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Fukuzawa F, Yanagita Y, Yokokawa D, Uchida S, Yamashita S, Li Y, Shikino K, Tsukamoto T, Noda K, Uehara T, Ikusaka M. Importance of Patient History in Artificial Intelligence-Assisted Medical Diagnosis: Comparison Study. JMIR Med Educ 2024; 10:e52674. [PMID: 38602313 PMCID: PMC11024399 DOI: 10.2196/52674] [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: 09/12/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024]
Abstract
Background Medical history contributes approximately 80% to a diagnosis, although physical examinations and laboratory investigations increase a physician's confidence in the medical diagnosis. The concept of artificial intelligence (AI) was first proposed more than 70 years ago. Recently, its role in various fields of medicine has grown remarkably. However, no studies have evaluated the importance of patient history in AI-assisted medical diagnosis. Objective This study explored the contribution of patient history to AI-assisted medical diagnoses and assessed the accuracy of ChatGPT in reaching a clinical diagnosis based on the medical history provided. Methods Using clinical vignettes of 30 cases identified in The BMJ, we evaluated the accuracy of diagnoses generated by ChatGPT. We compared the diagnoses made by ChatGPT based solely on medical history with the correct diagnoses. We also compared the diagnoses made by ChatGPT after incorporating additional physical examination findings and laboratory data alongside history with the correct diagnoses. Results ChatGPT accurately diagnosed 76.6% (23/30) of the cases with only the medical history, consistent with previous research targeting physicians. We also found that this rate was 93.3% (28/30) when additional information was included. Conclusions Although adding additional information improves diagnostic accuracy, patient history remains a significant factor in AI-assisted medical diagnosis. Thus, when using AI in medical diagnosis, it is crucial to include pertinent and correct patient histories for an accurate diagnosis. Our findings emphasize the continued significance of patient history in clinical diagnoses in this age and highlight the need for its integration into AI-assisted medical diagnosis systems.
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Affiliation(s)
- Fumitoshi Fukuzawa
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Yasutaka Yanagita
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Shun Uchida
- Uchida Internal Medicine Clinic, Saitama-shi, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Yu Li
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Tomoko Tsukamoto
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
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Alyami MB, Hakeem MN, Fadil AI, Jee BA, ElAbbasy HM, Ankawi G. Frequency of Repeating Antinuclear Antibody Testing: When Less Is More. Cureus 2024; 16:e52347. [PMID: 38361688 PMCID: PMC10867545 DOI: 10.7759/cureus.52347] [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] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives Antinuclear antibodies (ANA) are autoantibodies that are associated with and ordered to diagnose autoimmune connective tissue disease. ANA have high sensitivity (~98%) but low specificity (~75%), and because they can be found in healthy individuals and non-rheumatologic conditions leading to their elevation, ANA tests are often requested and interpreted inappropriately by clinicians. The aim of this study was to retrospectively assess how frequently ANA testing is repeated in the adult population of Saudi Arabia (SA) and which factors are associated with and lead to inappropriate testing. Methodology We investigated a study group of 40,634 adult patients who underwent 229,825 ANA tests from 2018 to 2022 in an academic hospital in Jeddah, SA. We took a random sample of 500 patients from the study group, along with their 998 ANA tests, to look in depth into our research questions. Variables related to patients, ANA tests, and ordering physicians were collected. Descriptive and analytical statistics were employed to address the research questions, and a p-value < 0.05 was considered statistically significant. Results We found 57% of the ordered ANA tests to have positive results, with the most common titers of mild positivity being 1:80 and 1:160. Most repeated ANA tests were ordered with an interval of more than one year, and when repeated, 67% of test results remained unchanged. The majority of seroconversions resulted from negative ANA tests or those with weak (titer 1:40) or mild positivity (titer 1:80-1:160). The results of the moderate (titer 1:320-1:640) and strong (titer ≥1280) positivity ANA tests did not change. Only 11% of repeated ANA tests were found to be appropriate for repetition. The most common specialties associated with ordering ANA tests in general were internal medicine, followed by rheumatology, and finally family medicine. Our correlation analysis revealed that being female, having systemic connective tissue disease, and having a rheumatologist as a specialist were all associated with ordering more than 10 ANA tests (p < 0.05). Conclusion Because the results of repeated ANA tests did not change much, our study suggests that the cost of repeating ANA tests and the subsequent potentially unnecessary interventions should all be carefully examined before scheduling a repeated ANA test. Further studies involving patients from SA and across wider healthcare settings (academic, community, and private hospitals and healthcare centers) are warranted.
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Affiliation(s)
- Mahadi B Alyami
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed N Hakeem
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdulaziz I Fadil
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Bassim A Jee
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Hamza M ElAbbasy
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ghada Ankawi
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Guo RY, Wang WY, Huang JY, Jia Z, Sun YF, Li B. Deciphering prognostic indicators in AQP4-IgG-seropositive neuromyelitis optica spectrum disorder: An integrative review of demographic and laboratory factors. Mult Scler 2024; 30:7-15. [PMID: 37982449 DOI: 10.1177/13524585231212832] [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] [Indexed: 11/21/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a group of inflammatory diseases affecting the central nervous system, characterized by optic neuritis and myelitis. The complex nature of NMOSD and varied patient response necessitates personalized treatment and efficient patient stratification strategies. OBJECTIVE To provide a comprehensive review of recent advances in clinical and biomarker research related to aquaporin-4 (AQP4)-immunoglobulin G (IgG)-seropositive NMOSD prognosis and identify key areas for future research. METHODS A comprehensive review and synthesis of recent literature were conducted, focusing on demographic factors and laboratory investigations. RESULTS Demographic factors, such as age, ethnicity, and sex, influence NMOSD prognosis. Key biomarkers for NMOSD prognosis include homocysteine, antinuclear antibodies, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, thyroid hormone levels, neurofilament light chain levels, and serum glial fibrillary acidic protein might also predict NMOSD attack prognosis. CONCLUSION Further investigation is required to understand sex-related disparities and biomarker inconsistencies. Identification and understanding of these factors can aid in the development of personalized therapeutic strategies, thereby improving outcomes for NMOSD patients. Future studies should focus on unifying research design for consistent results.
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Affiliation(s)
- Ruo-Yi Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Wen-Ya Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Jing-Ying Huang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Ya-Fei Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
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Badr MY, Elkholy AA, Shoeib SM, Bahey MG, Mohamed EA, Reda AM. Assessment of incidence of cerebral vascular diseases and prediction of stroke risk in chronic obstructive pulmonary disease patients using multimodal biomarkers. Clin Respir J 2023; 17:211-228. [PMID: 36696969 PMCID: PMC9978912 DOI: 10.1111/crj.13587] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Early assessment of cerebrovascular disease in chronic obstructive pulmonary disease (COPD) patients is an important issue for a favorable influence on the quality of life. METHODOLOGY This cross-sectional case-control study was conducted on 38 eligible COPD patients (mean age 55.5 ± 11.5, 25 males, and 13 females) and 26 age-/sex-matched healthy controls. All participants were subjected to stroke risk screening instruments that included the Stroke Riskometer™, the Framingham 10-Year Risk Score, the stroke risk screening tool (the Department of Disease Control of Thailand), the My Risk Stroke Calculator, and Q Stroke. Radiologically, diffusion tensor imaging (DTI) and echo-gradient MRI (T2 star) T2 star imaging were done. Color-coded duplex sonography was done. Laboratory investigations included C-reactive protein (CRP), serum amyloid A, plasma fibrinogen level, serum IL6, 8-Isoprostane, vWF and urinary albumin creatinine ratio. RESULTS Stroke risk screening instruments revealed a significant increase in COPD patients. DTI showed a significant bilateral reduction in fractional isotropy and a significant bilateral increase in mean diffusivity of white matter through many areas in COPD patients. Patients also had a significant increase of intima-media thickness, presence of atherosclerotic focal thicknesses or plaques on duplex sonography. There was a significant elevation of CRP, serum amyloid A, plasma fibrinogen level, serum IL6, 8-isoprostane, von Willebrand factor (vWF), and urinary albumin creatinine ratio in COPD patients. CONCLUSION COPD patients had an increased risk for stroke that could be assessed on stroke risk screening instruments, DTI, T2 star, duplex sonography, and laboratory investigation and could be correlated with the severity of the disease.
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Affiliation(s)
- Marwa Y Badr
- Neurology unit, Neuropsychiatry Department, Faculty of Medicine, Tanta University, Egypt
| | - Amira A Elkholy
- Pulmonology Department, Faculty of Medicine, Tanta University, Egypt
| | - Sara M Shoeib
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Egypt
| | - Marwa G Bahey
- Medical Microbiology and immunology Department, Faculty of Medicine, Tanta University, Egypt
| | - Esraa A Mohamed
- Medical Microbiology and immunology Department, Faculty of Medicine, Tanta University, Egypt
| | - Alaa M Reda
- Diagnostic Radiology Department, Faculty of Medicine, Tanta University, Egypt
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Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID-19) poses several challenges to clinicians. Timely diagnosis and hospitalization, risk stratification, effective utilization of intensive care services, selection of appropriate therapies, monitoring and timely discharge are essential to save the maximum number of lives. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact these components of patient care. COVID-19 is not a localized respiratory infection but a multisystem disease caused by a diffuse systemic process involving a complex interplay of the immunological, inflammatory and coagulative cascades. The understanding of what the virus does to the body and how the body reacts to it has uncovered a gamut of potential biomarkers. This review discusses the different classes of biomarkers - immunological, inflammatory, coagulation, hematological, cardiac, biochemical and miscellaneous - in terms of their pathophysiological basis followed by the current evidence. Differences between children and adults are highlighted. The role of biomarkers in the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C) is reviewed. The correlation of biomarkers with clinical and radiological features and the viral load, temporal evolution and the effect of treatment remain to be studied in detail. Which biomarker needs to be evaluated when and in whom, and how best this information can contribute to patient care are questions which currently lack convincing answers. With the evidence currently available broad guidelines on the rational use of available biomarkers are presented. Integrating clinical and laboratory data, monitoring trends rather than a single value, correlating with the natural course of the disease and tailoring guidelines to the individual patient and healthcare setting are essential.
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Bauer P, Lienhart W, Jost S. Accuracy Investigation of the Pose Determination of a VR System. Sensors (Basel) 2021; 21:s21051622. [PMID: 33669148 PMCID: PMC7956487 DOI: 10.3390/s21051622] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
The usage of VR gear in mixed reality applications demands a high position and orientation accuracy of all devices to achieve a satisfying user experience. This paper investigates the system behaviour of the VR system HTC Vive Pro at a testing facility that is designed for the calibration of highly accurate positioning instruments like geodetic total stations, tilt sensors, geodetic gyroscopes or industrial laser scanners. Although the experiments show a high reproducibility of the position readings within a few millimetres, the VR system has systematic effects with magnitudes of several centimetres. A tilt of about 0.4° of the reference plane with respect to the horizontal plane was detected. Moreover, our results demonstrate that the tracking algorithm faces problems when several lighthouses are used.
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Liu X, Lv J, Gan L, Zhang Y, Sun F, Meng B, Jheon A, Yan F, Li B, Xuan Z, Ma X, Wulasihana M. Comparative analysis of clinical characteristics, imaging and laboratory findings of different age groups with COVID-19. Indian J Med Microbiol 2020; 38:87-93. [PMID: 32719214 PMCID: PMC7706422 DOI: 10.4103/ijmm.ijmm_20_133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022]
Abstract
Objective This study aims to provide scientific basis for rapid screening and early diagnosis of the coronavirus disease 2019 (COVID-19) through analysing the clinical characteristics and early imaging/laboratory findings of the inpatients. Methods Three hundred and three patients with laboratory-confirmed COVID-19 from the East Hospital of People's Hospital of Wuhan University (Wuhan, China) were selected and divided into four groups: youth (20-40 years, n = 64), middle-aged (41-60 years, n = 89), older (61-80 years, n = 118) and elderly (81-100 years, n = 32). The clinical characteristics and imaging/laboratory findings including chest computed tomography (CT), initial blood count, C-reactive protein [CRP]), procalcitonin (PCT) and serum total IgE were captured and analysed. Results (1) The first symptoms of all age groups were primarily fever (76%), followed by cough (12%) and dyspnoea (5%). Beside fever, the most common initial symptom of elderly patients was fatigue (13%). (2) Fever was the most common clinical manifestation (80%), with moderate fever being the most common (40%), followed by low fever in patients above 40 years old and high fever in those under 40 years (35%). Cough was the second most common clinical manifestation and was most common (80%) in the middle-aged. Diarrhoea was more common in the middle-aged (21%) and the older (19%). Muscle ache was more common in the middle-aged (15%). Chest pain was more common in the youth (13%), and 13% of the youth had no symptoms. (3) The proportion of patients with comorbidities increased with age. (4) Seventy-one per cent of the patients had positive reverse transcription-polymerase chain reaction results and 29% had positive chest CT scans before admission to the hospital. (5) Lesions in all lobes of the lung were observed as the main chest CT findings (76%). (6) Decrease in lymphocytes and increase in monocytes were common in the patients over 40 years old but rare in the youth. Eosinophils (50%), red blood cells (39%) and haemoglobin (40%) decreased in all age groups. (7) The proportion of patients with CRP and PCT elevation increased with age. (8) Thirty-nine per cent of the patients had elevated IgE, with the highest proportion in the old (49%). Conclusion The clinical characteristics and imaging/laboratory findings of COVID-19 patients vary in different age groups. Personalised criteria should be formulated according to different age groups in the early screening and diagnosis stage.
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Affiliation(s)
- Xuemei Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jie Lv
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lin Gan
- Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Ying Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Feng Sun
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bo Meng
- School of Dental Medicine, University of California San Francisco, San Francisco, USA
| | - Andrew Jheon
- School of Dental Medicine, University of California San Francisco, San Francisco, USA
| | - Fang Yan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bin Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhou Xuan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Muhuyati Wulasihana
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Abstract
OBJECTIVE The aim of this in vitro study was to investigate the transfer of viable Pseudomonas aeruginosa biofilm microorganisms following treatment with debridement tools. METHOD The level of viable biofilm microorganisms transferred by debridement tools was compared following treatment that reflected the clinical practice of each product. RESULTS A significant level of microorganism transfer was seen in response to the mechanical debridement tool. Minimal transfer of microorganisms was seen when in vitro-established biofilms were treated with hydroresponsive wound dressing + polyhexamethylene biguanide (HRWD+PHMB, HydroClean plus). Less Pseudomonas aeruginosa was recovered from explants exposed to dressings compared with those exposed to debridement tools suggesting that there was less transfer of bacteria by dressings. CONCLUSION The reduced transfer of viable microorganisms by HRWD+PHMB may be the result of significant binding and retention of microbes by the superabsorbent polymer within the dressing, together with enhanced sequestered bacterial killing within the dressing by polymer-bound PHMB. The high levels of microbial transfer/transmission seen for debridement tools suggests that, in the clinical setting, a significant level of bacterial spread over the wound surface and/or surrounding skin by these cleansing tools is likely.
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Affiliation(s)
- Mark G Rippon
- Visiting Clinical Research Fellow; Huddersfield University, Queensgate, Huddersfield
| | - Alan A Rogers
- Medical Communications Consultant; Flintshire, North Wales
| | - Laura Sellars
- Senior Microbiologist; Perfectus Biomed Limited, Daresbury Laboratories, SciTech Daresbury, Cheshire
| | - Liam E J Purcell
- Microbiologist; Perfectus Biomed Limited, Daresbury Laboratories, SciTech Daresbury, Cheshire
| | - Samantha Westgate
- Perfectus Biomed Limited, Daresbury Laboratories, SciTech Daresbury, Cheshire
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Morton A, Teasdale S. Review article: Investigations and the pregnant woman in the emergency department - part 1: Laboratory investigations. Emerg Med Australas 2018; 30:600-609. [PMID: 29656593 DOI: 10.1111/1742-6723.12957] [Citation(s) in RCA: 2] [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: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
Accurate assessment of the pregnant patient in the ED depends on knowledge of physiological changes in pregnancy, and how these changes may impact on pathology tests, appearance on point-of-care ultrasound and electrocardiography. In addition the emergency physician needs to be cognisant of disorders that are unique to or more common in pregnancy. Part 1 of this review addresses potential deviations in laboratory investigation reference intervals resulting from physiological alterations in pregnancy, and the important causes of abnormal laboratory results in pregnancy. Part 2 will address the role of point-of-care ultrasound in pregnancy, physiological changes that may affect interpretation of point-of-care ultrasound, physiological changes in electrocardiography, and the safety of radiological procedures in the pregnant patient.
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Affiliation(s)
- Adam Morton
- Mater Health and The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie Teasdale
- Mater Health and The University of Queensland, Brisbane, Queensland, Australia
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10
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Abstract
The issue of overprescribing laboratory investigations is an old one in the world of medical practice and it has unfortunately seen a tremendous increase with the digitalisation of medicine, in more recent times. Phrased usually as 'defensive medicine,' this kind of overmedicalisation steers medical practice away from the ethical, skill-refining fronts on the part of doctors and imposes an unnecessary financial burden on the patients' pockets, adding to their suffering. Pakistan has not been able to save itself either, from the impropriety that roots out of what is now almost a norm in medical practice. The existent low literacy and awareness rates in the masses of the country, coupled with the cultural respect for doctors and lack of financial resources amongst the poor patients to stand up to doctors or the hospitals, have all made it even easier for physicians to get away with ordering whatever investigations they choose. The issue is a grave one and its rampancy demands that attention is drawn to it and efforts are made to transition into the practice of evidence-based medicine and quaternary prevention.
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Affiliation(s)
- Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Muqadus Tabraze
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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Adegbiji WA, Olajide GT, Olatoke F, Ogundipe OK, Alabi SB. The Role of Preoperative Evaluations in Otorhinolaryngological Procedures. Niger Med J 2018; 59:59-63. [PMID: 31423043 PMCID: PMC6668303 DOI: 10.4103/nmj.nmj_183_17] [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] [Indexed: 11/29/2022] Open
Abstract
Background: Routine laboratory investigations are important in preoperative preparation of otorhinolaryngological, head and neck patients to assess and to prevent operative risks. This study aimed at determining the American Society of Anesthesiologist (ASA) classification of the preoperative patients, causes of delayed surgery, associated comorbidity and abnormal laboratory investigation results in ear, nose, and throat surgical practice in a low-resource setting. Materials and Methods: This is a prospective hospital-based study of patients being worked up for elective surgical procedures in Ekiti State University Teaching Hospital, Nigeria, from January 2014 to December 2016. Patients that gave consent were enrolled into the study. Interviewer-assisted questionnaires were used to obtained data from the patients. Data obtained were collated and statistically analyzed by using SPSS version 16. Results: A total of 424 patients were enrolled into the study. Males constituted 61.8% and male to female ratio was 2:1. Majority, i.e. 69.8% of the patients belonged to the ASA Grade I. Preoperative findings leading to delayed surgery occurred in 17.9% of the patients. They were due to 2.4% arterial hypertension and 6.4% delayed routine laboratory investigations results. The overall comorbid illness was 21.2%. Major comorbid illnesses were 2.4% arterial hypertension and 6.8% diabetes mellitus. The types of surgery in the patients were 14.6% ear surgery, 12.3% nasal surgery, and 59.2% throat surgery. Delayed surgery occurred in 25.5% of the patients. The most common findings were 6.8% anemia, 6.3% abnormal prothrombin/international normalized ratio, and 5.7% blood electrolyte and urea. Conclusion: All surgical conditions are peculiar with different comorbid illnesses which can lead to untoward outcome. Adequate preoperative evaluation and preoperative laboratory investigation of ear, nose, and throat conditions are mandatory to detect subclinical illnesses in poor-resource setting.
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Affiliation(s)
- Waheed Atilade Adegbiji
- Department of Ear, Nose and Throat Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Gabriel Toye Olajide
- Department of Ear, Nose and Throat, Federal Teaching Hospital, Ido Ekiti/Afe Babalola University College of Medicine and Health Sciences, Ado Ekiti, Nigeria
| | - Fatai Olatoke
- Department of Surgery, ENT Unit, Federal Medical Center, Lokoja, Nigeria
| | | | - Sulyman Biodun Alabi
- Department of Ear, Nose and Throat, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Boltshauser E, Weber KP. Laboratory investigations. Handb Clin Neurol 2018; 154:287-298. [PMID: 29903445 DOI: 10.1016/b978-0-444-63956-1.00017-5] [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] [Indexed: 06/08/2023]
Abstract
This chapter deals with chemical and hematologic investigations which are often considered in the diagnostic workup of subacute to chronic cerebellar ataxias. Relevant investigations in blood (serum, plasma), urine, and cerebrospinal fluid are discussed. Particular attention is paid to early diagnosis of treatable metabolic ataxias (such as abetalipoproteinemia, coenzyme Q10 deficiency, cerebrotendinous xanthomatosis, glucose transporter type 1 deficiency, Refsum disease, and vitamin E deficiency), but autoimmune ataxias, other vitamin deficiencies, and endocrine disorders should also be kept in mind. Adequate interpretation of test results has to consider age-specific reference values. The selection of investigations should mainly be driven by the overall clinical context, considering gender, history, age, and mode of presentation, cerebellar and other neurologic as well as extraneurologic findings.
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Affiliation(s)
- Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Zurich, Switzerland; Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Konrad P Weber
- Department of Pediatric Neurology, University Children's Hospital, University of Zurich, Zurich, Switzerland; Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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13
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Abstract
OBJECTIVE The study aimed to investigate the efficacy of our therapeutic options on toxic epidermal necrolysis (TEN) patients. METHODS After giving informed consent, patients affected by TEN were included in the study between January 2001 and December 2013. Suspected causative drugs, onset to hospitalization, complications, management, outcome, laboratory investigations of blood tests and therapeutic options were recorded and analyzed. SCORTEN scoring system was used to evaluate the complications and the survival rate. Therapeutic interventions included immediate withdrawal of any potentially fatal drug, nursing care, supportive therapy, high-dose corticosteroids, antibiotics, plasma therapy, intravenous immunoglobulins (IVIG) and traditional Chinese medicine (TCM). Blood tests were taken as a result of clinical outcome. RESULTS Total 21 consecutive patients (10 males and 11 females, mean age 33 years) were included in the study. Cefalexin, paracetamol, quick cold capsules, compound aminopyrine phenacetin tablets, carbamazepine, propylthiouracil, sulfonamide, ampicillin, and phenylbutazone were suspected to be the causative agents. All patients received high-dose dexamethasone or methylprednisolone therapy. Eighteen patients received the administration of antibiotics. Twelve patients received plasma infusions, and 11 patients were given albumin. Only 2 patients applied IVIG. Additionally, 3 and 14 cases were intravenously injected with QKL and Xiyanping, respectively. The average score of SCORTEN was 2.52 and the average percentage of total body surface area was 68.8%. The mortality rate in our study was 19%. CONCLUSION The therapeutic options in our study, including nursing care, corticosteroid, anti-inflammatory and TCM are effective for the treatment of TEN.
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Affiliation(s)
- Feng Zhang
- a Department of Dermatology , The First Affiliated Hospital of Harbin Medical University , Harbin , PR China and
| | - Jin Zhou
- b Department of Hematology , The First Affiliated Hospital of Harbin Medical University , Harbin , PR China
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14
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Abstract
Purpose To identify any patterns in the cause of anterior uveitis in a Turkish population and compare them with results from previous studies. Methods The clinical records of 75 patients between January 2009 and January 2010 were retrospectively analyzed and classified as anterior uveitis according to Standardization of Uveitis Nomenclature criteria. Complete blood count, sedimentation rate, chest radiography, purified protein derivative skin test, and venereal disease research laboratory test were done on all patients. Additional serologic and radiographic tests were performed when indicated. Results Forty-one (54.6%) were male and 34 (45.3%) were female patients. The mean age at presentation was 39.1 ± 12.6 years. Fifty-six (74.6%) had unilateral and 19 (25.3%) had bilateral disease at presentation. A specific diagnosis was able to be established in 54 (72%) patients. The most common diagnoses were anterior uveitis associated with human leukocyte antigen B27 (14.6%) and Fuchs uveitis syndrome (14.6%). The second most common diagnosis was uveitis associated with herpes simplex virus (13.3%), followed by Behcet’s uveitis (6.6%). Systemic disease associations were noted in 15 (20%) patients, and the most commonly associated systemic disease was Behcet’s disease (6.6%). Conclusion Fuchs uveitis syndrome and anterior uveitis associated with human leukocyte antigen B27 were the most common form of anterior uveitis in this study. Using a systematic approach, a diagnosis was able to be established in 72% of the anterior uveitis cases.
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Affiliation(s)
- Esra Guney
- Ophthalmology Clinic, Umraniye Research and Training Hospital, Istanbul, Turkey
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15
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Abstract
Chiropractors and Osteopaths are routinely involved in the assessment and treatment of patients with back pain. An overview of pertinent laboratory studies is presented to facilitate a better understanding of the use and value of these procedures toward improved patient management and enhanced communication with other health care professionals, in particular medical practitioners, as some patients may benefit from a combined management approach.
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