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JNMA; Journal of the Nepal Medical... Feb 2024A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as...
UNLABELLED
A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes.
KEYWORDS
case reports; rectus abdominis; ventral hernia.
Topics: Female; Humans; Middle Aged; Hernia, Ventral; Laparoscopy; Fascia; Tomography, X-Ray Computed; Abdominal Pain
PubMed: 38409978
DOI: 10.31729/jnma.8440 -
Journal of Investigative Medicine High... 2021(also referred to as and ) is the most common intestinal parasite in the world, affecting approximately 200 million people annually. Symptoms of include foul-smelling... (Review)
Review
(also referred to as and ) is the most common intestinal parasite in the world, affecting approximately 200 million people annually. Symptoms of include foul-smelling diarrhea, abdominal cramping, bloating, gas, and nausea. Although usually self-limiting, can progress to dehydration, malnutrition, and failure to thrive, especially in immunocompromised individuals. Early diagnosis and treatment is imperative to prevent and control infection of . Infectious Disease Society of America diagnostic guidelines recommend obtaining stool studies to diagnose ; when stool studies are negative but suspicion remains high, duodenal aspirate microscopy is the only alternative diagnostic strategy suggested. We report a patient diagnosed incidentally with from a duodenal biopsy specimen obtained during a workup for a gastrointestinal bleed. There are limited cases of diagnosed by duodenal biopsy reported in the literature. We review studies that suggest duodenal biopsy can be a very sensitive strategy for the diagnosis of .
Topics: Biopsy; Duodenum; Feces; Giardia lamblia; Giardiasis; Humans
PubMed: 33733914
DOI: 10.1177/23247096211001649 -
Current Opinion in Ophthalmology Jul 2021This review will discuss the utility of high-resolution anterior segment optical coherence tomography (HR-OCT), in-vivo confocal microscopy (IVCM) and ultrasound... (Review)
Review
PURPOSE OF REVIEW
This review will discuss the utility of high-resolution anterior segment optical coherence tomography (HR-OCT), in-vivo confocal microscopy (IVCM) and ultrasound biomicroscopy (UBM) in characterizing and diagnosing various ocular surface tumors, namely ocular surface squamous neoplasia (OSSN), conjunctival lymphoma and conjunctival melanoma. The strengths and limitations of each imaging modality will be discussed along with the characteristics findings of each lesion on each imaging platform.
RECENT FINDINGS
HR-OCT can consistently be utilized in the clinic setting to distinguish between epithelial ocular surface tumors such as OSSN as compared with subepithelial tumors such as conjunctival lymphoma and conjunctival melanoma given their distinctive findings. IVCM can be used as an adjunct to HR-OCT to obtain cellular and surface characteristics, whereas UBM can be used to assess tumor depth and thickness for larger and highly pigmented lesions as well as to detect intraocular invasion.
SUMMARY
HR-OCT, IVCM and UBM are all helpful imaging modalities to diagnose and characterize various ocular surface tumors and can serve as valuable adjuncts to monitor treatment response and assess for recurrence ocular surface tumors.
Topics: Conjunctiva; Conjunctival Neoplasms; Diagnostic Imaging; Humans; Microscopy, Acoustic; Microscopy, Confocal; Tomography, Optical Coherence
PubMed: 33989235
DOI: 10.1097/ICU.0000000000000771 -
Journal of Healthcare Engineering 2023Cardiac auscultation is a noninvasive, convenient, and low-cost diagnostic method for heart valvular disease, and it can diagnose the abnormality of the heart valve at...
Cardiac auscultation is a noninvasive, convenient, and low-cost diagnostic method for heart valvular disease, and it can diagnose the abnormality of the heart valve at an early stage. However, the accuracy of auscultation relies on the professionalism of cardiologists. Doctors in remote areas may lack the experience to diagnose correctly. Therefore, it is necessary to design a system to assist with the diagnosis. This study proposed a computer-aided heart valve disease diagnosis system, including a heart sound acquisition module, a trained model for diagnosis, and software, which can diagnose four kinds of heart valve diseases. In this study, a training dataset containing five categories of heart sounds was collected, including normal, mitral stenosis, mitral regurgitation, and aortic stenosis heart sound. A convolutional neural network GoogLeNet and weighted KNN are used to train the models separately. For the model trained by the convolutional neural network, time series heart sound signals are converted into time-frequency scalograms based on continuous wavelet transform to adapt to the architecture of GoogLeNet. For the model trained by weighted KNN, features from the time domain and time-frequency domain are extracted manually. Then feature selection based on the chi-square test is performed to get a better group of features. Moreover, we designed software that lets doctors upload heart sounds, visualize the heart sound waveform, and use the model to get the diagnosis. Model assessments using accuracy, sensitivity, specificity, and 1 score indicators are done on two trained models. The results showed that the model trained by modified GoogLeNet outperformed others, with an overall accuracy of 97.5%. The average accuracy, sensitivity, specificity, and 1 score for diagnosing four kinds of heart valve diseases are 98.75%, 96.88%, 99.22%, and 97.99%, respectively. The computer-aided diagnosis system, with a heart sound acquisition module, a diagnostic model, and software, can visualize the heart sound waveform and show the reference diagnostic results. This can assist in the diagnosis of heart valve diseases, especially in remote areas, which lack skilled doctors.
Topics: Humans; Heart Valve Diseases; Heart Auscultation; Heart Sounds; Machine Learning; Computers
PubMed: 36726774
DOI: 10.1155/2023/7382316 -
Open Heart Aug 2020The diagnosis and quantification of right-to-left shunt (RLS) using transthoracic echocardiography (TTE) as well as transoesophageal echocardiography (TOE) have not been... (Comparative Study)
Comparative Study
BACKGROUND
The diagnosis and quantification of right-to-left shunt (RLS) using transthoracic echocardiography (TTE) as well as transoesophageal echocardiography (TOE) have not been well established. We aimed to diagnose RLS by TOE using direct visualisation of the shunt and to compare the diagnosis with TTE diagnosis using conventional methods.
METHODS AND RESULTS
We evaluated 141 patients with ischaemic stroke for RLS by both non-sedation TOE and TTE using saline contrast and Valsalva manoeuvre. The amount (graded as 0 to IV) and timing of RLS were demonstrated. All patients were classified into four groups by TOE based on direct visualisation of shunt through a patent foramen ovale (PFO) or either pulmonary vein: no shunt (group 1: n=11), PFO (group 2: n=47), pulmonary RLS (group 3: n=25) and indeterminate RLS (group 4: n=58). All cases in group 3 showed delayed shunt, and all cases in group 4 had small shunt. On TTE findings, all cases with early appearing large shunt (cardiac cycles ≤3 and shunt grade ≥III) were group 2. Six of the eight patients with delayed appearing large shunt on TTE were group 3. TTE diagnosis of PFO using criteria of cardiac beats ≤3 and grade ≥II had a sensitivity of 85% and a specificity of 98% compared with TOE diagnosis using shunt visualisation.
CONCLUSIONS
Compared with TOE using shunt visualisation, TTE accurately diagnosed large PFO using criteria of cardiac cycles ≤3 and shunt grade ≥III. TTE possibly diagnosed pulmonary shunt using criteria of cardiac cycles >3 and shunt grade ≥III. Both modalities showed limitations in diagnosing small amount of RLS.
Topics: Adult; Aged; Brain Ischemia; Coronary Circulation; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Foramen Ovale, Patent; Hemodynamics; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Pulmonary Circulation; Reproducibility of Results; Stroke
PubMed: 32763965
DOI: 10.1136/openhrt-2019-001150 -
Viruses Aug 2022COVID-19 has been in the headlines for the past two years. Diagnosing this infection with minimal false rates is still an issue even with the advent of multiple rapid...
COVID-19 has been in the headlines for the past two years. Diagnosing this infection with minimal false rates is still an issue even with the advent of multiple rapid antigen tests. Enormous data are being collected every day that could provide insight into reducing the false diagnosis. Machine learning (ML) and deep learning (DL) could be the way forward to process these data and reduce the false diagnosis rates. In this study, ML and DL approaches have been applied to the data set collected using an ultra-fast COVID-19 diagnostic sensor (UFC-19). The ability of ML and DL to specifically detect SARS-CoV-2 signals against SARS-CoV, MERS-CoV, Human CoV, and Influenza was investigated. UFC-19 is an electrochemical sensor that was used to test these virus samples and the obtained current response dataset was used to diagnose SARS-CoV-2 using different algorithms. Our results indicate that the convolution neural networks algorithm could diagnose SARS-CoV-2 samples with a sensitivity of 96.15%, specificity of 98.17%, and accuracy of 97.20%. Combining this DL model with the existing UFC-19 could selectively identify SARS-CoV-2 presence within two minutes.
Topics: COVID-19; COVID-19 Testing; Deep Learning; Humans; SARS-CoV-2; Sensitivity and Specificity
PubMed: 36146738
DOI: 10.3390/v14091930 -
Journal of Biomedical Physics &... Apr 2022Coronavirus disease (COVID-19) as an emerging disease decreases security among people from different countries. Sense of security can be raised via quick diagnosis of...
Coronavirus disease (COVID-19) as an emerging disease decreases security among people from different countries. Sense of security can be raised via quick diagnosis of COVID-19, and its management and control using clinical decision support systems (CDSS) to prevent further spread of the disease. So, the aim of this study is to identify and introduce the applications of a CDSS in the diagnosis, management, and control of COVID-19. This cross-sectional study was conducted to identify and introduce the applications of CDSS in the diagnosis, management, and control of COVID-19. Based on the results of some meetings with infectious disease specialists and a general practitioner as well as reviewing the related literature, information about COVID-19 and CDSS was obtained. Then based on the information obtained, a questionnaire was designed electronically and distributed in a two-round Delphi method among 19 experts in the three fields of medical informatics, health information management, and infectious disease specialists. According to the literature and expert opinions, 35 applications of CDSS applications were identified in the four main groups of "diagnosis", "medication", "monitoring", and "health services". Eventually, a collective agreement was reached on 30 applications in the first and second rounds of Delphi. Among all the applications, the highest means were assigned to "monitoring the vital signs" and "helping diagnose infections and damaged lung tissue through CT scan". Introducing these applications can provide general, basic knowledge of the design and implementation of clinical decision support systems in the real world to prevent irreversible complications and even many people's death.
PubMed: 35433521
DOI: 10.31661/jbpe.v0i0.2105-1336 -
BMC Neurology Nov 2021Primary orthostatic tremor (OT) is a rare movement disorder characterized by a 13-18 Hz leg tremor, which arises when standing and is relieved by walking/sitting....
BACKGROUND
Primary orthostatic tremor (OT) is a rare movement disorder characterized by a 13-18 Hz leg tremor, which arises when standing and is relieved by walking/sitting. Those affected generally do not fall, but experience fear of falling, lessened by ambulation. Because of its low amplitude, the tremor is not readily visible, and diagnosis requires confirmation with surface electromyography (sEMG). Recently, applications using the accelerometer feature of smartphones have been used to detect and quantify tremors, including OT, though the accuracy of smartphone accelerometry (SPA) in diagnosing OT is unknown.
METHODS
We completed SPA in consecutive adults (18+ years), who presented to our neurology clinic with either subjective leg shakiness upon standing or unsteadiness when standing that lessened with ambulation, which comprised 59 of 2578 patients. We assessed tremor using the StudyMyTremor application on an iPhone 6 s adhered with tape to the patient's tibialis anterior. Surface electromyography was completed on the same muscle. The primary outcome of this study was to determine SPA's sensitivity and specificity in detecting OT compared with surface electromyography.
RESULTS
Fifty-nine patients with the following diagnoses were included: OT (6), Parkinson's disease, Hereditary Spastic Paraplegia, orthostatic hypotension, essential tremor, spinal cerebellar ataxia, sensory ataxia and functional movement disorder. Smartphone accelerometry detected a 13-18 Hz tremor in 5 of 6 patients diagnosed with OT by sEMG with no false positives in other conditions, yielding a sensitivity of 83%, specificity of 100% in the cohort we studied.
CONCLUSIONS
Though a larger sample size is desirable, preliminary data suggest that smartphone accelerometry is an alternative to surface electromyography in diagnosing OT.
Topics: Accelerometry; Accidental Falls; Adult; Electromyography; Essential Tremor; Fear; Humans; Smartphone; Tremor
PubMed: 34809610
DOI: 10.1186/s12883-021-02486-0 -
Journal of Clinical Pathology Nov 2021An increasing number of small pulmonary nodules are being screened by CT, and an intraoperative diagnosis is necessary for preventing excessive treatment. However, there...
AIMS
An increasing number of small pulmonary nodules are being screened by CT, and an intraoperative diagnosis is necessary for preventing excessive treatment. However, there is limited literature on the frozen diagnosis of small sclerosing pneumocytomas (SPs). In particular, tumours smaller than 1 cm are challenging for pathologists performing intraoperative frozen diagnosis.
METHODS
In total, 230 cases of SP were surgically resected between January 2015 and March 2019 at Shanghai Chest Hospital, and of them, 76 cases were smaller than 1 cm. The histology and clinical information of these 76 cases (33.0%, 76/230) were reviewed retrospectively, 54 cases of which were diagnosed intraoperatively, and the pitfalls were summarised. All diagnoses were confirmed on permanent sections and immunohistochemical sections.
RESULTS
Histologically, 78.9% (60/76) of the small SP was dominated by one growth pattern, and solid and papillary growth pattern were the most commonly misdiagnosed circumstances. The rate of intraoperative misdiagnosis of these SP smaller than 1 cm was 11.1% (6/54).
CONCLUSIONS
The main reason for misdiagnosis was failure to recognise the dual cell populations and the cellular atypia. Diagnostic clues include the gross morphology, the presence of dual-cell populations and a hypercellular papillary core, foam cell accumulation in glandular spaces and haemorrhage and haemosiderin on the periphery. In spite of awareness of pitfalls some cases may still be essentially impossible to diagnose on frozen section.
Topics: Adult; Aged; Cytodiagnosis; Diagnosis, Differential; Diagnostic Errors; Female; Frozen Sections; Humans; Intraoperative Period; Lung Neoplasms; Male; Middle Aged; Multiple Pulmonary Nodules; Retrospective Studies; Sclerosis; Sensitivity and Specificity; Solitary Pulmonary Nodule
PubMed: 33782195
DOI: 10.1136/jclinpath-2020-206729 -
Acta Dermato-venereologica Oct 2021Trichotillomania is formally classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the...
Trichotillomania is formally classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the diagnostic value of trichoscopy in diagnosing trichotillomania. The analysis identified the 7 most specific trichoscopic features in trichotillomania. These features had the following prevalence and specificity: trichoptilosis (57.5%; 73/127 and 97.5%, respectively), v-sign (50.4%; 63/125 and 99%), hook hairs (43.1%; 28/65 and 100%), flame hairs (37.1%; 52/140 and 96.5%), coiled hairs (36.8%; 46/125 and 99.6%), tulip hairs (36.4%; 28/77 and 89.6%), and hair powder (35.6%; 42/118 and 97.9%). The 2 most common, but least specific, features were broken hairs and black dots. In conclusion, trichoscopy is a reliable new diagnostic method for hair loss caused by hair pulling. Trichoscopy should be included as a standard procedure in the differential diagnosis of trichotillomania in clinical practice.
Topics: Alopecia; Dermoscopy; Diagnosis, Differential; Hair; Humans; Trichotillomania
PubMed: 34184065
DOI: 10.2340/00015555-3859