Patient perceptions of a tuberculosis testing program provided in the community pharmacy setting.

OBJECTIVES: This study sought to describe patient experiences and perceptions of a public health initiative designed to improve tuberculosis (TB) testing access using the tuberculin skin test (TST) in a community pharmacy setting. STUDY DESIGN: This was a cross-sectional study. METHODS: A telephonic survey of patients who had received a TST at one of twelve participating community pharmacies between August 2014 and July 2016 was conducted. The 26-question survey was developed by two pharmacists with expertise in TB management and one pharmacy student. Before administration the survey was peer-reviewed for clarity. Potential study patients were identified through TST records at the study pharmacies. English-speaking patients older than 18 years were eligible for study inclusion. Statistical differences in responses based on location were identified using chi-squared test for frequency comparisons with a P-value of <0.05 to determine statistical significance. RESULTS: A total of 1709 patients received a TST during the study period, of whom 431 were contacted and 325 participated, meeting the predetermined representative sample needed of 314 patients. The majority of study patients were female (67.1%) and white (81%). The mean age was 36 years (standard deviation = 14.1). A majority (68.3%) lived <5 miles from the TST pharmacy, while 45.2% of those with a primary care provider (PCP) (61.6% of respondents) lived within 5 miles of the PCP's office. Care was accessible and met patients' testing needs. For most patients (84.6%), the initial and follow-up appointments took < 20 min. Follow-up TST reading rate was 98.5%; 4.3% of tests were positive. Positive TST results were associated with use of a small city pharmacy (P = 0.003). Perception differences based on location were identified. CONCLUSIONS: Uptake of the TST service in the community pharmacy setting was high and patients reported positive experiences.

Comparison of four methods for quantitative assessment of 99mTc-MDP SPECT in patients with suspected condylar hyperplasia. / Comparación de cuatro métodos de valoración cuantitativa de la SPECT con 99mTc-MDP en pacientes con sospecha clínica de hiperplasia condilar.

OBJECTIVE: To compare variability, reproducibility and repeatability of four quantitative evaluation methods to interpret the 99mTc-MDP SPECT reports in patients with clinically suspected unilateral condylar hyperplasia. METHOD: This was a descriptive observational study carried out with SPECT images of 38 patients with clinical and radiographic signs of unilateral condylar hyperplasia, and interpreted using four quantitative methods: 1) one image, variable-size region of interest (ROI); 2) one image, fixed-size ROI (1.76cm2), 3) five image variable-size ROI; 4) five image, fixed-size ROI (1.76cm2). Each of the images was reported simultaneously (but in an independent way) by two nuclear medicine experts, in both total radioactive counts as well as normalized counts to evaluate the reproducibility (inter-operator variability) and the repeatability (intra-operator variability). RESULTS: Higher reproducibility and repeatability were obtained in 5-image fixed-size ROI method (intra-class correlation coefficient: 0.979 [0.959; 0.989]). A high grade of diagnostic agreement (97.4%) was also attained in fixed methods (Kappa 0.940, p value: .000) from either total or normalized counts. There was no difference between fixed-size 1 vs 5 image methods. The methods based on variable-size ROI had a low grade of agreement (Kappa<0.20). More positive cases were identified using one image, ROI variable total counts (27 cases), but when the counts were normalized, they presented a lower number (5 cases). CONCLUSION: Five-image fixed-size ROI provides the best intra-operator and inter-operator reliability for the diagnosis of unilateral condylar hyperplasia. In the four methods using normalized counts fewer positive cases were detected (≥10%), unlike with total counts when more positive cases were found.

Lupus eritematoso sistémico asociado a síndrome de McCune-Albright: reporte de un caso / Systemic lupus erythematosus associated a McCune-Albright syndrome: case report

RESUMEN El Síndrome de McCune-Albright (SMA) es una enfermedad poco frecuente compuesta por una tríada clásica: displasia fibrosa poliostótica (DFP), manchas cutáneas de color café con leche y alteraciones endocrinas, siendo la más frecuente la pubertad precoz. Este síndrome no se ha visto asociado a enfermedades autoinmunes. Reportamos el primer caso de una paciente con SMA y lupus eritematoso sistémico.

ABSTRACT McCune-Albright Syndrome (MAS) is a rare disease characterized by a classical triad: polyostotic fibrous dysplasia (PFD), cafe-au-lait macules and endocrine abnormalities, most frequently precocious puberty. This syndrome has not been associated with autoimmune diseases. We report the first case of a patient with MAS and systemic lupus erythematosus.

Experience with FiberWire for pectus bar attachment.

BACKGROUND: Minimally invasive repair of pectus excavatum has become an established method for repair of pectus excavatum. Bar displacement or rotation remains the most common complication of this repair requiring return to the operating room. METHODS: Retrospective review of all patients at a single institution who underwent repair of pectus excavatum using FiberWire for bar stabilization between December 2009 and March 2013 was undertaken. RESULTS: 93 patients underwent minimally invasive pectus repair using FiberWire during the study period. The patients included 73 males and 20 females, with an average age of 14.6years (range 7-21years). Mean operative time was 102minutes (range 56-198minutes). No patients developed wound complications, two patients developed pain because of bar migration and required return to the OR, and no patients had recurrence of their pectus defect because of bar migration during the study period. Median length of follow-up was 17months (range 3-36months). CONCLUSION: Stabilization of pectus bars using circumferential rib fixation with FiberWire at multiple points on both sides of the bar appears to be effective in preventing bar rotation and displacement, and requires minimal change to the operation as it has been previously described. Early experience shows a low rate of complications.

Prognostic value of histological and immunohistochemical characteristics for predicting the recurrence of medullary thyroid carcinoma.

INTRODUCTION: In medullary thyroid carcinoma, there is currently no consensus about the prognostic value of histological and immunohistochemical parameters. This study was designed to analyze the value of various histological and immunohistochemical characteristics for predicting the recurrence of medullary carcinoma. METHODS: A total of 55 cases of medullary thyroid carcinoma have been reviewed. These were operated on consecutively between 1971 and 2004 after histological confirmation. The data referring to clinical characteristics and evolution were taken from the patient's clinical history. The macroscopic, microscopic, and immunohistochemical characteristics of the tumors were taken from the pathological anatomy report. RESULTS: In 14 (27%) cases, there was recurrence of the disease. The disease-free interval at 1 year was 88 +/- 5%; at 5 years 73 +/- 7%; at 10 years 73 +/- 7%; at 15 years 61 +/- 10%; and at 20 years or more 61 +/- 10%. Of the histological parameters, only vascular invasion (0.0098) was related to a higher relapse rate. No epidemiological variable or immunohistochemical marker was associated with relapse. However, it was found that staging (P = 0.0102), as well as tumor size (P = 0.0211) and lymph node affectation (P = 0.0012), are factors significantly related to relapse of the disease. According to Cox's regression model, the only variable with a statistically significant effect was vascular invasion (P = 0.0056; odds ratio = 5.2308). CONCLUSIONS: The overall recurrence rate was 27%, and the main independent prognostic factor of recurrence was tumoral vascular invasion at diagnosis. Staging, tumor size, and lymph node metastasis are prognostic factors of recurrence, although they are not significant in the multivariate analysis.

[Octreotide scintigraphy in thyroid orbitopathy]. / Gammagrafía con octreótido en la orbitopatía distiroidea.

INTRODUCTION: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. OBJECTIVE: To evaluate the efficiency of (111) In-Octreotide scintigraphy in the identification of orbital activity in Graves' disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. METHODS: We studied a group of eighteen patients with symptomatic Graves' ophthalmopathy of between two months and four years duration. We injected 6 mCi of (111) In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. RESULTS: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. CONCLUSION: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues.

[Extraosseous accumulation of 99mTc-HMDP in knees with synovial effusion]. / Acúmulo extraóseo de 99mTc-HMDP en rodillas con derrame sinovial.

In the presence of extraosseous activity seen in the late phase of the bone scintigraphy (BS) localized in the distal femur of patients prior to radiation synovectomy, we decided to review the frequency of this finding in 20 patients (24 joints) and its relationship with scintigraphic and clinical parameters. Mild soft tissue accumulation was seen in the late phase of the BS in 14 out of 24 joints, without association between this finding and knee uptake in vascular blood pool and late phases of the BS. However, a significant association with synovial effusion was found, and patients with higher degree of effusion presented extraosseous activity more frequently. In conclusion, we think that soft tissue accumulation in the late phase of the BS is a sign of synovial effusion.

Novel mechanisms in murine nitrofen-induced pulmonary hypoplasia: FGF-10 rescue in culture.

We evaluated the role of the key pulmonary morphogenetic gene fibroblast growth factor-10 (Fgf10) in murine nitrofen-induced primary lung hypoplasia, which is evident before the time of diaphragm closure. In situ hybridization and competitive RT-PCR revealed a profound disturbance in the temporospatial pattern as well as a 10-fold decrease in mRNA expression level of Fgf10 but not of the inducible inhibitor murine Sprouty2 (mSpry2) after nitrofen treatment. Exogenous FGF-10 increased branching not only of control lungs [13% (right) and 27% (left); P < 0.01] but also of nitrofen-exposed lungs [23% (right) and 77% (left); P < 0.01]. Expression of mSpry2 increased 10-fold with FGF-10 in both nitrofen-treated and control lungs, indicating intact downstream FGF signaling mechanisms after nitrofen treatment. We conclude that nitrofen inhibits Fgf10 expression, which is essential for lung growth and branching. Exogenous FGF-10 not only stimulates FGF signaling, marked by increased mSpry2 expression, in both nitrofen-treated and control lungs but also substantially rescues nitrofen-induced lung hypoplasia in culture.

Prenatal exposure to nitrofen induces Fryns phenotype in mice.

Prenatal exposure to nitrofen is known to cause multiple malformations in mice. The reported malformations include lung hypoplasia, diaphragmatic hernia, cardiovascular defects, skeletal malformations, cleft palate, and renal abnormalities. The authors present detailed findings of craniofacial defects after prenatal exposure to nitrofen, and propose that together with the previously reported malformations, nitrofen exposure induces a Fryns phenotype in mice. Fryns syndrome is a rare human genetic syndrome that is an autosomal recessive disorder characterized by lung hypoplasia, diaphragmatic hernia, craniofacial malformations, skeletal malformations, cardiovascular malformations, and genitourinary malformations. Timed-pregnant Swiss Webster mice were gavage-fed 25 mg of nitrofen on day 8 of gestation. Control animals received olive oil. Osteogenesis and chondrogenesis were studied in fetuses recovered on day 17 after Alcian blue-Alizarin red staining. Approximately 26% of the nitrofen-exposed embryos had severe craniofacial defects, and there was generalized delay in chondrogenesis and osteogenesis throughout the skeleton. No such defects were noted in the control group. The authors propose that prenatal exposure to nitrofen induces a Fryns phenotype in mice, and thus speculate that nitrofen may target similar molecular mechanisms to those that lead to Fryns syndrome.

Ampullary obstruction monitoring in acute gallstone pancreatitis: a safe, accurate, and reliable method to detect pancreatic ductal obstruction.

OBJECTIVE: The aim of this study was to determine the value of ordinary clinical and laboratory data, including the monitoring of ampullary gallstone obstruction in the early phases of the disease, in the diagnosis of acute gallstone pancreatitis (AGP). METHODS: One hundred and thirty-two patients were studied. The inclusion criteria were admission within 48 h from the onset of symptoms, clinical presentation compatible with AGP, bile-free gastric aspirate, elevation of serum amylase and bilirubin, and ultrasonographic demonstration of cholelithiasis. Monitoring of ampullary obstruction included severity of pain, presence of bile in the gastric aspirate, and serial serum bilirubin determinations. The clinical diagnosis of AGP was confirmed or excluded by surgical exploration, and that of ampullary obstruction by intraoperative cholangiography (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The overall accuracy of the diagnostic tests for AGP was high: sensitivity, 0.94; specificity, 0.99; positive predictive value, 0.95; and negative predictive value, 0.99. Detection of spontaneous ampullary decompression was correct in 100% of the patients, and that of ampullary obstruction, in 61%. The accuracy of this test was sensitivity, 1.0; specificity, 0.92; positive predictive value, 0.61; and negative predictive value, 1.0. CONCLUSIONS: Clinical criteria and ordinary laboratory determinations are sufficiently accurate to discriminate between patients with AGP and those with other acute abdominal pathologies. Careful monitoring of patients' pain, quality of nasogastric aspirate, and serum bilirubin level can accurately identify the few cases with persistent ampullary obstruction. Those patients can then be selected for intervention to restore the ampullary patency and prevent progression of acute pancreatitis.

Effect of duration of ampullary gallstone obstruction on severity of lesions of acute pancreatitis.

BACKGROUND: This study was done to determine the effects of duration of obstruction on severity of lesions in patients with acute pancreatitis of biliary origin. STUDY DESIGN: This case controlled study used patient data collected prospectively on protocol during a 27-year period in a university teaching hospital. We studied a group of 97 patients with acute pancreatitis, all with an impacted stone at the ampulla of Vater at exploration (Group Ob), and a control group of 49 patients with acute gallstone pancreatitis who experienced spontaneous ampullary disobstruction within 24 hours from the onset of symptoms and who showed a patent ampulla at exploration (Group Cont). Duration of obstruction was defined as the time elapsed between the onset of symptoms and exploration in Group Ob, and from the onset of symptoms until the appearance of signs of ampullary disobstruction in Group Cont. Severity of disease in both groups was determined by the appearance of the pancreas at exploration. Patients in Group Ob were divided into three subgroups according to duration of obstruction: under 24 hours, 25 to 48 hours, and more than 48 hours. RESULTS: The incidence of severe pancreatic lesions was higher in Group Ob than in Group Cont (19.7 percent compared to 6.1 percent, p < .01). Mean duration of obstruction was also significantly longer in Group Ob than in Group Cont (42.4 hours compared to 10.6 hours). In the subgroups of patients whose obstruction lasted under 48 hours, the incidence of severe lesions was low: in the 24 hours or fewer group, severe lesions were observed in 8.1 percent (3 of 37); and in the 25 to 48 hours group, the incidence was 10.6 percent (5 of 47). Neither subgroup differed significantly from Group Cont (6.1 percent, 3 of 49). When duration of obstruction exceeded 48 hours, however, frequency of severe lesions increased significantly to 84.6 percent (11 of 13) (p < .001). CONCLUSIONS: The findings in this study suggest that duration of ampullary obstruction is a major factor determining the severity of pancreatic lesions: severe pancreatic lesions are rare in patients whose obstruction lasts not more than 48 hours. In contrast, pancreatic necrosis develops in nearly all patients with obstruction beyond 48 hours. It may be safe to treat patients conservatively during the first day of the illness. If obstruction is not resolved by the second day, endoscopic retrograde cholangiopancreatography or surgical intervention must be carried out.

Control de calida en la determinacion de gases sanguineos. / Quality control in the assay of blood gases

Respondiendo a la necesidad de un adecuado control de calidad para los gases sanguineos, nuestro programa consistio en la medicion de pH, PO2 y PCO2 de ampulas acuosas disponibles en tres niveles: acidosis, normal y alcalosis, en dos analizadores de gases sanguineos. Se presentan los resultados de precision en tablas que muestran la media, desviacion estandar y coeficientes de variacion para cada una de las variables. Asimismo se hace analisis de regresion linear y correlacion para cada uno de los electrodos, en busca de diferencias sistemicas entre los analizadores

Purification and partial characterization of maize mosaic virus.

Leaf extracts containing maize mosaic virus (MMV) were purified by treatment with activated charcoal followed by filtration through Celite. Virus was concentrated from the filtrate by sedimentation onto a sucrose pad and then further purified by centrifugation in a 20--50% continuous sucrose density gradient. Buoyant density of virus particles in sucrose solution was 1.181 g/ml. Nucleic acid extracted from virus preparations reacted with orcinol and behaved like RNA in Pederson's diphenylamine test. It was digested by pancreatic RNase and apparently is single-stranded RNA. Virus preparations also contained lipids. The morphology and constituents of MMV particles are therefore those expected for a rhabdovirus.

Acute pancreatitis of rare causation.

From a review of 800 patients with acute pancreatitis, eight having rare causation were selected. Definite obstruction of the common pancreatic duct was noted in four patients, and direct injury of the parenchyma, vascular lesions of pancreatic vessels and presumed autoimmune factors were responsible in the remaining four patients. Although the definitive treatment of nonobstructive pancreatitis remains controversial, surgical relief of obstruction of the pancreatic duct provides the most appropriate therapeutic approach for obstructive pancreatitis.