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BACKGROUND: Infantile hypothyroidism, either caused by iodine-deficiency disorder (IDD) or congenital hypothyroidism (CH), is the world's leading cause of preventable mental retardation. Such hypothyroidism has virtually been eliminated in the developed world by salt iodization and neonatal thyroid screening. However, most developing countries do not have neonatal thyroid screening programs. Using India as an example, we review the case for newborn screening in the developing world. METHODS: A literature review on infantile hypothyroidism in India was conducted and three Indian thyroid experts were queried about their views on neonatal screening in India. RESULTS: Iodine nutrition improved markedly in India during the 1990s; 49% of the households are now using adequately iodized salt. The control of IDD is still insufficient in India. Nationally representative data on neonatal screening in India are not available, but two regional studies have been published. One study (n = 12,407) measured cord blood thyrotropin and the other (n = 25,244) measured filter paper thyroxine. These studies reported difficult socioeconomic and organizational barriers to the implementation of neonatal screening in India. DISCUSSION: It is time for India to make neonatal thyroid screening and mandatory iodization of salt a priority and develop a comprehensive infantile hypothyroidism policy. Prioritization of infantile hypothyroidism prevention is justified by its high frequency, sensitivity of screening in detecting both IDD and CH, adverse consequences of missing diagnosis at birth, high effectiveness of prevention, severity of disability from hypothyroidism, cost effectiveness of prevention, and lack of a clinical method of diagnosis near birth. 相似文献
993.
Linda M. Pak Mark A. Schattner Vinod Balachandran Michael I. DAngelica Ronald P. DeMatteo T. Peter Kingham William R. Jarnagin Peter J. Allen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):182-187
Background
Elevation in the serum immunoglobulin-G4 (IgG4) level has been used as a diagnostic marker to distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), but its true utility is ill-defined. This study evaluates the clinical utility of IgG4 in differentiating AIP from PDAC.Methods
All patients evaluated in the hepatopancreaticobiliary surgery clinics with measured serum IgG4 were included. Patients were divided into normal IgG4 (<135 mg/dL) and elevated IgG4 (≥135 mg/dL) groups. The final diagnosis was determined by operative pathology when available or by clinical outcome. The sensitivity, specificity, PPV, and NPV of IgG4 for diagnosing AIP was assessed.Results
Between 1997 and 2015, 298 patients were identified. Normal IgG4 levels were present in 85% of patients (254/298), while 15% (44/298) were elevated. The overall prevalence of AIP was 17% (52/298). The sensitivity and specificity of IgG4 for AIP was 67% and 96%, respectively; however, the PPV was only 80%, including a 9% occurrence of PDAC in patients with an elevated IgG4.Conclusion
In this study of selected patients who underwent IgG4 testing, 9% of elevated IgG4 patients had PDAC. The overreliance on IgG4 as diagnostic for AIP may lead to mis-diagnosis and delayed treatment for PDAC. 相似文献994.
Girish J. Kotwal PhD Dr. Vinod K. Rustgi MD Bahige M. Baroudy PhD 《Digestive diseases and sciences》1992,37(5):641-644
Semen samples from nine patients clinically diagnosed as having non-A, non-B hepatitis (NANBH) were tested by an ELISA using antibodies raised in rabbits against HCV-specific specific antigens. The semen from all nine patients had elevated levels of HCV-specific antigen in comparison to semen from five healthy donors. Semen from five of the nine patients had significant levels of the HCV-specific antigen. Seven of the eight serum samples from these patients were reactive with the standard C-100 HCV ELISA. Eight of these nine patients had serum reactive for HCV-specific antibodies in our ELISA using HCV-specific antigens. This more direct evidence for viral presence supports the earlier epidemiological data suggesting that HCV could be transmitted sexually. 相似文献
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High-dose chemotherapy (HDC) with autologous peripheral blood stem cell (PBSC) support is a common but expensive treatment for various hematological malignancies. A prospective cost analysis of evaluation/mobilization and the HDC + PBSC phase for patients with multiple myeloma was performed. Eleven consecutive patients at the National University Hospital Oslo, taking part in a Nordic treatment protocol, were included in the analysis during the period from May 1999 to December 2000. Clinical and resource use data were obtained prospectively on a daily basis registration and from patient records.The total cost for the evaluation/mobilization and the HDC + PBSC phase varied from 22,999 US dollars to 61,722 US dollars (mean 38,186 US dollars; median 30,569 US dollars). The mean length of hospital stay for the evaluation/mobilization phase was 8 days (range 4-17 days) and for the HDC + PBSC phase 19 days (range 14-29 days). A statistically significant correlation was found between the length of hospital stay and hospital costs for both phases (P < 0.003 and P < 0.010, respectively). A large part of the actual cost in the harvest phase was attributed to stem cell mobilization, including growth factors, harvesting and cryopreservation. In the HDC + PBSC phase, the most important part of the cost was paying nursing care personnel. 相似文献
1000.
Stefan Schreiber Konrad Aden Joana P. Bernardes Claudio Conrad Florian Tran Hanna Höper Valery Volk Neha Mishra Johanna Ira Blase Susanna Nikolaus Johannes Bethge Tanja Kühbacher Christoph Röcken Minhu Chen Ian Cottingham Niclas Petri Birgitte B. Rasmussen Juliane Lokau Philip Rosenstiel 《Gastroenterology》2021,160(7):2354-2366.e11