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Garg J, Verma P, Singh M, Das A, Pathak A, Agarwal J. Hepatitis C virus core antigen: A diagnostic and treatment monitoring marker of hepatitis C virus in Indian population. Indian J Gastroenterol 2024:10.1007/s12664-024-01549-7. [PMID: 38619807 DOI: 10.1007/s12664-024-01549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The diagnosis and treatment monitoring of hepatitis C is quite challenging. The screening test, i.e. antibody assay, is unable to detect acute cases, while the gold standard hepatitis C virus (HCV) reverse transcriptase polymerase chain reaction (RTPCR) assay is not feasible in resource-limited countries such as India due to high cost and infrastructure requirement. European Association for the Study of the Liver and World Health Organization have approved a new marker, i.e. HCV core antigen (HCVcAg) assay, as an alternative to molecular assay. In this study, we have evaluated HCVcAg assay for diagnosis and treatment monitoring follow-up in Indian population infected with hepatitis C. METHODS Blood specimen of 90 clinically suspected cases of acute hepatitis C were tested simultaneously for anti-HCV antibody assay via ELISA (enzyme-linked immunoassay), HCVcAg assay by chemiluminescence immune assay (CLIA) and HCV RTPCR VL (viral load) assay. Thirty-four HCV RTPCR positive patients were further enrolled in treatment monitoring group whose blood samples were tested at the beginning of treatment, two weeks, four weeks and 12 weeks via HCV core Ag assay and HCV RTPCR Viral Load assay. RESULTS Considering HCV RTPCR as gold standard, diagnostic performance of HCV core Ag assay and anti-HCV antibody assay was evaluated. The sensitivity and specificity of HCV core Ag assay were higher than that of anti-HCV Antibody assay, i.e. 88.3% and 100% vs. 23.3% and 83.3%, respectively. The overall diagnostic accuracy of HCV core Ag assay was 92.20%. Among treatment follow-up group, HCV core Ag levels correlated well with HCV viral load levels, at the beginning of treatment (baseline) till 12 weeks showing highly significant Spearman rank correlation coefficient of > 0.9 with HCV viral load levels. CONCLUSIONS HCV core Ag assay is a cost-effective, practically feasible substitute of HCV RTPCR viral load assay for diagnosis as well as long duration treatment monitoring of hepatitis C infection in resource-limited settings.
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Affiliation(s)
- Jaya Garg
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India.
| | - Prashant Verma
- Department of Gastromedicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India
| | - Mridu Singh
- Department of Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India
| | - Anupam Das
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India
| | - Anurag Pathak
- Department of Community Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India
| | - Jyotsna Agarwal
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226 010, India
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Oloukoi C, Dohan A, Gaillard M, Hoeffel C, Groussin-Rouiller L, Bertherat J, Jouinot A, Assié G, Fuks D, Sibony M, Soyer P, Jannot AS, Barat M. Differentiation between adrenocortical carcinoma and lipid-poor adrenal adenoma using a multiparametric MRI-based diagnostic algorithm. Diagn Interv Imaging 2024:S2211-5684(24)00081-0. [PMID: 38575426 DOI: 10.1016/j.diii.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the capabilities of multiparametric magnetic resonance imaging (MRI) in differentiating between lipid-poor adrenal adenoma (LPAA) and adrenocortical carcinoma (ACC). MATERIALS AND METHODS Patients of two centers who underwent surgical resection of LPAA or ACC after multiparametric MRI were retrospectively included. A training cohort was used to build a diagnostic algorithm obtained through recursive partitioning based on multiparametric MRI variables, including apparent diffusion coefficient and chemical shift signal ratio (i.e., tumor signal intensity index). The diagnostic performances of the multiparametric MRI-based algorithm were evaluated using a validation cohort, alone first and then in association with adrenal tumor size using a cut-off of 4 cm. Performances of the diagnostic algorithm for the diagnosis of ACC vs. LPAA were calculated using pathology as the reference standard. RESULTS Fifty-four patients (27 with LPAA and 27 with ACC; 37 women; mean age, 48.5 ± 13.3 [standard deviation (SD)] years) were used as the training cohort and 61 patients (24 with LPAA and 37 with ACC; 47 women; mean age, 49 ± 11.7 [SD] years) were used as the validation cohort. In the validation cohort, the diagnostic algorithm yielded best accuracy for the diagnosis of ACC vs. LPAA (75%; 46/61; 95% CI: 55-88) when used without lesion size. Best sensitivity was obtained with the association of the diagnostic algorithm with tumor size (96%; 23/24; 95% CI: 80-99). Best specificity was obtained with the diagnostic algorithm used alone (76%; 28/37; 95% CI: 60-87). CONCLUSION A multiparametric MRI-based diagnostic algorithm that includes apparent diffusion coefficient and tumor signal intensity index helps discriminate between ACC and LPAA with high degrees of specificity and accuracy. The association of the multiparametric MRI-based diagnostic algorithm with adrenal lesion size helps maximize the sensitivity of multiparametric MRI for the diagnosis of ACC.
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Affiliation(s)
- Carmelia Oloukoi
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France
| | - Martin Gaillard
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré, CRESTIC, URCA, 51000 Reims, France
| | - Lionel Groussin-Rouiller
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Jérome Bertherat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Guillaume Assié
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - David Fuks
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Mathilde Sibony
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anne-Sophie Jannot
- AP-HP.Centre- Université Paris Cité, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, 75015, Paris, France; INSERM, UMR_S1138, Cordeliers Research Center, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France.
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Shkodra M, Mulvey M, Fallon M, Brunelli C, Zecca E, Bracchi P, Caputo M, Massa G, Lo Dico S, Rolke R, Kaasa S, Caraceni A. Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer. Pain Rep 2024; 9:e1140. [PMID: 38375093 PMCID: PMC10876233 DOI: 10.1097/pr9.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy. Objectives Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST). Methods This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0-10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal-Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP. Results Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2-94.3) and 98.3% (95% CI 90.8-100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia (P = 0.0032), warm hypoesthesia (P = 0.0018), pressure hyperalgesia (P = 0.02), and the presence of allodynia (P = 0.0001). Conclusion The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.
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Affiliation(s)
- Morena Shkodra
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Matthew Mulvey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Marie Fallon
- Department of Palliative Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mariangela Caputo
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giacomo Massa
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Stein Kaasa
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Manchanda V, Muralidharan J, Nischal N, Aggarwal K, Gupta S, Gupta N, Velayudhan A, Kaur H, Brijwal M, Chhabra M, Vishwanathan R, Dhodapkar R, Mahajan SK, Deol S, Sekhar JC, Mitra S, Saxena S, Kumar J, Garg A, Lodha R, Ravi V, Soneja M, Verghese VP, Rodrigues C. Approach towards surveillance-based diagnosis of acute respiratory illness in India: Expert recommendations. Indian J Med Microbiol 2024; 48:100548. [PMID: 38403268 DOI: 10.1016/j.ijmmb.2024.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Emerging infectious diseases, often zoonotic, demand a collaborative "One-Health" surveillance approach due to human activities. The need for standardized diagnostic and surveillance algorithms is emphasized to address the difficulty in clinical differentiation and curb antimicrobial resistance. OBJECTIVE The present recommendations are comprehensive diagnostic and surveillance algorithm for ARIs, developed by the Indian Council of Medical Research (ICMR), which aims to enhance early detection and treatment with improved surveillance. This algorithm shall be serving as a blueprint for respiratory infections landscape in the country and early detection of surge of respiratory infections in the country. CONTENT The ICMR has risen up to the threat of emerging and re-emerging infections. Here, we seek to recommend a structured approach for diagnosing respiratory illnesses. The recommendations emphasize the significance of prioritizing respiratory pathogens based on factors such as the frequency of occurrence (seasonal or geographical), disease severity, ease of diagnosis and public health importance. The proposed surveillance-based diagnostic algorithm for ARI relies on a combination of gold-standard conventional methods, innovative serological and molecular techniques, as well as radiological approaches, which collectively contribute to the detection of various causative agents. The diagnostic part of the integrated algorithm can be dealt at the local microbiology laboratory of the healthcare facility with the few positive and negative specimens shipped to linked viral disease research laboratories (VRDLs) and other ICMR designated laboratories for genome characterisation, cluster identification and identification of novel agents.
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Affiliation(s)
- Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Jayshree Muralidharan
- Department of Pediatric Medicine (Advanced Pediatric Centre), PGIMER, Chandigarh, India.
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Kshitij Aggarwal
- Department of Pulmonary and Critical Care Medicine, Institute of Heart and Lung Diseases, Bahadurgarh, Haryana, India
| | - Swati Gupta
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Nivedita Gupta
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Anoop Velayudhan
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Harmanmeet Kaur
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Mala Chhabra
- Department of Microbiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RML), Delhi, India
| | | | | | - Sanjay K Mahajan
- Department of Medicine, Indira Gandhi Medical College & Hospital (IGMC), Shimla, India
| | - Saumya Deol
- Division of Epidemiology & Communicable Diseases, ICMR Headquarters, New Delhi, India
| | | | - Srestha Mitra
- Department of Microbiology, Maulana Azad Medical College, Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, Delhi, India
| | - Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - V Ravi
- Department of Neurovirology, NIMHANS, Bengaluru, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Delhi, India
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Krüger W. Diagnostic algorithm allows for a scientifically robust and reliable retrospective diagnosis using textual evidence from mid-19th century Basel, Switzerland. Int J Paleopathol 2024; 44:105-111. [PMID: 38218023 DOI: 10.1016/j.ijpp.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Diagnosing disease from the past using historic textual sources can be controversial as to its accuracy. To overcome these objections, an empirical approach to the historical clinical data was developed. The approach follows a standardised, objective, and systematic evaluation, satisfying the requirements of the philosophy of science. MATERIAL Physician-managed medical records of mid-19th century patients reported to have suffered from tuberculosis. METHOD A diagnostic algorithm, quantifying clinical data into a scoring system, was developed based on criteria recorded in the medical sources. The findings were compared to the autopsy results using the Receiver Operating Characteristics method. RESULTS The generated scoring system correctly predicted the diagnosis of tuberculosis in 86% of patients in the study. 6% false negatives and 8% false positives were predicted. CONCLUSIONS It is possible to retrospectively diagnose in a reliable and scientifically robust manner under certain conditions. It is important to embed the clinical data into the historical context. A general rejection of retrospective diagnosis is unsubstantiated. Well-designed, disease-specific, and source adapted medical scoring systems are new approaches and overcome criticism raised against retrospective diagnosis. SIGNIFICANCE This new approach utilises diverse historic sources and potentially leads to reliable retrospective diagnosis of most common diseases of the past. LIMITATIONS Selection bias of the records allocated. Quality of the historic sources utilized. Restricted statistical assessment potential of historic sources. SUGGESTIONS FOR FURTHER RESEARCH Development of disease- and epoch-specific medical score systems.
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Affiliation(s)
- Wolfgang Krüger
- Biological Anthropology, Faculty of Medicine, University of Freiburg, Hebelstrasse 29, D-79104 Freiburg im Breisgau, Germany.
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Settelmeier S, Steven S, Post F, Ahrens I, Giannitsis E, Breuckmann F. New categorization of chest pain: noncardiac is in, atypical is out! Herz 2024:10.1007/s00059-024-05240-7. [PMID: 38427126 DOI: 10.1007/s00059-024-05240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
Chest pain poses a diagnostic challenge in the emergency department and requires a thorough clinical assessment. The traditional distinction between "atypical" and "typical" chest pain carries the risk of not addressing nonischemic clinical pictures. The newly conceived subdivision into cardiac, possibly cardiac, and (probably) noncardiac causes of the presenting symptom complex addresses a much more interdisciplinary approach to a symptom-oriented diagnostic algorithm. The diagnostic structures of the chest pain units in Germany do not currently reflect this. An adaptation should therefore be considered.
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Affiliation(s)
- Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sebastian Steven
- Med. Klinik III-Department for Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Felix Post
- Internal Medicine, General and interventional Cardiology, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany
| | - Ingo Ahrens
- Krankenhaus der Augustinerinnen, Department for Cardiology and Intensive Care Medicine, Jakobstr. 27-31, 50678, Köln, Germany
| | - Evangelos Giannitsis
- Department for Internal Medicine III, Cardiology, Vascular Medicine and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Frank Breuckmann
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Cardiology, Pneumology, Neurology and Intensive Care Medicine, Klinik Kitzinger Land, Keltenstr. 67, 97318, Kitzingen, Germany.
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Martín-Enguix D, Pérez-Fernández N, Gomez-Gabaldón N, Medina-Gámez JA, Morales-Escobar FJ. [Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. Semergen 2024; 50:102114. [PMID: 37832471 DOI: 10.1016/j.semerg.2023.102114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.
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Affiliation(s)
- D Martín-Enguix
- Medicina Familiar y Comunitaria, Centro de Salud Albuñol, Distrito Sanitario Granada Sur, Albuñol, Granada, España.
| | - N Pérez-Fernández
- Otorrinolaringología, Clínica Universidad de Navarra, Madrid, España
| | - N Gomez-Gabaldón
- Medicina Familiar y Comunitaria, Otorrinolaringología, Hospital de Hellín, Hellín, Albacete, España
| | - J A Medina-Gámez
- Neurología, Medicina Familiar y Comunitaria, Centro de Salud de Armilla, Distrito Sanitario Granada Metropolitano, Armilla, Granada, España
| | - F J Morales-Escobar
- Medicina Familiar y Comunitaria, Centro de Salud Arucas, Arucas, Las Palmas, España
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Goldberg MR, Appel MY, Tobi K, Levy MB, Epstein-Rigbi N, Holmqvist M, Östling J, Nachshon L, Lidholm J, Elizur A. Validation of the NUT CRACKER Diagnostic Algorithm and Prediction for Cashew and Pistachio Co-Allergy. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00168-5. [PMID: 38382880 DOI: 10.1016/j.jaip.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Because of the high cross-sensitization among tree nuts, the NUT CRACKER (Nut Co-reactivity-Acquiring Knowledge for Elimination Recommendations) study proposed a diagnostic algorithm to minimize the number of required oral food challenges (OFCs). OBJECTIVE To validate the algorithm for cashew and pistachio allergy and determine markers for allergic severity. METHODS Patients (n = 125) with a median age of 7.8 (interquartile range, 5.9-11.2) years with suspected tree nut allergy were evaluated prospectively with decision tree points on the basis of skin prick test (SPT), basophil activation test (BAT), and knowledge of the coincidence of allergies. Validation of allergic status was determined by OFC. Markers of clinical severity were evaluated using the combined original and prospective cohort (n = 187) in relationship to SPT, BAT, and Ana o 3-sIgE. RESULTS Reactivity to cashew in SPT, BAT, and Ana o 3-sIgE and the incidence of abdominal pain on challenge were significantly higher in dual-allergic cashew/pistachio patients (n = 82) versus single cashew allergic patients (n = 18) (P = .001). All 3 diagnostic tests showed significant inverse correlation with log10 reaction doses for positive cashew OFC. The algorithm reduced overall the total number of OFCs by 72.0%, with a positive predictive value and negative predictive value of 93.0% and 99.0%, respectively. Cashew false-positives were observed primarily in hazelnut-allergic patients (P = .026). In this population, Ana o 3-specific IgE could diagnose cashew allergy with a sensitivity of more than 90% and a specificity of more than 95%. CONCLUSIONS The NUT CRACKER diagnostic algorithm was validated and reduced the number of diagnostic OFCs required. Markers for severity phenotypes may guide oral immunotherapy protocols, improving the risk/benefit ratio for patients.
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Affiliation(s)
- Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Michael Y Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Katz Tobi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Medicine, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Necpál J, Borsek M, Jeleňová B. PSP-Richardson syndrome mimics: An overview and pragmatic approach. Rev Neurol (Paris) 2024; 180:12-23. [PMID: 37543508 DOI: 10.1016/j.neurol.2023.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 08/07/2023]
Abstract
Progressive supranuclear palsy-Richardson syndrome (PSP-RS) is a sporadic atypical parkinsonian syndrome with levodopa-unresponsive axial-predominant parkinsonism, early postural instability, vertical supranuclear gaze palsy, dysarthria, executive dysfunction and behavioural changes. PSP-RS can be mimicked by numbers of other disorders, generally known as PSP mimics, or PSP-like syndromes. Their aetiological spectrum includes neurodegenerative (mostly genetic), vascular, infectious and drug-induced illnesses as well as other causes. Based on the available data, we have tried to create a definition of PSP-RS mimics: a syndrome resembling PSP-RS with at least one of the following red flags: 1) positive family history; 2) onset before 45 years of age; 3) rapid or stepwise progression; 4) acute or subacute onset; 5) atypical symptoms and/or signs; 6) normal or atypical brain MRI; 7) history of HIV or untreated syphilis, aortal surgery or recent therapy with dopamine-blocking agents. We have suggested a short diagnostic algorithm leading to the identification of PSP-RS mimics and the recommended diagnostic work-up. The key point of the diagnostic process is the early identification and treatment of potentially treatable PSP-RS mimics.
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Affiliation(s)
- J Necpál
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia; Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia.
| | - M Borsek
- Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia
| | - B Jeleňová
- Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia
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10
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Ling YH, Chowdhury D, Wang SJ. Treatment in the emergency department. Handb Clin Neurol 2024; 199:245-256. [PMID: 38307649 DOI: 10.1016/b978-0-12-823357-3.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
As a common headache disorder, migraine is also a common cause for emergency department (ED) visiting, which leads to tremendous medical and economic burden. The goals of migraine management in ED are resolving headache and migraine-related most bothersome symptoms rapidly, preventing ED revisiting due to headache relapse, and referring patients at risk, e.g., patients with chronic migraine and/or medication-overuse headache, to specialists. In this chapter, we elucidated the algorithm which was particularly adapted to ED settings for the diagnosis and treatment of migraine. We reviewed a plentiful amount of high-quality clinical trials, especially those conducted in populations derived from ED, to provide readers insights into the optimized treatment options for migraine in ED.
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Affiliation(s)
- Yu-Hsiang Ling
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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11
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Lin Y, Guo T, Lei C, Yang B, Yang D, Luo H, Peng H. Coexistent Sjogren's syndrome and Birt-Hogg-Dube´ syndrome: a case report. BMC Pulm Med 2023; 23:460. [PMID: 37993820 PMCID: PMC10664354 DOI: 10.1186/s12890-023-02680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
We report a rare case of Sjogren's syndrome complicated with Birt-Hogg-Dubé syndrome (BHDS) not previously mentioned in the literature. Further, there is insufficient evidence linking the two diseases. Here, we review existing diagnostic algorithms for diagnosing diffuse cystic lung disease and provide new insights. The patient initially complained of thirst and dry eyes for ten years, and gradually developed shortness of breath. After admission, physical examination showed five missing teeth, decreased respiratory sounds in both lower lungs, and Velcro rales. Computed tomography showed multiple thin-walled cystic lesions in both lungs. Initial xerophthalmia and labial gland biopsy seemed to reveal a pulmonary cystic change associated with Sjogren's syndrome. Before discharge, a rash suspected to indicate a fibrofollicular tumor in the neck was observed, and then FLCN variant has been found. The challenges how to clarify the diagnosis of DCLD causes are discussed.
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Affiliation(s)
- Yongkang Lin
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China
| | - Ting Guo
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China
| | - Cheng Lei
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China
| | - Binyi Yang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China
| | - Danhui Yang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China.
| | - Hong Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Furong District, Changsha, Hunan, 410011, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan, 410011, China.
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12
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Rodríguez-Otero N, Granados-Alarcón E, Antolín-Amérigo D, Solórzano-Zepeda C, Blázquez-Fernández M, Grandal-Platero M, De la Hoz-Caballer B. A Prospective Validation of a Diagnostic Algorithm for Hypersensitivity Reactions to COVID-19 Vaccines. J Investig Allergol Clin Immunol 2023; 33:392-394. [PMID: 36537912 DOI: 10.18176/jiaci.0877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- N Rodríguez-Otero
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - D Antolín-Amérigo
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Health Research Institute (IRyCIS), Madrid, Spain
| | | | | | - M Grandal-Platero
- Occupational Risk Prevention Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - B De la Hoz-Caballer
- Allergy Department, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Health Research Institute (IRyCIS), Madrid, Spain
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13
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Meier C, Yilmaz A. [Diagnostics of cardiac amyloidosis]. Inn Med (Heidelb) 2023; 64:830-841. [PMID: 37553542 DOI: 10.1007/s00108-023-01571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
The early diagnosis of cardiac amyloidosis is decisive for the success of treatment of affected persons. The thorough clinical investigation of the patient should be followed by appropriate diagnostics using modern procedures. The main symptoms are dyspnea, loss of performance and edema and in later stages cardiac arrhythmias in the form of atrioventricular conduction disturbances and atrial fibrillation but ventricular arrhythmias occur more rarely. During heart failure due to cardiac amyloidosis an increase of cardiac enzymes frequently occurs (e.g., creatine kinase, troponin, N‑terminal pro-brain natriuretic peptide), which can be included in the risk stratification and treatment monitoring, taking certain limitations into consideration. The investigation of light chains in serum and/or urine should be carried out immediately, as soon as there is a clinical and echocardiographic suspicion of cardiac amyloidosis. Subsequently, either cardiac magnetic resonance imaging (MRI) or bone scintigraphy should be carried out, depending on the locally available options. Depending on the results of these two imaging procedures, a decision must be made as to whether further diagnostic steps (e.g., endomyocardial biopsy) are necessary. In the last decade bone scintigraphy has proven to be a blessing for the diagnostics of cardiac amyloidosis but many partial aspects and limitations necessitate special and careful consideration. A Perugini score of 2 or 3 is initially "indicative" of cardiac amyloidosis but not yet "confirmative" for a specific subtype. Only after an additional negative result of the light chain determination, can the diagnosis of ATTR amyloidosis be noninvasively made. Cardiac amyloidosis shows a particularly characteristic contrast enhancement in cardiac MRI, which mostly begins in the inner (subendocardial) layers of the basal left ventricular (LV) wall and frequently appears to be circular in the cross-sectional view of the left ventricle. Supplementary T1 and extracellular volume fraction mapping results, which are shown as color-coded maps, enable the rapid and elegant assessment of the myocardial structure and the extent of amyloid deposition. An additional investigation of the TTR gene is recommended in the case of ATTR amyloidosis for a differentiation between hereditary and acquired ATTR, as from this, further therapeutic consequences can be derived.
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Affiliation(s)
- Claudia Meier
- Sektion für Herzbildgebung/Klinik für Kardiologie I, Universitätsklinikum Münster, Von-Esmarch-Str. 48, 48149, Münster, Deutschland
| | - Ali Yilmaz
- Sektion für Herzbildgebung/Klinik für Kardiologie I, Universitätsklinikum Münster, Von-Esmarch-Str. 48, 48149, Münster, Deutschland.
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14
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Laforga JB, Abdullah B. Diagnostic algorithm for challenging blue cell sinonasal carcinoma. Pathol Res Pract 2023; 248:154683. [PMID: 37478521 DOI: 10.1016/j.prp.2023.154683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
The newly emerging sinonasal carcinomas have demonstrated diverse morphologies and specific molecular rearrangements along with deviant clinical behavior from conventional counterparts. We aim to propose a diagnostic algorithm that is based on molecular findings of each sinonasal cancer and is considering the new entities has been called upon. Such a diagnostic algorithm should help diagnostic pathologists establish a diagnosis of a challenging sinonasal blue cell carcinomas and researchers performing retrospective analysis of archival cases. Along with consulting our archival cases, literature mining was conducted to retrieve the immunohistochemical and molecular findings regarding the newly emerging entities. Our proposed algorithm distinguishes poorly differentiated (non) keratinizing SNSCC, from anaplastic myoepithelial carcinoma, NUT midline carcinoma, SMARCB1/SMARCA4-deficient teratocarcinosarcoma, SMARCB1/SMARCA4-deficient carcinosarcoma, olfactory neuroblastoma, sinonasal undifferentiated carcinoma, HPV-related multiphenotypic sinonasal carcinoma and other adenocarcinomas. By incorporating morphologic features, immunohistochemical markers, and molecular investigations, the algorithm enhances the accuracy of diagnosis, particularly in cases where comprehensive molecular testing is not readily available. This algorithm serves as a valuable resource for pathologists, facilitating the proper diagnosis of sinonasal malignancies and guiding appropriate patient management.
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Affiliation(s)
- Juan B Laforga
- Department of Pathology, Hospital de Dénia, Alicante, Spain.
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15
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Biber R, Kopschina C, Willauschus M, Bail HJ, Lefering R. CT scan and conventional x-ray in multiple injured patient care: diagnostic strategies and outcomes analysed from the TraumaRegister DGU®. Eur J Trauma Emerg Surg 2023; 49:1927-1932. [PMID: 36305903 DOI: 10.1007/s00068-022-02140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the current practice regarding the prevalence and sequence of x-ray and CT scan in diagnostic algorithms for multiple injured patients. METHODS All primarily treated patients with ISS ≥ 9 were selected from the TraumaRegister DGU® (years 2008-2015; n = 109,257). Four subgroups of diagnostic algorithm were defined: CT only (group C; n = 63,763), CT before x-ray (group CX; n = 3711), x-ray followed by CT (group XC; n = 33,590), and x-ray only (group X, n = 8193). We analysed the type and sequence of diagnostic procedures and their association with hospital mortality and length-of-stay in the emergency room (ER-LOS). RESULTS Predominant strategies were CT only (58.4%) and x-ray followed by CT (30.7%). Overall mortality was between 10 and 12% in all subgroups involving CT, and 6.6% in the x-ray only group. Expected mortality was within the 95% confidence of observed mortality except for the CX group (observed 10.0%; CI95 8.9-11.0; expected 11.1%). Mean / median length of stay in the emergency room was shortest in the CT only subgroup: (60 / 50 min). Prior x-ray diagnostic resulted in additional 3 min (group XC). The use of additional x-ray diagnostic decreased from 51.6% (in 2008) to 35.4% (in 2015). CONCLUSIONS ER-LOS is significantly affected by diagnostic pathway. CT scan alone accelerates ER-LOS, which however was not associated with lower mortality rates. Performing completive x-ray examinations after an initial CT scan seems not to deteriorate mortality rates.
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Affiliation(s)
- Roland Biber
- Department of Traumatology, Kliniken Dr. Erler, Nuremberg, Germany.
- Paracelsus Medical University, Nuremberg, Germany.
| | - Carsten Kopschina
- Department of Traumatology and Orthopaedics, Krankenhäuser Nürnberger Land, Lauf, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - Maximilian Willauschus
- Department of Orthopaedics and Traumatology, Klinikum Nürnberg, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - Hermann Josef Bail
- Department of Orthopaedics and Traumatology, Klinikum Nürnberg, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany
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16
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Sever ML, Calatroni A, Roberts G, du Toit G, Bahnson HT, Radulovic S, Larson D, Byron M, Santos AF, Huffaker MF, Wheatley LM, Lack G. Developing a Prediction Model for Determination of Peanut Allergy Status in the Learning Early About Peanut Allergy (LEAP) Studies. J Allergy Clin Immunol Pract 2023; 11:2217-2227.e9. [PMID: 37146884 DOI: 10.1016/j.jaip.2023.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The Learning Early About Peanut Allergy (LEAP) study team developed a protocol-specific algorithm using dietary history, peanut-specific IgE, and skin prick test (SPT) to determine peanut allergy status if the oral food challenge (OFC) could not be administered or did not provide a determinant result. OBJECTIVE To investigate how well the algorithm determined allergy status in LEAP; to develop a new prediction model to determine peanut allergy status when OFC results are not available in LEAP Trio, a follow-up study of LEAP participants and their families; and to compare the new prediction model with the algorithm. METHODS The algorithm was developed for the LEAP protocol before the analysis of the primary outcome. Subsequently, a prediction model was developed using logistic regression. RESULTS Using the protocol-specified algorithm, 73% (453/617) of allergy determinations matched the OFC, 0.6% (4/617) were mismatched, and 26% (160/617) participants were nonevaluable. The prediction model included SPT, peanut-specific IgE, Ara h 1, Ara h 2, and Ara h 3. The model inaccurately predicted 1 of 266 participants as allergic who were not allergic by OFC and 8 of 57 participants as not allergic who were allergic by OFC. The overall error rate was 9 of 323 (2.8%) with an area under the curve of 0.99. The prediction model additionally performed well in an external validation cohort. CONCLUSION The prediction model performed with high sensitivity and accuracy, eliminated the problem of nonevaluable outcomes, and can be used to estimate peanut allergy status in the LEAP Trio study when OFC is not available.
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Affiliation(s)
- Michelle L Sever
- PPD Government and Public Health Services, Morrisville, NC; Rho Federal Systems Division, Durham, NC
| | | | - Graham Roberts
- University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, United Kingdom; David Hide Centre, Isle of Wight, United Kingdom
| | - George du Toit
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Henry T Bahnson
- The Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Suzana Radulovic
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Alexandra F Santos
- Department of Pediatric Allergy, School of Life Course Sciences, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Michelle F Huffaker
- Immune Tolerance Network, University of California San Francisco, San Francisco, Calf.
| | - Lisa M Wheatley
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Gideon Lack
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Rosa F, Martinetti C, Magnaldi S, Rizzo S, Manganaro L, Migone S, Ardoino S, Schettini D, Marchiolè P, Ragusa T, Gandolfo N. Uterine mesenchymal tumors: development and preliminary results of a magnetic resonance imaging (MRI) diagnostic algorithm. Radiol Med 2023:10.1007/s11547-023-01654-1. [PMID: 37311925 DOI: 10.1007/s11547-023-01654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of our study is to propose a diagnostic algorithm to guide MRI findings interpretation and malignancy risk stratification of uterine mesenchymal masses with a multiparametric step-by-step approach. METHODS A non-interventional retrospective multicenter study was performed: Preoperative MRI of 54 uterine masses was retrospectively evaluated. Firstly, the performance of MRI with monoparametric and multiparametric approach was assessed. Reference standard for final diagnosis was surgical pathologic result (n = 53 patients) or at least 1-year MR imaging follow-up (n = 1 patient). Subsequently, a diagnostic algorithm was developed for MR interpretation, resulting in a Likert score from 1 to 5 predicting risk of malignancy of the uterine lesion. The accuracy and reproducibility of the MRI scoring system were then tested: 26 preoperative pelvic MRI were double-blind evaluated by a senior (SR) and junior radiologist (JR). Diagnostic performances and the agreement between the two readers with and without the application of the proposed algorithm were compared, using histological results as standard reference. RESULTS Multiparametric approach showed the best diagnostic performance in terms of accuracy (94.44%,) and specificity (97.56%). DWI was confirmed as the most sensible parameter with a relative high specificity: low ADC values (mean 0.66) significantly correlated to uterine sarcomas diagnosis (p < 0.01). Proposed algorithm allowed to improve both JR and SR performance (algorithm-aided accuracy 88.46% and 96%, respectively) and determined a significant increase in inter-observer agreement, helping even the less-experienced radiologist in this difficult differential diagnosis. CONCLUSIONS Uterine leiomyomas and sarcomas often show an overlap of clinical and imaging features. The application of a diagnostic algorithm can help radiologists to standardize their approach to a complex myometrial mass and to easily identify suspicious MRI features favoring malignancy.
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Affiliation(s)
- Francesca Rosa
- Diagnostic Imaging Department, San Paolo Hospital-ASL 2, via Genova, 30, Savona, Italy.
| | - Carola Martinetti
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Silvia Magnaldi
- Diagnostic Imaging Unit, Esperia Medical Center, Porcia, PN, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Clinica di Radiologia EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), via Buffi 23, 6900, Lugano, Switzerland
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefania Migone
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Silvia Ardoino
- Anatomic Pathology Unit, San Paolo Hospital-ASL 2, via Genova, 30, Savona, Italy
| | - Daria Schettini
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Pierangelo Marchiolè
- Obstetrics and Gynecology Unit, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
- Obstetrics and Gynecology Department, IRCCS ospedale Policlinico San Martino, Genoa, Italy
| | - Tommaso Ragusa
- Anatomic Pathology Unit, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, Genoa, Italy
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18
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Khoury T. Metaplastic Breast Carcinoma Revisited; Subtypes Determine Outcomes: Comprehensive Pathologic, Clinical, and Molecular Review. Clin Lab Med 2023; 43:221-243. [PMID: 37169444 DOI: 10.1016/j.cll.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.
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Affiliation(s)
- Thaer Khoury
- Pathology Department, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA.
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19
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Cappellari GG, Semolic A, Zanetti M, Vinci P, Ius M, Guarnieri G, Busetto L, Donini LM, Barazzoni R. Sarcopenic obesity in free-living older adults detected by the ESPEN-EASO consensus diagnostic algorithm: Validation in an Italian cohort and predictive value of insulin resistance and altered plasma ghrelin profile. Metabolism 2023:155595. [PMID: 37245728 DOI: 10.1016/j.metabol.2023.155595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
Aging and obesity are synergistic sarcopenia risk factors (RF). Their association in sarcopenic obesity (SO) enhances morbidity and mortality, but consensus on SO diagnostic criteria is limited. ESPEN and EASO issued a consensus algorithm for SO screening (obesity and clinical SO suspicion) and diagnosis [low muscle strength by hand-grip (HGS) and low muscle mass by BIA], and we investigated its implementation in older adults (>65-years), as well as SO-associated metabolic RF [insulin resistance (IR: HOMA) and plasma acylated (AG) and unacylated (UnAG) ghrelin, with predictive value also assessed from 5-year-prior observations]. Older adults with obesity from the Italian MoMa study on metabolic syndrome in primary care (n = 76) were studied. 7 of 61 individuals with positive screening had SO (SO+; 9 % of cohort). No individuals with negative screening had SO. SO+ had higher IR, AG and plasma AG/UnAG ratio (p < 0.05 vs negative screening and SO-), and both IR and ghrelin profile predicted 5-year SO risk independent of age, sex and BMI. The current results provide the first ESPEN-EASO algorithm-based investigation of SO in free-living older adults, with 9 % prevalence in those with obesity and 100 % algorithm sensitivity, and they support IR and plasma ghrelin profile as SO risk factors in this setting.
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Affiliation(s)
| | - Annamaria Semolic
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Michela Zanetti
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Pierandrea Vinci
- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Mario Ius
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Gianfranco Guarnieri
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | | | | | - Rocco Barazzoni
- Dept. of Medical, Surgical and Health Sciences, University of Trieste, Italy; Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy.
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Truong B, Luu K. Diagnostic clues for the identification of pediatric foreign body aspirations and consideration of novel imaging techniques. Am J Otolaryngol 2023; 44:103919. [PMID: 37201356 DOI: 10.1016/j.amjoto.2023.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To better understand the diagnosis of foreign body aspiration by elucidating key components of its clinical presentation. METHODS This is a retrospective cohort study of pediatric patients with suspected foreign body aspiration. We collected information regarding demographics, history, symptoms, physical exam, imaging, and operative findings for rigid bronchoscopies. An evaluation of these findings for an association with foreign body aspiration and the overall diagnostic algorithm was performed. RESULTS 518 pediatric patients presented with 75.2 % presenting within one day of the inciting event. Identified history findings included wheeze (OR: 5.83, p < 0.0001) and multiple encounters (OR: 5.46, p < 0.0001). Oxygen saturation was lower in patients with foreign body aspiration (97.3 %, p < 0.001). Identified physical exam findings included wheeze (OR: 7.38, p < 0.001) and asymmetric breath sounds (OR: 5.48, p < 0.0001). The sensitivity and specificity of history findings was 86.7 % and 23.1 %, physical exam was 60.8 % and 88.4 %, and chest radiographs was 45.3 % and 88.0 %. 25 CT scans were performed with a sensitivity and specificity of 100 % and 85.7 %. Combining two components of the diagnostic algorithm yielded a high sensitivity and moderate specificity; the best combination was the history and physical exam. 186 rigid bronchoscopies were performed with 65.6 % positive for foreign body aspiration. CONCLUSION Accurate diagnosis of foreign body aspiration requires careful history taking and examination. Low-dose CT should be included in the diagnostic algorithm. The combination of any two components of the diagnostic algorithm is the most accurate for foreign body aspiration.
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Affiliation(s)
- Brandon Truong
- School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
| | - Kimberly Luu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
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Daghor-Abbaci K, Ait Hamadouche N, Makhloufi CD, Mechid F, Otmani F, Makrelouf M, Otmane A, Smail N, Boucelma M, Aissat FZ, Lefkir-Teffiani S, Bengana B, Boukheris N, Tebaibia A, Taharbouchet B, Ayoub S, Benziane B, Oumnia N, Haouichet C, Hanni F, Laraba N, Hakem D, Benfenatki N, Berrah A. Proposal of a new diagnostic algorithm for adult-onset Still's disease. Clin Rheumatol 2023; 42:1125-1135. [PMID: 36694091 DOI: 10.1007/s10067-023-06509-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study was performed to develop a new diagnostic algorithm for adult-onset Still's disease (AOSD). METHODS We conducted a multicenter prospective nationwide case-control study in tertiary Internal Medicine, Rheumatology, and Infectious Diseases departments, to include successively patients with suspected AOSD based on the presence of two or more major criteria of Yamaguchi and/or Fautrel classifications. Patients were classified as AOSD or controls according to a predefined procedure. A receiving operating characteristic curve was used to determine the best cutoff value of the points-based score for disease classification. A diagnostic algorithm was developed to help the physician in the diagnostic approach. RESULTS A total of 160 patients were included, 80 patients with AOSD and 60 controls with different diagnoses. Twenty patients with incomplete data were excluded. In the multivariate analysis, 6 items remained independently associated with AOSD diagnosis: typical rash (OR: 24.01, 3 points), fever ≥ 39 °C (OR: 17.34, 3 points), pharyngitis (OR: 10.23, 2 points), arthritis (OR: 9.01, 2 points), NLR ≥ 4 (OR: 11.10, 2 points), and glycosylated ferritin ≤ 20% (OR: 1.59, 1 point). AOSD should be considered if the patient satisfies 7 points with a sensitivity of 92.5%, specificity of 93.3%, and accuracy of 92.8% (area under the curve (AUC): 0.97 [95% CI: 0.94-0.99]). The present points-based score was more accurate and sensitive than the Yamaguchi classification (78.8%, 92.5%, p = 0.01) and Fautrel classification (76.3%, 92.5%, p = 0.004). A typical rash associated with a points-based score ≥ 7 points leads to a very likely disease. CONCLUSION The proposed new algorithm could be a good diagnostic tool for adult-onset Still's disease in clinical practice and research. Key Points • A diagnostic algorithm was performed to help the physician in the diagnostic approach of AOSD. • The points-based score included in this algorithm had a high sensitivity and accuracy. • This diagnostic algorithm can be useful in the clinical research.
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Affiliation(s)
- Karima Daghor-Abbaci
- Internal Medicine Department, University of Algiers 1, Faculty of Medical Sciences, Benyoucef Benkhedda, Bab El Oued University Hospital Center, 16000, Bab El Oued City, Algiers, Algeria. .,Biochemistry, Hemotology and Genetics Laboratory of Research, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria.
| | - Nadia Ait Hamadouche
- Department of Epidemiology, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria
| | - Chafia Dahou Makhloufi
- Rheumatology Department, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria
| | - Farida Mechid
- Rheumatology Department, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria
| | - Fifi Otmani
- Internal Medicine Department, Mustapha Bacha University Hospital Center, 1st May City, Algiers, Algeria
| | - Mohamed Makrelouf
- Biochemistry, Hemotology and Genetics Laboratory of Research, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria
| | - Amel Otmane
- Biochemistry, Hemotology and Genetics Laboratory of Research, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria
| | - Nourredine Smail
- Department of Epidemiology, Mustapha Bacha University Hospital Center, 1st May City, Algiers, Algeria
| | - Malika Boucelma
- Internal Medicine Department, Kouba University Hospital Center, Kouba City, Algiers, Algeria
| | - Fatma Zohra Aissat
- Infectious Diseases Department, El Hadi Flici University Hospital Center, Casbah City, Algiers, Algeria
| | - Salima Lefkir-Teffiani
- Rheumatology Department, Benimessous University Hospital Center, Algiers, Benimessous City, Algeria
| | - Bilel Bengana
- Rheumatology Department, Benimessous University Hospital Center, Algiers, Benimessous City, Algeria
| | - Nadia Boukheris
- Internal Medicine Department, Annaba University Hospital Center, Annaba City, Algeria
| | - Amar Tebaibia
- Internal Medicine Department, Birtraria University Hospital Center, El Biar City, Algiers, Algeria
| | - Baya Taharbouchet
- Internal Medicine Department, Bouloughine University Hospital Center, Algiers, Bouloughine City, Algeria
| | - Soraya Ayoub
- Internal Medicine Department, Benimessous University Hospital Center, Algiers, Benimessous City, Algeria
| | - Brahim Benziane
- Internal Medicine Department, Laghouat University Hospital Center, Laghouat City, Algeria
| | - Nadia Oumnia
- Internal Medicine Department, Zmirli University Hospital Center, El Harrache City, Algiers, Algeria
| | - Chafika Haouichet
- Rheumatology Department, Douera University Hospital Center, Blida City, Algeria
| | - Fella Hanni
- Rheumatology Department, Benaknoun University Hospital Center, Benaknoun City, Algiers, Algeria
| | - Nazim Laraba
- Internal Medicine Department, University of Algiers 1, Faculty of Medical Sciences, Benyoucef Benkhedda, Bab El Oued University Hospital Center, 16000, Bab El Oued City, Algiers, Algeria
| | - Djennete Hakem
- Internal Medicine Department, Mostaghanem University Hospital Center, Mostaghanem City, Algeria
| | - Nacera Benfenatki
- Internal Medicine Department, Rouiba University Hospital Center, Rouiba City, Algiers, Algeria
| | - Abdelkrim Berrah
- Internal Medicine Department, University of Algiers 1, Faculty of Medical Sciences, Benyoucef Benkhedda, Bab El Oued University Hospital Center, 16000, Bab El Oued City, Algiers, Algeria
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Pines M, Sheth S. Clinical Classification, Screening, and Diagnosis in Beta-Thalassemia and Hemoglobin E/Beta-Thalassemia. Hematol Oncol Clin North Am 2023; 37:313-325. [PMID: 36907605 DOI: 10.1016/j.hoc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
This article reviews the classification of beta-thalassemia syndromes, correlating clinical severity and genotype in the earlier classification, and broadening it recently based on clinical severity and transfusion status. The classification is dynamic, and individuals may progress from transfusion-independent to transfusion-dependent. Early and accurate diagnosis prevents delays in instituting treatment and comprehensive care, and precludes inappropriate and potentially harmful interventions. Screening can inform risk in an individual and subsequent generations when partners may be carriers as well. This article discusses the rationale for screening of the at-risk population. In the developed world, a more precise genetic diagnosis must be considered.
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Affiliation(s)
- Morgan Pines
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1117A, New York, NY 10065, USA
| | - Sujit Sheth
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA.
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23
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Reutemann B, Gordon FD. Evaluation of the Patient with Markedly Abnormal Liver Enzymes. Clin Liver Dis 2023; 27:1-16. [PMID: 36400459 DOI: 10.1016/j.cld.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver enzyme tests are very commonly ordered by physicians, and when they return as abnormal, they can pose a clinical challenge to the provider. Markedly abnormal liver enzymes indicate severe hepatic injury and require immediate evaluation. There are various causes for abnormal liver tests, including infectious, autoimmune, genetic, metabolic, drug, and vascular causes. An understanding of the patterns of aminotransferase and alkaline phosphatase elevations is useful in narrowing the differential diagnosis. A thorough history and physical examination, appropriate blood testing, and imaging are typically key to evaluating the patient with abnormal liver enzymes.
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Affiliation(s)
- Bethany Reutemann
- Dartmouth Hitchock Medical Center, 100 Hitchcock Way, Manchester, NH 03104, USA.
| | - Fredric D Gordon
- Tufts Medical Center, 800 Washington St. #40, South Building, 4th floor, Boston, MA 02111, USA
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Rodepeter FR, Teply-Szymanski J, Romey M, Grass A, Erber R, Lebeau A, Mack EKM, Tarawneh TS, Gremke N, Boekhoff J, Wündisch T, Wagner U, Jank P, Denkert C. [Clinically relevant molecular pathological diagnostics in breast cancer]. Pathologie (Heidelb) 2023; 44:39-49. [PMID: 36629894 DOI: 10.1007/s00292-022-01175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/12/2023]
Abstract
In breast cancer, the current guideline for pathological workup includes recommendations for advanced molecular analysis of certain predictive molecular markers in addition to basic immunohistochemical diagnostics. These markers are determined depending on tumor stage, including sequencing techniques and immunohistochemical methods. This comprises the systematic investigation of molecular alterations such as PIK3CA or BRCA1,2 mutations, NTRK fusions, or microsatellite instability as a basis for targeted therapy. Further alterations, for example in the PI3K pathway, ESR1 alterations, or ERBB2 mutations, may also be relevant for individual therapy decisions especially in the context of resistant or relapsed disease. Thus, particularly in advanced stages, a more comprehensive molecular characterization of the tumor may reveal genetic alterations that act as tumor drivers and provide targets for personalized therapies. Due to the large number of potential molecular targets, NGS panel diagnostics are a suitable approach in this conjunction with immunohistochemical characterization and the individual clinical situation. Molecular based therapeutical strategies outside of entity-specific approvals should be discussed in an interdisciplinary team within the framework of a molecular tumor board.
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Affiliation(s)
- Fiona R Rodepeter
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Julia Teply-Szymanski
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Marcel Romey
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Albert Grass
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Ramona Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.,Gemeinschaftspraxis für Pathologie, Lübeck, Deutschland
| | - Elisabeth K M Mack
- Abteilung für Hämatologie, Onkologie und Immunologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Thomas S Tarawneh
- Abteilung für Hämatologie, Onkologie und Immunologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Niklas Gremke
- Abteilung für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Jelena Boekhoff
- Abteilung für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Thomas Wündisch
- Comprehensive Cancer Center, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Uwe Wagner
- Abteilung für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Deutschland
| | - Paul Jank
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg (UKGM), Baldingerstr. 1, 35043, Marburg, Deutschland.
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Patil S, Khan SS, Hosmani J, Khan ZA, Muruganandhan J, Mushtaq S, Yadalam PK, Bhandi S, Awan KH. Identification of oral immune disorders- A review and a diagnostic algorithm. Dis Mon 2023; 69:101350. [PMID: 35337656 DOI: 10.1016/j.disamonth.2022.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Immunological disorders are observed in various clinical presentations in the oral cavity. The pathophysiology of these disorders include but are not limited to primary oral auto-immune disease, systemic disease with oral findings, malignancies, hypersensitivity reactions, drug-induced, and infection-related. Many of these disorders have overlapping oral features, making it difficult for the clinician to diagnose and treat the disorder. There is a need to provide a simple and practical decision-making algorithm to the clinicians and provide them guidance on laboratory investigations. The present review provides a diagnostic algorithm that might minimize outpatient process delays and lead to early management. This is crucial in many cases where oral findings may be the first sign of the disorder, and early treatment can preclude dissemination and complications of the disorder.
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Affiliation(s)
- Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia; Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Samar Saeed Khan
- Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Jagadish Hosmani
- Oral Pathology Division, Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Zafar Ali Khan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Jayanandan Muruganandhan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India
| | - Shazia Mushtaq
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Pradeep Kumar Yadalam
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600 077, India
| | - Shilpa Bhandi
- Department of Restorative Dental Science, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Kamran Habib Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States.
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Luo Y, Xue Y, Liu W, Song H, Huang Y, Tang G, Wang F, Wang Q, Cai Y, Sun Z. Development of diagnostic algorithm using machine learning for distinguishing between active tuberculosis and latent tuberculosis infection. BMC Infect Dis 2022; 22:965. [PMID: 36581808 PMCID: PMC9798640 DOI: 10.1186/s12879-022-07954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The discrimination between active tuberculosis (ATB) and latent tuberculosis infection (LTBI) remains challenging. The present study aims to investigate the value of diagnostic models established by machine learning based on multiple laboratory data for distinguishing Mycobacterium tuberculosis (Mtb) infection status. METHODS T-SPOT, lymphocyte characteristic detection, and routine laboratory tests were performed on participants. Diagnostic models were built according to various algorithms. RESULTS A total of 892 participants (468 ATB and 424 LTBI) and another 263 participants (125 ATB and 138 LTBI), were respectively enrolled at Tongji Hospital (discovery cohort) and Sino-French New City Hospital (validation cohort). Receiver operating characteristic (ROC) curve analysis showed that the value of individual indicator for differentiating ATB from LTBI was limited (area under the ROC curve (AUC) < 0.8). A total of 28 models were successfully established using machine learning. Among them, the AUCs of 25 models were more than 0.9 in test set. It was found that conditional random forests (cforest) model, based on the implementation of the random forest and bagging ensemble algorithms utilizing conditional inference trees as base learners, presented best discriminative power in segregating ATB from LTBI. Specially, cforest model presented an AUC of 0.978, with the sensitivity of 93.39% and the specificity of 91.18%. Mtb-specific response represented by early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) spot-forming cell (SFC) in T-SPOT assay, as well as global adaptive immunity assessed by CD4 cell IFN-γ secretion, CD8 cell IFN-γ secretion, and CD4 cell number, were found to contribute greatly to the cforest model. Superior performance obtained in the discovery cohort was further confirmed in the validation cohort. The sensitivity and specificity of cforest model in validation set were 92.80% and 89.86%, respectively. CONCLUSIONS Cforest model developed upon machine learning could serve as a valuable and prospective tool for identifying Mtb infection status. The present study provided a novel and viable idea for realizing the clinical diagnostic application of the combination of machine learning and laboratory findings.
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Affiliation(s)
- Ying Luo
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Ying Xue
- grid.33199.310000 0004 0368 7223Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, China
| | - Wei Liu
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Huijuan Song
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Yi Huang
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Guoxing Tang
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Feng Wang
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
| | - Qi Wang
- Télécom Physique Strasbourg, Illkirch-Graffenstaden, France
| | - Yimin Cai
- grid.33199.310000 0004 0368 7223Department of Epidemiology and Biostatistics, Key Laboratory of Environmental Health of Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, China
| | - Ziyong Sun
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, 430030 China
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Galati L, Chiocca S, Duca D, Tagliabue M, Simoens C, Gheit T, Arbyn M, Tommasino M. HPV and head and neck cancers: Towards early diagnosis and prevention. Tumour Virus Res 2022; 14:200245. [PMID: 35973657 PMCID: PMC9420391 DOI: 10.1016/j.tvr.2022.200245] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide with an increasing trend of its incidence. Alcohol consumption, smoking, and viral infections, such as the mucosal high-risk (HR) human papillomaviruses (HPVs) are major risk factors for HNSCC development. In particular, HR HPVs are mainly associated with a subset of oropharyngeal squamous cell carcinoma (OPSCC), while other head and neck sites are marginally affected by HPV infection. HPV16 is the most frequently HR HPV type associated with HNSCC. In contrast to the cervix, no screening programs or identifiable pre-malignant lesions have been characterized for HPV-related HNSCC. Therefore, identification of general diagnostic algorithms and HPV biomarkers that could facilitate the early diagnosis, disease evolution and recurrence for HPV-driven HNSCCs are urgently needed. We herein review the role of HPV in HNSCC with a focus on epidemiology, biology, applied diagnostic algorithms and available biomarkers in body fluids as early diagnostic tools in HPV-driven HNSCCs.
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Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, F-69372, Lyon, France
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Daria Duca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Cindy Simoens
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium
| | - Tarik Gheit
- International Agency for Research on Cancer, F-69372, Lyon, France.
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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de Winter RW, Rahman MS, van Diemen PA, Schumacher SP, Jukema RA, Somsen YBO, van Rossum AC, Verouden NJ, Danad I, Delewi R, Nap A, Knaapen P. Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting. Curr Cardiol Rep 2022. [PMID: 35925511 DOI: 10.1007/s11886-022-01746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/04/2022]
Abstract
Purpose of Review This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population. Recent Findings Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Summary Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.
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Hagendorff A, Stöbe S, Kandels J, de Boer R, Tschöpe C. Diagnostic role of echocardiography for patients with heart failure symptoms and preserved left ventricular ejection fraction. Herz 2022. [PMID: 35499562 DOI: 10.1007/s00059-022-05118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
The syndrome heart failure with preserved ejection fraction (HFpEF) represents patients with different comorbidities and specific etiologies, but with a key and common alteration: an elevation in left ventricular (LV) filling pressure or pulmonary capillary wedge pressure (PCWP). Expert consensuses, society guidelines, and diagnostic scores have been stated to diagnose HFpEF syndrome based mainly on the determination of elevated LV filling pressure or PCWP by transthoracic echocardiography (TTE). Echocardiographic parameters such as early (E) and late diastolic mitral inflow velocity (mitral E/A ratio), septal and lateral mitral annular early diastolic velocity (E'), ratio of the early diastolic mitral inflow and annular velocity (E/E'-ratio), maximal left atrial volume index (LAVImax), and tricuspid regurgitation peak velocity (VTR) constitute the pivotal parameters for determining elevated LV filling pressure or PCWP in patients with suspected HFpEF symptoms. Notwithstanding this, taking into consideration the heterogeneity of patients with HFpEF symptoms, the term "HFpEF" should be considered as a syndrome rather than an entity since HFpEF results from different pathological entities that should and can be characterized by echocardiography and multimodality imaging. Comprehensive TTE might help diagnose specific diseases and etiologies by characterization of specific cardiac phenotypes.
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Milani P, Mazzola M, Cigada M, Massacesi A, Setaccioli M, Moschini S, Ciaccia S, Scotti F, Mantovani E, Soranna D, Zambon A, Bergamini F. Algorithm of the major and minor diagnostic criteria for active myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2022; 260:2847-2857. [PMID: 35435447 DOI: 10.1007/s00417-022-05599-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To propose an algorithm of the major and minor diagnostic criteria for macular myopic choroidal neovascularization (mCNV). METHODS This single-center, retrospective, cross-sectional study was based in Istituto Auxologico Italiano, Milan, Italy. Two authors evaluated the clinical and imaging parameters of eyes with high myopia (spherical equivalent of -6D or less) and suspected to have naïve, recurrent, or inactive mCNV. Recordings of the eyes that met the inclusion criteria were then independently evaluated by two other senior retinal specialists. Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), and OCT angiography were used for multimodal imaging. RESULTS One-hundred and twenty-two eyes (n = 107; 39 men, 68 women) were included in the study. The mean patient age was 66 years (range, 22-89 years). There were 83 and 39 eyes in the active mCNV and control groups, respectively. The best diagnostic algorithm had positive- and negative-predictive values of 89% and 85%, respectively, and was based on four criteria: leakage/staining on FA, retinal thickening, fuzzy area on SD-OCT, and recent metamorphopsia. When excluding FA-derived findings, retinal pigment epithelium (RPE) features played a diagnostic role in 33 eyes (27%). Twenty-seven eyes with active mCNV (32%) did not have the fuzzy area. Taken singularly, no clinical or imaging parameter had both sensitivity and specificity greater than 78%. Matching of 2 or 3 biomarkers did not yield a sensitivity or specificity greater than 79%. Sensitivities and specificities ≥ 90% were found in ten criteria combinations that included four to five biomarkers. The most frequent were metamorphopsia, fuzzy area, retinal thickening, and leakage. Less frequently, they included hemorrhage, staining, and RPE features such as elevation, flattening, and focal interruption. For all the parameters, the agreement between the investigators was good (Cohen k ≥ 0.66), being the lowest when detecting the ELM interruption within the lesion. CONCLUSIONS A combination of at least four clinical and biological markers yielded the highest positive- and negative-predictive values. More ("major") and less ("minor") frequent diagnostic criteria are proposed.
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Affiliation(s)
- Paolo Milani
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Marco Mazzola
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Mario Cigada
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Amedeo Massacesi
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Setaccioli
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefania Moschini
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Ciaccia
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabrizio Scotti
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elena Mantovani
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Davide Soranna
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonella Zambon
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Italy
| | - Fulvio Bergamini
- Ophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Abstract
Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.
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Affiliation(s)
- Thaer Khoury
- Pathology Department, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA.
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32
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Geitenbeek RTJ, Martin E, Graven LH, Broen MPG, Anten MHME, van der Pol JAJ, Verhoef C, Taal W. Diagnostic value of 18F-FDG PET-CT in detecting malignant peripheral nerve sheath tumors among adult and pediatric neurofibromatosis type 1 patients. J Neurooncol 2022; 156:559-567. [PMID: 35025020 PMCID: PMC8860956 DOI: 10.1007/s11060-021-03936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Purpose Detecting malignant peripheral nerve sheath tumors (MPNSTs) remains difficult. 18F-FDG PET-CT has been shown helpful, but ideal threshold values of semi-quantitative markers remain unclear, partially because of variation among scanners. Using EU-certified scanners diagnostic accuracy of ideal and commonly used 18F-FDG PET-CT thresholds were investigated and differences between adult and pediatric lesions were evaluated. Methods A retrospective cohort study was performed including patients from two hospitals with a clinical or radiological suspicion of MPNST between 2013 and 2019. Several markers were studied for ideal threshold values and differences among adults and children. A diagnostic algorithm was subsequently developed. Results Sixty patients were included (10 MPNSTs). Ideal threshold values were 5.8 for SUVmax (sensitivity 0.70, specificity 0.92), 5.0 for SUVpeak (sensitivity 0.70, specificity 0.97), 1.7 for TLmax (sensitivity 0.90, specificity 0.86), and 2.3 for TLmean (sensitivity 0.90, specificity 0.79). The standard TLmean threshold value of 2.0 yielded a sensitivity of 0.90 and specificity of 0.74, while the standard SUVmax threshold value of 3.5 yielded a sensitivity of 0.80 and specificity of 0.63. SUVmax and adjusted SUV for lean body mass (SUL) were lower in children, but tumor-to-liver ratios were similar in adult and pediatric lesions. Using TLmean > 2.0 or TLmean < 2.0 and SUVmax > 3.5, a sensitivity and specificity of 1.00 and 0.63 can be achieved. Conclusion 18F-FDG PET-CT offers adequate accuracy to detect MPNSTs. SUV values in pediatric MPNSTs may be lower, but tumor-to-liver ratios are not. By combining TLmean and SUVmax values, a 100% sensitivity can be achieved with acceptable specificity. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03936-y.
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Affiliation(s)
- Ritch T J Geitenbeek
- Department of Plastic and Reconstructive Surgery G04.126, University Medical Center Utrecht, PO Box 85060, 3508 AB, Utrecht, The Netherlands.,Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Enrico Martin
- Department of Plastic and Reconstructive Surgery G04.126, University Medical Center Utrecht, PO Box 85060, 3508 AB, Utrecht, The Netherlands. .,Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands.
| | - Laura H Graven
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Martijn P G Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Monique H M E Anten
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jochem A J van der Pol
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Walter Taal
- Department of Neurology, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
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Hoffmann JC, Trimborn CP, Hoffmann M, Schröder R, Förster S, Dirks K, Tannapfel A, Anthuber M, Hollerweger A. Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology. Int J Colorectal Dis 2021; 36:2347-2360. [PMID: 34143276 DOI: 10.1007/s00384-021-03940-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Acute appendicitis (AA) is amongst the most common causes of acute abdominal pain. In spite of progress based on risk stratifications, "negative" appendectomies are performed in up to 30% of patients whilst the appendix perforates in others. Preoperative classification of AA based on imaging is therefore recommended. The aim was to classify AA based on imaging (ultrasound/US, computed tomography/CT), surgical pathology, and/or histopathology in order to differentiate between complicated and uncomplicated AA. A new classification of acute appendicitis (CAA) shall be illustrated by typical US and CT images and be employed in a diagnostic and therapeutic algorithm. METHODS Medline, Embase, and the Cochrane Library were searched. Any study after 1970, which investigated clinical scores, pathology, US, CT, magnetic resonance imaging, and treatment of AA, was included. Typical images were taken from the author's image database. RESULTS Five main types of AA are defined, normal appendix (type 0), nonvisualised appendix (type X), uncomplicated AA (type 1), complicated AA without perforation (type 2), and complicated AA with perforation (type 3). The imaging modality is indicated by an additional letter, e.g., type p3b for free perforation on pathology. Standardised reporting of the appendix evaluation by US and CT is presented, as well as algorithms for AA management. Imaging features indicating imminent perforation, as well as likely recurrence, were both classified as complicated AA. CONCLUSION Imaging is mandatory in suspected AA. The CAA clearly separates uncomplicated from complicated forms of AA allowing nonoperative management in selected patients with uncomplicated forms of AA.
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Affiliation(s)
- Jörg C Hoffmann
- Medizinische Klinik I mit Schwerpunkt Gastroenterologie, Diabetologie, Rheumatologie und Onkologie, St. Marien- und St. Annastiftskrankenhaus, Salzburger Straße 15, D67067, Ludwigshafen, Germany.
| | - Claus-Peter Trimborn
- Medizinische Klinik I mit Schwerpunkt Gastroenterologie, Diabetologie, Rheumatologie und Onkologie, St. Marien- und St. Annastiftskrankenhaus, Salzburger Straße 15, D67067, Ludwigshafen, Germany
| | - Michael Hoffmann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Ralf Schröder
- Radiologische Klinik, St. Marien- und St. Annastiftskrankenhaus Ludwigshafen, Ludwigshafen, Germany
| | - Sarah Förster
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Klaus Dirks
- Gastroenterologie, Allgemeine Innere Medizin und Geriatrie, Rems-Murr-Kliniken Winnenden, Winnenden, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Matthias Anthuber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Alois Hollerweger
- Abteilung für Radiologie und Nuklearmedizin Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria
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Abstract
BACKGROUND Aseptic loosening is one of the most common reasons for revision in knee arthroplasty. Its pathogenesis is multifactorial, and early diagnosis is necessary to initiate appropriate therapy and to avoid serious complications, such as substantial bone loss or even periprosthetic fractures. OBJECTIVES This paper describes the current standard in the diagnosis of aseptic loosening in total knee arthroplasty. Sensitivity and specificity of the individual diagnostic procedures are presented, and other causes for differential diagnoses of painful total knee arthroplasty (TKA) are discussed. RESULTS In the case of suspected loosening in TKA, infection diagnostics should be performed to rule out periprosthetic infection, as this is crucial in terms of surgical strategy. The gold standard in diagnosing aseptic loosening is conventional radiography. Radiolucent lines at the cement-bone or metal-cement interface of more than 2 mm or increasing in translucency, migration of components, and cement fractures are obvious signs of loosening. Artifact-reduced computed tomography can bring additional information regarding periprosthetic osteolysis. A single bone scan is not reliable in diagnosing aseptic loosening, especially in the first 2 years after surgery. Single photon emission computed tomography (SPECT-CT) could be a useful extension in loosening diagnosis in the future. CONCLUSIONS The diagnosis of aseptic loosening poses a great challenge to the treating physician and requires a structured diagnostic algorithm. After exclusion of infection, conventional radiography is the basic examination, which should be supplemented by computed tomography and nuclear medicine examinations according to the clinical symptoms and the time course.
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Andersen CF, Bang C, Lauridsen KG, Frederiksen CA, Schmidt M, Jensen T, Hornung N, Løfgren B. External validation of a high-sensitive troponin I algorithm for rapid evaluation of acute myocardial infarction in a Danish cohort. Eur Heart J Acute Cardiovasc Care 2021; 10:1056-1064. [PMID: 34423355 DOI: 10.1093/ehjacc/zuab062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/19/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022]
Abstract
AIMS An accelerated diagnostic algorithm for ruling-in or ruling-out myocardial infarction (MI) after 1 hour (1 h) has recently been derived and internally validated for the Siemens ADVIA Centaur TNIH assay. We aimed to validate the diagnostic performance of the TNIH 0 h/1 h algorithm ad modum Boeddinghaus in a Danish cohort. METHODS AND RESULTS Patients with chest pain suggestive of MI were prospectively enrolled. High-sensitive troponin I (TNIH) was measured at admission (0 h) and after 30 minutes (30 m), 1 h, and 3 hours (3 h). We externally validated the TNIH 0 h/1 h algorithm ad modum Boeddinghaus in Danish patients. Moreover, we applied the algorithm using the second TNIH measurement at 30 m instead of 1 h. We enrolled 1003 patients: median (Q1-Q3) age 64 (52-74) years, 42% female, and 23% with previous MI. Myocardial infarction was the final diagnosis in 9% of patients. Median (Q1-Q3) times from admission to 30 m and 1 h blood draw were 35 min (30-37 min) and 67 min (62-75 min), respectively. Using the 0 h and 1 h results, 468 (47%) patients were assigned to rule-out, 104 (10%) to rule-in, and 431 (43%) to the observational zone. This resulted in a negative predictive value of 100% (95% confidence interval: 99.2-100%), sensitivity of 100% (95.9-100%), positive predictive value of 79.8 (70.8-87.0%), and specificity of 97.7% (96.5-98.6%). The diagnostic performance after 30 m was similar. CONCLUSIONS The TNIH 0 h/1 h algorithm ad modum Boeddinghaus performed excellently for rule-out of MI in a Danish cohort. The Boeddinghaus algorithm also performed excellently after only 30 m. TRIAL REGISTRATION NUMBER NCT03634384. TRIAL REGISTRY NAME AND URL Rapid Use of High-Sensitive Cardiac Troponin I for Ruling-in and Ruling-out Acute Myocardial Infarction (RACING-MI), https://clinicaltrials.gov/ct2/show/NCT03634384.
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Affiliation(s)
- Camilla Fuchs Andersen
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, J103, Aarhus N 8200, Denmark.,Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, Randers 8930, Denmark.,Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej, 1, Herlev, Hellerup 2730, Denmark
| | - Camilla Bang
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, J103, Aarhus N 8200, Denmark.,Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, Randers 8930, Denmark.,Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, J103, Aarhus N 8200, Denmark.,Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, Randers 8930, Denmark.,Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark
| | | | - Morten Schmidt
- Department of Cardiology, Regional Hospital West Jutland, Gl Landevej 61, Herning 7400, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Tage Jensen
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark
| | - Nete Hornung
- Department of Clinical Biochemistry, Regional Hospital West Jutland, Gl Landevej 61, Herning 7400, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, J103, Aarhus N 8200, Denmark.,Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, Aarhus N 8200, Denmark
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Gunasekera KS, Walters E, van der Zalm MM, Palmer M, Warren JL, Hesseling AC, Cohen T, Seddon JA. Development of a Treatment-decision Algorithm for Human Immunodeficiency Virus-uninfected Children Evaluated for Pulmonary Tuberculosis. Clin Infect Dis 2021; 73:e904-e912. [PMID: 33449999 PMCID: PMC8366829 DOI: 10.1093/cid/ciab018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limitations in the sensitivity and accessibility of diagnostic tools for childhood tuberculosis contribute to the substantial gap between estimated cases and cases notified to national tuberculosis programs. Thus, tools to make accurate and rapid clinical diagnoses are necessary to initiate antituberculosis treatment in more children. METHODS We analyzed data from a prospective cohort of children <13 years old being routinely evaluated for pulmonary tuberculosis in Cape Town, South Africa, from March 2012 to November 2017. We developed a regression model to describe the contributions of baseline clinical evaluation to the diagnosis of tuberculosis using standardized, retrospective case definitions. We included baseline chest radiographic and Xpert MTB/RIF assay results to the model to develop an algorithm with ≥90% sensitivity in predicting tuberculosis. RESULTS Data from 478 children being evaluated for pulmonary tuberculosis were analyzed (median age, 16.2 months; interquartile range, 9.8-30.9 months); 242 (50.6%) were retrospectively classified with tuberculosis, bacteriologically confirmed in 104 (43.0%). The area under the receiver operating characteristic curve for the final model was 0.87. Clinical evidence identified 71.4% of all tuberculosis cases in this cohort, and inclusion of baseline chest radiographic results increased the proportion to 89.3%. The algorithm was 90.1% sensitive and 52.1% specific, and maintained a sensitivity of >90% among children <2 years old or with low weight for age. CONCLUSIONS Clinical evidence alone was sufficient to make most clinical antituberculosis treatment decisions. The use of evidence-based algorithms may improve decentralized, rapid treatment initiation, reducing the global burden of childhood mortality.
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Affiliation(s)
- Kenneth S Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Elisabetta Walters
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Megan Palmer
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Anneke C Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - James A Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
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Andersen CF, Bang C, Lauridsen KG, Frederiksen CA, Schmidt M, Jensen T, Hornung N, Løfgren B. Single troponin measurement to rule-out acute myocardial infarction in early presenters. Int J Cardiol 2021; 341:15-21. [PMID: 34391791 DOI: 10.1016/j.ijcard.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND A single high-sensitive cardiac troponin (hs-cTn) can be used to rule-out acute myocardial infarction (MI) in patients presenting >3 hours (3 h) after chest pain onset to the emergency department. This study aimed to investigate the safety of ruling-out MI in early presenters with chest pain ≤3 h using a single hs-cTnI at admission. METHODS We prospectively enrolled patients presenting with chest pain suggestive of MI. Hs-cTnI (Siemens ADVIA Centaur TNIH, Limit of detection: 2.2 ng/L) was measured at admission. Two physicians adjudicated final diagnosis. A diagnostic cut-off value <3 ng/L was used to rule-out MI. Patients were classified as early (chest pain ≤3 h) or late presenters (>3 h). RESULTS We included 1370 patients with available admission hs-cTnI results: median (Q1-Q3) age 65 (52-74), female sex: 43%, previous MI: 22%. We confirmed MI in 118 (8.6%) patients. Overall, 470 (34%) patients were classified as early, 770 (56%) as late presenters, and 130 (9%) patients had unknown onset. When applying the diagnostic cut-off value, MI was correctly ruled-out at admission in 370 (27%) patients: 134 (29%) early presenters, 206 (27%) late presenters and 30 (23%) patients with unknown onset. This resulted in an overall negative predictive value of 100% (95% CI: 99.0-100%), with both 100% (97.3-100%) for early and 100% (98.2-100%) for late presenters, respectively. Sensitivity was similarly high in the two groups. CONCLUSION MI could be safely ruled-out in all patients presenting with chest pain ≤3 h when using a single hs-cTnI value <3 ng/L as diagnostic cut-off. TRIAL REGISTRATION NUMBER NCT03634384.
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Affiliation(s)
- Camilla Fuchs Andersen
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 161, Building J103, 8200 Aarhus N, Aarhus, Denmark; Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.
| | - Camilla Bang
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 161, Building J103, 8200 Aarhus N, Aarhus, Denmark; Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 161, Building J103, 8200 Aarhus N, Aarhus, Denmark; Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.
| | - Christian Alcaraz Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark.
| | - Morten Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
| | - Tage Jensen
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.
| | - Nete Hornung
- Department of Clinical Biochemistry, Regional Hospital West Jutland, Gl. Landevej 61, 7400 Herning, Denmark.
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 161, Building J103, 8200 Aarhus N, Aarhus, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Incuba, Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
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Ling TK, Wong KC, Chan CY, Lau NKC, Law CY, Lee HCH, Lai CK, Chong YK, Yau KCE, Cheung KM, Ko CH, Fung CW, Lee LK, Wong SSN, Mak CM, Chan AYW, Tam S, Lam CW. Urine organic acid as the first clue towards aromatic L-amino acid decarboxylase (AADC) deficiency in a high prevalence area. Clin Chim Acta 2021; 521:40-44. [PMID: 34161777 DOI: 10.1016/j.cca.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase deficiency is a rare neurometabolic disease due to impaired decarboxylation of neurotransmitter precursors to its active form. CASE We retrospectively reviewed 8 cases from 2008 to 2019 with cerebrospinal fluid neurotransmitter analysis performed at our centre. All cases had an elevated urine vanillactic acid and, in most cases, with N-acetylvanilalanine detected. Cerebrospinal fluid analysis showed low downstream metabolites vanillylmandelic acid, homovanillic acid but high 3-O-methyl-L-DOPA, 5-hydroxytryptophan. Cerebrospinal fluid pterins were normal. Genotyping in DDC confirms the diagnosis. Urine organic acid analysis provided the first clue to diagnosis in four of the cases, which then triggered cerebrospinal fluid neurotransmitter and genetic analysis. We also developed a diagnostic decision support system to assist the interpretation of the mass spectrometry data from urine organic acids. CONCLUSIONS Urine organic acid could be essential in guiding subsequent investigations for the diagnosis of aromatic L-amino acid decarboxylase deficiency. We propose to screen suspected cases first with urine organic acids, specifically looking for vanillactic acid and N-acetylvanilalanine. Suggestive findings should be followed with target analysis for c.714 + 4A > T in ethnically Chinese patients. The assistive tool allowed expedite interpretation of profile data generated from urine organic acids analysis. It may also reduce interpreter's bias when peaks of interest are minor peaks in the spectrum.
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Affiliation(s)
- Tsz-Ki Ling
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Ka-Chung Wong
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Candace Yim Chan
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | | | - Chun-Yiu Law
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | | | - Chi-Kong Lai
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Yeow-Kuan Chong
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Kin-Cheong Eric Yau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Ka-Ming Cheung
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, China
| | - Chun-Hung Ko
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, China
| | - Cheuk-Wing Fung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Lai-Ka Lee
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Sheila Suet-Na Wong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Chloe M Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Albert Yan-Wo Chan
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Sidney Tam
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Ching-Wan Lam
- Department of Pathology, Queen Mary Hospital, Hong Kong, China; Department of Pathology, The University of Hong Kong, Hong Kong, China.
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Kim IH, Kang BH, Seo SH, Park YE, Kim GJ, Lee SW, Jang JH, Jo SK, Jeon JH, Kim JM, Chung YS, Han MG, Jung SO, Kim J, Hwang KJ, Yoo CK, Rhie GE. Early Laboratory Preparedness of the Korea Disease Control and Prevention Agency and Response to Unknown Pneumonia Outbreak from Wuhan, China, in January 2020. Ann Lab Med 2021; 41:532-539. [PMID: 34108280 PMCID: PMC8203432 DOI: 10.3343/alm.2021.41.6.532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/28/2020] [Accepted: 05/21/2021] [Indexed: 12/17/2022] Open
Abstract
We report the response process of the Laboratory Analysis Task Force (LATF) for Unknown Disease Outbreaks (UDOs) at the Korea Disease Control and Prevention Agency (KDCA) during January 2020 to coronavirus disease 2019 (COVID-19), which developed as a UDO in Korea. The advanced preparedness offered by the laboratory diagnostic algorithm for UDOs related to respiratory syndromes was critical for the rapid identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enabled us to establish and expand the diagnostic capacity for COVID-19 on a national scale in a timely manner.
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Affiliation(s)
- Il-Hwan Kim
- Division of Emerging Infectious Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Byung-Hak Kang
- Division of Laboratory Diagnosis Analysis, Gyeongnam Regional Centers for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Busan, Korea
| | - Seung Hee Seo
- Division of Laboratory Diagnosis Management, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Ye Eun Park
- Division of Laboratory Diagnosis Management, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Gab Jung Kim
- Division of Laboratory Diagnosis Management, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sang Won Lee
- Director General for Public Health Emergency Preparedness, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jun Hyeong Jang
- Division of Emerging Infectious Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Su Kyoung Jo
- Division of Laboratory Diagnosis Management, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jun Ho Jeon
- Division of High-Risk Pathogens, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jeong-Min Kim
- Division of Emerging Infectious Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Yoon-Seok Chung
- Division of Laboratory Diagnosis Analysis, Honam Regional Centers for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Gwangju, Korea
| | - Myung-Guk Han
- Division of Viral Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sang-Oun Jung
- Division of Laboratory Diagnosis Analysis, Capital Regional Centers for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Seoul, Korea
| | - Junyoung Kim
- Division of Bacterial Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Kyu-Jam Hwang
- Division of Bacterial Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Cheon-Kwon Yoo
- Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Gi-Eun Rhie
- Division of High-Risk Pathogens, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
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Milovanovic T, Dragasevic S, Nikolic AN, Markovic AP, Lalosevic MS, Popovic DD, Krstic MN. Anemia as a Problem: GP Approach. Dig Dis 2021; 40:370-375. [PMID: 34098557 DOI: 10.1159/000517579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anemia is a presentation of an underlying disease or deficiency. As stated by the WHO, anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. This review of clinical practice aimed to determine the diagnostic approach to anemia in primary care patients. SUMMARY Nutritional deficiencies, medications, chronic inflammatory conditions, malignancy, renal dysfunction, and bone marrow and inherent disorders contribute to anemia development. Anemia is classified and diagnosed by the values of hematological parameters, underlying pathological mechanism, and patient history. The diagnostic approach of anemia in primary care settings is focused on history, physical examination, laboratory findings including complete blood cell count, reticulocyte count, and peripheral smear examination, fecal occult blood test, and ultrasound findings. KEY MESSAGES Anemia is the most common hematological disorder that represents a major health burden worldwide. Hb levels alter with gender, ethnicity, and physiological status. Anemia is often multifactorial. The evaluation of a patient with anemia in primary care includes clinical history, physical examination, and laboratory findings with fecal occult blood test and abdominal ultrasound. The wide variations in general practice in European countries are based on different health care systems but also knowledge of GPs that reflect educational and research policy.
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Affiliation(s)
- Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Dragasevic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra Pavlovic Markovic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Stojkovic Lalosevic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan D Popovic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miodrag N Krstic
- Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Gall H, Yogeswaran A, Fuge J, Sommer N, Grimminger F, Seeger W, Olsson KM, Hoeper MM, Richter MJ, Tello K, Ghofrani HA. Validity of echocardiographic tricuspid regurgitation gradient to screen for new definition of pulmonary hypertension. EClinicalMedicine 2021; 34:100822. [PMID: 33997731 PMCID: PMC8102717 DOI: 10.1016/j.eclinm.2021.100822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Currently an echocardiographic threshold for the tricuspid regurgitation gradient (TRG) of > 31 mmHg is recommended for screening for pulmonary hypertension (PH). Invasively diagnosed PH was recently redefined as mean pulmonary arterial pressure (mPAP) > 20 mmHg instead of ≥ 25 mmHg. We investigated the ability of TRG to screen for the new PH-definition. METHODS Retrospective assessment of echocardiography and right heart catheterisation data from 1572 patients entering the Giessen PH-Registry during 2008-2018. Accuracy of different TRG thresholds and other echocardiographic parameters was evaluated using receiver operating characteristic curves. FINDINGS 1264 patients fulfilled the new PH-definition. Positive (PPV) and negative predictive values and accuracy of TRG > 46 mmHg were 95%, 39%, and 73%, respectively, for the new PH-definition. Lowering the TRG cut-off to 31 mmHg and below worsened PPV to ≤ 89%. The PPV of TRG for pre-capillary PH (mPAP > 20 mmHg and pulmonary vascular resistance ≥ 3 Wood Units) was ≤ 85%. In patients with TRG ≤ 46 mmHg, tricuspid annular plane systolic excursion/TRG and TRG/right ventricular outflow tract acceleration time were superior to TRG in screening for newly defined pre-capillary PH. INTERPRETATION In patients with suspected PH referred to a tertiary care centre, the PPV of TRG to meet the new PH-definition depended strongly on the TRG cut-off used. Our data do not support lowering the TRG cut-off. Combining TRG with other echocardiographic parameters might improve the validity of echocardiographic screening for PH.
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Affiliation(s)
- Henning Gall
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Athiththan Yogeswaran
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Natascha Sommer
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Karen M. Olsson
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Centre for Lung Research (DZL/BREATH), Germany
| | - Manuel J. Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany
- Cardio-Pulmonary Institute (CPI), Giessen , Germany
- Department of Medicine, Imperial College London, United Kingdom
- Corresponding author at: Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC, Member of the German Centre for Lung Research (DZL), Klinikstrasse 32, 35392, Germany.
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Limardo A, Blanco L, Menendez J, García L, Ortega A. The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(20)30192-8. [PMID: 33810827 DOI: 10.1016/j.otorri.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Parapharyngeal space (PPS) is defined as a deep space, located around the upper pharynx, in the shape of an inverted pyramid. Primary tumours in this region are rare, accounting for 0.5% of head and neck neoplasms, and most are benign. The objective of this study is to propose a new study algorithm based on a systematic review and our experience. MATERIALS AND METHODS A cross-sectional and analytical study was carried out through review of the clinical records of our hospital. Patients with tumours of the parapharyngeal space operated from January 2010 to December 2019 and a systematic review of Pubmed studies from the last 5years were included. We considered clinical signs, diagnostic methods, presumptive diagnosis and histopathological findings. Statistical analysis was performed with STATA v.14 software. RESULTS 53 of our cases and 1392 from the review were included. The clinical algorithm showed a sensitivity of 76.4% and a specificity of 96.3%, with an AUC of 0.57 for diagnosis. DISCUSSION Complementary radiological examinations are essential in the topographic diagnosis of the tumour. Angio-MRI links the tissue of origin of the tumours and provides the highest diagnostic certainty. FNA has some disadvantages in PPS, but it is useful in some patients. CONCLUSION The proposed algorithm contributes to obtaining excellent results in the management of these tumours because it turned out to be effective in diagnosis, and this enables improved surgical planning.
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Affiliation(s)
- Andrés Limardo
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
| | - Luis Blanco
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - José Menendez
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | - Laura García
- Sección de Cirugía de Cabeza y Cuello, Hospital Regional Gobernador Ernesto M. Campos, Ushuaia, Tierra del Fuego, Argentina
| | - Adrián Ortega
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
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Giacometti C, Bellan E, Ambrosi A, Dei Tos AP, Cassaro M, Ludwig K. "While there is p57, there is hope." The past and the present of diagnosis in first trimester abortions: Diagnostic dilemmas and algorithmic approaches. A review. Placenta 2021; 116:31-37. [PMID: 33714612 DOI: 10.1016/j.placenta.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
Distinction of hydatidiform moles (HM) from non-molar (NM) specimens and subclassification of HM as complete hydatidiform mole (CHM) versus partial hydatidiform mole (PHM) are important for clinical practice and investigational studies. The issue of diagnostic reproducibility is still unsolved, the lack of diagnostic accuracy based on morphology is substantial with an important interobserver variability, even between experienced gynecologic pathologists. Many ancillary techniques have been investigated in the last years to refine HM diagnosis. p57 (a paternally imprinted, maternally expressed gene) immunohistochemistry, based on the unique genetics of CHM (purely androgenetic), PHM (diandric triploid), and NM specimens (biparental, with allelic balance) can identify CHMs, which lack p57 expression because of a lack of maternal DNA. However, although its role in HM diagnosis is pivotal, it does not allow the distinction of PHM from NM specimens, both of which express p57 due to the presence of maternal DNA. Molecular genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic CHM from diandric triploid PHM, and both of these from NM specimens. Beyond the claim of establishing a "diagnostic truth", exceptions and peculiar genetic scenarios in the origin of rare CHM and PHM should be kept in mind when approaching any ancillary technique. An algorithmic approach, even in settings with limited resources, can help the pathologists in the diagnostic dilemma of diagnosis of first trimester abortions.
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Affiliation(s)
- Cinzia Giacometti
- Department of Services, Pathology Unit, ULSS 6 "Euganea", Via P. Cosma, 1 - 35012 Camposampiero (Padua), Italy.
| | - Elena Bellan
- Department of Medicine, Pathology Unit, University of Padua, Via A. Gabelli, 61 - 35128, Padua, Italy.
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58- 20132, Milan, Italy.
| | - Angelo Paolo Dei Tos
- Department of Medicine, Pathology Unit, University of Padua, Via A. Gabelli, 61 - 35128, Padua, Italy.
| | - Mauro Cassaro
- Department of Services, Pathology Unit, ULSS 6 "Euganea", Via P. Cosma, 1 - 35012 Camposampiero (Padua), Italy.
| | - Kathrin Ludwig
- Department of Medicine - Pathology & Cytopathology Unit, Padua University Hospital, Via Giustiniani, 2 - 35121 Padua, Italy.
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López Mateos A, Sánchez Pujol MJ, Silvestre Salvador JF. Skin Biopsy in Chronic Urticaria: When and Where and What to Look for? Actas Dermosifiliogr (Engl Ed) 2020; 112:406-413. [PMID: 33259814 DOI: 10.1016/j.ad.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Chronic urticaria is a relatively common condition in dermatology and is usually diagnosed on clinical grounds. Skin biopsy, however, may be indicated in certain cases to confirm diagnosis and rule out other conditions that can cause hive-like rashes. We review histopathologic findings seen in both chronic urticaria and other entities in the differential diagnosis. We then propose an algorithm of indications for skin biopsy in patients with hive-like rashes and suggest possible diagnoses based on the histopathologic findings.
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Affiliation(s)
- A López Mateos
- Servicio de Dermatología del Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - M J Sánchez Pujol
- Servicio de Dermatología del Hospital General de Alicante, Alicante, España
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Lombard C, Gillet R, Rauch A, Germain E, Dodin G, Blum A, Teixeira PG. Hallux sesamoid complex imaging: a practical diagnostic approach. Skeletal Radiol 2020; 49:1889-1901. [PMID: 32583133 DOI: 10.1007/s00256-020-03507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/02/2023]
Abstract
A wide variety of pathologies can affect the hallux sesamoid complex of the foot, including traumatic, micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic conditions. Symptoms are quite nonspecific, mainly related to pain in the plantar surface of the first metatarsal head. In this context, imaging is important for the etiologic diagnosis of hallux sesamoid complex pathology with implications in patient management. The hallux sesamoid complex has a complex anatomy, and pathologic processes of this region are poorly known of radiologists. Besides, some entities such as "sesamoiditis" remain poorly defined in the literature. Schematically, conditions affecting sesamoids will be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones). Thus, in this article, after a review of anatomical key points and pathologies affecting the hallux sesamoid complex, a practical multimodality approach for the diagnosis of hallux sesamoid pathologies will be proposed.
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Affiliation(s)
- Charles Lombard
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France.
| | - Romain Gillet
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Aymeric Rauch
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Edouard Germain
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Gauthier Dodin
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
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Malkomes P, Edmaier F, Liese J, Reinisch-Liese A, El Youzouri H, Schreckenbach T, Bucher AM, Bechstein WO, Schnitzbauer AA. DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis. Langenbecks Arch Surg 2020; 406:141-152. [PMID: 33210209 PMCID: PMC7870637 DOI: 10.1007/s00423-020-02022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Abstract
Purpose The management of patients with suspected appendicitis remains a challenge in daily clinical practice, and the optimal management algorithm is still being debated. Negative appendectomy rates (NAR) continue to range between 10 and 15%. This prospective study evaluated the accuracy of a diagnostic pathway in acute appendicitis using clinical risk stratification (Alvarado score), routine ultrasonography, gynecology consult for females, and selected CT after clinical reassessment. Methods Patients presenting with suspected appendicitis between November 2015 and September 2017 from age 18 years and above were included. Decision-making followed a clear management pathway. Patients were followed up for 6 months after discharge. The hypothesis was that the algorithm can reduce the NAR to a value of under 10%. Results A total of 183 patients were included. In 65 of 69 appendectomies, acute appendicitis was confirmed by histopathology, corresponding to a NAR of 5.8%. Notably, all 4 NAR appendectomies had other pathologies of the appendix. The perforation rate was 24.6%. Only 36 patients (19.7%) received a CT scan. The follow-up rate after 30 days achieved 69%, including no patients with missed appendicitis. The sensitivity and specificity of the diagnostic pathway was 100% and 96.6%, respectively. The potential saving in costs can be as much as 19.8 million €/100,000 cases presenting with the suspicion of appendicitis. Conclusion The risk-stratified diagnostic algorithm yields a high diagnostic accuracy for patients with suspicion of appendicitis. Its implementation can safely reduce the NAR, simultaneously minimizing the use of CT scans and optimizing healthcare-related costs in the treatment of acute appendicitis. Trial registration ClinicalTrials.gov Identifier: NCT02627781 (December 2015)
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Affiliation(s)
- Patrizia Malkomes
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Franziska Edmaier
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Juliane Liese
- Department of General, Abdominal, Thoracic and Transplant Surgery, University Hospital of Giessen, Giessen, Germany
| | | | - Hanan El Youzouri
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Teresa Schreckenbach
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas M Bucher
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Wolf Otto Bechstein
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas A Schnitzbauer
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Salam MA, Huda MM, Khan MGM, Shomik MS, Mondal D. Evidence-based diagnostic algorithm for visceral leishmaniasis in Bangladesh. Parasitol Int 2020; 80:102230. [PMID: 33147502 DOI: 10.1016/j.parint.2020.102230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
Evidence-based diagnostic algorithm is highly recommended for the visceral leishmaniasis (VL). This cross-sectional study was performed in Bangladesh to evaluate VL diagnostic tools including serology, buffy coat smear microscopy for LD body and various DNA-based techniques using buffy coat in 100 confirmed VL cases and 100 controls. The performance of tools against spleen smear (gold standard) was evaluated using kappa coefficient. Diagnostic precision and other inherent indicators were considered for index scoring (IS) of performance of tools using factor analysis. A diagnostic algorithm was formulated based on the IS and availability of the tools at different health care facilities of Bangladesh. A high level of agreement (kappa ≥ 0.80) was observed for all the diagnostic tools. The highest kappa coefficients were found for rK39 RDT and rK39 ELISA (0.95), followed by ssuRNA-PCR (0.94), Buffy coat smear (0.93), rK28 ELISA (0.92), rK28 RDT (0.89), LAMP (0.89), Mini-exon PCR (0.86), ITS1 (0.85), and ITS2 PCR (0.80). rK39 RDT was found to be the best diagnostic test (IS: 1.7) followed by rK28 RDT (IS: 1.5), buffy coat smear microscopy (IS: 0.5), rK39 & rK28 ELISA (IS: 0.3), ssuRNA-PCR (IS: -0.7) and LAMP, Mini-exon, ITS1, & ITS2 PCR (IS: -0.9). rK39 RDT has been proposed as the best option for primary health care facilities, while buffy coat smear microscopy was found to be a good adjunct for confirmation of serology-positive cases and proposed for secondary and tertiary facilities. ssuRNA-PCR or LAMP can be an alternate confirmation tool only applicable to the tertiary facilities.
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Affiliation(s)
- Md Abdus Salam
- Department of Microbiology, Rajshahi Medical College, Rajshahi 6000, Bangladesh.
| | - M Mamun Huda
- Associate Scientist, Nutrition and Infection, Nutrition and Clinical Services Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Md Gulam Musawwir Khan
- Doctoral Student (3rd cycle), Immunology Division, Department of Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, University of Sherbrooke, QC, Canada.
| | - Mohammad Sohel Shomik
- Deputy Project Coordinator, Nutrition and Clinical Services Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Dinesh Mondal
- Senior Scientist, Nutrition and Clinical Services Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
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Yadav S, Barapatre R, Sharma R, Neral A, Barde P. Proposed Algorithm for Hepatitis E Virus Diagnosis in the Early Phase of Illness. Intervirology 2020; 63:66-70. [PMID: 33022685 DOI: 10.1159/000510725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Hepatitis E virus (HEV), a major etiologic agent of enterically transmitted hepatitis worldwide, is known to cause outbreaks. Diagnosis of the causative agent is important for patient management, understanding epidemiology and outbreak mitigation. We attempted to develop an algorithm for molecular diagnosis and compared the diagnostic accuracy of 2 of HEV IgM ELISA tests during an outbreak. Eighty-four blood samples collected during an outbreak in central India were referred to a nodal laboratory for confirmation of diagnosis. The samples were tested by serological and molecular testes. The results were analyzed by statistical tests. Both the IgM ELISAs were equally competent to diagnose HEV infection when samples were collected after 7.95 ± 3.2 days of onset of illness, whereas nRT-PCR proved a better test when samples were collected between 0 and 6.17 ± 1.97 days of illness. During HEV outbreaks, it is not possible to test all suspected cases by both serological and molecular tests; we suggest testing all ELISA-negative and samples collected in early phase (<7 days) of illness by molecular tests to rule out false-negative results. More studies with large sample size will aid in designing national guidelines for molecular diagnosis of HEV.
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Affiliation(s)
- Sulekha Yadav
- ICMR-National Institute of Research in Tribal Health (NIRTH), Garha, India
| | - Rekha Barapatre
- Deptartment of Microbiology, Pandit Jawaharlal Nehru Memorial Medical College Raipur, Raipur, India
| | - Ravendra Sharma
- ICMR-National Institute of Research in Tribal Health (NIRTH), Garha, India
| | - Arvind Neral
- Deptartment of Microbiology, Pandit Jawaharlal Nehru Memorial Medical College Raipur, Raipur, India
| | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health (NIRTH), Garha, India,
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Yuan KC, Tsai LW, Lee KH, Cheng YW, Hsu SC, Lo YS, Chen RJ. The development an artificial intelligence algorithm for early sepsis diagnosis in the intensive care unit. Int J Med Inform 2020. [PMID: 32485555 DOI: 10.1016/j.ijmednf.2020.104176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Severe sepsis and septic shock are still the leading causes of death in Intensive Care Units (ICUs), and timely diagnosis is crucial for treatment outcomes. The progression of electronic medical records (EMR) offers the possibility of storing a large quantity of clinical data that can facilitate the development of artificial intelligence (AI) in medicine. However, several difficulties, such as poor structure and heterogenicity of the raw EMR data, are encountered when introducing AI with ICU data. Labor-intensive work, including manual data entry, personal medical records sorting, and laboratory results interpretation may hinder the progress of AI. In this article, we introduce the developing of an AI algorithm designed for sepsis diagnosis using pre-selected features; and compare the performance of the AI algorithm with SOFA score based diagnostic method. MATERIALS AND METHODS This is a prospective open-label cohort study. A specialized EMR, named TED_ICU, was implemented for continuous data recording. One hundred six clinical features relevant to sepsis diagnosis were selected prospectively. A labeling work to allocate SEPSIS or NON_SEPSIS status for each ICU patient was performed by the in-charge intensivist according to SEPSIS-3 criteria, along with the automatic recording of selected features every day by TED_ICU. Afterward, we use de-identified data to develop the AI algorithm. Several machine learning methods were evaluated using 5-fold cross-validation, and XGBoost, a decision-tree based algorithm was adopted for our AI algorithm development due to best performance. RESULTS The study was conducted between August 2018 and December 2018 for the first stage of analysis. We collected 1588 instances, including 444 SEPSIS and 1144 NON-SEPSIS, from 434 patients. The 434 patients included 259 (59.6%) male patients and 175 female patients. The mean age was 67.6-year-old, and the mean APACHE II score was 13.8. The SEPSIS cohort had a higher SOFA score and increased use of organ support treatment. The AI algorithm was developed with a shuffle method using 80% of the instances for training and 20% for testing. The established AI algorithm achieved the following: accuracy = 82% ± 1%; sensitivity = 65% ± 5%; specificity = 88% ± 2%; precision = 67% ± 3%; and F1 = 0.66 ± 0.02. The area under the receiver operating characteristic curve (AUROC) was approximately 0.89. The SOFA score was used on the same 1588 instances for sepsis diagnosis, and the result was inferior to our AI algorithm (AUROC = 0.596). CONCLUSION Using real-time data, collected by EMR, from the ICU daily practice, our AI algorithm established with pre-selected features and XGBoost can provide a timely diagnosis of sepsis with an accuracy greater than 80%. AI algorithm also outperforms the SOFA score in sepsis diagnosis and exhibits practicality as clinicians can deploy appropriate treatment earlier. The early and precise response of this AI algorithm will result in cost reduction, outcome improvement, and benefit for healthcare systems, medical staff, and patients as well.
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Affiliation(s)
- Kuo-Ching Yuan
- Department of Emergency and Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Lung-Wen Tsai
- Department of Medicine Education, Taipei Medical University Hospital, Taipei, Taiwan
| | | | | | | | - Yu-Sheng Lo
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Doucette RS, Dibble E, Arora NS, Somand DM, Kronick S, Kerr E, Flanders S, Barnes GD. Emergency Department Clinician Perceptions of Implementing High-Sensitivity Troponin T Assay in an Academic Hospital Emergency Department. Am J Med 2020; 133:e483-94. [PMID: 32165187 DOI: 10.1016/j.amjmed.2020.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE A newly approved, high-sensitivity troponin T (hsTnT) assay may offer opportunities to more rapidly assess for acute coronary syndrome and identify lower thresholds of myocardial injury. As more emergency departments begin to use the hsTnT assay, anticipating barriers to hsTnT implementation success are critical to realizing potential benefits in rapid, accurate patient assessment. METHODS At a tertiary health system emergency department, hsTnT was implemented along with a diagnostic algorithm and a decision tree to aid in utilization. Qualitative interviews with 18 physicians and advance practice providers were conducted 2 months' postimplementation and again 4 to 6 months postimplementation to capture clinician perceptions to hsTnT implementation efforts. Deductive coding was performed using implementation science determinants frameworks to identify emerging themes related to this topic. RESULTS Four themes emerged from the interviews: 1) the need for additional clinician education, 2) challenges with care handoffs, 3) lack of buy-in from the hospital community, and 4) key successes. CONCLUSION Interviews demonstrated that implementation of hsTnT was associated with several implementation barriers from the perspective of emergency department clinicians. Future implementation efforts should focus on diverse and sustained staff educational efforts, models that address challenges with care handoffs between emergency department clinicians and inpatient clinicians, and operational teams that include inpatient clinicians to facilitate buy-in.
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