Clinical and endocrine features of Brazilian infertile women with or without endometriosis: A comparative cross-sectional study

ObjectiveTo compare the clinical and endocrinological features of infertile Brazilian woman with or without endometriosis.MethodsThis is a cross-sectional comparative study including infertile patients without an established indication for in vitro fertilization or intracytoplasmatic sperm injection at a tertiary center for reproductive medicine. A complete investigation of the cause of female infertile included videolaparoscopy for pelvic cavity and peritoneal factor evaluation.ResultsAverage patient age was (31.6±4.6) years. Sixty-nine percent patients presented with dysmenorrhea, 38% with bowel disturbances, and 21% with deep dyspareunia. Endometriosis was found in 76% of patients, and 91% had primary infertility. Dysmenorrhea was the only symptom that was more prevalent in infertile women with endometriosis. Compared to those without, patients with endometriosis had higher levels of follicle-stimulating hormone (FSH), prolactin (PRL), thyroid-stimulating hormone (TSH), and carcinogen antigen-125 and lower levels of luteinizing hormone (LH), estradiol, progesterone, and free thyroxin.ConclusionsEndometriosis is highly prevalent in the Brazilian population and, dysmenorrhea is the only clinical symptom associated with the diagnosis of endometriosis. Infertile patients with endometriosis have higher levels of FSH, PRL and TSH than infertile women without endometriosis.     

A follow-up study of internal medicine residents' and faculty staff physicians' attitudes toward patients.

This study assesses the attitudes of internal medicine residents both before and one year after they began their residency, and of staff internists based at the hospitals where these residents rotate. Attitudes toward a broad range of patients' physical, psychological, social, and health-state characteristics were assessed. Results are compared with those obtained by Johnson and Hoffman in their study of medical students' attitudes toward these same characteristics. The results suggest that attitudes towards patient characteristics viewed as hindering communication in the doctor-patient relationship may become more positive as physicians obtain experience and enhance their clinical skills. The results also suggest that much of the research pertaining to medical students' and physicians' attitudes toward geriatric care and chronic illness may not generalize to the population of physicians who specialize in internal medicine.     

100例老年心血管患者临床与预防分析

目的分析老年心血管患者临床上的特点与预防的措施。方法回顾性的分析该院从2007年5月—2010年5月间,收治的100例老年心血管病人的临床资料,结合病人的具体病情,分析其临床上的特点,进而采取积极地干预措施,对患者进行临床实践上的指导,并对照同期没有进行干预的100例老年心血管病人的恢复情况。结果这100例老年心血管病人在进行多项性综合干预的措施后,其临床上的表现,如血压值、心情状况、睡眠状况等方面都要好于干预前的指标(P<0.05)。结论采取综合的预防措施,能够有效地改善老年心血管患者的一些临床上的症状以及忧郁狂躁的情绪,这样能偶从增强免疫力、预防猝死、心律失常以及心脏缺血等并发症的发生率,非常值得临床推广。     

Diagnostic strategy and management of anemia: a consensus from a detailed study of 100 patients followed in internal medicine

Anemia is a frequent reason for seeking medical care in Internal Medicine. It is not a diagnosis, but rather a symptom that needs to be investigated in order to find an etiology. In a retrospective review of 100 cases of anemia, the cause was found in 86 % of cases. The etiologic profile was varied. Iron deficiency remained by far the most frequent cause seen in 47% of case. Other etiologies have been found such as neoplasm in 13 % of cases, chronic renal failure in 8% of cases and endocrinal cause in 5 % of cases. We recommend a diagnostic decision tree that provides a tool for rational and cost effective approach for anemia.     

Psychosocial factors associated with frailty in the community-dwelling aged population with depression. A cross-sectional study

ObjectiveThere is a two-way relationship between frailty and depression, but the mechanisms by which one may influence the other are not well understood. The objective of this study was to evaluate the relationship between psychosocial factors and frailty in community-dwelling aged populations with depression.DesignObservational cross-sectional study.Site5 primary care centres.ParticipantsCommunity-dwelling subjects with depression aged ≥70 years.Main measurementsFrailty status was established according to Fried criteria, depression and depression severity were evaluated by DSM-IV criteria and the Hamilton Depression Rating Scale, respectively, and psychosocial factors were assessed using the Gijón Social-Familial Evaluation Scale and ad hoc questionnaires.ResultsRecruited were 338 subjects (mean age 77.2 years), 82% women and 36.1% rated as frail. A dose–response relationship was observed between depression severity and frailty risk. Widowhood was a risk factor for frailty, while a higher educational level, home internet, stairs in the home, and an active social life had a protective effect. A multivariate analysis showed that age, number of drugs, and depression severity were independent risk factors for frailty, while an active social life was a protective factor. The severity of depressive symptoms showed higher association with frailty than other clinical and socio-demographic characteristics.ConclusionsIn depressed elderly subjects, frailty is associated with psychologiocal factors such as the intensity of depressive symptoms and with social factors such as education level, widowhood, loneliness, and limited social life. More research is required to better understand the modifiable psychological risk factors for frailty.     

水痘100例临床病例资料分析

[目的]回顾性分析水痘的病例资料,对水痘的流行病学特点进行归纳总结。[方法]采取整群抽样法,选取某县2013年1月—2016年12月期间水痘疫情资料中的100例水痘病例资料进行回顾性研究分析,通过分析水痘的发病特点,对水痘的流行病学特征进行分析和总结。[结果]水痘的发病季节主要分布于春季、冬季,全年有两个高峰发病时间段,即4—5月、12月至次年1月;发病人群分布以儿童为主;症状以发热、出疹为主,部分患者伴随有前驱症状。100例水痘病例中,具有水痘疫苗接种史的病例5例,无接种史84例,接种史不详11例。有37例接受病原学监测,检出25例水痘-带状疱疹病毒核酸阳性,阳性病例以学龄儿童为主,有24例,占96%,均无疫苗接种史。[结论]水痘的传染性较强,在各年龄段均可能发生,高发季节为春、冬两季,高危人群为学龄儿童。为减少水痘疫情暴发,应加强学龄儿童的水痘疫苗接种及查漏补种。     

急诊内科意识障碍患者32例患者病情指征的临床分析

目的从临床上探讨急诊内科意识障碍患者病情特征和疾病的原因。方法在2009年3月～2010年5月中向送诊人员询问32例病患的病史,对其进行体格检查和相关的辅助检查,在临床上观察和分析患者病情的特征。统计构成意识障碍的原因。结果急诊内科意识障碍患者以急性脑血管病为主,其次为中毒类疾病、急性感染性疾病、肺性脑病和糖尿病引起的意识障碍。结论引起急诊内科意识障碍的因素很多,因此比较复杂,但是主要是由常见病引起,在临床上对其指征要引起注意和观察。在治疗过程中要与患者家属积极配合,引导其家属对其查体和观察,争取有针对的及时治疗。     

A study of factors associated with the ability to maintain weight loss.

The purpose of this study was to determine whether it is possible to predict which patients will have the most success in maintaining weight loss following an in-hospital weight reduction program. Subjects included 175 severely obese women who elected hospitalization for 3 weeks while they participated in a weight reduction program (average loss, 15 pounds). They were followed for 18 to 24 months after discharge. During hospitalization the women were studied intensively, and factors associated with the etiology of obesity were measured. The Minnesota Multiphasic Personality Inventory (MMPI) and Michill Adjective Rating Scale (MARS) psychological tests were used along with a comprehensive history questionnaire containing questions on many factors implicated in the etiology of obesity, including weight history, medical history, eating habits, obesity of family members, and demographics. Of the 89 factors examined, only 3 were found to be significantly related to an ability to maintain weight loss following discharge: the Control and Responsibility scales of the MMPI and a combination of number of meals a day and time of strong appetite. These factors, though statistically significant, were not adequate to predict which women would be able to maintain weight loss. The lack of importance of a large number of common etiologic factors in predicting weight loss suggests that future studies should concentrate on determining what etiologic factors change in subjects losing weight and what factors enable these subjects to make the necessary changes.     

Traffic exposure associated with allergic asthma and allergic rhinitis in adults. A cross-sectional study in southern Sweden

Background  

There is conflicting evidence that traffic-related air pollution is a risk factor for allergic conditions. Few studies have investigated this in adults. In adults, a high proportion of asthma, rhinitis and eczema is triggered by non-allergic factors. We investigated traffic as a risk factor for allergic versus non-allergic asthma and rhinitis, and eczema, in adults.     

Clinical features and treatment in Cushing's disease. 18 cases

We report a retrospective study about 18 Cushing's diseases in the department of endocrinology at Charles Nicolle hospital in 24 years. The mean age was 33.7 years with a male-female ratio of 4/14. Diagnosis was established on adrenocorticotropin hormone analysis and pituitary imaging. Transsphenoidal adenomectomy was released in 8 cases of Cushing's disease, it was successful in 5 patients (62.5%). Bilateral adrenalectomy was performed in three cases.     

A qualitative study of work-life choices in academic internal medicine

The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: (1) the love of being a physician (“Raison d’être”), (2) family obligations (“2nd Shift”), and (3) balancing work demands with non-work life (“Negotiating Academic Medicine”). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists’ planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement.     

Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: A cross-sectional study

Background  

Type D (distressed) personality has been associated with adverse cardiac prognosis and poor emotional well-being in cardiac patients, but it is still unclear what mechanisms link Type D personality with poor clinical outcomes in cardiac patients. In the present cohort of Icelandic cardiac patients, we examined potential pathways that may explain this relationship. The objectives were to examine 1) the association between Type D personality and impaired psychological status, and to explore whether this association is independent of disease severity; and 2) the association between Type D personality and an unhealthy lifestyle.     

A cross-sectional study of dietary patterns with glucose intolerance and other features of the metabolic syndrome

Previous epidemiological studies have demonstrated relationships between individual nutrients and glucose intolerance and type 2 diabetes, but the association with the overall pattern of dietary intake has not previously been described. In order to characterize this association, 802 subjects aged 40-65 years were randomly selected from a population-based sampling frame and underwent a 75 g oral glucose-tolerance test. Principal component analysis was used to identify four dietary patterns explaining 31.7% of the dietary variation in the study cohort. These dietary patterns were associated with other lifestyle factors including socio-economic group, smoking, alcohol intake and physical activity. Component 1 was characterized by a healthy balanced diet with a frequent intake of raw and salad vegetables, fruits in both summer and winter, fish, pasta and rice and low intake of fried foods, sausages, fried fish, and potatoes. This component was negatively correlated with central obesity, fasting plasma glucose, 120 min non-esterified fatty acid and triacylglycerol, and positively correlated with HDL-cholesterol. It therefore appears to be protective for the metabolic syndrome. Component 1 was negatively associated with the risk of having undiagnosed diabetes, and this association was independent of age, sex, smoking and obesity. The findings support the hypothesis that dietary patterns are associated with other lifestyle factors and with glucose intolerance and other features of the metabolic syndrome. The results provide further evidence for the recommendation of a healthy balanced diet as one of the main components of chronic disease prevention.     

Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study

Knowledge of which factors are prompting patients to seek primary care is important to the ongoing effort to improve management in general, and management of frequent attenders (FAs) in particular. We conducted a cross-sectional population-based study with the aim at examining associations between physical, mental and social factors and frequent attendance in general practice. We collected questionnaire and registry data in the County of Aarhus (630,000 inhabitants), Denmark. Half of the county general practices (132 practices, 220 GPs) were selected randomly. FAs were defined as the top 10% attenders over the past 12 months. A questionnaire including SF-36 and questions about physical and mental health and social conditions was sent to age and gender stratified samples of FAs and non-FAs from these practices. Impairments (SF-36) associated with frequent attendance were physical in 54-71% (prevalence difference (PD): 16-33%, adjusted prevalence ratio (adj. PR): 1.1-1.7), mental in 58-70% (PD: 17-25%, adj. PR:1.1-1.4) and social in 40-59% (PD: 13-28%, adj. PR:0.9-1.5). Among FAs, 46-88% had used three or more different drugs (PD: 26-39%, adj. PR:1.5-2.3) and 27-41% had been referred one or more times to outpatient specialists (PD: 4-19%, adj. PR:1.2-2.5). Although our data cannot determine the direction of causality, they clearly demonstrate that FAs carry a large burden of physical, mental and social impairments which underpins the complexity and heterogeneity of the problems which they present. The results make clear that biopsychosocial management is a core issue in FA management in general practice.     

巨脾5例临床分析

我们于2000年1月～2002年12月收治了5例巨脾病人,现总结如下. 例1,57岁,男,因发现脾大40年,皮肤巩膜黄染2年入院.     

Clinical epidemiology of primary lung cancer in Tunisia. 100 cases

BACKGROUND: Lung cancer is frequent and its incidence is increasing inTunisia and in all over the world. Few published Tunisian studies have described epidemiology of lung cancer. AIM: To report the clinical features and outcomes of lung cancer in Tunisia from a retrospective review of 100 consecutive patients seen in F.S.I. hospital in La Marsa. METHODS: a retrospective study was carried out 100 cases of bronchial carcinoma seen in pulmonology department between 2000 and 2004. We analysed diagnosis modalities, histological subtypes, staging of the disease, treatment strategies and survival. Survival rates were calculated using Kaplan-Meier method. RESULTS: mean age was 59.5 years,sex-ratio at 19.92% of patients were smokers; the average of tobacco consumption was 48.5 PY. The diagnosis was histologically proven in 90% of the cases. Specimen were obtained by bronchoscopy (53.4% of cases), fine-needle lung biopsy (30%), metastasis biopsy (7.7%), surgical biopsy (7.7%) and more rarely by thoracoscopy (1.2%). Histologically, 39% were squamous carcinomas, 30% adenocarcinomas and 8.7% small cell carcinomas. 51% of non small cell lung carcinomas were stage IV, 26% stage IIIB, 9% stage IIIA and 14% were stage I or II. 6 of 10 patients with small cell carcinomas were with disseminated disease. 18 of 21 patients with resectable tumors receive surgery. Patients with locally advanced tumors received combined chemotherapy and radiotherapy. 14 of 46 stage IV patients received palliative chemotherapy. Survival rate was 18% at 2 years.     

39例新型冠状病毒肺炎患者临床特征分析

胡蜂璽伤多表现为过敏反应和肝肾器官受损。现报道1例胡蜂蛰伤继发广泛性肠坏死的临床救治资料,以提高对此类鲜见并发症的认识。