Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Background:

The diagnosis of osteoarticular tuberculosis is clinico-radiological in endemic areas. However every patient does not have the classical picture. Osteoarticular tuberculosis is a paucibacillary disease hence bacteriological diagnosis is possible in 10-30% of the cases. The present study is undertaken to correlate clinico-radiological, bacteriological, serological, molecular and histological diagnosis.

Materials and Methods:

Fifty clinico-radiologically diagnosed patients of osteoarticular tuberculosis with involvement of dorsal spine (n = 35), knee (n = 8), shoulder (n = 1), elbow (n = 2) and lumbar spine lesion (n = 4), were analyzed. Tissue was obtained after decompression in 35 cases of dorsal spine and fine needle aspiration in the remaining 15 cases. Tissue obtained was subjected to AFB staining, AFB culture sensitivity, aerobic/anaerobic culture sensitivity histopathological examination and polymerase chain reaction (PCR) using 16srRNA as primer. Serology was performed by ELISA in 27 cases of dorsal spine at admission and one and three months postoperatively.

Results:

AFB staining (direct) and AFB culture sensitivity was positive in six (12%) cases. Aerobic/anaerobic culture sensitivity was negative in all cases. Histology was positive for TB in all the cases. The PCR was positive in 49 (98%) cases. All dorsal spine tuberculosis cases showed fall of IgM titer and rise of IgG titer at three months as compared to values at admission.

Conclusion:

Histopathology and PCR was diagnostic in all cases of osteoarticular tuberculosis. The serology alone is not diagnostic.     

Quality of care and mortality among patients with stroke: a nationwide follow-up study

BACKGROUND: The relationship between process and outcome measures among patients with stroke is unclear. OBJECTIVES: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. METHODS: Using data from The Danish National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific criteria: early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early examination with computed tomography/magnetic resonance imaging scan, and early assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Data on 30- and 90-day mortality rates were obtained through the Danish Civil Registration System. RESULTS: Six of 7 of these criteria were associated with lower 30- and 90-day mortality rates. Adjusted mortality rate ratios corrected for clustering by department ranged from 0.41 to 0.83. We found indication of an inverse dose-response relationship between the number of quality of care criteria met and mortality; the lowest mortality rate was found among patients whose care met all criteria compared with patients whose care failed to meet any criteria (ie, adjusted 30-day mortality rate ratios: 0.45, 95% confidence interval: 0.24-0.66). When analyses were stratified by age and sex, the dose-response relationship was found in all subgroups. CONCLUSIONS: Higher quality of care during the early phase of stroke was associated with substantially lower mortality rates.     

Homozygous CFTR mutation M348K in a boy with respiratory symptoms and failure to thrive. Disease-causing mutation or benign alteration?

We report on a 6-month-old premature boy from consanguineous parents. He presented with respiratory distress, necrotizing enterocolitis and hyperbilirubinemia shortly after birth. Persisting respiratory symptoms and failure to thrive prompted cystic fibrosis diagnostics, which showed the lack of wild-type signal for the mutation R347P suggesting a homozygous deletion or an alteration different from the known mutation at this position. Sequencing of this region revealed the homozygous substitution 1175?T?>?A (HGVS: c.1043?T?>?A) in exon 7 resulting in the homozygous amino acid change M348K. This mutation has never been reported in homozygosity before. Computational analysis tools classified M348K as 'presumably disease causing.' In our patient, sweat testing and electrophysiological assessment of CFTR function in native rectal epithelium demonstrated normal Cl(-) secretion. Conclusion: We assume that the homozygous alteration M348K is a harmless variant rather than a CF-causing mutation.     

Patients' priorities with respect to general practice care: an international comparison

Background and objectives. Improving the sensitivity of generalpractice to Patients' needs demands a good understanding ofPatients' expectations and priorities in care provision. Insightinto differences in expectations of patients in different culturesand health care systems may support decision-making on desirablemodels for care provision in general practice. An internationalstudy was conducted to determine priorities of patients in generalpractice care: which views do patients in different countrieshave in common and which views differ? Methods. Written surveys in general practices in the UK, Norway,Sweden, Denmark, The Netherlands, Germany, Portugal and Israelwere performed. Samples of patients from at least 12 practicesper country, stratified according to area and type of practice,were included. Patients rated the importance of 38 differentaspects of general practice care, selected on the basis of literatureanalysis, qualitative studies and consensus discussions. Rankingsbetween countries were compared. Results. A total number of 3540 patients (response rate on average55%) completed the questionnaire. Patients in different countrieshad many opinions in common. Aspects that got the highest rankingwere: getting enough time during the consultation; quick servicesin case of emergencies; confidentiality of information on patients;telling patients all they want to know about their illness;making patients feel free to talk about their problems; GPsgoing to courses regularly; and offering preventive services.However, differences between opinions of patients in differentcountries were also found for some of the selected aspects.A confounding effect of Patients' characteristics may have playeda role in these differences. Discussion. The study provides information on what patientsexpect of and value in general practice care. It shows thatpatients in different cultures and health care systems may havedifferent views on some aspects of care, but most of all thatthey have many views in common, particularly as far as doctor–patientcommunication and accessibility of services are concerned. Keywords. Doctor–patient communication, general practice care, international comparison, Patients' expectations, Patients' priorities..     

Aufgaben der Ärztekammer und Kammerbeitrag

Abstrakt 1. überschreitet eine ?rztekammer durch bestimmte Ma?nahmen den ihr zustehenden Aufgabenbereich, so müssen die Mitglieder dagegen Unterlassungsklage erheben. 2. Zu den Aufgaben einer ?rztekammer geh?rt auch die Einrichtung und der Betrieb einer Akademie für ?rztliche Fort- und Weiterbildung und einer Schule zur Aus- und Fortbildung von Arzthelferinnen/medizinischen Fachangestellten. Die ?rztekammer darf die hieraus resultierenden Kosten bei der Bemessung des Kammerbeitrags berücksichtigen. (Leits?tze der Bearbeiterin)