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Clinics in Liver Disease May 2016Nonalcoholic fatty liver disease (NAFLD) is a diagnosis of exclusion. Most patients are asymptomatic and diagnosed incidentally. Most patients remain undiagnosed. A high... (Review)
Review
Nonalcoholic fatty liver disease (NAFLD) is a diagnosis of exclusion. Most patients are asymptomatic and diagnosed incidentally. Most patients remain undiagnosed. A high index of suspicion and serologic work-up to rule out alternative causes of liver disease is required. In NALFD, fibrosis correlates with outcomes, including mortality. To diagnose, assess severity, and monitor fibrosis, 2 noninvasive methods can be used. However, noninvasive tests are more helpful at extremes of fibrosis: excluding it or diagnosing advanced fibrosis. Liver biopsy is usually reserved for cases whereby noninvasive tests fail to accurately determine the degree of fibrosis or the diagnosis is unclear.
Topics: Biopsy; Breath Tests; Diagnosis, Differential; Elasticity Imaging Techniques; Humans; Liver; Liver Cirrhosis; Non-alcoholic Fatty Liver Disease
PubMed: 27063269
DOI: 10.1016/j.cld.2015.10.006 -
Drug Metabolism and Disposition: the... Apr 2022Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD) and is diagnosed by a liver biopsy. Because of the invasiveness... (Review)
Review
Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD) and is diagnosed by a liver biopsy. Because of the invasiveness of a biopsy, the majority of patients with NASH are undiagnosed. Additionally, the prevalence of NAFLD and NASH creates the need for a simple screening method to differentiate patients with NAFLD versus NASH. Noninvasive strategies for diagnosing NAFLD versus NASH have been developed, typically relying on imaging techniques and endogenous biomarker panels. However, each technique has limitations, and none can accurately predict the associated functional impairment of drug metabolism and disposition. The function of several drug-metabolizing enzymes and drug transporters has been described in NASH that impacts drug pharmacokinetics. The aim of this review is to give an overview of the existing noninvasive strategies to diagnose NASH and to propose a novel strategy based on altered pharmacokinetics using an exogenous biomarker whose disposition and elimination pathways are directly impacted by disease progression. Altered disposition of safe and relatively inert exogenous compounds may provide the sensitivity and specificity needed to differentiate patients with NAFLD and NASH to facilitate a direct indication of hepatic impairment on drug metabolism and prevent subsequent adverse drug reactions. SIGNIFICANCE STATEMENT: This review provides an overview of the main noninvasive techniques (imaging and panels of biomarkers) used to diagnose NAFLD and NASH along with a biopsy. Pharmacokinetic changes have been identified in NASH, and this review proposes a new approach to predict NASH and the related risk of adverse drug reactions based on the assessment of drug elimination disruption using exogenous biomarkers.
Topics: Biomarkers; Biopsy; Drug-Related Side Effects and Adverse Reactions; Humans; Liver; Non-alcoholic Fatty Liver Disease
PubMed: 34531312
DOI: 10.1124/dmd.121.000413 -
Statistical Methods in Medical Research Aug 2022A cancer diagnosis is part of a complex stochastic process, which involves patient's characteristics, diagnosing methods, an initial assessment of cancer progression,...
A cancer diagnosis is part of a complex stochastic process, which involves patient's characteristics, diagnosing methods, an initial assessment of cancer progression, treatments and a certain outcome of interest. To evaluate the performance of diagnoses, one needs not only a consistent estimation of the causal effect under a specified regime of diagnoses and treatments but also reliable confidence interval, -value and hypothesis testing of the causal effect. In this article, we identify causal effects under various regimes of diagnoses and treatments by the point effects of diagnoses and treatments and thus are able to estimate and test these causal effects by estimating and testing point effects in the familiar framework of single-point causal inference. Specifically, using data from a Swedish prognosis study of stomach cancer, we estimate and test the causal effects on cancer survival under various regimes of diagnosing and treating hospitals including the optimal regime. We also estimate and test the modification of the causal effect by age. With its simple setting, one can readily extend the example to a large variety of settings in the area of cancer diagnosis: different personal characteristics such as family history, different diagnosing procedures such as multistage screening, and different cancer outcomes such as cancer progression.
Topics: Causality; Early Detection of Cancer; Humans; Neoplasms; Prognosis; Research Design; Treatment Outcome
PubMed: 35509212
DOI: 10.1177/09622802221098429 -
Spectrochimica Acta. Part A, Molecular... Aug 2019Cancer is the second-leading cause of death worldwide. It affects an unfathomable number of people, with almost 16 million Americans currently living with it. While many... (Review)
Review
Cancer is the second-leading cause of death worldwide. It affects an unfathomable number of people, with almost 16 million Americans currently living with it. While many cancers can be detected, current diagnostic efforts exhibit definite room for improvement. It is imperative that a person be diagnosed with cancer as early on in its progression as possible. An earlier diagnosis allows for the best treatment and intervention options available to be presented. Unfortunately, existing methods for diagnosing cancer can be expensive, invasive, inconclusive or inaccurate, and are not always made during initial stages of the disease. As such, there is a crucial unmet need to develop a singular universal method that is reliable, cost-effective, and non-invasive and can diagnose all forms of cancer early-on. Raman spectroscopy in combination with advanced statistical analysis is offered here as a potential solution for this need. This review covers recently published research in which Raman spectroscopy was used for the purpose of diagnosing cancer. The benefits and the risks of the methodology are presented; however, there is overwhelming evidence that suggests Raman spectroscopy is highly suitable for becoming the first universal method to be used for diagnosing cancer.
Topics: Animals; Early Detection of Cancer; Equipment Design; Humans; Models, Statistical; Neoplasms; Spectrum Analysis, Raman
PubMed: 31075613
DOI: 10.1016/j.saa.2019.04.067 -
Clinical Radiology Jul 2021Vasculitis, a systemic disease characterised by inflammation of the blood vessels, remains challenging to diagnose and manage. Vessel size has been the basis for... (Review)
Review
Vasculitis, a systemic disease characterised by inflammation of the blood vessels, remains challenging to diagnose and manage. Vessel size has been the basis for classifying systemic vasculitides. Imaging plays a vital role in diagnosing this challenging disease. This review article aims (a) to summarise up-to-date literature in this field, as well as include classification updates and (b) to review available imaging techniques, recent advances, and emphasis on imaging findings to diagnose large vessel vasculitides.
Topics: Contrast Media; Diagnosis, Differential; Humans; Systemic Vasculitis
PubMed: 33812649
DOI: 10.1016/j.crad.2021.03.002 -
Emergency Radiology Oct 2015The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect... (Review)
Review
The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect patient acute morbidity and long-term outcomes. Similarly, management based on erroneous diagnoses may lead to unnecessary treatment and restrictions. Body-part- or joint-specific supplemental radiographic views and stress radiography offer an alternative for further evaluation of subtle injuries in specific clinical situations and may obviate the need for the added cost and potential ionizing radiation exposure of further cross-sectional imaging. Familiarity with these complementary exams allows radiologists to play an important role in patient care, as their utilization can improve diagnostic accuracy, clarify subtle or uncertain findings, and direct timely patient management. This review highlights important supplemental views and stress radiographic examinations useful in the evaluation of emergent lower extremity musculoskeletal trauma.
Topics: Diagnosis, Differential; Humans; Leg Injuries; Radiography
PubMed: 25855083
DOI: 10.1007/s10140-015-1315-8 -
Emergency Radiology Oct 2015The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect... (Review)
Review
The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect patient acute morbidity and long-term outcomes. Similarly, management based on erroneous diagnoses may lead to unnecessary treatment and restrictions. Body part or joint specific supplemental radiographic views and stress radiography offer an alternative for further evaluation of subtle injuries in specific clinical situations and may obviate the need for the added cost and potential ionizing radiation exposure of further cross-sectional imaging. Familiarity with these complementary exams allows radiologists to play an important role in patient care, as their utilization can improve diagnostic accuracy, clarify subtle or uncertain findings, and direct timely patient management. This review highlights important supplemental views and stress radiographic examinations useful in the evaluation of emergent upper extremity musculoskeletal trauma.
Topics: Arm Injuries; Diagnosis, Differential; Humans; Radiography
PubMed: 25850394
DOI: 10.1007/s10140-015-1316-7 -
Journal of Psychosomatic Research Sep 2016Functional somatic symptoms (FSS) are bodily complaints of unclear etiology, which are (currently) not fully explained by well-recognized somatic pathology. Doctors are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Functional somatic symptoms (FSS) are bodily complaints of unclear etiology, which are (currently) not fully explained by well-recognized somatic pathology. Doctors are often hesitant to diagnose FSS, due to the risk to miss a somatic disease. The purpose of this study is to review available literature on the percentage of patients diagnosed with FSS reported to have an underlying somatic disease that explains their symptoms previously labeled as FSS.
METHODS
We performed a systematic search of Medline, Embase and PsycINFO databases and reference lists of selected articles. We included studies published between January 1980 and July 2014 without language restrictions. Studies that measured the percentage of underlying somatic diseases after a diagnostic evaluation or naturalistic follow-up period in adult patients initially diagnosed with FSS were included. As primary outcome measure the weighted percentage of revised diagnoses was calculated using meta-analyses.
RESULTS
Six diagnostic evaluation studies (total N=1804 patients) and 16 follow-up studies (total N=2440 patients) were included. The percentage of revised diagnosis in patients initially diagnosed with FSS was 8.8% (95% CI 1.0 to 22.2, p=0.007) in diagnostic evaluation studies and 0.5% (95% CI 0.01 to 1.5, p=0.03) in follow-up studies. Partially or possibly related diagnoses were rarely found. No specific somatic diagnosis seemed to be missed systematically.
CONCLUSIONS
The percentage of underlying somatic diseases in patients previously diagnosed with FSS is relatively small but unneglectable.
Topics: Diagnostic Errors; Humans; Medically Unexplained Symptoms; Somatoform Disorders
PubMed: 27455914
DOI: 10.1016/j.jpsychores.2016.07.001 -
Clinical Physiology and Functional... May 2017The risk and speed of progression from fibrosis to compensated and decompensated cirrhosis define the prognosis in liver diseases. Therefore, early detection and... (Review)
Review
The risk and speed of progression from fibrosis to compensated and decompensated cirrhosis define the prognosis in liver diseases. Therefore, early detection and preventive strategies affect outcomes. Patients with liver disease have traditionally been diagnosed at an advanced stage of disease, in part due to lack of non-invasive markers. Ultrasound elastography to measure liver stiffness can potentially change this paradigm. The purpose of this review was therefore to summarize advances in the field of ultrasound elastography with focus on diagnosis of liver fibrosis, cirrhosis and clinically significant portal hypertension, techniques and limitations. Four types of ultrasound elastography exist, but there is scarce evidence comparing the different techniques. The majority of experience concern transient elastography for diagnosing fibrosis and cirrhosis in patients with chronic viral hepatitis C. That said, the role of elastography in other aetiologies such as alcoholic- and non-alcoholic liver fibrosis still needs clarification. Although elastography can be used to diagnose liver fibrosis and cirrhosis, its true potential lies in the possibility of multiple, repeated measurements that allow for treatment surveillance, continuous risk stratification and monitoring of complications. As such, elastography may be a powerful tool for personalized medicine. While elastography is an exciting technique, the nature of ultrasound imaging limits its applicability, due to the risk of failures and unreliable results. Key factors that limit the applicability of liver stiffness measurements are as follows: liver vein congestion, cholestasis, a recent meal, inflammation, obesity, observer experience and ascites. The coming years will show whether elastography will be widely adapted in general care.
Topics: Disease Progression; Early Diagnosis; Elasticity Imaging Techniques; Humans; Hypertension, Portal; Liver Cirrhosis; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 26459184
DOI: 10.1111/cpf.12297 -
BMC Gastroenterology Oct 2021The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study...
BACKGROUND
The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complication.
METHODS
We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination, no ELISA stool antigen or PCR tests were used.
RESULTS
16 patients were diagnosed with amebic colitis by the colonoscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis (100%), and the caecum and rectum were also involved in many lesions (68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients (100%).The endoscopic findings included multiple irregular shaped ulcers and erosions with surrounding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients (54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients (45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1/HPF to > 50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases (62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case (16.7%). Cryptitis was observed in 12 cases (75%) and its severity was mild or moderate. No crypts abscess was observed in all cases.
CONCLUSIONS
The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the exudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.
Topics: Colonoscopy; Diagnosis, Differential; Dysentery, Amebic; Humans; Inflammatory Bowel Diseases; Retrospective Studies
PubMed: 34627159
DOI: 10.1186/s12876-021-01941-z