Clinical features in primary care electronic records before diagnosis of ankylosing spondylitis: a nested case-control study.

BACKGROUND: Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS. METHODS: Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis. RESULTS: Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the 3 years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis. CONCLUSIONS: We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

Haemoglobin Concentration and Cognitive Ability in the Aberdeen Children of the 1950s.

Introduction Haemoglobin concentrations decrease with age. Abnormally low and high haemoglobin concentrations are associated with reduced cognition; however, the evidence for these associations in cohort data is limited. This study aims to assess the relationship between haemoglobin concentration and cognition in a well-characterised cohort of older adults. Methods Two hundred and fifty-two healthy participants were drawn from the Aberdeen Children of the 1950s cohort, aged between 59 to 65 years. Participants underwent cognitive tests of processing speed, memory, verbal and nonverbal reasoning, and language ability and these were used to construct a global cognitive score, g, using principal component analysis. Haemoglobin concentration in the blood was measured concurrently. Hierarchical multiple regression models were constructed assessing the relationship between haemoglobin concentration and each cognitive measure and these were corrected for age, sex, education, C-reactive protein, hypertension, and body mass index. Results Significant linear association between haemoglobin concentration and nonverbal reasoning demonstrated that low haemoglobin levels are associated with lower scores. A quadratic relationship was found for haemoglobin concentration and immediate memory scores in which low and high haemoglobin levels were associated with lower scores. Conclusions Haemoglobin concentration was found to have a significant linear association with nonverbal reasoning scores and a significant quadratic association with memory scores. The results from this study help to understand the association between haemoglobin and different aspects of cognition.

Curing Benign Paroxysmal Positional Vertigo in Patients With Brain Tumor: Case Series and Literature Review.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. It accounts for a third of all vestibular disorders diagnosed in the general population and is usually diagnosed and treated successfully. This article presents two cases of BPPV in a 52-year-old man and a 45-year-old patient, respectively. Both patients presented with recurrent episodes of vertigo associated with certain head movements. Medical history for the first patient included surgery for acoustic neuroma 12 months before developing the vertigo episodes. The second patient underwent a neurosurgical operation for glioblastoma multiforme (GBM) followed by radiotherapy three months before this presentation. Both patients were diagnosed with right-sided posterior canal BPPV after the Dix-Hallpike test. Their symptoms completely resolved within few minutes of the Epley maneuver. These cases highlight the importance of diagnosing and treating a potentially curable condition that can coexist in some patients with brain tumors.

An Unusual Case of Thyroid Storm Masquerading as an Intestinal Obstruction in a Patient With Malrotation of the Gut.

Gut malrotation is usually a pediatric condition that presents mainly in the first month of life. It rarely presents in adults and is often a significant diagnostic dilemma to the surgeon. Failure to diagnose and treat this condition early may result in dire consequences like small gut gangrene. A previously healthy, 41-year-old female patient presented to the emergency department with a three-day history of lower abdominal pain and constipation. On examination, she had tachycardia, and her abdominal examination was soft, with mild tenderness in the hypogastric region and scanty bowel sounds. Urine pregnancy and dipstick were unremarkable. The patient was diagnosed with small bowel obstruction (malrotation of the small bowel loops with twisting of the mesenteric vessels). The patient was found to have thyrotoxicosis, which was the cause of the intestinal obstruction. She received conservative treatment and specific thyrotoxicosis management (carbimazole, cholestyramine, Lugol's iodine, and intravenous hydrocortisone). The symptoms resolved entirely after a two-day stay at the intensive care unit. Small bowel malrotation is a congenital anomaly and can present with abdominal pain and obstruction in adulthood. Thyrotoxicosis can cause small bowel obstruction if there is underlying malrotation.