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Pannu AK, Singla V, Suri V, Kumar R, Mathur Y, Mohindra R, Jain S. Adult-onset Still's disease and fever of unknown origin in India. Clin Exp Med 2023; 23:1659-1666. [PMID: 36178600 PMCID: PMC9523624 DOI: 10.1007/s10238-022-00903-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
Despite an essential differential diagnosis for fever of unknown origin (FUO) in young adults, adult-onset Still's disease (AOSD) is infrequently considered and remained underdiagnosed in low-middle-income countries. The present study analyzed the clinical, serological, radiological, and pathological characteristics of AOSD presented as FUO in India. A hospital-based retrospective study of patients aged > 13 years admitted with FUO and later diagnosed with AOSD in Postgraduate Institute of Medical Education and Research, Chandigarh (India), was conducted between January 2014 and December 2020. Petersdorf and Beeson's criteria were used to define FUO. The diagnosis of AOSD was made based on Yamaguchi's criteria. Twenty-seven patients (median age 26 years, 14 females) were enrolled. All presented with intermittent fever with a median duration of 10 weeks. The typical features of AOSD at admission were arthralgia (n = 24), hepatosplenomegaly (n = 21), spiking fever ≥ 39 °C (n = 19), lymphadenopathy (n = 18), typical rash (n = 17), and sore throat (n = 11). Leukocytosis (n = 25) and neutrophilia (n = 19) were frequent. Hyperferritinemia was universal (range, 700-145,003 ng/ml; ≥ 2000, n = 23). At admission, AOSD was suspected in only nine FUO cases, while tuberculosis (n = 16), undifferentiated connective tissue disorder (n = 14), and lymphoproliferative disorder (n = 11) were common diagnostic possibilities. Crispin et al. clinical scale detected AOSD in only 15 (55.5%) FUO patients. Whole-body imaging (n = 27), including fluorodeoxyglucose positron emission tomography (n = 12), demonstrated reticuloendothelial organ-system involvement and serositis. Seventeen (63%) patients had macrophage activation syndrome at the time of AOSD diagnosis. AOSD FUO presents with typical but nonspecific features; thus, early differentiation from common causes (e.g., tuberculosis, lymphoma) is difficult. Macrophage activation syndrome is common in AOSD with FUO presentation.
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Affiliation(s)
- Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Vidhi Singla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, Chandigarh, 160012 India
| | - Yamini Mathur
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, Chandigarh, 160012 India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, 4th floor, F block, Chandigarh, 160012 India
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Fraser T, Sargsyan Z, Baggett TP, Baggett M. Quantitative Study of the Characteristics of Effective Internal Medicine Noon Conference Presentations. J Grad Med Educ 2016; 8:185-90. [PMID: 27168885 PMCID: PMC4857508 DOI: 10.4300/jgme-d-15-00132.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/03/2015] [Accepted: 10/12/2015] [Indexed: 11/06/2022] Open
Abstract
Background Increasing demands on residents' time have made it critically important to maximize the effectiveness of didactic activities and motivate independent study. Objective Our aim was to correlate characteristics of noon conferences with internal medicine (IM) residents' ratings of perceived effectiveness and intent to pursue independent reading. Methods We assessed characteristics of each noon conference by direct observation using predetermined metrics. We surveyed IM residents to assess their perception of the conference's effectiveness and their intention to pursue additional reading. A variety of modeling techniques were used to discern meaningful correlations of effectiveness and motivation. Results A total of 649 evaluations of 29 conferences were submitted by 153 of 185 (83%) residents in the program. Median effectiveness score was 6 (on a scale of 1 to 7). Clinicopathological conferences had 0.55-point higher effectiveness scores than traditional conferences (P = .011). In multivariable analyses focusing on traditional conferences, summary statement inclusion was significantly associated with 0.43-point higher effectiveness scores (P = .016), and having resident speakers was associated with 0.50-point higher effectiveness scores than unfamiliar faculty (P = .045). Conferences with higher effectiveness scores had significantly higher proportions of respondents indicating intention to read. Conclusions This is the first study to quantitatively assess correlations of high effectiveness ratings of noon conferences in a residency program. Intention to read improved with increasing effectiveness scores of conferences, suggesting residents are more inclined to pursue self-directed learning when topics are well presented. Considering these attributes in designs of didactic sessions may enhance their educational value.
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Affiliation(s)
- Traci Fraser
- Corresponding author: Traci Fraser, MD, Massachusetts General Hospital, GRB 740, 55 Fruit Street, Boston, MA 02114, 832.428.8315, fax 617.724.7441,
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