Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders.

Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.

Correlations between the results of the histological and cytological examination in the diagnostic of the broncho-pulmonary cancer.

INTRODUCTION: Within the last years one discusses more and more about the association of the cytological examination with the histological one, becoming an important complementary examination. Casebook record. 163 patients were taken in the study, age between 37-79 years old, who showed clinical and radiological signs of broncho-pulmonary cancer. At all the patients a fibro-bronchoscopic examination was performed, with harvesting of material for histological and cytological examination. MATERIAL AND METHODS: The histological examination was performed on bioptic pieces, fixed with 10% formalin and colored with Hematoxylin-Eosin, Masson and Van Gieson. The cytological examination was performed on material harvested by aimed bronchial brushing and/or on stamps from bioptic material, coloured Giemsa. RESULTS: By histological examination (in the 163 cases) the diagnostic of broncho-pulmonary cancer was given with the establishing of the histological type of cancer in 87.12% of the cases, at 17 patients (10.42%) dysplasia was diagnosed and in 2.45% (4 cases) the examination was negative. Out of the 163 cytologically examined cases, in 66.25% (108 patients) diagnose of broncho-pulmonary cancer could be given and the histological type could be established. In 11.66% of the patients the cytological examination was negative and in 22.08% of the cases the cytology was strongly suggestive for broncho-pulmonary cancer, but one could not determine the histological type. According to the current classification of the broncho-pulmonary cancer by histological examination, we diagnosed the NSCLC type (non small cell lung carcinoma) by 123 patients (75.41%) and by cytological examination, by 124 (76.07%); the type SCLC (small cell lung carcinoma) was identified by histological examination in 18 cases (11.04%) while the cytological examination allowed the highlighting of this type of cancer in 5 cases (3.06%). CONCLUSIONS: Our data indicate the fact that the cytological examination on stamps from bioptic material or on that obtained by bronchial brushing offers a very high percentage of positive results, close to the histological one, but the establishing of the histological type of broncho-pulmonary cancer is more difficult by cytological examination, due to the heterogeneous structure of the NSCLC tumors. Despite this, the cytology may be extremely useful in diagnose of the small, necrotic tumors as well as in that of the carcinomas with non-small and small cells.

The histopathological and immunohistochemical diagnosis in small cell lung carcinoma.

The small cells lung carcinoma (SCLC) represents 10-25% of the bronchogenical carcinomas, prevails at middle ages and is closely associated with tobacco smoke. It belongs to the group of carcinomas with neuroendocrine differentiation, the patients presenting various paraneoplastic syndromes. The study was performed on 491 patients with a clinical and radiological suspicion of bronchopulmonary cancer. In this study, the histopathological examination gives results similar to those mentioned in the medical literature for the small cells lung carcinoma, prevailing in the case of young patients. The immunohistochemical examinations are particularly precious in confirming the diagnosis, especially in the diagnosis of the lymphonodular micrometastases.

[THe etiology of pleuropneumopathies in infants and small children]. / Etiologia pleuropneumopatiilor la sugar si copilul mic.

In a follow-up study during 20 years (1975-1994) we observed, beside clinical aspects, the evolution of pleuropneumopathies in infants and small children (1-3 years of age), and the etiology of these infections. The casuistry includes 456 children-237 infants (51,97%) and 219 small children, between 1-3 years of age (48,02%), which were admitted in Clinical Children's Hospital from Oradea (Clinical Hospital for Children) with pleuropneumopathies. 4 intervals of time were analyzed comparatively, each of 5 years, starting with a number of 235 cases in the first one and reaching only 45 observations in the last one. The etiology was dominated by coagulase-negative and coagulase-positive Staph, aureus (34,20-60,40%), Strept. pneumoniae (14,10-40,00%). From the Gram negative bacteria, there were identified Kl. pneumoniae (2,20-9,80%), Pseudomonas sp. (2,20-5,19%), E. coli and Proteus sp. (1,70-2,20%). There were 2,90-9,85% of cases with a potential of pathogenicity, in various associations. In the last 10 years, the number of cases with unprecised etiology is growing (22,50-33,30%) probably because of the implication of anaerobe and coagulase-negative staphylococci, no tests of isolation and identification being made for them.

[Enterobacteria of the genera Salmonella, Shigella and Yersinia with an etiological role in acute diarrheal disease]. / Enterobacterii din genurile Salmonella, Shigella si Yersinia cu rol etiologic in boala diareica acuta.

In a study made during 5 years, from 1990 to 1994 on 8363 subjects with acute diarrhoea disease, we found 486 cases (5,81%) in which the etiologic agent was belonging to a species of enterobacteria; as follows: Shigella (69,13%), Salmonella (27,78%) and Yersinia enterocolitica (3,08%), and which were isolated predominantly in children with ages ranging from 6 months to 7 years. The serogroups of Shigella most often isolated were Shigella sonnei, in 196 patients (35,11%). Regarding the cases with Salmonella, in most of the cases Salmonella enteritidis was isolated (60,74%) followed by Salmonella typhimurium and other Salmonellae from the serogroup BO (23,70%). In the last 2 years (1993 and 1994), in 12 cases Yersinia enterocolitica was isolated; together with Salmonella enteritidis and Salmonella typhimurium, they could cause infections associated with consume of infected food.

[The comparative testing of the tuberculostatic sensitivity of M. tuberculosis strains in 2 diagnostic centers in Romania]. / Testarea comparativa a sensibilitatii la tuberculostatice a unor tulpini de M. tuberculosis în doua centre de diagnostic din tara.

The study of sensibility was carried out on 152 strains of M. tuberculosis by the method of absolute concentrations in two laboratories in Romania. The results obtained show an agreement in 71.05% of the cases. The high proportion of the disagreeing results shows the role of subjective and objective factors. The paper shows the possible modalities for correcting these factors.

[Aspects of the etiological diagnosis of extrapulmonary tuberculous infections]. / Aspecte privind diagnosticul etiologic al infectiilor tuberculoase extrapulmonare.

An analysis is made of criteria used for making an etiologic diagnosis of extra-pulmonary tuberculosis over a period of 15 years, and a general correlation is noted between the figures for morbidity and those of bacteriologic confirmations. In the group of patients which has been investigated the diagnosis could be ascertained from urine samples in 44% of the cases, from lymph-nodes and nodules in 15% from pleural fluids in 14%, from purulent collections in 13%, and from the cerebrospinal fluid in 8% of the cases. Human type mycobacteria was evidenced in 90% of the cases. Bovine type of mycobacteria was found in 5% of the cases, with a higher frequency in the cerebrospinal fluid (14%) and in lymph-nodes (11%). In 79% of the cases the antibiogram has evidenced the sensitivity of the isolated strains. Resistance of the strains was noted in 10% of the cases. The strains isolated from lymph-nodes and nodules were resistant in a higher proportion (11%), and those from the pleural fluid in 15%.

[Bacteriological and epidemiological observations on atypical mycobacteria isolated at the laboratory of the Cluj-Napoca Tuberculosis Hospital]. / Observatii bacteriologice si epidemiologice legate de microbacteriile atipice izolate în laboratorul Spitulului de tuberculoza Cluj-Napoca.

Excluding cases of clinically manifest mycobacteriosis atypical mycobacteria can be detected in the excreta of healthy subjects, of tuberculous patients, or of other patients suffering from other diseases, without any major clinical implication. In certain environment conditions however epidemiologic manifestations may be induced by these organisms, of the hospitalism type. Atypical strains of the mycobacteria isolated over a period of 10 years represent 3.17% of all isolated strains. The highest percentage according to the Runyon groups were found in the IV-th group (43%), followed by the II-nd group (with 42%), and the III-rd group (with 11%). Diffusion of mycobacteria from the II-nd and the IV-th Runyon groups has determined hospitalism phenomena that developed in two distinct epidemic outbreaks determined by different factors.