Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Severe persistent visual field constriction associated with vigabatrin

Abstract: Case 1 –A 22 year old woman with longstanding complex partial epilepsy started taking vigabatrin 2000 mg/day in addition to carbamazepine 600 mg/day and sodium valproate 1400 mg/day. Thirty seven months later she complained of tunnel vision and was found to have normal acuity but severely constricted visual fields in both eyes (fig 1 (top)). Her optic discs were slightly pale, and the peripheral retina seemed somewhat atrophic. Magnetic resonance imaging showed left hippocampal atrophy. Blood tests, including mitochondrial DNA screen and measurement of phytanic acid and lysosomal enzyme concentrations, gave normal results. Cone and rod electroretinography showed normal a and b waves, but oscillatory potentials were slightly subnormal. An electro-oculogram showed abnormally low Arden indices (left 139%; right 167%). Visual evoked responses were normal. Fluorescein angiography showed spotty hyperfluorescence in retinal pigment epithelium. Vigabatrin was …

Pooled Results From 38 Analyses of the Accuracy of Distress Thermometer and Other Ultra-Short Methods of Detecting Cancer-Related Mood Disorders

Abstract: Ultra-short screening tools involving fewer than five questions have been recommended as a simple method of detecting distress, anxiety, or depression in cancer settings. Such methods have practical appeal, but their diagnostic accuracy is unclear. A literature search limited to diagnostic validity studies of ultra-short screening in cancer settings identified 38 analyses, including 19 assessing the Distress Thermometer alone, involving a total of 6,414 unique patients. The pooled ability of ultra-short methods to detect depression was given by a sensitivity of 78.4%, a specificity of 66.8%, a positive predictive value (PPV) of 34.2%, and a negative predictive value (NPV) of 93.4%. Thus these tools were very good at excluding possible cases of depression but poor at confirming a suspected diagnosis. The pooled ability of ultra-short methods to detect anxiety was given by a sensitivity of 77.3% and a specificity of 56.6% (PPV, 55.2%; NPV, 80.25%) and for distress a sensitivity of 78.3% and a specificity of 66.5% (PPV, 59.7%; NPV, of 82.8%). Results using the Distress Thermometer alone were similar. Scores of integrated accuracy, using the Youden index and diagnostic odds ratio, suggested modest overall accuracy with least success in diagnosing anxiety disorders. Ultra-short methods were modestly effective in screening for mood disorders. Their rule-in ability was poorer than their rule-out ability. Ultra-short methods cannot be used alone to diagnose depression, anxiety, or distress in cancer patients but they may be considered as a first-stage screen to rule out cases of depression.