ICD-10 CSHCS-Qualifying Diagnosis Code
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Lameness in Fattening Pigs – Mycoplasma Hyosynoviae, Osteochondropathy and Reduced Dietary Phosphorus Level As Three Infuencing Factors: a Case Report
Lameness in fattening pigs – Mycoplasma hyosynoviae, osteochondropathy and reduced dietary phosphorus level as three inuencing factors: A case report Birte Wegner Veterinary Practice Duemmerland Jörg Tenhündfeld Vetland Dr. Tenhündfeld & Kollegen Johanna Vogels Stiftung Tierarztliche Hochschule Hannover Marius Beumer Stiftung Tierarztliche Hochschule Hannover Josef Kamphues Stiftung Tierarztliche Hochschule Hannover Florian Hansmann Stiftung Tierarztliche Hochschule Hannover Hanna Rieger Stiftung Tierarztliche Hochschule Hannover Elisabeth grosse Beilage Stiftung Tierarztliche Hochschule Hannover Isabel Hennig-Pauka ( [email protected] ) University of Veterinary Medicine Hannover https://orcid.org/0000-0003-3994-5979 Case report Keywords: Locomotor disorder, mineral supply, Mycoplasma hyosynoviae, nutrition, swine Posted Date: September 25th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-35962/v2 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/28 Version of Record: A version of this preprint was published on December 15th, 2020. See the published version at https://doi.org/10.1186/s40813-020-00184-w. Page 2/28 Abstract Background: Multiple diagnostic procedures, their results and interpretation in a case with severe lameness in fattening pigs are described. It is shown that selected diagnostic steps lead to identication of various risk factors for disease development in the affected herd. One focus of this case report is the prioritization of diagnostic steps to verify the impact of the different conditions, which nally led to the clinical disorder. Disease is the consequence of previously acting factors, and the involved diagnostic institute is the last stage in the timeline. Some diagnostic ndings might therefore no longer be signicant. -
Percutaneous Conchotome Muscle Biopsy. a Useful Diagnostic and Assessment Tool CHRISTINA DORPH, INGER NENNESMO, and INGRID E
Percutaneous Conchotome Muscle Biopsy. A Useful Diagnostic and Assessment Tool CHRISTINA DORPH, INGER NENNESMO, and INGRID E. LUNDBERG ABSTRACT. Objective. To evaluate the diagnostic yield, performance simplicity, and safety of the percutaneous conchotome muscle biopsy technique for clinical and research purposes in an outpatient rheuma- tology clinic. Methods. Biopsies taken by rheumatologists in an outpatient clinic during 1996 and 1997 were eval- uated for histopathological and clinical diagnoses. Results. A total of 149 biopsies were performed on 122 patients. Physicians learned the method easily. Samples were of adequate size and quality to allow for diagnostics. In total 106 biopsies were taken due to different diagnostic suspicions: 24 polymyositis (PM) or dermatomyositis (DM); 43 PM, DM, or vasculitis in addition to another rheumatic condition; 19 systemic vasculitis; and 20 myalgias. Criteria for definite or probable PM/DM were fulfilled in 21 patients, 18 with positive biopsies. Thirteen patients received vasculitis as clinical diagnosis, 3 with positive biopsies. No patient with myalgia had a biopsy with inflammatory changes. Fifteen of 43 rebiopsies performed to assess disease activity had signs of active inflammation. In 48% there were changes in immuno- suppressive therapy after biopsy results. Four complications occurred; one was a serious subfascial hematoma. Conclusion. The percutaneous conchotome muscle biopsy technique gives a good size sample that allows for diagnostic evaluation and has a high yield in patients with myositis. It is a simple proce- dure, easy to learn and to perform, with a low complication rate and minimum discomfort for the patient. The method can preferably be used as a diagnostic tool and to perform repeated biopsies to assess the effect of a given therapy for both clinical and research purposes. -
Frequency and Criticality of Diagnoses in Family Medicine Practices: from the National Ambulatory Medical Care Survey (NAMCS)
J Am Board Fam Med: first published as 10.3122/jabfm.2018.01.170209 on 12 January 2018. Downloaded from ORIGINAL RESEARCH Frequency and Criticality of Diagnoses in Family Medicine Practices: From the National Ambulatory Medical Care Survey (NAMCS) Michael R. Peabody, PhD, Thomas R. O’Neill, PhD, Keith L. Stelter, MD, MMM, and James C. Puffer, MD Background: Family medicine is a specialty of breadth, providing comprehensive health care for the individual and the family that integrates the broad scope of clinical, social, and behavioral sciences. As such, the scope of practice (SOP) for family medicine is extensive; however, over time many family phy- sicians narrow their SOP. We sought to provide a nationally representative description of the most com- mon and the most critical diagnoses that family physicians see in their practice. Methods: Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS) to select all ICD-9 codes reported by family physicians. A panel of family physicians then reviewed 1893 ICD-9 codes to place each code into an American Board of Family Medicine Family Medicine Certifica- tion Examination test plan specifications (TPS) category and provide a rating for an Index of Harm (IoH). Results: An analysis of all 1893 ICD-9 codes seen by family physicians in the 2012 NAMCS found that 198 ICD-9 codes could not be assigned a TPS category, leaving 1695 ICD-9 codes in the dataset. Top 10 lists of ICD-9 codes by TPS category were created for both frequency and IoH. Conclusions: This study provides a nationally representative description of the most common diag- copyright. -
Amino Acid Disorders
471 Review Article on Inborn Errors of Metabolism Page 1 of 10 Amino acid disorders Ermal Aliu1, Shibani Kanungo2, Georgianne L. Arnold1 1Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA Contributions: (I) Conception and design: S Kanungo, GL Arnold; (II) Administrative support: S Kanungo; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: E Aliu, GL Arnold; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Georgianne L. Arnold, MD. UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15224, USA. Email: [email protected]. Abstract: Amino acids serve as key building blocks and as an energy source for cell repair, survival, regeneration and growth. Each amino acid has an amino group, a carboxylic acid, and a unique carbon structure. Human utilize 21 different amino acids; most of these can be synthesized endogenously, but 9 are “essential” in that they must be ingested in the diet. In addition to their role as building blocks of protein, amino acids are key energy source (ketogenic, glucogenic or both), are building blocks of Kreb’s (aka TCA) cycle intermediates and other metabolites, and recycled as needed. A metabolic defect in the metabolism of tyrosine (homogentisic acid oxidase deficiency) historically defined Archibald Garrod as key architect in linking biochemistry, genetics and medicine and creation of the term ‘Inborn Error of Metabolism’ (IEM). The key concept of a single gene defect leading to a single enzyme dysfunction, leading to “intoxication” with a precursor in the metabolic pathway was vital to linking genetics and metabolic disorders and developing screening and treatment approaches as described in other chapters in this issue. -
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Neutral Amino Acids in the Urine [5-7]
"This is a non-final version of an article published in final form in Current Opinion in Nephrology and Hypertension 22.5 (2013): 539-544 ". Epithelial neutral amino acid transporters, lessons from mouse models Stefan Bröer Research School of Biology, Australian National University Author of correspondence: Name: Stefan Bröer Address: Research School of Biology Linnaeus Way 134 Australian National University Canberra, ACT 0200, Australia Telephone number: +61-2-6125-2540 Email address: [email protected] Abstract (200 words max.): Purpose of review: Epithelial neutral amino acid transporters have been identified at the molecular level in recent years. Mouse models have now established the crucial role of these transporters for systemic amino acid homeostasis. The review summarises recent progress in this field. Recent findings: Epithelial neutral amino acid transporters play an important role in the homeostasis of neutral amino acid levels in the body. They are important for the maintenance of body weight, muscle mass and serve as fuels. They also serve a role in providing nutrients to epithelial cells. Changes of plasma amino acid levels are not necessarily correlated to the amino acids appearing in the urine, changes to organ amino acid metabolism need to be taken into account. Summary: Genetic deletion of neutral amino acid transporters provides insight into their role in protein nutrition and homestasis. Keywords: Protein nutrition, intestine, kidney Abbreviations: dss, dextran-sulphate; hpd, high protein diet; nd, normal diet Introduction The majority of epithelial amino acid transporters have been identified in recent years [1-3]. Many of these are expressed in both intestinal and renal epithelia (Fig. -
Code Description
Code Description 0061 Chronic intestinal amebiasis without mention of abscess 0062 Amebic nondysenteric colitis 0063 Amebic liver abscess 0064 Amebic lung abscess 00642 West Nile fever with other neurologic manifestation 00649 West Nile fever with other complications 0065 Amebic brain abscess 0066 Amebic skin ulceration 0068 Amebic infection of other sites 0069 Amebiasis, unspecified 0070 Other protozoal intestinal diseases, balantidiasis (Infection by Balantidium coli) 0071 Other protozoal intestinal diseases, giardiasis 0072 Other protozoal intestinal diseases, coccidiosis 0073 Other protozoal intestinal diseases, trichomoniasis 0074 Other protozoal intestinal diseases, cryptosporidiosis 0075 Other protozoal intestional disease cyclosporiasis 0078 Other specified protozoal intestinal diseases 0079 Unspecified protozoal intestinal disease 01000 Primary tuberculous infection, unspecified 01001 Primary tuberculous infection bacteriological or histological examination not done 01002 Primary tuberculous infection, bacteriological or histological examination results unknown 01003 Primary tuberculous infection, tubercle bacilli found by microscopy 01004 Primary tuberculous infection, tubercle bacilli found by bacterial culture 01005 Primary tuberculous infection, tubercle bacilli confirmed histolgically 01006 Primary tuberculous infection, tubercle bacilli found by other methods 01010 Tuberculous pleurisy in primary progressive tuberculosis unspecified 01011 Tuberculous pleurisy bacteriological or histological examination not done 01012 Tuberculous -
Hartnup Disease
Hartnup disease Description Hartnup disease is a condition caused by the body's inability to absorb certain protein building blocks (amino acids) from the diet. As a result, affected individuals are not able to use these amino acids to produce other substances, such as vitamins and proteins. Most people with Hartnup disease are able to get the vitamins and other substances they need with a well-balanced diet. People with Hartnup disease have high levels of various amino acids in their urine ( aminoaciduria). For most affected individuals, this is the only sign of the condition. However, some people with Hartnup disease have episodes during which they exhibit other signs, which can include skin rashes; difficulty coordinating movements ( cerebellar ataxia); and psychiatric symptoms, such as depression or psychosis. These episodes are typically temporary and are often triggered by illness, stress, nutrient-poor diet, or fever. These features tend to go away once the trigger is remedied, although the aminoaciduria remains. In affected individuals, signs and symptoms most commonly occur in childhood. Frequency Hartnup disease is estimated to affect 1 in 30,000 individuals. Causes Hartnup disease is caused by mutations in the SLC6A19 gene. This gene provides instructions for making a protein called B0AT1, which is primarily found embedded in the membrane of intestine and kidney cells. The function of this protein is to transport certain amino acids into cells. In the intestines, amino acids from food are transported into intestinal cells then released into the bloodstream so the body can use them. In the kidneys, amino acids are reabsorbed into the bloodstream instead of being removed from the body in urine. -
Diagnosis and Treatment of Tyrosinosis
Arch Dis Child: first published as 10.1136/adc.43.231.540 on 1 October 1968. Downloaded from Arch. Dis. Childh., 1968, 43, 540. Diagnosis and Treatment of Tyrosinosis ANGELA FAIRNEY, DOROTHY FRANCIS, R. S. ERSSER, J. W. T. SEAKINS, and DENNIS COTTOM From the Department ofChemical Pathology, Institute ofChild Health and The Hospitalfor Sick Children, London W.C.1 This paper describes the diagnosis of tyrosinosis A clean specimen of urine gave a deposit showing scanty in a girl aged 10 months. Her subsequent pro- pus cells, with a mixed growth on culture. X-rays gress after the institution of a diet low in phenyl- showed changes of rickets in the knees and anterior alanine and tyrosine has been good, and details of ends of the ribs and femora. An intravenous pyelogram showed enlarged kidneys with prompt excretion of the her treatment are discussed. dye; there was stretching of the calyces in the left and Tyrosinosis is an inherited metabolic disorder possibly in the right, which was suggestive of the adult characterized by cirrhosis, severe hypophosphat- type of polycystic disease. There was no clear sign of a aemic rickets, renal tubular defects, and a derange- focal lesion or paroxysmal features on the EEG. ment of tyrosine metabolism. The metabolic Biochemical results are listed in Table I. With the products arising from the deranged tyrosine exception of tyrosine, the plasma amino acid pattern metabolism point to a lack of p-hydroxyphenyl- was within the normal range, and in particular methio- pyruvate oxidase (Halvorsen, 1967). nine was never raised (normal approx. -
Exome Sequencing Reveals a Phenotype Modifying Variant in ZNF528 in Primary Osteoporosis with a COL1A2 Deletion
ORIGINAL ARTICLE Exome Sequencing Reveals a Phenotype Modifying Variant in ZNF528 in Primary Osteoporosis With a COL1A2 Deletion Sini Skarp,1,2,3† Ji-Han Xia,2,4† Qin Zhang,2,4 Marika Löija,2,3 Alice Costantini,5 Lloyd W Ruddock,2 Outi Mäkitie,5,6,7,8,9 Gong-Hong Wei,2,4,10† and Minna Männikkö1,3† 1Infrastructure for Population Studies, Northern Finland Birth Cohorts, Faculty of Medicine, University of Oulu, Oulu, Finland 2Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland 3Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland 4Biocenter Oulu, University of Oulu, Oulu, Finland 5Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet/Stockholm, Stockholm, Sweden 6Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden 7Children’s Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 8Folkhälsan Research Center, Genetics Research Program, Helsinki, Finland 9Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland 10Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences and Zhongshan Hospital, Fudan University, Shanghai, China ABSTRACT We studied a family with severe primary osteoporosis carrying a heterozygous p.Arg8Phefs*14 deletion in COL1A2, leading to hap- loinsufficiency. Three affected individuals carried the mutation and presented nearly identical spinal fractures but lacked other typical features of either osteogenesis imperfecta or Ehlers-Danlos syndrome. Although mutations leading to haploinsufficiency in COL1A2 are rare, mutations in COL1A1 that lead to less protein typically result in a milder phenotype. -
Treatable Inborn Errors of Metabolism Presenting As Cerebral Palsy Mimics
Leach et al. Orphanet Journal of Rare Diseases 2014, 9:197 http://www.ojrd.com/content/9/1/197 RESEARCH Open Access Treatable inborn errors of metabolism presenting as cerebral palsy mimics: systematic literature review Emma L Leach1,2, Michael Shevell3,4,KristinBowden2, Sylvia Stockler-Ipsiroglu2,5,6 and Clara DM van Karnebeek2,5,6,7,8* Abstract Background: Inborn errors of metabolism (IEMs) have been anecdotally reported in the literature as presenting with features of cerebral palsy (CP) or misdiagnosed as ‘atypical CP’. A significant proportion is amenable to treatment either directly targeting the underlying pathophysiology (often with improvement of symptoms) or with the potential to halt disease progression and prevent/minimize further damage. Methods: We performed a systematic literature review to identify all reports of IEMs presenting with CP-like symptoms before 5 years of age, and selected those for which evidence for effective treatment exists. Results: We identified 54 treatable IEMs reported to mimic CP, belonging to 13 different biochemical categories. A further 13 treatable IEMs were included, which can present with CP-like symptoms according to expert opinion, but for which no reports in the literature were identified. For 26 of these IEMs, a treatment is available that targets the primary underlying pathophysiology (e.g. neurotransmitter supplements), and for the remainder (n = 41) treatment exerts stabilizing/preventative effects (e.g. emergency regimen). The total number of treatments is 50, and evidence varies for the various treatments from Level 1b, c (n = 2); Level 2a, b, c (n = 16); Level 4 (n = 35); to Level 4–5 (n = 6); Level 5 (n = 8). -
Molecular Patterns Behind Immunological and Metabolic Alterations in Lysinuric Protein Intolerance
MOLECULAR PATTERNS BEHIND IMMUNOLOGICAL AND METABOLIC ALTERATIONS IN LYSINURIC PROTEIN INTOLERANCE Johanna Kurko TURUN YLIOPISTON JULKAISUJA – ANNALES UNIVERSITATIS TURKUENSIS Sarja - ser. D osa - tom. 1220 | Medica - Odontologica | Turku 2016 University of Turku Faculty of Medicine Institute of Biomedicine Department of Medical Biochemistry and Genetics Turku Doctoral Programme of Molecular Medicine (TuDMM) Supervised by Adjunct Professor Juha Mykkänen, Ph.D Professor Harri Niinikoski, MD, Ph.D Research Centre of Applied and Department of Paediatrics and Preventive Cardiovascular Medicine Adolescent Medicine University of Turku Turku University Hospital Turku, Finland University of Turku Turku, Finland Reviewed by Adjunct Professor Risto Lapatto, MD, Ph.D Adjunct Professor Outi Monni, Ph.D Department of Paediatrics Research Programs’ Unit and Institute of Helsinki University Hospital Biomedicine University of Helsinki University of Helsinki Helsinki, Finland Helsinki, Finland Opponent Adjunct Professor Päivi Saavalainen, Ph.D Research Programs Unit University of Helsinki Helsinki, Finland The originality of this thesis has been checked in accordance with the University of Turku quality assurance system using the Turnitin OriginalityCheck service. ISBN 978-951-29-6399-7 (PRINT) ISBN 978-951-29-6400-0 (PDF) ISSN 0355-9483 (PRINT) ISSN 2343-3213 (ONLINE) Painosalama Oy - Turku, Finland 2016 ‘Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life.’ Marcus -
Diagnosis and Treatment of Dermatomyositis-Systemic Lupus
Diagnosis and Treatment of Dermatomyositis-Systemic Lupus Erythematosus Overlap Syndrome Preston Williams1; Benjamin McKinney, MD2 1Texas A&M College of Medicine; 2Baylor University Medical Center Family Medicine Residency Introduction Case Description Discussion Dermatomyositis is an autoimmune condition classically A punch biopsy of her rash showed atrophic epithelium with This case of overlap syndrome between dermatomyositis and characterized by symmetric proximal muscle weakness, dyskeratotic keratinocytes, vacuolar interface changes, superficial systemic lupus erythematosus presents a rare but important inflammatory muscle changes, and dermatologic abnormalities.1 perivascular and lichenoid inflammation, and pigment challenge to the primary care physician. Our patient presented Several studies have shown that the inflammatory myopathies, incontinence consistent with systemic lupus erythematosus initially with arthralgias and fatigue, symptoms more such as dermatomyositis, commonly overlap with other (SLE). The patient was started on prednisone 40 mg daily for a 2- characteristic of systemic lupus erythematosus. However, these connective tissue disorders, significantly complicating the week taper to 10 mg and hydroxychloroquine 200 mg daily with symptoms were followed by a facial rash that involved the diagnosis.2 The reported incidence of overlap syndrome ranges marked improvement in symptoms. Further lab work-up was nasolabial folds and periorbital regions more in line with from 11% to 40% in patients diagnosed with significant