ABSTRACT
BACKGROUND: Patients with erythematous skin are likely to receive a diagnosis of cellulitis; however, the accuracy of this diagnosis is approximately only 33%. The diagnosis of cellulitis should be made only after a thorough evaluation of all possible differential diagnoses. Cellulitis may be a primary process (superficial spreading infective process involving only the epidermis and dermis) versus a secondary (reactive) process incited by a subcutaneous process, such as an abscess, tenosynovitis, necrotizing fasciitis, and osteomyelitis. CASE PRESENTATION: A 50-year-old man was admitted to a general hospital with the diagnosis of cellulitis. He was initially treated with systemic antibiotics without improvement. Following consultation with a wound management physician, the patient received a diagnosis of a pretibial abscess and was treated with surgical evacuation and postoperative systemic antibiotic therapy guided by tissue cultures. A postoperative wound was successfully treated with inelastic compression therapy. CONCLUSIONS: This case demonstrates the potential for misdiagnosis when evaluating erythematous skin. Furthermore, concluding that the erythema is due to a primary cellulitis may result in monotherapy with systemic antimicrobial agents. In such cases, making a correct diagnosis through a skillful and complete physical examination of the patient, coupled with appropriate investigations, will lead to the best possible outcome. A comprehensive treatment approach may include systemic antimicrobials, as well as surgical options and compression therapy.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cellulitis/diagnosis , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Cellulitis/drug therapy , Debridement/methods , Diagnosis, Differential , Emergency Service, Hospital , Fasciitis, Necrotizing/drug therapy , Follow-Up Studies , Humans , Lower Extremity , Male , Middle Aged , Severity of Illness Index , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Treatment OutcomeABSTRACT
Background and Objectives: Our study explored the validity of different threshold values on the 12-item version of the General Health Questionnaire (GHQ12) forestimating the prevalence of anxiety and mood disorders (AMD) in Ontario population survey data.Methods: Data were drawn from the 2003, 2004 and 2006 cycles of the CAMH Monitor(N = 7,126), an ongoing general population survey of Ontario adults aged 18 and older,which includes the GHQ12. The concordance of different threshold values on the GHQ12for determination of AMD with a criterion based on individuals who were prescribed eitheranti-anxiety or anti-depressant drugs in the past 12 months and who reported 14 ormore mentally unhealthy days in the past 30 days was examined using receiver operator characteristic (ROC) analysis.Results: Concordance between the GHQ12 determination of AMD and the criterionmeasure reached moderate levels. ROC analysis revealed an area under the curve (AUC)of 0.89. At a GHQ12 threshold value of 4, the specificity and sensitivity values obtained were 0.92 and 0.71, respectively. Also at that value, the estimated prevalence of AMD wasnearly identical to that seen in recent Canadian studies using the CIDI.Conclusions: These analyses suggest that the GHQ12 may be suitable for providing aproxy measure of AMD for epidemiological and surveillance purposes. A threshold score of 4 seems to be most suitable for these purposes when using Canadian data (AU)
Subject(s)
Humans , Anxiety Disorders/epidemiology , Mood Disorders/epidemiology , Psychometrics/instrumentation , Health Surveys/instrumentation , Threshold Limit ValuesABSTRACT
BACKGROUND: Cannabis use has been linked to anxiety and mood disorders (AMD) in clinical cases, but little research on this relationship has been reported at the epidemiological level. OBJECTIVES: We examined the relationship between self-reported frequency of cannabis use and risk for AMD in the general Ontario adult population. METHODS: Data were based on the CAMH Monitor survey of Ontario adults from 2001 to 2006 (n = 14,531). AMD was assessed with the 12-item version of the General Health Questionnaire (GHQ12). Frequency of cannabis use within the past year was grouped into five categories: No use (abstainer), less than once a month but at least once a year, less than once a week but at least once a month, less than daily but at least once a week, almost every day to more than once a day. Logistic regression analysis of AMD and cannabis use was implemented while controlling for demographics and alcohol problems. RESULTS: AMD was most common among heavy cannabis users (used almost every day or more) (18.1%) and lowest for abstainers (8.7%). Compared to abstainers, the risk of AMD was significantly greater for infrequent cannabis users (OR = 1.43) and heavy cannabis users (OR = 2.04) but not for those in between. CONCLUSION: These data provide epidemiological evidence for a link between both light and heavy cannabis use and AMD. SCIENTIFIC SIGNIFICANCE: Recognizing the comorbidity of heavy cannabis use and AMD should facilitate improved treatment efforts. Our results also suggest the possibility that, for some individuals, AMD may occur at relatively low levels of cannabis use.
