RESUMEN
The incidence of Chlamydia trachomatis (CT) & Neisseria gonorrhoeae (NG) are rising in Ireland. Both are often undiagnosed and may cause infertility amongst other complications. CT/NG screening is not routinely offered during cervical cancer screening. This study aimed to ascertain the feasibility and acceptability of screening for CT/NG at time of smear and to measure the diagnostic yield. Screening was offered to women aged 25-40 years attending four participating general practices as part of Cervical Check. A retrospective review of the three months preceding the study period, indicated that out of 138 smears, CT/NG testing was performed in 10 (7%) of cases. 236 (93%) patients consented to screening for CT/NG. The detection rate for Chlamydia was 6 (2.4%), with no positive results for NG. Feedback from patients was positive. Interestingly, 42 (18%) of participants who completed the questionnaire believed STI screening was already part of the routine smear.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Aceptación de la Atención de Salud , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Estudios de Cohortes , Detección Precoz del Cáncer , Estudios de Factibilidad , Femenino , Medicina General , Gonorrea/epidemiología , Humanos , Irlanda/epidemiología , Tamizaje Masivo , Neisseria gonorrhoeae , Prueba de Papanicolaou , Estudios Retrospectivos , Encuestas y Cuestionarios , Frotis VaginalRESUMEN
Ireland has the fourth highest prevalence of overweight and obese men in the European Union and the seventh highest prevalence among women. This study focuses on 777 referrals on the waiting list for Ireland's only fully funded hospital-based adult weight management service with special emphasis on the role of primary care in the referral process. Since our last review two years ago, we found that patients are now being referred at a younger age (mean 43 years). The mean BMI at referral has increased from 44 to 46. Five hundred and forty eight (70%) referrals were from primary care with males accounting for 163 (30%) of these, despite male obesity being more prevalent. Interestingly, as the distance from Dublin increased, the number of referrals decreased. Overall this is a concerning trend showing the increasing burden of obesity on a younger population and a health system inadequately equipped to deal with the problem. It also highlights the central role of the primary care physician in the timely and appropriate referral to optimise use of our available resources.
Asunto(s)
Manejo de la Enfermedad , Obesidad/terapia , Atención Primaria de Salud , Adulto , Índice de Masa Corporal , Femenino , Unidades Hospitalarias/economía , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Obesidad/prevención & control , Prevención Primaria , Derivación y Consulta , Listas de EsperaRESUMEN
Merkel cell carcinoma is a rare aggressive neuroendocrine carcinoma of the skin predominantly affecting elderly Caucasians. It has a high rate of local recurrence and regional lymph node metastases. It is associated with a poor prognosis. Complete spontaneous regression of Merkel cell carcinoma has been reported but is a poorly understood phenomenon. Here we present a case of complete spontaneous regression of metastatic Merkel cell carcinoma demonstrating a markedly different pattern of events from those previously published.
Asunto(s)
Carcinoma de Células de Merkel/patología , Regresión Neoplásica Espontánea/patología , Neoplasias Cutáneas/patología , Biopsia , Carcinoma de Células de Merkel/diagnóstico por imagen , Femenino , Ingle , Humanos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico por imagen , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos XRESUMEN
We report four sibs with Kenny-Caffey syndrome in a consanguineous Bedouin family. The first two died in the neonatal period while the remaining affected brother and sister had all the characteristic clinical, biochemical, and radiological abnormalities of the syndrome. These included severe pre- and postnatal growth retardation, cortical thickening of the tubular bones with medullary stenosis, eye abnormalities, facial dysmorphism, hypocalcaemia, and low levels of parathyroid hormone. The children also showed intracranial calcification, impaired neutrophil phagocytosis, increased proportion of B lymphocytes, reduced CD4 and CD8 subpopulations of T lymphocytes, and inhibited transformation in response to Candida antigen. Fluorescence in situ hybridisation (FISH) was applied to blood lymphocyte metaphase spreads from these two Bedouin sibs and their parents using probe D22S75 (Oncor), specific for the DiGeorge critical region on chromosome 22q11.2. The presence of 22q11.2 haploinsufficiency was identified in the affected sibs, which was transmitted from the phenotypically normal mother. The present report widens the spectrum of CATCH 22 microdeletion to accommodate Kenny-Caffey syndrome.
Asunto(s)
Anomalías Múltiples/genética , Aberraciones Cromosómicas/genética , Deleción Cromosómica , Cromosomas Humanos Par 22/genética , Anomalías Musculoesqueléticas/genética , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/fisiopatología , Árabes , Niño , Aberraciones Cromosómicas/diagnóstico por imagen , Aberraciones Cromosómicas/fisiopatología , Trastornos de los Cromosomas , Anomalías del Ojo/genética , Femenino , Trastornos del Crecimiento/diagnóstico por imagen , Trastornos del Crecimiento/genética , Haplotipos , Humanos , Recién Nacido , Masculino , Anomalías Musculoesqueléticas/diagnóstico por imagen , Núcleo Familiar , Radiografía , SíndromeRESUMEN
UNLABELLED: Seventy-five consecutive patients were selected to evaluate a disease-specific quality-of-life questionnaire (UW QOL). The new test was compared to two established equality of life evaluation tools, the Karnofsky scale and the Sickness Impact Profile (SIP). Each test was administered on three separate occasions: (1) several days preoperatively; (2) immediately postoperatively; and (3) 3 months postoperatively. The Karnofsky scale is relatively crude and lacks the ability to measure subtle changes. The SIP is a detailed questionnaire that is quite sensitive to change. However, due to its length, the SIP is inefficient and expensive to administer, and patient non-compliance is often a problem. The three questionnaires were compared according to the following factors: Acceptability: 97% of the patients favored the UW QOL scale compared with the SIP because it was more concise and easier to complete. VALIDITY: VALIDITY indicates the ability of the test under investigation to measure what it was intended to measure. Using the SIP as a gold standard, the UW QOL scale demonstrated an average criterion validity of 0.849, whereas the Karnofsky average criterion validity was 0.826. Reliability: Reliability is a measurement of the reproducibility of the data. The UW QOL questionnaire scored > 0.90 on reliability coefficients versus 0.80 for the Karnofsky and 0.87 for the SIP scale. Responsiveness: Responsiveness is the ability of the test to measure clinical change. The UW QOL scale faired better than the Karnofsky and the SIP scale in detecting change. The UW QOL scale is comparable to the Karnofsky and SIP scales when tested for validity and reliability. It was the preferred test format of 97% of patients and provided the greatest responsiveness to clinical change.