT had digital subtraction pulmonary angiography. All patients were followed up clinically for 3 months.

Results

The sensitivity of computerised strain gauge plethysmography was 33.3% (95% confidence interval (CI) 16.3 to 56.2%) and specificity 64.1% (95% CI 59.0 to 68.8%). The negative likelihood ratio was 1.04 (95% CI 0.68 to 1.33) and positive likelihood ratio 0.93 (95% CI 0.45 to 1.60).

Conclusions

Lower limb computerised strain gauge plethysmography does not aid in the diagnosis of PE.     

Health Education Materials for Arab Patients: Content and Design Preferences

Objective

To investigate the content and design preferences of printed health education leaflets among Arab patients.

Materials and Methods

A survey questionnaire to 17 subjects (women: n = 8, men: n = 9; age range 17–70 years) and three focus-group discussions (total 16 participants) were used to assess preferences by showing samples of Arabic health education materials. The questionnaire was administered by interviewers. For the focus-group discussions, the sessions were conducted by a trained interviewer, audio recorded and analyzed thematically. The subjects’ educational level was from no formal schooling to university level.

Results

In survey component, all patients preferred photographs over clipart. Typeface (‘font’) preferences were for Simplified Arabic in 8 subjects (47s%) and Mudir MT in 7 (41s%); the 16-point font size was favored by 14 (82s%) patients. In the three focus-group discussions, themes that participants expressed included use of standard Arabic with local dialects, short sentences, and culturally appropriate advice with practical and quantifiable examples.

Conclusions

The participants preferred health education materials to be color trifold brochures illustrated with pictures and not clipart and written in Arabic using the Simplified Arabic font in 16-point size.Key Words: Health education, Arabic world, Patient education handout     

Inflammatory Morbidity due to Compound Mandibular Body Fractures: Does It Have a Relationship with Treatment Outcome?

Objective

The aim of this study was to evaluate the relationship between the degree of preoperative pain and trismus with the development of complications following the repair of isolated unilateral compound mandibular body fractures using a closed reduction technique.

Subjects and Methods

This was a 7-year prospective study carried out at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria. Of a total of 97 patients, 83 (85.6s%) subjects (66 males, 17 females, ratio 5:1) were preoperatively evaluated for trismus and pain in a blinded manner by a single examiner, and complications were recorded postoperatively. The data obtained were statistically analyzed with EPI Info 2008 software.

Results

Of the 83 patients treated, 13 (15.7s%) developed complications. The fractures were most common in the age range of 21–40 years (n = 45, 54.2s%). The age (p = 0.02) and gender (p = 0.01) distribution of the subjects was significant. The more severe the limitation of mouth opening (p = 0.03) and pain (p = 0.04) before treatment, the more complications developed, and these significantly affected treatment outcome. Impaired mastication and facial asymmetry (n = 17, 41.5s%) were the most common complications.

Conclusion

This study showed that posttrauma pain and trismus due to unilateral mandibular body fractures may be associated with the development of complications. An adequately powered prospective study treating patients at 5 or 7 days is required in order to make the case for later intervention.Key Words: Mandible, Body fracture, Pain, Trismus, Complications     

Determining the Incidence of Gynecoid Pelvis Using Three-Dimensional Computed Tomography in Nonpregnant Multiparous Women

Objectives

To determine the incidence of gynecoid pelvis by using classical criteria and measured parameters obtained from three-dimensional computed tomography (3D CT) pelvimetry in nonpregnant multiparous women who delivered vaginally.

Subjects and Methods

Our hospital''s picture archiving and communication system was reviewed retrospectively. All adult women who had undergone CT examination with routine abdominal protocols were identified. In the pelvic inlet, midpelvis, and pelvic outlet, classical criteria and measured parameters, both alone and in combination, were used to determine the presence of gynecoid pelvis.

Results

3D CT pelvimetry was performed on 226 women aged 23-65 years without any history of cephalopelvic disproportion and who had at least one delivery of an average fetal size (>2,500 g). The median parity was 4, and the mean (±SD) birth weight was 3,700 ± 498 g. Compared to the classical criteria, measured parameters and their combined use with the classical criteria significantly reduced the frequency of gynecoid pelvis (51.3 and 47.8%, respectively, vs. 71.6%; p = 0.001); however, there was no significant difference between the measured parameters and their combined use with classical criteria with regard to the frequencies of gynecoid pelvis (p > 0.05).

Conclusions

With the use of measured parameters of 3D CT pelvimetry, the incidence of gynecoid pelvis reduces to a more acceptable level (51.3%) in accordance with obstetric knowledge. Since there is no considerable decrease with the addition of classical criteria, 3D CT pelvimetry alone has merit for determining a woman''s pelvic capacity for obstetric needs after the improvement and standardization of measured parameters.Key Words: Three-dimensional computed tomography, Cephalopelvic disproportion, Labor dystocia, Pelvic type, Gynecoid pelvis, Android pelvis, Anthropoid pelvis, Platypelloid pelvis, Multiparous women     

Direct and Transdentinal (Indirect) Antibacterial Activity of Commercially Available Dental Gel Formulations against Streptococcus mutans

Objective

To evaluate the direct and transdentinal (indirect) agar diffusion antibacterial activity of different commercially available antibacterial dental gel formulations against Streptococcus mutans.

Materials and Methods

The commercially available dental gel formulations were Corsodyl® (COG, 1s% chlorhexidine), Cervitec® (CEG, 0.2s% chlorhexidine s+ 0.2s% sodium fluoride), Forever Bright® (FOB, aloe vera), Gengigel® (GEG, 0.2s% hyaluronic acid), 35s% phosphoric acid gel and distilled water (control). Direct agar diffusion was performed by isolating three wells from brain-heart infusion agar plates using sterile glass pipettes attached to a vacuum pump and adding 0.1 ml of the gels to each well. Transdentinal (indirect) agar diffusion was performed by applying gel to 0.2- and 0.5-mm-thick human dentin discs previously etched with phosphoric acid and rinsed with distilled water. Zones formed around the wells and the dentin discs were measured and analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p < 0.01).

Results

Direct agar diffusion tests showed significant differences among all gel formulations (p < 0.01) except for COG and CEG (p > 0.01). COG and CEG exhibited higher antibacterial effects compared to FOB and GEG (p < 0.01) in both direct and transdentinal (indirect) testing procedures. GEG did not show any antimicrobial activity in transdentinal (indirect) testing.

Conclusion

Commercially available dental gels inhibited S. mutans, which may indicate their potential as cavity disinfectants.Key Words: Antibacterial dental gels, Streptococcus mutans, Cavity disinfectant, Chlorhexidine, Hyaluronic acid, Aloe vera     

Clinical Consequences of Untreated Dental Caries Evaluated with the Pulpal Involvement-Roots-Sepsis Index in the Primary Dentition of School Children from the Raipur and Durg Districts,Chhattisgarh State,India

Objective

To evaluate the prevalence of the clinical consequences of untreated dental caries in primary dentition among 6- to 8-year-old children using the prs [pulpal involvement (p), roots (r) and sepsis (s)] index and record the distribution of prs among boys and girls.

Subjects and Methods

The study included a sample of 371 children aged 6–8 years with at least one carious primary molar tooth, who had been randomly selected from schools in the districts of Raipur and Durg, Chhattisgarh State, India. We recorded the presence of decayed, extracted and filled (i.e. def) teeth. The prevalence of the consequences of untreated dental caries was evaluated using the prs index. The data were statistically analyzed to express the prevalence of prs among boys and girls and the distribution of individual prs codes in the sample population.

Results

The prevalence of carious lesions was very high (87s%) and teeth with clinical consequences of untreated dental caries were found in 49.3s% of the children. The prs distribution in children who were 8 years old (40.9s%) was higher than in the 6-year-old children (25.6s%). In the group of 8-year-olds, the occurrence of prs was greater among the boys whereas in the 6- and 7-year-old group, it was greater among the girls.

Conclusion

The prs index is a valuable tool for measuring the clinical consequences of untreated dental caries. It could be useful for epidemiological studies and provide relevant information regarding treatment needs.Key Words: Primary dentition, Dental caries, PRS index     

Role of CT Density in PET/CT-Based Assessment of Lymphoma

Purpose

In patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL), primary staging, as well as intermediate and late response assessment, is often performed by integrated 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) positron emission tomography/X-ray computed tomography (PET/CT). The purpose of this analysis was to evaluate if findings in patients with histopathologically proven HL or NHL might correlate with semi-automated density measurements of target lesions (TLs) in the CT component of the integrated PET/CT examination.

Procedures

After approval by the institutional review board, 176 lymph nodes (LN) in 90 PET/CT examinations of 90 patients were retrospectively analyzed (HL, 108 TLs out of 55 patients; NHL, 68 TLs out of 35 patients). PET/CT was performed for reasons of primary staging, response evaluation as interim PET, or as final examination after therapy, according to the clinical schedule. Analyses of TLs were performed on the basis of tracer uptake (SUV) 60 min after tracer injection and volumetric CT histogram analysis in non-contrast-enhanced CT.

Results

All patients were diagnosed with HL or NHL in a pretreatment biopsy. Prior to therapy induction, staging of all patients was performed using contrast-enhanced CT of the neck to the pelvis, or by [¹⁸F]FDG PET/CT. Of the 176 TLs, 119 were classified as malignant, and 57 were benign. Malignant TLs had significantly higher CT density values compared to benign (p?<?0.01).

Conclusion

Density measurements of TLs in patients with HL and NHL correlate with the dignity of TLs and might therefore serve as a complementary surrogate parameter for the differentiation between malignant and benign TLs. A possible density threshold in clinical routine might be a 20-Hounsfield units (HU) cutoff value to rule out benignancy in TLs that are above the 20-HU threshold.

     

The Impact of Shift Work on Brazilian Train Drivers with Different Chronotypes: A Comparative Analysis through Objective and Subjective Criteria

Objective

The aim of this study was to compare sleep pattern, tiredness sensation and quality of life between different chronotypes in train drivers from a Brazilian transportation company.

Subjects and Methods

Ninety-one train drivers, working a rotary work schedule including night shift, were divided into three groups according to their chronotype (morning types, intermediate or evening types) and were assessed for their sleep and quality of life, as characterized by a subjective questionnaire and the Psychomotor Vigilance Task (PVT), applied before and immediately after the night shift. The pattern of activity and rest was measured for 10 days by actigraphy, and the chronotype was determined through the Morningness-Eveningness Questionnaire.

Results

Forty-one (45.1s%) individuals were classified as morning type, 44 (48.4s%) were classified as intermediate and 6 (6.6s%) as evening type. The evening types had a tendency to remain awake for a longer period of time before the night shift (p = 0.05) and scored worse overall for quality of life compared to morning types (p = 0.11). There was no significant difference between the groups regarding variability in the PVT performance, even when covaried by the period of waking time before the test. There was no significant difference either in feelings of fatigue before and after starting the shift.

Conclusion

Although the evening type number was small, evening type individuals scored worse relative to sleep and quality of life than morning type individuals.Key Words: Chronotype, Fatigue, Shift work, Psychomotor Vigilance Task, Actigraphy     

Case report: Inflammatory myofibroblastic tumor of pancreatic origin in a patient with down syndrome: The role of diagnostic ultrasound

Introduction

Inflammatory myofibroblastic tumor (IMT) is a benign solid tumor of uncertain etiology.

Materials and methods

We report a case of a 4-year-old Down syndrome affected child, who had a pancreatic mass identified by ultrasonography (US) and confirmed by computed tomography (CT).

Results

Monitoring of IMT was performed by serial US studies, and at follow-up after 4 years there was no relapse.

Discussion

As radical removal of the lesion was not possible, the patient was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs). It was decided to monitor the lesion by serial US in order to reduce the number of CT examinations and thereby avoid excessive exposure to ionizing radiation. It is widely reported in the literature that repeated CT scans are associated with increased exposure to radiation which may cause cancer, a fact which should not be overlooked in children.     

Radionuclide Imaging of Cardiac Device Infection

Purpose of Review

Accurate diagnosis of cardiac device infection is critical for clinical decision-making and represents a challenge for current diagnostic methods. A non-invasive test with sufficient sensitivity and specificity to confirm or exclude infection would be desirable. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been emerging as a promising diagnostic tool for cardiac implantable electrophysiological devices (CIED) infection and its complications. The aim of this review is to describe the role of radionuclide imaging in cardiac device infection according to the different clinical presentations.

Recent Findings

¹⁸F-FDG PET/CT plays an important role in the diagnosis of CIED infection. It has been demonstrated that PET/CT imaging can accurately diagnose and distinguish deep pocket infection from superficial soft tissue infection. In lead infection, this technique has high specificity and is helpful when transthoracic echocardiography (TTE) does not detect vegetation. In addition, PET/CT may be useful in patients with suspected prosthesis valve endocarditis, in whom the initial TEE is negative or indeterminate.

Summary

The use of ¹⁸F-FDG PET/CT in the diagnosis of CIED infection has been implemented to respond to specific clinical needs. Different studies provided important data on the optimal conditions of PET/CT acquisition to better discriminate the infection. However, multicenter trials performed under standardized protocols for both acquisition and quantification of FDG uptake are needed. These efforts could help to achieve the level of evidence allowing FDG PET/CT to be included in clinical guidelines.