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Cost-Effective Laboratory Evaluation of Acute Viral Hepatitis

A cost-effective diagnostic workup of patients with possible acute viral hepatitis is the most reasonable approach. Because 75% of cases of acute viral hepatitis result from infection with either HAV or HBV, the initial laboratory investigation should include serologic tests to exclude HAV or HBV. If the results of these studies are negative, further testing should be done to rule out acute HCV infection, which is less common. Serum HCV RNA is detectable 1 to 2 weeks after the onset of infection, whereas anti-HCV can be detected 8 to 10 weeks following infection with the virus. In clinically stable patients, waiting and checking the presence of antibodies to HCV may be plausible. Checking for HCV RNA by polymerase chain reaction in all patients is not cost-effective, unless there is a known history of blood exposure. Finally, not all acute hepatitis is viral. If the initial evaluation fails to show viral hepatitis, then other causes of hepatitis, such as alcoholic hepatitis, drug toxicity, autoimmune hepatitis, or Wilson’s disease, should be considered. Continue reading “Cost-Effective Laboratory Evaluation of Acute Viral Hepatitis”

Pediatric Sequential Organ Failure Assessment (pSOFA) Score

The SOFA score at admission is useful for predicting outcomes in the Paediatric Intensive Care Units (PICUs) and is more accurate than SIRS for definition of paediatric sepsis.
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Allred Score for Estrogen and Progesterone Receptor Evaluation

Breast cancer (BC) hormonal receptors status is assessed by immunohistochemistry (IHC), a specific, sensitive, and accessible method that guide breast cancer treatment. Continue reading “Allred Score for Estrogen and Progesterone Receptor Evaluation”

Criteria to Initiate Evaluation for Growth Hormone Deficiency (GHD)

Tools for the diagnosis of GHD include auxology, radiographic assessment of bone age, measurement of insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 (IGFBP-3), provocative growth hormone (GH) testing, cranial magnetic resonance imaging (MRI), and, in certain cases, genetic testing. Growth velocity and the degree of short stature are primary considerations in the decision to pursue evaluation for GHD. Continue reading “Criteria to Initiate Evaluation for Growth Hormone Deficiency (GHD)”

The Sequential Organ Failure Assessment (SOFA) Score

The SOFA system was created in a consensus meeting of the European Society of Intensive Care Medicine in 1994 and further revised in 1996. The SOFA is a six-organ dysfunction/failure score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal), providing a daily score of 0 to 24 points. The objective in the development of the SOFA was to create a simple, reliable, and continuous score easily obtained in every institution.

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Perioperative Cardiovascular Evaluation for Noncardiac Surgery

Clinical Predictors of Increased Perioperative Cardiovascular Risk (Myocardial Infarction, Heart Failure, Death)

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