RESUMO
BACKGROUND: The description of the clinical presentation of celiac disease (CeD) has usually come from studies at referral centers. Data about CeD presentation in the community are sparse. AIMS: We aim to describe the clinical presentation of patients with biopsy-proven CeD at a community-based adult gastroenterology practice and compare it to a referral center. METHODS: We performed a retrospective study of two cohorts of patients diagnosed with CeD between 2000-2007 (n = 117) and 2013-2016 (n = 91) in a community practice, and a third cohort (n = 188) diagnosed between 2000 and 2007 in a tertiary referral center. The clinical presentation, body mass index, tissue-transglutaminase levels, DEXA scan, vitamin D levels, and vaccine recommendations were assessed. RESULTS: Celiac disease presentation changed over time in the two community cohorts. Recently, fewer patients presented with diarrhea and anemia, but constipation and neurologic symptoms were more common. The most recent cohort had a higher proportion of patients who were overweight or obese than the first cohort. However, the body mass index in both community cohorts was higher than in the tertiary referral center. The frequency of osteopenia and osteoporosis was high in both community cohorts. The tertiary referral center patients were younger, presented with a higher proportion of diarrhea and a lower body mass index. CONCLUSIONS: The clinical presentation of CeD differs between the community setting and a tertiary referral center. Patients with CeD presenting to the community setting tended to be older, overweight, and to have a high proportion of mineral bone disease.
Assuntos
Doença Celíaca , Gastroenterologia , Osteoporose , Adulto , Humanos , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Estudos Retrospectivos , Sobrepeso , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/epidemiologia , DiarreiaRESUMO
BACKGROUND: Press releases from academic medical centers often form the basis for health and science news stories. Press release coverage of mild traumatic brain injury (mTBI) research has not been formally appraised in the literature. OBJECTIVE: To perform a systematic content analysis of mTBI-based press releases. DESIGN: Retrospective database study. SETTING: EurekAlert! (eurekalert.org), the main distribution engine for scientific press releases. PARTICIPANTS: Press releases indexed between January 1, 2012 and December 31, 2019 containing a minimum of 150 words. INTERVENTIONS: Pre-established, investigator-generated criteria delineating aspects of misinformation. MAIN OUTCOME MEASUREMENTS: Press releases were evaluated for manifestations of "spin," including misleading title, misleading reporting, misleading claims, and inappropriate extrapolation. RESULTS: Our database search yielded 125 entries within the specified time period. Of these, 66 met inclusion criteria. Fifty-five of 66 (83%) press releases exhibited at least one manifestation of spin. We identified 38 (58%) with misleading titles, 49 (74%) with misleading reporting, 44 (67%) with misleading claims, and 38 (58%) with inappropriate extrapolation. CONCLUSIONS: Our analysis revealed a high degree of spin in recent press releases dedicated to mTBI research. The reports often overstated the strengths and practical impact of the study, publicize substandard research without clinical relevance, while downplaying or failing to report limitations and caveats. Misrepresentation in press releases can affect real-life medical decisions and outcomes.
Assuntos
Concussão Encefálica , Meios de Comunicação de Massa , Comunicação , Humanos , Disseminação de Informação , Estudos RetrospectivosAssuntos
Comunicação , Infecções por Coronavirus , Enganação , Internet , Pandemias , Pneumonia Viral , COVID-19 , Fraude , HumanosRESUMO
Corticosteroids are the most common etiological factor in nontraumatic avascular necrosis (AVN) of bone, accounting for about 10% of arthroplasties performed annually in the United States. Evidence is conflicting on the relative importance of peak dose, daily dose, or cumulative dose, and most likely all three represent "high dose" corticosteroid administration and play a role in AVN. The etiology may be multifactorial with corticosteroids superimposed on genetic or pathological predispositions. Joint preservation depends upon early diagnosis and treatment before fracture of the subchondral trabeculae and joint incongruity. Early intervention depends upon identifying at-risk patients and quantifying their risk by understanding clinical and pathophysiological contributions to that risk. Our data and that of others suggest that a screening MRI of at-risk populations will permit detection of AVN at a prefracture stage when preservation of the joint is possible.
Assuntos
Corticosteroides/efeitos adversos , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico por imagem , Osteonecrose/epidemiologia , Osteonecrose/cirurgia , Corticosteroides/uso terapêutico , Artrografia , Artroplastia , Feminino , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/genética , Humanos , Articulações , Imageamento por Ressonância Magnética , Masculino , Osteonecrose/genética , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Despite generally lower socioeconomic status and worse access to healthcare, Latinos have better overall health outcomes and longer life expectancy than non-Latino Whites. This "Latino Health Paradox" has been partially attributed to healthier cardiovascular (CV) behaviors among Latinos. However, as Latinos become more acculturated, differences in some CV behaviors disappear. This study aimed to explore how associations between acculturation and CV behaviors among Latinos vary by country of origin. Combined weighted data from the 2005 and 2007 California Health Interview Survey (CHIS) were used to investigate associations between acculturation level and CV behaviors among Latinos by country of origin. Among all Latinos, increased acculturation was associated with more smoking, increased leisure-time physical activity, and greater consumption of fast foods, but no change in fruit/vegetable and less soda intake. These trends varied, however, by Latino sub-groups from different countries of origin. Country of origin appears to impact associations between acculturation and CV behaviors among Latinos in complex ways.
Assuntos
Aculturação , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde/etnologia , Hispânico ou Latino , Adulto , California , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento de Redução do RiscoAssuntos
Serviços de Saúde Comunitária/organização & administração , Estudantes de Medicina , Transtornos da Visão/prevenção & controle , Seleção Visual/organização & administração , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta , Rhode Island , Inquéritos e Questionários , Recursos HumanosRESUMO
Objective. Eating disorders commonly present with nonspecific findings, masquerading as other, more common etiologies of malnutrition and wasting. In low-prevalence populations, these ambiguities can complicate clinicians' diagnostic reasoning, resulting in delayed or missed diagnoses. Method. We report the atypical case of a 51-year-old male with a five-year history of unexplained weight loss despite extensive past medical evaluation. Previous documentation of profound lymphopenia and bone marrow atrophy had not been linked to a known association with eating disorders. Results. Evaluation for medical etiologies of wasting was negative. Following psychiatric evaluation, the patient was diagnosed with an eating disorder, not otherwise specified, and admitted to a specialized nutritional rehabilitation program. Conclusion. The nonspecific clinical history, physical exam, and laboratory abnormalities of eating disorders can make these diagnoses challenging and delay appropriate treatment. Clinicians should consider eating disorders in patients with malnutrition, severe lymphopenias, and gelatinous marrow transformation early in their workup, so as to avoid potentially negative outcomes.
Assuntos
Clostridioides difficile , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/complicações , Enterocolite Pseudomembranosa/complicações , Histoplasmose/complicações , Abscesso do Psoas/complicações , Adulto , Alopurinol/uso terapêutico , Azatioprina/farmacocinética , Azatioprina/uso terapêutico , Colite Ulcerativa/complicações , Doença de Crohn/tratamento farmacológico , Doença de Crohn/microbiologia , Interações Medicamentosas , Quimioterapia Combinada , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/tratamento farmacológico , Feminino , Gota/complicações , Gota/tratamento farmacológico , Supressores da Gota/uso terapêutico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Masculino , Mercaptopurina/uso terapêutico , Pessoa de Meia-Idade , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/cirurgia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/fisiologiaAssuntos
Colite Ulcerativa/diagnóstico , Doença de Crohn/diagnóstico , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Diagnóstico Diferencial , Humanos , Síndrome do Intestino Irritável/diagnóstico , Sistema de Registros , Rhode Island/epidemiologiaAssuntos
Doenças Inflamatórias Intestinais/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Azatioprina/uso terapêutico , Ensaios Clínicos como Assunto , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/dietoterapia , Doenças Inflamatórias Intestinais/cirurgia , Mercaptopurina/uso terapêutico , Mesalamina/uso terapêutico , Metotrexato/uso terapêutico , Natalizumab , Probióticos/uso terapêutico , Sulfassalazina/uso terapêutico , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Educação Física e Treinamento/métodos , Esportes , Adolescente , Esgotamento Profissional/diagnóstico , Criança , Diagnóstico Diferencial , Suscetibilidade a Doenças , HumanosAssuntos
Barreiras de Comunicação , Surdez/psicologia , Pessoas com Deficiência Auditiva/psicologia , Relações Médico-Paciente , Identificação Social , Auxiliares de Comunicação para Pessoas com Deficiência , Cultura , Surdez/etnologia , Acessibilidade aos Serviços de Saúde , Humanos , Pessoas com Deficiência Auditiva/legislação & jurisprudência , Fatores Socioeconômicos , Estados UnidosAssuntos
Centros Comunitários de Saúde Mental/organização & administração , Comportamento Cooperativo , Pessoas sem Cobertura de Seguro de Saúde , Transtornos Mentais/terapia , Modelos Organizacionais , Adulto , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Humanos , Transtornos Mentais/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Rhode Island , VoluntáriosAssuntos
Dor Abdominal/diagnóstico , Volvo Intestinal/complicações , Doenças do Colo Sigmoide/complicações , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adolescente , Adulto , Colectomia , Colonoscopia , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Masculino , Radiografia Abdominal , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Resultado do TratamentoRESUMO
Extraintestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular complaints are often nonspecific; clinical relevance may not be appreciated by patient or physician and, thus, be misdiagnosed. Evaluation of the eye should be a routine component in the care of patients with IBD. Clinicians must be aware of the spectrum of ocular symptoms and know that these complaints may precede a diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). We review ocular pathology in IBD to alert clinicians to the diverse, at times confusing, spectrum of eye disorders associated with these diseases. Clinical manifestations include blurred vision, teary, burning or itchy eyes, ocular pain, photophobia, conjunctival or scleral hyperemia, loss of visual acuity, and possible blindness. Many patients are unaware that IBD has a risk of eye complications and, therefore, patient education is vital.
Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Comorbidade , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Quimioterapia Combinada , Oftalmopatias/tratamento farmacológico , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Prevalência , Prognóstico , Medição de Risco , Esclerite/diagnóstico , Esclerite/epidemiologia , Índice de Gravidade de Doença , Uveíte/diagnóstico , Uveíte/epidemiologiaRESUMO
The medical management of inflammatory bowel disease in the new millennium requires integrating cost concerns with the efficacy and safety profiles of the expanded therapeutic options available in order to achieve optimal patient outcome.