Characterizing primary care for patients with major depressive disorder using electronic health records of a US-based healthcare provider

Background: Major depressive disorder (MDD) is predominantly managed in primary care. However, primary care providers (PCPs) may not consistently follow evidence-based treatment algorithms, leading to variable patient management that can impact outcomes. Methods: We retrospectively analyzed adult patients with MDD seen at Geisinger, an integrated health system. Utilizing electronic health record (EHR) data, we classified patients as having MDD based on International Classification of Disease (ICD)-9/10 codes or a Patient Health Questionnaire (PHQ)-9 score ≥5. Outcomes assessed included time to first visit with a PCP or behavioral health specialist following diagnosis, antidepressant medication switching, persistence, healthcare resource utilization (HRU), and treatment costs. Results: Among the 38,321 patients with MDD managed in primary care in this study, significant delays between diagnosis with antidepressant prescribing and follow-up PCP visits were observed. There was also considerable variation in care following diagnosis. Overall, 34.9% of patients with an ICD-9/10 diagnosis of MDD and 41.3% with a PHQ-9 score ≥15 switched antidepressants. An ICD-9/10 diagnosis, but not moderately severe to severe depression, was associated with higher costs and HRU. More than 75% of patients with MDD discontinued antidepressant medication within 6 months. Limitations: The study population was comparable with other real-world studies of MDD, but study limitations include its retrospective nature and reliance on the accuracy of EHRs. Conclusions: Management of patients with MDD in a primary care setting is variable. Addressing these gaps will have important implications for ensuring optimal patient management, which may reduce HRU and treatment medication costs, and improve treatment persistence

A rare case of concomitant huge exophytic gastrointestinal stromal tumor of the stomach and Kasabach-Merritt phenomenon

<p>Abstract</p> <p>Background</p> <p>We report an extremely rare case of concomitant huge exophytic GIST of the stomach and Kasabach-Merritt phenomenon (KMP).</p> <p>Case presentation</p> <p>The patient was a 67-year-old man experiencing abdominal distension since September 2006. A physical examination revealed a 25 × 30 cm hard mass that was palpable in the middle and lower left abdomen minimal intrinsic mobility and massive ascites. Since the admitted patient was diagnosed with DIC, surgery could not be performed. The patient received a platelet transfusion and the DIC was treated. Due to this treatment, the platelet count recovered to 7.0 × 10⁴; tumor resection was performed at 16 days after admission. Laparotomy revealed a huge extraluminal tumor arising from the greater curvature of the stomach that measured 25 × 30 cm and had not ruptured into the peritoneal cavity or infiltrated other organs. Partial gastric resection was performed. The resected mass measured 25 × 25 × 20 cm. In cross section, the tumor appeared hard and homogenous with a small polycystic area. Histopathology of the resected specimen showed large spindle cell GIST with >5/50 HPF (high-power field) mitotic activity. The postoperative course was uneventful, and the coagulopathy improved rapidly.</p> <p>Conclusion</p> <p>Since the characteristic of tumor in this case was hypervascularity with bleeding and necrotic lesions, coagulopathy was thought to be caused by the trapping of platelets within a large vasculized tumor mass.</p

Effects of Methylthiouracil on the Serum Protein Fractions in Dog

The effects of a prolonged oral administration of methylthiouracil was studied on the electrophoretically - separated serum protein fractions in 24 dogs. Though the statistical mean of changes in serum albumin and alpha2 globulin were highly significant but the individual alterations were not consistent and therefore on the basis of the available data there does not seem to be a characteristic electrophoretic pattern in the experimentally produced hypothyroidism in the dog. This finding is in agreement with the clinical electrophoretic pattern reported in the human spontaneous hypothyroidism

EFFECTS OF THYROIDECTOMY ON THE SERUM PROTEIN FRACTIONS IN DOG

The study on the serum protein electrophoresis following thyroidectomy in A puppies showed a significant decrease in the albumin and -a-ratio associated with a relative increase in gamma and total globulin, but alterations of alpha I and beta globulin were not statistically charcteristic in our thyroidectomized dogs

Management of nasofrontal angle in rhinoplasty

Radix or nasofrontal angle has a special concern in rhinoplasty. Minimal changes in the position of nasofrontal angle can produce a different image of nasal and midfacial length in the profile view. In a patient with high radix, the profile of the forehead continues into the nose in a straight line and the nose appears too long. On the other hand, deep nasofrontal angle makes the illusion of a short nose. The ideal position of this angle has always been a matter of discussion and various methods have been introduced regarding its correction by deepening or augmenting the radix area. In this article, we first review the ideal position of nasofrontal angle and then discuss different procedures used to correct it. ©Iranian Red Crescent Medical Journal

Gorlin's syndrome presenting as recurrent mandibular cyst infection

A 38 year-old man with a history of painful swelling in the left mandibular angle region and skin lesions on the upper chest is reported. The symptoms, findings, diagnostic criteria and the approach for treatment are reviewed. Histological examinations of mandibular cystic and skin nodular lesions were reported as "Inflamed Keratinous Cyst" and "Basal Cell Carcinoma". It is important to consider the syndrome encountering multiple jaw cysts because of the high recurrence rate, associated medical problems, and need for close life-long follow-up of this syndrome. ©Iranian Red Crescent Society

How Plastic and Endoscopic Assisted Surgery Can Help Foreign Body Removal?

In this study we report a case with foreign body in the infratemporal fossa. The anatomic position of this region and the presence of important neurovascular structures make this region a sophisticated one. Commonly used open procedures can have morbidity of neurovascular system. To prevent probable complications like facial nerve injury in this case which was the most important factor for us, we decided to remove the foreign body under endoscopic guide. © 2011, Association of Otolaryngologists of India