-
American Family Physician Mar 2020Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When... (Review)
Review
Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.
Topics: Abscess; Aortic Aneurysm, Abdominal; Appendicitis; Cellulitis; Clinical Competence; Colic; Female; Fractures, Bone; Hemorrhage; Humans; Intestinal Perforation; Intracranial Hypertension; Lung; Male; Pericardial Effusion; Point-of-Care Systems; Pregnancy; Prenatal Care; Respiratory Distress Syndrome; Retinal Detachment; Rotator Cuff Injuries; Soft Tissue Infections; Spermatic Cord Torsion; Stroke Volume; Ultrasonography; Ultrasonography, Interventional; Venous Thrombosis
PubMed: 32109031
DOI: No ID Found -
Fertility and Sterility Jul 2022Endometriosis was classically diagnosed during diagnostic laparoscopies, which used to be routinely performed up until a decade ago or so. This practice fitted with the... (Review)
Review
Endometriosis was classically diagnosed during diagnostic laparoscopies, which used to be routinely performed up until a decade ago or so. This practice fitted with the long-held belief that surgery was the gold standard for diagnosing endometriosis. Today, the abandon of routine diagnostic laparoscopies-in favor of assisted reproductive technology-first therapeutic approaches-has created a void for diagnosing endometriosis. Modern-day imaging techniques-ultrasound and magnetic resonance imaging-when used with a systematic approach have offered a reliable replacement option for diagnosing endometriosis. In infertility, endometriosis should be identified or excluded on the basis of past history or confirmation or exclusion suspicion on the basis of history and/or physical examination.
Topics: Endometriosis; Female; Humans; Infertility; Magnetic Resonance Imaging; Reproductive Techniques, Assisted; Ultrasonography
PubMed: 35568524
DOI: 10.1016/j.fertnstert.2022.03.015 -
Indian Journal of Pediatrics Aug 2023Lung function testing is an essential modality of investigation in children as it provides objective evidence of lung disease/health. With advances in technology,... (Review)
Review
Lung function testing is an essential modality of investigation in children as it provides objective evidence of lung disease/health. With advances in technology, various tests are available that can aid in the diagnosis of lung disease, assess the progression and response to therapy and document the lung development and evolving lung diseases in infants. This narrative review discusses lung function tests in infants and children. Currently, lung function tests can be performed in every age group, from neonates to the elderly. Spirometry and peak expiratory flow rate (PEFR) are the most employed tests in children more than six years of age. Spirometry helps diagnose and monitoring of both obstructive and restrictive diseases. There is a need for expertise to perform and interpret spirometry correctly. The forced oscillation technique (FOT) or impulse oscillometry (IOS) is done with tidal volume breathing and is feasible even in preschool children. Their utility is mainly restricted to asthma in children at present. Lung function tests can be performed in neonates, infants and children using infant pulmonary function test (PFT) equipment, although their availability is limited. Diffusion capacity for carbon monoxide (DLCO) is a valuable tool in restrictive lung diseases. Lung volumes can be assessed by body plethysmography and multiple washout technique. The latter can also assess lung clearance index. It is essential to perform and interpret the lung function test results correctly and correlate them with the clinical condition for optimum treatment and outcome.
Topics: Child, Preschool; Infant, Newborn; Infant; Humans; Aged; Oscillometry; Respiratory Function Tests; Lung; Asthma; Spirometry; Forced Expiratory Volume
PubMed: 37261706
DOI: 10.1007/s12098-023-04588-8 -
Clinical and Translational... Apr 2023There is increasing appreciation that small intestinal bacterial overgrowth (SIBO) drives many common gastrointestinal symptoms, including diarrhea, bloating, and... (Review)
Review
There is increasing appreciation that small intestinal bacterial overgrowth (SIBO) drives many common gastrointestinal symptoms, including diarrhea, bloating, and abdominal pain. Breath testing via measurement of exhaled hydrogen and methane gases following ingestion of a readily metabolized carbohydrate has become an important noninvasive testing paradigm to help diagnose SIBO. However, because of a number of physiological and technical considerations, how and when to use breath testing in the diagnosis of SIBO remains a nuanced clinical decision. This narrative review provides a comprehensive overview of breath testing paradigms including the indications for testing, how to administer the test, and how patient factors influence breath testing results. We also explore the performance characteristics of breath testing (sensitivity, specificity, positive and negative predictive values, likelihood ratios, and diagnostic odds ratio). Additionally, we describe complementary and alternative tests for diagnosing SIBO. We discuss applications of breath testing for research. Current estimates of SIBO prevalence among commonly encountered high-risk populations are reviewed to provide pretest probability estimates under a variety of clinical situations. Finally, we discuss how to integrate breath test performance characteristics into clinical care decisions using clinical predictors and the Fagan nomogram.
Topics: Humans; Intestine, Small; Methane; Diarrhea; Hydrogen; Breath Tests
PubMed: 36744854
DOI: 10.14309/ctg.0000000000000567 -
Clinical Microbiology and Infection :... Sep 2021Diagnosing invasive or chronic fungal infections is a challenge, particularly in the immunocompromised host. Microscopy and culture remain the reference standard, but... (Review)
Review
BACKGROUND
Diagnosing invasive or chronic fungal infections is a challenge, particularly in the immunocompromised host. Microscopy and culture remain the reference standard, but are insensitive. The use of non-culture-based techniques is recommended in conjunction with conventional methods to improve the diagnostic yield.
OBJECTIVES
The aim was to provide an updated 2021 inventory of fungal antigen and serology tests for diagnosing invasive and chronic fungal infections, the key focus was set on Aspergillus, Candida and Cryptococcus species.
SOURCES
Pubmed search for publications with the key words fungal antigen tests, laboratory-based diagnosis of invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, invasive candidiasis, invasive fungal infections and cryptococcal infections published from 2017 to 2020.
CONTENT
Antigen assays such as the galactomannan (GM) and β-d-glucan detection systems are frequently used, but these tests vary in sensitivity and specificity, depending on the patient population involved, specimens inspected, cut-offs defined, test strategy applied and inclusion or exclusion of possible fungal case definitions. Multiple different detection systems are available, with recently introduced new point-of-care tests such as the lateral flow device and the lateral flow assay. Despite a wide heterogeneity in populations evaluated, studies indicate a better diagnostic performance of bronchoalveolar lavage GM in comparison with serum GM, and a suboptimal specificity of GM bronchoalveolar lavages (cut-off ≥1) and serum β-d-glucan in non-neutropenic individuals. Point-of-care cryptococcal antigen tests show excellent performance.
IMPLICATIONS
There are fungal antigen detection tests available with excellent to reasonable clinical performance to diagnose invasive fungal infections. Only a few assays are useful to monitor therapeutic response. There are multiple marketed IgG antibody tests to detect Aspergillus fumigatus antibodies, the titres vary widely and the performance differs significantly. In general, diagnostic tests are vulnerable to being affected by the host, the microbe and laboratory setting.
Topics: Antigens, Fungal; Bronchoalveolar Lavage Fluid; Candidiasis, Invasive; Clinical Laboratory Techniques; Cryptococcosis; Glucans; Humans; Invasive Fungal Infections; Invasive Pulmonary Aspergillosis; Mannans; Sensitivity and Specificity
PubMed: 33601011
DOI: 10.1016/j.cmi.2021.02.005 -
Pediatric Emergency Care Sep 2020The aims of the study were to perform the first systematic review of pediatric syncope etiologies and to determine the most common diagnoses with credible intervals...
OBJECTIVES
The aims of the study were to perform the first systematic review of pediatric syncope etiologies and to determine the most common diagnoses with credible intervals (CredIs).
METHODS
Review was performed within Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and used Embase, Scopus, PubMed, and the Cochrane Controlled Trial databases. The following inclusion criteria for the articles were used: minimum of 10 patients, standard definition of syncope used, subjects who were 21 years or younger, and subjects who were either a consecutive retrospective group or a prospective group. No restrictions were made regarding language of the studies, but an English abstract was required. The following information was collected: purpose of the study, definition of syncope, number of patients, patient age range, inclusion/exclusion criteria, and etiologies of syncope.
RESULTS
Of the 500 articles initially identified, 11 studies met the inclusion criteria and were the basis for this review. Three thousand seven hundred patients were included, ranging in age from 3 months to 21 years. The most common etiologies identified were vasovagal (52.2%; 95% CredI, 50.6-53.9), postural orthostatic tachycardia syndrome (13.1%; 95% CredI, 12.1-14.2), and cardiac causes (4.0%; 95% CredI, 3.39-4.65). A total of 18.3% (95% CredI, 17.0-19.5) of patients were found to have syncope of unknown cause.
CONCLUSIONS
Syncope is a common pediatric complaint. Most cases seen are a result of benign causes, with only a small percentage because of serious medical conditions. In addition, most syncopal episodes in the pediatric population are diagnosed clinically or with minimally invasive testing, emphasizing the importance of a detailed history and physical examination.
Topics: Child; Diagnosis, Differential; Humans; Medical History Taking; Physical Examination; Syncope
PubMed: 32530839
DOI: 10.1097/PEC.0000000000002149 -
Polski Przeglad Chirurgiczny Mar 2021Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with...
INTRODUCTION
Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with laboratory and imaging methods, and an invasive procedure such as diagnostic laparoscopy may be required to obtain a diagnosis. Diagnostic laparoscopy is also performed therapeutically, but laparotomy is inevitable in some cases. The aim of the study is to evaluate the role of diagnostic laparoscopy in diagnosis and treatment and to retrospectively examine the factors that force the surgeon to perform a laparotomy.
MATERIAL AND METHODS
Patients over the age of 18 who underwent diagnostic laparoscopy in the general surgery clinic of Sakarya University Training and Research Hospital between January 2013 and December 2019 were retrospectively evaluated. Patients under 18 years of age and patients diagnosed before surgery were excluded. Demographic data of the patients, whether there was a conversion from laparoscopy to laparotomy, postoperative morbidity, and mortality were recorded.
RESULTS
The data of 347 patients in total were evaluated retrospectively between the specified dates. 216 of the patients were previously diagnosed, laparoscopic procedures performed for staging purposes and they were not included in the study. The remaining 131 patients were included in the study. 68 of the patients were women and 63 were men. 79.4% of the patients were diagnostic laparoscopies performed due to emergency circumstances, and 20.6% for abdominal pain evaluation. While the procedure was concluded laparoscopically in 64.9% of the patients, the operation was continued by performing laparotomy in 35.1%.
CONCLUSION
Despite the increase in the variety and frequency of use of imaging modalities, a laparoscopic intervention is an essential approach in both diagnosis and treatment when the diagnosis is doubtful, especially in emergency cases in appropriate cases.
Topics: Abdomen; Abdominal Pain; Adolescent; Adult; Female; Humans; Laparoscopy; Laparotomy; Male; Retrospective Studies
PubMed: 33949333
DOI: 10.5604/01.3001.0014.8220 -
JACC. Cardiovascular Imaging Apr 2020This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven...
OBJECTIVES
This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration.
BACKGROUND
Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
METHODS
We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.
RESULTS
A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).
CONCLUSIONS
Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Biopsy; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Echocardiography; Europe; Female; Humans; Immunoglobulin Light-chain Amyloidosis; Magnetic Resonance Imaging; Male; Middle Aged; Myocardium; Predictive Value of Tests; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31864973
DOI: 10.1016/j.jcmg.2019.10.011 -
JAMA Network Open Mar 2023Artificial intelligence (AI) enables powerful models for establishment of clinical diagnostic and prognostic tools for hip fractures; however the performance and... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Artificial intelligence (AI) enables powerful models for establishment of clinical diagnostic and prognostic tools for hip fractures; however the performance and potential impact of these newly developed algorithms are currently unknown.
OBJECTIVE
To evaluate the performance of AI algorithms designed to diagnose hip fractures on radiographs and predict postoperative clinical outcomes following hip fracture surgery relative to current practices.
DATA SOURCES
A systematic review of the literature was performed using the MEDLINE, Embase, and Cochrane Library databases for all articles published from database inception to January 23, 2023. A manual reference search of included articles was also undertaken to identify any additional relevant articles.
STUDY SELECTION
Studies developing machine learning (ML) models for the diagnosis of hip fractures from hip or pelvic radiographs or to predict any postoperative patient outcome following hip fracture surgery were included.
DATA EXTRACTION AND SYNTHESIS
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and was registered with PROSPERO. Eligible full-text articles were evaluated and relevant data extracted independently using a template data extraction form. For studies that predicted postoperative outcomes, the performance of traditional predictive statistical models, either multivariable logistic or linear regression, was recorded and compared with the performance of the best ML model on the same out-of-sample data set.
MAIN OUTCOMES AND MEASURES
Diagnostic accuracy of AI models was compared with the diagnostic accuracy of expert clinicians using odds ratios (ORs) with 95% CIs. Areas under the curve for postoperative outcome prediction between traditional statistical models (multivariable linear or logistic regression) and ML models were compared.
RESULTS
Of 39 studies that met all criteria and were included in this analysis, 18 (46.2%) used AI models to diagnose hip fractures on plain radiographs and 21 (53.8%) used AI models to predict patient outcomes following hip fracture surgery. A total of 39 598 plain radiographs and 714 939 hip fractures were used for training, validating, and testing ML models specific to diagnosis and postoperative outcome prediction, respectively. Mortality and length of hospital stay were the most predicted outcomes. On pooled data analysis, compared with clinicians, the OR for diagnostic error of ML models was 0.79 (95% CI, 0.48-1.31; P = .36; I2 = 60%) for hip fracture radiographs. For the ML models, the mean (SD) sensitivity was 89.3% (8.5%), specificity was 87.5% (9.9%), and F1 score was 0.90 (0.06). The mean area under the curve for mortality prediction was 0.84 with ML models compared with 0.79 for alternative controls (P = .09).
CONCLUSIONS AND RELEVANCE
The findings of this systematic review and meta-analysis suggest that the potential applications of AI to aid with diagnosis from hip radiographs are promising. The performance of AI in diagnosing hip fractures was comparable with that of expert radiologists and surgeons. However, current implementations of AI for outcome prediction do not seem to provide substantial benefit over traditional multivariable predictive statistics.
Topics: Humans; Artificial Intelligence; Hip Fractures; Prognosis; Algorithms; Length of Stay
PubMed: 36930153
DOI: 10.1001/jamanetworkopen.2023.3391 -
Journal of Medical Ultrasonics (2001) Jul 2023The standard diagnostic modalities for gastrointestinal (GI) diseases have long been endoscopy and barium enema. Recently, trans-sectional imaging modalities, such as... (Review)
Review
The standard diagnostic modalities for gastrointestinal (GI) diseases have long been endoscopy and barium enema. Recently, trans-sectional imaging modalities, such as computed tomography and magnetic resonance imaging, have become increasingly utilized in daily practice. In transabdominal ultrasonography (US), the bowel sometimes interferes with the observation of abdominal organs. Additionally, the thin intestinal walls and internal gas can make structures difficult to identify. However, under optimal US equipment settings, with identification of the sonoanatomy and knowledge of the US findings of GI diseases, US can be used effectively to diagnose GI disorders. Thus, the efficacy of GIUS has been gradually recognized, and GIUS guidelines have been published by the World Federation for Ultrasound in Medicine and Biology and the European Federation of Societies for Ultrasound in Medicine and Biology. Following a systematic scanning method according to the sonoanatomy and precisely estimating the layered wall structures by employing color Doppler make diagnosing disease and evaluating the degree of inflammation possible. This review describes current GIUS practices from an equipment perspective, a procedure for systematic scanning, typical findings of the normal GI tract, and 10 diagnostic items in an attempt to help medical practitioners effectively perform GIUS and promote the use of GIUS globally.
Topics: Humans; Ultrasonography; Gastrointestinal Diseases; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 36087155
DOI: 10.1007/s10396-022-01236-0