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At least 1,207 records · Page 67Linked to original sources
PubMed2005

QuantiFERON-TB predicts tuberculin skin test boosting in U.S. foreign-born.

SETTING: Santa Clara County, Northern California. OBJECTIVE: To characterize agreement of tuberculin skin test (TST) and QuantiFERON-TB (QFT) with repeated testing. DESIGN: Fifty-two subjects participating in an ongoing prospective study of infectious disease transmission were tested by TST and QFT at two home visits 3 months apart. Boosting was defined as reclassification of TST from negative to positive. Agreement and reproducibility of TST and QFT were assessed using kappa and McNemar statistics. RESULTS: Of 48 individuals completing all tests, 75% were foreign-born (92% Latin America) and 58% were BCG-vaccinated. Initial TST and QFT were positive in 13 (27%) and 21 (44%), respectively, with an overall agreement of 67% (K = 0.29). Ten (29%) of 35 initial TST-negative reactions boosted, nine of whom were BCG-vaccinated subjects. Boosting occurred in eight (67%) of 12 subjects who were initially QFT-positive/TST-negative. Compared to the second TST, initial QFT had a relative post-test probability of 76% (95% CI 0.58-0.95); boosting accounted for 8/16 (50%) of initial testing discordances. CONCLUSION: Positive QFT in the setting of negative TST frequently anticipates a TST boost. This finding helps explain discordance between the two tests and may provide an alternative to serial TST testing.

Adolescent↗
PubMed2005

Biphasic sarcomatoid carcinoma or carcinosarcoma of the breast: prognosis and therapy.

Biphasic sarcomatoid carcinoma of the breast represents only 0.2% of all breast cancer. Due to its rarity and repetitive reclassifications little is known about optimal treatment modalities. These tumours form a diagnostic and therapeutic challenge. The present report describes our experience with a case of biphasic sarcomatoid carcinoma of the breast and a review of the relevant literature is discussed.

Breast Neoplasms↗
PubMed2005

Discrimination of Aedes aegypti (Diptera: Culicidae) laboratory lines based on wing geometry.

Recent techniques of geometric morphometrics were applied to the study of four Thailand laboratory lines of the dengue vector Aedes aegypti. These lines differed by their geographic origin and the number of generations spent in the laboratory. Using a phase contrast microscope, a set of sixteen landmarks of the wings could be identified. A subsequent Procrustean superposition analysis produced the corresponding size and shape variables which were statistically analyzed. Size showed a significant decrease with the number of generations spent in the laboratory. Shape allowed an almost perfect reclassification of the specimens. This tool is able to accurately distinguish different laboratory lines and will be useful in field studies related to entomological surveillance and vector control.

Aedes↗
PubMed2005

Headache and altitude decompression sickness: joint pain or neurological pain?

INTRODUCTION: Exposure to reduced ambient pressure may result in decompression sickness (DCS). Headache is among the DCS symptoms encountered and is usually regarded as neurological DCS, which is traditionally classified as serious DCS. Since cranial sutures may be considered joints, it is possible that some headaches are actually joint pain and when associated with decompression sickness need not be neurological DCS. METHODS: Records were individually recovered from the Davis Hyperbaric Laboratory at Brooks City-Base, TX. Information was extracted using a detailed survey instrument. Possible joint pain headache cases were identified using three criteria: headache localized at a suture, normal neurologic exam, and resolution within 30 min of hyperbaric oxygen treatment. RESULTS: A total of 729 records documenting treatment for DCS were scrutinized. Of these, 70 cases of altitude DCS with headache were examined. Analysis, using the three criteria, showed 23% (16 cases) of altitude headache DCS symptoms could potentially be re-classified as joint pain. CONCLUSION: Generally, headache DCS is considered neurological DCS. However, since cranial sutures are joints, both histologically and functionally, and since DCS most commonly affects joints, headache DCS may, at times, be joint pain DCS. Indeed, retrospective data analysis suggests that this possibility exists. Such a reclassification from neurological to joint pain DCS would lessen the aeromedical impact of a DCS headache.

Adult↗
PubMed2005

[Splicing site mutation of D19S418 in PRPF-31 gene and its phenotypic characters with autosomal dominant retinitis pigmentosa].

OBJECTIVE: To evaluate the disease-causing gene and phenotypic characters of a large family with autosomal dominant retinitis pigmentosa (adRP). METHODS: Disease status and associated ocular abnormalities of eight patients and six unaffected members who represent different generations of this family were assessed by measurement of visual psychophysics, full-field and multifocal electrophysiology (ERG and mfERG) and funds fluorescent angiography (FFA). The DNA samples of nineteen patients and fifteen unaffected individuals in this family were examined by Genome scanning, linkage analysis and mutation detection to identify coding sequence changes. RESULTS: A case with variable, early onset night blindness before 10 years and visual field loss in their teens was found. Macular dystrophy, progressing to a retinitis pigmentosa phenotype was demonstrated in most adult cases. Both a-wave and b-wave amplitudes of photopic and scotopic full-field ERG were marked reduced and nearly non-detectable, demonstrating severe damage of photoreceptor systems. There were two obligate gene carriers in the family which remained asymptomatic in the clinical. But one of them was found with a minimal RP characteristic and the other was normal by examination of fundus and ERG. An unreported splicing site mutation (IVS5-1G > A) was identified in intron 5- acceptor site of PRPF-31 gene on chromosome 19. ERG and molecular genetic findings were consistent with the reclassification of this disease as an autosomal dominant RP. CONCLUSION: It is a novel splicing site mutation that IVS5-1G > A of D19S418 site in PRFP31, the relative phenotypes by which main displayed type I/diffuse has variable expressivity and complex phenotype.

Adolescent↗
PubMed2006

Validation of an interphase fluorescence in situ hybridization approach for the detection of MLL gene rearrangements and of the MLL/AF9 fusion in acute myeloid leukemia.

To validate a 2-step FISH assay for the identification of the t(9;11)(p22;q23), 96 acute myeloid leukemias were studied by cytogenetic analysis, FISH and molecular biology. After a first FISH step using an MLL probe, 24/27 cases with 11q23 break showed MLL rearrangement. Southern blotting confirmed FISH data. In the second step, 24 cases with MLL rearrangement were studied using MLL and AF9 probes: 17/18 cases with t(9;11) showed MLL/AF9 fusion. In 6 patients with 11q23/MLL rearrangements other than t(9;11), FISH confirmed MLL involvement and excluded AF9 involvement. This is a reliable method for the identification of MLL/AF9 fusion in interphase cells, allowing for a reclassification of cases with suboptimal chromosome morphology. The frequency of deletion surrounding MLL and AF9 breakpoint is low.

Gene Rearrangement↗
PubMed1991

Top developments in health care: a watershed year.

Regulations, reimbursement battles, collaboration efforts, financial difficulties and the reform process all helped make 1991 a watershed year for health care issues--and an eventful one for executives. News media attention to health care policy, financing and delivery issues was intense: television, radio and print coverage focused on overcrowded emergency departments, uninsured pregnant women with no access to obstetrical care, employers demanding cost-efficient care and the pluses and minuses of foreign health care systems. The close of 1991 left hospital executives dealing with the effects of issues like the Medicare capital payment fold-in, physician payment reform, hospitals' geographic reclassification and the push for national health care reform. Below are brief summaries of some of the year's top issues.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Risk factors associated with default from multidrug-resistant tuberculosis treatment, South Africa, 1999-2001.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) treatment centers in five provinces, South Africa. OBJECTIVES: To estimate the mortality and evaluate risk factors associated with default from MDR-TB treatment. DESIGN: Using registries and a standardized questionnaire, we conducted a case-control study among patients diagnosed and treated for MDR-TB. Cases were defined as patients who began MDR-TB treatment between 1 October 1999 and 30 September 2001 and defaulted from treatment for more than 2 months; controls were defined as patients who began MDR-TB treatment during the same time and were cured, completed or failed. RESULTS: After initial identification and reclassification, 269 cases and 401 controls were confirmed eligible for interview. Further investigation revealed that 74 (27%) cases and 44 (10%) controls had died. Among 96 cases located who consented and were interviewed, 70% had defaulted after receiving at least 6 months of treatment. In a multivariate model, the strongest individual risk factors for default included reporting smoking marijuana or mandrax during treatment, and having an unsatisfactory opinion about the attitude of health care workers. CONCLUSION: Mortality among MDR-TB defaulters was high. Interventions to reduce default from MDR-TB treatment should center on substance abuse treatment, patient education and support and improving provider-patient relationships.

Adult↗
PubMed2006

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2007 rates; fiscal year 2007 occupational mix adjustment to wage index; health care infrastructure improvement program; selection criteria of loan program for qualifying hospitals engaged in cancer-related health care and forgiveness of indebtedness; and exclusion of vendor purchases made under the competitive acquisition program (CAP) for outpatient drugs and biologicals under part B for the purpose of calculating the average sales price (ASP). Final rules and interim final rule with comment period.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These changes are applicable to discharges occurring on or after October 1, 2006. In this final rule, we discuss public comments we received on our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients--to use a hospital-specific relative value (HSRV) cost center weighting methodology to adjust DRG relative weights; and to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are making are those changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are responding to requested public comments on a number of other issues that include performance-based hospital payments for services and health information technology, as well as how to improve health data transparency for consumers. In addition, we are responding to public comments received on a proposed rule issued in the Federal Register on May 17, 2006 that proposed to revise the methodology for calculating the occupational mix adjustment to the wage index for the FY 2007 hospital inpatient prospective payment system by applying an adjustment to 100 percent of the wage index using new 2006 occupational mix survey data collected from hospitals. We are finalizing two policy documents published in the Federal Register relating to the implementation of the Health Care Infrastructure Improvement Program, a hospital loan program for cancer research, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This final rule also revises the definition of the term "unit" to specify the exclusion of units of drugs sold to approved Medicare Competitive Acquisition Program (CAP) vendors for use under the CAP from average sales price (ASP) calculations for a period of up to 3 years, at which time we will reevaluate our policy.

Diagnosis-Related Groups↗
PubMed2006

Experience in reasoning with the foundational model of anatomy in OWL DL.

The objective of this study is to compare description logics (DLs) and frames for representing large-scale biomedical ontologies and reasoning with them. The ontology under investigation is the Foundational Model of Anatomy (FMA). We converted it from its frame-based representation in Protégé into OWL DL. The OWL reasoner Racer helped identify unsatisfiable classes in the FMA. Support for consistency checking is clearly an advantage of using DLs rather than frames. The interest of reclassification was limited, due to the difficulty of defining necessary and sufficient conditions for anatomical entities. The sheer size and complexity of the FMA was also an issue.

Computational Biology↗
PubMed2006

Validation of microsatellite markers for use in genotyping polyclonal Plasmodium falciparum infections.

Genotyping methods for Plasmodium falciparum drug efficacy trials have not been standardized and may fail to accurately distinguish recrudescence from new infection, especially in high transmission areas where polyclonal infections are common. We developed a simple method for genotyping using previously identified microsatellites and capillary electrophoresis, validated this method using mixtures of laboratory clones, and applied the method to field samples. Two microsatellite markers produced accurate results for single-clone but not polyclonal samples. Four other microsatellite markers were as sensitive as, and more specific than, commonly used genotyping techniques based on merozoite surface proteins 1 and 2. When applied to samples from 15 patients in Burkina Faso with recurrent parasitemia after treatment with sulphadoxine-pyrimethamine, the addition of these four microsatellite markers to msp1 and msp2 genotyping resulted in a reclassification of outcomes that strengthened the association between dhfr 59R, an anti-folate resistance mutation, and recrudescence (P = 0.31 versus P = 0.03). Four microsatellite markers performed well on polyclonal samples and may provide a valuable addition to genotyping for clinical drug efficacy studies in high transmission areas.

Animals↗
PubMed1991

[Differentiation of suicide and parasuicide. A study of the last letters of suicidal patients].

The paper presents a content-analytical comparison between "last letters" of suicidals (SUI) and parasuicidals (PARA). So far studies on this topic are mostly performed by "external" parameters, e.g. sociodemographic or anamnestic data. The content-analytical approach provides to describe the presuicidal situation on base of "internal" variables. Compared with the suicidal notes the parasuicidal communication can be evaluated as more ambivalent, emotionally disturbed, and cognitively restricted. The successful reclassification of the notes into the two samples by a stepwise discriminant analysis supports the hypothesis, that both groups are distinct even on base of internal variables.

Adolescent↗
PubMed2006

Tadalafil and modifications in peak systolic velocity (Doppler spectrum dynamic analysis) in the cavernosal arteries of patients with type 2 diabetes after continuous tadalafil treatment.

AIM: In this study peak systolic velocity (PSV) was measured by penile duplex Doppler spectrum dynamic analysis in diabetic patients with erectile dysfunction (ED) administered continuous treatment with tadalafil for 3 months in a weekly regimen (Monday-Wednesday-Friday). Responses to the Structured Interview on Erectile Dysfunction (SIEDY) questionnaire and hormonal blood levels (LH, testosterone, prolactin) were studied before and after treatment. METHODS: The study sample was 20 diabetic patients (mean age 60 years; range 55-65) with organic vascular arterial ED at enrollment into the study. All patients were eligible for receiving tadalafil. Patients were randomly assigned to 2 different treatment groups according to a computer-generated list. The first random set of numbers was assigned to group A, the second to group B. Group A (n=10) received tadalafil 20 mg per os on demand for 3 months (Cialis, Lilly ICOS; London, UK). Group B (n=10) received tadalafil 20 mg per os on weekly fixed days (Monday-Wednesday-Friday) for 3 months. All patients underwent duplex penile sonographic dynamic evaluation after intracavernosal injection of alprostadil 20 microg (Caverject, Pharmacia SpA; Milan, Italy); SIEDY questionnaire responses and changes in blood hormonal levels (LH, testosterone, prolactin) before and after treatment were compared. RESULTS: Increased PSV at 10 min and 20 min after alprostadil administration was found in 30% of Group A patients and in 60% of Group B patients. In 40% of Group B patients, the increase in PSV was so significant as to justify reclassification to a less severe diagnostic category (Benson classification) in vascular profile. No changes in hormonal levels after treatment were found in either group. Analysis of the questionnaires showed a more marked reduction in the global total scores in Group B, with a greater frequency and a clearer improvement in global scores. CONCLUSIONS: This study on a group of 20 patients with organic vascular arterial ED disclosed at least 2 basic aspects: 1) a higher percentage of Group B patients (fixed-day treatment regimen) showed a greater improvement in PSV than the controls; 40% of these patients were reclassified according to the Benson classification; 2) within the context of a clinical study, monitoring and supportive care to increase the frequency and quality of sexual intercourse led to a resumption of and a greater interest in sexual activity. This finding cannot be explained by changes in hormonal levels; instead, there appeared a sort of effect placebo that the continuous therapy, like conventional treatment for other health reasons, had on the patient.

Aged↗
PubMed1991

Calcium channels in the brain as targets for the calcium-channel modulators used in the treatment of neurological disorders.

Recent investigations of calcium channels in brain cells by voltage-clamp techniques have revealed that, in spite of electrophysiological similarities, the pharmacological properties of these channels differ considerably from channels in peripheral tissues, e.g., heart and smooth muscle. Therefore, instead of extrapolation from results obtained on cardiac or smooth muscle cells, a reclassification of calcium-channel modulators applied in disorders of the brain appears necessary. The present article reviews some pertinent observations from groups involved in neuronal calcium-channel characterization and draws the attention to major pharmacological differences on neurons in comparison to those in the heart and in smooth muscle. For certain therapeutic applications in neurology particularly, the low-voltage activated types of calcium channels deserve considerable attention.

Animals↗
PubMedDate not supplied

[Monocentric retrospective study on the prognosis of adenoid cystic carcinoma].

Studies on 26 patients confirm the relevance of the factors tumour size and histological subtype for the prognosis of adenoid cystic carcinoma. For high risk tumours (tumour size over 3 cm, solid or tubular subtype) a postoperative adjuvant radiologic therapy is recommendable. The rate of wrong diagnoses found by reclassification is surprisingly high.

Carcinoma, Adenoid Cystic↗
PubMed1991

Medicare appeals process offers hope for some hospitals.

For hospital officials who feel wronged by Medicare's payment system, a recent opportunity to appeal geographic status has stirred new hope for survival. Last September, the Health Care Financing Administration published interim final regulations detailing criteria hospitals have to meet to merit reclassification; hospitals had until Nov. 6, 1990, to file their appears. Now, officials are slogging through nearly 1,000 completed applications. "There has been pent-up demand for some review" of geographic classification, says one official.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Use of reported immunisation performance data in monitoring UIP.

Health information system is not well developed in most parts of the country. We propose to use locally available data on immunization performance so as to make them more informative and useful for implementing and supervisory personnel. Reclassification of data according to estimated number of eligibles, monthly performance and age of children immunized can given impressions about coverage, sustainability of services and their quality. Similarly, area and institution-wise data can be used to identify places needing more attention. Active use of available data will help in improvement of vaccine coverage and control of target diseases.

Data Interpretation, Statistical↗
PubMed1990

Subcutaneous fat necrosis of newborn children.

We report a case of subcutaneous fat necrosis of a newborn child which appeared 9 days after birth and was cured without any complications. We propose the reclassification of the etiological factors accompanying this lesion by classifying them in a plurietiological syndrome with some basic or essential factors and other causative factors.

Adipose Tissue, Brown↗