Course of disease

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Gender Differences in Presentation and Course of Disease in Pediatric Patients With Crohn Disease

Gender Differences in Presentation and Course of Disease in Pediatric Patients With Crohn Disease

of disease compared with boys. In addition, we found girls to have a higher prevalence of rectal bleeding (OR: 1.34; 95% CI: 0.99 –1.81; P ⫽ .06) and joint pain (OR: 1.56; 95% CI: 0.94 –2.57; P ⫽ .08) at symptom onset compared with boys but are at decreased risk for the development of a fistula (HR: 0.71; 95% CI: 0.47–1.05; P ⫽ .09). Although these results did not meet statistical significance because the 95% CIs crossed 1 in each case, taken together, the point estimates, 95% CIs, and P values interpreted in the context of a sample size of 989 patients show clinically important results. Although a higher proportion of girls in our cohort reported joint pain at presentation, gender differences in the risk for development of clinical signs of arthritis during the course of disease were not found. In contrast, Wagtmans et al 14 reported that the frequencies of CD-related symp-
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Management of diabetes across the course of disease: minimizing obesity-associated complications

Management of diabetes across the course of disease: minimizing obesity-associated complications

Overweight and obesity are common in the US population. Obesity increases the risk for T2DM as well as that for complications in people with the disease. Close attention to diet and lifestyle can significantly decrease the frequency of T2DM in high-risk patients and help control blood glucose in patients with the disease. These interventions have also been shown to be effective for reversing T2DM in patients diagnosed with this disease. Treatment for diabetes evolves with disease progression, and clinicians must consider effects on weight when selecting medications. Among older agents,
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ASSESSMENT OF MEDICATION ADHERENCE AMONG PATIENTS WITH THYROID DYSFUNCTION IN A TERTIARY CARE CENTRE – A PROSPECTIVE OBSERVATIONAL STUDY

ASSESSMENT OF MEDICATION ADHERENCE AMONG PATIENTS WITH THYROID DYSFUNCTION IN A TERTIARY CARE CENTRE – A PROSPECTIVE OBSERVATIONAL STUDY

From the study population it was found that majority of the patients had thyroid disease for a period of 1-5 years and only 2.6% patients had a period of more than 20 years. The study results showed that most of the patients were non-adherent to their treatment as well as the disease condition i.e., they do not follow their prescription accordingly. This may increase the course of disease and is the reason for long disease duration in our study population. [6, 8]

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Prognostic factors in pulmonary arterial hypertension: assessing the course of the disease

Prognostic factors in pulmonary arterial hypertension: assessing the course of the disease

when assessing central cardiopulmonary haemo- dynamics. Factors reflecting right ventricular func- tion as assessed by right heart catheterisation (RHC), including mean right atrial pressure (P ra ), cardiac output and cardiac index, have been shown to be significant predictors of survival in PAH [3–5]. In addition, a range of other factors that reflect right ventricular structure and function, including echocardiographic parameters, exercise capacity and serum biomarkers, have been shown to be of prognostic value. In order to identify the best way to use such surrogate markers in assessing the course of disease in PAH, we need to under- stand not only how the primary lesion, i.e. pul- monary vascular remodelling, is triggered and develops, but also how the right ventricle adapts and how its function deteriorates over time. This article will discuss how disease progression of PAH is currently assessed in clinical practice, and explore the use of multifaceted follow-up using a range of markers of right heart function and structure.
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Interstitial Pneumonia in a 94 Year Old Woman with MPO ANCA Positive Vasculitis

Interstitial Pneumonia in a 94 Year Old Woman with MPO ANCA Positive Vasculitis

Although the relationship between the clinical damages and patients’ age and course of disease revealed that age and disease course do not have a significant effect on the kidney, and heart involvement, the age of patients with pulmonary damage was significantly higher than that of patients without lung damage, and the course of disease was shorter, which suggested that elderly patients experienced early lung damage, or more serious lung damage such as pulmonary hemorrhage leading to early death [5]. Older patients were more likely to show lung involvement in the early disease stage in Japan [6]. This tendency is compatible with European patients [2].
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Differential protein profiling as a potential multi marker approach for TSE diagnosis

Differential protein profiling as a potential multi marker approach for TSE diagnosis

The terminal study consolidated the initial results in a larger group of samples with many differential expression differences apparent. This experiment represented the most extreme comparisons, infected versus non-infected at the end stage of disease, therefore it was necessary to examine time points during disease progression to ascer- tain subtle changes occurring throughout the course of disease which would indicate potential biomarkers for a pre-clinical diagnostic panel. In this temporal study there were numerous proteins in both uninfected and infected groups which clustered together over a wide molecular weight range and over several time points. Statistically sig- nificant differentially expressed proteins grouped together separated the scrapie brain homogenate inoculated group from the normal brain homogenate inoculated group at several time points however statistical significance for the proteins individually was not achieved at every time point throughout the course of disease. Further investigation of the data (Tables 3, 4, 5 and 6) was carried out in the Ciphergen Express software to ascertain if these protein clusters observed as statistically significant at particular time points were present at all time points. This analysis shows a clear relationship between time points as demon- strated in Figures 5 &6, with trends of up regulation or down regulation apparent over the course of infection. Given that these data are derived from individual animals and the samples analysed in "batches" of samples over time the results in expression differences are extremely consistent. Several proteins displayed consistent up or down regulation as displayed by the peak seen in Figure 7 at 10180 m/z which is particularly striking as the normal group remains consistently low at all the time points whereas the diseased group displays an up regulated trend from an early time point. Utilizing similarly robust biomarkers and combining highly significant markers at specific time points, a diagnostic panel could be compiled to be applied as a diagnostic decision tree algorithm for the presence of TSE disease.
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Efficacy of embedded nurse led versus conventional physician led follow up in rheumatoid arthritis: a systematic review and meta analysis

Efficacy of embedded nurse led versus conventional physician led follow up in rheumatoid arthritis: a systematic review and meta analysis

essential question remains, however, whether the involve- ment of nurses in the follow-up care can achieve the same degree of disease control, indicated by DAS-28, as when the follow-up is performed by physicians alone. In addition, it is interesting whether nurses can contribute to enhanced patient satisfaction and self-efficacy. These questions need a systematic evaluation of the evidence. Hence, our objective was to conduct a systematic review and meta-analysis to investigate the efficacy of embedded nurse-led versus conventional physician-led follow-up in the treat to target strategy in RA.
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Detection of Parkinson'S Disease by Speech Analysis

Detection of Parkinson'S Disease by Speech Analysis

ABSTRACT: - Parkinson's Disease (PD) is a degenerative disorder of central nervous system. PD occurs when nerve cells or neurons, in the brain die or became impaired. The main symptoms are shaking, stiffness, slowness of movement and unsteadiness. PD is incurable disease. PD is also called as IDIOPATHIC PD. Its main affect lies on SUBSTANTIA NIGRA. Speech analysis is one of ways of diagnosing this disease depending on pronunciation of vowel sound. This project's core idea is to identify and indicate whether the person has the disease or not. And we are going to implement this project under the platform of the MATLAB software. The design of this project is executed through some of the respective sequential modules. The initial step is to take the respective person's voice as the input and to this input, the desired or framed noise is to be added and processed. After the processing, the added noise is removed and compared and cross-checked with reference signal, which is free from PD. Finally the presence or absence of the Parkinson’s disease of respective person is will be indicated in the output module.
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ibd2672.pdf

ibd2672.pdf

health care improvement efforts have focused on reducing unin- tended variation in care in an effort to improve patient outcomes and decrease costs and resource utilization. This is one of the first studies to describe variation in adult IBD care by GI practice setting. We found that significant variations in care patterns and quality measures exist for CD across GI provider types, without similar variation in UC care. We recognize that severity of dis- ease is likely associated with important outcomes, such as ste- roid use or clinical remission; thus, we did control for factors associated with a prior complicated disease course. In our study, patients seen by GIA had increased risk of prior surgery, which may represent a more severe IBD phenotype. Despite this, a greater percentage of these complicated CD patients treated by GIA were in remission on biologic and immunomodulator therapy with less dependence on corticosteroids. GIA had a high- er rate of in fl uenza vaccination and also had fewer individuals who were current smokers within the CD population. It is pos- sible that this provider group may place a greater emphasis on health care maintenance and preventive care. Important preven- tive health maintenance counseling in individuals with IBD in- cludes yearly discussions about the importance of tobacco cessation and education about appropriate vaccinations for those with IBD. For example, yearly influenza vaccine is recommen- ded in all patients with IBD, with avoidance of live virus vac- cines in those on immunosuppression. 1
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Managing inflammatory bowel disease in pregnancy: current perspectives

Managing inflammatory bowel disease in pregnancy: current perspectives

Abstract: Inflammatory bowel disease (IBD) affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treat- ments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes.
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Neurocognitive Rehabilitation in Parkinson’s Disease with Motor Imagery: A Rehabilitative Experience in a Case Report

Neurocognitive Rehabilitation in Parkinson’s Disease with Motor Imagery: A Rehabilitative Experience in a Case Report

Balance and gait impairments are not fully addressed by phar- macological agents in Parkinson’s disease (PD); thus non- pharmacological approaches are necessary. For patients with central nervous system (CNS) lesions and sensorimotor impairments, a solid introduction to motor imagery (MI) is crucial for optimizing the retraining of motor function [1]. The motor imagery is a biological phenomenon and results from cognitive processes closely related to our world experi- ence. Through mental images situations and actions can be anticipated, formulating behavioral strategies to be adopted. The image acts as a bridge between perception and memory and between perception and motor control; furthermore the perception capacity is closely related to the perception of pain. PD patients usually present impairments in terms of motor control as well as in sensory integration, resulting in static and dynamic postural control deficits. Another symp- tom of the most common nonmotorsymptoms of Parkinson’s disease is chronic pain; we hypothesize that MI could be an effective instrument against pain, restoring the somesthetic channel suppressed and thus reestablishing the coherency of afference to the central level (CNS). This study was
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Clinical course of nonalcoholic fatty liver disease: an assessment of severity, progression, and outcomes

Clinical course of nonalcoholic fatty liver disease: an assessment of severity, progression, and outcomes

Limitations include the following: disease stage was identified using algorithms derived from liver severity scores based on clinical biomarkers, diagnosis codes, and procedure codes, rather than results from biopsies, although multiple liver biopsies are infrequently performed on the same patient in clinical practice. Patients with diabetes may have had more opportunities to be classified as having disease progression than patients without diabetes due to increased monitoring by health care providers; however, the present study was intended to characterize the clinical course of NAFLD in a real-world cohort of patients. As diagnosis codes for NAFLD were used to identify patients in the study sample, all included patients should be considered as having clinically significant nonalcoholic liver disease. Published algorithms that reliably identify mild fibrosis from liver disease severity scores were not found in the literature, so this disease stage could not be included in the progression model. Cause of death informa- tion was not available; some deaths observed in the data were likely unrelated to progression of NAFLD.
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Predictive factors for the development and disease course of rheumatoid arthritis

Predictive factors for the development and disease course of rheumatoid arthritis

Deciding which measure of severity is best depends on the reason it is selected. The advantages and disadvantages of several severity measures are summarized in Table 1. For research purposes, the rate of joint damage, as visualized on radiographs of the hands and feet, is the most common outcome measure. The main advantage is that it can be assessed objectively using a validated scoring method. The radiographs can be scored by the same reader, thus making it possible to evaluate within-reader variation and between-reader variation (in the case of ≥1 reader). Another advantage of measuring the severity of joint damage is that it accumulates over time and thus reflects disease history. In summary, the rate of joint destruction correlates with the cumulative burden of inflammation over time, is highly linked with physical function and other outcomes such as work disability, and is inexpensive to measure using validated scoring methods; consequently, the rate of joint destruction is a comprehensive endpoint in observational studies. In this review, we focus on radiographic joint damage as an outcome for identifying new risk factors for severity of RA.
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A Mouse Model for Inflammatory Bowel Disease Associated Tumorigenesis

A Mouse Model for Inflammatory Bowel Disease Associated Tumorigenesis

Abstract: Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, is one kind of chronic, relapsing inflammatory disorder of the gastrointestinal tract and has the potential of tumorigenesis. However, no stable and mature cell line is available for relative basic research, so animal model is essential. In this study, a mice model was built, which mimics the dynamic disease course of inflammatory bowel disease associated tumorigenesis with injection of azoxymethane and sequent cycles of drinking water with dextran sulfate sodium. All the mice survived till the end of the modeling procedure. Compared with the mice in the control group, the mice in the modeling group experienced obvious bloody diarrhea and body weight loss (P<0.001). The colorectum was significantly swollen and shorter (P<0.001) while the spleen was significantly bigger (P<0.001) in mice in the modeling group compared with the mice in the control group. All the mice in the modeling group developed tumors in the colorectum, with an average tumor number of 6.5 and an average tumor size of 10.25 mm 3 . Pathological evaluation by hematoxylin and eosin staining confirmed the tumors as adenomas with high-grade dysplasia. In conclusion, this model is inducible and stable which would be very useful in the research in this field.
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A Clinical study of 100 cases of Herpes Zoster.

A Clinical study of 100 cases of Herpes Zoster.

Patient’s age, sex, occupation, and address were noted. A detailed history regarding the prodromal symptoms, skin lesions, nature of pain, duration of illness at the time of presentation, provocative factors were recorded. Associated cutaneous disease, systemic disease and HIV infection were recorded. History of chicken pox and previous attack of zoster were elicited and time taken for complete resolution of lesions were noted. Complications of herpes zoster and association with HIV were also recorded.

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A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses

symptoms ever going into remission (type A cases). To explain this finding, we noted that EATL, UJI and SBC are more frequent among cases type A than cases type B. On the other hand, RCD1 is more frequent among cases type B. Thus, we could hypothesise that, in those coeliac patients who developed complications very rapidly without GFD being able to induce any remission of the symptoms, a malignant complication had already been trig- gered when CD was diagnosed. The course of the disease was therefore much more aggressive. Finally, since now- adays there is no efficient treatment for these complications [7], this finding is unlikely to have an immediate, strong clinical impact. Nevertheless, it certainly helps in better understanding the clinical course of these conditions and in figuring out their prognoses.
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Case Report Extranodal Rosai-Dorfman disease involving appendix and mesenteric nodes with a protracted course: report of a rare case lacking relationship to IgG4-related disease and review of the literature

Case Report Extranodal Rosai-Dorfman disease involving appendix and mesenteric nodes with a protracted course: report of a rare case lacking relationship to IgG4-related disease and review of the literature

Abstract: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare disease of unknown etiology that typically presents as nodal disease in young children. However, it also can pres- ent in various extranodal sites and can be difficult to recognize if not considered in the differential diagnosis. Here, we report a case of appendix involvement by extranodal RDD, which occurred in a 69-year-old woman with a long duration of 12 years for intermittent right lower quadrant pain. The patient underwent a right hemicolectomy for a clinical diagnosis of appendiceal cancer. A mixed inflammatory infiltration of mature lymphocytes, plasma cells and histiocytes exhibiting emperipolesis were indentified. Other areas had storiform fibrosis and sclerosis admixed with numerous plasma cells. These histologic features combination with immunoreactivity for CD68 and S100 protein were indicative of a diagnosis of extranodal RDD. We discuss the clinical, pathologic findings as well as differential diagnoses and consideration of a possible relationship of this entity to IgG4-related lesion.
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Tangled up in mood : predicting the disease course of bipolar disorder

Tangled up in mood : predicting the disease course of bipolar disorder

Also for scientific research on the course of illness, the LCM-p, especially the daily version, has been used frequently. However, processing and analysing the LCM-p for research purposes, is challenging because of the multitude of complex measures that can be derived from the data. The largest bene- fit of the LCM-p is that it summarizes the course of mania or depression associated functional impairment over time without diagnostic bias as to what constitutes for example a manic or depressive episode. However, to interpret these complex data, researchers need to transform the raw LCM-p data into course variables. The main course variables that are derived from the LCM are: number of episodes (e.g. 64), number of mood switches (e.g. 65), average mood severity over time (e.g. 30) or proportion of time im- paired (66). Although clinical definitions of several bipolar course variables (e.g. recurrence, relapse, remission, response) are previously described by a taskforce of the International Society of Bipolar Disorders (ISBD), crite- ria to derive these course variables from the LCM were not always clear and differed across studies. For example, for the definition of an episode some researchers have used the Diagnostic and Statistical Manual IV (DSM-IV) (4) duration criteria (e.g. 67) while others used more strict criteria (e.g. 62). One reason for these differences is the fact that different aspects of the mood course are relevant for different research questions. Another reason might be that there is a lack of concise and unequivocal criteria for the calculation of p-LCM course variables.
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Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial

Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial

in MS and CIS patients. The randomized, controlled, double-blinded study design and the implementation of independent evaluation of outcome parameters fulfill the criteria for a high-quality clinical phase II trial in MS [34]. Some aspects of the study design however may deserve a closer discussion: Why was an active treat- ment regimen instead of a placebo treatment chosen for the control arm, i.e. low-dose vitamin D? In fact, this question was heavily debated. Although we do not know whether this represents rather a causal factor or a con- sequence, serum levels of 25-hydroxyvitamin D are often quite low in MS patients [13,35]. Thus, we expect that low serum levels or even vitamin D deficiency will be detected in a substantial number of screened study candidates. From an ethical point of view and bearing in mind the importance of vitamin D for bone metabolism it would be difficult not to supplement these patients with vitamin D. On the other hand, the daily dose pro- vided in the control arm may not be immunologically active itself as this would prevent the detection of any difference between both groups. Thus, the daily dose recommended by the German Nutrition Society for this group of age which corresponds to 5 μ g or 200 IU and which most probably has no immunomodulatory poten- tial represents a compromise between ethical concerns and efficacy aspects. Another important question relates to the dose used in the high-dose arm. In fact, we do not know, at which minimum doses or serum levels vitamin D starts to have immunomodulatory effects. To prevent failure of the trial because of an insufficient treatment dose, we choose the maximum dose for which sufficient safety data are available, which currently corresponds to 10.000 IU per day [23]. It might well be that already smaller doses would be sufficient, but on the other hand it is rather unlikely, that if this dose does not demonstrate any treatment effect, even higher daily doses would do. A further question might be why an add-on regimen to an established immunomodula- tory treatment with interferon- b was chosen? In fact, from a methodological point of view, a monotherapeutic design would be preferable. However, since disease- modifying drugs are established and approved for the treatment of MS it would again be unethical to withhold these treatment options in favor of an experimental approach. The restriction to interferon-b as immunomo- dulatory treatment is explained by the need for maxi- mum homogeneity in the trial cohort on the one hand and the reported synergistic effects of interferon- b and the vitamin D system on the other [18]. Finally, one might suspect that in view of the rather small sample size of 80 participants the study might be underpowered to detect a significant difference between both groups. However, the study will be able to detect a difference in mean new T2-hyperintense lesions per year of 1.5 with
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Inflammatory bowel disease incidence, prevalence and twelve month initial disease course in Tasmania, Australia

Inflammatory bowel disease incidence, prevalence and twelve month initial disease course in Tasmania, Australia

Histopathology databases were searched to identify additional IBD cases at the end of the study period. Searches were conducted using the terms “IBD”, “ulcerative colitis”, “Crohn’s disease”, “colitis” and “ulcerative proctitis”, from 1 st Jan 1986 up to the end of the study period. Neither self-referrals from the broader community nor referrals from primary care practitioners were sought. Hospital International Classification of Disease (ICD) discharge codes were not analysed as a source of eligible cases. It was felt that these methods of case recruitment had potentially poor specificity.
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