A Case of VEXAS: Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic Syndrome With Co-existing DNA (Cytosine-5)-Methyltransferase 3A Mutation Complicated by Localized Skin Reaction to Tocilizumab and Azacitidine.

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently identified autoinflammatory condition with a correlating missense somatic mutation of the X chromosome. Here we present a unique case of a patient with VEXAS syndrome with coinciding ubiquitin-like modifier activating enzyme 1 (UBA1) and DNA (cytosine-5)-methyltransferase 3A (DNMT3A) mutations who developed cutaneous and systemic reactions to tocilizumab and azacitidine therapy, respectively.

Predicting Liver Fibrosis in the Hepatitis C Population: Concordance Analysis Between Noninvasive Scoring Systems and Percutaneous Liver Biopsy.

Background Due to the slow progression of many chronic liver diseases, including hepatitis C, it is not practical or safe to monitor disease progression by serial liver biopsies. Noninvasive laboratory scoring systems based on routine laboratory tests are appealing surrogate markers of liver fibrosis for the staging and monitoring of chronic liver diseases such as hepatitis C. Methods We explored the accuracy of three scoring systems: the fibrosis-4 score (FIB-4), the aspartate aminotransferase to platelet ratio index (APRI score), and the aspartate aminotransferase to alanine aminotransferase ratio (AAR) in 496 patients with chronic hepatitis C virus (HCV) infection who had undergone percutaneous liver biopsy at a viral hepatitis clinic in Shreveport, Louisiana.

Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus.

Aim: To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM).

Methods: We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (hemoglobin A1C level ≥ 6.

A participatory approach to understanding and measuring patient satisfaction in a primary care teaching setting.

Background: Patient satisfaction is a complex, multidimensional concept that is difficult to measure. However, there is agreement that understanding the expectations of a patient community or "what is important to them" is an essential consideration. We chose a participatory approach to address patient satisfaction in the context of a primary care teaching clinic.

Detecting and addressing adolescent issues and concerns: evaluating the efficacy of a primary care previsit questionnaire.

Objective: To assess the efficacy of a previsit questionnaire (PVQ), implemented without formal training, that was designed to screen for biomedical and psychosocial health issues and concerns among adolescent patients in a hospital-based primary care clinic, and to examine the subsequent action taken for health issues and concerns identified with the PVQ.

Design: Retrospective review of adolescent medical charts, using a pre-post design.

Setting: An outpatient primary care clinic located in an urban teaching hospital in Montreal, Que.

Computer-aided diagnostic system in dentistry.

A dental diagnostic system for patient database management, automated measurements, diagnostics and statistical estimation of health conditions is described. To increase the diagnosis quality various diagnostic tools are developed using several statistical methods. The analysis provides information about the importance of particular general, dental, and periodontal data which are further used in quantitative modeling of healing process in the oral cavity.

Priorities in adolescent health care: the teenager's viewpoint.

The purpose of this study was to determine what issues teenagers want discussed or covered when they visit primary care physicians and to assess to what extent such discussion takes place. A questionnaire was administered to 1,564 students aged between 13 and 18 years in six high schools. Mean participant age was 15.

A school-based outreach program in adolescent health.

Teenagers are often in a medical care vacuum. They avoid institutions and often see the family physician as part of the family setting of which they are striving to achieve independence. This article describes a school-based outreach program which has resulted in the creation of a Teenage Health Unit within a family-practice centre.

Teenage Concerns about the Physical Examination.

A study of teenagers' thoughts about doctor/patient relationships revealed a high level of discomfort deriving from the physical examination. Our report attempts to clarify the indications for genital and breast examination and techniques for performing these exams in a manner least distressing to teenagers.

Obstetrical practice and training in canadian family medicine: conserving an endangered species.

Family practice obstetricians are an endangered species. Our practices and teaching sites must provide the correct attitudinal as well as technical messages to result in a practitioner who will be able to meet the psychosocial and medical needs of the pregnant couple. Family practice obstetrics can be as safe as care given by obstetricians provided that the family practice group functions well, that obstetrical consultants are available and supportive, and assuming that technical approaches are reserved for those truly in need.

Screening and management of diethylstilbestrol exposed offspring.

Prenatal diethylstilbestrol (DES) exposure in pregnancy has been associated with adenocarcinoma of the vagina and/or cervix as well as teratogenic abnormalities of the genital tract in both female and male offspring. DES Action groups are alerting the public to the dangers inherent in being a `DES daughter' or a `DES son'. Family physicians must be able to reassure those patients who are not DES offspring, manage those who are, and detect those who didn't know they were.