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Turkish Journal of Medical Sciences 2023Accurately measuring and recording the length or area of lesions affects the judgement of the forensic report, surgical wound management and, in some countries, the...
BACKGROUND/AIM
Accurately measuring and recording the length or area of lesions affects the judgement of the forensic report, surgical wound management and, in some countries, the billing of health care services. The aim of this study was to determine whether the length and area of lesions described by physicians by estimation are accurate.
MATERIALS AND METHODS
This study was designed as a cross-sectional descriptive study and was conducted with 494 participants consisting of internists and physicians at Ondokuz Mayıs University, Faculty of Medicine. The participants were asked to estimate the lengths or areas of 6 different shapes in the questionnaire form without using a measuring instrument.
RESULTS
Of the participants, 216 (43.7%) were interned physicians and 278 (56.3%) were physicians. Most 122 people (24.7%) answered the curved line shape with a length of 4 cm as "exact value". The average of the values given by the internists to each shape was higher than the average of the values given by the physicians to each shape and was found to be further away from the true value. It was determined that more than half of the participants gave values above the actual length and area values of the shapes. It was observed that the rate of correct estimation of line shapes was higher than the rate of correct estimation of area shapes both as exact values and with ±10% margin of error. For line shapes, it was observed that the number of those who gave exact values decreased as the line length increased.
CONCLUSION
When preparing forensic reports, determining surgical wound management and billing, estimated data should not be used in lesion description. It would also be useful to develop tools that will enable physicians to make measurements in terms of easy use.
Topics: Humans; Cross-Sectional Studies; Forensic Medicine; Male; Female; Surveys and Questionnaires; Physicians; Adult
PubMed: 38813036
DOI: 10.55730/1300-0144.5709 -
Biomedicines Apr 2024Drug-induced myopathies are a common cause of muscle pain, and the range of drugs that can cause muscle side effects is constantly expanding. In this article, the... (Review)
Review
Drug-induced myopathies are a common cause of muscle pain, and the range of drugs that can cause muscle side effects is constantly expanding. In this article, the authors comprehensively discuss the diagnostic and therapeutic process in patients with myalgia, and present the spectrum of drug-induced myopathies. The review provides a detailed analysis of the literature on the incidence of myopathy during treatment with hypolipemic drugs, beta-blockers, amiodarone, colchicine, glucocorticosteroids, antimalarials, cyclosporine, zidovudine, and checkpoint inhibitors, a group of drugs increasingly used in the treatment of malignancies. The article considers the clinical course of the different types of myopathies, their pathogenesis, histopathological features, and treatment methods of these disorders. The aim of this paper is to gather from the latest available literature up-to-date information on the course, pathophysiology, and therapeutic options of drug-induced myopathies, to systematize the knowledge of drug-induced myopathies and to draw the attention of internists to the fact that these clinical issues are an important therapeutic problem.
PubMed: 38790948
DOI: 10.3390/biomedicines12050987 -
JMIR Medical Informatics May 2024Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias.
BACKGROUND
Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias.
OBJECTIVE
We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias.
METHODS
In this cross-sectional study, we extracted EHR notes for patients who were aged 18 years or older; had more than 5 years of diabetes diagnosis codes; and received care between 2006 and 2014 from family physicians, general internists, or endocrinologists practicing in an urban, academic network of clinics. The race and ethnicity of patients were defined as White non-Hispanic, Black non-Hispanic, or Hispanic or Latino. We hypothesized that Sentiment Analysis and Social Cognition Engine (SEANCE) components (ie, negative adjectives, positive adjectives, joy words, fear and disgust words, politics words, respect words, trust verbs, and well-being words) and mean word count would be indicators of bias if racial differences emerged. We performed linear mixed effects analyses to examine the relationship between the outcomes of interest (the SEANCE components and word count) and patient race and ethnicity, controlling for patient age. To validate this approach, we asked clinicians to indicate the extent to which they thought variation in the use of SEANCE language domains for different racial and ethnic groups was reflective of bias in EHR notes.
RESULTS
We examined EHR notes (n=12,905) of Black non-Hispanic, White non-Hispanic, and Hispanic or Latino patients (n=1562), who were seen by 281 physicians. A total of 27 clinicians participated in the validation study. In terms of bias, participants rated negative adjectives as 8.63 (SD 2.06), fear and disgust words as 8.11 (SD 2.15), and positive adjectives as 7.93 (SD 2.46) on a scale of 1 to 10, with 10 being extremely indicative of bias. Notes for Black non-Hispanic patients contained significantly more negative adjectives (coefficient 0.07, SE 0.02) and significantly more fear and disgust words (coefficient 0.007, SE 0.002) than those for White non-Hispanic patients. The notes for Hispanic or Latino patients included significantly fewer positive adjectives (coefficient -0.02, SE 0.007), trust verbs (coefficient -0.009, SE 0.004), and joy words (coefficient -0.03, SE 0.01) than those for White non-Hispanic patients.
CONCLUSIONS
This approach may enable physicians and researchers to identify and mitigate bias in medical interactions, with the goal of reducing health disparities stemming from bias.
PubMed: 38787295
DOI: 10.2196/50428 -
Cureus Apr 2024Sezary syndrome (SS) is a rare but aggressive type of cutaneous T-cell lymphoma (CTCL). Patients with SS have characteristic skin lesions (erythroderma) and a leukemic...
Sezary syndrome (SS) is a rare but aggressive type of cutaneous T-cell lymphoma (CTCL). Patients with SS have characteristic skin lesions (erythroderma) and a leukemic phase. The rash associated with CTCLs can often mimic common benign skin conditions such as psoriasis, atopic dermatitis, etc. and therefore can go undiagnosed until later stages. We present a case of a patient with SS who managed eczema for over one year with topical steroids before receiving a skin biopsy. Workup confirmed leukemic involvement, and the patient was started on systemic therapy with bexarotene. The patient continues to have a good response to systemic therapy. When treating patients with persistent rash of uncertain etiology and/or unresponsive to treatment, primary care physicians and internists need to consider SS/Mycosis fungoides as a possible differential and should have a low threshold to initiate early referral to dermatology for definitive diagnosis.
PubMed: 38765439
DOI: 10.7759/cureus.58570 -
BMC Medicine May 2024Antidepressants are first-line medications for many psychiatric disorders. However, their widespread long-term use in some indications (e.g., mild depression and...
BACKGROUND
Antidepressants are first-line medications for many psychiatric disorders. However, their widespread long-term use in some indications (e.g., mild depression and insomnia) is concerning. Particularly in older adults with comorbidities and polypharmacy, who are more susceptible to adverse drug reactions, the risks and benefits of treatment should be regularly reviewed. The aim of this consensus process was to identify explicit criteria of potentially inappropriate antidepressant use (indicators) in order to support primary care clinicians in identifying situations, where deprescribing of antidepressants should be considered.
METHODS
We used the RAND/UCLA Appropriateness Method to identify the indicators of high-risk and overprescribing of antidepressants. We combined a structured literature review with a 3-round expert panel, with results discussed in moderated meetings in between rounds. Each of the 282 candidate indicators was scored on a 9-point Likert scale representing the necessity of a critical review of antidepressant continuation (1-3 = not necessary; 4-6 = uncertain; 7-9 = clearly necessary). Experts rated the indicators for the necessity of review, since decisions to deprescribe require considerations of patient risk/benefit balance and preferences. Indicators with a median necessity rating of ≥ 7 without disagreement after 3 rating rounds were accepted.
RESULTS
The expert panel comprised 2 general practitioners, 2 clinical pharmacologists, 1 gerontopsychiatrist, 2 psychiatrists, and 3 internists/geriatricians (total N = 10). After 3 assessment rounds, there was consensus for 37 indicators of high-risk and 25 indicators of overprescribing, where critical reviews were felt to be necessary. High-risk prescribing indicators included settings posing risks of drug-drug, drug-disease, and drug-age interactions or the occurrence of adverse drug reactions. Indicators with the highest ratings included those suggesting the possibility of cardiovascular risks (QTc prolongation), delirium, gastrointestinal bleeding, and liver injury in specific patient subgroups with additional risk factors. Overprescribing indicators target patients with long treatment durations for depression, anxiety, and insomnia as well as high doses for pain and insomnia.
CONCLUSIONS
Explicit indicators of antidepressant high-risk and overprescribing may be used directly by patients and health care providers, and integrated within clinical decision support tools, in order to improve the overall risk/benefit balance of this commonly prescribed class of prescription drugs.
Topics: Humans; Antidepressive Agents; Deprescriptions; Inappropriate Prescribing; Risk Assessment; Aged; Consensus
PubMed: 38735930
DOI: 10.1186/s12916-024-03397-w -
European Journal of Case Reports in... 2024Melioidosis is an infection caused by , a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has...
BACKGROUND
Melioidosis is an infection caused by , a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection.
CASE DESCRIPTION
This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses.
CONCLUSION
In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future.
LEARNING POINTS
Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.
PubMed: 38715889
DOI: 10.12890/2024_004415 -
European Journal of Case Reports in... 2024Syphilis, a disease caused by the bacteria , has a multitude of clinical manifestations and is classified into primary syphilis, secondary syphilis and tertiary...
UNLABELLED
Syphilis, a disease caused by the bacteria , has a multitude of clinical manifestations and is classified into primary syphilis, secondary syphilis and tertiary syphilis, based on clinical presentations and the time elapsed since the primary infection. The secondary stage of the disease can affect multiple organs and systems, and some of these involvements may be general and non-specific, justifying its name as 'the great imitator'. We present a case of a 30-year-old woman with a history of painful neck lymph nodes with progressive enlargement, persistent headache, weight loss, myalgia and alopecia. During investigations, stomatitis on the dorsal face of the tongue developed. A secondary study showed serum positive for rapid plasma reagin (RPR) and haemagglutination (TPHA), negative RPR in cerebrospinal fluid and normal MRI, thus the diagnosis of secondary syphilis was made. The patient was treated with a single dose of penicillin with complete resolution of symptoms. The case highlights the need for an exhaustive clinical examination, especially in cases presenting with non-specific and general symptoms, and raises awareness for this disease which has increased its prevalence in the last decades.
LEARNING POINTS
Syphilis is a resurgent infection with increasing prevalence, and its manifestations in the secondary stage of the disease are general and non-specific, being able to affect every organ system.The oral mucosa may be involved at any stage of the disease and the tongue, often a neglected organ, can be particularly affected and should be routinely observed.The internist, integrating a cornerstone speciality able to manage and diagnose systemic diseases, must be aware of the individual aspects of the physical examination, notably the appreciation and interpretation of each clue and sign found.
PubMed: 38715887
DOI: 10.12890/2024_004416 -
Journal of Clinical Medicine Research Apr 2024Spinal cord injury (SCI) is a traumatic event that significantly impacts body composition and alters energy and nutritional needs. This places patients with SCI at a... (Review)
Review
Spinal cord injury (SCI) is a traumatic event that significantly impacts body composition and alters energy and nutritional needs. This places patients with SCI at a high risk of malnutrition, which can hinder optimal functional recovery, prolong hospital stays, increase hospital admissions, and contribute to the development of obesity and cardiovascular and metabolic ailments in chronic patients. Consequently, there is an urgent need for clear guidance to support clinicians in managing the nutritional needs of patients with SCI at different stages of the disease, including the acute (0 - 4 months after injury), post-acute (4 - 26 months after injury), and post-discharge phases. This study utilized a cross-sectional survey to assess the strategies employed in seven spinal units across Italy to address the nutritional needs of patients with SCI during the acute, post-acute, and post-discharge phases of the condition. Eight clinicians (five physiatrists, two internists, and one urologist) and one nurse participated in the survey. Following the survey completion, the participants were invited to partake in a round table session to delve deeper into the questionnaire results to gather their opinions and gain insights into clinical practices related to the various challenges surrounding the management of malnutrition in patients with SCI. We here review the available evidence on the energy needs and nutritional requirements of patients with SCI, highlighting the clinical aspects that deserve more attention throughout the distinct phases of the disease. We additionally provide an overview of the scenario regarding the management of malnutrition in patients with SCI across various spinal units in Italy. Through this comprehensive analysis, we aimed to enhance understanding and provide valuable insights for clinicians working with patients with SCI, equipping them with the knowledge and confidence to provide nutritional support to patients with SCI efficiently. By addressing the challenges of defining nutritional needs and presenting a practical guide, we aspire to contribute to the overall management and care of individuals with SCI and the prevention of malnutrition and its associated complications, thereby improving patient outcomes.
PubMed: 38715555
DOI: 10.14740/jocmr5015 -
Cureus Apr 2024Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. Bangladesh Rheumatology Society (BRS) proposes these management recommendations to... (Review)
Review
2023 Management Recommendations of Bangladesh Rheumatology Society on Pharmacological Treatment of Rheumatoid Arthritis With Synthetic and Biologic Disease-Modifying Drugs.
Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. Bangladesh Rheumatology Society (BRS) proposes these management recommendations to treat the considerable burden of RA in the resource-constrained situation based on the best current evidence combined with societal challenges and opportunities. BRS formed a task force (TF) comprising four rheumatologists. The TF searched for all available literature, including updated American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR), and Asia-Pacific League of Associations for Rheumatology (APLAR) and several other guidelines, and systematic literature reviews until October 2023, and then a steering committee was formed, which included rheumatologists and internists. We followed the EULAR standard operating procedures to categorize levels of evidence and grading of recommendations. This recommendation has two parts -- general (diagnosis of RA, nomenclature of disease-modifying anti-rheumatic drugs [DMARDs], disease activity indices) and management portion. The TF agreed on four overarching principles and 12 recommendations. Overarching principles deal with early diagnosis and disease activity monitoring. Recommendations 1-5 discuss using glucocorticoids, NSAIDs, and conventional synthetic DMARDs (csDMARD). Recommendations 6-9 stretch the use of targeted synthetic DMARDs (tsDMARDs) and biological DMARDs (bDMARDs). The suggested DMARD therapy includes initiation with methotrexate (MTX) or another csDMARD (in case of contraindication to MTX) in the first phase and the addition of a tsDMARD in the second phase, switching to an alternative tsDMARDs or bDMARDs in the subsequent phases. The TF included the Padua prediction score for the thromboembolism risk estimation. Recommendations 10-12 cover infection screening, vaccination, and DMARD tapering. Bangladesh has a higher prevalence of RA. This recommendation will serve as a tool to treat this high burden of patients with RA scientifically and more effectively.
PubMed: 38707172
DOI: 10.7759/cureus.59395 -
Journal of Clinical Medicine Apr 2024The application of transthoracic contrast-enhanced ultrasound (CEUS) to the study of peripheral lung lesions is still a topic of debate. The main objective of this... (Review)
Review
The application of transthoracic contrast-enhanced ultrasound (CEUS) to the study of peripheral lung lesions is still a topic of debate. The main objective of this review was to evaluate the diagnostic accuracy of CEUS in the diagnosis of malignant subpleural pulmonary consolidations and, therefore, differentiate them from benign ones. Papers published before December 2023 were detected through a search of PubMed, Cochrane library, and Embase. The pooled specificity and sensitivity, summary receiver operating characteristic (SROC) curve and diagnostic odds ratio (DOR) were used. CEUS is characterized by a pooled sensitivity of 0.95 (95% CI: 0.93-0.97) and a pooled specificity of 0.93 (95% CI: 0.90-0.95) in differentiating benign and malignant subpleural lung diseases; the AUC of SROC was 0.97. Homogeneous CE was characterized by a pooled sensitivity of 0.43 (95% CI: 0.40-0.45) and the pooled specificity of 0.49 (95% CI: 0.46-0.52). Non-homogeneous CE displayed a pooled sensitivity of 0.57 (95% CI: 0.55-0.60) and a pooled specificity of 0.51 (95% CI: 0.48-0.54). The lack of CE displayed a pooled sensitivity of 0.01 (95% CI: 0.00-0.06) and a pooled specificity of 0.76 (95% CI: 0.64-0.85). Marked CE displayed a pooled sensitivity of 0.41 (95% CI: 0.37-0.44) and a pooled specificity of 0.54 (95% CI: 0.50-0.58). Non-marked CE displayed a pooled sensitivity of 0.59 (95% CI: 0.56-0.63) and a pooled specificity of 0.46 (95% CI: 0.42-0.50). The early AT displayed a pooled sensitivity of 0.04 (95% CI: 0.02-0.08) and a pooled specificity of 0.83 (95% CI: 0.77-0.87). The early wash out displayed a pooled sensitivity of 0.61 (95% CI: 0.48-0.72) and a pooled specificity of 0.98 (95% CI: 0.92-1.00). The delayed wash out displayed a pooled sensitivity of 0.15 (95% CI: 0.10-0.20) and a pooled specificity of 0.69 (95% CI: 0.62-0.75). CEUS is characterized by excellent diagnostic accuracy for the diagnosis of the malignancy of subpleural lung lesions. By separately analyzing the CEUS findings, the diagnostic accuracy values are considerably lower and not significant in some cases. The simultaneous evaluation of multiple CEUS features allows us to reach an excellent diagnostic accuracy. Non-homogeneous CE with early wash out are the most indicative features of malignancy of a lung lesion.
PubMed: 38673575
DOI: 10.3390/jcm13082302