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Current Diabetes Reports Aug 2023This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction... (Review)
Review
PURPOSE OF REVIEW
This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population.
RECENT FINDINGS
There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
Topics: Child; Adult; Humans; Adolescent; Metabolic Syndrome; Risk Factors; Obesity; Body Mass Index; Cardiovascular Diseases
PubMed: 37273161
DOI: 10.1007/s11892-023-01513-3 -
The Journal of the American Osteopathic... Jun 2020There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more...
CONTEXT
There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more subjective measures to evaluate this important association. To better understand this relationship, palpatory forces can be observed while diagnosing a somatic dysfunction.
OBJECTIVE
To quantify the pressure applied in diagnosing lumbar somatic dysfunction, find a correlation between accuracy of diagnosis and palpation pressure, set the standards for palpation, and develop precise palpatory skills for osteopathic medical students.
METHODS
The palpatory forces were evaluated between participants with varying experience levels (osteopathic medical students and attending physicians from the New York Institute of Technology College of Osteopathic Medicine). Two osteopathic physicians confirmed an L5 somatic dysfunction diagnosis in a volunteer standardized patient (SP), who served as the control. Participants then palpated the lumbar segment of the SP in a prone position with F-Scan System (TekScan) sensors, which recorded the amount of pressure and time used to reach a full diagnosis.
RESULTS
Participants (11 osteopathic medical students and 10 attending physicians) who diagnosed an L5 somatic dysfunction consistent with the SP's diagnosis had less of a difference in peak force (mean [SD] difference, 62.50 [325.7] g/cm2) between the contact points (right hand vs left hand). In contrast, participants with a dissimilar L5 diagnosis from the SP's had a mean (SD) difference in peak force of 319.38 (703.1) g/cm2. Similarly, the difference in the mean (SD) force of palpation between the contact points was lower in participants who made the correct diagnosis (16.81 [117.4] g/cm2) vs those who made an incorrect diagnosis (123.92 [210.3] g/cm2). No statistical significance was found between the diagnostic accuracy of the students and physicians (P=.387) or the time taken to reach a diagnosis (P=.199).
CONCLUSION
We observed that using equal pressures in both hands while palpating a lumbar segment correlates to more accurate somatic dysfunction diagnoses.
Topics: Humans; New York; Osteopathic Medicine; Palpation; Pressure
PubMed: 32451546
DOI: 10.7556/jaoa.2020.066 -
Seminars in Reproductive Medicine May 2020To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020....
To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[Text Word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. Included articles described: pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. Prevalence estimates range from 20% to 88.8% in symptomatic women (average 30-35%) with most diagnosed between 32-38 years old. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report younger symptomatic women are being diagnosed with adenomyosis based on both magnetic resonance imaging (MRI) and/or transvaginal ultrasound (TVUS). High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. Adenomyosis remains a challenge to identify, assess and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathological and imaging diagnoses to gain deeper understandings of adenomyosis.
Topics: Adenomyosis; Adolescent; Adult; Diagnosis, Differential; Disease Progression; Dysmenorrhea; Dyspareunia; Endometriosis; Female; Humans; Infertility, Female; Magnetic Resonance Imaging; Menorrhagia; Myometrium; Ultrasonography; Young Adult
PubMed: 33352607
DOI: 10.1055/s-0040-1721795 -
JMIR Dermatology Sep 2022Challenges remain for general practitioners (GPs) in diagnosing (pre)malignant and benign skin lesions. Teledermoscopy (TDsc) supports GPs in diagnosing these skin...
BACKGROUND
Challenges remain for general practitioners (GPs) in diagnosing (pre)malignant and benign skin lesions. Teledermoscopy (TDsc) supports GPs in diagnosing these skin lesions guided by teledermatologists' (TDs) diagnosis and advice and prevents unnecessary referrals to dermatology care. However, the impact of the availability of TDsc on GPs' self-reported referral decisions to dermatology care before and after the TDsc consultation is unknown.
OBJECTIVE
The objective of this study is to assess and compare the initial self-reported referral decisions of GPs before TDsc versus their final self-reported referral decisions after TDsc for skin lesions diagnosed by the TD as (pre)malignant or benign.
METHODS
TDsc consultations requested by GPs in daily practice between July 2015 and June 2020 with a TD assessment and diagnosis were extracted from a nationwide Dutch telemedicine database. Based on GP self-administered questions, the GPs' referral decisions before and their final referral decision after TDsc consultation were assessed for (pre)malignant and benign TD diagnoses.
RESULTS
GP self-administered questions and TD diagnoses were evaluated for 6364 TDsc consultations (9.3% malignant, 8.8% premalignant, and 81.9% benign skin lesions). In half of the TDsc consultations, GPs adjusted their initial referral decision after TD advice and TD diagnosis. Initially, GPs did not have the intention to refer 67 (56.8%) of 118 patients with a malignant TD diagnosis and 26 (16.0%) of 162 patients with a premalignant TD diagnosis but then decided to refer these patients after the TDsc consultation. Furthermore, GPs adjusted their decision from referral to nonreferral for 2534 (74.9%) benign skin lesions (including 676 seborrheic keratosis and 131 vascular lesions).
CONCLUSIONS
GPs adjusted their referral decision in 52% (n=3306) of the TDsc consultations after the TD assessment. The availability of TDsc is thus of added value and assists GPs in their (non)referral for patients with skin lesions to dermatology care. TDsc resulted in referrals of patients with (pre)malignant skin lesions that GPs would not have referred directly to the dermatologist. TDsc also led to a reduction of unnecessary referrals of patients with low complex benign skin lesions (eg, seborrheic keratosis and vascular lesions).
PubMed: 37632902
DOI: 10.2196/40888 -
Journal of Psychiatric and Mental... Aug 2022WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is a term used to describe persons who have a co-occurring mental health and substance misuse disorders. It is the cause of...
WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is a term used to describe persons who have a co-occurring mental health and substance misuse disorders. It is the cause of significant economic burden to health care, justice and educational systems. It is well reported that to date dual diagnosis is under-diagnosed and poorly treated within the confines of mental health services WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It demonstrates that the need for service reform where all services are equipped with the necessary tools required to adequately support a person with dual diagnosis. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The narrative provides a real-life, candid description of how trauma in early childhood can cause significant challenges when one becomes older. The narrative identifies the dangers of not diagnosing a dual diagnosis early, resulting in only treating half the presenting issues. This narrative also offers hope to individuals in current distress, as well as for those supporting such individuals, as it clearly demonstrates that with the right supports and encouragement, recovery is possible. ABSTRACT: Introduction Dual diagnosis describes when a person has two co-occurring disorders. It is often difficult to diagnose and this can lead to prolonged suffering on behalf of the individual. Aim To provide a lived experience narrative of the early recovery journey of a person with a dual diagnosis. Method This aim was achieved through the use of a narrative based methodology. Results The journey of life leading to a dual diagnosis and beyond is described under the following headings: Formative Years, Substance Misuse, When Life gives you Lemons, They Say Nothing lasts Forever, From the Ashes, Early Recovery and Luck or Fate? DISCUSSION: The narrative presented describes a first hand experience of the struggles leading to a dual diagnosis and how receiving the diagnosis has supported the recovery journey of the first author.
Topics: Child, Preschool; Diagnosis, Dual (Psychiatry); Humans; Mental Health; Mental Health Services; Substance-Related Disorders
PubMed: 34623010
DOI: 10.1111/jpm.12801 -
Fetal Diagnosis and Therapy 2021Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion...
INTRODUCTION
Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses.
METHODS
This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed. Prenatal imaging findings were compared by the most common diagnoses and regression patterns.
RESULTS
Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (n = 12; 27.3%), adrenal hemorrhage (n = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (n = 4), adrenal hyperplasia (n = 3), bilateral adrenal calcifications (n = 1), and indeterminate lesions (n = 6). Sequestrations were uniformly left-sided (100 vs. 50%; p = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (p = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (p = 0.005), low T1 MRI signal (p = 0.015), and no MRI blood products (p = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (p = 0.003; p = 0.044).
DISCUSSION/CONCLUSION
Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.
Topics: Bronchopulmonary Sequestration; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 33730724
DOI: 10.1159/000512689 -
Seminars in Roentgenology Apr 2020Emergency department (ED) visits for eye and vision-related concerns are common. In most cases, accurate diagnosis is made using clinical history and physical exam... (Review)
Review
Emergency department (ED) visits for eye and vision-related concerns are common. In most cases, accurate diagnosis is made using clinical history and physical exam findings without the need for emergent imaging. When orbital imaging is performed in the ED, it is often in patients with orbital trauma where CT is used to assess for orbital fractures and associated injuries. However, CT or MR imaging can also be critical to appropriately diagnose and manage certain ED patients with nontraumatic eye and vision-related conditions. The purpose of this article is to review the imaging findings and differential diagnoses for nontraumatic orbital and neuro-ophthalmological emergencies from a practical, clinical perspective, based on a patient's typical presenting symptoms. The more commonly imaged clinical indications will be discussed including periorbital swelling, proptosis, eye pain, diplopia, and visual disturbances. In addition, rare but easily overlooked and clinically important diagnoses for the emergency radiologist to recognize will be highlighted.
Topics: Emergency Service, Hospital; Humans; Magnetic Resonance Imaging; Orbital Diseases; Tomography, X-Ray Computed
PubMed: 32438976
DOI: 10.1053/j.ro.2019.11.004 -
Irish Journal of Medical Science Apr 2024Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review... (Review)
Review
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
Topics: Adult; Humans; Neoplasm Recurrence, Local; Heart Neoplasms; Myxoma; Echocardiography; Magnetic Resonance Imaging
PubMed: 37737916
DOI: 10.1007/s11845-023-03531-2 -
The Journal of the Association of... Sep 2023Hyperglycemia occurring in pregnancy is a growing burden worldwide. It is now standard of care to screen all women during pregnancy, both to detect preexisting diabetes...
Hyperglycemia occurring in pregnancy is a growing burden worldwide. It is now standard of care to screen all women during pregnancy, both to detect preexisting diabetes as well as gestational diabetes mellitus (GDM). Traditionally, GDM was diagnosed at 24-28 weeks. However, with many international bodies recommending screening at first contact or booking, we are now diagnosing GDM earlier on in pregnancy. Based on the time of gestation at which it is diagnosed, GDM can be classified as conventional gestational diabetes mellitus (cGDM) or early gestational diabetes mellitus (eGDM). The cGDM is diagnosed between 24 and 28 weeks of gestation while eGDM is diagnosed in early pregnancy (<20 weeks). Till recently, there was little and conflicting evidence, on whether diagnosing and treating eGDM was beneficial or safe. The recent Treatment of BOoking Gestational diabetes Mellitus (ToBOGM) study, was a randomized control trial, showing clear benefits of diagnosing and treating eGDM. ToBOGM also showed that the best results were seen in those screened before 14 weeks of pregnancy and those in the higher band of glucose levels (FPG 95-109 mg/dL, 1-hour >191 mg/dL, and 2-hour glucose 162-199 mg/dL). In India, where the burden of hyperglycemia in pregnancy is high, the findings from the ToBOGM study further emphasize the need for screening for GDM at the time of first booking of the pregnancy followed by appropriate treatment for those detected to have eGDM. How to cite this article: Hannah W, Pradeepa R, Anjana RM, et al. Early Gestational Diabetes Mellitus: An Update. J Assoc Physicians India 2023;71(9):101-103.
Topics: Female; Humans; Pregnancy; Blood Glucose; Diabetes, Gestational; Early Diagnosis; Glucose Tolerance Test; India; Clinical Studies as Topic
PubMed: 38700309
DOI: 10.59556/japi.71.0351 -
Current Rheumatology Reports Nov 2019Positron emission tomography (PET) combined with computed tomography (CT) has proven useful as a cancer screening technique in patients with inflammatory myopathy,... (Review)
Review
PURPOSE OF REVIEW
Positron emission tomography (PET) combined with computed tomography (CT) has proven useful as a cancer screening technique in patients with inflammatory myopathy, mainly dermatomyositis. In this review, we focus on advances in this direction and other potential applications of PET/CT in patients with inflammatory myopathy.
RECENT FINDINGS
Cancer screening by PET/CT seems suitable and cost-effective in patients with myositis. It has also shown value as a hybrid technique for diagnosing myositis versus controls and could be of interest for differentiating between polymyositis and sporadic inclusion body myositis. Quantification of muscle activity by PET/CT seems reliable. Preliminary data suggest that it could also be used to diagnose and measure the activity of the disease in the lung. PET/CT should be in the toolbox of physicians managing patients with myositis. The multiple applications of PET/CT include its value for cancer screening, measuring the activity of the disease in muscle, and helping to differentiate between myositis phenotypes. The possibility to diagnose and monitor inflammatory lung activity remains to be demonstrated in well-designed studies.
Topics: Dermatomyositis; Diagnosis, Differential; Humans; Mass Screening; Myositis; Neoplasms; Polymyositis; Positron Emission Tomography Computed Tomography
PubMed: 31754890
DOI: 10.1007/s11926-019-0864-3