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This communication or any portion hereof , may not be reprinted, resold or redistributed without the prior written consent of Morgan Stanley. This is an unusual case in comparison to other sonographically described prenatal cases due to very early diagnosis and surgical intervention following prompt delivery. A year-old pregnant, ultrasonography showed presence of cystic structure in the fetal abdomen that was consistent with intestinal dilatation. At 32 weeks' of gestation, repeat ultrasound showed collapse of the bowel dilatation along with the presence of hyperechogenic fluid in the fetal abdominal cavity.

Cesarean section was performed. The clinical utility of this report is the recognition that meconium peritonitis MP may be diagnosed in the acute phase with typical ultrasound features, and should be considered in the differential diagnoses of cases presented with reduced fetal movements. Although it appears that morbidity and mortality in MP cases depend upon gestational age, this case report may help to manage similar cases for defining the appropriate delivery time and treatment modality after prenatal identification of the problem.

Agreement between hospital discharge diagnosis codes and medical records to identify metastatic colorectal cancer and associated comorbidities in elderly patients. Data on mCRC and comorbidities were collected from medical records. All diagnosis codes main, related and associated registered into the PMSI were extracted. These results are reassuring with regard to detection through PMSI of mCRC if all types of diagnosis codes are considered and useful to better choose comorbidities in elderly mCRC patients that could be well identified through hospital diagnosis codes.

Full Text Available A year-old primigravida was referred to our hospital at 36 weeks of gestation with a fetal pelvic mass. Marked left hydronephrosis resulting from mass compression was also detected. Fetal magnetic resonance imaging further defined a pelvic lesion extending cephalically into the abdomen and caudally into the vagina. Membranal protrusion of the introitus was clearly identified. Therefore, the diagnosis of congenital imperforate hymen with hydrocolpos was established.

At 38 weeks of gestation, a 2,g female infant was delivered vaginally with good Apgar scores. Physical examination of the neonate revealed a bulging membrane covering the vaginal opening. The presence of syndromic disorders McKusick-Kaufman, Ellis-van Creveld or Bardet-Biedl syndromes, genitourinary and anorectal anomalies were excluded.

The karyotype was 46, XX. A hymenotomy was performed on the second day of life. The infant recovered fully after hymenotomy. Chlamydia trachomatis CT pharyngitis has rarely been described in the literature. Among homosexual men, only one study, conducted more than 5 years ago, detected the presence of CT in the throat in one patient out of 13 tested.

A 33 year-old homosexual man consulted for cutaneous lesions on the palms and the chest. Infected by HIV, he was taking antiretroviral therapy but no antibiotic prophylaxis. He admitted practising unprotected insertive and receptive fellatio with unknown partners. The lesions were those of secondary syphilis but the location of the chancre remained unknown.

An enlarged screening for sexually transmitted infections detected the presence, through molecular amplification, of CT in the throat without further localisation urethra, anus. After intramuscular injection of Extencillin and an 8-day-regimen of cycline, CT was no longer detected in the throat.

The course of HIV infection did not appear modified by this infectious episode. Chlamydia trachomatis is more frequently detected in the genital tract rather than the pharynx of women also screened in various localisations. These results must be tempered by the participant recruitment methods, diagnostic methods used, sample size and history of recent antibiotherapy.

The pharyngeal mucosa might be less receptive to CT than the urethral mucosa. Association of CT pharyngitis with syphilis or its occurrence during HIV infection are not documented. The molecular amplification technique detects CT in the throat with sensitivity and specificity. A one-week regimen of cycline can cure this pharyngitis. Cost-effectiveness of screening for pharyngeal CT has not yet been assessed in persons 'at risk'.

Role of diagnosis of dyslipidemia in primary and secondary vascular prevention in a neurology department. Lipids have important functions in the human body, but high serum cholesterol level is an important risk factor for cardiovascular and cerebrovascular diseases.

Prevention of stroke includes modifying risk factors, like dyslipidemias. Based on this theory, we examined in practice the possible role of a public care neurology and stroke department with a large patient turnover in vascular risk screening with regard to the diagnosis of hyperlipidemia.

Patients included in the study were classified into three groups: 1 those admitted with acute stroke; 2 those with a history of acute stroke, but without evidence of a novel cerebrovascular event; 3 no history and evidence of cerebrovascular disease during hospitalization. Our data show that Altogether, Known hypercholesterolemia was Newly diagnosed elevated cholesterol levels had highest rate In the first two groups, the number of patients newly diagnosed with elevated serum cholesterol almost equaled to those with already known hypercholesterolemia.

Based on our data, neurology departments have an important role in diagnosing hyperlipidemia and vascular prevention. Chylous vaginal discharge in a patient with lymphangioleiomyomatosis. We present the case of a patient having chylous vaginal discharge , which may be a symptom of the secondary to an established diagnosis of the systemic disorder, lymphangioleiomyomatosis, a disease predominantly affecting women during their reproductive years.

Lymphangioleiomyomatosis causes dyspnea, pneumothorax, chylous pleural effusions, and eventually respiratory failure. The study objectives were to assess the use of evidence-based secondary prevention medication at discharge among ACS patients in Qatar and to determine the clinical and demographic characteristics associated with the use of these medications.

A retrospective medical record review was conducted at the Heart Hospital in Qatar. A random sample of ACS patients was selected. Patient characteristics were summarized. Prevalence of medications at discharge were computed for each medication as well as for medication combinations. Multiple logistic regression was used to detect patient variables that were associated with the outcomes. In total, records were reviewed. The majority were males At discharge , patients were prescribed the following: aspirin Being overweight or obese, and having PCI percutaneous coronary intervention or hypertension were associated with higher prescription of the concurrent medications.

Quantitative PCR of ear discharge from Indigenous Australian children with acute otitis media with perforation supports a role for Alloiococcus otitidis as a secondary pathogen. Alloiococcus otitidis is an outer ear commensal and putative middle ear pathogen that has not previously been described in acute otitis media AOM in this population. The aims of this study were to determine the presence, antibiotic susceptibility and bacterial load of A.

Methods Paired nasopharyngeal and ear discharge swabs from 27 children with AOM with perforation were tested by A. Positive swabs were cultured for 21 days. Total and respiratory pathogen bacterial loads in A. Results A. All A. The relative abundance of A. In 6 of 11 qPCR-positive swabs the A. Conclusions A. The absence of A.

The significance of A. Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions. The records of 62 men and 43 women, years old, admitted to general medical wards in a public teaching hospital during were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers.

The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed.

This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

Assessing significance of peripheral blood indicators for differential diagnosis and prognosis of thrombotic complications in polycythemia vera and secondary erythrocytosis. Full Text Available The aim of the study — determining of changes in peripheral blood PB in patients with secondary erythrocytosis SE and polycythemia vera PV, detection of discriminatory parameters levels of PB indicators and analyzing of their operating characteristics for differentiation of erythrocytosis and predicting of thrombotic events in patients with PV.

Materials and methods. The material for the study was the results of clinical trials of patients with erythrocytosis who underwent differential diagnosis between PV and SE. Results and discussion. Hemoglobin has not confirmed its value for the differential diagnosis between PV and SE.

Using other parameters of PB with the aim of differentiating PV and SE is rational, but their discriminatory power levels greatly depend on the group erythrocytosis. Pancreatitis - discharge. Chronic pancreatitis - discharge ; Pancreatitis - chronic - discharge ; Pancreatic insufficiency - discharge ; Acute pancreatitis - discharge You were in the hospital because you have pancreatitis.

This is a swelling of the pancreas. Chest pain is a common symptom for referring patients to emergency departments ED. Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran.

Adverse cardiac events, including acute coronary syndrome ACS , revascularization and death were observed in 30 patients 3. Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

Heart pacemaker - discharge. Cardiac pacemaker implantation - discharge ; Artificial pacemaker - discharge ; Permanent pacemaker - discharge ; Internal pacemaker - discharge ; Cardiac resynchronization therapy - discharge ; CRT - discharge ; Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study. Pharmacoepidemiological study. In the 12 dialysis units located in the French region of Lorraine. Patients in the 'uncontrolled SHPT' group were significantly p diagnosis , a younger age and a higher rate of alkaline phosphatase were associated to a continuous uncontrolled SHPT.

Patients with the lowest PTH at the end of the follow-up tended to receive more often cinacalcet. Evaluation of a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care: the role of Primary Care Mental Health Specialists. Aim We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care.

Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support.

Time and Activity Recording Sheets were used to capture data required for economic analysis. Findings Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a 'safety net' they could fall back on in case of difficulties, whereas staff used the analogy of a 'bridge' to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient's care.

Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer.

The distinction between primary and secondary ovarian tumors may be challenging for pathologists. The purpose of the present work was to develop genomic and transcriptomic tools to further refine the pathological diagnosis of ovarian tumors after a previous history of breast cancer.

Sixteen paired breast-ovary tumors from patients with a former diagnosis of breast cancer were collected. A hierarchical clustering of these samples was performed, combined with a dataset of well-identified primary and secondary ovarian tumors. Among four cases with uncertain pathological diagnosis , genomic profiles were clearly distinct between the ovarian and breast tumors in two pairs, thus indicating primary ovarian carcinomas, and showed common patterns in the two others, indicating metastases from breast cancer.

In all pairs, the result of the transcriptomic analysis was concordant with that of the genomic analysis. In patients with ovarian carcinoma and a previous history of breast cancer, SNP array analysis can be used to distinguish primary and secondary ovarian tumors. Transcriptomic analysis may be used when primary breast tissue specimen is not available.

Nipple Discharge. Nipple discharge in men under any circumstances could be a problem and needs further evaluation. One or both breasts may produce a nipple discharge , either spontaneously or when you squeeze your Studies in children with AD H D without mathematical learning disability MLD as well as studies on the effects of methylphenidate on arithmetic have shown that most deficits in mathematics and most error types commonly described as specific to developmental dyscalculia e.

This article proposes using the overall score in the dyscalculia test Basis-Math Moser Opitz et al. Hierarchical cluster analyses were calculated in a sample of 51 clinically referred children with normal IQ and suspicion of MLD, using IQ, years of schooling, overall score of the Basis-Math 4—8 and number of self-corrections in this test as variables.

The results revealed a subgroup with primary dyscalculia as well as three subgroups with secondary MLD two with attention deficit hyperactivity disorder, one with depression and one small subgroup with high IQ. In conclusion, the Basis-Math 4—8 Moser Opitz et al. Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: Usefulness of 99mTc-pyrophosphate bone scintigraphy.

Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia AL O. Mean Fogelman score in RO patients 9. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism.

The Finnish Hospital Discharge Register data are frequently used for research purposes. The Finnish Hospital Discharge Register has shown excellent validity in single injuries or disease groups, but no studies have assessed patients with multiple trauma diagnoses. We aimed to evaluate the accuracy and coverage of the Finnish Hospital Discharge Register but at the same time validate the data of the trauma registry of the Helsinki University Hospital's Trauma Unit. We assessed the accuracy and coverage of the Finnish Hospital Discharge Register data by comparing them to the original patient files and trauma registry files from the trauma registry of the Helsinki University Hospital's Trauma Unit.

We identified a baseline cohort of patients with severe thorax injury from the trauma registry of the Helsinki University Hospital's Trauma Unit of sample of patients. We hypothesized that the Finnish Hospital Discharge Register would lack valuable information about these patients. Using patient files, we identified trauma diagnoses in these patients. From the Finnish Hospital Discharge Register, we identified A total of The coverage and accuracy of diagnoses in the Finnish Hospital Discharge Register were According to patient records, these patients were subjects in operations.

We identified 40 Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present. Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study.

Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis the gold standard. Diagnostic accuracy was measured with sensitivity, specificity, positive ppv and negative predictive values npv. The most commonly encountered microorganisms by culture were Candida species Clinically, the most commonly made diagnoses were mixed infection Symptoms did not predict laboratory results.

Predisposing factors DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills were not found to be statistically important influencing factors for vaginal infections. Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing. Shoulder replacement - discharge.

Total shoulder arthroplasty - discharge ; Endoprosthetic shoulder replacement - discharge ; Partial shoulder replacement - discharge ; Partial shoulder arthroplasty - discharge ; Replacement - shoulder - discharge ; Arthroplasty - shoulder - discharge. Secondary electron emission and glow discharge properties of 12CaOcenterdot7Al2O3 electride for fluorescent lamp applications. The electron emission yield was higher and the discharge voltage was lower for 12CaOcenterdot7Al2O3 than for existing cathode materials such as Ni, Mo or W; therefore, the energy consumption of the fluorescent lamps can be improved using 12CaOcenterdot7Al2O3 cathodes.

Prototype glow- discharge lamps using 12CaOcenterdot7Al2O3 were constructed and exhibited reasonable durability. Assistive technology outcomes in post- secondary students with disabilities: the influence of diagnosis , gender, and class-level. This study investigated how outcomes of assistive technology AT services for college students with disabilities are influenced by diagnosis , gender and class-level e.

Students' pre- and post-intervention ratings of their performance and satisfaction of common academic tasks using the Canadian Occupational Performance Measure, COPM were analyzed, as well as students' responses on a survey about AT service provision, use, and preferences. COPM scores significantly and similarly improved for females and males, and across class levels.

Gender and class-level variables did not significantly impact AT Survey ratings. The study results reveal that features of a college student's diagnosis may influence AT service outcomes, and student-perceptions of AT services ability to use AT. While student ratings of academic task performance significantly increase across diagnostic groupings, these improvements were greatest for those with a mood disorder compared to other diagnostic groups.

Service-providers should consider that features of certain diagnoses or disabilities may influence the student? The revolving door syndrome in internal medicine: a study on 11, subjects discharged from all Internal Medicine Departments of Tuscany with diagnosis of heart failure and pneumonia. Full Text Available Rehospitalization is the return of a patient to a surgical or medical department within 30 days from discharge.

We have limited information on the frequency and patterns of rehospitalization in Italy. Our purpose is to describe this phenomenon in Tuscany. We analyzed regional hospital discharge abstract data in Tuscany , to describe day all cause readmissions. We studied patients aged 18 or more 11, discharged with diagnoses of heart failure and pneumonia from Internal Medicine Departments.

Relationships between day readmission rates, demographic and clinical characteristics have been analyzed. Risk factors significantly related to readmissions were longer length of stay, increasing number of different medications taken during the year preceding hospitalization and greater number of hospitalizations during the semester preceding admission.

From the analysis of risk factors we found that frailty and complexity of patients identified by long hospitalization stays, high number of drugs and previous admissions are the most important factors for unplanned readmissions. Radio-isotope scanning using labelled bleomycin in positive and differential diagnosis of primary and secondary malignant pulmonary lesions.

A lung scan using bleomycin labelled with cobalt 57 was carried out in patients representing primary malignant tumours, 48 pulmonary metastases and 69 benign lesions. The primary and secondary malignant lesions always gave rise to a hyperactive focus except in 8 cases of primary lung tumour.

The negative examination may be explained, either by the small size of the lesion or by radiotherapy in progress. Among the benign lesions, only advanced tuberculosis and very inflammatory lung diseases frequently took up labelled bleomycin 15 hyperactive foci out of 69 benign lesions.

Quantitative measurements, i. The malignant lesions were usually more active than the benign lesions. There was no definite correlation between the uptake of labelled bleomycin and the histological nature of the lesion. However, undifferentiated and anaplastic carcinomas were often more active. Left ventricular outflow tract to left atrial communication secondary to rupture of mitral-aortic intervalvular fibrosa in infective endocarditis: diagnosis by transesophageal echocardiography and color flow imaging.

Infection of the mitral-aortic intervalvular fibrosa occurs most commonly in association with infective endocarditis of the aortic valve. Infection of the aortic valve results in a regurgitant jet that presumably strikes this subaortic interannular zone of fibrous tissue and produces a secondary site of infection. Infection of this interannular zone then leads to the formation of subaortic abscess or pseudoaneurysm of the left ventricular outflow tract.

This infected zone of mitral-aortic intervalvular fibrosa or subaortic aneurysm can subsequently rupture into the left atrium with systolic ejection of blood from the left ventricular outflow tract to the left atrium. This report describes the echocardiographic findings in three patients with pathologically proved left ventricular outflow tract to left atrial communication.

Precise preoperative diagnosis is important, and this lesion should be differentiated from ruptured aneurysm of the sinus of Valsalva and perforation of the anterior mitral leaflet. Transthoracic echocardiography using color flow imaging and conventional Doppler techniques may show an eccentric mitral regurgitation type of signal in the left atrium originating from the region of the left ventricular outflow tract. However, transesophageal echocardiography provides an accurate preoperative diagnosis and should be used intraoperatively during repair of such lesions.

In Germany approximately 40, amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. The microdata of the diagnosis -related groups DRG statistics of the Federal Statistical Office were analyzed over the period from to All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications diabetic angiopathy and peripheral arterial disease was encrypted.

Benefits and limitations of fine needle aspiration cytology in the diagnosis and classification of leprosy in primary and secondary healthcare settings. This will only be possible when all patients are detected and cured using multidrug therapy, which requires accurate diagnosis prior to treatment. The objective of this study was to evaluate the possibility of the diagnosis of leprosy lesions by fine needle aspiration cytology according to a modification of the Ridley-Jopling scale, as it can be used in primary and secondary healthcare centres, especially in low-resource settings in which leprosy is prevalent.

A prospective study comprising 54 cases with cardinal features of leprosy was performed. Among the 54 cases, 27 patients consented to a histopathological biopsy procedure. The slides were stained with Giemsa, modified Ziehl-Neelsen, Papanicolaou and haematoxylin and eosin methods. Among the 54 cases, 34 were reported as tuberculoid leprosy, five as mid-borderline BB , three as borderline lepromatous BL and eight as lepromatous leprosy LL ; four were unsatisfactory.

Agreement between histological and cytological diagnosis was achieved in 12 of the 15 tuberculoid cases, one of the three BB cases, one of the two BL cases and all seven LL cases. With the implementation of the WHO classification based on patch counting, there is the possibility of the over-treatment of paucibacillary cases and under-treatment of multibacillary cases.

Cytology in terms of cellular type morphology and bacteriological study can complement the WHO classification. Double discharges in unipolar-pulsed dielectric barrier discharge xenon excimer lamps. Excitation of dielectric barrier discharge xenon excimer lamps by unipolar short square pulses is studied in this paper.

Two discharges with different polarity are excited by each voltage pulse double discharge phenomenon. The primary discharge occurs at the top or at the rising flank of the applied unipolar square pulse, which is directly energized by the external circuit.

The secondary discharge with the reversed polarity occurs at the falling flank or shortly after the falling flank end zero external voltage depending on the pulse width, which is energized by the energy stored by memory charges deposited by the primary discharge.

Fast-speed ICCD imaging shows the primary discharge has a conic discharge appearance with a channel broadening on the anode side. This channel broadening increases with increasing the pulse top level. Only the anode-side surface discharge is observed in the primary discharge. The surface discharge on the cathode side which is present in bipolar sine voltage excitation is not observed.

On the contrary, the secondary discharge has only the cathode-side surface discharge. The surface discharge on the anode side is not observed. The secondary discharge is much more diffuse than the primary discharge.

Time-resolved emission measurement of double discharges show the secondary discharge emits more VUV xenon excimer radiation but less infrared IR xenon atomic emission than the primary discharge. It was found that the IR xenon atomic emission from the secondary discharge can be reduced by shortening the pulse width.

The energy efficiency of unipolar-pulsed xenon excimer lamps the overall energy efficiency of double discharges is much higher than that obtained under bipolar sine wave excitation. The output VUV spectrum under unipolar pulse excitation is found to be identical to that under sine wave excitation and independent of injected electric power. Nipple discharge may be serous, bloody, purulent, and colostric. Ileostomy - discharge. Tips for when no Female genital schistosomiasis--a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe.

To examine the association between schistosomiasis and reproductive tract symptoms. A cross-sectional study was conducted in a Schistosoma haematobium-endemic area of rural Zimbabwe. A total of permanently resident adult women of Mupfure Ward aged were interviewed and examined clinically, each providing three consecutive urine samples. Logistic regression analysis was used to control for sexually transmitted diseases STDs.

Eighty percent of the women who had genital itch, yellow discharge , and childhood or current waterbody contact had sandy patches. Fifty-two percent of the women with genital sandy patches did not have detectable S. Genital schistosomiasis was associated with stress incontinence and pollakisuria, but not with menstrual irregularities, current or previous ulcers, or tumours.

Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity. Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care.

Current information from hospitals with large Hispanic representations and updated quality resources is needed. No significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had For several years, efforts have been made to strengthen collaboration between health professionals with different specializations and to improve patient transition from hospital to home care.

In the Danish health care system, these efforts have concentrated on cancer and heart diseases, whereas Drawing on methods from discourse and interaction analysis, the paper studies the practice of the discharge coordinator in two encounters between patients New discharge tube with virtual cathode. Till this time known methods of the excitation of the discharge between electrodes are using either secondary or thermo emission of electrons by the cathode.

Usually we speak about the self-maintained discharge. Lifetime of the cathode, that is shortened by the emission, limits in principle, the lifetime of the whole discharge tube. The discharge can, according to the present state of the art, be induced also by the inductive way. Arrangement for excitation of such discharge is rather expensive. The construction of the inductive excited discharge tube is considerably influenced by the necessity of the limitation of the losses in excitation magnetic circuits.

Especially length of the discharge and pressure of the working gas are limited by the economic standpoints. Function of the discharge is always connected with unwanted electromagnetic radiation, whose restraint is expensive and represents limiting factor for arrangement of the discharge tube Authors.

Angioplasty and stent - heart - discharge. Drug-eluting stents - discharge ; PCI - discharge ; Percutaneous coronary intervention - discharge ; Balloon angioplasty - discharge ; Coronary angioplasty - discharge ; Coronary artery angioplasty - discharge ; Cardiac Radiological discharges. Current practice of North Sea States on the discharge and disposal of liquid radioactive wastes to the North Sea are based on the declaration issued at the Second International Conference on the Protection of the North Sea, known as the London Declaration.

This has three main points the first of which emphasises the application of the Best Available Technology to protect the North Sea, the second provides a framework on which future controls on radioactive discharges should be based. The third identifies two parts of the framework; to take into account the recommendations of international organizations and that any repositories of radioactive waste which are built should not pollute the North Sea.

This chapter looks at how the concensus based on the London Declaration is working, gauges the progress made in the implementation of the policy goal, identifies existing and future areas for concern and proposes ways of strengthening the control of radioactive discharges.

The emphasis is on the United Kingdom practice and regulations for liquid wastes, most of which comes from the Sellafield Reprocessing Plant. Hysterectomy - vaginal - discharge. Vaginal hysterectomy - discharge ; Laparoscopically assisted vaginal hysterectomy - discharge ; LAVH - discharge Your surgeon made a cut in your Prepubertal vaginal discharge : Vaginoscopy to rule out foreign body.

Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between and were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for months.

None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. There was no complication related to vaginoscopy and removal of foreign body.

Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies. Lung surgery - discharge.

Lung biopsy - discharge ; Thoracoscopy - discharge ; Video-assisted thoracoscopic surgery - discharge ; VATS - discharge Pediatric heart surgery - discharge. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier; chap Recurrent vaginal discharge in children.

Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology PAG service at Kettering General Hospital was established in and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time.

Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures.

Awareness of the less common causes of vaginal discharge is essential. Published by Elsevier Inc. Characteristics and generation of secondary jets and secondary gigantic jets. The secondary jets likely are negative electric discharges with vertically straight luminous columns, morphologically resembling the trailing jet of the type-I GJs. The number of luminous columns in a secondary jet seems to be affected by the size of the effective capacitor plate formed near the base of the preceding sprites and the charge distribution left behind by the sprite-inducing positive cloud-to-ground discharges.

The observed morphology of the secondary GJs can either be the curvy shifted secondary GJs extending outside the region occupied by the preceding sprites or the straight pop-through secondary GJs developing through the center of the preceding circular sprites. A key factor in determining the terminal height of the secondary TLEs appears to be the local ionosphere boundary height that established by the preceding sprites. The abundance and the distribution of the negative charge in the thundercloud following the sprite-inducing positive cloud-to-ground discharges may play important role in the generation of the secondary TLEs.

Full Text Available [english] Often geriatric patients with secondary diagnosis dementia do not receive a rehabilitation treatment, although it is an obligatory service offered by the statutory health insurance. Scientists have examined the benefit of relevant measures for patients who are slightly or moderately affected with dementia. Thus, also these patients would profit by a rehabilitation. Demnach profitieren durchaus auch diese Patienten von einer Rehabilitation.

Spectrophotometric intracutaneous analysis versus dermoscopy for the diagnosis of pigmented skin lesions: prospective, double-blind study in a secondary reference centre. Dermoscopy is considered to be the golden standard for the clinical assessment of pigmented skin lesions. In expert hands, this instrument improves both sensitivity and specificity for the diagnosis of melanoma, however, the outcome is highly dependent on the skills and experience of the examiner The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care.

Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using i the discharge summary alone, ii case notes and discharge summary, and iii discharge summary with the addition of medical input.

For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group HRG and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary.

Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study. Outpatient discharge decision making in dermatology is poorly understood. To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.

The interviews were audiorecorded, transcribed, coded and thematically analysed. The mean age of the clinicians was This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness. Adrenal insufficiency secondary to tuberculosis: the value of telemedicine in the remote diagnosis of Addison's disease in Ebeye, Republic of the Marshall Islands. A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.

Limited laboratory studies revealed anemia, leukocytosis, and hyponatremia. Imaging studies, as well as digital photographs, transmitted over the Internet, using the secure Pacific Island Health Care Project PIHCP , store-and-forward telemedicine system, suggested the diagnosis of disseminated tuberculosis, and antimycobacterial antibiotics were begun.

Sputum cultures eventually grew Mycobacterium tuberculosis. Based on the constellation of clinical signs and symptoms, the transmitted images, and limited laboratory data, adrenal tuberculosis Addison's disease with adrenal insufficiency was diagnosed and corticosteroids were initiated. The patient responded dramatically This case underscores the utility of telemedicine in the diagnosis and treatment of patients with unusual conditions, rarely seen today in the United States, from remote sites in the Developing World.

Secondary Hypertension. Secondary hypertension Overview Secondary hypertension secondary high blood pressure is high blood pressure that's caused by another medical condition. Secondary hypertension can be caused by conditions that affect your kidneys, Tennis elbow surgery - discharge. This helps ensure tennis elbow will not return. You may be prescribed a Ankle replacement - discharge. You had an ankle replacement. Your surgeon removed and reshaped You received pain medicine and were Hip fracture - discharge.

Asthma - child - discharge. Pediatric asthma - discharge ; Wheezing - discharge ; Reactive airway disease - discharge Your child has asthma , which causes the airways of the lungs to swell and narrow. In the hospital, the doctors and nurses helped Challenges in secondary prevention after acute myocardial infarction. The people behind these numbers spur this call for action. Prevention after myocardial infarction is crucial to reduce risk and suffering.

Effective interventions in relation to the patients, healthcare providers and healthcare systems are proposed and discussed. Finally, innovative strategies in hospital as well as in outpatient and long-term settings Prostate brachytherapy - discharge. Implant therapy - prostate cancer - discharge ; Radioactive seed placement - discharge You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, Galactography in non-lactating nipple discharge.

Nipple discharge in non-lactating breast is classified as 2 groups. The first group is stagnation discharge which is determined by an apocrino-like exfoliation and stagnation within the ductal system. The second group is hyperplastic or neoplastic group. The secretory breast disease combined with nipple discharge can not be diagnosed by simple X-ray mammography of ultrasonography.

For differential diagnosis of secretory breast disease and for localization of lesions, the galactography is necessary. We analysed 49 cases of galactography is non-lactating breat and obtained following results. Hyperplastic discharge group occurred most frequently in 5th decade of age and was discovered more frequently in fatty parenchymal pattern on simple mammography.

The most frequent type of nipple discharge was cloudy-milky type in stagnation group and bloody nature in hyperplastic group. White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker.

The aim of the study was to investigate white blood cell counts and neutrophil to lymphocyte ratio NLR as markers of systemic inflammation in the diagnosis of localized testicular cancer as a malignancy with initially low volume. Thirty-six patients with localized testicular cancer with a mean age of White blood cell counts and NLR were calculated from complete blood cell counts. White blood cell counts and NLR were statistically significantly higher in patients with testicular cancer compared with the control group ptesticular cancer besides the well-known accurate serum tumor markers as AFP alpha fetoprotein , hCG human chorionic gonadotropin and LDH lactate dehydrogenase.

Compact Intracloud Discharges. In November of , mysterious signals recorded by a satellite-borne broadband VHF radio science experiment called Blackboard led to a completely unexpected discovery. Prior to launch of the ALEXIS satellite, it was thought that its secondary payload, Blackboard, would most often detect the radio emissions from lightning when its receiver was not overwhelmed by noise from narrowband communication carriers.

Instead, the vast majority of events that triggered the instrument were isolated pairs of pulses that were one hundred times more energetic than normal thunderstorm electrical emissions. The events, which came to be known as TIPPs for transionospheric pulse pairs , presented a true mystery to the geophysics community.

At the time, it was not even known whether the events had natural or anthropogenic origins. After two and one half years of research into the unique signals, two ground-based receiver arrays in New Mexico first began to detect and record thunderstorm radio emissions that were consistent with the Blackboard observations. On two occasions, the ground-based systems and Blackboard even recorded emissions that were produced by the same exact events. From the ground based observations, it has been determined that TIPP events areproduced by brief, singular, isolated, intracloud electrical discharges that occur in intense regions of thunderstorms.

These discharges have been dubbed CIDS, an acronym for compact intracloud discharges. During the summer of , ground-based receiver arrays were used to record the electric field change signals and broadband HF emissions from hundreds of CIDS.

Event timing that was accurate to within a few microseconds made possible the determination of source locations using methods of differential time of arrival. Twenty-four CIDS were recorded from three. Radiological diagnosis and differential diagnosis of headache. Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common.

Beside the clinical course headaches are classified as either primary or secondary , with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms.

An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome. Supersonic CO electric- discharge lasers. Laser modeling activity is described which involved addition of an option allowing N2 as a second diatomic gas. Results from these initial test cases are summarized. In the laboratory, a CW double- discharge test facility was constructed and tested.

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MD Hloba Investments Treasurer – Dumisa Joseph Ndlala MD DJ Mlalane Investment MD DJ Brokers Coordinator – Macabane Joseph Nkalanga MD MJNS​. View Hloba Clothing (richardbudeinvestmentservice.com) location in South Africa, revenue, industry and description. Find related and similar companies as well as employees by. Hloba Clothing (Pty) Ltd was founded in The company's line of business includes the retail sale of clothing, furnishings, and accessories for men, women,​.