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Danish Medical Journal Nov 2023Complicated appendicitis is a severe condition, requiring early diagnosis and intervention to prevent complications. We aimed to investigate how resident surgeons...
INTRODUCTION
Complicated appendicitis is a severe condition, requiring early diagnosis and intervention to prevent complications. We aimed to investigate how resident surgeons distinguish and manage complicated appendicitis and their perspectives on preoperative diagnostic markers.
METHODS
The electronic survey was face validated. It contained questions about demographics, resident surgeons' considerations on the preoperative diagnosis of complicated appendicitis, and views on the need for and relevance of preoperative diagnostic markers. It was sent to all resident surgeons in the Eastern part of Denmark.
RESULTS
Seven hospitals and their 92 resident surgeons received the survey, and 90% responded. Most resident surgeons used symptoms and signs of pain to diagnose suspected complicated appendicitis. Half of the surgeons used computed tomographies, and 95% used routine blood tests. Most surgeons (83%) would change the management of patients with preoperatively diagnosed complicated appendicitis in comparison to uncomplicated appendicitis. However, only 17% felt the need for a preoperative diagnostic marker.
CONCLUSIONS
Resident surgeons in Eastern Denmark use non-specific diagnostic techniques to distinguish complicated from uncomplicated appendicitis and would change treatment if appendicitis was diagnosed preoperatively. However, despite limited interest, our results suggest a need for new diagnostic markers to differentiate between the severity of appendicitis, thus enhancing education and training in managing such cases.
FUNDING
None.
TRIAL REGISTRATION
None.
Topics: Humans; Appendicitis; Appendectomy; Surveys and Questionnaires; Diagnosis, Differential; Tomography, X-Ray Computed; Acute Disease
PubMed: 38018705
DOI: No ID Found -
Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics.Epilepsia Open Sep 2023Differential diagnosis between epileptic seizures and psychogenic nonepileptic events (PNEEs) is a worldwide problem for neurologists. The present study aims to identify... (Observational Study)
Observational Study
OBJECTIVE
Differential diagnosis between epileptic seizures and psychogenic nonepileptic events (PNEEs) is a worldwide problem for neurologists. The present study aims to identify important characteristics from body fluid tests and develop diagnostic models based on them.
METHODS
This is a register-based observational study in patients with a diagnosis of epilepsy or PNEEs at West China Hospital of Sichuan University. Data from body fluid tests between 2009 and 2019 were used as a training set. We constructed models with a random forest approach in eight training subsets divided by sex and categories of tests, including electrolyte, blood cell, metabolism, and urine tests. Then, we collected data prospectively from patients between 2020 and 2022 to validate our models and calculated the relative importance of characteristics in robust models. Selected characteristics were finally analyzed with multiple logistic regression to establish nomograms.
RESULTS
A total of 388 patients, including 218 with epilepsy and 170 with PNEEs, were studied. The AUROCs of random forest models of electrolyte and urine tests in the validation phase achieved 80.0% and 79.0%, respectively. Carbon dioxide combining power, anion gap, potassium, calcium, and chlorine in electrolyte tests and specific gravity, pH, and conductivity in urine tests were selected for the logistic regression analysis. C (ROC) of the electrolyte and urine diagnostic nomograms achieved 0.79 and 0.85, respectively.
SIGNIFICANCE
The application of routine indicators of serum and urine may help in the more accurate identification of epileptic and PNEEs.
Topics: Humans; Epilepsy; Seizures; Diagnosis, Differential; Body Fluids; Cell Differentiation
PubMed: 37329211
DOI: 10.1002/epi4.12775 -
PloS One 2023In this review, we assessed the diagnostic efficiency of artificial intelligence (AI) models in detecting temporomandibular joint osteoarthritis (TMJOA) using... (Meta-Analysis)
Meta-Analysis
Artificial intelligence for detecting temporomandibular joint osteoarthritis using radiographic image data: A systematic review and meta-analysis of diagnostic test accuracy.
In this review, we assessed the diagnostic efficiency of artificial intelligence (AI) models in detecting temporomandibular joint osteoarthritis (TMJOA) using radiographic imaging data. Based upon the PRISMA guidelines, a systematic review of studies published between January 2010 and January 2023 was conducted using PubMed, Web of Science, Scopus, and Embase. Articles on the accuracy of AI to detect TMJOA or degenerative changes by radiographic imaging were selected. The characteristics and diagnostic information of each article were extracted. The quality of studies was assessed by the QUADAS-2 tool. Pooled data for sensitivity, specificity, and summary receiver operating characteristic curve (SROC) were calculated. Of 513 records identified through a database search, six met the inclusion criteria and were collected. The pooled sensitivity, specificity, and area under the curve (AUC) were 80%, 90%, and 92%, respectively. Substantial heterogeneity between AI models mainly arose from imaging modality, ethnicity, sex, techniques of AI, and sample size. This article confirmed AI models have enormous potential for diagnosing TMJOA automatically through radiographic imaging. Therefore, AI models appear to have enormous potential to diagnose TMJOA automatically using radiographic images. However, further studies are needed to evaluate AI more thoroughly.
Topics: Humans; Artificial Intelligence; ROC Curve; Temporomandibular Joint; Osteoarthritis; Diagnostic Tests, Routine
PubMed: 37450501
DOI: 10.1371/journal.pone.0288631 -
Medical Ultrasonography Sep 2023Portal Venous Gas (PVG) provides an important differential diagnosis in the diagnose of intrahepatic reflexogenic structures. This review article is intended to provide... (Review)
Review
Portal Venous Gas (PVG) provides an important differential diagnosis in the diagnose of intrahepatic reflexogenic structures. This review article is intended to provide an overview of the current literature on the detection of PVG, its special forms and important differential diagnoses, it also shows possibilities for the diagnostic procedure in the case of sonographic detection of PVG.
Topics: Humans; Gases; Portal Vein; Ultrasonography; Diagnosis, Differential; Tomography, X-Ray Computed
PubMed: 36780605
DOI: 10.11152/mu-4010 -
The Lancet. Child & Adolescent Health May 2024Febrile infants presenting in the first 90 days of life are at higher risk of invasive and serious bacterial infections than older children. Modern clinical practice... (Meta-Analysis)
Meta-Analysis
Diagnostic test accuracy of procalcitonin and C-reactive protein for predicting invasive and serious bacterial infections in young febrile infants: a systematic review and meta-analysis.
BACKGROUND
Febrile infants presenting in the first 90 days of life are at higher risk of invasive and serious bacterial infections than older children. Modern clinical practice guidelines, mostly using procalcitonin as a diagnostic biomarker, can identify infants who are at low risk and therefore suitable for tailored management. C-reactive protein, by comparison, is widely available, but whether C-reactive protein and procalcitonin have similar diagnostic accuracy is unclear. We aimed to compare the test accuracy of procalcitonin and C-reactive protein in the prediction of invasive or serious bacterial infections in febrile infants.
METHODS
For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, Web of Science, and The Cochrane Library for diagnostic test accuracy studies up to June 19, 2023, using MeSH terms "procalcitonin", and "bacterial infection" or "fever" and keywords "invasive bacterial infection*" and "serious bacterial infection*", without language or date restrictions. Studies were selected by independent authors against eligibility criteria. Eligible studies included participants aged 90 days or younger presenting to hospital with a fever (≥38°C) or history of fever within the preceding 48 h. The primary index test was procalcitonin, and the secondary index test was C-reactive protein. Test kits had to be commercially available, and test samples had to be collected upon presentation to hospital. Invasive bacterial infection was defined as the presence of a bacterial pathogen in blood or cerebrospinal fluid, as detected by culture or quantitative PCR; authors' definitions of serious bacterial infection were used. Data were extracted from selected studies, and the detection of invasive or serious bacterial infections was analysed with two models for each biomarker. Diagnostic accuracy was determined against internationally recognised cutoff values (0·5 ng/mL for procalcitonin, 20 mg/L for C-reactive protein) and pooled to calculate partial area under the curve (pAUC) values for each biomarker. Optimum cutoff values were identified for each biomarker. This study is registered with PROSPERO, CRD42022293284.
FINDINGS
Of 734 studies derived from the literature search, 14 studies (n=7755) were included in the meta-analysis. For the detection of invasive bacterial infections, pAUC values were greater for procalcitonin (0·72, 95% CI 0·56-0·79) than C-reactive protein (0·28, 0·17-0·61; p=0·016). Optimal cutoffs for detecting invasive bacterial infections were 0·49 ng/mL for procalcitonin and 13·12 mg/L for C-reactive protein. For the detection of serious bacterial infections, procalcitonin and C-reactive protein had similar pAUC values (0·55, 0·44-0·69 vs 0·54, 0·40-0·61; p=0·92). For serious bacterial infections, the optimal cutoffs for procalcitonin and C-reactive protein were 0·17 ng/mL and 16·18 mg/L, respectively. Heterogeneity was low for studies investigating the test accuracy of procalcitonin in detecting invasive bacterial infection (I=23·5%), high for studies investigating procalcitonin for serious bacterial infection (I=75·5%), and moderate for studies investigating C-reactive protein for invasive bacterial infection (I=49·5%) and serious bacterial infection (I=28·3%). The absence of a single definition of serious bacterial infection across studies was the greatest source of interstudy variability and potential bias.
INTERPRETATION
Within a large cohort of febrile infants, a procalcitonin cutoff of 0·5 ng/mL had a superior pAUC value to a C-reactive protein cutoff of 20 mg/L for identifying invasive bacterial infections. In settings without access to procalcitonin, C-reactive protein should therefore be used cautiously for the identification of invasive bacterial infections, and a cutoff value below 20 mg/L should be considered. C-reactive protein and procalcitonin showed similar test accuracy for the identification of serious bacterial infection with internationally recognised cutoff values. This might reflect the challenges involved in confirming serious bacterial infection and the absence of a universally accepted definition of serious bacterial infection.
FUNDING
None.
Topics: Infant; Child; Humans; Adolescent; C-Reactive Protein; Procalcitonin; Fever; Biomarkers; Bacterial Infections; Diagnostic Tests, Routine
PubMed: 38499017
DOI: 10.1016/S2352-4642(24)00021-X -
BMC Pregnancy and Childbirth Sep 2023Patients with omphalocele, a midline abdominal wall defect at the umbilical cord base, have a low survival rate. However, the long-term outcomes of fetuses with...
BACKGROUND
Patients with omphalocele, a midline abdominal wall defect at the umbilical cord base, have a low survival rate. However, the long-term outcomes of fetuses with prenatally diagnosed omphalocele have scarcely been studied. Therefore, we investigated the ultrasonographic features, genetic characteristics, and maternal and fetal outcomes of fetuses with omphalocele and provided a reference for the perinatal management of such cases.
METHODS
A total of 120 pregnant females with fetal omphalocele were diagnosed using prenatal ultrasonography at the Fujian Provincial Maternity and Child Health Hospital from January 2015 to March 2022. Amniotic fluid or cord blood samples were drawn at different gestational weeks for routine karyotype analysis, chromosomal microarray analysis (CMA) detection, and whole exome sequencing (WES). The maternal and fetal outcomes were followed up.
RESULTS
Among the 120 fetuses, 27 were diagnosed with isolated omphalocele and 93 with nonisolated omphalocele using prenatal ultrasonography. Cardiac anomalies were the most observed cause in 17 fetuses. Routine karyotyping and CMA were performed on 35 patients, and chromosomal abnormalities were observed in five patients, trisomy 18 in three, trisomy 13 in one, and chromosome 8-11 translocation in one patient; all were non-isolated omphalocele cases. Six nonisolated cases had normal CMA results and conventional karyotype tests, and further WES examination revealed one pathogenic variant and two suspected pathogenic variants. Of the 120 fetuses, 112 were successfully followed up. Eighty of the 112 patients requested pregnancy termination. Seven of the cases died in utero. A 72% 1-year survival rate was observed from the successful 25 live births.
CONCLUSION
The prognosis of fetuses with nonisolated omphalocele varies greatly, and individualized analysis should be performed to determine fetal retention carefully. Routine karyotyping with CMA testing should be provided for fetuses with omphalocele. WES is an option if karyotype and CMA tests are normal. If the fetal karyotype is normal and no associated abnormalities are observed, fetuses with omphalocele could have a high survival rate, and most will have a good prognosis.
Topics: Pregnancy; Child; Humans; Female; Hernia, Umbilical; Prenatal Care; China; Family; Amniotic Fluid
PubMed: 37726736
DOI: 10.1186/s12884-023-05999-3 -
Cureus Jul 2023Objective Lumbar puncture (LP) is a diagnostic procedure that accesses the spinal subarachnoid space to measure the opening pressure of the cerebrospinal fluid (CSF) and...
Objective Lumbar puncture (LP) is a diagnostic procedure that accesses the spinal subarachnoid space to measure the opening pressure of the cerebrospinal fluid (CSF) and obtain samples of CSF for analysis. Although commonly performed, LPs are associated with the risk of morbidity and mortality. In addition, thrombocytopenia is thought to increase the risk of LP complications, particularly spinal bleeds. This study compares rates of complications among patients who received LPs with and without thrombocytopenia in hopes of establishing more evidence-based platelet thresholds for an LP. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent LPs - those with thrombocytopenia (defined as a platelet level of 10,000-50,000 platelets {plts}/μL) and those without thrombocytopenia. The outcomes of interest were the new occurrence of subdural hematoma, epidural hematoma, subarachnoid hemorrhage, receipt of a blood patch, new onset of paralysis, and requirement of spinal decompression. Results The risk of developing a spinal bleed following an LP was 1.496% (42 of 2,808) for the cohort with thrombocytopenia versus 1.09% (31 of 2,843) for the cohort without thrombocytopenia. The risk difference, risk ratio, and odds ratio of patients from these two cohorts experiencing a spinal bleed following an LP were insignificant at 0.05. The risk of receiving a blood patch following an LP was 7.844% for those with thrombocytopenia compared to 1.421% for those without thrombocytopenia. The odds ratio of receiving a blood patch between the two cohorts was 5.906, significant to the 0.05 level (95% CI: 4.213-8.279). There was no significant difference in the cohorts' risk of developing paralysis or requiring spinal decompression following an LP. Conclusion In support of recent findings against conventional platelet count thresholds prior to LP, it was observed in the present study that the incidence of post-LP spinal bleeding in the 30 days after LP is not associated with platelet counts below the guideline threshold of 50,000 plts/μL. Patients with thrombocytopenia are also not significantly more likely to require spinal decompression or develop new onset paralysis. However, thrombocytopenia is associated with a significantly increased likelihood of receiving a blood patch following an LP.
PubMed: 37593278
DOI: 10.7759/cureus.42019 -
Cureus Oct 2023Due to the clear depiction of facial aesthetics and other craniofacial parameters, portraiture photography (PP) is becoming more and more necessary in modern clinical... (Review)
Review
Due to the clear depiction of facial aesthetics and other craniofacial parameters, portraiture photography (PP) is becoming more and more necessary in modern clinical practice. The studies chosen for this review's inclusion looked at how PP affected the orthodontic treatment and diagnostic procedure on the subjects who were watched in the studies. Studies published within the last decade precisely from 2013 were searched for across major online databases after devising a proper search strategy. Multiple reviewers created a specific data extraction form that was used for the investigation, followed by the evaluation of bias and the variables found in each of the chosen papers. This form was meant for the assessment for various variables encountered in this study. According to the meta-analysis, using PP was related with a statistically significant decrease in the risk of orthodontic treatment and diagnostic modalities, with odds ratios (OR) of 0.52 with a 95% confidence interval (CI) of (0.28, 0.96), and a relative risk (RR) of 0.66 with a CI of (0.45, 0.96). In orthodontics, PP is an important tool that offers useful data for diagnosis, treatment planning, and tracking treatment success. To validate the results of studies like ours, a sizable evidence sample is required due to the limited number of trials that have been performed in this area.
PubMed: 37933372
DOI: 10.7759/cureus.48054 -
Sensors (Basel, Switzerland) Nov 2023In recent years, marked progress has been made in wearable technology for human motion and posture recognition in the areas of assisted training, medical health, VR/AR,... (Review)
Review
In recent years, marked progress has been made in wearable technology for human motion and posture recognition in the areas of assisted training, medical health, VR/AR, etc. This paper systematically reviews the status quo of wearable sensing systems for human motion capture and posture recognition from three aspects, which are monitoring indicators, sensors, and system design. In particular, it summarizes the monitoring indicators closely related to human posture changes, such as trunk, joints, and limbs, and analyzes in detail the types, numbers, locations, installation methods, and advantages and disadvantages of sensors in different monitoring systems. Finally, it is concluded that future research in this area will emphasize monitoring accuracy, data security, wearing comfort, and durability. This review provides a reference for the future development of wearable sensing systems for human motion capture.
Topics: Humans; Posture; Motion; Wearable Electronic Devices; Monitoring, Physiologic; Motion Capture
PubMed: 38005436
DOI: 10.3390/s23229047 -
Journal of Pharmacy & Bioallied Sciences Apr 2024May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between... (Review)
Review
May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between common iliac artery and lumbar vertebra causes deep-vein thrombosis, venous hypertension, and chronic venous insufficiencies. In this article, we review present evidence of the clinical diagnosis and management of MTS. Here, we conducted a literature review of studies on MTS. We also reviewed different clinical features, presentation, diagnostic methods, and therapeutic procedure for this condition. Most studies mentioned the diagnosis of this condition is performed by color Doppler, computed tomographic angiography, venography, and problem-solving cases by intravascular ultrasound technique. Nonsurgical methods of management are first line, and vascular surgery is reserved for refractory cases. Multiple modalities are required to reach the diagnosis of MTS, and noninvasive intervention radiology methods are the first line of management. This review highlights the presentations of MTS and outlines diagnostic procedure and management.
PubMed: 38882842
DOI: 10.4103/jpbs.jpbs_1135_23