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International Journal of... Jan 2024The most common organ affected due to tuberculosis (TB) is the lungs. Extrapulmonary TB is less common. Musculoskeletal organs are affected in around 8% of all...
BACKGROUND
The most common organ affected due to tuberculosis (TB) is the lungs. Extrapulmonary TB is less common. Musculoskeletal organs are affected in around 8% of all tubercular patients, of which the spine is affected in almost half of the patients. The criteria for diagnosing spinal TB are quite difficult and we use an array of investigations for the same.
METHODS
A retrospective study was carried out in the Neurosurgery and Microbiology Department at IMS and SUM Hospital between January 2021 and November 2023, and data were collected and tabulated in an Excel sheet. One hundred patients with spinal TB were evaluated, and their age, sex, samples sent, diagnostic investigation, duration of diagnosis from hospital admission, histopathology results, and surgical intervention (done or not) were recorded.
RESULTS
The best investigation done to diagnose spinal TB was imaging and surgical/computed tomography (CT)-guided biopsy. The earliest result to diagnose spinal TB was histopathology. The yield of positivity in pus culture, smear microscopy, and true nucleic acid amplification test (NAAT) was found to be low even though sensitivity was on the higher side.
CONCLUSION
Even though we have an array of investigations for diagnosing spinal TB, the best and the earliest diagnosing test was imaging plus CT-guided biopsy. The confirmation is made in the biopsy. Finding acid-fast bacteria (AFB) and NAAT tests are additional beneficial tests to supplement the diagnosis. Hence, we can conclude that sending for tests like AFB in pus, NAAT, and GeneXpert is a wastage of biological samples and delays in diagnosis.
Topics: Humans; Tuberculosis, Spinal; Retrospective Studies; Male; Female; Adult; Middle Aged; Mycobacterium tuberculosis; Young Adult; Aged; Tomography, X-Ray Computed; Adolescent; Biopsy; Nucleic Acid Amplification Techniques; Sensitivity and Specificity
PubMed: 38771286
DOI: 10.4103/ijmy.ijmy_14_24 -
World Journal of Emergency Surgery :... Dec 2023To assess the efficacy of artificial intelligence (AI) models in diagnosing and prognosticating acute appendicitis (AA) in adult patients compared to traditional... (Review)
Review
BACKGROUND
To assess the efficacy of artificial intelligence (AI) models in diagnosing and prognosticating acute appendicitis (AA) in adult patients compared to traditional methods. AA is a common cause of emergency department visits and abdominal surgeries. It is typically diagnosed through clinical assessments, laboratory tests, and imaging studies. However, traditional diagnostic methods can be time-consuming and inaccurate. Machine learning models have shown promise in improving diagnostic accuracy and predicting outcomes.
MAIN BODY
A systematic review following the PRISMA guidelines was conducted, searching PubMed, Embase, Scopus, and Web of Science databases. Studies were evaluated for risk of bias using the Prediction Model Risk of Bias Assessment Tool. Data points extracted included model type, input features, validation strategies, and key performance metrics.
RESULTS
In total, 29 studies were analyzed, out of which 21 focused on diagnosis, seven on prognosis, and one on both. Artificial neural networks (ANNs) were the most commonly employed algorithm for diagnosis. Both ANN and logistic regression were also widely used for categorizing types of AA. ANNs showed high performance in most cases, with accuracy rates often exceeding 80% and AUC values peaking at 0.985. The models also demonstrated promising results in predicting postoperative outcomes such as sepsis risk and ICU admission. Risk of bias was identified in a majority of studies, with selection bias and lack of internal validation being the most common issues.
CONCLUSION
AI algorithms demonstrate significant promise in diagnosing and prognosticating AA, often surpassing traditional methods and clinical scores such as the Alvarado scoring system in terms of speed and accuracy.
Topics: Adult; Humans; Artificial Intelligence; Appendicitis; Prognosis; Algorithms; Machine Learning; Acute Disease
PubMed: 38114983
DOI: 10.1186/s13017-023-00527-2 -
ESC Heart Failure Aug 2023The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction... (Meta-Analysis)
Meta-Analysis Review
The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction (HFpEF) and to pose clues in the field of scientific and clinical practice. Electronic databases of PubMed, Web of Science, Cochrane Library, and Embase were systematically searched. Studies investigating the use of the HFA-PEFF score to diagnose HFpEF were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative Likelihood Ratio (NLR), diagnostic odds ratio (DOR), area under the curve of summary receiver operating characteristic, and superiority index were calculated. Five studies with 1521 participants were included in this meta-analysis. In the pooled analysis of the 'Rule-out' approach, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.98 (0.94, 1.00), 0.33 (0.08, 0.73), 1.5 (0.8, 2.5), 0.05 (0.02, 0.17), and 28 (6, 127). In the pooled analysis of the 'Rule-in' approach, the pooled sensitivity and specificity, PLR, NLR, and DOR were 0.69 (0.62, 0.75), 0.87 (0.64, 0.96), 5.5 (1.8, 16.9), 0.35 (0.30, 0.41), and 16 (5, 50). This meta-analysis indicates that the HFA-PEFF algorithm showed acceptable specificity and sensitivity for the diagnosis and exclusion of HFpEF. More relevant studies on the diagnostic validity of the HFA-PEFF score are needed in the future.
Topics: Humans; Heart Failure; Stroke Volume; Sensitivity and Specificity; ROC Curve; Algorithms
PubMed: 37292053
DOI: 10.1002/ehf2.14421 -
The Journal of Allergy and Clinical... May 2024When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that...
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
Topics: Humans; Diagnosis, Differential; Female; Male; Drug Hypersensitivity; Middle Aged; Lymphohistiocytosis, Hemophagocytic; Adult; Aged; Diagnostic Errors; Drug Hypersensitivity Syndrome
PubMed: 38325764
DOI: 10.1016/j.jaip.2024.01.047 -
Clinical & Experimental Optometry Mar 2024The use of optical coherence tomography angiography (OCTA) holds significant promise for optometrists in the diagnosis and management of glaucoma. It offers reliable... (Review)
Review
The use of optical coherence tomography angiography (OCTA) holds significant promise for optometrists in the diagnosis and management of glaucoma. It offers reliable differentiation of glaucomatous eyes from healthy ones and extends monitoring capabilities for advanced cases. OCTA represents a valuable addition to traditional assessment methods, particularly in complex cases. Glaucoma, a major cause of irreversible blindness, is traditionally diagnosed using structural and functional metrics. With growing interest, OCTA is being explored to diagnose, monitor, and manage glaucoma. This review focuses on the application of OCTA in glaucoma patients. A database search was carried out using Embase Elsevier ( = 664), PubMed ( = 574), and Cochrane Central Register of Controlled Trials ( = 19) on 15 August 2023. After deduplication and screening, 272 original papers were included in the narrative review. Inclusion criteria comprised English-language original studies on OCTA use in human glaucoma patients, with or without healthy controls. Exclusion criteria encompassed animal studies, in-vivo/in-vitro research, reviews, and congress abstracts. OCTA has good repeatability and reproducibility. OCTA metrics have good discriminatory power to differentiate glaucomatous eyes from healthy eyes and show strong associations with structural changes and visual field defects. OCTA can extend the monitoring of advanced glaucoma, addressing the 'floor effect' of traditional structural measurements. OCTA metrics can be affected by the choice of OCTA machine, post-image processing algorithms, systemic diseases, and ocular factors. Image artefacts can affect the accuracy of OCTA measurements, and proper scan quality evaluation is crucial to ensure reliable results. Additionally, artificial intelligence techniques offer promise for enhancing the diagnostic accuracy of OCTA by combining data from various retinal layers and regions. OCTA complements traditional methods in assessing glaucoma, especially in challenging cases, providing valuable insights for detection and management. Further research and clinical validation are needed to integrate OCTA into routine practice.
Topics: Humans; Optic Disk; Fluorescein Angiography; Tomography, Optical Coherence; Artificial Intelligence; Reproducibility of Results; Retinal Vessels; Retinal Ganglion Cells; Glaucoma
PubMed: 38266148
DOI: 10.1080/08164622.2024.2306963 -
European Journal of Neurology Dec 2023Despite the 2017 revisions to the McDonald criteria, diagnosing primary progressive multiple sclerosis (PPMS) remains challenging. To improve clinical practice, the aim...
BACKGROUND AND PURPOSE
Despite the 2017 revisions to the McDonald criteria, diagnosing primary progressive multiple sclerosis (PPMS) remains challenging. To improve clinical practice, the aim was to identify frequent diagnostic challenges in a real-world setting and associate these with the performance of the 2010 and 2017 PPMS diagnostic McDonald criteria.
METHODS
Clinical, radiological and laboratory characteristics at the time of diagnosis were retrospectively recorded from designated PPMS patient files. Possible complicating factors were recorded such as confounding comorbidity, signs indicative of alternative diagnoses, possible earlier relapses and/or incomplete diagnostic work-up (no cerebrospinal fluid examination and/or magnetic resonance imaging brain and spinal cord). The percentages of patients fulfilling the 2010 and 2017 McDonald criteria were calculated after censoring patients with these complicating factors.
RESULTS
A total of 322 designated PPMS patients were included. Of all participants, it was found that n = 28/322 had confounding comorbidity and/or signs indicative of alternative diagnoses, n = 103/294 had possible initial relapsing and/or uncertainly progressive phenotypes and n = 73/191 received an incomplete diagnostic work-up. When applying the 2010 and 2017 diagnostic PPMS McDonald criteria on n = 118 cases with a full diagnostic work-up and a primary progressive disease course without a better alternative explanation, these were met by 104/118 (88.1%) and 98/118 remaining patients (83.1%), respectively (p = 0.15).
CONCLUSION
Accurate interpretation of the initial clinical course, consideration of alternative diagnoses and a full diagnostic work-up are the cornerstones of a PPMS diagnosis. When these conditions are met, the 2010 and 2017 McDonald criteria for PPMS perform similarly, emphasizing the importance of their appropriate application in clinical practice.
Topics: Humans; Multiple Sclerosis; Multiple Sclerosis, Chronic Progressive; Retrospective Studies; Spinal Cord; Magnetic Resonance Imaging
PubMed: 37578087
DOI: 10.1111/ene.16042 -
Revista Alergia Mexico (Tecamachalco,... Dec 2023The most effective method for diagnosing food allergy is the clinical history, which includes anamnesis and physical examination. The anamnesis must include a directed...
The most effective method for diagnosing food allergy is the clinical history, which includes anamnesis and physical examination. The anamnesis must include a directed and detailed questioning, and together with the physical examination, it will provide the necessary data to guide the diagnosis and suggest whether the pathophysiology is mediated or not by IgE, which is relevant for the selection and interpretation of the tests. specific and establish the accurate diagnosis, in addition to evaluating the possibility of distinguishing between the different differential diagnoses. It is important to assess the clinical history, because no in vivo or in vitro test is relevant if it is not confirmed with it. Even if there is a strong history of food allergy detected in the history, positive tests can confirm the diagnosis without the need for oral challenge, thus avoiding the risk and cost of performing it. The expression of food allergy is influenced by non-modifiable risk factors that include sex, race and genetics (familial), and modifiable factors: atopic dermatitis, vitamin D deficiency, diet high in polyunsaturated fats and deficient in antioxidants, consumption of antacid drugs, obesity, increased hygiene, influence of the microbiota, time and route of food exposure (increased risk by delaying oral ingestion of allergens and concomitant environmental exposure of the same that leads to sensitization and allergy).
Topics: Humans; Antioxidants; Dermatitis, Atopic; Diagnosis, Differential; Environmental Exposure; Food Hypersensitivity
PubMed: 38506863
DOI: 10.29262/ram.v70i4.1333 -
World Journal of Pediatrics : WJP Aug 2023Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and... (Review)
Review
BACKGROUND
Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior, interests and activities. The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers, focusing on their similarities and disparities.
DATA SOURCES
The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows: differential diagnosis, preschoolers, diagnostic challenge, attention deficit hyperactivity disorder, intellectual disability, high abilities/giftedness, childhood apraxia of speech, social communication disorder, Landau-Kleffner syndrome, stereotyped movement disorder and excessive screen time.
RESULTS
We describe conditions commonly found in clinical practice, taking ASD as a reference. We addressed converging and divergent aspects of behavior, cognition, communication, language, speech, socialization, and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses.
CONCLUSIONS
The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD, thus properly diagnosing and directing social, professional, or medication interventions. This detailed discussion adds to the literature since, although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles, they rarely occupy a prominent place as we aimed herein.
Topics: Child; Child, Preschool; Humans; Autism Spectrum Disorder; Diagnosis, Differential; Developmental Disabilities; Comorbidity; Cognition
PubMed: 36282408
DOI: 10.1007/s12519-022-00629-y -
RoFo : Fortschritte Auf Dem Gebiete Der... Jun 2024Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging... (Review)
Review
BACKGROUND
Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging characteristics. Further, invasive evaluation is only necessary in cases of splenic lesions with uncertain or potentially malignant etiology.
METHOD
While in most cases a correct diagnosis can be made from computed tomography (CT), (additional) magnetic resonance imaging (MRI) can aid in the identification of lesions. As these lesions are rare, only a few of the differential diagnoses are regularly diagnosed in the clinical routine.
RESULT AND CONCLUSION
This review presents the differential diagnoses of splenic lesions, including imaging characteristics and a flowchart to determine the right diagnosis. In conjunction with laboratory results and clinical symptoms, histological workup is necessary only in a few cases, especially in incidental findings. In these cases, image-guided biopsies should be preferred over splenectomy, if possible.
KEY POINTS
· Splenic lesions are rare and are usually incidental findings on abdominal imaging. · CT imaging and MRI imaging are the diagnostic tools of choice for the further workup of splenic lesions. · Based on their image morphological characteristics, a large number of splenic lesions can be assigned to one entity and do not need histological analysis.
CITATION FORMAT
· Krähling H, Seidensticker M, Heindel WL et al. Diagnostic approach to splenic lesions. Fortschr Röntgenstr 2024; 196: 573 - 581.
Topics: Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Diagnosis, Differential; Splenic Diseases; Incidental Findings; Spleen; Splenic Neoplasms; Splenectomy
PubMed: 37967822
DOI: 10.1055/a-2193-2292 -
Fertility and Sterility Feb 2024Endometriosis affects 1 in 9 women, and diagnosis is often delayed using conventional laparoscopy. Noninvasive markers of endometriosis have the potential to enable... (Review)
Review
Endometriosis affects 1 in 9 women, and diagnosis is often delayed using conventional laparoscopy. Noninvasive markers of endometriosis have the potential to enable earlier diagnosis, leading to more timely treatment and better surgical planning. This issue's Views and Reviews seek to summarize the current status of noninvasive markers of endometriosis. Experts in reproductive medicine with prior work in this field summarize the key literature on endometrial biomarkers, blood biomarkers, and advanced imaging, including ultrasound and magnetic resonance imaging. At present, there is no single definitive biomarker that can diagnose endometriosis with high sensitivity and specificity. Advancing endometriosis biomarkers beyond the discovery phase is challenging, and more work is needed. Clinicians who have an improved understanding of noninvasive imaging and biomarkers will be able to identify endometriosis earlier and more easily, allowing for prompt consideration of treatment options. We believe that continued research, innovation, and development will lead to improved diagnostic accuracy and guidance toward the best treatments for endometriosis-related pain and infertility.
Topics: Humans; Female; Endometriosis; Ultrasonography; Endometrium; Magnetic Resonance Imaging; Biomarkers
PubMed: 38104885
DOI: 10.1016/j.fertnstert.2023.12.021