Prevalence of cognitive disorders in HIV plus patients with long-term suppression of viremia

Background: HAART has contributed to decrease the HIV-related mortality and morbidity. However, the prevalence of HIV-associated neurocognitive disorders (HAND) seems to have increased. The aim of this study was to determine the prevalence of cognitive complaint and of HAND in a cohort of aviremic HIV_patients in the South-western part of Switzerland. Design/Methods: Two hundred HIV_ patients who had (1) undetectable HIV RNA concentrations in the plasma for_3 months, (2) no history of major opportunistic infection of the CNS in the past three years, (3) no current use of IV drugs and (4) no signs of major depression according to the DSM-IV criteria, answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of a subset of HIV_ patients with or without cognitive complaints were assessed using the HIV Dementia scale (HDS) and a battery of neuropsychological tests evaluating the sub-cortical functions. Cognitive impairment was defined according to the revised diagnostic criteria for HAND. Non-parametric tests were used for statistics and a Bonferroni corrected standard p level of pB0.002 was applied for multiple comparisons. Results: The prevalence of cognitive complaints was 27% (54 patients) among the 200 questioned patients. At the time of writing this abstract, cognitive functions of 50 complaining and 28 noncomplaining aviremic patients had been assessed with the HDS and the full neuropsychological battery. The prevalence of HAND producing at least mild interference in daily functioning (mild neurocognitive disorders [MND] or HIV-associated dementia [HAD]) was 44% (34/78 patients) in the group who underwent neuropsychological testing. Objective evidences of HAND were more frequent in complaining than in non-complaining patients (pB0.001). Using a ROC curve, a cut-off of 13 on the HDS was found to have a sensitivity of 74% and a specificity of 71% (p_0.001) for the diagnosis of HAND. A trend for lower CNS Penetrating-Effectiveness scores for HAART in patients with MND or HAD as compared to the others was present (1.59 0.6 vs. 1.990.6; p_0.006 [Bonferroni correction]). Conclusions/Relevance: So far, our results suggest that (1) the prevalence of HAND is high in HIV_ patients with a long-term suppression of viremia, and (2) cognitive complaints expressed by aviremic HIV_ patients should be carefully investigated as they correlate with objective evidences of cognitive decline in a neuropsychological testing. HAART with a high CNS penetrating-effectiveness may contribute to prevent HAND. Funding: Swiss HIV Cohort Study.

Axiomatization of the nucl eolus of assignment games

On the domain of general assignment games (with possible reservation prices) the core is axiomatized as the unique solution satisfying two consistency principles: projection consistency and derived consistency. Also, an axiomatic characterization of the nucleolus is given as the unique solution that satisfies derived consistency and equal maximum complaint between groups. As a consequence, we obtain a geometric characterization of the nucleolus. Maschler et al. (1979) provide a geometrical characterization for the intersection of the kernel and the core of a coalitional game, showing that those allocations that lie in both sets are always the midpoint of certain bargaining range between each pair of players. In the case of the assignment game, this means that the kernel can be determined as those core allocations where the maximum amount, that can be transferred without getting outside the core, from one agent to his / her optimally matched partner equals the maximum amount that he / she can receive from this partner, also remaining inside the core. We now prove that the nucleolus of the assignment game can be characterized by requiring this bisection property be satisfied not only for optimally matched pairs but also for optimally matched coalitions. Key words: cooperative games, assignment game, core, nucleolus

Tuberculose miliaire chez une personne âgée: diagnostic inattendu à l'autopsie [Miliary tuberculosis: unexpected autopsy finding in an elderly person].

Miliary tuberculosis is a rare disease that is difficult to diagnose because of its non-specific presentation. It should be suspected in elderly patients who complaint of failure to thrive, unexplained fatigue and weight loss. Using a clinical situation where the diagnosis was made only at autopsy, we briefly review the epidemiology of miliary tuberculosis and propose recommendations for the diagnosis and the prophylaxis of latent tuberculosis. Finally, we discuss criteria to perform epidemiological investigations among close contacts in this situation.

Cultural differences affecting claim handling process and perceived quality in Finnish-Japanese paperboardbusiness

Tutkimuksen tavoitteena oli selvittää Suomen ja Japanin välisten kulttuurierojen vaikutus valitustenkäsittelyprosessiin ja laatukäsityksiin case-yrityksen ja sen asiakkaiden välillä. Teoreettisen viitekehyksen muodostamisessa käytettiin näkemyksiä kulttuurista, kulttuurienvälisestä viestinnästä, valitustenkäsittelystä ja laatukäsityksistä. Kulttuurierojen tarkastelemiseksi esiteltiin kulttuurien ulottuvuuksia eritteleviä viitekehyksiä ja kulturaalisten tekijöiden vaikutusta viestintään. Suomen ja Japanin kulttuureja esiteltiin myös yksityiskohtaisemmin aikaisempien tutkimusten valossa. Työn empiirisessä osassa tutkittiin case-yrityksen sisäisiä sekä yrityksen ja sen asiakkaiden välisiä näkemyseroja. Tutkimus suoritettiin laadullisena case-tutkimuksena, jossa tarkasteltiin myös toimenpiteitä case-yrityksen liiketoimintaympäristön parantamiseksi. Tarvittava tieto kerättiin kirjallisuudesta, artikkeleista, taustahaastatteluilla sekä haastattelemalla yrityksen henkilöstöä Suomessa ja Japanissa samoin kuin sen japanilaisia asiakkaita. Japanilaiset asiakas/toimittaja-suhteet ovat ulkomaalaiselle yritykselle haastava liiketoimintaympäristö. Luottamuksen rakentaminen pitkällä tähtäimellä vaatii läheistä kommunikointia vastapuolen tuntemiseksi, jotta voidaan kehittää tuotteita paremmiksi ja vähentää valituskustannuksia. Laatuajattelua tulee myös yhdenmukaistaa tuotteiden ja palvelujen laadun parantamiseksi.

Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center.

OBJECTIVE: This study aimed to analyze complaints of patients, their relatives, and friends who consulted a complaints center based (Espace Patients & Proches (EPP)) in a hospital so as to better understand the reasons that motivated them and their underlying expectations. METHODS: This study was based on the analysis of written accounts of the 253 situations that occurred during the first year of operation of the EPP. The accounts were analyzed qualitatively using an inductive, thematic analytic approach. RESULTS: We identified 372 different types of complaints and 28 main analytic themes. Five clustered themes emerged from the analysis of the interconnections among the core themes: (1) interpersonal relationship (N=160-the number of accounts including a complaint related to this general theme); (2) technical aspects of care (N=106); (3) health-care institution (N=69); (4) billing and insurance; (5) access to information (N=13). CONCLUSION: The main reason for patients, their relatives, and friends going to EPP was related to the quality of the interpersonal relationship with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. PRACTICE IMPLICATIONS: These results raise important questions concerning changing patient expectations as well as how hospitals integrate complaints into the process of quality health care.

Fatigue prolongée ou chronique d'origine indéterminée [Prolonged or chronic fatigue of unknown origin].

Although prolonged or chronic fatigue is a very common complaint in primary care medicine, a biomedical obvious cause is often not found. In such a case, for women between 18 and 50 years with a ferritin level of less than 50 µg/l in the absence of anaemia, an iron supplementation may be associated with an improvement in fatigue. Appropriate treatment is also important for depression, anxiety or insomnia. In other cases, the approach is essentially non-pharmacological in the form of lifestyle advice, empathy and cognitive behavioural therapy as well as progressive and adapted physical exercises. Bien que la fatigue prolongée ou chronique soit une plainte très fréquente en médecine de premier recours, une cause biomédicale évidente n'est souvent pas retrouvée. Dans une telle situation, pour les femmes entre 18 et 50 ans avec un taux de ferritine inférieur à 50 µg/l en l'absence d'anémie, un traitement de fer peut être associé à une amélioration de la fatigue. Un traitement adapté est également important en cas de dépression, d'anxiété ou d'insomnie. Dans les autres situations, la prise en charge est essentiellement non pharmacologique sous forme de conseils d'hygiène de vie, d'empathie, de thérapie cognitivo-comportementale ainsi que d'exercices physiques progressifs et adaptés.

Fatigue prolongée ou chronique d'origine indéterminée : prise en charge pharmacologique et non pharmacologique

Bien que la fatigue prolongée ou chronique soit une plainte très fréquente en médecine de premier recours, une cause biomédicale évidente n'est souvent pas retrouvée. Dans une telle situation, pour les femmes entre 18 et 50 ans avec un taux de ferritine inférieur à 50 µg/l en l'absence d'anémie, un traitement de fer peut être associé à une amélioration de la fatigue. Un traitement adapté est également important en cas de dépression, d'anxiété ou d'insomnie. Dans les autres situations, la prise en charge est essentiellement non pharmacologique sous forme de conseils d'hygiène de vie, d'empathie, de thérapie cognitivo-comportementale ainsi que d'exercices physiques progressifs et adaptés. Although prolonged or chronic fatigue is a very common complaint in primary care medicine, a biomedical obvious cause is often not found. In such a case, for women between 18 and 50 years with a ferritin level of less than 50 µg/l in the absence of anaemia, an iron supplementation may be associated with an improvement in fatigue. Appropriate treatment is also important for depression, anxiety or insomnia. In other cases, the approach is essentially non-pharmacological in the form of lifestyle advice, empathy and cognitive behavioural therapy as well as progressive and adapted physical exercises.

Gonalgies: que faire en médecine de premier recours [Knee pain in ambulatory practice].

Knee pain is a frequent complaint in ambulatory practice. Because of its complexity, the knee is prone to trauma, arthritis and the impact of aging. Septic arthritis is an emergency and has to be suspected when important knee pain is associated with fever, an alteration of the general condition, or in a particular social context. In most cases the clinical examination can identify the type of pathology. Conservative treatment is beneficial in most cases and physiotherapy a major component of the prognosis.

Sonography of the iliotibial band: spectrum of findings

Iliotibial band lesions constitute a potential source of discomfort and are frequently confounded with other conditions which cause pain on the lateral aspect of the hip, thigh and knee. Ultrasonography is usually regarded as a first-line imaging modality in the assessment of such conditions because of its excellent diagnostic accuracy, low cost and wide availability. The correct identification of the structure involved in the production of symptoms leads to an appropriate management and to a higher probability of resolution of the clinical complaint. The present article is aimed at reviewing the different sonographic presentations of iliotibial band syndromes.

The carpal boss: a review of different sonographic findings

Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

Personal Liberty in Psychiatric Care - Towards Service User Involvement

This study explores personal liberty in psychiatric care from a service user involvement perspective. The data were collected in four phases during the period 2000-2006 in psychiatric settings in Finland. Firstly, patient satisfaction and factors associated with user involvement were studied (n = 313). Secondly, patients’ experiences of deprivation of their liberty were explored (n = 51). Thirdly, an overview on patients’ options for lodging complaints was conducted, and all complaints (n = 4645) lodged in Finland from 2000 to 2004 were examined. Fourthly, the effects of different patient education methods on inpatients’ experiences of deprivation of liberty were tested (n = 311). It emerged that patients were quite satisfied, but reported dissatisfaction in restrictions, compulsory care and information dissemination. Patients experienced restrictions on leaving the ward and on communication, confiscation of property and coercive measures as deprivation of liberty. Patients’ experienced these interventions to be negative. In Finland, the patient complaint process is complicated and not easily accessible. In general, patient complaints increased considerably in Finland during the study period. In psychiatric care the number of complaints was quite stable and complaints led more seldom to consequences. An Internet-based patient education system was equivalent with traditional education and treatment as usual in supporting personal liberty during hospital care. This dissertation provides new information about the realization of patients' rights in psychiatric care. In order to improve patients' involvement, systematic methods to increase personal liberty during care need to be developed, the procedures for patients lodging complaints should be simplified, and patients' access to information needs to be ensured using multiple methods.

Diverticulo epifrênico do esôfago

Disphagia is a very common complaint among patients seeking a gastroenterologists. Esophageal motility disorder is a frequent finding, at times associated with pulsion diverticula. We present a case of a 68 year old female patient with thoracic pain and double epiphrenic diverticula. The upper gastrointestinal tract examination revealed two epiphrenic diverticula, one with 6-7 cm and the other measuring 2 cm, located 30 cm from the dental arcade. She underwent surgical treatment to remove the larger diverticula, a long esophageal myotomy and a Belsey-Mark IV antireflux technique. She presented an uneventful recovery and is doing well I8 months following surgery.

Linfangioma cístico do fígado

Hepatic lymphangioma developed from a malformation that blocks the lymphatic system of a given area of the liver is a rare benign tumor observed most often in children and adolescents. The authors report and discuss a case of cystic lymphangioma of the liver in a 65 years old female patient, from a region where hydatid disease is endemic, with a complaint of epigastric pain, nausea, and vomiting. The patient presented a non-pulsatile mass, with severe pain at palpation in the epigastric region, The diagnostic investigation revealed a large cystic lesion in the left lobe of the liver; and she was submitted to bisegmentectomy II and III, which showed a hepatic lymphangioma. Considering the progressive character of this lesion, it should be carefully evaluated, since the removal of the lymphangioma is a safe, curative procedure.

Lipoma gástrico: relato de caso

We report a case of gastric lipoma, a rare benign stomach tumor. There are approximately 200 cases previously described in literature. A male, 62-year-old patient with no clinical complaint presented a tumor lesion in the stomach antrum found in a routine upper endoscopy. A surgical resection (subtotal gastrectomy) was done and the histological examination showed submucosal lipoma without signs of malignancy. This report points to the growth of routine examination in the current clinical practice and the dilemma brought by overdiagnosis.

Lobular Carcinoma in Situ with Atypical Mass Presentation: a Case Report

Lobular carcinoma in situ (LCIS) is associated with an increased risk of breast cancer and accounts for 1 to 2% of all breast cancers. LCIS diagnosis currently remains one of the major identifiable risk factors for subsequent breast cancer development. Imaging methods are becoming increasingly sensitive, and the consequent detection of small lesions and subtle abnormalities increases the chance of detection of in situ and invasive carcinomas, leading to a reduction in mortality. This report describes a case of a palpable complaint with abnormal imaging findings, including a solid LCIS mass.