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Sample records for diagnosis diagnostic energetique

  1. Energy diagnosis; Diagnostic energetique

    Energy Technology Data Exchange (ETDEWEB)

    Vivien, P. [Centre Technique des Industries Mecaniques (CETIM), Franche-Comte (France)

    1996-12-31

    Through a partnership with regional authorities and the French Energy Conservation Agency (ADEME), the CETIM (Technical Agency for Mechanical Industries) is proposing energy audits in industrial plants with the aim to increase the plant performances, reduce energy costs and work out environmental issues. Concrete improvement solutions are proposed with profitability calculations. The audit procedure is presented. The most efficient solutions generally involve energy tariff rate shifts, heating regulation, power cut-off, reactive energy compensation and lighting management

  2. The energy diagnostic of the textile industry enterprise; Le diagnostic energetique d'une entreprise du secteur textile

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    This document formalizes the reasoning of an energy diagnostic (optimization of the energy management and of the energy consumption) and illustrates it by the measures of energy conservation concerned. (A.L.B.)

  3. Diagnostic Ultrasound in Gynecologic Diagnosis

    OpenAIRE

    Coates, C. F.

    1983-01-01

    Diagnostic ultrasound is helpful in the assessment of many common gynecological conditions from early teens to the late postmenopause. Female pelvic anatomy and pathology are readily imaged through a distended urinary bladder. In gynecologic cancer, examination of peritoneal cavity, kidneys and liver can suggest metastatic spread, which aids tumor staging.

  4. Diagnosis and diagnostic tests for fibromyalgia (syndrome

    Directory of Open Access Journals (Sweden)

    F. Wolfe

    2012-09-01

    Full Text Available Objectives: To present diagnostic criteria for the clinical diagnosis of fibromyalgia syndrome (FMS and to offer a scheme for diagnostic work-up in clinical practice. Methods: Narrative review of the literature, consensus documents by the American College of Rheumatology (ACR, evidence-based interdisciplinary German guidelines on the diagnosis and management of FMS. Results: The ACR 1990 classification criteria emphasized tender points and widespread pain as the key features of FMS. In 2010, the ACR proposed preliminary diagnostic criteria for fibromyalgia that abandoned the tender point count and placed increased emphasis of patient symptoms. A later modification of the ACR 2010 criteria for use in surveys employed a self-report questionnaire (Fibromyalgia Survey Questionnaire FSQ to assess patient symptoms. The FSQ can be used to assist physician’s diagnosis of FMS. We recommend a stepwise diagnostic work-up of patients with chronic widespread pain (CWP in primary care: Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, screening for other functional somatic symptoms and mental disorders, and referring to mental health specialists in case of mental disorder. Conclusions: The diagnosis of FMS is easy in most patients with CWP and does not ordinarily require a rheumatologist. A rheumatologist’s expertise might be needed to exclude difficult to diagnose or concomitant inflammatory rheumatic diseases. In the presence of mental illness referral to a mental health specialist for evaluation is recommended.

  5. Struggling with a depression diagnosis: Negotiations with diagnostic categories

    DEFF Research Database (Denmark)

    Rønberg, Mette

    2017-01-01

    and complicated struggles with, a psychiatric diagnosis stand out, as she continu- ously struggles to articulate an oppositional stance to the dominant diagnostic categories. The negotiations take place in a complex network where medical authorities, the workplace and the diagnostic cultures play a crucial part...... of persons’ ongoing and changing responses to diagnostic labels over time....

  6. Culture in Diagnostics of Refugees : The Cultural Formulation of Diagnosis

    NARCIS (Netherlands)

    Rohlof, Hans; Knipscheer, J.W.|info:eu-repo/dai/nl/126584591; Kleber, R.J.|info:eu-repo/dai/nl/069316929

    2011-01-01

    Background and purpose: The Cultural Formulation of Diagnosis (CFD) is a qualitative instrument in DSM-IV to describe the influence of culture on diagnostics. In ethnic minorities and refugees it is important to use this instrument in order to enhance diagnostic validity, communication and

  7. FNA diagnosis of CD99 positive neuroblastoma: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Gagandeep Kaur

    2012-01-01

    Full Text Available Tissue diagnosis of small round cell tumors relies heavily on immunohistochemical staining. Two of the small round cell tumors, namely neuroblastoma and primitive neuroectodermal tumor, have considerable morphologic overlap. Many studies suggest that CD99 positivity virtually excludes the diagnosis of neuroblastoma. We report a case of poorly differentiated neuroblastoma in which aberrant CD99 positivity led to diagnostic dilemma.

  8. Diagnostic Bias and Conduct Disorder: Improving Culturally Sensitive Diagnosis

    Science.gov (United States)

    Mizock, Lauren; Harkins, Debra

    2011-01-01

    Disproportionately high rates of Conduct Disorder are diagnosed in African American and Latino youth of color. Diagnostic bias contributes to overdiagnosis of Conduct Disorder in these adolescents of color. Following a diagnosis of Conduct Disorder, adolescents of color face poorer outcomes than their White counterparts. These negative outcomes…

  9. Diagnostic Bias and Conduct Disorder: Improving Culturally Sensitive Diagnosis

    Science.gov (United States)

    Mizock, Lauren; Harkins, Debra

    2011-01-01

    Disproportionately high rates of Conduct Disorder are diagnosed in African American and Latino youth of color. Diagnostic bias contributes to overdiagnosis of Conduct Disorder in these adolescents of color. Following a diagnosis of Conduct Disorder, adolescents of color face poorer outcomes than their White counterparts. These negative outcomes…

  10. Diagnosis demystified: CT as diagnostic tool in endodontics.

    Science.gov (United States)

    Shruthi, Nagaraja; Murthy, B V Sreenivasa; Sundaresh, K J; Mallikarjuna, Rachappa

    2013-06-27

    Diagnosis in endodontics is usually based on clinical and radiographical presentations, which are only empirical methods. The role of healing profession is to apply knowledge and skills towards maintaining and restoring the patient's health. Recent advances in imaging technologies have added to correct interpretation and diagnosis. CT is proving to be an effective tool in solving endodontic mysteries through its three-dimensional visualisation. CT imaging offers many diagnostic advantages to produce reconstructed images in selected projection and low-contrast resolution far superior to that of all other X-ray imaging modalities. This case report is an endeavour towards effective treatment planning of cases with root fracture, root resorption using spiral CT as an adjuvant diagnostic tool.

  11. The Diagnostic Value of Skin Disease Diagnosis Expert System.

    Science.gov (United States)

    Jeddi, Fatemeh Rangraz; Arabfard, Masoud; Arabkermany, Zahra; Gilasi, Hamidreza

    2016-02-01

    Evaluation is a necessary measure to ensure the effectiveness and efficiency of all systems, including expert systems. The aim of this study was to determine the diagnostic value of expert system for diagnosis of complex skin diseases. A case-control study was conducted in 2015 to determine the diagnostic value of an expert system. The study population included patients who were referred to Razi Specialized Hospital, affiliated to Tehran University of Medical Sciences. The control group was selected from patients without the selected skin diseases. Data collection tool was a checklist of clinical signs of diseases including pemphigus vulgaris, lichen planus, basal cell carcinoma, melanoma, and scabies. The sample size formula estimated 400 patients with skin diseases selected by experts and 200 patients without the selected skin diseases. Patient selection was undertaken with randomized stratified sampling and their sign and symptoms were logged into the system. Physician's diagnosis was determined as the gold standard and was compared with the diagnosis of expert system by SPSS software version 16 and STATA. Kappa statistics, indicators of sensitivity, specificity, accuracy and confidence intervals were calculated for each disease. An accuracy of 90% was considered appropriate. Comparing the results of expert system and physician's diagnosis at the evaluation stage showed an accuracy of 97.1%, sensitivity of 97.5% and specificity of 96.5% The Kappa test indicated a high agreement of 93.6%. The expert system can diagnose complex skin diseases. Development of such systems is recommended to identify all skin diseases.

  12. Diagnosis of occlusal caries: Part II. Recent diagnostic technologies.

    Science.gov (United States)

    Tam, L E; McComb, D

    2001-09-01

    Accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. The diagnosis of non-overt occlusal decay is challenging and can be highly subjective, and its inherent uncertainties can lead to widely differing treatment decisions. The purpose of this 2-part paper is to review current knowledge concerning conventional and new diagnostic methods for occlusal caries. Part I looked at established methods for diagnosing occlusal decay. These methods have several limitations, particularly in their ability to diagnose early carious lesions. Part II examines new and emerging technologies that are being developed for the diagnosis of occlusal decay. Electrical conductance measurements and quantitative laser- or light-induced fluorescence represent significant improvements over conventional diagnostic methods, especially for in vitro applications and particularly with regard to sensitivity and reproducibility. Proponents of the DIAGNOdent laser fluorescence system claim that it evaluates the fluorescence that develops when laser light is incident on areas of demineralization. This noninvasive device is simple to use and provides quantitative data. Studies supporting its validity are limited but do suggest good sensitivity and excellent reproducibility. However, the DIAGNOdent system requires more scientific scrutiny. Although it offers a high rate of disease detection, it has little ability to indicate the extent of decay. In all treatment decisions, clinicians must be aware of the limitations of the diagnostic methods that have been used. Clinical judgment based on the patient s case history, visual cues, review of radiographs and probability of disease is still the most important aspect of optimum patient care. New technologies may provide supplemental information, but they cannot yet replace established methods for the diagnosis of occlusal caries.

  13. Prenatal diagnosis--principles of diagnostic procedures and genetic counseling.

    Directory of Open Access Journals (Sweden)

    Ryszard Slezak

    2008-04-01

    Full Text Available The frequency of inherited malformations as well as genetic disorders in newborns account for around 3-5%. These frequency is much higher in early stages of pregnancy, because serious malformations and genetic disorders usually lead to spontaneous abortion. Prenatal diagnosis allowed identification of malformations and/or some genetic syndromes in fetuses during the first trimester of pregnancy. Thereafter, taking into account the severity of the disorders the decision should be taken in regard of subsequent course of the pregnancy taking into account a possibilities of treatment, parent's acceptation of a handicapped child but also, in some cases the possibility of termination of the pregnancy. In prenatal testing, both screening and diagnostic procedures are included. Screening procedures such as first and second trimester biochemical and/or ultrasound screening, first trimester combined ultrasound/biochemical screening and integrated screening should be widely offered to pregnant women. However, interpretation of screening results requires awareness of both sensitivity and predictive value of these procedures. In prenatal diagnosis ultrasound/MRI searching as well as genetic procedures are offered to pregnant women. A variety of approaches for genetic prenatal analyses are now available, including preimplantation diagnosis, chorion villi sampling, amniocentesis, fetal blood sampling as well as promising experimental procedures (e.g. fetal cell and DNA isolation from maternal blood. An incredible progress in genetic methods opened new possibilities for valuable genetic diagnosis. Although karyotyping is widely accepted as golden standard, the discussion is ongoing throughout Europe concerning shifting to new genetic techniques which allow obtaining rapid results in prenatal diagnosis of aneuploidy (e.g. RAPID-FISH, MLPA, quantitative PCR.

  14. Image standards in Tissue-Based Diagnosis (Diagnostic Surgical Pathology

    Directory of Open Access Journals (Sweden)

    Vollmer Ekkehard

    2008-04-01

    Full Text Available Abstract Background Progress in automated image analysis, virtual microscopy, hospital information systems, and interdisciplinary data exchange require image standards to be applied in tissue-based diagnosis. Aims To describe the theoretical background, practical experiences and comparable solutions in other medical fields to promote image standards applicable for diagnostic pathology. Theory and experiences Images used in tissue-based diagnosis present with pathology – specific characteristics. It seems appropriate to discuss their characteristics and potential standardization in relation to the levels of hierarchy in which they appear. All levels can be divided into legal, medical, and technological properties. Standards applied to the first level include regulations or aims to be fulfilled. In legal properties, they have to regulate features of privacy, image documentation, transmission, and presentation; in medical properties, features of disease – image combination, human – diagnostics, automated information extraction, archive retrieval and access; and in technological properties features of image acquisition, display, formats, transfer speed, safety, and system dynamics. The next lower second level has to implement the prescriptions of the upper one, i.e. describe how they are implemented. Legal aspects should demand secure encryption for privacy of all patient related data, image archives that include all images used for diagnostics for a period of 10 years at minimum, accurate annotations of dates and viewing, and precise hardware and software information. Medical aspects should demand standardized patients' files such as DICOM 3 or HL 7 including history and previous examinations, information of image display hardware and software, of image resolution and fields of view, of relation between sizes of biological objects and image sizes, and of access to archives and retrieval. Technological aspects should deal with image

  15. Image standards in tissue-based diagnosis (diagnostic surgical pathology).

    Science.gov (United States)

    Kayser, Klaus; Görtler, Jürgen; Goldmann, Torsten; Vollmer, Ekkehard; Hufnagl, Peter; Kayser, Gian

    2008-04-18

    Progress in automated image analysis, virtual microscopy, hospital information systems, and interdisciplinary data exchange require image standards to be applied in tissue-based diagnosis. To describe the theoretical background, practical experiences and comparable solutions in other medical fields to promote image standards applicable for diagnostic pathology. THEORY AND EXPERIENCES: Images used in tissue-based diagnosis present with pathology-specific characteristics. It seems appropriate to discuss their characteristics and potential standardization in relation to the levels of hierarchy in which they appear. All levels can be divided into legal, medical, and technological properties. Standards applied to the first level include regulations or aims to be fulfilled. In legal properties, they have to regulate features of privacy, image documentation, transmission, and presentation; in medical properties, features of disease-image combination, human-diagnostics, automated information extraction, archive retrieval and access; and in technological properties features of image acquisition, display, formats, transfer speed, safety, and system dynamics. The next lower second level has to implement the prescriptions of the upper one, i.e. describe how they are implemented. Legal aspects should demand secure encryption for privacy of all patient related data, image archives that include all images used for diagnostics for a period of 10 years at minimum, accurate annotations of dates and viewing, and precise hardware and software information. Medical aspects should demand standardized patients' files such as DICOM 3 or HL 7 including history and previous examinations, information of image display hardware and software, of image resolution and fields of view, of relation between sizes of biological objects and image sizes, and of access to archives and retrieval. Technological aspects should deal with image acquisition systems (resolution, colour temperature, focus

  16. Desquamative inflammatory vaginitis: differential diagnosis and alternate diagnostic criteria.

    Science.gov (United States)

    Bradford, Jennifer; Fischer, Gayle

    2010-10-01

    To describe alternate diagnostic protocols and describe the differential diagnosis for desquamative inflammatory vaginitis (DIV). One hundred one cases of DIV were audited retrospectively. All patients were seen exclusively by the authors in their private practices using diagnostic criteria applicable to local practice limitations. Other potential etiologies (infection, contact irritant vaginitis, fixed drug eruptions, immunobullous diseases, estrogen hypersensitivity vulvovaginitis, and graft-vs-host disease) were excluded by history, examination, and focused trials of treatment. Historical triggers in the study cohort and a control group of 75 women with lichen planus also drawn from the authors' private practice were compared. Patients were treated with 4 to 6 weeks of topical vaginal antibiotics, 94% with clindamycin, and response to treatment was recorded at subsequent follow-up. All patients were white. Of 101 patients, 57 (56%) had historical triggers, most frequently diarrhea or antibiotic treatment. Of the 75 women in the control group with vaginal lichen planus, 11 had historical triggers (15%, p vaginitis, which were ongoing, were cured when their triggers were finally controlled or cured, leaving 35 patients who required long-term maintenance therapy. Desquamative inflammatory vaginitis seems to be a distinct entity of vaginitis that, in an office setting, can be distinguished from other diagnostic possibilities by careful clinical evaluation and focused trials of treatment. The majority of women responded promptly to intravaginal antibiotics, with approximately 35% of cases requiring maintenance therapy. More than half the cases have an historical trigger. We postulate that DIV occurs when a trigger causes shifts in vaginal homeostasis, resulting in an inflammatory response associated with increased epithelial cell turnover.

  17. Quantifying diagnostic uncertainty using item response theory: the Posterior Probability of Diagnosis Index.

    Science.gov (United States)

    Lindhiem, Oliver; Kolko, David J; Yu, Lan

    2013-06-01

    Using traditional Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (American Psychiatric Association, 2000) diagnostic criteria, clinicians are forced to make categorical decisions (diagnosis vs. no diagnosis). This forced choice implies that mental and behavioral health disorders are categorical and does not fully characterize varying degrees of uncertainty associated with a particular diagnosis. Using an item response theory (latent trait model) framework, we describe the development of the Posterior Probability of Diagnosis (PPOD) Index, which answers the question: What is the likelihood that a patient meets or exceeds the latent trait threshold for a diagnosis? The PPOD Index is based on the posterior distribution of θ (latent trait score) for each patient's profile of symptoms. The PPOD Index allows clinicians to quantify and communicate the degree of uncertainty associated with each diagnosis in probabilistic terms. We illustrate the advantages of the PPOD Index in a clinical sample (N = 321) of children and adolescents with oppositional defiant disorder.

  18. Meckel-Gruber syndrome: pathologic manifestations, minimal diagnostic criteria, and differential diagnosis.

    Science.gov (United States)

    Alexiev, Borislav A; Lin, Xiaoqing; Sun, Chen-Chih; Brenner, David S

    2006-08-01

    This article provides an overview of the major pathologic manifestations of Meckel-Gruber syndrome, current knowledge about its pathogenesis, minimal diagnostic criteria, and differential diagnosis. Typical sonographic findings (occipital encephalocele, postaxial polydactyly, and cystic enlargement of the kidneys) allow for diagnosis of most cases before the 14th week of gestation, but the pathologist may encounter clinically unsuspected or atypical cases that require morphologic confirmation. In these cases, a meticulous autopsy is necessary to establish the diagnosis of Meckel-Gruber syndrome.

  19. Mathematical (diagnostic algorithms in the digitization of oral histopathology: The new frontier in histopathological diagnosis

    Directory of Open Access Journals (Sweden)

    Abhishek Banerjee

    2015-01-01

    Full Text Available The technological progress in the digitalization of a complete histological glass slide has opened a new door in the tissue based diagnosis. Automated slide diagnosis can be made possible by the use of mathematical algorithms which are formulated by binary codes or values. These algorithms (diagnostic algorithms include both object based (object features, structures and pixel based (texture measures. The intra- and inter-observer errors inherent in the visual diagnosis of a histopathological slide are largely replaced by the use of diagnostic algorithms leading to a standardized and reproducible diagnosis. The present paper reviews the advances in digital histopathology especially related to the use of mathematical algorithms (diagnostic algorithms in the field of oral histopathology. The literature was reviewed for data relating to the use of algorithms utilized in the construction of computational software with special applications in oral histopathological diagnosis. The data were analyzed, and the types and end targets of the algorithms were tabulated. The advantages, specificities and reproducibility of the software, its shortcomings and its comparison with traditional methods of histopathological diagnosis were evaluated. Algorithms help in automated slide diagnosis by creating software with possible reduced errors and bias with a high degree of specificity, sensitivity, and reproducibility. Akin to the identification of thumbprints and faces, software for histopathological diagnosis will in the near future be an important part of the histopathological diagnosis.

  20. Qualitative Event-Based Diagnosis: Case Study on the Second International Diagnostic Competition

    Science.gov (United States)

    Daigle, Matthew; Roychoudhury, Indranil

    2010-01-01

    We describe a diagnosis algorithm entered into the Second International Diagnostic Competition. We focus on the first diagnostic problem of the industrial track of the competition in which a diagnosis algorithm must detect, isolate, and identify faults in an electrical power distribution testbed and provide corresponding recovery recommendations. The diagnosis algorithm embodies a model-based approach, centered around qualitative event-based fault isolation. Faults produce deviations in measured values from model-predicted values. The sequence of these deviations is matched to those predicted by the model in order to isolate faults. We augment this approach with model-based fault identification, which determines fault parameters and helps to further isolate faults. We describe the diagnosis approach, provide diagnosis results from running the algorithm on provided example scenarios, and discuss the issues faced, and lessons learned, from implementing the approach

  1. Evaluation of diagnostic criteria of DSM-IV-TR for diagnosis of internet addiction disorder

    OpenAIRE

    2011-01-01

    Background: The latest version of Diagnostic and Statistical Manual for Mental Disorder (DSM-IV-TR), classified internet addiction disorder under "impulse control disorder not elsewhere classified". This study evaluates diagnostic criteria of DSM-IV-TR for diagnosis of IAD correspondence with Iranian society and culture.Materials and Method: This is a descriptive-analytical and cross-sectional research. For these purpose 400 students of Isfahan universities were entered into the study. Sampli...

  2. Diagnostic dilemma of FNA diagnosis of secretory carcinoma of breast

    Directory of Open Access Journals (Sweden)

    Archana C Buch

    2014-01-01

    Full Text Available Secretory carcinoma (SC is one of the least common types of breast carcinoma. The tumor has distinctive histologic features with prominent secretory activity similar to lactational change and minimal nuclear atypia. As the cytomorphologic features of SC overlaps benign breast lesions with lactational change and apocrine change, the initial diagnosis of SC may be missed on cytology in some cases. A 29-year-old woman presented with a lump in the left breast since 9 months. The fine needle aspiration cytology (FNAC suggested proliferative breast disease without atypia. Excision biopsy showed secretory carcinoma. The case is presented to highlight the cytologic features of SC, which may overlap with lactational change and apocrine change.

  3. Cytological diagnosis of chondroblastoma: diagnostic challenge for the cytopathologist.

    Science.gov (United States)

    Akhtar, Kafil; Qadri, Shagufta; Sen Ray, Prasenjit; Sherwani, Rana K

    2014-05-29

    Chondroblastoma is an uncommon osseous neoplasm that accounts for less than 1% of all bone tumours. It characteristically arises in the epiphysis or epimetaphyseal region of long bones and has been reported to affect people of all ages with slight male predilection. WHO has defined chondroblastoma as 'a benign, cartilage-producing neoplasm usually arising in the epiphyses of skeletally immature patients'. The authors document the cytological features on fine-needle aspiration cytology of a chondroblastoma which appeared as a lytic lesion in the upper end of the right fibula, an uncommon site, in an 18-year-old male patient. X-ray feature combined with fine-needle aspiration cytology favoured the diagnosis of chondroblastoma, which was further confirmed by histopathological examination.

  4. CT-diagnosis of optic nerve lesions. Differential diagnostic criteria

    Energy Technology Data Exchange (ETDEWEB)

    Unsoeld, R.

    1982-01-01

    Computed tomograms of 166 optic nerve lesions were analyzed: 97 were mainly orbital and 69 mainly intracranial. The criteria were clinical course, size, density and delineation of the optic nerve shadow, orbital and cerebral soft tissue abnormalities, and bony changes in the optic canal. Characteristic CT features are described of individual disease entities such as optic gliomas, optic nerve sheath meningiomas, neoplastic and inflammatory infiltrations. The differential diagnostic importance of individual CT criteria is evaluated and discussed. Simultaneous visualization of orbital and intracranial soft tissue changes as well as bony changes in the optic canal allow the location and identification of the majority of optic nerve lesions based on the criteria mentioned above, and optic nerve tumors can be differentiated. In 9 patients with optic neuritis due to clinically proven encephalitis and in 17 patients with total optic atrophy, no changes in the size of the optic nerve could be found. CT evaluation of the intraorbital portion of the optic nerve requires special examination techniques. Oblique computer reformations through the optic canal provide excellent visualization of bony changes in the optic canal. The exclusion of intracranial causes of optic nerve lesions requires intravenous injection of contrast material.

  5. Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis

    DEFF Research Database (Denmark)

    Jahn, H; Mathiesen, F K; Neckelmann, K

    1997-01-01

    OBJECTIVE: To evaluate the diagnostic accuracy of clinical judgment and diagnostic ultrasonography (US) used routinely and to create a scoring system to aid diagnosis. DESIGN: Prospective, double-blind study. SETTING: University hospital, Denmark. SUBJECTS: 222 Consecutive patients suspected...... to create a scoring system. MAIN OUTCOME MEASURES: Results of surgical pathological findings, clinical outcome (observed group), diagnostic US, and values of diagnostic score. RESULTS: The decision to operate was made by a junior surgeon solely on the clinical examination, which yielded a diagnostic......%. Of the 21 predictive factors for acute appendicitis 11 were significant (p 10 x 10[9]/1), migration of pain to the right lower quadrant, gradual onset of pain, increasing intensity of pain, pain aggravated by movement, pain aggravated by coughing, anorexia, vomiting...

  6. Equilibrium disorders in elderly: diagnostic classification and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Alessandro Castiglione

    2013-04-01

    Full Text Available Background: Balance is primarily related to the proper functioning of three sensory input: vestibular, visual and proprioceptive. The integration of these different afferences contributes to the proper attitude of the body in static and dynamic conditions. Equilibrium disorders are common among elderly patients and are responsible for falls and fractures, leading sometimes to catastrophic outcomes, representing a serious health and social problem. Approximately one third of elderly patients at home and about 50% of institutionalized, over 75 year-old, suffer from this particular condition, with at least one fall a year and almost 50% of these with recurrent episodes. Females are more affected than males. Attempts to ascertain the underlying cause of unbalance should be done, leading then to specific treatment. Nevertheless, many elderly patients do not have a single disease but rather a multitude of medical conditions which may cause dizziness, imbalance and vertigo: effects of ageing, drugs, cardiovascular and neurological disorders, ocular and orthopaedic diseases. Aim of the study: A literature review was carried out with the intention to offer practical and useful notions for the management and treatment of equilibrium disorders. Discussion: In clinical practice, the main challenge is to distinguish between peripheral and central imbalance disorders. The data collected from history and clinical exams should be integrated with the intent to include the patient in one of the following clinical conditions: vertiginous syndrome, pre-syncope and/or syncope, neurological diseases, other conditions.Conclusions: Following the differential diagnosis, treatment mainly consists in drug administration (antiemetic and vestibular suppressor drugs and vestibular rehabilitation (physiotherapy and vestibular exercises.

  7. A possible new diagnostic biomarker in early diagnosis of Alzheimer's disease

    DEFF Research Database (Denmark)

    Kork, Felix; Holthues, Jan; Hellweg, Rainer;

    2009-01-01

    Early diagnosis in patients with Alzheimer's disease (AD) is of great importance since only a sufficient treatment in early stages of this disease helps to keep patients in an autonomous state for as long as possible. Until now, there is no single diagnostic biomarker for AD derived from material...

  8. Diagnostic Accuracy of Cerebrospinal Fluid Amyloid-beta Isoforms for Early and Differential Dementia Diagnosis

    NARCIS (Netherlands)

    Struyfs, Hanne; Van Broeck, Bianca; Timmers, Maarten; Fransen, Erik; Sleegers, Kristel; Van Broeckhoven, Christine; De Deyn, Peter P.; Streffer, Johannes R.; Mercken, Marc; Engelborghs, Sebastiaan

    2015-01-01

    Background: Overlapping cerebrospinal fluid biomarkers (CSF) levels between Alzheimer's disease (AD) and non-AD patients decrease differential diagnostic accuracy of the AD core CSF biomarkers. Amyloid-beta (A beta) isoforms might improve the AD versus non-AD differential diagnosis. Objective: To de

  9. Diagnosis of renovascular hypertension: current practice; Diagnostic de l`hypertention renovasculaire: donnees actuelles

    Energy Technology Data Exchange (ETDEWEB)

    Prigent, A.; Froissart, M.; Hignette, C. [Hopital Broussais, 75 - Paris (France); Maksud, P. [Hopital Pitie-Salpetriere, 75 - Paris (France); Archambaud, F. [Hopital de Bicetre, 94 - le Kremlin-Bicetre (France)

    1995-12-31

    This article aims to review the efficacy of the different methods used for thee screening of renal artery stenoses in hypertensive patients and the diagnosis of renovascular hypertension in order to propose some current recommendations for the diagnostic strategy. (authors). 80 refs., 3 figs., 1 tab.

  10. Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia

    DEFF Research Database (Denmark)

    Salem, Lise Cronberg; Andersen, Birgitte Bo; Nielsen, T Rune

    2014-01-01

    BACKGROUND: Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. METHODS: Two hundred ...... be misinterpreted by clinicians and that a diagnosis of dementia in the young is only rarely based on a complete basic diagnostic work-up, calling for increased competency.......BACKGROUND: Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. METHODS: Two hundred...... patients were randomly selected from 891 patients aged ≤65 years registered with a diagnosis of dementia for the first time in 2008 in Danish hospitals, and 159 medical records were available for review. Three raters evaluated their medical records for the completeness of the diagnostic work-up on which...

  11. Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea

    Science.gov (United States)

    Gasparini, Giulio; Vicini, Claudio; De Benedetto, Michele; Salamanca, Fabrizio; Sorrenti, Giovanni; Romandini, Mario; Bosi, Marcello; Saponaro, Gianmarco; Foresta, Enrico; Laforì, Andreina; Meccariello, Giuseppe; Bianchi, Alessandro; Toraldo, Domenico Maurizio; Campanini, Aldo; Montevecchi, Filippo; Rizzotto, Grazia; Cervelli, Daniele; Moro, Alessandro; Arigliani, Michele; Gobbi, Riccardo; Pelo, Sandro

    2015-01-01

    Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82–0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76–0.92) for severe OSA (AHI ≥ 30). Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed. PMID:26636102

  12. Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Giulio Gasparini

    2015-01-01

    Full Text Available Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5 and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p<0.01. The area under the ROC curve (95% CI was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00 for the diagnosis of OSA (AHI ≥ 5, 0.90 (0.82–0.98 for moderate OSA (AHI ≥ 15, and 0.84 (0.76–0.92 for severe OSA (AHI ≥ 30. Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.

  13. Laboratory diagnosis of Toxoplasma gondii infection with direct and indirect diagnostic techniques

    Directory of Open Access Journals (Sweden)

    Salvatore Pignanelli

    2011-01-01

    Full Text Available Background: Toxoplasma gondii infection, common parasitic zoonoses, is an important cause of spontaneous abortion, mental retardation, encephalitis, ocular disease and death worldwide. Today the major diagnostic techniques for the toxoplasmosis are serological assays, but its have many limitations. Aim : The goal in this study is to improve the diagnostic accuracy of T. gondii infection, using direct (Real Time PCR and indirect (IgM, IgA, IgG and IgG avidity diagnostic techniques. Materials and Methods: In the period between 2007 and 2008, 96 non consecutive different clinical samples (38 blood, 40 amniotic fluids, 8 cerebrospinal fluids, 10 vitreous humors and 96 sera have been studied simultaneously through molecular biology and serological techniques. Results: Direct and indirect diagnostic techniques used in this study for laboratory diagnosis of T. gondii infection were always concordant. Conclusions : The high correlation between direct and indirect diagnostic techniques exhibit that serologic techniques are accurate diagnostic assays as screening test in laboratory diagnosis of toxoplasmosis.

  14. Diagnostic and Treatment Reproducibility of Cervical Intraepithelial Neoplasia / Squamous Intraepithelial Lesion and Factors Affecting the Diagnosis.

    Science.gov (United States)

    Sağlam, Arzu; Usubütün, Alp; Dolgun, Anıl; Mutter, George L; Salman, M Coşkun; Kurtulan, Olcay; Akyol, Aytekin; Özkan, Eylem Akar; Baykara, Sema; Bülbül, Dilek; Calay, Zerrin; Eren, Funda; Gümürdülü, Derya; Haberal, Nihan; Ilvan, Şennur; Karaveli, Şeyda; Koyuncuoğlu, Meral; Müezzinoğlu, Bahar; Müftüoğlu, Kamil Hakan; Özen, Özlem; Özdemir, Necmettin; Peştereli, Elif; Ulukuş, Çağnur; Zekioğlu, Osman

    2017-01-01

    Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. 19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

  15. Motor onset and diagnosis in Huntington disease using the diagnostic confidence level.

    Science.gov (United States)

    Liu, Dawei; Long, Jeffrey D; Zhang, Ying; Raymond, Lynn A; Marder, Karen; Rosser, Anne; McCusker, Elizabeth A; Mills, James A; Paulsen, Jane S

    2015-12-01

    Huntington disease (HD) is a neurodegenerative disorder characterized by motor dysfunction, cognitive deterioration, and psychiatric symptoms, with progressive motor impairments being a prominent feature. The primary objectives of this study are to delineate the disease course of motor function in HD, to provide estimates of the onset of motor impairments and motor diagnosis, and to examine the effects of genetic and demographic variables on the progression of motor impairments. Data from an international multisite, longitudinal observational study of 905 prodromal HD participants with cytosine-adenine-guanine (CAG) repeats of at least 36 and with at least two visits during the followup period from 2001 to 2012 was examined for changes in the diagnostic confidence level from the Unified Huntington's Disease Rating Scale. HD progression from unimpaired to impaired motor function, as well as the progression from motor impairment to diagnosis, was associated with the linear effect of age and CAG repeat length. Specifically, for every 1-year increase in age, the risk of transition in diagnostic confidence level increased by 11% (95% CI 7-15%) and for one repeat length increase in CAG, the risk of transition in diagnostic confidence level increased by 47% (95% CI 27-69%). Findings show that CAG repeat length and age increased the likelihood of the first onset of motor impairment as well as the age at diagnosis. Results suggest that more accurate estimates of HD onset age can be obtained by incorporating the current status of diagnostic confidence level into predictive models.

  16. Direct PCR: Alternative Diagnostic Method for Diagnosis of Diphtheria Rapidly, Easily and Cost Effective

    Directory of Open Access Journals (Sweden)

    Sunarno Sunarno

    2013-12-01

    Full Text Available Some diseases require immediate and appropriate treatment to decrease the fatality risk patients incident, for example diphtheria. Time to help patients is very crucial since delay of therapy may increase the mortality cases up to 20 times. In other hands, conventional diagnostic methods (the gold standard for diagnosis of diphtheria is time consuming and laborious. Therefore, an alternative diagnostic method which is rapid, easy and inexpensive is needed. In this case, direct PCR has been proved to reduce time and cost in laboratory examination. This study aimed to develop direct PCR as alternative diagnostic method for diagnosis of diphtheria rapidly, easily, and inexpensive. Fifteen samples include 10 isolates of Corynebacterium diphtheriae (toxigenic and 3 isolates of Corynebacterium non- diphtheriae (nontoxigenic and 2 clinical specimens (throat swab was examined by performing direct PCR method and a standard PCR method was used for optimizing the protocols. Result showed that direct PCR can be used to amplify target genes correctly as well as standard PCR. All of C. diphtheriae samples showed bands at 168 bp (dtxR gene marker and 551 bp (tox gene marker while no band appeared in others. Direct PCR detected at least 71 CFU/uL of bacterial cells in samples. We concluded that direct PCR can be used for alternative diagnostic method for diagnosis of diphtheria which is rapid, easy and cost effective.

  17. ADHD Diagnosis: As Simple As Administering a Questionnaire or a Complex Diagnostic Process?

    Science.gov (United States)

    Parker, Ashton; Corkum, Penny

    2016-06-01

    The present study investigated the validity of using the Conners' Teacher and Parent Rating Scales (CTRS/CPRS) or semistructured diagnostic interviews (Parent Interview for Child Symptoms and Teacher Telephone Interview) to predict a best-practices clinical diagnosis of ADHD. A total of 279 children received a clinical diagnosis based on a best-practices comprehensive assessment (including diagnostic parent and teacher interviews, collection of historical information, rating scales, classroom observations, and a psychoeducational assessment) at a specialty ADHD Clinic in Truro, Nova Scotia, Canada. Sensitivity and specificity with clinical diagnosis were determined for the ratings scales and diagnostic interviews. Sensitivity and specificity values were high for the diagnostic interviews (91.8% and 70.7%, respectively). However, while sensitivity of the CTRS/CPRS was relatively high (83.5%), specificity was poor (35.7%). The low specificity of the CPRS/CTRS is not sufficient to be used alone to diagnose ADHD. (J. of Att. Dis. 2016; 20(6) 478-486). © The Author(s) 2013.

  18. Signposting for diagnosis of autism spectrum disorder using the Diagnostic Interview for Social and Communication Disorders (DISCO)

    OpenAIRE

    Sarah J Carrington; Leekam, Susan R.; Kent, Rachel Grace; Maljaars, Jarymke; Gould, Judith; Wing, Lorna; Le Couteur, Ann; van Berckelaer-Onnes, Ina

    2015-01-01

    Recent research has investigated the capability of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) descriptions to identify individuals who should receive a diagnosis of Autism Spectrum Disorder (ASD) using standardised diagnostic instruments. Building on previous research investigating behaviours essential for the diagnosis of DSM-5 ASD, the current study investigated the sensitivity and specificity of a set of 14 items derived from the Diagnostic Interview for Social and ...

  19. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian S.;

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...... at rural operational primary care centres. METHODS: Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients...

  20. A Diagnostic Model for Dementia in Clinical Practice-Case Methodology Assisting Dementia Diagnosis.

    Science.gov (United States)

    Londos, Elisabet

    2015-04-02

    Dementia diagnosis is important for many different reasons. Firstly, to separate dementia, or major neurocognitive disorder, from MCI (mild cognitive impairment), mild neurocognitive disorder. Secondly, to define the specific underlying brain disorder to aid treatment, prognosis and decisions regarding care needs and assistance. The diagnostic method of dementias is a puzzle of different data pieces to be fitted together in the best possible way to reach a clinical diagnosis. Using a modified case methodology concept, risk factors affecting cognitive reserve and symptoms constituting the basis of the brain damage hypothesis, can be visualized, balanced and reflected against test results as well as structural and biochemical markers. The model's origin is the case method initially described in Harvard business school, here modified to serve dementia diagnostics.

  1. Prospective evaluation of three rapid diagnostic tests for diagnosis of human leptospirosis.

    Directory of Open Access Journals (Sweden)

    Marga G A Goris

    Full Text Available BACKGROUND: Diagnosis of leptospirosis by the microscopic agglutination test (MAT or by culture is confined to specialized laboratories. Although ELISA techniques are more common, they still require laboratory facilities. Rapid Diagnostic Tests (RDTs can be used for easy point-of-care diagnosis. This study aims to evaluate the diagnostic performance of the RDTs LeptoTek Dri Dot, LeptoTek Lateral Flow, and Leptocheck-WB, prospectively. METHODOLOGY: During 2001 to 2012, one or two of the RDTs at the same time have been applied prior to routine diagnostics (MAT, ELISA and culture on serum specimens from participants sent in for leptospirosis diagnosis. The case definition was based on MAT, ELISA and culture results. Participants not fulfilling the case definition were considered not to have leptospirosis. The diagnostic accuracy was determined based on the 1(st submitted sample and paired samples, either in an overall analysis or stratified according to days post onset of illness. RESULTS: The overall sensitivity and specificity for the LeptoTek Dri Dot was 75% respectively 96%, for the LeptoTek Lateral Flow 78% respectively 95%, and for the Leptocheck-WB 78% respectively 98%. Based on the 1(st submitted sample the sensitivity was low (51% for LeptoTek Dri Dot, 69% for LeptoTek Lateral Flow, and 55% for Leptocheck-WB, but substantially increased when the results of paired samples were combined, although accompanied by a lower specificity (82% respectively 91% for LeptoTek Dri Dot, 86% respectively 84% for LeptoTek Lateral Flow, and 80% respectively 93% for Leptocheck-WB. CONCLUSIONS: All three tests present antibody tests contributing to the diagnosis of leptospirosis, thus supporting clinical suspicion and contributing to awareness. Since the overall sensitivity of the tested RDTs did not exceed 80%, one should be cautious to rely only on an RDT result, and confirmation by reference tests is strongly recommended.

  2. Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Maria Isabel da Conceição Dias Fernandes

    2015-12-01

    Full Text Available Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

  3. Doing diagnosis: whether and how clinicians use a diagnostic tool of uncertain clinical utility.

    Science.gov (United States)

    Armstrong, Natalie; Hilton, Paul

    2014-11-01

    Diagnosis is fundamental to the practice of medicine and mastery of it is central to the process of both becoming and practicing as a doctor. We focus on diagnosis as a process, in particular from the perspective of clinicians performing it. We explore how UK clinicians exercise discretion about whether and how to use a diagnostic tool (invasive urodynamic tests - IUT) for which there is, currently, no clear, high-quality evidence. Interviews were conducted with a purposive sample of 18 clinicians who had previously completed a survey on their use of IUT. Analysis was based on the constant comparative method. Participants tended to be polarised in their view of IUT. While many regarded it as a valuable diagnostic tool that they used frequently and thought was important, others reported using it only infrequently, and some were sceptical of its value in the diagnostic process even if they commonly used it. In addition to the anticipated clinical functions (e.g. adding to understanding of the condition, helping determine best treatment) there were additional, more social, functions that IUT could serve, including fitting in with local practice and helping to defend against possible future litigation. We discern two distinct approaches to the practice of diagnosis: one approach means 'leaving no stone unturned' and seeking all available evidence, proven or otherwise; while a second means using clinical judgement to say 'enough is enough' and thereby avoid exposing patients to possibly unnecessary tests and potentially wasting scarce healthcare resources.

  4. Evaluation of diagnostic criteria of DSM-IV-TR for diagnosis of internet addiction disorder

    Directory of Open Access Journals (Sweden)

    S.Salman Alavi

    2011-11-01

    Full Text Available Background: The latest version of Diagnostic and Statistical Manual for Mental Disorder (DSM-IV-TR, classified internet addiction disorder under "impulse control disorder not elsewhere classified". This study evaluates diagnostic criteria of DSM-IV-TR for diagnosis of IAD correspondence with Iranian society and culture.Materials and Method: This is a descriptive-analytical and cross-sectional research. For these purpose 400 students of Isfahan universities were entered into the study. Sampling method was quota sampling. At first we performed clinical interview (based on DSM-IV-TR for all cases, then the interviews reevaluated by another specialist. Data analysis has been done by content validity, inter-scorer reliability (Kappa coefficient and test-retest with SPSS1-14 software.Results: Content validity of diagnostic interviews match with DSM-IV-TR criteria and their content is appropriate, two items including "chatroom pathological use" and "monthly fees for internet" were added to promote its validity. Internal reliability (Kappa was 0.80 and test –retest reliability was r=0.74(p<0.01.Conclusion: Results suggest that diagnostic criteria of DSM-IV-TR are valid and reliable for internet addiction diagnosis and with this clinical interview. We have a more effective way to diagnose internet addiction in the future studies

  5. In vitro gliadin challenge: diagnostic accuracy and utility for the difficult diagnosis of celiac disease.

    Science.gov (United States)

    Tortora, Raffaella; Russo, Ilaria; De Palma, Giovanni D; Luciani, Alessandro; Rispo, Antonio; Zingone, Fabiana; Iovino, Paola; Capone, Pietro; Ciacci, Carolina

    2012-01-01

    Diagnosis of celiac disease is difficult when treatment with gluten-free diet (GFD) is started before diagnosis and/or when the results of tests are inconsistent. The objective of this study was to evaluate the in vitro gliadin challenge. The study cohort included patients without celiac disease (negative controls, n=57), patients with celiac disease (positive controls, n=166 untreated and n=55 on GFD), and patients with difficult diagnosis (n=59). All patients underwent endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Patients of the difficult diagnosis group were asked to stop GFD for repeated search of these antibodies under untreated conditions. The area under the receptor-operated curve (ROC) was used for statistical analyses on accuracy. HLA-DR had the highest accuracy for celiac disease diagnosis in analyses on negative controls and positive controls also excluding patients on GFD (area under ROC=0.99). Accuracy of test did not increase combining data of HLA-DR with data of other markers. Findings were similar in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions. The in vitro response of mucosal HLA-DR to gliadin is an accurate tool for the diagnosis of celiac disease also in patients with difficult diagnosis.

  6. Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Nuwaha, Fred

    2011-01-01

    -based diagnosis for uncomplicated malaria in rural health centres (HCs) was investigated with a view to recommending measures for scaling up the policy. METHODS: Thirty HCs were randomized to implement parasite-based diagnosis based on rapid diagnostic tests [RDTs] (n=10), blood microscopy (n=10) and presumptive...... waiting time. Clinicaltrials.gov: NCT00565071. RESULTS: 102,087 outpatients were enrolled. Patients were more likely to be tested in the RDT 44,565 (96.6%) than in microscopy arm 19,545 (60.9%) [RR: 1.59]. RDTs reduced patient waiting time compared to microscopy and were more convenient to health workers...... and patients. Majority 23,804 (99.7%) in presumptive arm were prescribed AL. All (100%) of patients who tested positive for malaria in RDT and microscopy arms were prescribed anti-malarials. Parasitological-based diagnosis significantly reduced AL prescription in RDT arm [RR: 0.62] and microscopy arm [RR: 0...

  7. Diagnosis of acute surgical abdomen - The best diagnostic tool to reach a final diagnosiscin

    Institute of Scientific and Technical Information of China (English)

    Wong CS; Al-Ajami AK; Boshahri M; Naqvi SA

    2012-01-01

    Objective: To evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland. Methods: Data was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients’ charts were searched manually and final diagnosis of each patient was recorded. Results: Out of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation. Conclusions: Appendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.

  8. General practice consultations, diagnostic investigations, and prescriptions in the year preceding a lung cancer diagnosis

    DEFF Research Database (Denmark)

    Guldbrandt, Louise M; Møller, Henrik; Jakobsen, Erik;

    2017-01-01

    Patterns of general practice utilization in the period before lung cancer (LC) diagnosis may provide new knowledge to ensure timelier and earlier diagnosis of LC. This study aimed to explore the prediagnostic activity in general practice in the year preceding LC diagnosis. The activity was compared...... = 340,170). During months 12 to 1 prior to diagnosis, 92.6% of LC patients and 88.4% of comparison subjects had one or more contacts with general practice. 13.0% of LC patients and 3.3% of comparison subjects had two or more X-rays. 20.8% of LC patients and 8.5% of comparison subjects had two or more...... than COPD patients without lung cancer, but not as pronounced as compared to patients without COPD. There was a significant increase in healthcare seeking and diagnostic activity in the year prior to a LC diagnosis, regardless of stage at diagnosis. COPD may mask the symptoms of LC. This indicates...

  9. Retrospective comparison between preoperative diagnosis by International Consensus Diagnostic Criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer

    DEFF Research Database (Denmark)

    Ikeura, Tsukasa; Detlefsen, Sönke; Zamboni, Giuseppe

    2014-01-01

    OBJECTIVE: The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. METHODS: Thirty patients (type 1 AIP in 23 and type 2 AIP ...

  10. Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions.

    Science.gov (United States)

    Boonsarngsuk, Viboon; Kanoksil, Wasana; Laungdamerongchai, Sarangrat

    2015-04-01

    There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs). A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques-including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)-were evaluated for the diagnosis. The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (Ptechniques should be performed together.

  11. The reliability of child psychiatric diagnosis. A comparison among Danish child psychiatrists of traditional diagnoses and a multiaxial diagnostic system

    DEFF Research Database (Denmark)

    Skovgaard, A M; Isager, T; Jørgensen, O S

    1988-01-01

    diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders......The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different...... and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high....

  12. Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

    DEFF Research Database (Denmark)

    Hansen, Kristian S; Grieve, Eleanor; Mikhail, Amy;

    2015-01-01

    BACKGROUND: Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve tr...

  13. Diagnostic accuracy at several reduced radiation dose levels for CT imaging in the diagnosis of appendicitis

    Science.gov (United States)

    Zhang, Di; Khatonabadi, Maryam; Kim, Hyun; Jude, Matilda; Zaragoza, Edward; Lee, Margaret; Patel, Maitraya; Poon, Cheryce; Douek, Michael; Andrews-Tang, Denise; Doepke, Laura; McNitt-Gray, Shawn; Cagnon, Chris; DeMarco, John; McNitt-Gray, Michael

    2012-03-01

    Purpose: While several studies have investigated the tradeoffs between radiation dose and image quality (noise) in CT imaging, the purpose of this study was to take this analysis a step further by investigating the tradeoffs between patient radiation dose (including organ dose) and diagnostic accuracy in diagnosis of appendicitis using CT. Methods: This study was IRB approved and utilized data from 20 patients who underwent clinical CT exams for indications of appendicitis. Medical record review established true diagnosis of appendicitis, with 10 positives and 10 negatives. A validated software tool used raw projection data from each scan to create simulated images at lower dose levels (70%, 50%, 30%, 20% of original). An observer study was performed with 6 radiologists reviewing each case at each dose level in random order over several sessions. Readers assessed image quality and provided confidence in their diagnosis of appendicitis, each on a 5 point scale. Liver doses at each case and each dose level were estimated using Monte Carlo simulation based methods. Results: Overall diagnostic accuracy varies across dose levels: 92%, 93%, 91%, 90% and 90% across the 100%, 70%, 50%, 30% and 20% dose levels respectively. And it is 93%, 95%, 88%, 90% and 90% across the 13.5-22mGy, 9.6-13.5mGy, 6.4-9.6mGy, 4-6.4mGy, and 2-4mGy liver dose ranges respectively. Only 4 out of 600 observations were rated "unacceptable" for image quality. Conclusion: The results from this pilot study indicate that the diagnostic accuracy does not change dramatically even at significantly reduced radiation dose.

  14. DIAGNOSIS OF ABDOMINAL TUBERCULOSIS IN CHRONIC ABDO MINAL PAIN: LAPAROSCOPY AS AN EFFECTIVE DIAGNOSTIC TOOL

    Directory of Open Access Journals (Sweden)

    Rajiv

    2013-04-01

    Full Text Available ABSTRACT: Chronic abdominal pain is a FREQUENTLY ENCOUNTERED pr oblem and abdominal tuberculosis is a very common cause of the same. Di agnostic laparoscopy is a highly sensitive, specific, and safe procedure for the early diagnosis of abdominal tuberculosis. The procedure is beneficial because it is minimally invasive and prov ides diagnostic benefit in terms of both visual appearances and tissue yield for histopathologi cal and cytological confirmation. We have performed an extensive retrospective study with 250 s ubjects and were able to justify the safety, sensitivity & early selection of laparoscopy as a procedure of choice to confirm tuberculosis in chronic abdominal pain.

  15. High diagnostic value of general practitioners' presumptive diagnosis for pyelonephritis, meningitis and pancreatitis

    DEFF Research Database (Denmark)

    Sriskandarajah, Srishamanthi; Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik

    2016-01-01

    INTRODUCTION: In Denmark, patients referred from the general practitioner (GP) to the emergency department (ED) can be referred with either specific symptoms or with a presumptive diagnosis. The aim of the present study was to evaluate the diagnostic accuracy for various presumptive diagnoses made...... by the GP in a population acutely referred to an ED. METHODS: This was a retrospective cohort study of all registered acute referrals for admission to Kolding ED in 2010. Eight presumptive diagnoses were selected for further studies: meningitis, acute coronary syndrome (ACS), pulmonary embolism, pneumonia...

  16. Intelligent Condition Diagnosis Method Based on Adaptive Statistic Test Filter and Diagnostic Bayesian Network.

    Science.gov (United States)

    Li, Ke; Zhang, Qiuju; Wang, Kun; Chen, Peng; Wang, Huaqing

    2016-01-08

    A new fault diagnosis method for rotating machinery based on adaptive statistic test filter (ASTF) and Diagnostic Bayesian Network (DBN) is presented in this paper. ASTF is proposed to obtain weak fault features under background noise, ASTF is based on statistic hypothesis testing in the frequency domain to evaluate similarity between reference signal (noise signal) and original signal, and remove the component of high similarity. The optimal level of significance α is obtained using particle swarm optimization (PSO). To evaluate the performance of the ASTF, evaluation factor Ipq is also defined. In addition, a simulation experiment is designed to verify the effectiveness and robustness of ASTF. A sensitive evaluation method using principal component analysis (PCA) is proposed to evaluate the sensitiveness of symptom parameters (SPs) for condition diagnosis. By this way, the good SPs that have high sensitiveness for condition diagnosis can be selected. A three-layer DBN is developed to identify condition of rotation machinery based on the Bayesian Belief Network (BBN) theory. Condition diagnosis experiment for rolling element bearings demonstrates the effectiveness of the proposed method.

  17. Initial diagnosis and treatment in first-episode psychosis: can an operationalized diagnostic classification system enhance treating clinicians' diagnosis and the treatment chosen?

    LENUS (Irish Health Repository)

    Coentre, Ricardo

    2011-05-01

    Diagnosis during the initial stages of first-episode psychosis is particularly challenging but crucial in deciding on treatment. This is compounded by important differences in the two major classification systems, International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). We aimed to compare the concordance between an operationalized diagnosis using Operational Criteria Checklist (OPCRIT) and treating clinician-generated diagnosis in first episode psychosis diagnosis and its correlation with treatment prescribed.

  18. [Diagnostic significance and therapeutic consequences of computerized tomography (patient outcome research). II: General surgical diagnosis].

    Science.gov (United States)

    Hidajat, N; Schröder, R J; Vogl, T; Neuhaus, P; Schedel, H; Felix, R

    1995-03-01

    Computed tomography is one of the indispensable diagnostic methods in the treatment of many surgical patients. On the other hand, the high cost of equipment and effort and the expensive examination must be taken into account. For the purposes of a patient-outcome study all CT examinations of surgical patients performed in March to May 1993 were analysed under medical and economic aspects. 49% of the 210 examinations (153 patients) were primary examinations, 51% served as control examinations. In 61% the diagnosis was already known, but additional information with decisive influence on the further treatment was obtained. In 17% the supposed diagnosis could be verified and in 22% it was rejected. In 170 examinations (81%) the necessity of an operation was the question. 53% of all CT examinations revealed that indication for an operation was absent, and in 28% an operative intervention was performed. The CT examination of surgical patients cannot be substituted by lower-cost methods. The use of an efficient planning of the therapeutic procedures, shortcutting of many other diagnostic examinations, and the avoidance of unnecessary surgical interventions result in shortening the duration of treatment and are instrumental in reducing the total treatment cost.

  19. DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma.

    Science.gov (United States)

    Tjörnstrand, Axel; Nyström, Helena Filipsson

    2017-10-01

    Thyrotropin (TSH)-secreting adenomas (TSHomas) are the rarest form of pituitary adenomas, and most endocrinologists will see few cases in a lifetime, if any. In most cases, the diagnostic approach is complicated and cases may be referred after being presented as a syndrome of inappropriate TSH secretion or as a pituitary mass. This review aims to cover the past, present and possible future diagnostic approaches to TSHomas, including different clinical presentations, laboratory assessment and imaging advances. The differential diagnoses will be discussed, as well as possible coexisting disorders. By evaluating the existing reports and reviews describing this rare condition, this review aims to present a clinically practical suggestion on the diagnosic workup for TSHomas, Major advances and scientific breakthroughs in the imaging area in recent years, facilitating diagnosis of TSHomas, support the belief that future progress within the imaging field will play an important role in providing methods for a more efficient diagnosis of this rare condition. © 2017 European Society of Endocrinology.

  20. Non-invasive diagnostic techniques in the diagnosis of squamous cell carcinoma.

    Science.gov (United States)

    Warszawik-Hendzel, Olga; Olszewska, Małgorzata; Maj, Małgorzata; Rakowska, Adriana; Czuwara, Joanna; Rudnicka, Lidia

    2015-12-31

    Squamous cell carcinoma is the second most common cutaneous malignancy after basal cell carcinoma. Although the gold standard of diagnosis for squamous cell carcinoma is biopsy followed by histopathology evaluation, optical non-invasive diagnostic tools have obtained increased attention. Dermoscopy has become one of the basic diagnostic methods in clinical practice. The most common dermoscopic features of squamous cell carcinoma include clustered vascular pattern, glomerular vessels and hyperkeratosis. Under reflectance confocal microscopy, squamous cell carcinoma shows an atypical honeycomb or disarranged pattern of the spinous-granular layer of the epidermis, round nucleated bright cells in the epidermis and round vessels in the dermis. High frequency ultrasound and optical coherence tomography may be helpful in predominantly in pre-surgical evaluation of tumor size. Emerging non-invasive or minimal invasive techniques with possible application in the diagnosis of squamous cell carcinoma of the skin, lip, oral mucosa, vulva or other tissues include high-definition optical coherence tomography, in vivo multiphoton tomography, direct oral microscopy, electrical impedance spectroscopy, fluorescence spectroscopy, Raman spectroscopy, elastic scattering spectroscopy, differential path-length spectroscopy, nuclear magnetic resonance spectroscopy, and angle-resolved low coherence interferometry.

  1. Diagnostic Value of Ultrasound Compared to Electro Diagnosis in Carpal Tunnel Syndrome

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    Seyed Mansour Rayegani

    2014-10-01

    Full Text Available Introduction: Carpal Tunnel Syndrome (CTS is one of the main causes of disability. The diagnosis of CTS confirm by electrodiagnostic tests. Sonography is an alternative method for diagnosis of CTS that can investigate anatomy and probable pathology. The aim of this study is to investigate the multiple sonographic diagnostic criteria and compare its diagnostic value with electrodiagnosis. Materials and Methods:In this descriptive-cross sectional study, 84 wrists (42 patients with CTS and 42 individuals without any clinical signs in upper limb were investigated. Symptomatic patients underwent clinical examination, standard electrodiagnostic evaluation of upper limb and sonographic investigation of median nerve in forearm and wrist. The control group underwent sonographic investigation. Results: Cross Sectional Area (CSA of Median nerve at distal wrist crease, at the level of Hamate hook and Trapezium, the amount of flexor retinaculum bowing, ratio of CSA at the forearm to distal wrist crease and ratio of CSA at the Pisiform level to distal wrist crease had significant difference in the case group compared to the control group (P-value

  2. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway)), Email: trond.mogens.aalokken@rikshospitalet.no; Naalsund, Anne (Dept. of Pulmonology, Oslo Univ. Hospital Rikshospitalet (Norway)); Elnaes Berstad, Audun (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway); Univ. of Oslo (Norway)); Solberg, Steinar (Dept. of Thoracic Surgery, Oslo Univ. Hospital Rikshospitalet (Norway)); Stroem, Erik H.; Scott, Helge (Dept. of Pathology, Oslo Univ. Hospital Rikshospitalet (Norway)); Soeyseth, Vidar (Univ. of Oslo (Norway); Depts. of Pulmonology, Akershus Univ. Hospital, Loerenskog (Norway))

    2012-04-15

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (kappa = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  3. Diagnostic Efficacy of Radiology in the Diagnosis of Giant Cell Tumour of Bone

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    Afia Akhter

    2014-01-01

    Full Text Available Background: Giant cell tumour (GCT is an aggressive and potentially malignant lesion. Microscopic feature reveals osteoclast like giant cells in a mononuclear stromal cells background. The mononuclear stromal cell is interpreted as neoplastic. Objective: As radiological diagnosis is non invasive and cost effective in comparison to histopathological diagnosis, considering the patients’ compliance, the aim of the study was to observe the diagnostic efficacy of radiology in diagnosis of GCT. Materials and method: This cross sectional study was carried out in the department of Pathology, Delta Hopital Ltd., Dhaka, Bangladesh from July 2011 to December 2012. A total of 30 study subjects were enrolled in the study irrespective of age and sex. Biopsy material and relevant data of clinically suspected cases of GCT along with radiology report were sent from National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR, Dhaka, Bangladesh. Histopathological diagnosis was made by expert pathologists. Results: Mean (±SD age of the study subjects was 29.20 (±7.34 years with highest number of patients were observed in 3rd decade and female was predominant (60% with a male female ratio of 1:1.5. Common site of GCT was around knee (50%. Among 30 clinically diagnosed GCT, 25 (83.3% cases were radiologically diagnosed as GCT, 2 (6.7% diagnosed as fibrous dysplasia, 1 (3.3% as chondroblastoma, 1 (3.3% as simple bone cyst and 1 (3.3% as aneurysmal bone cyst. However among 30 clinically diagnosed GCT, 28 (93.3% patients were histopathologically diagnosed as Giant cell lesion and rest 2 (6.7% patients diagnosed as fibrous dysplasia. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of radiological diagnosis of GCT were found to be 92.6%, 100.0%, 100.0%, 40.0% and 90.0%, respectively. Conclusion: Radiology can be effectively used as a screening tool in diagnosing GCT.

  4. Mobility energy label: An indicator for a sustainable city; Les etiquettes energetiques de mobilite: Un indicateur pour la ville durable

    Energy Technology Data Exchange (ETDEWEB)

    Flety, Yann; Antoni, Jean-Philippe; Vuidel, Gilles; de Sede-Marceau, Marie-Helene

    2010-09-15

    Perspectives of energy consumption reduction linked to global warming are bringing a desire for actions relating to the mastering and the improvement of energy efficiency. In this context, from the French example of greater Besancon (Communaute d'Agglomeration du Grand Besancon (CAGB)), the research presented here wants to define an energy indicator useful to planners called 'Territory energy label': to measure how the urban area is situated energy wise in terms of the daily mobility of its inhabitants, the behaviour of whom is looked at in a prescriptive manner. [French] Les perspectives de reduction des consommations energetiques en lien avec le rechauffement climatique se traduisent par une volonte d'actions en matiere de maitrise et d'amelioration de l'efficacite energetique. Dans ce contexte, a partir de l'exemple francais de la Communaute d'Agglomeration du Grand Besancon (CAGB), la recherche presentee vise a definir un indicateur energetique utile aux amenageurs intitule 'etiquette energetique Territoriale' : il s'agit de mesurer comment 'se situent energetiquement' les differents espaces que regroupent une meme aire urbaine du point de vu des mobilites quotidiennes de ses habitants, dont le comportement est apprehende de maniere normative.

  5. Energy policy on the move. Vademecum 2000; La politique energetique en mouvement. Au seuil du XXIe siecle

    Energy Technology Data Exchange (ETDEWEB)

    Bartlome, J.

    1999-10-01

    Energy policy is going to be an important issue of the period of functions 1999-2003 of the Swiss parliament. In Switzerland, it has received a significant impulse in the recent years. The present vademecum is targeted at politicians and speakers. The first part `Global aspects of energy issues` locates todays energy supply on the way form the the first to the second solar age. The second part `The nineties` is a summary of the energy policy evolution in Switzerland in the past ten years. The third part `Possible solutions on the threshold of the future` describes five trends for the energy policy debate in the next few years [Francais] La politique energetique va etre un important sujet de la legislature de 1999 a 2003. Ces dernieres annees, elle a gagne en dynamisme en Suisse. La presente brochure veut servir les milieux politiques et les conferenciers. La premiere partie, `Les points cardinaux des questions energetiques`, situe l`approvisionnement energetique actuel sur le chemin qui mene de la premiere a la seconde ere solaire. La seconde partie, `Les annees nonante`, est une retrospective de l`evolution de la politique energetique suisse durant la derniere decennie. La troisieme partie, `Des pistes au seuil de l`avenir`, propose une ebauche du debat de politique energetique de ces prochaines annees

  6. How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging.

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    Marcio Melo

    Full Text Available BACKGROUND: In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life. METHODOLOGY AND PRINCIPAL FINDINGS: To test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14 seconds and 1.23 (SD ±0.13 seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds. The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals. CONCLUSIONS: Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of

  7. [Serological diagnosis of congenital infections and algorithms to improve diagnostic efficacy].

    Science.gov (United States)

    García-Bermejo, Isabel; de Ory-Manchón, Fernando

    2015-07-01

    Congenital infection is those transmitted by the mother to the fetus before delivery. It can occur transplacentally or by direct contact with the pathogen during birth or in the immediate postnatal period. Congenital infection can be due to viruses (rubella, cytomegalovirus, herpes simplex, varicella-zoster, hepatitis B and C virus, human inunodeficiencia, erythrovirus B19) as bacteria (Treponema pallidum) and parasites (Toxoplasma gondii and Trypanosoma cruzi). Serological diagnosis of congenital infection is based on both the knowledge of infectious serology in the mother, including the systematic serological screening and diagnostic aspects of the determination of IgM and confirmatory methods, IgG avidity tests, establishment of antibody profiles, and in the diagnosis the neonate. Serological diagnosis of congenital infection in the newborn is mainly based on the detection of specific IgM usually by immunoenzymatic assays or immunochemiluminescence techniques. In some instances it is important to perform the serological follow up of the newborn to confirm the congenital infection. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Sequential fault diagnosis for mechatronics system using diagnostic hybrid bond graph and composite harmony search

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    Ming Yu

    2015-12-01

    Full Text Available This article proposes a sequential fault diagnosis method to handle asynchronous distinct faults using diagnostic hybrid bond graph and composite harmony search. The faults under consideration include fault mode, abrupt fault, and intermittent fault. The faults can occur in different time instances, which add to the difficulty of decision making for fault diagnosis. This is because the earlier occurred fault can exhibit fault symptom which masks the fault symptom of latter occurred fault. In order to solve this problem, a sequential identification algorithm is developed in which the identification task is reactivated based on two conditions. The first condition is that the latter occurred fault has at least one inconsistent coherence vector element which is consistent in coherence vector of the earlier occurred fault, and the second condition is that the existing fault coherence vector has the ability to hide other faults and the second-level residual exceeds the threshold. A new composite harmony search which is capable of handling continuous variables and binary variables simultaneously is proposed for identification purpose. Experiments on a mobile robot system are conducted to assess the proposed sequential fault diagnosis algorithm.

  9. Pseudoactinomycotic Radiate Granules (PAMRAGs)- An Unusual Differential Diagnosis for Ovarian Neoplasm; A Diagnostic Dilemma.

    Science.gov (United States)

    P J, Cicy; P J, Tessy; P, Lekshmidevi; V, Letha; Poothiode, Usha

    2015-03-01

    Pseudoactinomycotic radiate granules (PAMRAGs) are rarely detected lesions in ovary. Endometrium is the usual site and a detailed search of literature yielded only two cases in the ovary. PAMRAGs must be differentiated from actinomycotic granules which are also strongly associated with the use of intrauterine contraceptive devices (IUCDs). In cases of suppurative oophoritis due to actinomycosis, a proper diagnosis and culture confirmation is mandatory to avoid further complications. This case is reported due to its rarity, unusual clinical presentation and to highlight the importance of special stains in cases of tuboovarian abscess, where PAMRAGs may cause diagnostic dilemma. Our patient was a 50 yr old female admitted with clinical diagnosis of malignant ovarian tumour. After preoperative work up, panhysterectomy, infracolic omentectomy and excision biopsy of the right inguinal lymph node were done. Peroperatively the right ovary was enlarged and adherent to the fallopian tube and pelvic wall. Gross examination revealed a right tuboovarian mass with yellowish areas of necrosis and fibrosis. Histology showed a suppurative granulomatous lesion with spherical granules having club like peripheral projections. A panel of special stains (GMS, GRAMs and AFB) done were negative. Thus, we ruled out actinomycosis and gave a diagnosis of PAMRAG.

  10. Diagnostic Efficacy of Modified Coagglutination Test in the Diagnosis of Human Brucellosis

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    Mohite S.T

    2013-07-01

    Full Text Available Background: Laboratory help is must for thediagnosis of human brucellosis due to proteanclinical manifestations. As culture is hazardous,time consuming and less sensitive, serologicaltests are preferred for the diagnosis. Aggluti-nation tests like Rose Bengal PlateTest (RBPT, Serum Agglutination tests (SAT,2-Mercaptoethanol test (2-ME that are com-monly employed for the diagnosis either lacksensitivity or specificity. Coombs test andBrucellacapt though are sensitive and specific,workout costly. Therefore, modifiedcoagglutination test was developed and its di-agnostic efficacy was evaluated. Aims and Ob-jectives: To develop modified coagglutinationtest for the diagnosis of human brucellosis andcompare it with Coombs test. Materials andMethods: Serum samples collected from 191brucellosis patients and 100 controls were sub-jected to 2-ME, Coombs test and modifiedcoagglutination test (MCOAG. Blood culturewas performed by Castaneda’s method in all thepatients. Results: Significant difference in thepositivity rate was seen between MCOAG and2-ME. The results of MCOAG were compa-rable with Coombs test. Conclusions: Modi-fied coagglutination test is a better option toCoombs test for the serodiagnosis of brucel-losis in resource constrained countries as it issensitive, specific and cost effective.

  11. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings.

    Science.gov (United States)

    Odaga, John; Sinclair, David; Lokong, Joseph A; Donegan, Sarah; Hopkins, Heidi; Garner, Paul

    2014-04-17

    In 2010, the World Health Organization recommended that all patients with suspected malaria are tested for malaria before treatment. In rural African settings light microscopy is often unavailable. Diagnosis has relied on detecting fever, and most people were given antimalarial drugs presumptively. Rapid diagnostic tests (RDTs) provide a point-of-care test that may improve management, particularly of people for whom the RDT excludes the diagnosis of malaria. To evaluate whether introducing RDTs into algorithms for diagnosing and treating people with fever improves health outcomes, reduces antimalarial prescribing, and is safe, compared to algorithms using clinical diagnosis. We searched the Cochrane Infectious Disease Group Specialized Register; CENTRAL (The Cochrane Library); MEDLINE; EMBASE; CINAHL; LILACS; and the metaRegister of Controlled Trials for eligible trials up to 10 January 2014. We contacted researchers in the field and reviewed the reference lists of all included trials to identify any additional trials. Individual or cluster randomized trials (RCTs) comparing RDT-supported algorithms and algorithms using clinical diagnosis alone for diagnosing and treating people with fever living in malaria-endemic settings. Two authors independently applied the inclusion criteria and extracted data. We combined data from individually and cluster RCTs using the generic inverse variance method. We presented all outcomes as risk ratios (RR) with 95% confidence intervals (CIs), and assessed the quality of evidence using the GRADE approach. We included seven trials, enrolling 17,505 people with fever or reported history of fever in this review; two individually randomized trials and five cluster randomized trials. All trials were conducted in rural African settings.In most trials the health workers diagnosing and treating malaria were nurses or clinical officers with less than one week of training in RDT supported diagnosis. Health worker prescribing adherence to RDT

  12. What is depression? Psychiatrists’ and GPs’ experiences of diagnosis and the diagnostic process

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    Annette S. Davidsen

    2014-11-01

    Full Text Available The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners’ (GPs’ treatment of depression is insufficient and a collaborative care (CC model between general practice and psychiatry has been proposed to overcome this. However, for successful implementation, a CC model demands shared agreement about the concept of depression and the diagnostic process in the two sectors. We aimed to explore how depression is understood by GPs and clinical psychiatrists. We carried out qualitative in-depth interviews with 11 psychiatrists and 12 GPs. Analysis was made by Interpretative Phenomenological Analysis. We found that the two groups of physicians differed considerably in their views on the usefulness of the concept of depression and in their language and narrative styles when telling stories about depressed patients. The differences were captured in three polarities which expressed the range of experiences in the two groups. Psychiatrists considered the diagnosis of depression as a pragmatic and agreed construct and they did not question its validity. GPs thought depression was a “gray area” and questioned the clinical utility in general practice. Nevertheless, GPs felt a demand from psychiatry to make their diagnosis based on instruments created in psychiatry, whereas psychiatrists based their diagnosis on clinical impression but used instruments to assess severity. GPs were wholly skeptical about instruments which they felt could be misleading. The different understandings could possibly lead to a clash of interests in any proposed CC model. The findings provide fertile ground for organizational research into the actual implementation of cooperation between sectors to explore how differences are dealt with.

  13. Self-diagnosis of malaria by travelers and expatriates: assessment of malaria rapid diagnostic tests available on the internet.

    Science.gov (United States)

    Maltha, Jessica; Gillet, Philippe; Heutmekers, Marloes; Bottieau, Emmanuel; Van Gompel, Alfons; Jacobs, Jan

    2013-01-01

    In the past malaria rapid diagnostic tests (RDTs) for self-diagnosis by travelers were considered suboptimal due to poor performance. Nowadays RDTs for self-diagnosis are marketed and available through the internet. The present study assessed RDT products marketed for self-diagnosis for diagnostic accuracy and quality of labeling, content and instructions for use (IFU). Diagnostic accuracy of eight RDT products was assessed with a panel of stored whole blood samples comprising the four Plasmodium species (n = 90) as well as Plasmodium negative samples (n = 10). IFUs were assessed for quality of description of procedure and interpretation and for lay-out and readability level. Errors in packaging and content were recorded. Two products gave false-positive test lines in 70% and 80% of Plasmodium negative samples, precluding their use. Of the remaining products, 4/6 had good to excellent sensitivity for the diagnosis of Plasmodium falciparum (98.2%-100.0%) and Plasmodium vivax (93.3%-100.0%). Sensitivity for Plasmodium ovale and Plasmodium malariae diagnosis was poor (6.7%-80.0%). All but one product yielded false-positive test lines after reading beyond the recommended reading time. Problems with labeling (not specifying target antigens (n = 3), and content (desiccant with no humidity indicator (n = 6)) were observed. IFUs had major shortcomings in description of test procedure and interpretation, poor readability and lay-out and user-unfriendly typography. Strategic issues (e.g. the need for repeat testing and reasons for false-negative tests) were not addressed in any of the IFUs. Diagnostic accuracy of RDTs for self-diagnosis was variable, with only 4/8 RDT products being reliable for the diagnosis of P. falciparum and P. vivax, and none for P. ovale and P. malariae. RDTs for self-diagnosis need improvements in IFUs (content and user-friendliness), labeling and content before they can be considered for self-diagnosis by the traveler.

  14. Helicobacter Pylori Infection: Diagnostic Strategies in Primary Diagnosis and After Therapy.

    Science.gov (United States)

    Atkinson, Nathan S S; Braden, Barbara

    2016-01-01

    Accurate diagnosis of Helicobacter pylori infection pre- and post-treatment is mandatory in the current era of decreasing prevalence and increasing antibiotic resistance. The diagnostic performance of most tests is poorer in clinical situations with low bacterial density which is seen in conditions such as atrophic gastritis or intake of antisecretory and antibiotic medications. Noninvasive tests require less cost and resource but provide excellent accuracy; however, endoscopy with testing of gastric biopsy specimens is indicated where alarming symptoms are present or antibiotic susceptibility testing by culture is desired. Newer modalities such as polymerase chain reaction testing provide additional virulence and antibiotic sensitivity profiling. This article outlines new developments and the key parameters of each test, as careful selection of test modality within the clinical context is required for adequate management of infected symptomatic patients.

  15. Diagnostic accuracy of urinary prostate protein glycosylation profiling in prostatitis diagnosis

    Science.gov (United States)

    Vermassen, Tijl; Van Praet, Charles; Poelaert, Filip; Lumen, Nicolaas; Decaestecker, Karel; Hoebeke, Piet; Van Belle, Simon; Rottey, Sylvie

    2015-01-01

    Introduction Although prostatitis is a common male urinary tract infection, clinical diagnosis of prostatitis is difficult. The developmental mechanism of prostatitis is not yet unraveled which led to the elaboration of various biomarkers. As changes in asparagine-linked-(N-)-glycosylation were observed between healthy volunteers (HV), patients with benign prostate hyperplasia and prostate cancer patients, a difference could exist in biochemical parameters and urinary N-glycosylation between HV and prostatitis patients. We therefore investigated if prostatic protein glycosylation could improve the diagnosis of prostatitis. Materials and methods Differences in serum and urine biochemical markers and in total urine N-glycosylation profile of prostatic proteins were determined between HV (N = 66) and prostatitis patients (N = 36). Additionally, diagnostic accuracy of significant biochemical markers and changes in N-glycosylation was assessed. Results Urinary white blood cell (WBC) count enabled discrimination of HV from prostatitis patients (P < 0.001). Urinary bacteria count allowed for discriminating prostatitis patients from HV (P < 0.001). Total amount of biantennary structures (urinary 2A/MA marker) was significantly lower in prostatitis patients compared to HV (P < 0.001). Combining the urinary 2A/MA marker and urinary WBC count resulted in an AUC of 0.79, 95% confidence interval (CI) = (0.70–0.89) which was significantly better than urinary WBC count (AUC = 0.70, 95% CI = [0.59–0.82], P = 0.042) as isolated test. Conclusions We have demonstrated the diagnostic value of urinary N-glycosylation profiling, which shows great potential as biomarker for prostatitis. Further research is required to unravel the developmental course of prostatic inflammation. PMID:26526330

  16. Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis.

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    Hugo Botha

    Full Text Available INTRODUCTION: Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM. Recently, an expert consensus case definition (CCD and set of imaging criteria for diagnosing basal meningeal enhancement (BME have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. METHODS: Initial diagnoses were based on the CCD, classifying patients into: 'Definite TBM' (microbiological confirmation, 'Probable TBM' (diagnostic score ≥10, 'Possible TBM' (diagnostic score 6-9, 'Not TBM' (confirmation of an alternative diagnosis or 'Uncertain' (diagnostic score of <6. CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both 'Definite TBM' and either 'Definite TBM' or 'Probable TBM' as gold standards. RESULTS: CT scan criteria for BME had good intra-rater agreement (κ range 0.35-0.78 and fair to moderate inter-rater agreement (κ range 0.20-0.52. Intra- and inter-rater agreement on the CCD components were good to fair (κ  =  ranges 0.47-0.81 and 0.21-0.63. Using 'Definite TBM' as a gold standard, the criteria for BME were very specific (61.5%-100%, but insensitive (5.9%-29.4%. Similarly, the imaging components of the CCD were highly specific (69.2-100% but lacked sensitivity (0-56.7%. Similar values were found when using 'Definite TBM' or 'Probable TBM' as a gold standard. DISCUSSION: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria

  17. Rapid diagnostic tests duo as alternative to conventional serological assays for conclusive Chagas disease diagnosis.

    Science.gov (United States)

    Egüez, Karina E; Alonso-Padilla, Julio; Terán, Carolina; Chipana, Zenobia; García, Wilson; Torrico, Faustino; Gascon, Joaquim; Lozano-Beltran, Daniel-Franz; Pinazo, María-Jesús

    2017-04-01

    Chagas disease is caused by the parasite Trypanosoma cruzi. It affects several million people, mainly in Latin America, and severe cardiac and/or digestive complications occur in ~30% of the chronically infected patients. Disease acute stage is mostly asymptomatic and infection goes undiagnosed. In the chronic phase direct parasite detection is hampered due to its concealed presence and diagnosis is achieved by serological methods, like ELISA or indirect hemagglutination assays. Agreement in at least two tests must be obtained due to parasite wide antigenic variability. These techniques require equipped labs and trained personnel and are not available in distant regions. As a result, many infected people often remain undiagnosed until it is too late, as the two available chemotherapies show diminished efficacy in the advanced chronic stage. Easy-to-use rapid diagnostic tests have been developed to be implemented in remote areas as an alternative to conventional tests. They do not need electricity, nor cold chain, they can return results within an hour and some even work with whole blood as sample, like Chagas Stat-Pak (ChemBio Inc.) and Chagas Detect Plus (InBIOS Inc.). Nonetheless, in order to qualify a rapidly diagnosed positive patient for treatment, conventional serological confirmation is obligatory, which might risk its start. In this study two rapid tests based on distinct antigen sets were used in parallel as a way to obtain a fast and conclusive Chagas disease diagnosis using whole blood samples. Chagas Stat-Pak and Chagas Detect Plus were validated by comparison with three conventional tests yielding 100% sensitivity and 99.3% specificity over 342 patients seeking Chagas disease diagnosis in a reference centre in Sucre (Bolivia). Combined used of RDTs in distant regions could substitute laborious conventional serology, allowing immediate treatment and favouring better adhesion to it.

  18. Gilbert’s syndrome: clinical features, diagnostics, differential diagnosis and treatment (part 2

    Directory of Open Access Journals (Sweden)

    T.V. Sorokman

    2017-03-01

    discoloration of the skin (“teinte bilieuse”, especially on the face, hands, and feet without a distinct scleral icterus. Sometimes the development of repeatedly intermittent episodes of jaundice with high bilirubinemia (indirect bilirubin without the evidence of hemolysis (differential diagnostic feature is observed. 2. A tendency to development of pigmented and vascular nevi and xanthelasma of the eyelids, and hyperpigmentation around the eyes; to bradycardia, hypothermia, migraine, postural, intermittent albuminuria or to alimentary glycosuria. 3. An increased tendency to pigmentation under the influence of light, heat, and also chemical and mechanical stimuli. 4. A neuromuscular hyperexcitability. 5. Increased sensitivity to cold. 6. Dyspeptic complaints (pain, nausea, abdominal bloa­ting, diarrhea or constipation. 7. No signs of increased hemolysis (differential diagnostic feature with increasing content in, bilirubin (differential diagnostic feature. 8. The majority of patients have normal liver function tests (differential diagnostic feature also normal bromsulphalein test is also normal (differential diagnostic feature. 9. The biochemical abnormality is not detected by histological methods (differential diagnostic feature .10. Frequently, a family disease of the liver is observed. The differential diagnosis of GS is conducted with all types of hyperbilirubinemias, hemolytic anemias, congenital hepatic cirrhosis, hepatitis, cholecystopathy, atresia of biliary ducts or the small intestine. Medications are used only in severe hyperbilirubinemias and as concomitant therapy in the presence of symptoms of vitamin deficiencies, violations of a motor-evacuation function of the upper digestive tract in the clinical picture and to prevent complications (cholelithiasis.

  19. [Doppler ultrasonography in the diagnosis of ovarian cysts: indications, pertinence and diagnostic criteria].

    Science.gov (United States)

    Marret, H

    2001-11-01

    To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or border line tumors. It is now well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this work was to review the literature and to establish, with the evidence based medicine model, which parameters and existing diagnostic models using ultrasound and Doppler performs best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. It is no longer reasonable to subject all patients undergoing pelvic sonography to bladder distension. Functional ovarian cyst characterization seems easy using sonography and Doppler. In case of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Papillary formations on the inside of the cyst wall and masses with a non hyperechoic solid component are the most statistically significant predictors of a malignant ovarian mass. Ultrasound and morphologic parameters have a sensitivity of 80% and a specificity of 93%, that make this exam the gold standard for ovarian masses diagnosis. Another parameter is important: experienced hands with subjective evaluation seems to be one of the best ultrasound method for adnexal masses discrimination. Scoring system help differentiate benign from malignant masses (sensitivity 90%, VPP 50%). Doppler flow measurement and assessment of tumor vascularity by doppler energy increase the confidence with which a correct diagnosis is made. Moreover

  20. Application of diagnostic methods and molecular diagnosis of hemoglobin disorders in Khuzestan province of Iran

    Directory of Open Access Journals (Sweden)

    Fakher Rahim

    2007-01-01

    Full Text Available Background : The hemoglobinopathies refer to a diverse group of inherited disorders characterized by a reduced synthesis of one or more globin chains (thalassemias or the synthesis of structurally abnormal hemoglobin (Hb. The thalassemias often coexist with a variety of structural Hb variants giving rise to complex genotypes and an extremely wide spectrum of clinical and hematological phenotypes. Hematological and biochemical investigations and family studies provide essential clues to the different interactions and are fundamental to DNA diagnostics of the Hb disorders. Although DNA diagnostics have made a major impact on our understanding and detection of the hemoglobinopathies, DNA mutation testing should never be considered a shortcut or the test of first choice in the workup of a hemoglobinopathy. Materials and Methods: A careful three-tier approach involving: (1 Full blood count (2 Special hematological tests, followed by (3 DNA mutation analysis, provides the most effective way in which to detect primary gene mutations as well as gene-gene interactions that can influence the overall phenotype. With the exception of a few rare deletions and rearrangements, the molecular lesions causing hemoglobinopathies are all identifiable by PCR-based techniques. Furthermore, each at-risk ethnic group has its own combination of common Hb variants and thalassemia mutations. In Iran, there are many different forms of a and β thalassemia. Increasingly, different Hb variants are being detected and their effects per se or in combination with the thalassemias, provide additional diagnostic challenges. Results:We did step-by-step diagnosis workup in 800 patients with hemoglobinopathies who referred to Research center of Thalassemia and Hemoglobinopathies in Shafa Hospital of Ahwaz Joundishapour University of medical sciences, respectively. We detected 173 patients as iron deficiency anemia (IDA and 627 individuals as thalassemic patients by use of different

  1. A narrative review of new trends in the diagnosis of myofascial trigger points: diagnostic ultrasound imaging and biomarkers

    Science.gov (United States)

    Srbely, John Z; Kumbhare, Dinesh; Grosman-Rimon, Liza

    2016-01-01

    Myofascial pain syndrome (MPS) is one of the most common conditions of chronic musculoskeletal pain encountered by primary healthcare practitioners on a daily basis. It is generally accepted amongst the broad profile of healthcare practitioners treating MPS that the presence of discrete, palpable and tender nodules within the muscle, known as myofascial trigger points (MTrP), is necessary to confirm the diagnosis of MPS. Manual palpation is currently the most common technique used to detect MTrP, however, previous research has shown that the reliability of manual palpation for detecting MTrP is poor, and in our opinion unacceptably poor, leading to inconsistent diagnosis of MPS and poor patient outcomes. There are currently no objective accepted diagnostic criteria for the clinical detection of MTrP, nor are there standardized diagnostic criteria for MPS. Two promising areas of research with potential for enhancing the diagnosis of MPS include the use of diagnostic ultrasound and biomarkers. Further research is needed to advance the development of composite diagnostic criteria employing ultrasound imaging, biomarker assessments and physical assessment to enhance the accuracy and objectivity of MTrP detection and diagnosis of chronic MPS disorder. PMID:27713577

  2. The difference in diagnosis rate of different diagnostic criteria of autoimmune pancreatitis and its major influential factors

    Institute of Scientific and Technical Information of China (English)

    王珏磊

    2013-01-01

    Objective To discuss the difference in diagnostic criteria of autoimmune pancreatitis (AIP) and its major influential factors,so as to provide guidance for AIP diagnosis and treatment.Methods The clinical data of 561cases of chronic pancreatitis admitted to PLA General Hospital from June,2008 to January,2013 were

  3. Rapid antigen detection test for respiratory syncytial virus diagnosis as a diagnostic tool,

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    Flávio da Silva Mesquita

    Full Text Available Abstract Objective: The aim of this study was to evaluate the QuickVue® RSV Test Kit (QUIDEL Corp, CA, USA as a screening tool for respiratory syncytial virus in children with acute respiratory disease in comparison with the indirect immunofluorescence assay as gold standard. In Brazil, rapid antigen detection tests for respiratory syncytial virus are not routinely utilized as a diagnostic tool, except for the diagnosis of dengue and influenza. Methods: The authors retrospectively analyzed 486 nasopharyngeal aspirate samples from children under age 5 with acute respiratory infection, between December 2013 and August 2014, the samples were analyzed by indirect immunofluorescence assay and QuickVue® RSV Test kit. Samples with discordant results were analyzed by real time PCR and nucleotide sequencing. Results: From 313 positive samples by immunofluorescence assays, 282 (90% were also positive by the rapid antigen detection test, two were positive only by rapid antigen detection test, 33 were positive only by immunofluorescence assays, and 171 were positive by both methods. The 35 samples with discordant results were analyzed by real time PCR; the two samples positive only by rapid antigen detection test and the five positive only by immunofluorescence assays were also positive by real time PCR. There was no relation between the negativity by QuickVue® RSV Test and viral load or specific strain. The QuickVue® RSV Test showed sensitivity of 90%, specificity of 98.8%, predictive positive value of 99.3%, and negative predictive value of 94.6%, with accuracy of 93.2% and agreement κ index of 0.85 in comparison to immunofluorescence assay. Conclusions: This study demonstrated that the QuickVue® RSV Test Kit can be effective in early detection of Respiratory syncytial virus in nasopharyngeal aspirate and is reliable for use as a diagnostic tool in pediatrics.

  4. Rapid antigen detection test for respiratory syncytial virus diagnosis as a diagnostic tool.

    Science.gov (United States)

    Mesquita, Flávio da Silva; Oliveira, Danielle Bruna Leal de; Crema, Daniela; Pinez, Célia Miranda Nunes; Colmanetti, Thaís Cristina; Thomazelli, Luciano Matsumia; Gilio, Alfredo Elias; Vieira, Sandra Elisabeth; Martinez, Marina Baquerizo; Botosso, Viviane Fongaro; Durigon, Edison Luiz

    The aim of this study was to evaluate the QuickVue(®) RSV Test Kit (QUIDEL Corp, CA, USA) as a screening tool for respiratory syncytial virus in children with acute respiratory disease in comparison with the indirect immunofluorescence assay as gold standard. In Brazil, rapid antigen detection tests for respiratory syncytial virus are not routinely utilized as a diagnostic tool, except for the diagnosis of dengue and influenza. The authors retrospectively analyzed 486 nasopharyngeal aspirate samples from children under age 5 with acute respiratory infection, between December 2013 and August 2014, the samples were analyzed by indirect immunofluorescence assay and QuickVue(®) RSV Test kit. Samples with discordant results were analyzed by real time PCR and nucleotide sequencing. From 313 positive samples by immunofluorescence assays, 282 (90%) were also positive by the rapid antigen detection test, two were positive only by rapid antigen detection test, 33 were positive only by immunofluorescence assays, and 171 were positive by both methods. The 35 samples with discordant results were analyzed by real time PCR; the two samples positive only by rapid antigen detection test and the five positive only by immunofluorescence assays were also positive by real time PCR. There was no relation between the negativity by QuickVue(®) RSV Test and viral load or specific strain. The QuickVue(®) RSV Test showed sensitivity of 90%, specificity of 98.8%, predictive positive value of 99.3%, and negative predictive value of 94.6%, with accuracy of 93.2% and agreement κ index of 0.85 in comparison to immunofluorescence assay. This study demonstrated that the QuickVue(®) RSV Test Kit can be effective in early detection of Respiratory syncytial virus in nasopharyngeal aspirate and is reliable for use as a diagnostic tool in pediatrics. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  5. Study on validity of a rapid diagnostic test kit versus light microscopy for malaria diagnosis in Ahmedabad city, India.

    Science.gov (United States)

    Vyas, S; Puwar, B; Patel, V; Bhatt, G; Kulkarni, S; Fancy, M

    2014-05-01

    Light microscopy of blood smears for diagnosis of malaria in the field has several limitations, notably delays in diagnosis. This study in Ahmedabad in Gujarat State, India, evaluated the diagnostic performance of a rapid diagnostic test for malaria (SD Bioline Malaria Ag P.f/Pan) versus blood smear examination as the gold standard. All fever cases presenting at 13 urban health centres were subjected to rapid diagnostic testing and thick and thin blood smears. A total of 677 cases with fever were examined; 135 (20.0%) tested positive by rapid diagnostic test and 86 (12.7%) by blood smear. The sensitivity of the rapid diagnostic test for malaria was 98.8%, specificity was 91.5%, positive predictive value 63.0% and negative predictive value 99.8%. For detection of Plasmodium falciparum the sensitivity of rapid diagnostic test was 100% and specificity was 97.3%. The results show the acceptability of the rapid test as an alternative to light microscopy in the field setting.

  6. An MRI-based diagnostic framework for early diagnosis of dyslexia

    Energy Technology Data Exchange (ETDEWEB)

    El-Baz, A. [University of Louisville, Bioengineering Department, Louisville, KY (United States); Casanova, M.; Mott, M.; Switala, A. [University of Louisville, Department of Psychiatry and Behavioral Science, Louisville, KY (United States); Gimel' farb, G. [University of Auckland, Computer Science Department, Auckland (New Zealand)

    2008-09-15

    A computer-aided diagnosis (CAD) system for early diagnosis of dyslexia was developed and tested. Dyslexia can severely impair the learning abilities of children so improved diagnostic methods are needed. Neuropathological studies show abnormal anatomy of the cerebral white matter (CWM) in dyslexic brains. We sought to develop an MRI-based macroscopic neuropathological correlate to the minicolumnopathy of dyslexia that relates to cortical connectivity: the gyral window. The brains of dyslexic patients often exhibit decreased gyrifications, so the thickness of gyral CWM for dyslexic subjects is greater than for normal subjects. We developed an MRI-based method for assessment of gyral CWM thickness with automated recognition of abnormal (e.g., dyslexic) brains. In vivo data was collected from 16 right-handed dyslexic men aged 18-40 years, and a group of 14 controls matched for gender, age, educational level, socioeconomic background, handedness and general intelligence. All the subjects were physically healthy and free of history of neurological diseases and head injury. Images were acquired with the same 1.5T MRI scanner (GE, Milwaukee, WI, USA) with voxel resolution 0.9375 x 0.9375 x 1.5 mm using a T1-weighted imaging sequence protocol. The ''ground truth'' diagnosis to evaluate the classification accuracy for each patient was given by the clinicians. The accuracy of diagnosis/classification of both the training and test subjects was evaluated using the Chi-square test at the three confidence levels - 85, 90 and 95% - in order to examine significant differences in the Levy distances. As expected, the 85% confidence level yielded the best results, the system correctly classified 16 out of 16 dyslexic subjects (a 100% accuracy) and 14 out of 14 control subjects (a 100% accuracy). At the 90% confidence level, 16 out of 16 dyslexic subjects were still classified correctly; however, only 13 out of 14 control subjects were correct, bringing the

  7. Diagnostic accuracy of FNAC in diagnosis for causes of lymphadenopathy: a hospital based analysis

    Directory of Open Access Journals (Sweden)

    Arjun Singh

    2013-06-01

    Full Text Available Introduction: The lymphadenopathy consist wide range of etiology from inflammatory process to a malignant condition and it is most common clinical presentation in outpatient department. Fine needle aspiration cytology is a simple, safe, reliable, rapid and inexpensive method of diagnosis in lymph nodes. Aims and objectives: To find out diagnostic accuracy of FNAC in lymphadenopathy and common pattern of lymphadenopathy in our institute. Methods: This prospective study was carried out in the department of Pathology of Index Medical College Hospital and research Centre, Indore, India from June 2011 to May 2013. The patients with palpable lymph nodes were included in this study. The slides were stained with Papanicolaou and May Grunewald Geimsa stain. Special stain like Ziel Neelson, Alcian blue was done whenever is required. A detailed analytic study was performed for correlation of Cyto-histopathological diagnosis. Results: The result shows male to female ratio of 1.0:0.8. The age of the patients ranges from 2 to 79 year with mean age of 32 years. The study shows reactive hyperplasia 149 (33.38%, tubercular lymphadenitis 177 (39.77%, granulomatous lymphadenitis 32(7.1%, lymphoma 25 (5.5%, metastatic carcinoma 40 (8.9% and others 22 (4.9%. We found cyto-histpathological concordant in 161 (95.8% cases and discordant in 7 (4.2% cases. Conclusion: The sensitivity of FNAC in lymphoma and metastatic tumors is 81.48% and 97.5% with test accuracy of 96.5% and 99.4% respectively. Hence FNAC should be used as preliminary screening investigation in all forms of lymphadenopathy and interpretation should be done in conjunction with clinical picture of the patients. [Int J Res Med Sci 2013; 1(3.000: 271-277

  8. Validation of three early ejaculation diagnostic tools: a composite measure is accurate and more adequate for diagnosis by updated diagnostic criteria.

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    Patrick Jern

    Full Text Available PURPOSE: To validate three early ejaculation diagnostic tools, and propose a new tool for diagnosis in line with proposed changes to diagnostic criteria. Significant changes to diagnostic criteria are expected in the near future. Available screening tools do not necessarily reflect proposed changes. MATERIALS AND METHODS: Data from 148 diagnosed early ejaculation patients (M age = 42.8 and 892 controls (M age = 33.1 years from a population-based sample were used. Participants responded to three different questionnaires (Premature Ejaculation Profile; Premature Ejaculation Diagnostic Tool; Multiple Indicators of Premature Ejaculation. Stopwatch measured ejaculation latency times were collected from a subsample of early ejaculation patients. We used two types of responses to the questionnaires depending on the treatment status of the patients 1 responses regarding the situation before starting pharmacological treatment and 2 responses regarding current situation. Logistic regressions and Receiver Operating Characteristics were used to assess ability of both the instruments and individual items to differentiate between patients and controls. RESULTS: All instruments had very good precision (Areas under the Curve ranging from .93-.98. A new five-item instrument (named CHecklist for Early Ejaculation Symptoms - CHEES consisting of high-performance variables selected from the three instruments had validity (Nagelkerke R (2 range .51-.79 for backwards/forwards logistic regression equal to or slightly better than any individual instrument (i.e., had slightly higher validity statistics, but these differences did not achieve statistical significance. Importantly, however, this instrument was more in line with proposed changes to diagnostic criteria. CONCLUSIONS: All three screening tools had good validity. A new 5-item diagnostic tool (CHEES based on the three instruments had equal or somewhat more favorable validity statistics compared to the other three

  9. Revisiting DLB Diagnosis: A Consideration of Prodromal DLB and of the Diagnostic Overlap With Alzheimer Disease.

    Science.gov (United States)

    McKeith, Ian; Taylor, John-Paul; Thomas, Alan; Donaghy, Paul; Kane, Joseph

    2016-09-01

    Efforts to clinically diagnose cases having dementia with Lewy bodies (DLB) identify those with a characteristic clinical syndrome (probable DLB) at the expense of missing an equal, if not greater, number of cases who have atypical presentations thought to be associated with coexisting Alzheimer pathologies. This article argues that further efforts should now be made to characterize this atypical group that constitutes cases previously identified postmortem as the Lewy body variant of Alzheimer disease (AD) or as AD with Lewy bodies. Since such fine distinction is unlikely to be achieved on clinical grounds alone, this new diagnostic category will require robust biomarker validation. Turning to a consideration of early/prodromal diagnosis of both typical and atypical DLB cases, it is suggested that there will be at least 3 prototypical forms-a mild cognitive impairment variant, associated with early visuoperceptual and attentional deficits; a delirium onset DLB with provoked or spontaneous delirium as the presenting features; and a psychiatric disorder DLB with its primary presentation as a late-onset affective disorder or psychosis.

  10. A diagnosis of bipolar spectrum disorder predicts diagnostic conversion from unipolar depression to bipolar disorder: a 5-year retrospective study.

    Science.gov (United States)

    Woo, Young Sup; Shim, In Hee; Wang, Hee-Ryung; Song, Hoo Rim; Jun, Tae-Youn; Bahk, Won-Myong

    2015-03-15

    The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. This study was conducted using a retrospective design and did not include structured diagnostic interviews. The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. The influencing factors of energy poverty in rural Cameroon; Les determinants de la pauvrete energetique en milieu rural au Cameroun

    Energy Technology Data Exchange (ETDEWEB)

    Kamdem, Maxime; Edzengte, Joseph

    2010-09-15

    The objective of this study is to assess the influencing factors of energy poverty in rural Cameroon. The method used is in two stages: the first stage is a statistical analysis that has allowed to determine the level of energy poverty in rural areas, which is 7.5%. The second stage assesses the influencing factors of this poverty type. The results show that the revenue impacts on energy poverty, as well as the size of the household, in which the arrival of an additional person increases by 1.16% the chances that the household will suffer from energy poverty. [French] L'objectif de cette etude est d'evaluer les determinants de la pauvrete energetique en milieu rural au Cameroun. La methode mise en oeuvre procede en deux etapes : la premiere est une analyse statistique qui a permis de determiner le seuil de pauvrete energetique en milieu rural, qui se situe a 7,5%. La deuxieme etape evalue les determinants de ce type de pauvrete. Les resultats indiquent que le revenu explique la pauvrete energetique, de meme que la taille du menage dont l'arrivee d'une personne supplementaire accroit de 1,16% les chances de ce menage d'etre pauvre sur le plan energetique.

  12. Diagnostic Principles of Peri-Implantitis: a Systematic Review and Guidelines for Peri-Implantitis Diagnosis Proposal

    Directory of Open Access Journals (Sweden)

    Ausra Ramanauskaite

    2016-09-01

    Full Text Available Objectives: To review and summarize the literature concerning peri-implantitis diagnostic parameters and to propose guidelines for peri-implantitis diagnosis. Material and Methods: An electronic literature search was conducted of the MEDLINE (Ovid and EMBASE databases for articles published between 2011 and 2016. Sequential screening at the title/abstract and full-text levels was performed. Systematic reviews/guidelines of consensus conferences proposing classification or suggesting diagnostic parameters for peri-implantitis in the English language were included. The review was recorded on PROSPERO system with the code CRD42016033287. Results: The search resulted in 10 articles that met the inclusion criteria. Four were papers from consensus conferences, two recommended diagnostic guidelines, three proposed classification of peri-implantitis, and one suggested an index for implant success. The following parameters were suggested to be used for peri-implantitis diagnosis: pain, mobility, bleeding on probing, probing depth, suppuration/exudate, and radiographic bone loss. In all of the papers, different definitions of peri-implantitis or implant success, as well as different thresholds for the above mentioned clinical and radiographical parameters, were used. Current evidence rationale for the diagnosis of peri-implantitis and classification based on consecutive evaluation of soft-tissue conditions and the amount of bone loss were suggested. Conclusions: Currently there is no single uniform definition of peri-implantitis or the parameters that should be used. Rationale for diagnosis and prognosis of peri-implantitis as well as classification of the disease is proposed.

  13. Distribution & diagnostic efficacy of cardiac markers CK-MB & LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease.

    Science.gov (United States)

    Ghormade, Pankaj Suresh; Kumar, Narendra Baluram; Tingne, Chaitanya Vidyadhar; Keoliya, Ajay Narmadaprasad

    2014-11-01

    The aim of the present study is to evaluate the diagnostic efficacy of biochemical markers creatine kinase-MB (CK-MB) and LDH in pericardial fluid for postmortem diagnosis of ischemic heart disease (IHD). We studied 119 medico-legal autopsies selected during a period of 2 years. Subjects were assigned into diagnostic groups upon final cause of death as follows: (1) sudden cardiac death due to IHD's (n = 52), (2) violent asphyxia (n = 24); (3) polytraumatic deaths (n = 20); (4) natural deaths excluding cardiac causes (n = 23). Pericardial fluid samples were tested for estimating enzyme levels. Histological examination was performed with hematoxylin and eosin (H&E) stain on myocardial tissue samples. We observed highest levels of CK-MB & LDH in deaths due to IHD's. Kruskal-Wallis test revels significant differences in activities of CK-MB (P = 0.0001) and LDH (P = 0.0065) amongst all diagnostic groups. Mann-Whitney test showed highly significant (P MB in group 1 as compared to other diagnostic groups. However, LDH levels were non-discriminatory (P = 0.0827) between cases of IHD's and cases of other natural deaths. CK-MB levels were statistically non-significant between cases divided as myocardial infarction (MI) and severe coronary artery disease in group 1, hence its role for postmortem detection of MI is somewhat limiting. However, sensitivity and negative predictive values of its cut off level obtained in cases of IHD's are nearly equal to diagnostic efficacy in clinical settings. Hence, it can be useful additional diagnostic tool for autopsy diagnosis of IHD's. Whereas, LDH is not useful for postmortem diagnosis in these cases. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  14. Self-diagnosis of malaria by travelers and expatriates: assessment of malaria rapid diagnostic tests available on the internet.

    Directory of Open Access Journals (Sweden)

    Jessica Maltha

    Full Text Available INTRODUCTION: In the past malaria rapid diagnostic tests (RDTs for self-diagnosis by travelers were considered suboptimal due to poor performance. Nowadays RDTs for self-diagnosis are marketed and available through the internet. The present study assessed RDT products marketed for self-diagnosis for diagnostic accuracy and quality of labeling, content and instructions for use (IFU. METHODS: Diagnostic accuracy of eight RDT products was assessed with a panel of stored whole blood samples comprising the four Plasmodium species (n = 90 as well as Plasmodium negative samples (n = 10. IFUs were assessed for quality of description of procedure and interpretation and for lay-out and readability level. Errors in packaging and content were recorded. RESULTS: Two products gave false-positive test lines in 70% and 80% of Plasmodium negative samples, precluding their use. Of the remaining products, 4/6 had good to excellent sensitivity for the diagnosis of Plasmodium falciparum (98.2%-100.0% and Plasmodium vivax (93.3%-100.0%. Sensitivity for Plasmodium ovale and Plasmodium malariae diagnosis was poor (6.7%-80.0%. All but one product yielded false-positive test lines after reading beyond the recommended reading time. Problems with labeling (not specifying target antigens (n = 3, and content (desiccant with no humidity indicator (n = 6 were observed. IFUs had major shortcomings in description of test procedure and interpretation, poor readability and lay-out and user-unfriendly typography. Strategic issues (e.g. the need for repeat testing and reasons for false-negative tests were not addressed in any of the IFUs. CONCLUSION: Diagnostic accuracy of RDTs for self-diagnosis was variable, with only 4/8 RDT products being reliable for the diagnosis of P. falciparum and P. vivax, and none for P. ovale and P. malariae. RDTs for self-diagnosis need improvements in IFUs (content and user-friendliness, labeling and content before they can be considered for self-diagnosis

  15. Self-Diagnosis of Malaria by Travelers and Expatriates: Assessment of Malaria Rapid Diagnostic Tests Available on the Internet

    Science.gov (United States)

    Maltha, Jessica; Gillet, Philippe; Heutmekers, Marloes; Bottieau, Emmanuel; Van Gompel, Alfons; Jacobs, Jan

    2013-01-01

    Introduction In the past malaria rapid diagnostic tests (RDTs) for self-diagnosis by travelers were considered suboptimal due to poor performance. Nowadays RDTs for self-diagnosis are marketed and available through the internet. The present study assessed RDT products marketed for self-diagnosis for diagnostic accuracy and quality of labeling, content and instructions for use (IFU). Methods Diagnostic accuracy of eight RDT products was assessed with a panel of stored whole blood samples comprising the four Plasmodium species (n = 90) as well as Plasmodium negative samples (n = 10). IFUs were assessed for quality of description of procedure and interpretation and for lay-out and readability level. Errors in packaging and content were recorded. Results Two products gave false-positive test lines in 70% and 80% of Plasmodium negative samples, precluding their use. Of the remaining products, 4/6 had good to excellent sensitivity for the diagnosis of Plasmodium falciparum (98.2%–100.0%) and Plasmodium vivax (93.3%–100.0%). Sensitivity for Plasmodium ovale and Plasmodium malariae diagnosis was poor (6.7%–80.0%). All but one product yielded false-positive test lines after reading beyond the recommended reading time. Problems with labeling (not specifying target antigens (n = 3), and content (desiccant with no humidity indicator (n = 6)) were observed. IFUs had major shortcomings in description of test procedure and interpretation, poor readability and lay-out and user-unfriendly typography. Strategic issues (e.g. the need for repeat testing and reasons for false-negative tests) were not addressed in any of the IFUs. Conclusion Diagnostic accuracy of RDTs for self-diagnosis was variable, with only 4/8 RDT products being reliable for the diagnosis of P. falciparum and P. vivax, and none for P. ovale and P. malariae. RDTs for self-diagnosis need improvements in IFUs (content and user-friendliness), labeling and content before they can be considered for

  16. Biomarkers for diagnosis of neonatal infections: A systematic analysis of their potential as a point-of-care diagnostics

    Directory of Open Access Journals (Sweden)

    Mahbuba Meem

    2011-12-01

    Full Text Available Neonatal infections annually claim lives of 1.4 million neonates worldwide. Until now, there is no ideal diagnostic test for detecting sepsis and thus management of possible sepsis cases often depends on clinical algorithm leading to empirical treatment. This often results in unnecessary antibiotic use, which may lead to emergence of antibiotic resistance. Biomarkers have shown great promise in diagnosis of sepsis and guiding appropriate treatment of neonates. In this study, we conducted a literature review of existing biomarkers to analyze their status for use as a point-of-care diagnostic in developing countries.

  17. Multiple sclerosis: imaging, diagnostic criteria and differential diagnosis; Bildgebung, Diagnosekriterien und Differenzialdiagnose der Multiplen Sklerose

    Energy Technology Data Exchange (ETDEWEB)

    Harting, I.; Sartor, K. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Sellner, J.; Meyding-Lamade, U. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)

    2003-05-01

    Multiple sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system (CNS), presenting with multifocal, disseminated inflammatory lesions referred to as plaques. Magnetic resonance imaging (MRI) typically depicts multiple, round to oval, circumscript lesions predominantly involving periventricular and subcortical white matter, brainstem and cerebellum. More recent investigations have demonstrated that the macroscopically visible plaques only present the tip of the iceberg: Already early in its course, MS causes neuroaxonal damage and diffusely involves the entire brain parenchyma including normal appearing white matter. These changes are reflected by strongly T{sub 1}w hypointense lesions and atrophy of early onset, by reduction of the neuronal Marker N-acetylaspartate (NAA) on spectroscopy, by a decrease of the magnetization transfer ratio (MTR), by an increased in diffusibility and decreased anisotropy on diffusion-weighted imaging (DWI). MRI imaging is an important tool in the diagnosis of MS by revealing the characteristic spatial and temporal dissemination of the cerebral and spinal manifestations of this disease. Diagnostic criteria increase the diagnostic specificity and allow better differentiation from other diseases with multifocal white matter abnormalities. (orig.) [German] Die multiple sklerose (MS) ist die haeufigste entzuendliche, demyelinisierende Erkrankung des zentralen Nervensystems (ZNS) Sie ist durch multifokale, disseminierte Entzuendungsherde, sogenannte Plaques, in den myelinhaltigen Strukturen des ZNS charakterisiert. In der Magnetresonanztomographie (MRT) sind multiple umschriebene, rundlich-ovale Laesionen der weissen Substanz charakteristisch, die bevorzugt im periventrikulaeren Marklager, an der Mark-Rindengrenze, im Hirnstamm und im Kleinhirn lokalisiert sind. Neuere Untersuchungen zeigen, dass die sichtbaren Entmarkungsherde nur die Spitze des Eisbergs sind: Bereits fruehzeitig verursacht die MS

  18. Field evaluation of a rapid diagnostic test (Parascreen™ for malaria diagnosis in the Peruvian Amazon

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    Rodriguez Hugo

    2010-06-01

    Full Text Available Abstract Background The rapid diagnostic tests for malaria (RDT constitute a fast and opportune alternative for non-complicated malaria diagnosis in areas where microscopy is not available. The objective of this study was to validate a RDT named Parascreen™ under field conditions in Iquitos, department of Loreto, Peru. Parascreen™ is a RDT that detects the histidine-rich protein 2 (HRP2 antigen from Plasmodium falciparum and lactate deshydrogenase from all Plasmodium species. Methods Parascreen™ was compared with microscopy performed by experts (EM and polymerase chain reaction (PCR using the following indicators: sensitivity (Se, specificity (Sp, positive (PV+ and negative predictive values (PV-, positive (LR+ and negative likehood ratio (LR-. Results 332 patients with suspected non-complicated malaria who attended to the MOH health centres were enrolled between October and December 2006. For P. falciparum malaria, Parascreen™ in comparison with EM, had Se: 53.5%, Sp: 98.7%, PV+: 66.7%, PV-: 97.8%, LR+: 42.27 and LR-: 0.47; and for non-P. falciparum malaria, Se: 77.1%, Sp: 97.6%, PV+: 91.4%, PV-: 92.7%, LR+: 32.0 and LR-: 0.22. The comparison of Parascreen™ with PCR showed, for P. falciparum malaria, Se: 81.8%, Sp: 99.1%, PV+: 75%, PV-: 99.4, LR+: 87.27 and LR-: 0.18; and for non-P. falciparum malaria Se: 76.1%, Sp: 99.2%, PV+: 97.1%, PV-: 92.0%, LR+: 92.51 and LR-: 0.24. Conclusions The study results indicate that Parascreen™ is not a valid and acceptable test for malaria diagnosis under the field conditions found in the Peruvian Amazon. The relative proportion of Plasmodium species, in addition to the genetic characteristics of the parasites in the area, must be considered before applying any RDT, especially after the finding of P. falciparum malaria parasites lacking pfhrp2 gene in this region.

  19. Medical diagnosis aboard submarines. Use of a computer-based Bayesian method of analysis in an abdominal pain diagnostic program.

    Science.gov (United States)

    Osborne, S F

    1984-02-01

    The medical issues that arise in the isolated environment of a submarine can occasionally be grave. While crewmembers are carefully screened for health problems, they are still susceptible to serious acute illness. Currently, the submarine medical department representative, the hospital corpsman, utilizes a history and physical examination, clinical acumen, and limited laboratory testing in diagnosis. The application of a Bayesian method of analysis to an abdominal pain diagnostic system utilizing an onboard microcomputer is described herein. Early results from sea trials show an appropriate diagnosis in eight of 10 cases of abdominal pain, but the program should still be viewed as an extended "laboratory test" until proved effective at sea.

  20. Diagnostic Dilemma in a Young Woman with Acute Headache: Delayed Diagnosis of Third Ventricular Colloid Cyst with Hydrocephalus

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    Jasem Y. Al-Hashel

    2015-01-01

    Full Text Available Objectives. To highlight the importance of early diagnosis of colloid cyst of the third ventricle and its early management. Clinical Presentation and Intervention. This is a young lady who presented with sudden onset headache. She attended a local clinic and also her area hospital. Her diagnosis was delayed several hours due to a diagnostic dilemma initially. No surgical intervention was tried since the patient developed early signs of brainstem coning by the time she was seen by neurosurgeon. Patient died after few days in spite of intensive ICU measures. Conclusion. Sudden onset headache in young adults should be looked at carefully. Early imaging is mandatory to prevent mortality.

  1. Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis

    DEFF Research Database (Denmark)

    Larsen, Ellen Frøsig Moseholm; Rydahl Hansen, Susan; Overgaard, Dorthe

    2016-01-01

    diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors. Methods A prospective, multicenter survey study of patients...... of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis......-specific symptoms experience a high prevalence of anxiety and affected quality of life prior to knowledge of the diagnosis. The predictive value of the baseline scores is important when assessing the psychological impact of undergoing diagnostic evaluations for cancer....

  2. The Diagnostic Utility of Bact/ALERT and Nested PCR in the Diagnosis of Tuberculous Meningitis

    Science.gov (United States)

    Sastry, Apurba Sankar; Bhat K, Sandhya; Kumudavathi

    2013-01-01

    Objective: The early laboratory diagnosis of Tuberculous Meningitis (TBM) is crucial, to start the antitubercular chemotherapy and to prevent its complications. However, the conventional methods are either less sensitive or time consuming. Hence, the diagnostic potentials of BacT/ALERT and Polymerase Chain Reaction (PCR) was evaluated in this study. Material and Method: The study group comprised of 62 cases and 33 controls. The cases were divided according to Ahuja’s criteria into the confirmed (two cases), highly probable (19 cases), probable (26 cases) and the possible (15 cases) subgroups. Ziehl Neelsen’s (ZN) and Auramine Phenol (AP) staining, Lowenstein Jensen (LJ) medium culture, BacT/ALERT and nested Polymerase Chain Reaction (PCR) which targeted IS6110 were carried out on all the patients. Observation and Results: The sensitivity of the LJ culture was 3.22%. BacT/ALERT showed a sensitivity and a specificity of 25.80% and 100% and those of nested PCR were found to be 40.32% and 96.97% respectively. The mean detection time of growth of the LJ culture was 31.28 days, whereas that of BacT/ALERT was 20.68 days. The contamination rate in the LJ culture and BacT/ALERT were 7.2% and 5.8% respectively. Conclusion: Nested PCR was found to be more sensitive, followed by BacT/ALERT as compared to the LJ culture and smear microscopy. As both false negative and false positive results have been reported for nested PCR, so it should not be used alone as a criterion for initiating or terminating the therapy, but it should be supported by clinical, radiological, cytological and other microbiological findings. PMID:23450650

  3. Algorithm for the Diagnosis of Scleroderma. Early Systemic Sclerosis: Definitions and diagnostic criteria

    Directory of Open Access Journals (Sweden)

    Domenico Galasso

    2013-04-01

    Full Text Available Introduction: The term scleroderma derives from the Greek words skleros, which means hard, and derma, which means skin. It refers to an acquired systemic inflammatory disease of the connective tissue –also known as systemic sclerosis (SSc– characterized by excessive collagen deposition in the skin and the internal organs that results in fibrosis. The typical vascular lesion in SSc leads to narrowing of the vessel lumen, intimal thickening, medial hypotrophy, and adventitial fibrosis of small muscular vessels, collagen deposition in the other matrix components of interstice, and the Raynaud phenomenon secondary to these widespread microvascular abnormalities. All these characteristics lead to a connective tissue re-modeling. Discussion: Several clinical studies utilize the American Rheumatology Association’s 1980 classification. However, these diagnostic criteria are unsatisfactory because they fail to take into consideration part of the disease spectrum. Early-phase SSc is characterized by the Raynaud phenomenon (in 90% of all patients, sclerodactyly, and positivity for SSc-specific autoantibodies (antinuclear antibodies, anti-topoisomerase I antibodies, anti-RNA polymerase I and III antibodies, anti-centromere antibodies, anti-fibrillarin antibodies, anti-PM-SCL antibodies.. It is necessary to reduce delays in the diagnosis of SSc. Conclusions: Patients with red-flag positivity (Raynaud phenomenon and digital edema require Phase I SSc screening, which consists in capillaroscopic assessment of possible microvascular abnormalities. The work-up will then focus on inflammatory indices, renal function tests, and internal organ involvement (echocardiography, high-resolution computed tomography of the chest, diffusing capacity of the lungs for carbon monoxide.

  4. A comparative laboratory diagnosis of malaria:microscopy versus rapid diagnostic test kits

    Institute of Scientific and Technical Information of China (English)

    Azikiwe CCA; Ifezulike CC; Siminialayi IM; Amazu LU; Enye JC; Nwakwunite OE

    2012-01-01

    Objective: To compare the two methods of rapid diagnostic tests (RDTs) and microscopy in the diagnosis of malaria. Methods: RDTs and microscopy were carried out to diagnose malaria. Percentage malaria parasitaemia was calculated on thin films and all non-acute cases of plasmodiasis with less than 0.001% malaria parasitaemia were regarded as negative. Results were simply presented as percentage positive of the total number of patients under study. The results of RDTs were compared to those of microscopy while those of RDTs based on antigen were compared to those of RDTs based on antibody. Patients' follow-up was made for all cases. Results:All the 200 patients under present study tested positive to RDTs based on malaria antibodies (serum) method (100%). 128 out of 200 tested positive to RDTs based on malaria antigen (whole blood) method (64%), while 118 out of 200 patients under present study tested positive to visual microscopy of Lieshman and diluted Giemsa (59%). All patients that tested positive to microscopy also tested positive to RDTs based on antigen. All patients on the second day of follow-up were non-febrile and had antimalaria drugs. Conclusions: We conclude based on the present study that the RDTs based on malaria antigen (whole blood) method is as specific as the traditional microscopy and even appears more sensitive than microscopy. The RDTs based on antibody (serum) method is unspecific thus it should not be encouraged. It is most likely that Africa being an endemic region, formation of certain levels of malaria antibody may not be uncommon. The present study also supports the opinion that a good number of febrile cases is not due to malaria. We support WHO’s report on cost effectiveness of RDTs but, recommend that only the antigen based method should possibly, be adopted in Africa and other malaria endemic regions of the world.

  5. Molecular diagnosis of bacterial vaginosis: Does adjustment for total bacterial load or human cellular content improve diagnostic performance?

    Science.gov (United States)

    Plummer, E L; Garland, S M; Bradshaw, C S; Law, M G; Vodstrcil, L A; Hocking, J S; Fairley, C K; Tabrizi, S N

    2017-02-01

    We investigated the utility of quantitative PCR assays for diagnosis of bacterial vaginosis and found that while the best model utilized bacterial copy number adjusted for total bacterial load (sensitivity=98%, specificity=93%, AUC=0.95[95%CI=0.93,0.97]), adjusting for total bacterial or human cell load did not consistently increase the diagnostic performance of the assays. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Diagnosis of acute surgical abdomen – The best diagnostic tool to reach a final diagnosiscin

    Directory of Open Access Journals (Sweden)

    CS Wong

    2012-01-01

    Conclusions: Appendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.

  7. The Diagnostic and Differential Diagnosis Utility of Cerebrospinal Fluid α -Synuclein Levels in Parkinson's Disease: A Meta-Analysis.

    Science.gov (United States)

    Zhou, Bo; Wen, Min; Yu, Wen-Feng; Zhang, Chun-Lin; Jiao, Ling

    2015-01-01

    Several recent studies showed that α-syn might be a potential diagnostic biomarker for PD in human cerebrospinal fluid (CSF), but the results were inconsistent. The purpose of this meta-analysis was to investigate the diagnostic and differential diagnosis efficacy of CSF α-syn in PD. Studies which measured CSF α-syn or α-syn oligomers in patients with PD and met the inclusion criteria were included in the analysis. Results of the meta-analysis indicated that mean concentration of CSF α-syn was significantly lower in PD compared to controls and significantly higher in PD compared to multiple system atrophy (MSA). No significant difference in mean concentration of CSF α-syn was found between PD and dementia with Lewy bodies (DLB). Mean concentration of CSF α-syn was slightly decreased in PD compared to progressive supranuclear palsy (PSP). Mean concentration of CSF α-syn oligomers was significantly higher in PD than control. These results support the findings that CSF α-syn may be a potential diagnostic and differential diagnosis biomarker in PD compared to control and MSA but not DLB. Furthermore, α-syn oligomer may represent a better biomarker for diagnosis of PD.

  8. [Cross-Mapping: diagnostic labels formulated according to the ICNP® versus diagnosis of NANDA International].

    Science.gov (United States)

    Tannure, Meire Chucre; Salgado, Patrícia de Oliveira; Chianca, Tânia Couto Machado

    2014-01-01

    This descriptive study aimed at elaborating nursing diagnostic labels according to ICNP®; conducting a cross-mapping between the diagnostic formulations and the diagnostic labels of NANDA-I; identifying the diagnostic labels thus obtained that were also listed in the NANDA-I; and mapping them according to Basic Human Needs. The workshop technique was applied to 32 intensive care nurses, the cross-mapping and validation based on agreement with experts. The workshop produced 1665 diagnostic labels which were further refined into 120 labels. They were then submitted to a cross-mapping process with both NANDA-I diagnostic labels and the Basic Human Needs. The mapping results underwent content validation by two expert nurses leading to concordance rates of 92% and 100%. It was found that 63 labels were listed in NANDA-I and 47 were not.

  9. Diagnostic validity of an expert tuberculosis commission that assists the diagnosis of bacteriologically negative suspected TB cases in Havana, Cuba.

    Science.gov (United States)

    Matthys, F; Pérez, M Peralta; Díaz, S Valdés; Silvera, E García; Díaz, T Crespo; Pérez, L Armas; Ochoa, E González; Van der Stuyft, P

    2009-01-01

    The Provincial Tuberculosis Commission of Havana, Cuba, a multi-speciality committee, assists clinicians in diagnosing bacteriologically negative tuberculosis (TB). At its weekly meetings, clinicians present the files of suspected TB cases for discussion, diagnosis and recommendations. This prospective study assessed the validity of the diagnoses made by the Commission by comparing the diagnoses made with diagnoses ascertained after one year of follow-up. Between October 2002 and December 2003, 126 patients suspected to have TB but who were bacteriologically negative completed diagnostic work at the Commission. Fifty-three (42%) were diagnosed as TB cases. The definite diagnosis of 116 patients (92%) was ascertained after one year of follow-up. Six patients diagnosed by the Commission as TB cases were suffering from other diseases, while one patient diagnosed with pneumonia had a definite diagnosis of pulmonary TB. The diagnostic sensitivity and specificity of the Commission were 98% (95% CI 93-100) and 92% (95% CI 85-98), respectively. The Provincial Tuberculosis Commission of Havana can be considered a valuable tool for the diagnosis of TB in patients suspected of TB but who are bacteriologically negative. A comparable approach, adapted to the local conditions, could prove useful in other epidemiological and healthcare settings.

  10. Virtual microscopy: an evaluation of its validity and diagnostic performance in routine histologic diagnosis of skin tumors

    DEFF Research Database (Denmark)

    Nielsen, Patricia Switten; Lindebjerg, Jan; Rasmussen, Jan;

    2010-01-01

    Digitization of histologic slides is associated with many advantages, and its use in routine diagnosis holds great promise. Nevertheless, few articles evaluate virtual microscopy in routine settings. This study is an evaluation of the validity and diagnostic performance of virtual microscopy...... that it is feasible to make histologic diagnosis on the skin tumor types represented in this study using virtual microscopy after pathologists have completed a period of training. Larger studies should be conducted to verify whether virtual microscopy can replace conventional microscopy in routine practice....... in routine histologic diagnosis of skin tumors. Our aim is to investigate whether conventional microscopy of skin tumors can be replaced by virtual microscopy. Ninety-six skin tumors and skin-tumor-like changes were consecutively gathered over a 1-week period. Specimens were routinely processed, and digital...

  11. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    Directory of Open Access Journals (Sweden)

    Manzar Vakili

    2015-01-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2 less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 % in the 24 hours and 4 (1.33% patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937 and sex (P

  12. Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS.

    Science.gov (United States)

    Schellhaas, Barbara; Görtz, Ruediger S; Pfeifer, Lukas; Kielisch, Christian; Neurath, Markus F; Strobel, Deike

    2017-09-01

    A comparison is made of two contrast-enhanced ultrasound (CEUS) algorithms for the diagnosis of hepatocellular carcinoma (HCC) in high-risk patients: Erlanger Synopsis of Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at Risk (ESCULAP) and American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System (ACR-CEUS-LI-RADSv.2016). Focal liver lesions in 100 high-risk patients were assessed using both CEUS algorithms (ESCULAP and CEUS-LI-RADSv.2016) for a direct comparison. Lesions were categorized according to size and contrast enhancement in the arterial, portal venous and late phases.For the definite diagnosis of HCC, categories ESCULAP-4, ESCULAP-Tr and ESCULAP-V and CEUS-LI-RADS-LR-5, LR-Tr and LR-5-V were compared. In addition, CEUS-LI-RADS-category LR-M (definitely/probably malignant, but not specific for HCC) and ESCULAP-category C [intrahepatic cholangiocellular carcinoma (ICC)] were compared.Histology, CE-computed tomography and CE-MRI served as reference standards. The reference standard among 100 lesions included 87 HCCs, six ICCs and seven non-HCC-non-ICC-lesions. For the diagnosis of HCC, the diagnostic accuracy of CEUS was significantly higher with ESCULAP versus CEUS-LI-RADS (94.3%/72.4%; p<0.01). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value for ESCULAP/CEUS-LI-RADS were 94.3%/72.4%; 61.5%/69.2%; 94.3%/94%; and 61.5%/27.3%, respectively.The diagnostic accuracy for ICC (LR-M/ESCULAP-C) was identical with both algorithms (50%), with higher PPV for ESCULAP-C versus LR-M (75 vs. 50%). CEUS-based algorithms contribute toward standardized assessment and reporting of HCC-suspect lesions in high-risk patients. ESCULAP shows significantly higher diagnostic accuracy, sensitivity and negative predictive value with no loss of specificity compared with CEUS-LI-RADS. Both algorithms have an excellent PPV. Arterial hyperenhancement is the key feature for the

  13. CLINICAL DIAGNOSTIC VALUE OF AUTOANTIBODIES IN THE DIAGNOSIS OF AUTOIMMUNE LIVER DISEASES

    Directory of Open Access Journals (Sweden)

    V. V. Bazarnyi

    2015-01-01

    Full Text Available We are studied the 15 patients with autoimmune liver diseases and 36 patients without autoimmune pathology found the diagnostic value of antinuclear and antimitochondrial autoantibodies (AMA-M2 tests, and antibodies to asialoglycoprotein receptor (anti-ASGPR. Based on the ROC analysis showed that the diagnostic sensitivity and diagnostic specificity of AMA-M2 was 73% and 100% and for anti-ASGPR – 60% and 77%, respectively. Therefore, the test for anti-ASGPR in autoimmune diseases of the liver showed no advantages over standart tests, and its using in clinical practice requires clarification. 

  14. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear

    DEFF Research Database (Denmark)

    Reiman, M P; Goode, A P; Cook, C E;

    2015-01-01

    to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI). RESULTS: The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated...... surgical decision-making. OBJECTIVE: Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS: A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well...

  15. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...

  16. Comparison of the diagnostic performance of microscopic examination with nested polymerase chain reaction for optimum malaria diagnosis in Upper Myanmar.

    Science.gov (United States)

    Kang, Jung-Mi; Cho, Pyo-Yun; Moe, Mya; Lee, Jinyoung; Jun, Hojong; Lee, Hyeong-Woo; Ahn, Seong Kyu; Kim, Tae Im; Pak, Jhang Ho; Myint, Moe Kyaw; Lin, Khin; Kim, Tong-Soo; Na, Byoung-Kuk

    2017-03-16

    Accurate diagnosis of Plasmodium infection is crucial for prompt malaria treatment and surveillance. Microscopic examination has been widely applied as the gold standard for malaria diagnosis in most part of malaria endemic areas, but its diagnostic value has been questioned, particularly in submicroscopic malaria. In this study, the diagnostic performance of microscopic examination and nested polymerase chain reaction (PCR) was evaluated to establish optimal malaria diagnosis method in Myanmar. A total of 1125 blood samples collected from residents in the villages and towns located in Naung Cho, Pyin Oo Lwin, Tha Beik Kyin townships and Mandalay of Upper Myanmar were screened by microscopic examination and species-specific nested PCR method. Among the 1125 blood samples, 261 samples were confirmed to be infected with malaria by microscopic examination. Evaluation of the 1125 samples by species-specific nested PCR analysis revealed that the agreement between microscopic examination and nested PCR was 87.3% (261/299). Nested PCR successfully detected 38 Plasmodium falciparum or Plasmodium vivax infections, which were missed in microscopic examination. Microscopic examinations also either misdiagnosed the infected Plasmodium species, or did not detect mixed infections with different Plasmodium species in 31 cases. The nested PCR method is more reliable than conventional microscopic examination for the diagnosis of malaria infections, and this is particularly true in cases of mixed infections and submicroscopic infections. Given the observed higher sensitivity and specificity of nested PCR, the molecular method holds enormous promise in malaria diagnosis and species differentiation, and can be applied as an effective monitoring tool for malaria surveillance, control and elimination in Myanmar.

  17. Flow Cytometry as a Diagnostic Tool in the Early Diagnosis of Aggressive Lymphomas Mimicking Life-Threatening Infection

    Directory of Open Access Journals (Sweden)

    Nikolaos J. Tsagarakis

    2011-01-01

    Full Text Available Aggressive lymphomas can present with symptoms mimicking life-threatening infection. Flow cytometry (FC is usually recommended for the classification and staging of lymphomas in patients with organomegaly and atypical cells in effusions and blood, after the exclusion of other possible diagnoses. FC may also have a place in the initial diagnostic investigation of aggressive lymphoma. Three cases are presented here of highly aggressive lymphomas in young adults, which presented with the clinical picture of fever of unknown origin (FUO in patients severely ill. All followed a life-threatening clinical course, and two developed the hemophagocytic syndrome (HPS, but microbiological, immunological, and morphological evaluation and immunohistochemistry (IHC failed to substantiate an early diagnosis. FC was the technique that provided conclusive diagnostic evidence of lymphoma, subsequently verified by IHC. Our experience with these three cases highlights the potential role of FC as an adjunct methodology in the initial assessment of possible highly aggressive lymphoma presenting with the signs and symptoms of life-threatening infection, although the definitive diagnosis should be established by biopsy. In such cases, FC can contribute to the diagnosis of lymphoma, independently of the presence of HPS.

  18. Diagnostic Value of Liquid-Based Cytology in Urothelial Carcinoma Diagnosis: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    You Luo

    Full Text Available To evaluate the value of liquid-based cytology (LBC in the diagnosis of urothelial carcinoma.Diagnostic studies were searched for the diagnostic value of LBC in urothelial carcinoma in PubMed, Embase, Cochrane Library, Web of Science, CBM and CNKI. The latest retrieval date was September 2014. The data were extracted and the quality of the included studies was independently assessed by 2 reviewers. Stata 13 software was used to perform the statistical analysis. The research was conducted in compliance with the PRISMA statement.Nineteen studies, which included 8293 patients, were evaluated. The results of the meta-analysis showed that the pooled sensitivity and specificity of LBC were 0.58 (0.51-0.65 and 0.96 (0.93-0.98, respectively. The diagnostic odds ratio (DOR was 31 (18-56 and the area under the curve (AUC of summary receiver operating characteristic (SROC was 0.83 (0.80-0.86. The post-test probability was 80% when a positive diagnosis was made. Compared with high grade urothelial carcinoma (HGUC, the sensitivity of detecting low-grade urothelial carcinoma (LGUC was significantly lower, risk ratio of sensitivity was 0.54 (0.43-0.66, P<0.001. However, no significant sensitivity improvement was observed with LBC when compared with traditional cytospin cytology, risk ratio was 1.03 (0.94-1.14, P = 0.524.Despite LBC having a pooled 58% positive rate for urothelial carcinoma diagnosis in our meta-analysis, no significant improvement in sensitivity was observed based on the studies evaluated. Further research is needed to validate these findings.

  19. Diagnostic Value of Liquid-Based Cytology in Urothelial Carcinoma Diagnosis: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Luo, You; She, Dong-Li; Xiong, Hu; Yang, Li; Fu, Sheng-Jun

    2015-01-01

    To evaluate the value of liquid-based cytology (LBC) in the diagnosis of urothelial carcinoma. Diagnostic studies were searched for the diagnostic value of LBC in urothelial carcinoma in PubMed, Embase, Cochrane Library, Web of Science, CBM and CNKI. The latest retrieval date was September 2014. The data were extracted and the quality of the included studies was independently assessed by 2 reviewers. Stata 13 software was used to perform the statistical analysis. The research was conducted in compliance with the PRISMA statement. Nineteen studies, which included 8293 patients, were evaluated. The results of the meta-analysis showed that the pooled sensitivity and specificity of LBC were 0.58 (0.51-0.65) and 0.96 (0.93-0.98), respectively. The diagnostic odds ratio (DOR) was 31 (18-56) and the area under the curve (AUC) of summary receiver operating characteristic (SROC) was 0.83 (0.80-0.86). The post-test probability was 80% when a positive diagnosis was made. Compared with high grade urothelial carcinoma (HGUC), the sensitivity of detecting low-grade urothelial carcinoma (LGUC) was significantly lower, risk ratio of sensitivity was 0.54 (0.43-0.66), Pcytology, risk ratio was 1.03 (0.94-1.14), P = 0.524. Despite LBC having a pooled 58% positive rate for urothelial carcinoma diagnosis in our meta-analysis, no significant improvement in sensitivity was observed based on the studies evaluated. Further research is needed to validate these findings.

  20. Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis.

    Science.gov (United States)

    Dowdy, D W; O'Brien, M A; Bishai, D

    2008-09-01

    The potential cost-effectiveness of improved diagnostic tests for tuberculosis (TB) in resource-limited settings is unknown. To estimate the incremental cost-effectiveness of a hypothetical new point-of-care TB diagnostic test in South Africa, Brazil and Kenya. Decision-analysis model, adding four diagnostic interventions (sputum smear microscopy, new test, smear plus new test and smear plus TB culture) to a baseline of existing infrastructure without smear. Adding sputum smear was estimated to be more cost-effective (incremental cost per disability-adjusted life year [DALY] of $86 [South Africa], $131 [Brazil], $38 (Kenya]) than a new TB diagnostic with 70% sensitivity, 95% specificity and price of $20 per test ($198 [South Africa], $275 [Brazil], $84 [Kenya]). However, compared to sputum smear, smear plus new test averted 46-49% more DALYs per 1000 TB suspects (321 vs. 215 [South Africa], 243 vs. 166 [Brazil], 790 vs. 531 [Kenya]), at an incremental cost of $170 (Kenya) to $625 (Brazil) per DALY averted. Cost-effectiveness was most sensitive to the specificity and price of the new test, the baseline TB case detection rate and the discount rate. Novel diagnostic tests for TB are potentially highly cost-effective. Cost-effectiveness is maximized by high-specificity, low-cost tests deployed to regions with poor infrastructure.

  1. Major Salivary Gland Ultrasonography in the Diagnosis of Sjögren's Syndrome: A Place in the Diagnostic Criteria?

    Science.gov (United States)

    Jonsson, Malin V; Baldini, Chiara

    2016-08-01

    Major salivary gland (SG) ultrasonography (US) represents a noninvasive, nonirradiating imaging modality for evaluation of the major SGs in the diagnosis and follow-up of primary and secondary Sjögren syndrome. Structural changes can be visualized as hyperechogenic and hypoechogenic areas, inhomogeneity, and altered echogenicity in general. The reliability of SG-US is poorly investigated, and the definition of US abnormalities varies in previously published studies. Recent studies have shown correlations between SG-US findings and focus score in the minor SGs; however further studies are needed to validate a US criterion in updated classification/diagnostic criteria.

  2. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools.

    Science.gov (United States)

    Bulakci, Mesut; Cengel, Ferhat

    2016-01-01

    Emergency physicians and radiologists have been increasingly encountering internal concealment of illegal drugs. The packages commonly contain powdered solid drugs such as cocaine, heroin, methamphetamine and hashish, but they may also contain cocaine in the liquid form. The second type of package has recently been more commonly encountered, and poses a greater diagnostic challenge. As clinical evaluation and laboratory tests frequently fail to make the correct diagnosis, imaging examination is typically required. Imaging methods assume a vital role in the diagnosis, follow-up and management. Abdominal X-ray, ultrasonography, CT and MRI are used for the imaging purposes. Among the aforementioned methods, low-dose CT is state-of-the-art in these cases. It is of paramount importance that radiologists have a full knowledge of the imaging characteristics of these packages and accurately guide physicians and security officials.

  3. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

    2014-01-01

    Objective: European ST-segment elevation myocardial infarction (STEMI) guidelines recommend prehospital diagnosis to facilitate early reperfusion in patients with STEMI, and they provide recommendations regarding optimal system delay (time from first medical contact (FMC) to the primary...... percutaneous coronary intervention (PPCI)). There are limited data on achievable system delays in an optimal STEMI system of care using prehospital diagnosis to triage patients with STEMI directly to percutaneous coronary intervention (PCI) centres. We examined the proportion of tentative prehospital STEMI...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported

  4. Qualitative Event-based Diagnosis with Possible Conflicts: Case Study on the Third International Diagnostic Competition

    Data.gov (United States)

    National Aeronautics and Space Administration — We describe two model-based diagnosis algo- rithms entered into the Third International Diag- nostic Competition. We focus on the first diag- nostic problem of the...

  5. The Diagnostic Challenge Competition: Probabilistic Techniques for Fault Diagnosis in Electrical Power Systems

    Science.gov (United States)

    Ricks, Brian W.; Mengshoel, Ole J.

    2009-01-01

    Reliable systems health management is an important research area of NASA. A health management system that can accurately and quickly diagnose faults in various on-board systems of a vehicle will play a key role in the success of current and future NASA missions. We introduce in this paper the ProDiagnose algorithm, a diagnostic algorithm that uses a probabilistic approach, accomplished with Bayesian Network models compiled to Arithmetic Circuits, to diagnose these systems. We describe the ProDiagnose algorithm, how it works, and the probabilistic models involved. We show by experimentation on two Electrical Power Systems based on the ADAPT testbed, used in the Diagnostic Challenge Competition (DX 09), that ProDiagnose can produce results with over 96% accuracy and less than 1 second mean diagnostic time.

  6. Early Diagnosis of Pneumonia in Severe Stroke: Clinical Features and the Diagnostic Role of C-Reactive Protein.

    Directory of Open Access Journals (Sweden)

    Anushka Warusevitane

    Full Text Available Accurate diagnosis of pneumonia complicating severe stroke is challenging due to difficulties in physical examination, altered immune responses and delayed manifestations of radiological changes. The aims of this study were to describe early clinical features and to examine C-reactive protein (CRP as a diagnostic marker of post-stroke pneumonia.Patients who required nasogastric feeding and had no evidence of pneumonia within 7 days of stroke onset were included in the study and followed-up for 21 days with a daily clinical examination. Pneumonia was diagnosed using modified British Thoracic Society criteria.60 patients were recruited (mean age 77 years, mean National Institutes of Health Stroke Scale Score 19.47. Forty-four episodes of pneumonia were identified. Common manifestations on the day of the diagnosis were new onset crackles (43/44, 98%, tachypnoea>25/min (42/44, 95%, and oxygen saturation 38°C were observed in 27 (61%, 25 (57% and 15 (34% episodes respectively. Leucocytosis (WBC>11,000/ml and raised CRP (>10 mg/l were observed in 38 (86% and 43 (97% cases of pneumonia respectively. The area under the ROC curve for CRP was 0.827 (95% CI 0.720, 0.933. The diagnostic cut-off for CRP with an acceptable sensitivity (>0.8 was 25.60 mg/L (Youden index (J 0.515; sensitivity 0.848; specificity 0.667. A cut-off of 64.65 mg/L had the highest diagnostic accuracy (J 0.562; sensitivity 0.636; specificity 0.926.Patients with severe stroke frequently do not manifest key diagnostic features of pneumonia such as pyrexia, cough and purulent sputum early in their illness. The most common signs in this group are new-onset crackles, tachypnoea and hypoxia. Our results suggest that a CRP >25 mg/L should prompt investigations for pneumonia while values >65 mg/L have the highest diagnostic accuracy to justify consideration of this threshold as a diagnostic marker of post-stroke pneumonia.

  7. Evaluation of the rapid diagnostic test OptiMAL for diagnosis of malaria due to Plasmodium vivax

    Directory of Open Access Journals (Sweden)

    Alonso Soto Tarazona

    2004-04-01

    Full Text Available OBJECTIVE: To determine the sensitivity and specificity of the rapid diagnostic test OptiMAL® for diagnosis of Plasmodium vivax malaria. MATERIAL AND METHODS: We included all the patients who sought medical attention in the San Martin Pangoa Hospital, Junin, an area endemic for vivax malaria in Peru, between October and December 1998, who had fever during the previous 72 hours and who were older than 12 months. The gold standard for diagnosis was thick blood film microscopy. We determined the parasitemia rate for each of the positive slides. We calculated sensitivity, specificity, positive predictive value and negative predictive value of the test. RESULTS: We included 72 patients; 39 of them were positive for P. vivax by microscopic examination. The sensitivity of the Optimal test was 92.3%, the specificity 100%, the positive predictive value 100% and the negative predictive value 91.6%. The accuracy of the test was 95.8%. The sensitivity of the OptiMAL® test progressively decreased when parasitemia was lower than 1,000 parasites/microliter. CONCLUSIONS: the OptiMAL® test has a high sensitivity and specificity for diagnosis of P. vivax malaria. However, its sensitivity decreased when parasitemia levels were lower. It is a very simple technique, which makes it a good alternative for malaria diagnosis in remote places, although its elevated cost is still a problem.

  8. Peste des petits ruminants diagnosis and diagnostic tools at a glance: perspectives on global control and eradication.

    Science.gov (United States)

    Santhamani, Ramasamy; Singh, Rabindra Prasad; Njeumi, Felix

    2016-11-01

    Peste des petits ruminants (PPR) is a highly contagious, economically important viral disease of small ruminants, targeted for global eradication by the year 2030. The recent geographic surge in PPR virus distribution, economic implications, the success of the rinderpest eradication campaign, and ongoing national/regional efforts convinced the FAO and OIE to initiate a global PPR control and eradication strategy. Since its discovery, a series of diagnostic tools have been developed for detecting PPR virus and virus-specific antibodies. Furthermore, it is understood that diagnostic and vaccine-monitoring tools are inevitable components of the four-stage strategy of global PPR eradication from assessment to the post-eradication phase. However, these tools may not be suitable for all stages of PPR control and eradication. For instance, diagnostics such as ELISA could be used for mass screening of clinical and serum samples, whereas immunochromatographic tests can be used at the field level as a pen-side test. Yet, assays with higher sensitivity, such as RT-PCR, RT-PCR ELISA, real-time RT-PCR and LAMP are important for early diagnosis of PPR and also, theoretically, during the late stages of eradication or when sampling non-natural hosts. Moreover, during the later stages of any control program, suspected/doubtful outbreaks will have to be reconfirmed using multiple laboratory tests. Hence, diagnostics can and should be efficiently applied at different stages of the PPR control and eradication campaign based on available resources and the number of samples to be tested. This article provides an overview of the various PPR diagnostic tools and suggests where and how they should be logically applied during the different phases of global PPR control and eradication.

  9. Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail

    DEFF Research Database (Denmark)

    Eckardt, J; Olsen, K E; Jørgensen, O D;

    2010-01-01

    Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. EBUS has also proved to be a valuable diagnostic tool for patients with different intrathoracic lesions who remain...

  10. The Call for a New "Diagnostic and Statistical Manual of Mental Disorders" Diagnosis: Addictive Disorders

    Science.gov (United States)

    Hagedorn, W. Bryce

    2009-01-01

    Without a consensually validated definition and a set of diagnostic criteria, counselors lack the necessary assessment and treatment tools to work effectively with clients with process addictions and their families. Necessary criteria and the results of a needs assessment are presented.

  11. Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail

    DEFF Research Database (Denmark)

    Eckardt, J; Olsen, K E; Jørgensen, O D

    2010-01-01

    Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. EBUS has also proved to be a valuable diagnostic tool for patients with different intrathoracic lesions who remain undia...

  12. [Molecular diagnostic methods of respiratory infections. Has the scheme diagnosis changed?].

    Science.gov (United States)

    Vila Estapé, Jordi; Zboromyrska, Yuliya; Vergara Gómez, Andrea; Alejo Cancho, Izaskun; Rubio García, Elisa; Álvarez-Martínez, Miriam José; la Bellacasa Brugada, Jorge Puig de; Marcos Maeso, M Ángeles

    2016-07-01

    Lower respiratory tract infections remain one of the most common causes of mortality worldwide, which is why early diagnosis is crucial. Traditionally the microbiological diagnosis of these infections has been based on conventional methods including culture on artificial media for isolation of bacteria and fungi and cell cultures for virus and antibody or antigen detection using antigen-antibody reactions. The main drawback of the above mentioned methods is the time needed for an etiological diagnosis of the infection. The techniques based on molecular biology have drawn much attention in recent decades as tools for rapid diagnosis of infections. Some techniques are very expensive, especially those that can detect various microorganisms in the same reaction, therefore the question that arises is whether the cost of such testing is justified by the information obtained and by the clinical impact that its implementation will determine. In this article we make a review of the various techniques of molecular biology applied to the diagnosis of pneumonia and focus primarily on analysing the impact they may have on the management of patients with acute respiratory tract infections. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  13. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria

    Directory of Open Access Journals (Sweden)

    Ville Valtonen

    2017-08-01

    Full Text Available A great variety of non-specific symptoms may occur in patients living or working in moisture-damaged buildings. In the beginning, these symptoms are usually reversible, mild, and present irritation of mucosa and increased morbidity due to respiratory tract infections and asthma-like symptoms. Later, the disease may become chronic and a patient is referred to a doctor where the assessment of dampness and mold hypersensitivity syndrome (DMHS often presents diagnostic challenges. Currently, unanimously accepted laboratory tests are not yet available. Therefore, the diagnosis of DMHS is clinical and is based on the patient’s history and careful examination. In this publication, I reviewed contemporary knowledge on clinical presentations, laboratory methods, and clinical assessment of DMHS. From the literature, I have not found any proposed diagnostic clinical criteria. Therefore, I propose five clinical criteria to diagnose DMHS: (1 the history of mold exposure in water-damaged buildings, (2 increased morbidity to due infections, (3 sick building syndrome, (4 multiple chemical sensitivity, and (5 enhanced scent sensitivity. If all the five criteria are met, the patient has a very probable DMHS. To resolve the current problems in assigning correct DMHS diagnosis, we also need novel assays to estimate potential risks of developing DMHS.

  14. Early diagnosis of Gaucher disease in pediatric patients: proposal for a diagnostic algorithm.

    Science.gov (United States)

    Di Rocco, Maja; Andria, Generoso; Deodato, Federica; Giona, Fiorina; Micalizzi, Concetta; Pession, Andrea

    2014-11-01

    Gaucher disease (GD) is caused by an enzyme deficiency that leads to the accumulation of glycolipids in various organs. Although the signs and symptoms of GD emerge in childhood in the majority of patients, the disease often remains unrecognized for many years with delay of benefits of therapy or development of irreversible complications. Based on published data and data from the International Collaborative Gaucher Group Registry, an algorithm has been drafted for early diagnosis of GD in pediatric patients. It will help hematologists in promoting a timely diagnosis and early access to therapy for pediatric patients with GD.

  15. Clinical diagnosis of influenza virus infection : evaluation of diagnostic tools in general practice

    NARCIS (Netherlands)

    van Elden, LJR; van Essen, GA; Boucher, CAB; van Loon, AM; Nijhuis, M; Schipper, P; Verheij, TJM; Hoepelman, IM

    2001-01-01

    Background: With the development of new antiviral agents for influenza, the urge for rapid and reliable diagnosis of influenza becomes increasingly important. Respiratory virus infections are difficult to distinguish on clinical grounds General practitioners (GPs) however still depend on their clini

  16. Is ADHD Diagnosed in Accord with Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis

    Science.gov (United States)

    Bruchmuller, Katrin; Margraf, Jurgen; Schneider, Silvia

    2012-01-01

    Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to "Diagnostic…

  17. Is ADHD Diagnosed in Accord with Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis

    Science.gov (United States)

    Bruchmuller, Katrin; Margraf, Jurgen; Schneider, Silvia

    2012-01-01

    Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to "Diagnostic…

  18. Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic keratocyst by imaging modalities and observers

    Energy Technology Data Exchange (ETDEWEB)

    Gang, Tae In; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Kim, Jeong Hwa; Moon, Je Woon; Choi, Soon Chul [Seoul National Univ. School of Dentistry, Seoul (Korea, Republic of)

    2006-12-15

    To evaluate the diagnostic ability in differentiating between ameloblastoma and odontogenic keratocyst according to the imaging modalities and observes. We evaluated thirty-six cases of ameloblastomas and forty-seven cases of odontogenic keratocysts all histologically confirmed. Six oral and maxillofacial radiologists diagnosed the lesions by 3 methods: using panoramic radiograph, using computed tomograph (CT), and using panoramic radiograph and CT. The observers were classified by 3 groups: group 1 had experienced over 10 years in oral and mazilofacial radiologic field, group 2 had experienced for 3-4 years, and group 3 was in the process of residentship. After over 2 weeks, the observers diagnosed them by the same methods. The ROC curve areas except for group 3 were the highest with interpretation using panoramic radiograph and CT, followed by interpretation using CT only, and the lowest with interpretation using panoramic radiograph only. The overall difference was not found in diagnostic ability among groups in using panoramic radiograph only, but there was difference in diagnostic ability of group 1 and 2 vs 3 in using CT only, and combination panoramic radiograph and CT. To differentiate between ameloblastoma and odontogenic keratocyst more accurately, the experienced oral and maxillofacial radiologist should diagnose with combination of panoramic radiograph and CT.

  19. Pitfalls in the biopsy diagnosis of intraoral minor salivary gland neoplasms: diagnostic considerations and recommended approach.

    Science.gov (United States)

    Turk, Andrew T; Wenig, Bruce M

    2014-01-01

    Among the more common types of intraoral minor salivary gland neoplasms are pleomorphic adenoma, basal cell adenoma, polymorphous low-grade adenocarcinoma, and adenoid cystic carcinoma. These minor salivary gland neoplasms share similar morphologic features and to a large extent immunohistochemical findings. Differentiation between these benign and malignant neoplasms is often predicated on the presence or absence of invasion. As such, in the presence of limited tissue sampling that typifies the initial testing modalities, including fine needle aspiration biopsy and/or incisional biopsy, it often is not possible to differentiate a benign from malignant minor salivary gland neoplasm. The diagnostic difficulties arise from the absence in needle or incisional biopsy of the tumor's periphery to determine whether infiltrative growth is or is not present. In this manuscript we discuss limitations and considerations associated with evaluation of incisional biopsies of intraoral minor salivary gland tumors. We offer a diagnostic approach to evaluating these biopsies, and suggest diagnostic terminology for biopsy specimens in which distinction between benignancy and malignancy is not feasible. The pathologist's approach to this distinction is critical, as treatment of benign neoplasms is generally conservative, whereas malignant lesions may warrant more aggressive management.

  20. [Evaluation of a rapid diagnostic test in the diagnosis of toxoplasmosis in pregnant women in Cotonou (Bénin)].

    Science.gov (United States)

    Ogouyèmi-Hounto, A; Agbayahoun-Chokki, F; Sissinto Savi de Tove, Y; Biokou Bankole, B; Adinsi de Souza, V; Assogba, M; Kinde-Gazard, D; Massougbodji, A

    2014-05-01

    The aim of the study was to evaluate the performance of the ImmunoComb® Toxo IgG and ImmunoComb® Toxo IgMassays (rapid diagnostic test) in the laboratory diagnosis of toxoplasmosis in pregnant women in Cotonou. We interviewed 266 pregnant women, who first answered an epidemiological questionnaire, and collected blood samples for measurement of IgG and IgM anti T. gondii antibodies with the ImmunoComb toxo assays and with the ARCHITECT CIMA method. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated to determine the performance of the rapid test. The seroprevalences of IgG against T. gondii by CIMA technique and rapid test were respectively 48.9% and 48.5%. The prevalence increased with age. Performances for IgG were: sensitivity 97%, specificity 100%, PPV 100%, NPV = 97.10%. For IgM, Sensitivity: 33.3% Specificity: 100%, PPV 100%, NPV = 99.2%. Seroprevalence obtained shows that about half of the study population is not immune against T. gondii and requires regular serological monitoring until delivery. According to these results, and given the needs of toxoplasmosis diagnosis on the field characterized by an important decrease of immunized women, this test may be recommended in the laboratory diagnosis of toxoplasmosis in peripheral levels of the health pyramid.

  1. Update on diabetes diagnosis: a historical review of the dilemma of the diagnostic utility of glycohemoglobin A1c and a proposal for a combined glucose-A1c diagnostic method.

    Science.gov (United States)

    Aldasouqi, Saleh A; Gossain, Ved V

    2012-01-01

    The role of glycohemoglobin A1c (A1c) for the diagnosis of diabetes has been debated for over three decades. Recently, the American Diabetes Association (ADA) has recommended adding A1c as an additional criterion for diabetes diagnosis. In view of the continued debate about the diagnostic utility of A1c, and in view of the unabated burden of undiagnosed diabetes, the search for alternative diagnostic methods is discussed. A historical literature review is provided, in view of the new ADA diagnostic guidelines, and a proposal is provided for combining A1c and a glucose measurement as a diagnostic alternative/adjunct to the use of a single criterion. This proposal is based on the non-overlapping of the advantages and disadvantages of these individual tests. The cost-effectiveness of this method remains to be tested.

  2. Diagnostic imaging in the diagnosis of small bowel Crohn's Disease - A literature review

    Energy Technology Data Exchange (ETDEWEB)

    Clark, Victoria Louise [Bristol Royal Infirmary, UBHT, Radiology, Marlborough Street, Bristol (United Kingdom)], E-mail: vlc198@hotmail.com

    2008-11-15

    Crohn's Disease can be imaged using Barium sulphate studies, ultrasound, magnetic resonance imaging, computerised tomography and nuclear medicine. However, the radiological pathway used for the diagnosis and management of this disease can vary from hospital to hospital. By evaluating the literature a broad picture can be developed regarding the sensitivity and specificity of each modality. It is often the case that the sensitivity and specificity of a modality can change due to the level of skill of the operator. Barium sulphate studies are still considered to be the recognised route for diagnosing Crohn's Disease, but it is apparent that newer studies are concerned with trying to find a more patient tolerant, less invasive method of radiological diagnosis. It is also important to consider when evaluating a pathway, the availability of each modality within each individual hospital setting.

  3. Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Nuwaha, Fred

    2011-01-01

    and patients. Majority 23,804 (99.7%) in presumptive arm were prescribed AL. All (100%) of patients who tested positive for malaria in RDT and microscopy arms were prescribed anti-malarials. Parasitological-based diagnosis significantly reduced AL prescription in RDT arm [RR: 0.62] and microscopy arm [RR: 0...... to fully harness the benefits of parasitological confirmation of malaria, it is necessary to reduce the prescription of anti-malarials in negative patients....

  4. Antigen Detection in the Diagnosis of Histoplasmosis: A Meta-analysis of Diagnostic Performance.

    Science.gov (United States)

    Fandiño-Devia, Estefanía; Rodríguez-Echeverri, Carolina; Cardona-Arias, Jaiberth; Gonzalez, Angel

    2016-04-01

    We performed a meta-analysis of diagnostic data to evaluate the performance of Histoplasma antigen detection tests for diagnosing histoplasmosis. We included all studies involving human subjects that assessed the performance of any antigen detection test for histoplasmosis in urine or serum by carrying out an exhaustive and reproducible search of the literature between 1980 and 2014 from four databases. Quality of the articles was assessed, and meta-analysis was performed under the random effects model, calculating sensitivity, specificity, likelihood and odds ratios, and ROC curve using Meta-DiSc(es). Nine out of a total of 23 studies met strict quality criteria and were therefore included. The overall sensitivity for antigen detection in serum and urine was 81% (95% CI 78-83%), while specificity was 99% (95% CI 98-99%). Sensitivity for antigenuria and antigenemia was 79% (95% CI 76-82%) and 82% (95% CI 79-85%), respectively; specificity values were 99% (95% CI 98-100%) in urine and 97% (95% CI 96-98%) in serum. The positive and negative likelihood ratios were 49.5 (95% CI 20.7-118.7) and 0.19 (95% CI 0.14-0.26), respectively, while the diagnostic OR was 362 (95% CI 121.2-1080.3) and area under the curve was 0.99. In conclusion, the performance of Histoplasma antigen detection assay of urine was not significantly different from that of blood, indicating that antigenuria and antigenemia have equal diagnostic value in histoplasmosis.

  5. Diagnostic properties of inhaled mannitol in the diagnosis of asthma: a population study

    DEFF Research Database (Denmark)

    Sverrild, Asger; Porsbjerg, Celeste; Thomsen, Simon Francis;

    2009-01-01

    BACKGROUND: A new indirect bronchial provocation test measuring airway responsiveness by using inhaled mannitol was recently introduced. OBJECTIVE: The aim of this study was to examine the diagnostic properties of airway responsiveness to inhaled mannitol in the assessment of asthma in an unselec......BACKGROUND: A new indirect bronchial provocation test measuring airway responsiveness by using inhaled mannitol was recently introduced. OBJECTIVE: The aim of this study was to examine the diagnostic properties of airway responsiveness to inhaled mannitol in the assessment of asthma...... operating characteristic curve was constructed, and the accuracy of the test, defined as the area under the curve, was computed. RESULTS: Fifty-one (21.4%) subjects had current asthma. Of 33 subjects with airway hyperresponsiveness to mannitol, 30 had current asthma. The specificity and sensitivity were 98.......4% (95% CI, 96.2% to 99.4%) and 58.8% (95% CI, 50.7% to 62.6%), respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 90.9% (95% CI, 78.4% to 96.8%) and 89.8 (95% CI, 87.7% to 90.7%), respectively. The area under the receiver operating characteristic curve was 0...

  6. The role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis.

    Science.gov (United States)

    Kumar, Arun; Debata, Pradeep Kumar; Ranjan, Amitabh; Gaind, Rajani

    2015-04-01

    To evaluate the role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis in children using reagent strips. This prospective, single blinded study was conducted in the Department of Pediatrics of VMMC & Safdarjung Hospital, New Delhi in collaboration with the Department of Microbiology of VMMC & Safdarjung Hospital, New Delhi, over a period of 15 mo (August 2009 to Nov 2010). Seventy-five children aged 3 mo to 12 y admitted in the pediatric ward with suspected diagnosis of acute meningitis were included. All enroled patients underwent lumbar puncture. CSF samples were taken and divided in 2 parts for laboratory evaluation and rapid strip analysis. The sensitivity, specificity, positive predictive value and the negative predictive values of the reagent strips for the diagnosis of bacterial meningitis were calculated. Accuracy of the reagent strips was established using kappa statistics. Latex agglutination for antigen detection and microbiological culture were also done. Highly significant association was observed between CSF examination in routine laboratory method and dipstick method. The number of laboratory values that correlated were- for cells 71(94.63%), for protein 68 (90.67%), for glucose 68(90.67%) out of total 75 cases. The sensitivity and specificity of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. The positive predictive and negative predictive values of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. Staphylococcus aureus was found to be the most common organism isolated (50%). Thus reagent strip analysis is a very rapid, reliable and effective method for diagnosis of acute bacterial meningitis in children. Staphylococcus aureus was the most common organism isolated.

  7. High diagnostic value of general practitioners' presumptive diagnosis for pyelonephritis, meningitis and pancreatitis

    DEFF Research Database (Denmark)

    Sriskandarajah, Srishamanthi; Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik;

    2016-01-01

    , pancreatitis, deep venous thrombosis (DVT), pyelonephritis and intestinal obstruction. The presumptive diagnoses were compared with the final diagnosis on discharge. Sensitivity, specificity, predictive values and likelihood ratios were calculated. RESULTS: A total of 8,841 patients were enrolled. The highest...... and lowest sensitivities were seen for DVT (90%) and meningitis (36%), respectively; and the highest and lowest values for specificity were observed for meningitis (99%) and ACS (30%), respectively. The positive predictive value had a wide range with the lowest value for ACS (9%) and the highest...

  8. Limited diagnostic value of procalcitonin in early diagnosis of adult onset Still's disease.

    Science.gov (United States)

    Gowin, Ewelina; Wysocki, Jacek

    2016-01-01

    A 17-year-old female patient was referred to the Infectious Diseases Ward because of fever lasting for 14 days. On admission to the hospital the patient was in a generally good state, without any abnormalities on physical examination. Laboratory investigation revealed elevated inflammatory markers. Diagnostic imaging comprising chest X-ray, abdominal ultrasonography, and echocardiography showed no abnormalities. During the hospitalization, there occurred episodes of fever with skin rash and musculoskeletal pain of the lower limbs. Procalcitonin concentrations continued to increase. C-reactive protein concentrations decreased during therapy, starting from 191 mg/l. On the 23(rd) day of the disease, edema of the feet, ankles, and knees appeared. On the basis of the clinical picture and after excluding other possible causes of fever, the patient was diagnosed with adult onset Still's disease. The procalcitonin concentration was normalized after 5 days of steroid therapy. The patient was discharged under ambulatory rheumatologic supervision.

  9. Limited diagnostic value of procalcitonin in early diagnosis of adult onset Still’s disease

    Science.gov (United States)

    Wysocki, Jacek

    2016-01-01

    A 17-year-old female patient was referred to the Infectious Diseases Ward because of fever lasting for 14 days. On admission to the hospital the patient was in a generally good state, without any abnormalities on physical examination. Laboratory investigation revealed elevated inflammatory markers. Diagnostic imaging comprising chest X-ray, abdominal ultrasonography, and echocardiography showed no abnormalities. During the hospitalization, there occurred episodes of fever with skin rash and musculoskeletal pain of the lower limbs. Procalcitonin concentrations continued to increase. C-reactive protein concentrations decreased during therapy, starting from 191 mg/l. On the 23rd day of the disease, edema of the feet, ankles, and knees appeared. On the basis of the clinical picture and after excluding other possible causes of fever, the patient was diagnosed with adult onset Still’s disease. The procalcitonin concentration was normalized after 5 days of steroid therapy. The patient was discharged under ambulatory rheumatologic supervision. PMID:27826176

  10. Diagnostic pitfalls in cytological diagnosis of subcutaneous fungal infection in renal transplant recipients.

    Science.gov (United States)

    Jaiswal, Sushila; Vij, Mukul; Prasad, Narayan; Kaul, Anupama; Marak, Rungmei S K; Pandey, Rakesh

    2012-03-01

    Renal transplant recipients (RTRs) are at increased risk of the development of a variety of skin infections that can result from graft-preserving immuno-suppressive therapy. In this study, we aimed to determine cytomorphological findings of fungal subcutaneous swelling in seven RTRs and to analyze diagnostic pitfalls in fungal cytology. A retrospective review of fine needle aspiration cytology (FNAC) smears of subcutaneous swelling with positive fungal elements in RTRs from 2008 to 2010 was performed. We had seven cases (all males; age range, 34-58 years, mean, 46.3 years). The time interval between the renal transplantation and appearance of swelling ranged from 8 to 19 months (mean, 13.4 months). The swelling was located on lower limb (six cases) and arm (one case). The lesion was solitary (six cases) and multiple (one case). The cytology of aspirated material showed branched septate fungal hyphae in six cases. These were well delineated on Periodic acid schiffs (PAS) and chromic silver methenamine (CSM) stains. One case showed presence of faint, thin walled, broad ribbon like hyphae. Culture of aspirated material was performed in four cases which grew phaeohyphomycosis in all. Histology of excised tissue showed numerous septate, branched, pigmented fungal elements suggestive of pheohyphomycosis in four cases and broad ribbon hyphae suggestive of zygomycosis in one case. All of our cases responded well with anti-fungal treatment. Fungal infection can manifest as subcutaneous swelling in RTRs. It is often severe, rapidly progressive and difficult to diagnose. FNAC is an important diagnostic tool which is simple, cost effective and rapid method.

  11. Diagnostic value of 64-slice spiral CT angiography in the diagnosis of multiple intracranial aneurysms: a report of 25 cases

    Directory of Open Access Journals (Sweden)

    Hong-sheng WANG

    2013-02-01

    Full Text Available Objective  To evaluate the diagnostic value of 64-slice spiral CT angiography (CTA in multiple intracranial aneurysms (MIA. Methods  Twenty-five patients (9 males and 16 females, aged from 17 to 68 years with suspected MIA underwent 64-slice spiral CTA with slice thickness of 0.625mm. The data of all patients were reconstructed with multiplanar reconstruction (MPR, 3-dimensional shade surface display (3-SSD, volume rendering (VR and maximum intensity projection (MIP. The clinical diagnostic value was evaluated with the results of surgery or interventional embolization therapy. Results  A total of 61 aneurysms were detected by 64-slice spiral CTA in 25 patients, among them 17 patients were with 2 aneurysms, 6 patients with 3 aneurysms, 1 patient with 4 aneurysms and 1 patient with 5 aneurysms. The 64-slice spiral CTA could not only clearly demonstrate MIA, but also the size, neck, axis point and parent artery of each aneurysm, and the spatial relationship between aneurysm and the adjacent vessels and bone structures. Twenty-one patients underwent microsurgery and four underwent embolization, the location, size and shape of aneurysm and its spatial relationship with adjacent structures were in accordance with the findings of 64-slice spiral CTA. Conclusion  The 64-slice spiral CTA could be used as the first choice in the diagnosis of MIA for its high accuracy, and may be an important adjunct to digital subtraction angiography (DSA in MIA treatment.

  12. Diagnostic value of sTREM-1 and procalcitonin levels in the early diagnosis of sepsis

    Science.gov (United States)

    Aksaray, Sebahat; Alagoz, Pinar; Inan, Asuman; Cevan, Simin; Ozgultekin, Asu

    2016-01-01

    OBJECTIVE: Sepsis is still major cause of morbidity and mortality, despite improvements in diagnosis and treatment in modern medicine. Therefore, laboratory examinations that provide correct and rapid results are needed to support the diagnosis. This study was conducted to investigate value of immunological indicators procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in differential diagnosis of patients with sepsis and systemic inflammatory response syndrome (SIRS), as well as to assess their importance in determining prognosis of patients with sepsis. METHODS: Total of 90 patients, 38 with SIRS and 52 with sepsis, who were between the ages 20 to 92, were included in this prospectively planned study. Blood sample was collected from the patients during hospitalization and again in follow-up visit. Enzyme-linked immunosorbent assay (MyBioSource, Inc., San Diego, CA, USA) was used to measure sTREM-1, and PCT was measured using mini VIDAS B.R.A.H.M.S PCT assay (Biomerieux, S.A., Marcy-l’Étoile, France). In addition, patients were clinically assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. RESULTS: On day of intensive care unit admission, sTREM-1 and PCT levels, as well as APACHE II score were significantly higher in sepsis group than SIRS group (p=0.001, p=0.01, p=0.001, respectively). Values of sTREM-1 and APACHE II score were higher in the patients with positive blood cultures than those with negative culture results (p=0.002, p=0.006, respectively). PCT, C-reactive protein, and sTREM-1 levels were significantly higher in nonsurviving group. In differentiation of SIRS from sepsis, sTREM-1 cut-off value ≥133 pg/mL and PCT cut-off value of 1.57 ng/mL yielded sensitivity of 71.1% and 67.33%, and specificity of 73.3% and 65.79%, respectively. CONCLUSION: In patients with suspected sepsis, sTREM-1 and PCT can be used as indicators, in addition to scoring systems such as APACHE II and

  13. Neopterin as a diagnostic biomarker for diagnosis of inflammatory diseases like periodontitis

    Directory of Open Access Journals (Sweden)

    Jammula Surya Prasanna

    2017-01-01

    Full Text Available Neopterin is a catabolic product of guanosine triphosphate, a purine nucleotide and belongs to the group pteridines. When the cytokine interferon gamma stimulates the human macrophages, they synthesize the neopterin. It is an indicative of a pro-inflammatory immune status and hence serves as a cellular immune system marker. In most of the diseases, in which the cellular immune system is involved, we find that the neopterin concentrations are usually high. In the periodontal diseases, the levels of neopterin usually fluctuate which is proved by its increase in disease progression and a decrease after treatment. Periodontal diseases are characterized by enhanced macrophage infiltration to the periodontal lesion, so neopterin being a macrophage activation marker may be seen in higher levels. This review deals with neopterin and its mechanism and its use as a marker in the diagnosis of the periodontal diseases.

  14. Current aspects of the clinic, diagnosis and treatment of acquired myasthenia gravis (review. Part 1: diagnostics

    Directory of Open Access Journals (Sweden)

    S. N. Bardakov

    2016-01-01

    Full Text Available Acquired myasthenia gravis is an autoimmune disease, based on the imbalance of humoral and cellular immunity, characterized by weakness and fatigue of skeletal muscles, and in some cases involvement of the heart muscle. In most cases, the object of the autoimmune destruction is peripheral nicotinic acetylcholine receptors of the postsynaptic membrane of the neuromuscular synapse. In myasthenia gravis there has been identified a number of other antigenic targets: muscle-specific tyrosine kinase, lowdensity lipoprotein receptor-related protein 4, titin, and ryanodine receptors skeletal muscles. Their specificity and pathogenetic role have been disclosed, but it is about 15-20% of seronegative forms that require further immunological research. Accurate diagnosis depends on the efficient detection of clinical forms of myasthenia gravis and full analysis of the autoimmune mechanisms underlying the disease.

  15. Circulating nucleic acids in plasma and serum: applications in diagnostic techniques for noninvasive prenatal diagnosis

    Directory of Open Access Journals (Sweden)

    Gahan PB

    2013-04-01

    Full Text Available Peter B Gahan Anatomy and Human Sciences Department, King's College London, London Bridge, London, UK Abstract: The analysis of fetal nucleic acids in maternal blood 13 years ago has led to the initiation of noninvasive methods for the early determination of fetal gender, rhesus D status, and a number of aneuploid disorders and hemoglobinopathies. Subsequently, a comparatively large quantity of fetal DNA and RNA has been demonstrated in amniotic fluid as well as small amounts in premature infant saliva. The DNA and RNA in amniotic fluid has permitted an analysis of core transcriptomes, whilst the DNA and RNA in saliva allows the early detection and treatment monitoring of fetal developmental problems. These aspects are discussed together with the methodology and limits of analysis for noninvasive prenatal diagnosis in predictive, preventive, and personalized medicine. Keywords: fetal circulating DNA/RNA, amniotic fluid, saliva, aneuploidy, thalassemias

  16. The Positron Emission Tomography. A diagnostic technique; Con la PET diagnosi precoce della malattia

    Energy Technology Data Exchange (ETDEWEB)

    Salvadori, P. [Consiglio Nazionale delle Ricerche, Istituto di Fisiologia Clinica, Chimica e Radiofarmaceutica, Gruppo PET/Ciclotrone, Pisa (Italy)

    2001-07-01

    Positron Emission Tomography (PET) is a new imaging modality, which is able to assess non-invasively the biochemical mechanisms, underlying physiological and pathophysiological processes in vivo in humans. The technique relies on the administration of radioactive tracers labeled with short-lived positron emitters, which need to be produced on site via a particle accelerator (cyclotron). Radionuclides are produced upon request and formulated into biologically active organic molecules having precise pharmacokinetics and specificity. The radiotracer can be detected by the PET scanner and represented as tomographic sections (images of body sections) showing its regional distribution and concentration. This makes it possible to address clinical questions concerning occurrence and evolution of many diseases as well as their response to therapy. The ability to image (measure) biological processes and not only anatomy enables PET to explore diseases in the very early stage, including those diseases which are not related to modifications of organ structure (e.g. psychiatric diseases, metabolic disorders, biochemical disfunction). PET plays a major role, in conjunction with the other imaging modalities, to improve diagnosis capabilities and disease mechanism understanding. [Italian] La PET e' correntemente utilizzata come efficace strumento clinico, per l'elevata sensibilita' e specificita', nella valutazione dell'iter diagnostico di pazienti con sospetta cardiopatia ischemica e nel processo di decision making clinico di pazienti con disfunzione ventricolare sinistra e cardiopatia ischemica, in quanto metodica di riferimento per la diagnosi di vitalita' miocardica. In campo oncologico, viene impiegata l'ormai ben documentata capacita' del fluorodesossiglucosio (FDG), un tracciante contenente fluoro-18 ed in grado di permettere la misura del consumo cellulare di glucosio, nel porre in evidenza all'esame PET il tessuto neoplastico

  17. Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis.

    Science.gov (United States)

    Moseholm, Ellen; Rydahl-Hansen, Susan; Overgaard, Dorthe; Wengel, Hanne S; Frederiksen, Rikke; Brandt, Malene; Lindhardt, Bjarne Ø

    2016-05-20

    Undergoing diagnostic evaluation for cancer has been associated with a high prevalence of anxiety and depression and affected health-related quality of life (HRQoL). The aims of this study were to assess HRQoL, anxiety, and depression pre- and post-diagnosis in patients undergoing diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors. A prospective, multicenter survey study of patients suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus patients with non-cancer diagnoses were calculated. The impact of baseline psychological, socio-demographic, and medical factors on HRQoL, anxiety and depression at follow-up was explored by bootstrapped multivariate linear regression analyses and logistic regression analyses. A total of 838 patients participated in this study; 679 (81 %) completed the follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of the follow-up. Patients presented initially with a high burden of symptoms and affected role and emotional functioning and global health/QL, irrespective of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis. There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self

  18. Evaluation of diagnostic performance of rK28 ELISA using urine for diagnosis of visceral leishmaniasis.

    Science.gov (United States)

    Ghosh, Prakash; Bhaskar, Khondaker R H; Hossain, Faria; Khan, Md Anik Ashfaq; Vallur, Aarthy C; Duthie, Malcolm S; Hamano, Shinjiro; Salam, Md Abdus; Huda, M Mamun; Khan, Md Gulam Musawwir; Coler, Rhea N; Reed, Steven G; Mondal, Dinesh

    2016-07-04

    Recombinant fusion proteins are now commonly used to detect circulating antibodies for the serodiagnosis of visceral leishmaniasis (VL) in Asia, Africa and the Americas. Although simple, these tests still require blood collection and their use in remote settings can be limited due to the need of collection devices, serum fractionation instrument and generation of biohazardous waste. The development of an accurate and non-invasive diagnostic algorithm for VL, such as could be achieved with urine, is desirable. We enrolled 87 VL patients and 81 non-VL individuals, including 33 healthy endemic controls, 16 healthy non-endemic controls, 16 disease controls and 16 tuberculosis (TB) patients. We compared the efficacy of recombinant antigens rK28, rK39 and rKRP42 for the diagnosis of VL when either serum or urine were used to develop antibody-detection ELISA. As expected, each of the antigens readily detected antibodies in the serum of VL patients. rK28 ELISA showed the highest sensitivity (98.9 %), followed by rK39 and rKRP42 ELISA (97.7 and 94.4 %, respectively); overall specificity was > 96 %. When urine was used as the test analyte, only a marginal drop in sensitivity was observed, with rK28 ELISA again demonstrating the greatest sensitivity (95.4 %), followed by rK39 and rKRP42 ELISA, respectively. Again, the overall specificity was > 96 %. Our data indicate the potential for using urine in the diagnosis of VL. Detection of antibodies against rK28 demonstrated the greatest sensitivity. Together, our results indicate that rK28-based antibody detection tests using urine could provide a completely non-invasive tool amenable for diagnosis of VL in remote locations.

  19. Same-day diagnosis based on histology for women suspected of breast cancer: high diagnostic accuracy and favorable impact on the patient.

    Directory of Open Access Journals (Sweden)

    Maarten W Barentsz

    Full Text Available Same-day diagnosis based on histology is increasingly being offered to patients suspected of breast cancer. We evaluated to which extent same-day diagnosis affected diagnostic accuracy and patients' anxiety levels during the diagnostic phase.All 759 women referred for same-day evaluation of suspicious breast lesions between November 2011-March 2013 were included. Diagnostic accuracy was assessed by linking all patients to the national pathology database to identify diagnostic discrepancies, in which case slides were reviewed. Patients' anxiety was measured in 127 patients by the State Trait and Anxiety Inventory on six moments during the diagnostic workup and changes over time (< = 1 week were analyzed by mixed effect models.Core-needle biopsy was indicated in 374/759 patients (49.3% and in 205/759 (27% patients, invasive or in situ cancer was found. Final diagnosis on the same day was provided for 606/759 (79.8% patients. Overall, 3/759 (0.4% discordant findings were identified. Anxiety levels decreased significantly over time from 45.2 to 30.0 (P = <0.001. Anxiety levels decreased from 44.4 to 25.9 (P = <0.001 for patients with benign disease, and remained unchanged for patients diagnosed with malignancies (48.6 to 46.7, P = 0.933. Time trends in anxiety were not affected by other patient or disease characteristics like age, education level or (family history of breast cancer.Same-day histological diagnosis is feasible in the vast majority of patients, without impairing diagnostic accuracy. Patients' anxiety rapidly decreased in patients with a benign diagnosis and remained constant in patients with malignancy.

  20. Diagnosis of allergy against beta-lactams in primary care: prevalence and diagnostic criteria.

    Science.gov (United States)

    Salden, Odette A E; Rockmann, Heike; Verheij, Theo J M; Broekhuizen, Berna D L

    2015-06-01

    Secondary care studies showed that a recorded allergy to beta-lactams could not be confirmed by valid allergy testing in >85% of cases. In daily practice, recorded beta-lactam allergies probably cause prescription of secondary choice antibiotics. This overrating of beta-lactam allergy hampers appropriate use of narrow spectrum antibiotic and generates unnecessary cost and bacterial resistance. To assess registration and over diagnosis of allergies against beta-lactams in Dutch primary care. A retrospective cohort study in 8288 primary care subjects was performed. Patients with recorded allergy were identified through International Classification for Primary Care coding. Signs and symptoms of the recorded allergic reaction and patient's characteristics were extracted from patient's files and patients were sent a questionnaire. The probability of allergy was based on a composite reference standard that was scored by two authors independently. One hundred sixty-three subjects had a recorded allergy (2.0%). In 51.5% of cases, no characteristics of the recorded allergic reaction were reported in patients' medical files. Based on our composite reference standard, allergy was excluded in 19 subjects (11.7%). Risk factors for allergy registration were female gender, age beta-lactams are needed in primary care. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Diagnostic dilemma of the single screening test used in the diagnosis of syphilis in Nepal.

    Science.gov (United States)

    Dumre, S P; Shakya, G; Acharya, D; Malla, S; Adhikari, N

    2011-12-01

    Syphilis screening by the nontreponemal rapid plasma reagin (RPR) test is not usually followed up by specific treponemal tests in most of the resource poor healthcare settings of Nepal. We analyzed serum specimens of 504 suspected syphilis cases at the immunology department of the national reference laboratory in Nepal during 2007-2009 using RPR test and Treponema pallidum hemagglutination assay (TPHA). In overall, 35.7% were positive by both methods (combination) while 13.1% were RPR positive and TPHA negative, 8.7% were positive by TPHA only and 42.5% were negative by both methods. Among the RPR reactive (n = 246), 73.2% were positive by TPHA. Non-specific agglutination in RPR testing was relatively higher (26.8%) compared to TPHA (19.6%). Although TPHA was found more specific than RPR test, either of the single tests produced inaccurate diagnosis. Since the single RPR testing for syphilis may yield false positive results, specific treponemal test should be routinely used as confirmatory test to rule out false RPR positive cases. More attention needs to be paid on formulation of strict policy on the implementation of the existing guidelines throughout the country to prevent misdiagnosis in syphilis with the use of single RPR test.

  2. Development and evaluation of diagnostic tests for the serological diagnosis of brucellosis in swine

    Directory of Open Access Journals (Sweden)

    Tiziana Di Febo

    2012-06-01

    Full Text Available A competitive enzyme-linked immunosorbent assay (c-ELISA, an indirect ELISA (i-ELISA and a dissociation-enhanced lanthanide fluorescence immunoassay (DELFIA were developed to test for antibodies to Brucella suis in pig and wild boar sera. An anti-Brucella-LPS monoclonal antibody (MAb 4B5A (c-ELISA and DELFIA and an anti-swine IgG monoclonal antibody (MAb 10C2G5 (i-ELISA were used for the three assays. The specificity (Sp and sensitivity (Se of the assays gave the following results: Se and Sp = 100% at a cut-off value of 61.0% (B/B0% for c-ELISA; Sp = 99.1% and Se = 100% at a cut-off value of 21.7% (percentage positivity: PP% for i-ELISA; Sp = 91.0% and Se = 75% at a cut-off value of 37.0% (B/B0% for DELFIA. In addition, the performance of a commercial fluorescence polarisation assay (FPA, standardised for bovine sera, was evaluated in swine sera. The specificity and sensitivity obtained were both 100% at a cut-off value of 99.5 (millipolarisation unit values. These results suggest that the combination of c-ELISA, i-ELISA and FPA can be used to improve the serological diagnosis of swine brucellosis.

  3. Diagnostic value of latex agglutination test in diagnosis of acute bacterial meningitis.

    Science.gov (United States)

    Mohammadi, Syeda Fasiha; Patil, Asha B; Nadagir, Shobha D; Nandihal, Namrata; Lakshminarayana, S A

    2013-10-01

    To know the incidence of bacterial meningitis in children below five years of age. To compare conventional culture and antigen detection methods (Latex agglutination test). 100 CSF samples of clinically suspected meningitis cases in children below 5 years of age were included. The samples were subjected to cell count, Gram stain, culture and LAT. The organisms isolated in the study were characterized according to standard procedures. Of the 100 cases studied, 31 cases were diagnosed as ABM by Gram stain, culture and latex agglutination test as per WHO criteria. The hospital frequency of ABM was 1.7%. 15 (48.38) cases were culture positive. Gram stain was positive in 22(70.96) cases and LAT in 17(54.83) cases. Haemophilus influenzae was the most common causative agent of acute bacterial meningitis followed by S.pneumoniae. Case fatality rate was 45.16%. The sensitivity and specificity of LAT was 66.66% and 87.91% respectively. Bacterial meningitis is a medical emergency and early diagnosis and treatment is life saving and reduces chronic morbidity. LAT was more sensitive compared to conventional Gram stain and Culture technique in identifying the fastidious organisms like H.influenzae, S.pneumoniae and Group B Streptococcus. However, the combination of Gram stain, Culture and LAT proved to be more productive than any of the single tests alone.

  4. [Diagnostic strategy of beta-thalassemic mutation in a Tunisian family, application in prenatal diagnosis].

    Science.gov (United States)

    Khelil, A H; Laradi, S; Ferchichi, S; Carion, N; Béjaoui, M; Saad, A; Chaieb, A; Miled, A; Ben Chibani, J; Perrin, P

    2003-01-01

    At present, the application of combined methods in molecular biology allows us to carry out the prenatal diagnosis in a more rapid and less onerous manner especially when the family presents an index case. In this study, we have analyzed a family with one case of intermediate beta-thalassemia. First, we have used the denaturing gradient gel electrophoresis (DGGE). Then, we have identified the mutations by the refractory mutation system technique (ARMS PCR) using specific primers for the most frequent mutations in the Tunisian population (codon 39 (C --> T) and IVS-I-2 (T--> G) for beta0 thalassemias and IVS-I-110 (G --> A) for beta+ thalassemias). The analyzed family has shown the IVS-I-110 (G --> A) mutation in the heterozygous state in the mother and the index case. Subsequently, sequencing in the gene revealed a frameshift 8 (-AA) mutation in the father and his daughter. This patient is thus a compound heterozygote Codon 8 (-AA)/IVS-I-110. DGGE and ARMS PCR analysis of foetal DNA extracted from trophoblast culture didn't show any of the two mutations found in the family.

  5. Diagnostic value of latex agglutination test in diagnosis of acute bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Syeda Fasiha Mohammadi

    2013-01-01

    Full Text Available Objectives: To know the incidence of bacterial meningitis in children below five years of age. To compare conventional culture and antigen detection methods ( Latex agglutination test. Materials and Methods: 100 CSF samples of clinically suspected meningitis cases in children below 5 years of age were included. The samples were subjected to cell count, Gram stain, culture and LAT. The organisms isolated in the study were characterized according to standard procedures. Results: Of the 100 cases studied, 31 cases were diagnosed as ABM by Gram stain, culture and latex agglutination test as per WHO criteria. The hospital frequency of ABM was 1.7%. 15 (48.38 cases were culture positive. Gram stain was positive in 22(70.96 cases and LAT in 17(54.83 cases. Haemophilus influenzae was the most common causative agent of acute bacterial meningitis followed by S.pneumoniae. Case fatality rate was 45.16%.The sensitivity and specificity of LAT was 66.66% and 87.91% respectively. Conclusion : Bacterial meningitis is a medical emergency and early diagnosis and treatment is life saving and reduces chronic morbidity. LAT was more sensitive compared to conventional Gram stain and Culture technique in identifying the fastidious organisms like H.influenzae, S.pneumoniae and Group B Streptococcus. However, the combination of Gram stain, Culture and LAT proved to be more productive than any of the single tests alone.

  6. Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a 'sit-to-stand test'.

    Science.gov (United States)

    Shaw, Brett H; Garland, Emily M; Black, Bonnie K; Paranjape, Sachin Y; Shibao, Cyndya A; Okamoto, Luis E; Gamboa, Alfredo; Diedrich, André; Plummer, W Dale; Dupont, William D; Biaggioni, Italo; Robertson, David; Raj, Satish R

    2017-05-01

    This study aimed to identify optimal blood pressure cut-offs to diagnose orthostatic hypotension during a sit-to-stand manoeuvre. This was a cross-sectional study of patients and healthy controls from the Vanderbilt Autonomic Dysfunction Center. Blood pressure was measured while supine, seated and standing. Blood pressure changes were calculated from supine-to-standing and seated-to-standing. Orthostatic hypotension was diagnosed on the basis of a supine-to-standing SBP drop at least 20 mmHg or a DBP drop at least 10 mmHg. Receiver operator characteristic (ROC) curves identified optimal sit-to-stand cut-offs. Amongst the 831 individuals, more had systolic orthostatic hypotension [n = 354 (43%)] than diastolic orthostatic hypotension [n = 305 (37%)] during lying-to-standing. The ROC curves had good characteristics [SBP area under curve = 0.916 (95% confidence interval: 0.896-0.936), P sit-to stand SBP drop at least 15 mmHg had optimal test characteristics (sensitivity = 80.2%; specificity = 88.9%; positive predictive value = 84.2%; negative predictive value = 85.8%), as did a DBP drop at least 7 mmHg (sensitivity = 87.2%; specificity = 87.2%; positive predictive value = 80.1%; negative predictive value = 92.0%). A sit-to-stand manoeuvre with lower diagnostic cut-offs for orthostatic hypotension provides a simple screening test for orthostatic hypotension in situations wherein a supine-to-standing manoeuvre cannot be easily performed. Our analysis suggests that a SBP drop at least 15 mmHg or a DBP drop at least 7 mmHg best optimizes sensitivity and specificity of this sit-to-stand test.

  7. Performance of thyroid scintigraphy in the thyrotoxicosis etiological diagnosis: about 210 cases; Performance de la scintigraphie thyroidienne dans le diagnostic etiologique des thyrotoxicoses: a propos de 210 cas

    Energy Technology Data Exchange (ETDEWEB)

    Chatti, K.; Nouira, M.; Guezguez, M.; Sfar, R.; Essabbah, H. [CHU Sahloul, Service de medecine nucleaire, Sousse (Tunisia); Zantour, B. [CHU Mahdia, service d' endocrinologie (Tunisia)

    2010-07-01

    Purpose: The thyrotoxicosis is a syndrome linked to thyroid hormones excess grouping any causes leading to a overload in circulating hormones, including these ones linked to an inflammatory process (thyroiditis) or an exogenous contribution. The etiologic diagnosis is based on complementary examinations. The objective of our work is to elucidate the performance of scintigraphy in the etiologic diagnosis and the therapy approach of thyrotoxicosis through the experience of our service. Conclusions: Scintigraphy has a place in the etiologic diagnosis of thyrotoxicosis. it brings functional and morphological information and allows to guide the diagnostic and therapeutic approach. (N.C.)

  8. A basic diagnostic headache diary (BDHD) is well accepted and useful in the diagnosis of headache. a multicentre European and Latin American study

    DEFF Research Database (Denmark)

    Jensen, Rigmor Højland; Tassorelli, C; Rossi, P;

    2011-01-01

    Aims: We tested the usability and usefulness of the basic diagnostic headache diary (BDHD) for the diagnosis of migraine, tension-type headache and medication-overuse headache in European and Latin American countries. Methods: Patients were subdivided into two groups according to a 1...

  9. Performance of rapid diagnostic test, blood-film microscopy and PCR for the diagnosis of malaria infection among febrile children from Korogwe District, Tanzania

    DEFF Research Database (Denmark)

    Mahende, Coline; Ngasala, Billy; Lusingu, John

    2016-01-01

    Background: Rapid diagnostic tests (RDT) and light microscopy are still recommended for diagnosis to guide the clinical management of malaria despite difficult challenges in rural settings. The performance of these tests may be affected by several factors, including malaria prevalence and intensi...

  10. The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults--An International Validation Study

    Science.gov (United States)

    Ritvo, Riva Ariella; Ritvo, Edward R.; Guthrie, Donald; Ritvo, Max J.; Hufnagel, Demetra H.; McMahon, William; Tonge, Bruce; Mataix-Cols, David; Jassi, Amita; Attwood, Tony; Eloff, Johann

    2011-01-01

    The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a valid and reliable instrument to assist the diagnosis of adults with Autism Spectrum Disorders (ASD). The 80-question scale was administered to 779 subjects (201 ASD and 578 comparisons). All ASD subjects met inclusion criteria: DSM-IV-TR, ADI/ADOS diagnoses and standardized IQ…

  11. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis: implications for malaria control in Uganda

    Directory of Open Access Journals (Sweden)

    Batwala Vincent

    2011-12-01

    Full Text Available Abstract Background Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT before treatment with artemether-lumefantrine (AL. However, the cost-effectiveness of these strategies has not been assessed at rural operational primary care centres. Methods Three health centres (HCs were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients departments were enrolled from March 2010 to February 2011. Of these, a random sample of 1,627 was selected to measure additional socio-economic characteristics. Costing was performed following the standard step-down cost allocation and the ingredients approach. Effectiveness was measured as the number and proportion of patients correctly diagnosed and treated. Incremental Cost-Effectiveness Ratios (ICERs were estimated from the societal perspective (http://Clinicaltrials.gov, NCT00565071. Results Overall RDT was most cost-effective with lowest ICER US$5.0 compared to microscopy US$9.61 per case correctly diagnosed and treated. In the high transmission setting, ICER was US$4.38 for RDT and US$12.98 for microscopy. The corresponding ICERs in the low transmission setting were US$5.85 and US$7.63 respectively. The difference in ICERs between RDT and microscopy was greater in the high transmission area (US$8.9 than in low transmission setting (US$1.78. At a willingness to pay of US$2.8, RDT remained cost effective up to a threshold value of the cost of treatment of US$4.7. Conclusion RDT was cost effective in both low and high transmission settings. With a global campaign to reduce the costs of AL and RDT, the Malaria Control Programme and stakeholders need a strategy for malaria diagnosis because as the cost of AL decreases, presumptive treatment is likely to become

  12. Computer-aided diagnosis for diagnostically challenging breast lesions in DCE-MRI based on image registration and integration of morphologic and dynamic characteristics

    Science.gov (United States)

    Retter, Felix; Plant, Claudia; Burgeth, Bernhard; Botella, Guillermo; Schlossbauer, Thomas; Meyer-Bäse, Anke

    2013-12-01

    Diagnostically challenging lesions comprise both foci (small lesions) and non-mass-like enhancing lesions and pose a challenge to current computer-aided diagnosis systems. Motion-based artifacts lead in dynamic contrast-enhanced breast magnetic resonance to diagnostic misinterpretation; therefore, motion compensation represents an important prerequisite to automatic lesion detection and diagnosis. In addition, the extraction of pertinent kinetic and morphologic features as lesion descriptors is an equally important task. In the present paper, we evaluate the performance of a computer-aided diagnosis system consisting of motion correction, lesion segmentation, and feature extraction and classification. We develop a new feature extractor, the radial Krawtchouk moment, which guarantees rotation invariance. Many novel feature extraction techniques are proposed and tested in conjunction with lesion detection. Our simulation results have shown that motion compensation combined with Minkowski functionals and Bayesian classifier can improve lesion detection and classification.

  13. Evaluation of the diagnostic performance of platelet-derived indices for the differential diagnosis of thrombocytopenia in pediatrics

    Directory of Open Access Journals (Sweden)

    Nelson Hernando Aponte-Barrios

    2014-10-01

    Full Text Available Background. Platelet-derived indices have a well-established correlation with the differential diagnosis of thrombocytopenia in adult-based research. These indices include mean platelet volume, platelet distribution width, and platelet-large cell ratio. Objective. To determine the values of platelet-derived indices in a pediatric population with diagnoses of thrombocytopenia and their etiologic correlation. Materials and methods. Analytic observational diagnostic-test study. The population for this analytical study was pediatric patients between 6 months and 18 years of age who had thrombocytopenia (<100x10(9/L. The study period was 18 months long. Results. Of 54 subjects, 18 (33.3% were diagnosed with idiopathic thrombocytopenic purpura, and 36 (66.7% were diagnosed with acute leukemia. Mean age was 7.4 years and 6.8 years for immune thrombocytopenic purpura and acute leukemia, respectively. Mean platelet distribution width values for immune thrombocytopenic purpura and acute leukemia were 15.08 fL and 10.73, respectively. Mean MPV for immune thrombocytopenic purpura and acute leukemia was 11.7 fL and 9.8 fL, respectively. Mean platelet-large cell ratio was 38.26% and 24.97% for idiopathic thrombocytopenic purpura and acute leukemia, respectively. Differences in these three distinct platelet indices between idiopathic thrombocytopenic purpura and acute leukemia were statistically significant (p=0.00. The area under the ROC curve for platelet-derived indices showed that they were adequate for defining the causes of thrombocytopenia. MPV and platelet-large cell ratio had an area under the curve of 0.89 and 0.88, respectively, while platelet size deviation width had an area under the curve of 0.903. Conclusions. Platelet-derived indices could be useful in the initial approach for the differential diagnosis of pediatric patients with thrombocytopenia.

  14. Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients.

    Science.gov (United States)

    Muyanja, David; Kalyesubula, Robert; Namukwaya, Elizabeth; Othieno, Emmanuel; Mayanja-Kizza, Harriet

    2015-03-01

    Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.

  15. Diagnostic value of culture and serological tests in the diagnosis of histoplasmosis in HIV and non-HIV Colombian patients.

    Science.gov (United States)

    Arango-Bustamante, Karen; Restrepo, Angela; Cano, Luz Elena; de Bedout, Catalina; Tobón, Angela Maria; González, Angel

    2013-11-01

    We determined the value of culture and serological tests used to diagnose histoplasmosis. The medical records of 391 histoplasmosis patients were analyzed. Diagnosis of the mycosis was assessed by culture, complement fixation, and immunodiffusion tests; 310 patients (79.5%) were male, and 184 patients (47.1%) were infected with human immunodeficiency virus (HIV). Positivity value for cultures was 35.7% (74/207), reactivity of serological tests was 95.2% (160/168), and a combination of both methodologies was 16.9% (35/207) for non-HIV patients. Positivity value for cultures was 75.0% (138/184), reactivity of serological tests was 92.4% (85/92), and a combination of both methodologies was 26.0% (48/184) for HIV/acquired immunodeficiency syndrome (AIDS) patients; 48.1% (102/212) of extrapulmonary samples from HIV/AIDS patients yielded positive cultures compared with 23.1% (49/212) in non-HIV patients. Lymphocyte counts made for 33.1% (61/184) of HIV/AIDS patients showed a trend to low CD4+ numbers and higher proportion of positive cultures. These results indicate that culture is the most reliable fungal diagnostic method for HIV/AIDS patients, and contrary to what is generally believed, serological assays are useful for diagnosing histoplasmosis in these patients.

  16. [Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].

    Science.gov (United States)

    Kruppa, C; Goericke, S L; Matheney, T; Ozokyay, L; Schildhauer, T A; Muhr, G; Dudda, M

    2010-10-01

    Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

  17. Comparative efficacy of conventional diagnostic methods and evaluation of polymerase chain reaction for the diagnosis of bovine brucellosis

    Directory of Open Access Journals (Sweden)

    Raheela Akhtar

    2010-04-01

    Full Text Available The comparative efficacy of Rose Bengal Plate Test (RBPT and Milk Ring test (MRT was calculated in terms of sensitivity and specificity for the diagnosis of bovine brucellosis in cows (Group A and buffaloes (Group B from Lahore and Okara districts of Punjab, Pakistan. Using bacterial growth as a gold standard RBPT showed high sensitivity values of 100% in both groups. While its specificity was 96.29% (Group A and 90.62% (Group B. On the other hands MRT showed low sensitivity (80.0% in Group A; 86.6% in Group B while its specificity was 100% in all the animals of both groups. The calculated positive predictive and negative predictive values of both groups were in correspondence with their specificity and sensitivity values respectively. High sensitivity and low specificity of RBPT as compare to high specificity and low sensitivity of MRT in all groups suggested the poor efficacy of both tests used individually as compare to bacterial growth. In the continuation of this study polymerase chain reaction (PCR was evaluated for its diagnostic efficacy of quick Brucella abortus isolation from same samples. PCR conducted on serum samples gave more positive results than on milk samples. Therefore, the combination of both conventional tests alongwith serum PCR can be recommended. [Vet. World 2010; 3(2.000: 53-56

  18. FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods.

    Science.gov (United States)

    Steinmann, Peter; Cringoli, Giuseppe; Bruschi, Fabrizio; Matthys, Barbara; Lohourignon, Laurent K; Castagna, Barbara; Maurelli, Maria P; Morgoglione, Maria E; Utzinger, Jürg; Rinaldi, Laura

    2012-08-01

    Hymenolepis nana is the most common cestode parasitizing humans, yet it is under-diagnosed. We determined the optimal flotation solution (FS) for the diagnosis of this intestinal parasite with the FLOTAC method, and compared its diagnostic accuracy with an ether-concentration technique and the Kato-Katz method. Zinc sulphate (specific gravity 1.20) proved to be the best-performing FS. Using this FS, we detected 65 H. nana infections among 234 fixed fecal samples from Tajik and Sahrawi children (prevalence 27.8 %). The ether-concentration technique detected 40 infections (prevalence 17.1 %) in the same samples. Considering the combined results as a reference, the sensitivities of FLOTAC and ether-concentration were 95.6 % and 58.8 %, respectively. The Kato-Katz method resulted in a prevalence of only 8.7 %. In terms of eggs per gram of stool, a significantly (P Hymenolepis diminuta infections in 302 fecal samples, whereas five samples were found positive with the Kato-Katz technique. We conclude that FLOTAC is an accurate coprodiagnostic technique for H. nana and H. diminuta, two species which join a growing list of intestinal parasites that can be reliably diagnosed by this technique.

  19. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Science.gov (United States)

    Martens, Leon; Goode, Grahame; Wold, Johan F H; Beck, Lionel; Martin, Georgina; Perings, Christian; Stolt, Pelle; Baggerman, Lucas

    2014-01-01

    To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines. Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four. With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests. Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  20. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Directory of Open Access Journals (Sweden)

    Leon Martens

    Full Text Available To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1 Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2 Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3 Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048 and a 75% increase in diagnostic yield (p = 0.007. There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  1. Analyse des interactions energetiques entre un arena et son systeme de refrigeration

    Science.gov (United States)

    Seghouani, Lotfi

    La presente these s'inscrit dans le cadre d'un projet strategique sur les arenas finance par le CRSNG (Conseil de Recherche en Sciences Naturelles et en Genie du Canada) qui a pour but principal le developpement d'un outil numerique capable d'estimer et d'optimiser la consommation d'energie dans les arenas et curlings. Notre travail s'inscrit comme une suite a un travail deja realise par DAOUD et coll. (2006, 2007) qui a developpe un modele 3D (AIM) en regime transitoire de l'arena Camilien Houde a Montreal et qui calcule les flux de chaleur a travers l'enveloppe du batiment ainsi que les distributions de temperatures et d'humidite durant une annee meteorologique typique. En particulier, il calcule les flux de chaleur a travers la couche de glace dus a la convection, la radiation et la condensation. Dans un premier temps nous avons developpe un modele de la structure sous la glace (BIM) qui tient compte de sa geometrie 3D, des differentes couches, de l'effet transitoire, des gains de chaleur du sol en dessous et autour de l'arena etudie ainsi que de la temperature d'entree de la saumure dans la dalle de beton. Par la suite le BIM a ete couple le AIM. Dans la deuxieme etape, nous avons developpe un modele du systeme de refrigeration (REFSYS) en regime quasi-permanent pour l'arena etudie sur la base d'une combinaison de relations thermodynamiques, de correlations de transfert de chaleur et de relations elaborees a partir de donnees disponibles dans le catalogue du manufacturier. Enfin le couplage final entre l'AIM +BIM et le REFSYS a ete effectue sous l'interface du logiciel TRNSYS. Plusieurs etudes parametriques on ete entreprises pour evaluer les effets du climat, de la temperature de la saumure, de l'epaisseur de la glace, etc. sur la consommation energetique de l'arena. Aussi, quelques strategies pour diminuer cette consommation ont ete etudiees. Le considerable potentiel de recuperation de chaleur au niveau des condenseurs qui peut reduire l'energie requise par

  2. Comparative Study of the Sensitivity of Different Diagnostic Methods for the Laboratory Diagnosis of Buruli Ulcer Disease

    NARCIS (Netherlands)

    Herbinger, Karl-Heinz; Adjei, Ohene; Awua-Boateng, Nana-Yaa; Nienhuis, Willemien A.; Kunaa, Letitia; Siegmund, Vera; Nitschke, Joerg; Thompson, William; Klutse, Erasmus; Agbenorku, Pius; Schipf, Alexander; Reu, Simone; Racz, Paul; Fleischer, Bernhard; Beissner, Marcus; Fleischmann, Erna; Helfrich, Kerstin; van der Werf, Tjip S.; Loescher, Thomas; Bretzel, Gisela

    2009-01-01

    Background. Several diagnostic laboratory methods are available for case confirmation of Buruli ulcer disease. This study assessed the sensitivity of various diagnostic tests in relation to clinical presentation of the disease, type of diagnostic specimen, and treatment history. Methods. Swab sample

  3. Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis

    DEFF Research Database (Denmark)

    Larsen, Ellen Frøsig Moseholm; Rydahl Hansen, Susan; Overgaard, Dorthe;

    2016-01-01

    suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus....... There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self-rated health. Conclusions Patients undergoing diagnostic evaluations for cancer based on non...

  4. Computer-aided diagnosis of diagnostically challenging lesions in breast MRI: a comparison between a radiomics and a feature-selective approach

    Science.gov (United States)

    Hoffmann, Sebastian; Lobbes, Marc; Houben, Ivo; Pinker-Domenig, Katja; Wengert, Georg; Burgeth, Bernhard; Meyer-Bäse, Uwe; Lemaitre, Guillaume; Meyer-Baese, Anke

    2016-05-01

    Diagnostically challenging lesions pose a challenge both for the radiological reading and also for current CAD systems. They are not well-defined in both morphology (geometric shape) and kinetics (temporal enhancement) and pose a problem to lesion detection and classification. Their strong phenotypic differences can be visualized by MRI. Radiomics represents a novel approach to achieve a detailed quantification of the tumour phenotypes by analyzing a large number of image descriptors. In this paper, we apply a quantitative radiomics approach based on shape, texture and kinetics tumor features and evaluate it in comparison to a reduced-order feature approach in a computer-aided diagnosis system applied to diagnostically challenging lesions.

  5. Crystal arthritides - gout and calcium pyrophosphate arthritis : Part 2: clinical features, diagnosis and differential diagnostics.

    Science.gov (United States)

    Schlee, S; Bollheimer, L C; Bertsch, T; Sieber, C C; Härle, P

    2017-02-23

    Gout develops in four stages beginning with an asymptomatic increase in blood levels of uric acid. An acute gout attack is an expression of an underlying inflammatory process, which in the course of time is self-limiting. Without therapy monosodium urate crystals remain in the synovial fluid and synovial membrane and trigger more acute attacks. In the course of the disease monosodium urate crystals form deposits (tophi) leading in severe forms to irreversible joint deformities with loss of functionality. In 20% of cases gout leads to involvement of the kidneys. Overproduction of uric acid can cause nephrolithiasis. These stones can be composed of uric acid or calcium phosphate. Another form of kidney disease caused by gout is uric acid nephropathy. This is a form of abacterial chronic inflammatory response with deposition of sodium urate crystals in the medullary interstitium. Acute obstructive nephropathy is relatively rare and characterized by renal failure due to uric acid precipitation in the tubules because of rapid cell lysis that occurs, for example, with chemotherapy. There is a causal interdependence between the occurrence of hyperuricemia and hypertension. Uric acid activates the renin-angiotensin-aldosterone (RAA) system and inhibits nitric oxide (NO) with the possible consequence of a rise in systemic vascular resistance or arteriolar vasculopathy; however, uric acid is also an apparently independent risk factor for atherosclerosis. In contrast to young patients, the diagnosis of an acute gout attack in the elderly can be a challenge for the physician. Polyarticular manifestations and obscure symptoms can make it difficult to differentiate it from rheumatoid arthritis and calcium pyrophosphate deposition disease (CPPD). Aspiration of synovial fluid with visualization of urate crystals using compensated polarized light microscopy is the gold standard for diagnosis of acute gout. Moreover, analysis of synovial fluid enables a distinction from septic

  6. Direct microscopy versus sputum cytology analysis and bleach sedimentation for diagnosis of tuberculosis: a prospective diagnostic study

    Directory of Open Access Journals (Sweden)

    Hepple Pamela

    2010-09-01

    Full Text Available Abstract Background Diagnostic options for pulmonary tuberculosis in resource-poor settings are commonly limited to smear microscopy. We investigated whether bleach concentration by sedimentation and sputum cytology analysis (SCA increased the positivity rate of smear microscopy for smear-positive tuberculosis. Methods We did a prospective diagnostic study in a Médecins Sans Frontières-supported hospital in Mindouli, Republic of Congo. Three sputum samples were obtained from 280 consecutive pulmonary tuberculosis suspects, and were processed according to WHO guidelines for direct smear microscopy. The remainder of each sputum sample was homogenised with 2.6% bleach, sedimented overnight, smeared, and examined blinded to the direct smear result for acid-fast bacilli (AFB. All direct smears were assessed for quality by SCA. If a patient produced fewer than three good-quality sputum samples, further samples were requested. Sediment smear examination was performed independently of SCA result on the corresponding direct smear. Positivity rates were compared using McNemar's test. Results Excluding SCA, 43.2% of all patients were diagnosed as positive on direct microscopy of up to three samples. 47.9% were diagnosed on sediment microscopy, with 48.2% being diagnosed on direct microscopy, sediment microscopy, or both. The positivity rate increased from 43.2% to 47.9% with a case definition of one positive smear (≥1 AFB/100 high power fields of three, and from 42.1% to 43.9% with two positive smears. SCA resulted in 87.9% of patients producing at least two good-quality sputum samples, with 75.7% producing three or more. Using a case definition of one positive smear, the incremental yield of bleach sedimentation was 14/121, or 11.6% (95% CI 6.5-18.6, p = 0.001 and in combination with SCA was 15/121, or 12.4% (95% CI 7.1-19.6, p = 0.002. Incremental yields with two positive smears were 5/118, or 4.2% (95% CI 1.4-9.6, p = 0.062 and 7/118, or 5.9% (95

  7. Monstrous venous haemangioma tumor of the retroperitonial space - Diagnosis and diagnostic problems; Monstroeses venoeses Haemangiom des Retroperitoneums - Probleme der Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Leinung, S.; Wuerl, P.; Frey, A.; Schoenfelder, M. [Leipzig Univ. (Germany). Chirurgische Klinik 1; Lotz, I. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie; Lochhaas, L. [Leipzig Univ. (Germany). Inst. fuer Pathologie

    2000-07-01

    The preoperative diagnosis and its inherent problems are illustrated using a coincidentally diagnosed monstrous haemangioma tumor of the retroperitonial space in a twenty year old patient. With respect to our patient, X-ray, computer tomography and angiography all failed as diagnostic tools. Only the use of Doppler sonographic flow signals suggested the presence of a haemangioma. The morphology, prognosis and clinical significance of blood vessel tumors are multifaceted. The most important differential diagnoses to the venous haemangioma are the cavernous and the cappilliary haemangioma. The venous haemangioma distinguishes itself through the presence of blood vessel walls. Haemangiomas are common benign tumors. In the presence of highly developed muscular components, there exists a transition to angiomyomas and to leiomyomas. Venal haemangiomas are extremely rare in the demonstrated localisation of the retroperitoneal space. Here they can grow to monstrous preportions whilst remaining undetected. Thus the patient is under the potential danger of bleeding to death through trivial injuries. The therapy of choice reamins total surgical excision. (orig.) [German] Am Beispiel eines zufaellig diagnostizierten monstroesen Haemangioms des Retroperitoneoums bei einem zwanzigjaehrigen Patienten wird die praeoperative Diagnostik und deren Problematik dargestellt. So konnte in unserem Fall durch Roentgenuebersicht, Computertomographie und Angiographie die Diagnose nicht gestellt werden, ausschliesslich das dopplersonographische Flusssignal gab einen Hinweis auf das Vorliegen eines Haemangioms. Morphologie, Prognose und klinische Bedeutung der Gefaesstumoren sind sehr vielfaeltig. Die wichtigsten Differentialdiagnosen des venoesen Haemangioms sind das kavernoese und das kapillaere Haemangiom. Das venoese Haemangiom unterscheidet sich von diesen beiden Formen insbesondere durch das Auftreten von Gefaesswaenden. Haemangiome gelten als haeufige gutartige Tumoren. Bei stark

  8. Diagnostic value of tendon thickness and structure in the sonographic diagnosis of supraspinatus tendinopathy: room for a two-step approach

    Energy Technology Data Exchange (ETDEWEB)

    Arend, Carlos Frederico, E-mail: carlos_arend@hotmail.com; Arend, Ana Amalia, E-mail: ana.amalia.arend@hotmail.com; Rodrigues da Silva, Tiago, E-mail: rumoabali@hotmail.com

    2014-06-15

    Objective: The aim of our study was to systematically compare different methodologies to establish an evidence-based approach based on tendon thickness and structure for sonographic diagnosis of supraspinatus tendinopathy when compared to MRI. Methods: US was obtained from 164 symptomatic patients with supraspinatus tendinopathy detected at MRI and 42 asymptomatic controls with normal MRI. Diagnostic yield was calculated for either maximal supraspinatus tendon thickness (MSTT) and tendon structure as isolated criteria and using different combinations of parallel and sequential testing at US. Chi-squared tests were performed to assess sensitivity, specificity, and accuracy of different diagnostic approaches. Results: Mean MSTT was 6.68 mm in symptomatic patients and 5.61 mm in asymptomatic controls (P < .05). When used as an isolated criterion, MSTT > 6.0 mm provided best results for accuracy (93.7%) when compared to other measurements of tendon thickness. Also as an isolated criterion, abnormal tendon structure (ATS) yielded 93.2% accuracy for diagnosis. The best overall yield was obtained by both parallel and sequential testing using either MSTT > 6.0 mm or ATS as diagnostic criteria at no particular order, which provided 99.0% accuracy, 100% sensitivity, and 95.2% specificity. Among these parallel and sequential tests that provided best overall yield, additional analysis revealed that sequential testing first evaluating tendon structure required assessment of 258 criteria (vs. 261 for sequential testing first evaluating tendon thickness and 412 for parallel testing) and demanded a mean of 16.1 s to assess diagnostic criteria and reach the diagnosis (vs. 43.3 s for sequential testing first evaluating tendon thickness and 47.4 s for parallel testing). Conclusions: We found that using either MSTT > 6.0 mm or ATS as diagnostic criteria for both parallel and sequential testing provides the best overall yield for sonographic diagnosis of supraspinatus tendinopathy when

  9. Test and Evaluation of Field-Deployable Infectious Disease Diagnostic Assays in Support of the Joint Biological Agent Identification and Diagnosis System (JBAIDS): Malaria (Plasmodium/JBAIDS)

    Science.gov (United States)

    2012-05-31

    Disease Diagnostic Assays in Support of the Joint Biological Agent Identification and Diagnosis System 5b. GRANT NUMBER (JBAIDS): Malaria ( Plasmodium ...Texas (MOA 2007-2012 Agreement No.: DODI 4000.19· AFI 25-201). 14.ABSTRACT A Plasmodium genus dual-fluorogenic, hydrolysis probe (TaqMan) polymerase...chain reaction (PCR) assay was developed using real-time PCR instrumentation (MiniOpticon Real-Time PCR System, Bio-Rad, Hercules, CA). The Plasmodium

  10. Diagnostic value of S100B protein in the differential diagnosis of acute vertigo in the emergency department.

    Science.gov (United States)

    Kartal, Aslı Gülfer; Yılmaz, Serkan; Yaka, Elif; Pekdemir, Murat; Sarısoy, Hasan Tahsin; Çekmen, Mustafa Baki; Yüksel, Melih

    2014-07-01

    Vertigo is a common presenting complaint resulting from central or peripheral etiologies. Because central causes may be life-threatening, ascertaining the nature of the vertigo is crucial in the emergency department (ED). With a broad range of potential etiologies, distinguishing central causes from benign peripheral causes is a diagnostic challenge. Cranial magnetic resonance imaging (MRI) is the recommended neuroimaging method when clinical findings are ambiguous. However, MRI scanning for every patient with an uncertain diagnosis may not be efficient or possible. Therefore, to improve ED resource utilization for patients with vertigo, there is a need to identify the subset most likely to have MRI abnormalities. It has previously been shown that S100B protein provides a useful serum marker of stroke, subarachnoid hemorrhage, and traumatic brain injury. This study evaluated whether S100B levels could predict central causes of vertigo as identified by cranial MRI in the ED. This prospective, observational study was conducted with adult patients with acute-onset vertigo (within 6 hours) in the ED of a teaching hospital in Kocaeli, Turkey. Patients with nausea or dizziness complaints without previously known vertigo or cranial pathology, and who agreed to participate in the study, were included. Patients with trauma or with neurologic findings that developed concurrent with their symptoms were excluded. Serum levels of S100B were measured with an electrochemiluminescence immunoassay kit. All subjects underwent cranial MRI. The predictors of positive MRI results were evaluated using logistic regression analysis. Sensitivity and specificity of S100B​ levels for identifying subjects with central causes of vertigo on MRI were calculated with receiver operating characteristic (ROC) curve. Of the 82 subjects included in the study, 48 (58.5%) were female, and the mean (±SD) age was 51 (±16) years. Thirty-one (37.8%) subjects had positive MRI results. Median (with

  11. Using risk factors to help in the diagnosis of acute myocardial infarction in patients with non-diagnostic electrocardiogram changes in emergency department

    Directory of Open Access Journals (Sweden)

    Ali Arhami Dolatabadi

    2015-01-01

    Full Text Available Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI in Emergency Department (ED patients with non-diagnostic ECG changes. Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, Hypertension (HTN, Hyperlipidemia (HLP, renal failure, positive family history of Coronary Artery Disease (CAD, smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH, etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB serum markers and Troponin I. The data were analyzed by using SPSS V. 20 and the level of statistical significance was considered to be P< 0.05. Results: HTN, HLP, family history of heart disease were significantly higher in those who had non-diagnostic ECG (P< 0.05. However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG. Conclusion: Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.

  12. Analysis of the energy efficiency of the transport system in Algeria; Analyse de l'efficacite energetique du systeme de transport en Algerie

    Energy Technology Data Exchange (ETDEWEB)

    Hamdani, Sid Ahmed

    2010-09-15

    The objective of this communication is analyze the energy efficiency of the transport system in Algeria and to show the areas of possible rationalization in this sector. Our approach is to analyze the existing configuration of the sector and its impact on energy consumption, by developing a sectional model Bottom Up, where the transport park has been modified by the means used. We have shown that the potential to improve the transport system energy efficiency is important and have recommended some options aimed at the sector organisation and aimed at increasing the relative part of transport systems to make it more energy efficient. [French] L'objectif de cette communication est d'analyser l'efficacite energetique du systeme de transport algerien et de montrer les gisements de rationalisation possibles dans ce secteur. Notre approche consiste a analyser la configuration existante du secteur et son impact sur la consommation d'energie, en elaborant un modele sectoriel Bottom Up, ou le parc de transport a ete desagrege par moyen utilise. Nous avons montre que le potentiel d'amelioration de la performance energetique du systeme de transport est important et avons recommande quelques options ciblant l'organisation du secteur et visant a augmenter la part relative de moyens de transport plus efficace energetiquement.

  13. Evaluation of the diagnostic value of serologic microagglutination testing and a polymerase chain reaction assay for diagnosis of acute leptospirosis in dogs in a referral center.

    Science.gov (United States)

    Fraune, Claudia Kümmerle; Schweighauser, Ariane; Francey, Thierry

    2013-05-15

    To determine the diagnostic value of a serologic microagglutination test (MAT) and a PCR assay on urine and blood for the diagnosis of leptospirosis in dogs with acute kidney injury (AKI). Cross-sectional study. Animals-76 dogs with AKI in a referral hospital (2008 to 2009). Dogs' leptospirosis status was defined with a paired serologic MAT against a panel of 11 Leptospira serovars as leptospirosis-associated (n = 30) or nonleptospirosis-associated AKI (12). In 34 dogs, convalescent serologic testing was not possible, and leptospirosis status was classified as undetermined. The diagnostic value of the MAT single acute or convalescent blood sample was determined in dogs in which leptospirosis status could be classified. The diagnostic value of a commercially available genus-specific PCR assay was evaluated by use of 36 blood samples and 20 urine samples. Serologic acute testing of an acute blood sample had a specificity of 100% (95% CI, 76% to 100%), a sensitivity of 50% (33% to 67%), and an accuracy of 64% (49% to 77%). Serologic testing of a convalescent blood sample had a specificity of 92% (65% to 99%), a sensitivity of 100% (87% to 100%), and an accuracy of 98% (88% to 100%). Results of the Leptospira PCR assay were negative for all samples from dogs for which leptospirosis status could be classified. Serologic MAT results were highly accurate for diagnosis of leptospirosis in dogs, despite a low sensitivity for early diagnosis. In this referral setting of dogs pretreated with antimicrobials, testing of blood and urine samples with a commercially available genus-specific PCR assay did not improve early diagnosis.

  14. Prenatal Diagnosis Procedures and Techniques to Obtain a Diagnostic Fetal Specimen or Tissue: Maternal and Fetal Risks and Benefits.

    Science.gov (United States)

    Wilson, R Douglas; Gagnon, Alain; Audibert, François; Campagnolo, Carla; Carroll, June; Brock, Jo-Ann; Chong, Karen; Johnson, Jo-Ann; MacDonald, William; Okun, Nanette; Pastuck, Melanie; Vallee-Pouliot, Karine

    2015-07-01

    Objectif : Offrir aux fournisseurs de soins de maternité et à leurs patientes des lignes directrices factuelles contemporaines en ce qui concerne les services de counseling traitant des risques et des avantages maternels propres à la tenue des interventions diagnostiques prénatales orientées par échographie (et/ou des techniques permettant l’établissement d’un diagnostic génétique) nécessaires dans les cas où il a été établi pendant la période prénatale que la grossesse serait exposée à des risques, ainsi qu’en ce qui concerne la prise de décisions subséquentes quant à la prise en charge de la grossesse (questions abordant des aspects tels que le niveau du fournisseur de soins obstétricaux, la surveillance prénatale, le lieu où devraient se dérouler les soins et l’accouchement, et la décision de poursuivre ou d’interrompre la grossesse). La présente directive clinique se limite aux services de counseling traitant des risques et des avantages maternels, et aux décisions en matière de prise en charge de la grossesse pour les femmes qui nécessitent (ou qui envisagent) la mise en œuvre d’une intervention ou d’une technique effractive orientée par échographie aux fins de l’établissement d’un diagnostic prénatal. Population de patientes : Femmes enceintes identifiées, à la suite de la mise en œuvre de protocoles établis de dépistage prénatal (taux sériques maternels ± imagerie, résultats d’analyse de l’ADN acellulaire indiquant des risques élevés, résultats anormaux au moment de l’imagerie fœtale diagnostique ou antécédents familiaux de troubles héréditaires), comme étant exposées à un risque accru d’anomalie génétique fœtale. Ces femmes pourraient nécessiter ou demander des services de counseling au sujet des risques et des avantages pour la grossesse de la tenue d’une intervention effractive orientée par échographie visant à déterminer l’étiologie, le diagnostic, et/ou la

  15. Self-report and subjective history in the diagnosis of painful neck conditions: A systematic review of diagnostic accuracy studies.

    Science.gov (United States)

    Mizer, Adam; Bachmann, Alexa; Gibson, Jessie; Donaldson, Megan Burrowbridge

    2017-10-01

    Rising healthcare costs and inherent risks with over-utilizing diagnostic imaging require a quality subjective examination to improve effectiveness and time management of physical examinations. This systematic review investigates the diagnostic accuracy of subjective history and self-report items to determine if there is significant alteration in the probability of identifying specific painful neck conditions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. 1) Written in the English language 2) Cervical pain with/without referred upper extremity or head pain 3) Subjective history or self-report items 4) Study designs that reported diagnostic statistics or allowed calculation of sensitivities, specificities, diagnostic odds ratios, and likelihood ratios 5) used a reference standard that has a sensitivity or specificity ≥75% or a diagnostic tool that is strongly supported in the literature where this data is not available. Quality Assessment of Studies of Diagnostic Accuracy II was performed to evaluate risk of bias. Five studies with 830 total patients met the inclusion criteria. Conditions commonly reported in the literature included: cervical radiculopathy, cervical myelopathy, degenerative joint disease, and cervicogenic headache. Individual history questions show minimal diagnostic value in identifying cervical conditions without the physical examination. The value of the subjective history report is important and requires further investigation for specific neck conditions. Clustering symptoms may provide more insight than individual history items in future studies. The diagnostic value of history for neck conditions may be underrepresented due to the lack of studies that isolate subjective examination from the physical examination. 3a. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders.

    Science.gov (United States)

    Colombi, Marina; Dordoni, Chiara; Chiarelli, Nicola; Ritelli, Marco

    2015-03-01

    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is an evolving and protean disorder mostly recognized by generalized joint hypermobility and without a defined molecular basis. JHS/EDS-HT also presents with other connective tissue features affecting a variety of structures and organs, such as skin, eye, bone, and internal organs. However, most of these signs are present in variable combinations and severity in many other heritable connective tissue disorders. Accordingly, JHS/EDS-HT is an "exclusion" diagnosis which needs the absence of any consistent feature indicative of other partially overlapping connective tissue disorders. While both Villefranche and Brighton criteria include such an exclusion as a mandatory item, a systematic approach for reaching a stringent clinical diagnosis of JHS/EDS-HT is still lacking. The absence of a consensus on the diagnostic approach to JHS/EDS-HT concerning its clinical boundaries with similar conditions contribute to limit our actual understanding of the pathologic and molecular bases of this disorder. In this review, we revise the differential diagnosis of JHS/EDS-HT with those heritable connective tissue disorders which show a significant overlap with the former and mostly include EDS classic, vascular and kyphoscoliotic types, osteogenesis imperfecta, Marfan syndrome, Loeys-Dietz syndrome, arterial tortuosity syndrome, and lateral meningocele syndrome. A diagnostic flow chart is also offered with the attempt to support the less experienced clinician in stringently recognizing JHS/EDS-HT and stimulate the debate in the scientific community for both management and research purposes.

  17. Neural network vector quantization improves the diagnostic quality of computer-aided diagnosis in dynamic breast MRI

    Science.gov (United States)

    Wismüller, Axel; Meyer-Baese, Anke; Leinsinger, Gerda L.; Lange, Oliver; Schlossbauer, Thomas; Reiser, Maximilian F.

    2007-03-01

    We quantitatively evaluate a novel neural network pattern recognition approach for characterization of diagnostically challenging breast lesions in contrast-enhanced dynamic breast MRI. Eighty-two women with 84 indeterminate mammographic lesions (BIRADS III-IV, 38/46 benign/malignant lesions confirmed by histopathology and follow-up, median lesion diameter 12mm) were examined by dynamic contrast-enhanced breast MRI. The temporal signal dynamics results in an intensity time-series for each voxel represented by a 6-dimensional feature vector. These vectors were clustered by minimal-free-energy Vector Quantization (VQ), which identifies groups of pixels with similar enhancement kinetics as prototypical time-series, so-called codebook vectors. For comparison, conventional analysis based on lesion-specific averaged signal-intensity time-courses was performed according to a standardized semi-quantitative evaluation score. For quantitative assessment of diagnostic accuracy, areas under ROC curves (AUC) were computed for both VQ and standard classification methods. VQ increased the diagnostic accuracy for classification between benign and malignant lesions, as confirmed by quantitative ROC analysis: VQ results (AUC=0.760) clearly outperformed the conventional evaluation of lesion-specific averaged time-series (AUC=0.693). Thus, the diagnostic benefit of neural network VQ for MR mammography analysis is quantitatively documented by ROC evaluation in a large data base of diagnostically challenging small focal breast lesions. VQ outperforms the conventional method w.r.t. diagnostic accuracy.

  18. Real-time PCR assay and rapid diagnostic tests for the diagnosis of clinically suspected malaria patients in Bangladesh

    Directory of Open Access Journals (Sweden)

    Khanum Hamida

    2011-06-01

    Full Text Available Abstract Background More than 95% of total malaria cases in Bangladesh are reported from the 13 high endemic districts. Plasmodium falciparum and Plasmodium vivax are the two most abundant malaria parasites in the country. To improve the detection and management of malaria patients, the National Malaria Control Programme (NMCP has been using rapid diagnostic test (RDT in the endemic areas. A study was conducted to establish a SYBR Green-based modified real-time PCR assay as a gold standard to evaluate the performance of four commercially-available malaria RDTs, along with the classical gold standard- microscopy. Methods Blood samples were collected from 338 febrile patients referred for the diagnosis of malaria by the attending physician at Matiranga Upazila Health Complex (UHC from May 2009 to August 2010. Paracheck RDT and microscopy were performed at the UHC. The blood samples were preserved in EDTA tubes. A SYBR Green-based real-time PCR assay was performed and evaluated. The performances of the remaining three RDTs (Falcivax, Onsite Pf and Onsite Pf/Pv were also evaluated against microscopy and real-time PCR using the stored blood samples. Result In total, 338 febrile patients were enrolled in the study. Malaria parasites were detected in 189 (55.9% and 188 (55.6% patients by microscopy and real-time PCR respectively. Among the RDTs, the highest sensitivity for the detection of P. falciparum (including mixed infection was obtained by Paracheck [98.8%, 95% confidence interval (CI 95.8-99.9] and Falcivax (97.6%, 95% CI 94.1-99.4 compared to microscopy and real-time PCR respectively. Paracheck and Onsite Pf/Pv gave the highest specificity (98.8%, 95% CI 95.7-99.9 compared to microscopy and Onsite Pf/Pv (98.8, 95% CI 95.8-99.9 compared to real-time PCR respectively for the detection of P. falciparum. On the other hand Falcivax and Onsite Pf/Pv had equal sensitivity (90.5%, 95% CI 69.6-98.8 and almost 100% specificity compared to microscopy for

  19. The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): a scale to assist the diagnosis of Autism Spectrum Disorder in adults: an international validation study.

    Science.gov (United States)

    Ritvo, Riva Ariella; Ritvo, Edward R; Guthrie, Donald; Ritvo, Max J; Hufnagel, Demetra H; McMahon, William; Tonge, Bruce; Mataix-Cols, David; Jassi, Amita; Attwood, Tony; Eloff, Johann

    2011-08-01

    The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a valid and reliable instrument to assist the diagnosis of adults with Autism Spectrum Disorders (ASD). The 80-question scale was administered to 779 subjects (201 ASD and 578 comparisons). All ASD subjects met inclusion criteria: DSM-IV-TR, ADI/ADOS diagnoses and standardized IQ testing. Mean scores for each of the questions and total mean ASD vs. the comparison groups' scores were significantly different (p test-retest reliability r = .987. Cronbach alpha coefficients for the subscales and 4 derived factors were good. We conclude that the RAADS-R is a useful adjunct diagnostic tool for adults with ASD.

  20. Three-phase bone scintigraphy for diagnosis of Charcot neuropathic osteoarthropathy in the diabetic foot - does quantitative data improve diagnostic value?

    Science.gov (United States)

    Fosbøl, M; Reving, S; Petersen, E H; Rossing, P; Lajer, M; Zerahn, B

    2017-01-01

    To investigate whether inclusion of quantitative data on blood flow distribution compared with visual qualitative evaluation improve the reliability and diagnostic performance of (99 m) Tc-hydroxymethylene diphosphate three-phase bone scintigraphy (TPBS) in patients suspected for charcot neuropathic osteoarthropathy (CNO) of the foot. A retrospective cohort study of TPBS performed on 148 patients with suspected acute CNO referred from a single specialized diabetes care centre. The quantitative blood flow distribution was calculated based on the method described by Deutsch et al. All scintigraphies were re-evaluated by independent, blinded observers twice with and without quantitative data on blood flow distribution at ankle and focus level, respectively. The diagnostic validity of TPBS was determined by subsequent review of clinical data and radiological examinations. A total of 90 patients (61%) had confirmed diagnosis of CNO. The sensitivity, specificity and accuracy of three-phase bone scintigraphy without/with quantitative data were 89%/88%, 58%/62% and 77%/78%, respectively. The intra-observer agreement improved significantly by adding quantitative data in the evaluation (Kappa value 0·79/0·94). The interobserver agreement was not significantly improved. Adding quantitative data on blood flow distribution in the interpretation of TBPS improves intra-observer variation, whereas no difference in interobserver variation was observed. The sensitivity of TPBS in the diagnosis of CNO is high, but holds limited specificity. Diagnostic performance does not improve using quantitative data in the evaluation. This may be due to the reference intervals applied in the study or the absence of a proper gold standard diagnostic procedure for comparison. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  1. Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Si Eun; Moon, Ji Eun Ho; Kim, Eun Kyung; Yoon, Jung Hyun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US.

  2. Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting

    Science.gov (United States)

    Khumalo, Jermaine; Nicol, Mark; Hardie, Diana; Muloiwa, Rudzani; Mteshana, Phindile

    2017-01-01

    Introduction Accurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR) assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children. Methods We developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis. Results From 292 samples, bacterial DNA was detected in 12 (4.1%) and viral nucleic acids in 94 (32%). Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10%) of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR. Discussion In this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation. PMID:28346504

  3. Diagnostic Value of Multislice Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Retroperitoneal Spread of Testicular Cancer: A Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, J. (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus Sygehus, Aarhus (Denmark)); Jurik, A.G. (Dept. of Radiology, Aarhus Univ. Hospital, Aarhus Sygehus, Aarhus (Denmark))

    2009-11-15

    Testicular cancer is the most frequent malignant disorder in men aged 15-35 years. Generally, diagnosing and follow-up include computer tomography (CT) examinations to detect possible retroperitoneal spread (abdomen and pelvis), resulting in at least eight CT examinations. This patient group is thereby exposed to a non-neglectable radiation dose, increasing the risk of future radiation-induced secondary cancer. This is especially problematic in potentially surgically cured patients with stage 1 testicular cancer. Thus, it can be beneficial to substitute CT with magnetic resonance imaging (MRI), provided there is valid evidence that the diagnostic value of MRI is at least comparable to current multislice CT (MSCT). The purpose of this study was to analyze whether there is evidence to recommend a substitution of MSCT with MRI in the diagnosis of retroperitoneal spread of testicular cancer. A literature search on the diagnostic accuracy, specificity, and sensitivity of MSCT and MRI in the diagnosis of retroperitoneal spread of testicular cancer was performed in the following databases: PubMed, EmBase, and ISI Web of Science. The search was limited to include the period from 2000 to September 2008, and to human and English-language publications. Forty-four publications were obtained for formal review (27 from PubMed, 15 from EmBase, two from ISI Web of Science). None of the publications reviewed encompassed diagnostic specificity and sensitivity of MSCT, and they lacked systematic comparison of MSCT and MRI. Only one study included sensitivity and specificity of MRI compared to single-slice CT. Both methods had a sensitivity and a specificity of approximately 70%. The literature review did not reveal valid data regarding diagnostic accuracy of MRI compared with MSCT for diagnosing retroperitoneal spread of testicular cancer. A prospective blinded comparative study is needed to provide valid evidence

  4. Importance of 123I-metaiodobenzylguanidine scintigraphy/single photon emission computed tomography for diagnosis and differential diagnostics of Parkinson syndromes.

    Science.gov (United States)

    Jost, Wolfgang H; Del Tredici, Kelly; Landvogt, Christian; Braune, Stefan

    2010-01-01

    The goal of Parkinson syndrome diagnostics is twofold: early diagnosis on the one hand, and accurate differentiation among idiopathic and atypical Parkinson syndromes on the other. (123)I-metaiodobenzylguanidine scintigraphy is the only method that can distinguish with a high degree of sensitivity and specificity between atypical Parkinson syndromes and Parkinson's disease or dementia with Lewy bodies. Additional advantages are the method's widespread availability and radioactive exposure dose comparable to that for single photon emission computed tomography imaging with much lower costs. Only a single radiotracer study is necessary. (123)I-metaiodobenzylguanidine scintigraphy is an indispensable tool for purposes of differentiating among the various Parkinson syndromes.

  5. Laboratory diagnosis of malaria by conventional peripheral blood smear examination with Quantitative Buffy Coat (QBC and Rapid Diagnostic Tests (RDT - A comparative study

    Directory of Open Access Journals (Sweden)

    Bhat Sandhya K

    2012-10-01

    Full Text Available Aim: Rapid diagnosis is prerequisite for effective treatment and reducing mortality and morbidity of malaria. Microscopy has been the Gold standard for malaria diagnosis for decades. Recently, many new rapid diagnostic tests like Quantitative Buffy Coat (QBC examination and rapid antigen detection methods are being widely used. We made an attempt to compare peripheral smear, QBC and rapid antigen detection methods for the diagnosis of malaria. Materials and Methods: A total number of 500 samples were collected from patients presenting with classical symptoms of malaria. Thick and thin blood smears were prepared and stained with Leishman’s stain. QBC, Histidine Rich Protein-II antigen test and plasmodium Lactate Dehydrogenase tests were done using commercially available kits. Results: Taking thick smear as gold standard, thin smear had sensitivity, specificity, positive and negative predictive values of 90.9%, 100%, 100% and 98.6% respectively. QBC showed sensitivity, specificity, positive and negative predictive values of 95.45%, 100%, 100% and 99.31% respectively. HRP-II antigen detection showed sensitivity, specificity, positive and negative predictive values of 56.06%, 100%, 100% and 94.20%. pLDH showed sensitivity, specificity, PPV and NPV of 95.45%, 100%, 100% and 99.40% respectively. Conclusion: In our study, QBC had highest sensitivity followed by pLDH assay. Leishman’s stained thick smear is cost effective but requires technical expertise to interpret the results, so if facilities are available, QBC can be used for routine diagnosis. In places where facilities are not available rapid diagnostic test devices can be used, especially in endemic areas.

  6. Mucormycosis Rhinosinusitis at Diagnosis of Acute Lymphoblastic Leukemia: Diagnostics and Management Challenges in a Low-Middle-income Country.

    Science.gov (United States)

    Mandegari, Elham; Fu, Ligia; Arambú, Carolina; Montoya, Sandra; Peña, Armando; Johnson, Kyle M; Perfect, John R; Caniza, Miguela A

    2015-04-01

    We present the case of an adolescent with mucor rhinosinusitis diagnosed concomitantly with acute lymphoblastic leukemia at a hospital in Tegucigalpa, Honduras. We also discuss the challenges faced in the dual management of hematologic malignancies and invasive fungal disease in a low-middle-income country, such as access to diagnostics, immunosuppressants, imaging, and antifungals. Despite these shortcomings, the patient was successfully treated for both the diseases. Low-middle-income country hospitals can effectively treat invasive fungal diseases by providing adequate diagnostic and support services, which can improve the outcomes of pediatric cancer patients.

  7. A double-fuzzy diagnostic methodology dedicated to online fault diagnosis of proton exchange membrane fuel cell stacks

    Science.gov (United States)

    Zheng, Zhixue; Péra, Marie-Cécile; Hissel, Daniel; Becherif, Mohamed; Agbli, Kréhi-Serge; Li, Yongdong

    2014-12-01

    To improve the performance and lifetime of the low temperature polymer electrolyte membrane fuel cell (PEMFC) stack, water management is an important issue. This paper aims at developing an online diagnostic methodology with the capability of discriminating different degrees of flooding/drying inside the fuel cell stack. Electrochemical impedance spectroscopy (EIS) is utilized as a basis tool and a double-fuzzy method consisting of fuzzy clustering and fuzzy logic is developed to mine diagnostic rules from the experimental data automatically. Through online experimental verification, a high interpretability and computational efficiency of the proposed methodology can be achieved.

  8. Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis.

    Science.gov (United States)

    Lee, Kwang-Hoon; Choi, Sang-Tae; Lee, Soo-Kyung; Lee, Joo-Hyun; Yoon, Bo-Young

    2015-06-01

    Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

  9. Impact of diagnostic interval on mortality after diagnosis of colorectal cancer: A new perspective on the waiting list paradox

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Frydenberg, Morten; Hansen, Rikke Pilegaard

    INTRODUCTION: The impact of diagnostic delay on colorectal cancer mortality has never been conclusively evaluated. Most studies show either no association or find that rapidly diagnosed patients have higher mortality rates than patients with longer waits in the primary and secondary health care...

  10. Does Radar Technology Support the Diagnosis of Pneumothorax? PneumoScan—A Diagnostic Point-of-Care Tool

    Directory of Open Access Journals (Sweden)

    T. Lindner

    2013-01-01

    Full Text Available Background. A nonrecognized pneumothorax (PTX may become a life-threatening tension PTX. A reliable point-of-care diagnostic tool could help in reduce this risk. For this purpose, we investigated the feasibility of the use of the PneumoScan, an innovative device based on micropower impulse radar (MIR. Patients and Methods. addition to a standard diagnostic protocol including clinical examination, chest X-ray (CXR, and computed tomography (CT, 24 consecutive patients with chest trauma underwent PneumoScan testing in the shock trauma room to exclude a PTX. Results. The application of the PneumoScan was simple, quick, and reliable without functional disorder. Clinical examination and CXR each revealed one and PneumoScan three out of altogether four PTXs (sensitivity 75%, specificity 100%, positive predictive value 100%, and negative predictive value 95%. The undetected PTX did not require intervention. Conclusion. The PneumoScan as a point-of-care device offers additional diagnostic value in patient management following chest trauma. Further studies with more patients have to be performed to evaluate the diagnostic accuracy of the device.

  11. Diagnostic accuracy of morphologic identification of filamentous fungi in paraffin embedded tissue sections: correlation of histological and culture diagnosis.

    Science.gov (United States)

    Challa, Sundaram; Pamidi, Umabala; Uppin, Shantveer G; Uppin, Megha S; Vemu, Lakshmi

    2014-01-01

    The aim was to investigate the correlation between histological and culture diagnosis of filamentous fungi. Tissue sections from biopsy samples stained with Hematoxylin and Eosin and special stains from samples of chronic invasive/noninvasive sinusitis and intracranial space occupying lesions during 2005-2011 diagnosed to have infection due to filamentous fungi were reviewed. The histopathology and culture diagnoses were analyzed for correlation and discrepancy. There were 125 samples positive for filamentous fungi on biopsy. Of these 76 (60.8%) were submitted for culture and fungi grew in 30 (39.97%) samples. There was a positive correlation between histological and culture diagnosis in 25 (83.33%) samples that included Aspergillus species (16/19), Zygomycetes species (8/10) and dematiaceous fungi (1/1). The negative yield of fungi was more in Zygomycetes species (20/30) when compared to Aspergillus species (25/44). There was a discrepancy in diagnosis in 5/30 (16.67%) samples which included probable dual infection in two, and dematiaceous fungi being interpreted as Aspergillus species in three samples. Histopathology plays a major role in the diagnosis of infection due to filamentous fungi, especially when cultures are not submitted or negative. The discrepancy between histological and culture diagnosis was either due to dematiaceous fungi being interpreted as Aspergillus species or probable dual infection.

  12. Tuberculosis-Diagnostic Expert System: an architecture for translating patients information from the web for use in tuberculosis diagnosis.

    Science.gov (United States)

    Osamor, Victor C; Azeta, Ambrose A; Ajulo, Oluseyi O

    2014-12-01

    Over 1.5-2 million tuberculosis deaths occur annually. Medical professionals are faced with a lot of challenges in delivering good health-care with unassisted automation in hospitals where there are several patients who need the doctor's attention. To automate the pre-laboratory screening process against tuberculosis infection to aid diagnosis and make it fast and accessible to the public via the Internet. The expert system we have built is designed to also take care of people who do not have access to medical experts, but would want to check their medical status. A rule-based approach has been used, and unified modeling language and the client-server architecture technique were applied to model the system and to develop it as a web-based expert system for tuberculosis diagnosis. Algorithmic rules in the Tuberculosis-Diagnosis Expert System necessitate decision coverage where tuberculosis is either suspected or not suspected. The architecture consists of a rule base, knowledge base, and patient database. These units interact with the inference engine, which receives patient' data through the Internet via a user interface. We present the architecture of the Tuberculosis-Diagnosis Expert System and its implementation. We evaluated it for usability to determine the level of effectiveness, efficiency and user satisfaction. The result of the usability evaluation reveals that the system has a usability of 4.08 out of a scale of 5. This is an indication of a more-than-average system performance. Several existing expert systems have been developed for the purpose of supporting different medical diagnoses, but none is designed to translate tuberculosis patients' symptomatic data for online pre-laboratory screening. Our Tuberculosis-Diagnosis Expert System is an effective solution for the implementation of the needed web-based expert system diagnosis. © The Author(s) 2013.

  13. [Peripheral artery disease as supplemental diagnosis in coronary heart disease--influence on diagnostics, treatment and prognosis].

    Science.gov (United States)

    Espinola-Klein, C; Savvidis, S; Kopp, H

    2014-01-01

    Peripheral arterial disease (PAD) increases cardiovascular event rate in patients with coronary artery disease (CAD). Therefore PAD should be considered in patients with CAD with regard to diagnostic and therapeutic strategies. PAD may difficult diagnostic tests in CAD patients. Patients with PAD and CAD may be limited in stress testing by decreased leg perfusion. In addition, arterial puncture can be more difficult in sclerotic femoral arteries. Cardiovascular risk factors should be treated carefully in all manifestations of atherosclerosis. Target values from current guidelines are similar for PAD and CAD. Inhibitors of platelet aggregation are indication in both CAD and PAD. Exercise not only improves walking distance in patients with intermittent claudication but also improves cardiovascular prognosis in patients with atherosclerosis.

  14. A Comparison of DSM-IV-TR and DSM-5 Diagnostic Classifications in the Clinical Diagnosis of Autistic Spectrum Disorder.

    Science.gov (United States)

    Yaylaci, Ferhat; Miral, Suha

    2017-01-01

    Aim of this study was to compare children diagnosed with Pervasive Developmental Disorder (PDD) according to DSM-IV-TR and DSM-5 diagnostic systems. One hundred fifty children aged between 3 and 15 years diagnosed with PDD by DSM-IV-TR were included. PDD symptoms were reviewed through psychiatric assessment based on DSM-IV-TR and DSM-5 criteria. Clinical severity was determined using Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). A statistically significant decrease (19.3 %) was detected in the diagnostic ratio with DSM-5. Age and symptom severity differed significantly between those who were and were not diagnosed with PDD using DSM-5. B4 criteria in DSM-5 was most common criterion. Results indicate that individuals diagnosed with PDD by DSM-IV-TR criteria may not be diagnosed using DSM-5 criteria.

  15. Bronchial wall measurements in patients after lung transplantation: evaluation of the diagnostic value for the diagnosis of bronchiolitis obliterans syndrome

    NARCIS (Netherlands)

    Dettmer, S.; Peters, L.; Wall, C. de; Schaefer-Prokop, C.M.; Schmidt, M.; Warnecke, G.; Gottlieb, J.; Wacker, F.; Shin, H.O.

    2014-01-01

    To prospectively evaluate quantitative airway wall measurements of thin-section {CT} for the diagnosis of Bronchiolitis Obliterans Syndrome ({BOS}) following lung transplantation.In 141 {CT} examinations, bronchial wall thickness ({WT}), the wall area percentage ({WA%}) calculated as the ratio of

  16. The Importance of Alternative Diagnostic Modalities in the Diagnosis of Small Bowel Tumors After a Negative Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Iolanda Ribeiro

    2015-05-01

    We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.

  17. The diagnosis of urinary tract infections in young children (DUTY: protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness

    Directory of Open Access Journals (Sweden)

    Downing Harriet

    2012-07-01

    Full Text Available Abstract Background Urinary tract infection (UTI is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods/design DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results most strongly associated with a positive urine culture result. We will

  18. Translation and validation of Autism Diagnostic Interview-Revised (ADI-R for autism diagnosis in Brazil

    Directory of Open Access Journals (Sweden)

    Michele M. Becker

    2012-03-01

    Full Text Available OBJECTIVE: To translate into Brazilian Portuguese the Autism Diagnostic Interview-Revised (ADI-R, an extremely useful diagnostic tool in autism. METHODS: A case-control study was done to validate the ADI-R. After being translated, the interview was applied in a sample of 20 patients with autism and 20 patients with intellectual disability without autism, in order to obtain the initial psychometric properties. RESULTS: The internal consistency was high, with a of Crombach of 0.967. The validity of criterion had sensitivity and specificity of 100%, having as a gold standard the DSM-IV diagnostic criteria. The interview had high discriminant validity, with higher scores in the group of patients with autism, as well as high interobserver consistency, with median kappa of 0.824. CONCLUSION: The final version of ADI-R had satisfactory psychometric characteristics, indicating good preliminary validation properties. The instrument needs to be applied in bigger samples in other areas of the country.

  19. Comparison of High Resolution Ultrasonography and Nerve Conduction Study in the Diagnosis of Carpal Tunnel Syndrome: Diagnostic Value of Median Nerve Cross-Sectional Area

    Directory of Open Access Journals (Sweden)

    A. Mohammadi

    2009-11-01

    Full Text Available Background/Objective: Carpal tunnel syndrome (CTS is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study (NCS in the diagnosis of carpal tunnel syndrome. "nPatients and Methods: 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. "nResults: The mean cross-sectional area (CSA of the median nerve at the tunnel inlet was 11.4±1.7 mm2 for the patient group and 5.78 ±0.9 mm2 for the control group (P<0.001. The mean cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the patient group and 4.7±0.7 mm2 for the control group (P<0.001. The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm2. "nConclusion: In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS.

  20. Performance of a new gelled nested PCR test for the diagnosis of imported malaria: comparison with microscopy, rapid diagnostic test, and real-time PCR.

    Science.gov (United States)

    Iglesias, Nuria; Subirats, Mercedes; Trevisi, Patricia; Ramírez-Olivencia, Germán; Castán, Pablo; Puente, Sabino; Toro, Carlos

    2014-07-01

    Microscopy and rapid diagnostic tests (RDTs) are the techniques commonly used for malaria diagnosis but they are usually insensitive at very low levels of parasitemia. Nested PCR is commonly used as a reference technique in the diagnosis of malaria due to its high sensitivity and specificity. However, it is a cumbersome assay only available in reference centers. We evaluated a new nested PCR-based assay, BIOMALAR kit (Biotools B&M Labs, Madrid, Spain) which employs ready-to-use gelled reagents and allows the identification of the main four species of Plasmodium. Blood samples were obtained from patients with clinical suspicion of malaria. A total of 94 subjects were studied. Fifty-two (55.3%) of them were malaria-infected subjects corresponding to 48 cases of Plasmodium falciparum, 1 Plasmodium malariae, 2 Plasmodium vivax, and 1 Plasmodium ovale. The performance of the BIOMALAR test was compared with microscopy, rapid diagnostic test (RDT) (BinaxNOW® Malaria) and real-time quantitative PCR (qPCR). The BIOMALAR test showed a sensitivity of 98.1% (95% confidence interval [CI], 89.7-100), superior to microscopy (82.7% [95% CI, 69.7-91.8]) and RDT (94.2% [95% CI, 84.1-98.8]) and similar to qPCR (100% [95% CI, 93.2-100]). In terms of specificity, the BIOMALAR assay showed the same value as microscopy and qPCR (100% [95% CI, 93.2-100]). Nine subjects were submicroscopic carriers of malaria. The BIOMALAR test identified almost all of them (8/9) in comparison with RDT (6/9) and microscopy (0/9). In conclusion, the BIOMALAR is a PCR-based assay easy to use with an excellent performance and especially useful for diagnosis submicroscopic malaria.

  1. Different diagnostic cut-off values of urinary fractionated metanephrines according to sex for the diagnosis of pheochromocytoma in Korean subjects.

    Science.gov (United States)

    Sohn, Seo Young; Park, Hyung Doo; Lee, Soo Youn; Kim, Jung Han; Jung, Byong Chang; Kim, Hye Jeong; Jang, Hye Won; Kim, Kwang Won; Lee, Moon Kyu; Min, Yong Ki; Kim, Jae Hyeon

    2012-01-01

    The diagnosis of pheochromocytoma depends on the documentation of catecholamine overproduction. The use of urinary fractionated metanephrines has recently become common for the diagnosis of pheochromocytoma. In order to avoid false positive and false negative results, optimal cut-off levels are necessary; however, there have been few published reports on whether different cut-off levels are needed to diagnose pheochromocytoma according to sex. We reviewed the medical records of 815 subjects (including 103 pheochromocytoma patients) whose of 24-h urinary fractionated metanephrine was measured using high-performance liquid chromatography methods and adrenal imaging at Samsung Medical Center. Receiver operating characteristic (ROC) curves were used to determine cut-off values according to sex. The upper limit values of fractionated metanephrine in healthy volunteers and the control group were significantly higher in male subjects compared with females. When we applied cut-off values according to sex, the diagnostic efficacies (defining a positive test as either metanephrine or normetanephrine levels above the cut-off value) were a sensitivity of 96% in male subjects and 98.1% in female subjects and a specificity of 88.6% in male subjects and 94.1% in female subjects. However, when we applied cut-off values without considering sex, the specificity decreased from 88.6% to 77.8% in male subjects. In this study, urinary fractionated metanephrines had a high level of sensitivity and specificity for the diagnosis of pheochromocytoma. However, diagnostic cut-off values were higher in male subjects than in female subjects. Therefore, different cut-off values may be needed according to sex to diagnose pheochromocytoma in Koreans.

  2. Diagnosis of soil-transmitted helminths in the era of preventive chemotherapy: effect of multiple stool sampling and use of different diagnostic techniques.

    Directory of Open Access Journals (Sweden)

    Stefanie Knopp

    Full Text Available BACKGROUND: Soil-transmitted helminth infections are common throughout the tropics and subtropics and they disproportionately affect the poorest of the poor. In view of a growing global commitment to control soil-transmitted helminthiasis, there is a need to elucidate the effect of repeated stool sampling and the use of different diagnostic methods in areas targeted for preventive chemotherapy that are characterized by low-infection intensities. In this study, we focused on schoolchildren on Unguja Island, Zanzibar, an area where anthelminthic drugs have been repeatedly administered over the past decade. METHODOLOGY/PRINCIPAL FINDINGS: Three serial stool samples from each of 342 schoolchildren were examined using the Kato-Katz (K-K, Koga agar plate (KAP, and Baermann (BM techniques. These methods were used individually or in combination for the diagnosis of Ascaris lumbricoides (K-K, Trichuris trichiura (K-K, hookworm (K-K and KAP, and Strongyloides stercoralis (KAP and BM. The examination of multiple stool samples instead of a single one resulted in an increase of the observed prevalence; e.g., an increase of 161% for hookworm using the K-K method. The diagnostic sensitivity of single stool sampling ranged between 20.7% for BM to detect S. stercoralis and 84.2% for K-K to diagnose A. lumbricoides. Highest sensitivities were observed when different diagnostic approaches were combined. The observed prevalences for T. trichiura, hookworm, A. lumbricoides, and S. stercoralis were 47.9%, 22.5%, 16.5%, and 10.8% after examining 3 stool samples. These values are close to the 'true' prevalences predicted by a mathematical model. CONCLUSION/SIGNIFICANCE: Rigorous epidemiologic surveillance of soil-transmitted helminthiasis in the era of preventive chemotherapy is facilitated by multiple stool sampling bolstered by different diagnostic techniques.

  3. Diagnostic accuracy of {sup 18}F amyloid PET tracers for the diagnosis of Alzheimer's disease: a systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Morris, Elizabeth; Chalkidou, Anastasia [St Thomas' Hospital, King' s Technology Evaluation Centre, King' s College London, London (United Kingdom); St Thomas' Hospital, Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King' s College London, London (United Kingdom); Hammers, Alexander [St Thomas' Hospital, Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King' s College London, London (United Kingdom); Peacock, Janet; Summers, Jennifer [St Thomas' Hospital, King' s Technology Evaluation Centre, King' s College London, London (United Kingdom); King' s College London, Division of Health and Social Care Research, London (United Kingdom); King' s College London, NIHR Biomedical Research Centre at Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Keevil, Stephen [St Thomas' Hospital, King' s Technology Evaluation Centre, King' s College London, London (United Kingdom); St Thomas' Hospital, Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King' s College London, London (United Kingdom); St Thomas' Hospital, Department of Medical Physics, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom)

    2016-02-15

    Imaging or tissue biomarker evidence has been introduced into the core diagnostic pathway for Alzheimer's disease (AD). PET using {sup 18}F-labelled beta-amyloid PET tracers has shown promise for the early diagnosis of AD. However, most studies included only small numbers of participants and no consensus has been reached as to which radiotracer has the highest diagnostic accuracy. First, we performed a systematic review of the literature published between 1990 and 2014 for studies exploring the diagnostic accuracy of florbetaben, florbetapir and flutemetamol in AD. The included studies were analysed using the QUADAS assessment of methodological quality. A meta-analysis of the sensitivity and specificity reported within each study was performed. Pooled values were calculated for each radiotracer and for visual or quantitative analysis by population included. The systematic review identified nine studies eligible for inclusion. There were limited variations in the methods between studies reporting the same radiotracer. The meta-analysis results showed that pooled sensitivity and specificity values were in general high for all tracers. This was confirmed by calculating likelihood ratios. A patient with a positive ratio is much more likely to have AD than a patient with a negative ratio, and vice versa. However, specificity was higher when only patients with AD were compared with healthy controls. This systematic review and meta-analysis found no marked differences in the diagnostic accuracy of the three beta-amyloid radiotracers. All tracers perform better when used to discriminate between patients with AD and healthy controls. The sensitivity and specificity for quantitative and visual analysis are comparable to those of other imaging or biomarker techniques used to diagnose AD. Further research is required to identify the combination of tests that provides the highest sensitivity and specificity, and to identify the most suitable position for the tracer in the

  4. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

    Science.gov (United States)

    Sumida, Yoshio; Nakajima, Atsushi; Itoh, Yoshito

    2014-01-14

    It is estimated that 30% of the adult population in Japan is affected by nonalcoholic fatty liver disease (NAFLD). Fatty changes of the liver are generally diagnosed using imaging methods such as abdominal ultrasonography (US) and computed tomography (CT), but the sensitivity of these imaging techniques is low in cases of mild steatosis. Alanine aminotransferase levels may be normal in some of these patients, warranting the necessity to establish a set of parameters useful for detecting NAFLD, and the more severe form of the disease, nonalcoholic steatohepatitis (NASH). Although liver biopsy is currently the gold standard for diagnosing progressive NASH, it has many drawbacks, such as sampling error, cost, and risk of complications. Furthermore, it is not realistic to perform liver biopsies on all NAFLD patients. Diagnosis of NASH using various biomarkers, scoring systems and imaging methods, such as elastography, has recently been attempted. The NAFIC score, calculated from the levels of ferritin, fasting insulin, and type IV collagen 7S, is useful for the diagnosis of NASH, while the NAFLD fibrosis score and the FIB-4 index are useful for excluding NASH in cases of advanced fibrosis. This article reviews the limitations and merits of liver biopsy and noninvasive diagnostic tests in the diagnosis of NAFLD/NASH.

  5. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  6. Individual and combined diagnostic accuracy of ultrasound diagnosis, ultrasound-guided fine-needle aspiration and polymerase chain reaction in identifying tuberculous lymph nodes in the neck.

    Science.gov (United States)

    Kim, Dong Wook; Jung, Soo Jin; Ha, Tae Kwun; Park, Ha Kyoung

    2013-12-01

    The aim of this study was to assess the efficacy of, both individually and in combination, ultrasound (US) diagnosis, US-guided fine-needle aspiration (US-FNA) and polymerase chain reaction (PCR) in diagnosing tuberculous lymph nodes in the neck (i.e., tuberculous cervical lymph nodes [TCLs]). Eighty-two patients who underwent US diagnosis, US-FNA and PCR for clinical suspicion of TCLs were enrolled. Of the 82 patients, 31 were confirmed as having TCLs. The sensitivity, specificity, positive and negative predictive values and accuracy of US diagnosis, US-FNA and PCR were 93.5%, 76.5%, 70.7%, 95.1% and 82.9%; 64.5%, 98.0%, 95.2%, 82.0% and 85.4%; and 100%, 96.1%, 93.9%, 100% and 97.6%, respectively. The diagnostic values of PCR alone and in combination with US-FNA were found to be higher than those of other methods. No US feature with high sensitivity and specificity was identified.

  7. Diagnostic accuracy of segmental enhancement inversion for the diagnosis of renal oncocytoma using biphasic computed tomography (CT) and multiphase contrast-enhanced magnetic resonance imaging (MRI)

    Energy Technology Data Exchange (ETDEWEB)

    Schieda, Nicola; McInnes, Matthew D.F. [The University of Ottawa, The Ottawa Hospital, Department of Medical Imaging, Ottawa, Ontario (Canada); Al-Subhi, Maali; Flood, Trevor A.; El-Khodary, Mohammed [The University of Ottawa, The Ottawa Hospital, Department of Anatomical Pathology, Ottawa, ON (Canada)

    2014-11-15

    Segmental enhancement inversion (SEI) is a controversial imaging finding reportedly specific for the diagnosis of renal oncocytoma. The purpose of this study was to re-evaluate SEI using biphasic CT and multiphase MRI. With research ethics board approval, a retrospective analysis of patients with resection or biopsy of oncocytoma or chromophobe renal cell carcinoma (Ch-RCC) between 2008-2012 was performed. Twenty-four patients with oncocytoma and 13 patients with Ch-RCC underwent CT, while 13 patients with oncocytoma and 10 patients with Ch-RCC underwent MRI. Two blinded radiologists reviewed the CT and MRI studies independently in separate sessions to assess for SEI. A third radiologist established consensus. Interobserver variability was calculated and diagnostic accuracy was compared using ROC and the Fisher exact test. There was no difference in detection of SEI between oncocytoma and Ch-RCC at CT [both readers (p = 0.65, 0.5) and consensus review (p = 0.29)] or MRI [both readers (p = 0.64, 0.74) and consensus review (p = 0.53)]. The interobserver variability at CT (K = 0.28-0.33) and MRI (K = 0.25-0.44) was fair. The sensitivity and specificity for diagnosis of oncocytoma were 21 % and 92 % at CT and 15 % and 90 % at MRI. SEI is not useful for the diagnosis of renal oncocytoma with CT or MRI. (orig.)

  8. Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

    Directory of Open Access Journals (Sweden)

    Cássio M.C. Bottino

    Full Text Available Abstract In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1 to present the evidence found on Brazilian (LILACS, SCIELO and International (MEDLINE databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2 to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

  9. Health and environment in Eastern Europe: an alarming diagnosis. Sante et environnement a l'Est: un diagnostic alarmant

    Energy Technology Data Exchange (ETDEWEB)

    Bonnefoy, X.

    1993-05-01

    Life-expectancy, infant and maternal mortality rates... the distance between East and West in increasing. Among the explanations: ways of life, systems of health care, socioeconomic situations or even historical fatality. But other factors can be pointed out: polluted air, water and soil - an environment whose deterioration is reason for alarm. International organizations have the job of making a diagnosis prior to any treatment.

  10. Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study

    Science.gov (United States)

    Hay, Alastair D.; Sterne, Jonathan A. C.; Hood, Kerenza; Little, Paul; Delaney, Brendan; Hollingworth, William; Wootton, Mandy; Howe, Robin; MacGowan, Alasdair; Lawton, Michael; Busby, John; Pickles, Timothy; Birnie, Kate; O’Brien, Kathryn; Waldron, Cherry-Ann; Dudley, Jan; Van Der Voort, Judith; Downing, Harriet; Thomas-Jones, Emma; Harman, Kim; Lisles, Catherine; Rumsby, Kate; Durbaba, Stevo; Whiting, Penny; Butler, Christopher C.

    2016-01-01

    PURPOSE Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. METHODS We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. RESULTS Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. CONCLUSIONS A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic

  11. Physics for health from diagnosis to therapy; La physique pour la sante du diagnostic a la therapie

    Energy Technology Data Exchange (ETDEWEB)

    Kibler, M.; Poizat, J.C. [Institut de Physique Nucleaire de Lyon, 69 - Villeurbanne (France)

    2003-07-01

    The different titles of conferences and contributions are as follow: interaction of waves and particles with biological matter; living signals and their interpretation; scanner: principle, technology, applications; nuclear medicine: gamma camera and positron cameras; medical physics: outlets and professions; electro neurology: electric signals (EEG) and magnetic signals (M.E.G.); medical imaging: the photons techniques; lasers, diagnostic tools: example of application to the detection of dental caries; nuclear magnetic resonance imaging (MRI); ultrasonics: medical applications; animals models and imaging; laboratories on chips: physics and chemistry in the wings of the genomic revolution; biomaterials; ultrasonics: from fundamental physics to medicine; imaging by ultrashort laser pulses; Pull and twist a molecule of DNA or how watch an enzyme working; treatment of cancers by ionizing radiations; hadron therapy by light ions: situation of the E.T.O.I.L.E. project; PET imaging in hadron therapy; evaluation and management of risks linked to the physical methods of investigation. (N.C.)

  12. Diagnostic test allergens used for in vivo diagnosis of allergic diseases are at risk: a European Perspective.

    Science.gov (United States)

    Klimek, L; Hoffmann, H J; Renz, H; Demoly, P; Werfel, T; Matricardi, P M; Muraro, A; Schmid-Grendelmeier, P; Cardona, V; Papadopoulos, N G

    2015-10-01

    In the European Union (EU), allergens used for diagnostic tests (TAs) are defined as medicinal products and have to be registered by national authorities. The current situation is not homogeneous. Existing authorizations need to be kept in the market in some EU states, while others need complete new authorizations requiring clinical trials, quality assurance methods, stability studies, and periodic safety update reports. Allergen manufacturers argue that offering a comprehensive panel of TAs may be economically disastrous. Expenses for initiation and maintenance of TA authorizations far exceed their related revenues and manufacturers may be forced to significantly limit their allergen portfolios. The availability of a wide range of high-quality TAs is very important for in vivo diagnoses of IgE-mediated allergies. Increased regulatory demands induce costs that need to be covered by public health organizations or reimbursed by health insurance companies.

  13. Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation.

    Science.gov (United States)

    Giess, Catherine S; Chikarmane, Sona A; Sippo, Dorothy A; Birdwell, Robyn L

    2017-06-01

    The purpose of this study was to determine the clinical utility of breast MRI for diagnosing malignancy in women with equivocal mammographic findings but no symptoms. Retrospective review of an institutional MRI database of 7332 contrast-enhanced breast MRI examinations from January 1, 2009, through December 31, 2012, yielded the records of 296 (4.0%) examinations of 294 women without symptoms who underwent MRI for mammographic findings uncertain at diagnostic evaluation. Imaging findings, histopathologic results, and patient demographics were obtained from the electronic medical record. The mean patient age was 55 years (range, 29-83 years). Mammographic lesion type (n = 294) included 89 focal asymmetries, 76 asymmetries, 64 masses, 44 architectural distortions, 17 surgical scar versus lesion, and four miscellaneous lesions. Diagnostic ultrasound, performed on 286 of 294 (97.3%) lesions at mammographic evaluation, showed an ultrasound correlate in 37 (12.9%) lesions, equivocal correlate in 48 (16.8%), and no ultrasound correlate in 201 (70.3%). MRI examination of 294 index lesions showed a correlate in 133 (45.2%) and no correlate in 161 (54.8%). Forty of 294 (13.6%) index lesions were malignant, 37 (92.5%) with an MRI correlate and three (7.5%) without an MRI correlate. Among 250 patients who underwent biopsy or had 2 or more years of imaging stability, the sensitivity, specificity, negative predictive value, and positive predictive value of breast MRI for malignancy were 92.5%, 62.4%, 97.8%, and 31.9%. Forty-four of 294 (15.0%) patients had lesions incidentally found at MRI; 7 of 41 (17.1%) lesions that were biopsied or were stable for at least 1 year were malignant. Problem-solving breast MRI for inconclusive mammographic findings helps identify malignancies with high sensitivity and a high negative predictive value.

  14. Diagnostic systems for motor vehicles. From diagnosis and moni; Diagnosesysteme fuer Kraftfahrzeuge. Von der Diagnose und Ueberwachung bis zum E-Commerce

    Energy Technology Data Exchange (ETDEWEB)

    Baeker, B.; Forchert, T. [DB DaimlerChrysler AG, Stuttgart (Germany). Abt. FT2/ED

    2001-07-01

    Starting from the technical necessity of having monitoring and diagnostic systems in all compartments of modern passenger cars, the contribution discusses how new service concepts can be integrated as well. New diagnostic approaches are outlined which, in addition to failure detection, also enable optimization of the development process chain. At the same time, the depth of diagnosis is improved in order to obtain a multitude of new meta information while driving, which will serve as a basis for installing new services in the vehicle. [German] Gestiegend Komfortanforderungen und die gewachsene Komplexitaet in heutigen und zukuenftigen Elektrik/Elektronik-Systemen fuer Kraftfahrzeuge erfordern leistungsfaehige Diagnosesysteme. Um gleichzeitig im Rahmen der Globalisierung die Wertschoepfungskette weiter zu staerken, muessen als logische Konsequenz des Marktes Ansaetze fuer neuartige Dienstleistungskonzepte erdacht und integriert werden. Dieser Aufsatz diskutiert ausgehend von der technischen Notwendigkeit zukuenftiger Ueberwachungs- und Diagnosesysteme in allen Bereichen moderner Kraftfahrzeuge moegliche Wege zu derartigen Ansaetzen denkbarer systemuebergreifender Dienstleistungsschritte am Fahrzeug. Dabei werden technologisch neuartige Diagnoseansaetze skizziert, die neben einer Fehlererkennung auch die Optimierung der Entwicklungsprozesskette zulassen. Eine gleichzeitige Erhoehung der Diagnosetiefe schafft die Grundlage, eine Vielzahl neuer Meta-Informationen waehrend der Fahrt zu generieren. Diese bilden die Basis fuer neue Dienste am Fahrzeug. (orig.)

  15. Diagnostic accuracy of an IgM enzyme-linked immunosorbent assay and comparison with 2 polymerase chain reactions for early diagnosis of human leptospirosis.

    Science.gov (United States)

    Vanasco, N B; Jacob, P; Landolt, N; Chiani, Y; Schmeling, M F; Cudos, C; Tarabla, H; Lottersberger, J

    2016-04-01

    Enzyme-linked immunosorbent assay (ELISA) tests and polymerase chain reaction (PCR) may play a key role for early detection and treatment of human leptospirosis in developing countries. The aims of this study were to develop and validate an IgM ELISA under field conditions and to compare the diagnostic accuracy among IgG, IgM ELISAs, conventional PCR (cPCR), and real-time PCR (rtPCR) for early detection of human leptospirosis. Overall accuracy of IgM ELISA was sensitivity of 87.9%, specificity of 97.0%, and area under the curve of 0.940. When the 4 methods were compared, IgM ELISA showed the greatest diagnostic accuracy (J=0.6) followed by rtPCR (J=0.4), cPCR (J=0.2) and IgG ELISA (J=0.1). Our results support the use of IgM ELISA and rtPCR for early diagnosis of the disease. Moreover, due to their high specificity, they could be also useful to replace or supplement microscopic agglutination test as a confirmatory test, allowing more confirmations.

  16. Comparison of DSM-IV diagnostic criteria versus the Broad Categories for the Diagnosis of Eating Disorders scheme in a Japanese sample.

    Science.gov (United States)

    Nakai, Yoshikatsu; Nin, Kazuko; Teramukai, Satoshi; Taniguchi, Ataru; Fukushima, Mitsuo; Wonderlich, Stephen A

    2013-08-01

    The purposes of this study were to compare DSM-IV diagnostic criteria and the Broad Categories for the Diagnosis of Eating Disorders (BCD-ED) scheme in terms of the number of cases of Eating Disorder Not Otherwise Specified (EDNOS) and to test which diagnostic tool better captures the variance of psychiatric symptoms in a Japanese sample. One thousand and twenty-nine women with an eating disorder (ED) participated in this study. Assessment methods included structured clinical interviews and administration of the Eating Attitudes Test and the Eating Disorder Inventory. The BCD-ED scheme dramatically decreased the proportion of DSM-IV EDNOS from 45.1% to 1.5%. However, the categorization of patients with the BCD-ED scheme was less able to capture the variance in psychopathology scales than the DSM-IV, suggesting that the BCD-ED scheme may differentiate ED groups less effectively than the DSM-IV. These results suggest that the BCD-ED scheme may have the potential to eliminate the use of DSM-IV EDNOS, but it may have problems capturing the variance of psychiatric symptoms.

  17. Diagnostic exome sequencing identifies two novel IQSEC2 mutations associated with X-linked intellectual disability with seizures: implications for genetic counseling and clinical diagnosis.

    Science.gov (United States)

    Gandomi, Stephanie K; Farwell Gonzalez, K D; Parra, M; Shahmirzadi, L; Mancuso, J; Pichurin, P; Temme, R; Dugan, S; Zeng, W; Tang, Sha

    2014-06-01

    Intellectual disability is a heterogeneous disorder with a wide phenotypic spectrum. Over 1,700 OMIM genes have been associated with this condition, many of which reside on the X-chromosome. The IQSEC2 gene is located on chromosome Xp11.22 and is known to play a significant role in the maintenance and homeostasis of the brain. Mutations in IQSEC2 have been historically associated with nonsyndromic X-linked intellectual disability. Case reports of affected probands show phenotypic overlap with conditions associated with pathogenic MECP2, FOXG1, CDKL5, and MEF2C gene mutations. Affected individuals, however, have also been identified as presenting with additional clinical features including seizures, autistic-behavior, psychiatric problems, and delayed language skills. To our knowledge, only 5 deleterious mutations and 2 intragenic duplications have been previously reported in IQSEC2. Here we report two novel IQSEC2 de novo truncating mutations identified through diagnostic exome sequencing in two severely affected unrelated male probands manifesting developmental delay, seizures, hypotonia, plagiocephaly, and abnormal MRI findings. Overall, diagnostic exome sequencing established a molecular diagnosis for two patients in whom traditional testing methods were uninformative while expanding on the mutational and phenotypic spectrum. In addition, our data suggests that IQSEC2 may be more common than previously appreciated, accounting for approximately 9 % (2/22) of positive findings among patients with seizures referred for diagnostic exome sequencing. Further, these data supports recently published data suggesting that IQSEC2 plays a more significant role in the development of X-linked intellectual disability with seizures than previously anticipated.

  18. Comparison of the diagnostic performance of {sup 14}C-urea breath test according to counting method for the diagnosis of Helicobacter pylori infection

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Woo; Lim, Seok Tae; Lee, Seung Ok; Sohn, Myung Hee [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2005-02-15

    {sup 14}C-urea breath test (UBT) is a non-invasive and reliable method for the diagnosis of Helicobacter pylon, (HP) infection. In this study, we evaluated the diagnostic performance of a new and rapid {sup 14}C-UBT (Heliprobe method), which was equipped with Geiger-Muller counter and compared the results with those obtained by using the conventional method. Forty-nine patients with dyspepsia underwent gastroduodenoscopy and {sup 14}C-UBT. A 37 KBq {sup 14}C-urea capsule was administered to patients and breath samples were collected. In Heliprobe method, patients exhaled into a Heliprobe BreathCard for 10 min. And then the activities of the BreathCard were countered using Heliprobe analyzer. In the conventional method, results were countered using liquid scintillation counter. During gastroduodenoscopy, 18 of 49 patients were underwent biopsies. According to these histologic results, we evaluated the diagnostic performance of two different methods and compared them. Also we evaluated the concordant and disconcordant rates between them. In all 49 patients, concordant rate of both conventional and Heliprobe methods was 98% (48/49) and the discordant rate was 2% (1/49). thirteen of 18 patients to whom biopsies were applied, were found to be HP positive on histologic results. And both Heliprobe method and conventional method classified 13 of 13 HP-positive patients and 5 of 5 HP-negative patients correctly (sensitivity 100%, specificity 100%, accuracy 100%). The Heliprobe method demonstrated the same diagnostic performance compared with the conventional method and was a simpler and more rapid technique.

  19. Differences in the prevalence of diagnosis of overweight-obesity in Spanish children according to the diagnostic criteria set used.

    Science.gov (United States)

    Ajejas Bazán, María Julia; Jiménez Trujillo, María Isab; Wärnberg, Julia; Domínguez Fernández, Silvia; López de Andrés, Ana; Pérez Farinós, Napoleón

    2017-09-28

    To examine relevant differences in the prevalence of overweight and obesity in children aged 2-15 years according to different sets of criteria (Orbegozo Foundation, International Obesity Task Force and World Health Organization), and how their use affects the trends in obesity recorded for both sexes between 1995 and 2011 in Spain. Cross-sectional study, a population between 2 and 15 years. Three diagnosis criteria of overweight and obesity were be used. The boys according to the three criteria, showed higher values of overweight and obesity compared to the girls. The lowest levels of overweight and obesity were observed using the Orbegozo tables. The prevalence of overweight and obesity varies significantly according to the criteria used to define overweight and obesity. The percentiles of the Foundation Orbegozo gave the lowest estimates and the standards of growth of the World Health Organization were higher. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Localised acute irradiations. radiological bases of diagnosis and treatment; Irradiations aigues localisees. Bases radiobiologiques du diagnostic et du traitement

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    Daburon, F. [CEA, 75 - Paris (France)

    1997-12-31

    The prognosis, the diagnosis and the treatment of localized acute irradiations coming from a therapeutic overdose is still now a difficult problem. The skin structure and this one of subjacent tissues have several different cellular components with a very different response to irradiation; The analyzed data come from experimental irradiations, clinical examinations after accidental overexposure and the observations that lead to therapeutic protocols of irradiations. All these results have given the preference to the description of cutaneous lesions. Skin has often been used as normal tissue. The results for subjacent tissues are more fragmentary whereas it is the attack of these tissues that will condition the prognosis and the ability to heal the superficial lesions. (N.C.)

  1. Comparison of Diagnostic Value of Antigen B and Protoscoleces Antigen in Diagnosis of Hydatid Cyst by Blotting Method

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    F. Oreizi

    2006-01-01

    Full Text Available Introduction & Objective : Hydatidosis, a disease caused by the cestod helminth echinococcus granulosus, is one of the most important parasitic zoonosis in man and a variety of animals. Sensitive and reliable serologic methods are necessary to confirm the diagnosis. In this study, Ag B and Psc Ag were purified as two specific parasitic antigens and evaluated by Dot blotting used on the serum of hydatidosis patients and control group in order to identify the most sensitive and specific subunits.Materials and Methods: In an analytic and comparative study, serum samples collected from 22 patients under operation of hydatid cyst. As a control group, 4 patients with acute toxoplasmosis, 4 patients with leishmaniasis, 4 patients infected by non-hydatid cestods(Tenia saginata and H.nana and 4 normal subjects were included in this investigation. Infected sheep’s liver and lung were used for the preparation of antigen. Cyst fluid containing protoscoleces was extracted and then partially purified with a protein A column. AgB and Psc Ags were interacted with hydatid and control sera, with Dot blot method and sensitivity and specificity of these antigens were evaluated. Results: Sensitivity and specificity were estimated 95.9% and 81% respectively, for AgB and 100% and 63% respectively, for Psc Ag in Dot blot Method. Conclusion: Evaluation of sensitivity and specificity of AgB and Psc Ag using Dot blotting revealed that AgB has high value for diagnosis of hydatidosis. and presumably can help physicians to diagnose hydatid cyst easier than other routine tests.

  2. Diagnostic value of microRNA-21 in the diagnosis of lung cancer: evidence from a meta-analysis involving 11 studies.

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    Wu, Renjie; Jiang, Yingjiu; Wu, Qingcheng; Li, Qiang; Cheng, Dan; Xu, Ling; Zhang, Cheng; Zhang, Ming; Ye, Ling

    2014-09-01

    Molecular biomarkers that can be detected in easily accessible body fluids have been proposed as non-invasive, cost-effective, and useful tools for cancer diagnosis. Recently, extensive research has explored the involvement of the aberrant expression of microRNA-21 (miRNA-21, miR-21) in lung cancer. Inconsistent results, however, have prevented its widespread use in diagnosis. In light of this situation, our meta-analysis aimed to systematically determine whether aberrant miR-21 expression can distinguish patients with lung cancer from cancer-free controls with a high level of diagnostic accuracy. A comprehensive literature search for relevant studies published before December 23, 2013 was conducted in the MEDLINE, EMBASE, the Cochrane Library, and three Chinese databases. The pooled sensitivity, specificity and other parameters were used to assess the overall performance of miR-21-based assays. Statistical analysis was conducted using the STATA 11.0 software. Eleven research articles involving 676 patients with lung cancer and 529 healthy controls were considered eligible for inclusion in the present meta-analysis. The following summary parameters were calculated from all the included studies: sensitivity of 0.66 (95 % confidence interval [CI]: 0.57-0.74), specificity of 0.82 (95 % CI: 0.74-0.88), positive likelihood ratio (PLR) of 3.70 (95 % CI: 2.50-5.60), negative likelihood ratio (NLR) of 0.42 (95 % CI: 0.32-0.54); diagnostic odds ratio (DOR) of 9.00 (95 % CI: 5.00-16.00), and area under the curve (AUC) of 0.81 (95 % CI: 0.77-0.84). In addition, we added two pre-specified covariates (ethnicity and specimen types) to the bivariate model to assess their impact on the diagnostic value of miR-21 for lung cancer. Similar results were also observed in subgroup analyses, indicating a relatively low level of accuracy. The current meta-analysis indicates that a single miR-21 may not be sufficient to identify lung cancer and that more miRNAs should be used to detect

  3. Additional diagnostic value of tumor markers in cytological fluid for diagnosis of non-small-cell lung cancer

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    Hur Jin

    2012-09-01

    Full Text Available Abstract Background Cytological fluid from a needle aspiration biopsy (NAB is obtained directly from tumor tissue, therefore many biomarker candidates will be present in high concentrations. The aim of this study was to prospectively assess and validate the tumor markers CYFRA 21–1, CEA, and SCC in cytological fluid obtained from NAB samples to determine if they improved the performance of NAB for diagnosing non-small cell lung cancer (NSCLC. Methods A total of 194 patients (M:F = 128:66, mean age 63.7 years with suspected malignant pulmonary lesions were prospectively enrolled and underwent percutaneous NAB. Levels of CYFRA 21–1, CEA, and SCC were measured by immunoassay in serum and cytological fluid obtained during aspiration biopsy. Cut-off values to determined malignancy were 3.3 ng/mL in serum and 15.7 ng/mL in cytological fluid for CYFRA 21–1, 5 ng/mL and 0.6 ng/mL for CEA, and 2 ng/mL and 0.86 ng/mL for SCC. Results Of 194 patients, 139 patients (71.6% had NSCLC and 55 (28.4% had benign lesions. Sensitivity increased significantly for NAB combined with cytological tumor markers compared with NAB alone (CYFRA 21–1: 95% versus 83.5%, p Conclusion Of the tested tumor markers, cytological fluid measurements of CYFRA 21–1 improved the diagnostic performance of NAB for NSCLC.

  4. Diagnostic Accuracy of GeneXpert MTB/RIF Assay in Comparison to Conventional Drug Susceptibility Testing Method for the Diagnosis of Multidrug-Resistant Tuberculosis

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    Pandey, Pratikshya; Rijal, Komal Raj; Shrestha, Bhawana; Kattel, Sirita; Banjara, Megha Raj; Maharjan, Bhagwan; KC, Rajendra

    2017-01-01

    Xpert MTB/RIF assay is regarded as a great achievement of modern medicine for the rapid diagnosis of multidrug-resistant tuberculosis (MDR-TB). The main purpose of this study was to determine the performance of Xpert MTB/RIF assay compared to conventional drug susceptibility testing (DST) method for the diagnosis of MDR-TB. A comparative cross sectional study was carried out at German-Nepal Tuberculosis Project, Kathmandu, Nepal, from April 2014 to September 2014. A total of 88 culture positive clinical samples (83 pulmonary and 5 extra-pulmonary) received during the study period were analyzed for detection of multidrug-resistant tuberculosis by both GeneXpert MTB/RIF assay and conventional DST method. McNemar chi square test was used to compare the performance of Xpert with that of DST method. A p-value of less than 0.05 was considered as statistically significant. Of total 88 culture positive samples, one was reported as invalid while 2 were found to contain nontuberculous Mycobacteria (NTM). Among remaining 85 Mycobacterium tuberculosis culture positive samples, 69 were found to be MDR-TB positive by both methods. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GeneXpert MTB/RIF assay were found to be 98.6%, 100%, 100% and 93.8% respectively. Statistically, there was no significant difference between the diagnostic performance of Xpert and conventional DST method for detection of MDR-TB. GeneXpert MTB/RIF assay was found to be highly sensitive, specific and comparable to gold standard conventional DST method for the diagnosis of MDR-TB. PMID:28081227

  5. Influence of age and renal function on high-sensitivity cardiac troponin T diagnostic accuracy for the diagnosis of acute myocardial infarction.

    Science.gov (United States)

    Chenevier-Gobeaux, Camille; Meune, Christophe; Freund, Yonathan; Wahbi, Karim; Claessens, Yann-Erick; Doumenc, Benoit; Zuily, Stéphane; Riou, Bruno; Ray, Patrick

    2013-06-15

    Concerns have been raised about the performance of highly sensitive cardiac troponin assays to accurately detect acute myocardial infarction (AMI), particularly in non-ST segment elevation (NSTEMI), in elderly patients, and in patients with renal failure. We evaluated whether increased age and low estimated glomerular filtration rate (eGFR) alter diagnostic performance of high-sensitivity cardiac troponin T (HScTnT). In a prospective multicentric study, HScTnT levels were measured blindly at presentation in patients with acute chest pain. Three hundred and sixty-seven patients were enrolled, including 84 patients ≥70 years. Final diagnosis was AMI for 57 patients (16%) and NSTEMI for 43 patients (12%). NSTEMI was more frequent in elderly patients (p = 0.008). Sensitivity and specificity of HScTnT >14 ng/L at admission for AMI were 96% and 51% in patients ≥70 years versus 91% (NS) and 88% (p 53.5 ng/L for the diagnosis of AMI and NSTEMI, respective sensitivities were 87% and 84% and respective specificities were 87% and 87% in elderly patients. Using a cutoff at 35.8 ng/L (for AMI) or 43.2 ng/L (for NSTEMI), sensitivities were 94% and 92%, and specificities were 86% and 88% in patients with low eGFR. Older age, but not low eGFR, was an independent predictive factor of an elevated HScTnT at admission (odds ratio 2.2 [1.2-3.9], p = 0.007). In conclusion, adapted thresholds of HScTnT are required for an accurate diagnosis of AMI/NSTEMI in patients aged ≥70 and in those with low eGFR.

  6. Multidetector CT: a new gold standard in the diagnosis of pulmonary embolism? State of the art and diagnostic algorithms; La TC multitettore: il nuovo gold standard nella diagnosi di embolia polmonare? Stato dell'arte e algoritmi diagnostici

    Energy Technology Data Exchange (ETDEWEB)

    Russo, Vincenzo; Piva, Tommaso; Lovato, Luigi; Fattori, Rossella; Gavelli, Giampaolo [Policlinico S. Orsola, Bologna (Italy). Dipartimento di Radiologia Radiologia III

    2005-02-01

    Purpose: From the early 90s, spiral CT technology has considerably changed the diagnostic capability of Pulmonary Embolism (PE), giving a direct vision of intravascular thrombi. Further technological progress has straightened its diagnostic impact leading to an essential role in clinical practice. The advent of Multi-Detector CT (MDCT) has subsequently increased the reliability of this technique to the point of undermining the role of pulmonary angiography as the gold standard and occupying a central position in diagnostic algorithms. The aim of this paper is to appraise this evolution by means of a meta-analysis of the relevant literature from 1995 to 2004. Results: The review of the literature showed the sensitivity and specificity of CT to have increased from 37-94% and 91-100% (single detector CT) to 87-94% and 94-100% (4-channel multidetector CT), especially thanks to the possibility of depicting subsegmental clots, with an interobserver agreement of 0.63-0.94 (k). Conclusions: CT is one of the most reliable and effective methods in the diagnosis is PE, with the advantage of being extremely fast and providing alternative diagnoses. Recent improvements in MDCT technology confers the highest value of diagnostic accuracy with respect to other imaging modalities such as scintigraphy, angiography, MRI, D-dimer essay and Doppler US. [Italian] Scopo: Dall'inizio degli anni '90, la tecnologia TC spirale (TCS) ha cambiato notevolmente la capacita' diagnostica di Embolia Polmonare (EP), fornendo una visione diretta dei trombi endoluminali. Successivi progressi tecnologici hanno fortificato il suo impatto diagnostico a tal punto che questa metodica e' ora essenziale nella pratica clinica. L'avvento della TC Multi-Detettore (TCMD) ha aumentato di conseguenza l'affidabilita' di questa tecnica fino a tal punto da scalzare l'angiopneumografia dal ruolo di Gold Standard ed occupare una posizione cantrale negli algoritmi diagnostici

  7. Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH diagnostic accuracy study.

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    James M Mason

    Full Text Available BACKGROUND: The performance of biomarkers for heart failure (HF in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD and HF with preserved ejection fraction (HFpEF. METHODS: This is the first diagnostic accuracy study in this population to assess the differential diagnostic performance and acceptability of a range of biomarkers against a clinical diagnosis using portable echocardiography. A total of 405 residents, aged 65-100 years (mean 84.2, in 33 UK long-term care facilities were enrolled between April 2009 and June 2010. RESULTS: For undifferentiated HF, BNP or NT-proBNP were adequate rule-out tests but would miss one in three cases (BNP: sensitivity 67%, NPV 86%, cut-off 115 pg/ml; NT-proBNP: sensitivity 62%, NPV 87%, cut-off 760 pg/ml. Using higher test cut-offs, both biomarkers were more adequate tests of LVSD, but would still miss one in four cases (BNP: sensitivity 76%, NPV 97%, cut-off 145 pg/ml; NT-proBNP: sensitivity 73%, NPV 97%, cut-off 1000 pg/ml. At these thresholds one third of subjects would test positive and require an echocardiogram. Applying a stricter 'rule out' threshold (sensitivity 90%, only one in 10 cases would be missed, but two thirds of subjects would require further investigation. Biomarkers were less useful for HFpEF (BNP: sensitivity 63%, specificity 61%, cut-off 110 pg/ml; NT-proBNP: sensitivity 68%, specificity 56%, cut-off 477 pg/ml. Novel biomarkers (Copeptin, MR-proADM, and MR-proANP and common signs and symptoms had little diagnostic utility. CONCLUSIONS: No test, individually or in combination, adequately balanced case finding and rule-out for heart failure in this population; currently, in-situ echocardiography provides the only adequate diagnostic assessment. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN19781227.

  8. Comparison of the conventional diagnostic modalities, bactec culture and polymerase chain reaction test for diagnosis of tuberculosis

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    Negi S

    2005-01-01

    Full Text Available PURPOSE: To evaluate the performance of 65 kDa antigen based PCR assay in clinical samples obtained from pulmonary and extrapulmonary cases of tuberculosis. METHODS: One hundred and fifty six samples were processed for detection of Mycobacterium tuberculosis by ZN smear examination, LJ medium culture, BACTEC radiometric culture and PCR tests. RESULTS: A significant difference was seen in the sensitivities of different tests, the figures being 74.4% for PCR test, 33.79% for ZN smear examination, 48.9% for LJ culture and 55.8% for BACTEC culture (P0.05 as far as specificity of different tests was concerned. PCR test sensitivity in pulmonary and extrapulmonary clinical samples were 72.7% and 75.9% respectively and found to be significantly higher (PM.tuberculosis was 24.03 days by LJ medium culture, 12.89 days by BACTEC culture and less than one day by PCR test. CONCLUSIONS: PCR is a rapid and sensitive method for the early diagnosis of pulmonary and extrapulmonary tuberculosis.

  9. Bronchial wall measurements in patients after lung transplantation: evaluation of the diagnostic value for the diagnosis of bronchiolitis obliterans syndrome.

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    Sabine Dettmer

    Full Text Available OBJECTIVES: To prospectively evaluate quantitative airway wall measurements of thin-section CT for the diagnosis of Bronchiolitis Obliterans Syndrome (BOS following lung transplantation. MATERIALS AND METHODS: In 141 CT examinations, bronchial wall thickness (WT, the wall area percentage (WA% calculated as the ratio of the bronchial wall area and the total area (sum of bronchial wall area and bronchial lumen area and the difference of the WT on inspiration and expiration (WTdiff were automatically measured in different bronchial generations. The measurements were correlated with the lung function parameters. WT and WA% in CT examinations of patients with (n = 25 and without (n = 116 BOS, were compared using the unpaired t-test and univariate analysis of variance, while also considering the differing lung volumes. RESULTS: Measurements could be performed in 2,978 bronchial generations. WT, WA%, and WTdiff did not correlate with the lung function parameters (r<0.5. The WA% on inspiration was significantly greater in patients with BOS than in patients without BOS, even when considering the dependency of the lung volume on the measurements. WT on inspiration and expiration and WA% on expiration did not show significant differences between the groups. CONCLUSION: WA% on inspiration was significantly greater in patients with than in those without BOS. However, WA% measurements were significantly dependent on lung volume and showed a high variability, thus not allowing the sole use of bronchial wall measurements to differentiate patients with from those without BOS.

  10. Comparative Evaluation of Diagnostic Value of Prenatal USG and MRI in the Diagnosis of Fetal Central Nervous System Defects

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    I. Herman-Sucharska

    2011-05-01

    Full Text Available Background/Objective: The purpose of the study was"nto compare the diagnostic values of prenatal ultrasound"nand MRI in fetal central nervous system defects."nPatients and Methods: Three-hundred eighty-five"nMRIs were performed in pregnant women with the"nultrasound suspicion of fetal defect. US was conducted"nwith the Voluson-Kretz730PRO. In 158 cases (41%"nfetal CNS defect was found. MR was performed with the"n1.5T system, torso surface coil, SSFSET2 sequence. MR"nresults were compared with prenatal US and verified"nafter the delivery by physical tests, US, TK and surgery"nor in cases of infant death with a pathomorphological"nexamination."nResults: Of 158 infants, eight died after delivery, 93 were"nconsulted in the neurosurgical clinic, 19 underwent a"nneurosurgery treatment and the remaining seven infants'"nfate is unknown. Fetal MRI widened the pertinent US"ndiagnoses in 62%. The 100% compliance is pertained"nto hydrocephalus and anencephaly. US results failed"nin some cases of corpus callosum agenesis, aqueductal"nstenosis, intracranial cyst, holoprosencephaly,"nschizencephaly, Dandy-Walker complex, syringomyelia,"ndiplomyelia and myelomeningocele. In 15 cases, MRI"ncompletely changed the prognosis and treatment"n(holoprosencephaly, myelomeningocoele, diplomyelia,"nintracranial cyst, lung hypoplasia, urinary bladder"nagenesis-not detected during prenatal US. Postnatal"nexaminations and surgery confirmed the results of"nprenatal MRI."nConclusion: MRI compared with prenatal US proved"nbetter effectiveness in imaging of fetal CNS defects,"nespecially in the imaging of the posterior fossa structures,"nthe ventricular system, the corpus callosum, the"nevaluation of meningocoele contents and the complex"nmalformations of the central nervous system.

  11. Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found.

    Science.gov (United States)

    Suda, Arnold J; Tinelli, Marco; Beisemann, Nils D; Weil, Yoram; Khoury, Amal; Bischel, Oliver E

    2017-07-01

    Diagnosing periprosthetic infection remains a challenge. Multiplex-PCR and biomarkers such as alpha-defensin are potentially useful and fast methods for detecting periprosthetic infection. This study compared these new methods with clinical assessment, conventional microbiological methods and histo-pathological examination. Twenty-eight consecutive patients with 30 joints and a mean age of 67.7 years (range 39 to 88) with removal of total hip arthroplasty (THA) or total knee replacement (TKR) were included in this study. Patients were classified according to the modified Musculoskeletal Infection Society score (MSIS) for infected joints. Punction fluid and tissue specimens were taken for conventional microbiological examination, alphadefensin test was performed, a synovial membrane specimen was used for multiplex-PCR and histopathological examination was carried out. The alpha-defensin test and multiplex-PCR showed a sensitivity of 76.9 vs. 30.8% and a specificity of 82.4 vs. 100%, respectively. We found a significant difference between the positive and negative results (p = 0.0023). The conventional microbiological methods were not significantly different from the alpha-defensin test (p = 0.244) with a sensitivity of 84.6% and a specificity of 100% but did differ significantly from the multiplex PCR (p = 0.0030). There was a significant difference between modified MSIS classification and multiplex PCR (p = 0.0007). Neither alpha-defensin test nor multiplex-PCR could detect periprosthetic infection immediately and reliably. Multiplex-PCR was suitable for detecting the non-infected but not the truly infected. Alpha-defensin test was helpful but showed no satisfactory results. Conventional microbiological methods remain the most reliable for periprosthetic infection diagnosis.

  12. Comparison of the in vivo autologous skin test with in vitro diagnostic tests for diagnosis of chronic autoimmune urticaria.

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    Altrich, Michelle L; Halsey, John F; Altman, Leonard C

    2009-01-01

    Previous studies indicate that 30-50% of chronic urticaria patients have an autoimmune etiology. Clinical diagnosis of autoimmune urticaria is supported with the autologous serum skin test. The purpose of this study was to compare two laboratory tests for measurement of IgG autoantibodies to IgE or IgE receptors and compare the results with the autologous serum and plasma skin tests. We performed skin tests and two functional in vitro tests, basophil histamine release, and CD63 up-regulation to detect autoantibodies relevant to autoimmune urticaria. Both sera and citrated plasma were evaluated in the autologous skin test and histamine release assay. Thyroid autoantibodies were also measured. Basophils were incubated with patient plasma, sera, buffer, or anti-IgE. The cells were analyzed for CD63 expression and the supernatants were recovered for histamine analysis. There was high correlation between CD63 up-regulation and histamine release assays, but histamine release was more sensitive. There was a high concordance between sera and citrated plasma for the skin test. Sera from chronic urticaria patients produced higher mean histamine release (23%) compared with citrated plasma (12%). Thirty-one percent of patients positive in the histamine release assay were also positive for thyroid autoantibodies. This compares with 12% who were negative in the histamine release assay. These data show that in vitro basophil histamine release can be used to measure antibodies to FceRI, FceRII/CD23, or IgE and identify patients with autoimmune urticaria.

  13. Early diagnosis of neuropathy in leprosy--comparing diagnostic tests in a large prospective study (the INFIR cohort study.

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    Wim H van Brakel

    Full Text Available BACKGROUND: Leprosy is the most frequent treatable neuromuscular disease. Yet, every year, thousands of patients develop permanent peripheral nerve damage as a result of leprosy. Since early detection and treatment of neuropathy in leprosy has strong preventive potential, we conducted a cohort study to determine which test detects this neuropathy earliest. METHODS AND FINDINGS: One hundred and eighty-eight multibacillary (MB leprosy patients were selected from a cohort of 303 and followed for 2 years after diagnosis. Nerve function was evaluated at each visit using nerve conduction (NC, quantitative thermal sensory testing and vibrometry, dynamometry, monofilament testing (MFT, and voluntary muscle testing (VMT. Study outcomes were sensory and motor impairment detected by MFT or VMT. Seventy-four of 188 patients (39% had a reaction, neuritis, or new nerve function impairment (NFI event during a 2-year follow-up. Sub-clinical neuropathy was extensive (20%-50%, even in patients who did not develop an outcome event. Sensory nerve action potential (SNAP amplitudes, compound motor action potential (CMAP velocities, and warm detection thresholds (WDT were most frequently affected, with SNAP impairment frequencies ranging from 30% (median to 69% (sural. Velocity was impaired in up to 43% of motor nerves. WDTs were more frequently affected than cold detection thresholds (29% versus 13%, ulnar nerve. Impairment of SNC and warm perception often preceded deterioration in MF or VMT scores by 12 weeks or more. CONCLUSIONS: A large proportion of leprosy patients have subclinical neuropathy that was not evident when only MFT and VMT were used. SNC was the most frequently and earliest affected test, closely followed by WDT. They are promising tests for improving early detection of neuropathy, as they often became abnormal 12 weeks or more before an abnormal monofilament test. Changes in MFT and VMT score mirrored changes in neurophysiology, confirming their

  14. Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations.

    Science.gov (United States)

    Poninska, J K; Bilinska, Z T; Franaszczyk, M; Michalak, E; Rydzanicz, M; Szpakowski, E; Pollak, A; Milanowska, B; Truszkowska, G; Chmielewski, P; Sioma, A; Janaszek-Sitkowska, H; Klisiewicz, A; Michalowska, I; Makowiecka-Ciesla, M; Kolsut, P; Stawinski, P; Foss-Nieradko, B; Szperl, M; Grzybowski, J; Hoffman, P; Januszewicz, A; Kusmierczyk, M; Ploski, R

    2016-05-04

    Thoracic aortic aneurysms and dissections (TAAD) are silent but possibly lethal condition with up to 40 % of cases being hereditary. Genetic background is heterogeneous. Recently next-generation sequencing enabled efficient and cost-effective examination of gene panels. Aim of the study was to define the diagnostic yield of NGS in the 51 TAAD patients and to look for genotype-phenotype correlations within families of the patients with TAAD. 51 unrelated TAAD patients were examined by either whole exome sequencing or TruSight One sequencing panel. We analyzed rare variants in 10 established thoracic aortic aneurysms-associated genes. Whenever possible, we looked for co-segregation in the families. Kaplan-Meier survival curve was constructed to compare the event-free survival depending on genotype. Aortic events were defined as acute aortic dissection or first planned aortic surgery. In 21 TAAD patients we found 22 rare variants, 6 (27.3 %) of these were previously reported, and 16 (73.7 %) were novel. Based on segregation data, functional analysis and software estimations we assumed that three of novel variants were causative, nine likely causative. Remaining four were classified as of unknown significance (2) and likely benign (2). In all, 9 (17.6 %) of 51 probands had a positive result when considering variants classified as causative only and 18 (35.3 %) if likely causative were also included. Genotype-positive probands (n = 18) showed shorter mean event free survival (41 years, CI 35-46) than reference group, i.e. those (n = 29) without any plausible variant identified (51 years, CI 45-57, p = 0.0083). This effect was also found when the 'genotype-positive' group was restricted to probands with 'likely causative' variants (p = 0.0092) which further supports pathogenicity of these variants. The mean event free survival was particularly low (37 years, CI 27-47) among the probands with defects in the TGF beta signaling (p = 0.0033 vs. the

  15. The engineer, sustainable development craftsman at the center of the global energy challenge!; L'ingenieur, artisan du developpement durable au centre du defi energetique mondial!

    Energy Technology Data Exchange (ETDEWEB)

    Laplatte, Benjamin; Bourque, Francis; Granger, Francois P.; Dery, Gaston; Berube, Martin

    2010-09-15

    By its omnipresence in society, the energy question is at the heart of sustainable development issues. The engineer, as a central actor of human society development, is therefore tightly linked to the energy issue and he must actively contribute to resolve it by integrating to his practices the principles of sustainable development and by applying the solutions that arises. Part of these elements include as the main ones, listening to the consideration of citizens, becoming aware of the environment importance and reducing costs at all levels. The engineer is a social actor that cannot be ignored in the resolution of these issues. [French] Par son omnipresence dans la societe, la question energetique est au coeur des enjeux du developpement durable. L'ingenieur, etant un acteur central du developpement des societes humaines, est donc inextricablement lie a la question energetique qu'il doit contribuer activement a resoudre en integrant a sa pratique les principes du developpement durable et en appliquant les solutions qui en decoulent. Parmi ces elements, l'ecoute des considerations citoyennes, la prise de conscience de l'importance de l'environnement et la reduction des couts a tous les niveaux sont des elements centraux. L'ingenieur est un acteur social incontournable pour la resolution de ces enjeux.

  16. Evaluation of three parasite lactate dehydrogenase-based rapid diagnostic tests for the diagnosis of falciparum and vivax malaria

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    Leimanis Mara

    2009-10-01

    Full Text Available Abstract Background In areas where non-falciparum malaria is common rapid diagnostic tests (RDTs capable of distinguishing malaria species reliably are needed. Such tests are often based on the detection of parasite lactate dehydrogenase (pLDH. Methods In Dawei, southern Myanmar, three pLDH based RDTs (CareStart™ Malaria pLDH (Pan, CareStart™ Malaria pLDH (Pan, Pf and OptiMAL-IT®were evaluated in patients presenting with clinically suspected malaria. Each RDT was read independently by two readers. A subset of patients with microscopically confirmed malaria had their RDTs repeated on days 2, 7 and then weekly until negative. At the end of the study, samples of study batches were sent for heat stability testing. Results Between August and November 2007, 1004 patients aged between 1 and 93 years were enrolled in the study. Slide microscopy (the reference standard diagnosed 213 Plasmodium vivax (Pv monoinfections, 98 Plasmodium falciparum (Pf mono-infections and no malaria in 650 cases. The sensitivities (sens and specificities (spec, of the RDTs for the detection of malaria were- CareStart Malaria™ pLDH (Pan test: sens 89.1% [CI95 84.2-92.6], spec 97.6% [CI95 96.5-98.4] OptiMal-IT®: Pf+/- other species detection: sens 95.2% [CI95 87.5-98.2], spec 94.7% [CI95 93.3-95.8]; non-Pf detection alone: sens 89.6% [CI95 83.6-93.6], spec 96.5% [CI95 94.8-97.7] CareStart Malaria™ pLDH (Pan, Pf: Pf+/- other species: sens 93.5% [CI9585.4-97.3], spec 97.4% [95.9-98.3]; non-Pf: sens 78.5% [CI9571.1-84.4], spec 97.8% [CI95 96.3-98.7] Inter-observer agreement was excellent for all tests (kappa > 0.9. The median time for the RDTs to become negative was two days for the CareStart™ Malaria tests and seven days for OptiMAL-IT®. Tests were heat stable up to 90 days except for OptiMAL-IT® (Pf specific pLDH stable to day 20 at 35°C. Conclusion None of the pLDH-based RDTs evaluated was able to detect non-falciparum malaria with high sensitivity, particularly

  17. Assessing the reliability of microscopy and rapid diagnostic tests in malaria diagnosis in areas with varying parasite density among older children and adult patients in Nigeria

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    E E Ayogu

    2016-01-01

    Full Text Available Background: Current malaria control strategies are based on early diagnosis and appropriate treatment of malaria cases. The study aimed at comparing the performance of blood film microscopy and rapid diagnostic test (RDT in Plasmodium falciparum detection in patients ≥6 years of age. Materials and Methods: A total of 154 consecutive pyretic patients aged 6-62 years were enrolled, sampled, and tested for malaria using RDT (first response and microscopy by Giemsa staining. Genomic DNA was extracted after saponin hemolysis and nested polymerase chain reaction (PCR was used to detect Plasmodium falciparum. The endpoints were sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV. Results: Of the 154 patients, 80 (51.9% had fever of ≥37.5°C. 106 (68.8% were positive by First response® , 132 (85.7% by microscopy, and 121 (78.6% by PCR. The sensitivity, specificity, PPV, and NPV of first response compared to microscopic method were 82.2%, 100.0%, 100.0%, and 34.3%, respectively, while it was 75.4%, 75.0%, 95.3%, and 31.2%, respectively, when compared to PCR. The sensitivity, specificity, PPV, and NPV of the microscopic method compared to PCR were 92.3%, 50.0%, 90.91%, and 54.5%, respectively. There was a significant difference in the performance of RDT and film microscopy methods (P ≤ 0.05. Conclusion: Microscopy performed better and is more reliable than first response (RDT in areas with low parasite density among patients ≥6 years of age. Rapid diagnostic tests could be useful in aareas with high parasite density as an alternative to smear microscopy

  18. Chlamydophila felis CF0218 is a novel TMH family protein with potential as a diagnostic antigen for diagnosis of C. felis infection.

    Science.gov (United States)

    Ohya, Kenji; Takahara, Yu; Kuroda, Etsuko; Koyasu, Saori; Hagiwara, Shigeyuki; Sakamoto, Maki; Hisaka, Mitsuaki; Morizane, Kazuko; Ishiguro, Shinryou; Yamaguchi, Tsuyoshi; Fukushi, Hideto

    2008-10-01

    Chlamydophila felis is a causative agent of acute and chronic conjunctivitis and pneumonia in cats (feline chlamydiosis). Also, C. felis is a suspected zoonotic agent of such diseases as non-Chlamydia trachomatis conjunctivitis in humans, although this is controversial. At present, there is no serodiagnostic system that specifically detects C. felis infection conveniently. Current systems use antigens such as lipopolysaccharide that cross-react with all chlamydia species. In addition, it is difficult to distinguish between cats that are vaccinated with the commercial vaccine against C. felis and cats that are infected with C. felis. Here, we describe a new candidate diagnostic antigen for diagnosis of C. felis infection, CF0218, that was obtained by screening a genomic expression library of C. felis Fe/C-56 with C. felis-immunized serum. CF0218 was a putative transmembrane head (TMH) family protein with bilobed hydrophobic motifs at its N terminus, and orthologues of CF0218 were not found in the Chlamydophila pneumoniae or Chlamydia trachomatis genomes. The recombinant CF0218 was not recognized by antiserum against C. trachomatis, suggesting that CF0218 is C. felis specific. CF0218 transcription during the course of C. felis infection was confirmed by reverse transcription-PCR. By indirect immunofluorescence analysis, CF0218 was colocalized with the C. felis-formed inclusion bodies in the infected cells. The antibody response against CF0218 was elevated following C. felis infection but not by vaccination in experimentally vaccinated and infected cats. These results suggest that CF0218, a novel TMH family protein of C. felis, possesses potential as a C. felis infection-specific diagnostic antigen.

  19. Decline in the Use of Surgical Biopsy for Diagnosis of Pulmonary Disease in Hematopoietic Cell Transplantation Recipients in an Era of Improved Diagnostics and Empirical Therapy.

    Science.gov (United States)

    Cheng, Guang-Shing; Stednick, Zach J; Madtes, David K; Boeckh, Michael; McDonald, George B; Pergam, Steven A

    2016-12-01

    Historically, diagnosis of enigmatic pulmonary disease after hematopoietic cell transplantation (HCT) required lung biopsy, but recent advancements in diagnosis and therapy for respiratory infections have changed how clinicians approach pulmonary abnormalities. We examined temporal trends in the use of lung biopsy after HCT. We retrospectively reviewed patients who underwent their first allogeneic HCT at the Fred Hutchinson Cancer Research Center between the years 1993 to 1997, 2003 to 2007, and 2013 to 2015 and subsequently underwent surgical lung biopsy for any reason. Lung biopsy between cohorts were analyzed using a Cox proportional hazards model with death and relapse considered competing risks. Of 1418 patients, 52 (3.7%) underwent 54 post-HCT surgical lung biopsies during 1993 to 1997 compared with 24 (2.1%) and 25 biopsies in the 2003 to 2007 cohort; 2 cases of surgical lung biopsies out of 786 HCT recipients occurred during the 2013 to 2015 cohort (.25%). The median time to biopsy post-HCT was 71.5 days (IQR, 31 to 89) for the early cohort and 97 days (IQR, 42 to 124) for the late cohort, for an overall biopsy incidence of .15 and .075 per 1000 patient days in the first year after HCT, respectively. Patients in the 2003 to 2007 cohort were less likely to undergo a lung biopsy (adjusted HR, .50; 95% CI, .29 to .83; P = .008) when compared with patients in the early cohort, but more patients in the early cohort underwent lung biopsy without antecedent bronchoscopy (25/54 [46%] versus 3/25 [12%], P = .005). Although infections were a more common finding at biopsy in the early cohort (35/1418 versus 8/1148, P disease in the 2 cohorts (8/54 [15%] versus 4/25 [16%]). Surgical evaluation of lung disease in HCT recipients significantly declined over a span of 2 decades. The decline from the years 1993 to 1997 compared with 2003 to 2007 was because of a reduction in the number of biopsies for post-transplant infections due to aspergillosis, which is

  20. Quebec energy development in a sustainable development context; Le developpement energetique du Quebec dans un contexte de developpement durable

    Energy Technology Data Exchange (ETDEWEB)

    Laplatte, Benjamin; Bourque, Francis; Granger, Francois P.

    2010-09-15

    Quebec is a net importer of oil and it is clear that the reduction of its dependence with regards to hydrocarbons must be a main preoccupation. Moreover, the energy consumption per habitant of Quebec is higher than that of the majority of the other developed countries. This analysis looks at the choice on offer to the society of the province of Quebec, in terms of energy resources and technologies of today and tomorrow, in a context of sustainable development. [French] Le Quebec est un importateur net de petrole et il est clair que la reduction de sa dependance a l'egard des hydrocarbures doit etre une preoccupation de premier plan. De plus, la consommation energetique par habitant du Quebec est plus elevee que celle de la majorite des autres pays developpes. La presente analyse adresse les choix qui s'offrent a la societe quebecoise, en matiere de ressources et de technologies de l'energie d'aujourd'hui et de demain, dans un contexte de developpement durable.

  1. Amelioration de l'efficacite energetique du procede d'electrolyse de l'aluminium conception d'un nouveau bloc cathodique

    Science.gov (United States)

    Blais, Mathieu

    Au Quebec, les alumineries sont de grandes consommatrices d'energie electrique, soit pres de 14 % de la puissance installee d'Hydro-Quebec. Dans ce contexte, des petits gains en efficacite energetique des cuves d'electrolyse pourraient avoir un impact important sur la reduction globale de la consommation d'electricite. Le projet de maitrise decrit dans cette etude repond a la problematique suivante : comment l'optimisation de la geometrie d'un bloc cathodique en vue d'uniformiser la densite de courant peut augmenter l'efficacite energetique et la duree de vie de la cuve d'aluminium? Le but premier du projet est de modifier la geometrie en vue d'ameliorer le comportement thermoelectrique des blocs cathodiques et d'accroitre par le fait meme l'efficacite energetique du procede de production d'aluminium. La mauvaise distribution de la densite de courant dans la cuve est responsable de certains problemes energetiques ayant des impacts negatifs sur l'economie et l'environnement. Cette non-uniformite de la distribution du courant induit une usure prematuree de la surface de la cathode et contribue a reduire la stabilite magnetohydrodynamique de la nappe de metal liquide. Afin de quantifier les impacts que peut avoir l'uniformisation de la densite de courant a travers le bloc cathodique, un modele d'un bloc cathodique d'une cuve de la technologie AP-30 a ete concu et analyse par elements finis. A partir de son comportement thermoelectrique et de donnees experimentales d'une cuve AP-30 tirees de la litterature, une correlation entre le profil de densite de courant a la surface du bloc et le taux d'erosion local au meme endroit a ete creee. Cette relation correspond au modele predictif de la duree de vie de tout bloc du meme materiau a partir de son profil de densite de courant. Ensuite, une programmation a ete faite incorporant dans une meme fonction cout les impacts economiques de la duree de vie, de la chute de voltage cathodique et de l'utilisation de nouveaux materiaux

  2. CLINICAL AND MORPHOLOGICAL APPROACH TO DIAGNOSIS OF "IDIOPATHIC" ARRHYTHMIAS AND DILATED CARDIOMYOPATHY SYNDROME AS A BASIS FOR DIFFERENTIATED THERAPY. Part I (Diagnostics

    Directory of Open Access Journals (Sweden)

    O. V. Blagova

    2014-01-01

    Full Text Available PAim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA and the syndrome of dilated cardiomyopathy (DCM.Material and methods. Patients (n=320 with IA (n=190; 117 women, age 45.3±14.8 years and DCM (n=130, 41 women, age 46.9±12.5 years were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM, viral serology (166 and 122, multispiral computed tomography (42 and 88, cardiac magnetic resonance imaging (41 and 22, coronary angiography (19 and 54, myocardial biopsy/autopsy (19/0 and 33/9 were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% of IA and 66.7% of DCM-patients, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency  of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower, while in the main group a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patients.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach.

  3. CLINICAL AND MORPHOLOGICAL APPROACH TO DIAGNOSIS OF "IDIOPATHIC" ARRHYTHMIAS AND DILATED CARDIOMYOPATHY SYNDROME AS A BASIS FOR DIFFERENTIATED THERAPY. Part I (Diagnostics

    Directory of Open Access Journals (Sweden)

    O. V. Blagova

    2015-09-01

    Full Text Available PAim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA and the syndrome of dilated cardiomyopathy (DCM.Material and methods. Patients (n=320 with IA (n=190; 117 women, age 45.3±14.8 years and DCM (n=130, 41 women, age 46.9±12.5 years were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM, viral serology (166 and 122, multispiral computed tomography (42 and 88, cardiac magnetic resonance imaging (41 and 22, coronary angiography (19 and 54, myocardial biopsy/autopsy (19/0 and 33/9 were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% of IA and 66.7% of DCM-patients, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency  of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower, while in the main group a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patients.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach.

  4. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness.

    Science.gov (United States)

    Hay, Alastair D; Birnie, Kate; Busby, John; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Durbaba, Stevo; Fletcher, Margaret; Harman, Kim; Hollingworth, William; Hood, Kerenza; Howe, Robin; Lawton, Michael; Lisles, Catherine; Little, Paul; MacGowan, Alasdair; O'Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Sterne, Jonathan Ac; Thomas-Jones, Emma; van der Voort, Judith; Waldron, Cherry-Ann; Whiting, Penny; Wootton, Mandy; Butler, Christopher C

    2016-01-01

    BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old

  5. Nursing diagnosis

    OpenAIRE

    Ščavničar, Ema

    2015-01-01

    Nursing diagnosis is an integral part of nursing process approach. There are many definitions, which have one common theme: it's a stth status of a client.A nursing diagnostic statement has two or three parts. The article includes section on making of nursing diagnosis and a section on classification. Negovalna diagnoza je sestavni del v procesnem pristopu zdravstvene nege. Predstavljene so definicije, katere temeljijo na varovančevem stanju zdravja. Negovalna diagnoza ima dva ali tri dele...

  6. Les reseaux de politique publique comme facteur d'influence du choix des instruments de politique energetique canadienne a des fins environnementales de 1993 a nos jours

    Science.gov (United States)

    Fathy El Dessouky, Naglaa

    Au cours de la derniere decennie, les modes de la gouvernance ont pris place dans un contexte totalement different de celui qu'ils avaient auparavant. Les gouvernements modernes se rendent compte qu'ils perdent de plus en plus leur capacite a elaborer et a gerer les changements d'une maniere autonome. Ainsi, les fonctions et les activites traditionnellement accomplies exclusivement par le gouvernement engagent de nos jours une gamme d'acteurs etatiques et non etatiques. A l'encontre du concept traditionnel de l'Etat controleur, la gouvernance contemporaine est ainsi devenue moins une question d'offre de service et davantage une gestion indirecte des reseaux de politique publique. Dans cette entreprise, les gouvernements contemporains, cherchant plus d'information, de soutien et de legitimite en matiere de formulation des decisions, ont besoin d'etablir des relations avec les divers groupes d'interet qui, a leur tour, voulaient plus de promotion et de protection en faveur de leurs interets a travers leur implication au processus de l'elaboration et de la mise en oeuvre des politiques publiques. Ainsi, l'approche des reseaux de politique publique represente aujourd'hui un courant considerable au sein du champ d'analyse des politiques publiques. Toutefois, les preoccupations des chercheurs pour cette approche, dans le domaine des politiques energetiques a des fins environnementales, semblent recentes, et les etudes realisees sont encore trop peu nombreuses. Au Canada, au debut des annees 1990, le gouvernement ainsi que plusieurs groupes d'interets, des differents secteurs energetique, industriel et environnemental, ont commence a intensifier leurs efforts pour s'attaquer au probleme du changement climatique d'origine energetique, genere surtout par le secteur de l'industrie. Au cours de la derniere decennie, la question touchant plutot le sujet du developpement energetique durable represente le plus important domaine des politiques publiques ayant surgi recemment dans

  7. DSM-5, ICD-10, ICD-11, the Psychodynamic Diagnostic Manual, and Person-Centered Integrative Diagnosis: An Overview for College Mental Health Therapists

    Science.gov (United States)

    Cooper, Stewart E.

    2014-01-01

    Therapists in the field of college mental health counseling commonly voice an ambivalent orientation towards the utilization of formal psychological diagnostic systems yet often use diagnostic terms. Knowledge of the current and emerging diagnostic systems may contribute to greater syntheses of these differing approaches. This article will first…

  8. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica : a diagnostic systematic review

    NARCIS (Netherlands)

    van Rijn, Rogier M.; Wassenaar, Merel; Verhagen, Arianne P.; Ostelo, Raymond W. J. G.; Ginai, Abida Z.; de Boer, Michiel R.; van Tulder, Maurits W.; Koes, Bart W.

    2012-01-01

    In low back pain if serious pathology is suspected diagnostic imaging could be performed. One of the imaging techniques available for this purpose is computed tomography (CT), however, insight in the diagnostic performance of CT is unclear. Diagnostic systematic review. Studies assessing the diagnos

  9. DSM-5, ICD-10, ICD-11, the Psychodynamic Diagnostic Manual, and Person-Centered Integrative Diagnosis: An Overview for College Mental Health Therapists

    Science.gov (United States)

    Cooper, Stewart E.

    2014-01-01

    Therapists in the field of college mental health counseling commonly voice an ambivalent orientation towards the utilization of formal psychological diagnostic systems yet often use diagnostic terms. Knowledge of the current and emerging diagnostic systems may contribute to greater syntheses of these differing approaches. This article will first…

  10. A Comparative Evaluation of Different Diagnostic Modalities in the Diagnosis of Typhoid Fever Using a Composite Reference Standard: A Tertiary Hospital Based Study in Central India.

    Science.gov (United States)

    Maheshwari, Veena; Kaore, Navinchandra Motiram; Ramnani, Vijay Kumar; Sarda, Sheil

    2016-10-01

    Enteric fever, caused by Salmonella spp. is a major cause of morbidity and mortality worldwide and endemic in many developing countries including India and other South-East Asian countries. Blood culture is regarded as the gold standard for diagnosis. Currently, the standard serological method is tube agglutination with moderate sensitivity and specificity. Dot blot assay detecting IgM and IgG antibodies to a specific 50kD Outer Membrane Protein (OMP) antigen of Salmonella spp. is a simple, reliable, affordable and rapid test which can help in the early diagnosis of typhoid fever. To systematically evaluate the different diagnostic modalities against a composite reference standard for the better diagnosis of typhoid fever in clinically suspected cases of typhoid fever. This cross-sectional, prospective analytical study was carried out at a tertiary care hospital attached to Medical College in central India from November 2011 to June 2013. A total of 163 blood samples, collected aseptically from patients clinically diagnosed of enteric fever, were tested using various component tests like blood culture, Tube Widal and Dot Enzyme Immuno Assay (Dot EIA) for IgG and/or IgM. Composite Reference Standard (CRS) was created for defining the confirmed cases of typhoid fever using the component tests, wherein culture positive and in absence of culture positivity any two component test positive patients were taken as confirmed cases. All the component tests were evaluated against the CRS for sensitivity, specificity, PPV and NPV and their significance in relation to the duration of illness using statistical tests of significance. Blood culture was positive in 16 (9.81%) whereas, Tube Widal, IgM, IgG and IgM+IgG in combination were positive in 88(54%), 58(35.58%), 30 (18.40%) and 75 (46.01%) respectively. Using a two test criteria of CRS framed, a total of 104 patients were considered as confirmed cases. Though specificity of blood culture was 100%, the sensitivity was low

  11. Thyroid diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.

    1985-03-01

    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

  12. Willingness to pay for rapid diagnostic tests for the diagnosis and treatment of malaria in southeast Nigeria: ex post and ex ante

    Directory of Open Access Journals (Sweden)

    Uguru Nkoli P

    2010-01-01

    Full Text Available Abstract Background The introduction of rapid diagnostic tests (RDTs has improved the diagnosis and treatment of malaria. However, any successful control of malaria will depend on socio-economic factors that influence its management in the community. Willingness to pay (WTP is important because consumer responses to prices will influence utilization of services and revenues collected. Also the consumer's attitude can influence monetary valuation with respect to different conditions ex post and ex ante. Methods WTP for RDT for Malaria was assessed by the contingent valuation method using a bidding game approach in rural and urban communities in southeast Nigeria. The ex post WTP was assessed at the health centers on 618 patients immediately following diagnosis of malaria with RDT and the ex ante WTP was assessed by household interviews on 1020 householders with a prior history of malaria. Results For the ex ante WTP, 51% of the respondents in urban and 24.7% in rural areas were willing to pay for RDT. The mean WTP (235.49 naira in urban is higher than WTP (182.05 Naira in rural areas. For the ex post WTP, 89 and 90.7% of the respondents in urban and rural areas respectively were WTP. The mean WTP (372.30 naira in urban is also higher than (296.28 naira in rural areas. For the ex post scenario, the lower two Social Economic Status (SES quartiles were more willing to pay and the mean WTP is higher than the higher two SES while in the ex ante scenario, the higher two SES quartiles were more WTP and with a higher WTP than the lower two SES quartile. Ex ante and ex post WTP were directly dependent on costs. Conclusion The ex post WTP is higher than the ex ante WTP and both are greater than the current cost of RDTs. Urban dwellers were more willing to pay than the rural dwellers. The mean WTP should be considered when designing suitable financial strategies for making RDTs available to communities.

  13. [Diagnostic performance of T-SPOT.TB on peripheral blood in combination with adenosine deaminase on pleural fluid for the diagnosis of tuberculous pleurisy within different age group].

    Science.gov (United States)

    Xu, H Y; Zhang, D Q; Ye, J R; Su, S S; Xie, Y P; Chen, C S; Li, Y P

    2017-06-27

    Objective: To evaluate the performance of T cell enzyme-linked immuno-spot assay (T-SPOT) on peripheral blood in combination with adenosine deaminase (ADA) on pleural fluid for diagnosis of tuberculous (TB) pleurisy within different age groups. Methods: The data of patients with pleural effusion from the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from April 2012 to November 2016 were retrospectively analyzed, and the diagnoses of these patients were histopathologically confirmed through medical thoracoscopy. The cases who had confirmed diagnosis, in the same time, received peripheral blood T-SPOT.TB were enrolled. The performance of peripheral blood T-SPOT.TB in combination with pleural fluid ADA on diagnosing TB pleurisy in the younger patients (16-59 years old) and elderly patients (≥60 years old) were analyzed respectively. The sensitivity, specificity and the receiver operating characteristic (ROC) curve were adopted for statistical analysis. Results: A total of 448 cases were finally enrolled, 341(76.1%) confirmed with TB pleurisy, 224 males, 117 females, (47±19) years old; and 107 (23.9%) classified as non-TB pleurisy, 65 males, 42 females, (61±14) years old. There were 285 cases who were classified as younger group, and the other 163 cases were classified as elderly group. The sensitivity and specificity of peripheral blood T-SPOT.TB were 85.4% (204/239) and 71.7% (33/46) in the younger patients, 76.5% (78/102) and 59.0% (36/61) respectively in the elderly patients. The sensitivity of peripheral blood T-SPOT.TB in the younger patients was significantly higher than that in the elderly patients (P=0.047). The sensitivity and specificity were 99.2% and 95.7% in combination with peripheral blood T-SPOT.TB and pleural fluid ADA respectively in the younger patients. The area under ROC curve (AUC) of T-SPOT.TB in the younger patients was 0.833, AUC of T-SPOT.TB combined with ADA was 0

  14. Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: Diagnostic cohort study

    Science.gov (United States)

    Birnie, Kate; Hay, Alastair D.; Wootton, Mandy; Howe, Robin; MacGowan, Alasdair; Whiting, Penny; Lawton, Michael; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Hollingworth, William; Lisles, Catherine; Little, Paul; O’Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Thomas-Jones, Emma; Van der Voort, Judith; Waldron, Cherry-Ann; Harman, Kim; Hood, Kerenza; Butler, Christopher C.; Sterne, Jonathan A. C.

    2017-01-01

    Objectives To compare the validity of diagnosis of urinary tract infection (UTI) through urine culture between samples processed in routine health service laboratories and those processed in a research laboratory. Population and methods We conducted a prospective diagnostic cohort study in 4808 acutely ill children aged <5 years attending UK primary health care. UTI, defined as pure/predominant growth ≥105 CFU/mL of a uropathogen (the reference standard), was diagnosed at routine health service laboratories and a central research laboratory by culture of urine samples. We calculated areas under the receiver-operator curve (AUC) for UTI predicted by pre-specified symptoms, signs and dipstick test results (the “index test”), separately according to whether samples were obtained by clean catch or nappy (diaper) pads. Results 251 (5.2%) and 88 (1.8%) children were classified as UTI positive by health service and research laboratories respectively. Agreement between laboratories was moderate (kappa = 0.36; 95% confidence interval [CI] 0.29, 0.43), and better for clean catch (0.54; 0.45, 0.63) than nappy pad samples (0.20; 0.12, 0.28). In clean catch samples, the AUC was lower for health service laboratories (AUC = 0.75; 95% CI 0.69, 0.80) than the research laboratory (0.86; 0.79, 0.92). Values of AUC were lower in nappy pad samples (0.65 [0.61, 0.70] and 0.79 [0.70, 0.88] for health service and research laboratory positivity, respectively) than clean catch samples. Conclusions The agreement of microbiological diagnosis of UTI comparing routine health service laboratories with a research laboratory was moderate for clean catch samples and poor for nappy pad samples and reliability is lower for nappy pad than for clean catch samples. Positive results from the research laboratory appear more likely to reflect real UTIs than those from routine health service laboratories, many of which (particularly from nappy pad samples) could be due to contamination. Health service

  15. Evaluation des retombees economiques des projets energetiques au Quebec : Analyse couts-avantages de la mini-centrale hydroelectrique de Val-Jalbert

    Science.gov (United States)

    Ossoro, Marcel Thierry

    Evaluer les retombees economiques d'un projet, cela consiste a evaluer le benefice du projet du point de vue de la collectivite. C'est le processus d'analyse, de mesure et d'appreciation de l'impact du projet, sur l'economie locale, regionale ou nationale. Il permet de prendre une decision optimale sur la faisabilite de l'investissement compte tenu de ses incidences sur l'ensemble des agents economiques. L'incoherence des approches et outils dans l'evaluation peut biaiser le calcul de l'impact net du projet, et par consequent, biaiser les termes de la hierarchisation des priorites en matiere d'investissement. Dans le cas des projets sensibles, necessitant de lourds investissements et beaucoup mediatises, comme cela est le cas des projets energetiques ; le biais peut s'averer desastreux et aboutir a une situation chaotique. La presente recherche porte sur l'evaluation des retombees economiques des projets energetiques au Quebec ; la pertinence et la coherence des outils et methodes d'evaluation. Elle est edifiee par une etude de cas. L'etude porte sur l'evaluation du projet de la mini-centrale hydroelectrique de Val Jalbert par la methode de l'analyse couts-avantages. Nous utilisons la methode des prix de reference selon l'approche de l'ONUDI. L'etude revele que le projet de la mini-centrale hydroelectrique de Val Jalbert repond positivement aux deux objectifs : l'efficience---maximisation de la consommation, et l'equite sociale---maximisation de la justice sociale. Il est donc considere, du point de vue de l'ONUDI, comme etant economiquement (ou socialement) rentable. L'analyse couts-avantages est un puissant evaluateur d'impact. Elle evalue le projet en l'integrant dans un cadre coherent d'analyses economiques, qui repose non seulement sur des valeurs nationales mais egalement, qui prend en compte les couts et avantages directs, indirects, internes et externes ; ce qui fait de l'outil, l'evaluateur le plus complet. A travers l'etude, nous montrons comment l

  16. Evaluation of a novel assay for detection of the fetal marker RASSF1A: facilitating improved diagnostic reliability of noninvasive prenatal diagnosis.

    Directory of Open Access Journals (Sweden)

    Helen E White

    Full Text Available BACKGROUND: Analysis of cell free fetal (cff DNA in maternal plasma is used routinely for non invasive prenatal diagnosis (NIPD of fetal sex determination, fetal rhesus D status and some single gene disorders. True positive results rely on detection of the fetal target being analysed. No amplification of the target may be interpreted either as a true negative result or a false negative result due to the absence or very low levels of cffDNA. The hypermethylated RASSF1A promoter has been reported as a universal fetal marker to confirm the presence of cffDNA. Using methylation-sensitive restriction enzymes hypomethylated maternal sequences are digested leaving hypermethylated fetal sequences detectable. Complete digestion of maternal sequences is required to eliminate false positive results. METHODS: cfDNA was extracted from maternal plasma (n = 90 and digested with methylation-sensitive and insensitive restriction enzymes. Analysis of RASSF1A, SRY and DYS14 was performed by real-time PCR. RESULTS: Hypermethylated RASSF1A was amplified for 79 samples (88% indicating the presence of cffDNA. SRY real time PCR results and fetal sex at delivery were 100% accurate. Eleven samples (12% had no detectable hypermethylated RASSF1A and 10 of these (91% had gestational ages less than 7 weeks 2 days. Six of these samples were male at delivery, five had inconclusive results for SRY analysis and one sample had no amplifiable SRY. CONCLUSION: Use of this assay for the detection of hypermethylated RASSF1A as a universal fetal marker has the potential to improve the diagnostic reliability of NIPD for fetal sex determination and single gene disorders.

  17. Accuracy of erythrogram and serum ferritin for the maternal anemia diagnosis (AMA): a phase 3 diagnostic study on prediction of the therapeutic responsiveness to oral iron in pregnancy.

    Science.gov (United States)

    Bresani, Cristiane Campello; Braga, Maria Cynthia; Felisberto, Daniel Falcão; Tavares-de-Melo, Carlos Eduardo Lopes; Salvi, Debora Bresani; Batista-Filho, Malaquias

    2013-01-16

    Pregnancy anemia remains as a public health problem, since the official reports in the 70's. To guide the treatment of iron-deficiency anemia in pregnancy, the haemoglobin concentration is the most used test in spite of its low accuracy, and serum ferritin is the most reliable test, although its cutoff point remains an issue. The aim of this protocol is to verify the accuracy of erythrocyte indices and serum ferritin (studied tests) for the diagnosis of functional iron-deficiency in pregnancy using the iron-therapy responsiveness as the gold-standard. This is an ongoing phase III accuracy study initiated in August 2011 and to be concluded in April 2013. The subjects are anemic pregnant women (haemoglobin concentration iron during 90 days and will be analyzed as a delayed-type cross-sectional study. Women at the second trimester of pregnancy are being evaluated with clinical and laboratorial examinations at the enrollment and monthly. The 'responsiveness to therapeutic test with oral iron' (gold-standard) was defined to an increase of at least 0.55 Z-score in haemoglobin after 4 weeks of treatment and a total dose of 1200 mg of iron. At the study conclusion, sensitivities, specificities, predictive values, likelihood ratios and areas under the ROC (Receiver Operating Characteristic) curves of serum ferritin and erythrocyte indices (red blood cell count, haematocrit, haemoglobin concentration, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell distribution width, reticulocyte count) will be tested. The compliance and adverse effects are considered confounding variables, since they are the main obstacles for the iron-therapy responsiveness. This study protocol shows a new approach on iron-deficiency anemia in pregnancy from a functional point of view that could bring some insights about the diagnostic misclassifications arising from the dynamic physiologic changes during the gestational cycle. WHO

  18. Diagnostic value of cystatin C for diagnosis of early renal damages in type 2 diabetic mellitus patients: The first experience in Iran

    Directory of Open Access Journals (Sweden)

    Mitra Javanmardi

    2015-01-01

    Full Text Available Background: Diabetic nephropathy (DN is one of the most important complications of diabetes mellitus. Now-a-days, cystatin C (CysC is introduced as a new marker for diagnosis of renal damages; however, use of this marker in clinical laboratories is still controversial. The present study was aimed to evaluate the diagnostic value of serum CysC for early detection or monitoring treatment of kidney damages in the Kurdish people with type 2 diabetes mellitus. Materials and Methods: Glomerular filtration rate (GFR was estimated by Modification of Diet in Renal Disease formula. Serum CysC and urine microalbumin were also measured in 126 diabetic and healthy subjects. Blood glycated hemoglobin (Hb also measured in all healthy and diabetic patients. Two independent samples t-test, Mann-Whitney U-test, one-way ANOVA, and Kruskal-Wallis test, as well as Pearson/Spearman correlation coefficient statistical tests were used as appropriate. Results: Serum CysC was higher (1312.41 ng/ml in diabetic patients with GFR <60 ml/min than other subjects (993.25 ng/ml (patients with normal kidney function and healthy subjects. A borderline significant correlation between CysC and estimating GFR (rs = −0.16, P = 0.05 but highly significant with microalbumin (rs = 0.22, P = 0.014 was observed. Serum CysC sensitivity, negative and positive predictive values were 100 and 4%. Conclusion: CysC cover variation of GFR and urine microalbumin, but it cannot be used as a surrogating marker of glycated Hb. According to our results, it seems that serum CysC is a useful marker for screening of DN; but it cannot be used for monitoring of treatment in diabetic patients.

  19. Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis.

    Science.gov (United States)

    Hammar, Samuel P; Abraham, Jerrold L

    2015-10-01

    We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers.

  20. The group study of diagnostic efficacy of cerebro-vascular disease by I-123 IMP SPECT images obtained with ring type SPECT scanner; The ROC analysis on the diagnosis of perfusion defect and redistribution

    Energy Technology Data Exchange (ETDEWEB)

    Machida, Kikuo; Honda, Norinari (Saitama Medical School, Kawagoe (Japan). Saitama Medical Center); Matsumoto, Toru (and others)

    1991-11-01

    We performed two image reading experiments in order to investigate the diagnostic capability of I-123 IMP SPECT obtained by the ring type SPECT scanner in cerebro-vascular disease. Fourteen physicians diagnosed SPECT images of 55 cases with reference to clinical neurological information, first without brain XCT images and second with XCT images. Each physician detected perfusion defects and redistributions of I-123 IMP and assigned a confidence level of abnormality for these SPECT findings by means of five rating method. From results obtained by ROC analysis, we concluded as follows. (1) Generally, I-123 IMP SPECT is a stable diagnostic modality in the diagnosis of cerebro-vascular disease and the image reading of XCT had no effects on the diagnosis of SPECT on the whole of physician. (2) However, there were unnegligible differences among individuals in the detectability of findings and the effect of XCT image reading. (3) Detectability of redistribution of I-123 IMP was lower than that of perfusion defect and inter-observer variation in the diagnostic performance for redistribution was larger than that of perfusion defect. The results suggest that it is necessary to standardize diagnostic criteria among physicians for redistribution of I-123 IMP. (author).

  1. Core-needle biopsy under CT fluoroscopy guidance and fine-needle aspiration cytology: Comparison of diagnostic yield in the diagnosis of lung and mediastinum tumors. Analysis of frequency and types of complications.

    Science.gov (United States)

    Szlęzak, Przemysław; Srutek, Ewa; Gorycki, Tomasz; Kowalewski, Janusz; Studniarek, Michał

    2014-01-01

    Patients with pathological tissue mass in thoracic cage found with imaging require histopathological or cytological confirmation of malignancy before treatment. The tissue material essential for patomorphological evaluation can be acquired with fine-needle aspiration biopsies (FNAB) controlled with CT and core-needle biopsy (CNB) under real-time CT fluoroscopy guidance. The purpose of this work is to carry out a retrospective analysis of the two methods with regards to their informativity, frequency and the kind of complications. From January, 2012 to May 2013, 76 core-needle biopsies of lung and mediastinum tumors were conducted and compared with 86 fine-needle aspiration biopsies(FNAB) of lung and mediastinum tumors, including 30 patients who underwent FNAB and were referred to CNB in order to specify the diagnosis. Complete histopathological diagnosis was made in 91% with the use of CNB and in 37% when FNAB was the chosen method. Early complications were observed in 32% patients who underwent BG and in group of 11% who underwent FNAB. Late complications, however, appeared in 29% patients after CNB and 13% after FNAB. In 24 cases CNB specified the complete diagnosis. Core-needle biopsy in comparison to fine-needle aspiration biopsy has more frequent rate of negligible complications, however, it offers higher diagnostic yield for diagnostic of lung and mediastinum neoplastic disease and allows for more precise diagnosis of focal lesions.

  2. The diagnostic value of PET/CT imaging with the {sup 68}Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Afshar-Oromieh, Ali; Giesel, Frederik L.; Kratochwil, Clemens; Haberkorn, Uwe [University Hospital of Heidelberg, Department of Nuclear Medicine, Heidelberg (Germany); Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Centre, Heidelberg (Germany); Avtzi, Eleni [University Hospital of Heidelberg, Department of Nuclear Medicine, Heidelberg (Germany); Holland-Letz, Tim [German Cancer Research Center, Department of Biostatistics, Heidelberg (Germany); Linhart, Heinz G. [German Cancer Research Centre, Heidelberg, National Centre for Tumor Diseases (NCT), Heidelberg (Germany); Eder, Matthias; Eisenhut, Michael; Kopka, Klaus [German Cancer Research Center, Division of Radiopharmaceutical Chemistry, Heidelberg (Germany); Boxler, Silvan; Hadaschik, Boris A. [University Hospital of Heidelberg, Department of Urology, Heidelberg (Germany); Weichert, Wilko [University Hospital of Heidelberg, Department of Pathology, Heidelberg (Germany); Debus, Juergen [University Hospital Heidelberg, Department of Radiation Oncology and Therapy, Heidelberg (Germany)

    2014-11-20

    Since the introduction of positron emission tomography (PET) imaging with {sup 68}Ga-PSMA-HBED-CC (={sup 68}Ga-DKFZ-PSMA-11), this method has been regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). However, published data exist for small patient cohorts only. The aim of this evaluation was to analyse the diagnostic value of {sup 68}Ga-PSMA-ligand PET/CT in a large cohort and the influence of several possibly interacting variables. We performed a retrospective analysis in 319 patients who underwent {sup 68}Ga-PSMA-ligand PET/CT from 2011 to 2014. Potential influences of several factors such as prostate-specific antigen (PSA) level and doubling time (DT), Gleason score (GSC), androgen deprivation therapy (ADT), age and amount of injected tracer were evaluated. Histological verification was performed in 42 patients after the {sup 68}Ga-PSMA-ligand PET/CT. Tracer uptake was measured in 901 representative tumour lesions. In 82.8 % of the patients at least one lesion indicative of PCa was detected. Tumor-detection was positively associated with PSA level and ADT. GSC and PSA-DT were not associated with tumor-detection. The average maximum standardized uptake value (SUV{sub max}) of tumour lesions was 13.3 ± 14.6 (0.7-122.5). Amongst lesions investigated by histology, 30 were false-negative in 4 different patients, and all other lesions (n = 416) were true-positive or true-negative. A lesion-based analysis of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) revealed values of 76.6 %, 100 %, 91.4 % and 100 %. A patient-based analysis revealed a sensitivity of 88.1 %. Of 116 patients available for follow-up, 50 received local therapy after {sup 68}Ga-PSMA-ligand PET/CT. {sup 68}Ga-PSMA-ligand PET/CT can detect recurrent PCa in a high number of patients. In addition, the radiotracer is highly specific for PCa. Tumour detection is positively associated with PSA and ADT. {sup 68}Ga

  3. [Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and the role of (18)F-FDG PET-CT: a proposal of diagnostic algorithm].

    Science.gov (United States)

    Becerra Nakayo, E M; García Vicente, A M; Soriano Castrejón, A M; Mendoza Narváez, J A; Talavera Rubio, M P; Poblete García, V M; Cordero García, J M

    2012-01-01

    To analyze the costs of Fever of Unknown Origin (FUO) prior to the PET-CT study. To determine the effectiveness of PET-CT in the diagnosis of FUO. A proposal of diagnostic algorithm. A retrospective study was performed that included 20 patients who had been studied between January 2007 and January 2011, with a mean age of 57.75 years and FUO diagnosis. All underwent a PET-CT study with (18)F-FDG. Individual and mean costs of FUO in these patients were assessed, including hospitalization days and complementary tests prior to the PET-CT study. The effectiveness of the PET-CT study in the diagnosis of FUO was analyzed. Costs of the FUO process were determined, including those of the PET-CT study, and if it had been done earlier in the diagnostic process. Mean hospital stay per patient until the PET-CT study was 28 days. The cost per hospitalization day was 342 €. Average cost per patient in complementary tests was 1395 €. Total cost of the FUO process until the PET-CT study was around 11167 € per patient. The PET-CT study showed a 78% sensitivity, 83% specificity, 92% PPV and 62% NPV. If PET-CT had been performed earlier in the FUO process, assuming the same effectiveness, 5471 € per patient would have been saved. The PET-CT study could be cost-effective in the FUO process if used at an early stage, helping to establish an early diagnosis, reducing hospitalization days due to diagnostic purposes and the repetition of unnecessary tests. Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.

  4. Contribution of the SPECT in the etiologic diagnosis of dementia; Apport de la tomographie par emission monophotonique dans le diagnostic etiologique des demences

    Energy Technology Data Exchange (ETDEWEB)

    Rollain-Sillaire, A.; Bombois, S.; Deramecourt, V.; Pasquier, F. [EA 2691, centre memoire de ressources et de recherche, CHU de Lille, (France); Steinert-Emptaz, A.; Morvan, J.; Steinling, M. [EA 1049, imagerie fonctionnelle cerebrale, universite Lille-II, CHU de Lille, (France); Maurage, C.A. [pole de neuropathologie, CHU de Lille, (France)

    2009-05-15

    The aim of this study is to test the contribution of the SPECT of perfusion with hexamethyl propylene amine oxime (H.M.P.A.O.) in the etiologic diagnosis of dementia by comparing the clinical data, tomography and pathology ones at the heart of a patients cohort followed in a center of resources memory and research. The SPECT increases the specificity of the etiologic diagnosis of degenerative dementia. The diagnosis concordance of the clinical and the SPECT corresponds in the most of cases to the certainty diagnosis. (N.C.)

  5. Diagnostic thoracoscopy

    Directory of Open Access Journals (Sweden)

    Plavec Goran

    2002-01-01

    Full Text Available Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic diagnosis was confirmed histopathologically in 31 patient (81.12%. In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%. Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%. Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%. In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

  6. Diagnostic imaging of the breast. Examination techniques, appearances, differential diagnosis and interventiones. 3. compl. rev. ed.; Bildgebende Mammadiagnostik. Untersuchungstechnik, Befundmuster, Differenzialdiagnose und Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Heywang-Koebrunner, Sylvia H. [Referenzzentrum Mammographie, Muenchen (Germany).; Schreer, Ingrid [Radiologische Allianz, Hamburg (Germany).

    2015-07-01

    The book on diagnostic imaging of the breast covers the following topics: Part I: Techniques: anamnesis and dialogue, clinical indications, mammography, sonography, nuclear magnetic resonance imaging, new imaging techniques, image clarification and percutaneous breast biopsy, preoperative marking. Part II: Appearance: the normal mamma, benign mamma modifications, cysts, benign tumors, inflammatory diseases, lesions with uncertain biological potential (B3 lesions), in-situ carcinoma, invasive carcinoma. Lymph nodes, other semi-malign and malign tumors, post-traumatic, post-operative and post-therapeutic changes, imaging diagnostics for breast implants, skin changes, the male breast. Part III: Use of imaging breast diagnostics: continuative diagnostics of screening indications and problem solution for the symptomatic patient.

  7. Improving T-cell assays for the diagnosis of latent TB infection: potential of a diagnostic test based on IP-10

    DEFF Research Database (Denmark)

    Ruhwald, Morten; Petersen, Janne; Kofoed, Kristian

    2008-01-01

    BACKGROUND: There is a need for simple tools such as the M.tuberculosis specific IFN-gamma release assays (IGRA) to improve diagnosis of M.tuberculosis-infection in children. The aim of the study was to evaluate the performance of an IP-10 and IL-2 based tests for the diagnosis of M.tuberculosis-...

  8. From diagnosis to social diagnosis.

    Science.gov (United States)

    Brown, Phil; Lyson, Mercedes; Jenkins, Tania

    2011-09-01

    In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of 'social diagnosis' which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.

  9. Elementwise Business Diagnosis of Enterprise Activity

    Directory of Open Access Journals (Sweden)

    Skrynkovskyy Ruslan M.

    2016-02-01

    Full Text Available The article presents methodological and indicator apparatus for elementwise business diagnosis of enterprise activity directed at achieving such elementwise diagnostic objectives: diagnosis of return on assets; diagnosis of return on equity capital; diagnosis of production profitability; diagnosis of gross profit margin of product sales; diagnosis of operating margin of product sales; diagnosis of net margin of product sales; diagnosis of absolute liquidity; diagnosis of instant liquidity; diagnosis of overall liquidity; diagnosis of coverage; diagnosis of financial independence; diagnosis of equity capital maneuverability; diagnosis of financial leverage; diagnosis of the long-term investment structure; diagnosis of accounts payable turnover; diagnosis of the accounts payable repayment period, diagnosis of receivables turnover; diagnosis of receivables repayment period; diagnosis of assets turnover; diagnosis of inventories turnover; diagnosis of the inventories turnover period; diagnosis of equity capital turnover; diagnosis of fixed assets turnover (return on assets; diagnosis of capital coefficient; diagnosis of the ratio of output value to the materials cost; diagnosis of material consumption; diagnosis of the total production cost; diagnosis of enterprise market share; diagnosis of fixed assets wear; diagnosis of fixed assets renewal; diagnosis of fixed assets retirement; performance diagnosis; diagnosis of labor intensity, diagnosis of the capital-labour ratio; diagnosis of efficiency; diagnosis of conducting the business; diagnosis of business relations; diagnosis of administrative-legal relations; diagnosis of knowledge management. The elementwise diagnostic objectives of the enterprise system of diagnostic objectives are aimed at a narrow highly detailed diagnostics of individual indicators of the enterprise activity, i.e. the evaluation of specific analytical indicators,monitoring (research of their dynamics, comparison of the planned

  10. Comparison of Hysteroscopy and Traditional Diagnostic Curettage Applied in the Diagnosis of Abnormal Uterine Bleeding%比较宫腔镜与传统诊刮术在子宫异常出血中诊断的应用

    Institute of Scientific and Technical Information of China (English)

    钱月芳

    2014-01-01

    目的:比较宫腔镜与传统诊刮术在子宫异常出血中诊断的应用。方法选取该院2012年1月_2014年3月期间收治的54例子宫异常出血患者,所有患者均经诊断性刮宫术,并行宫腔镜治疗。比较两种诊断与术后病理诊断结果的符合率。结果54例子宫异常出血患者经病理学诊断,32例为子宫内膜息肉,20例为子宫粘膜下肌瘤;与病理学诊断比较,宫腔镜检查符合率﹙90.6%﹚明显高于诊断性刮宫术﹙68.8%﹚﹙P<0.05﹚;子宫粘膜下肌瘤宫腔镜检查符合率﹙85.0%﹚明显高于诊断性刮宫术﹙65.0%﹚,两组数据比较差异有统计学意义﹙P<0.05﹚。结论宫腔镜下检查与治疗术在子宫内膜息肉和子宫粘膜下肌瘤引起的子宫异常出血的诊断中有明显的优势,值得临床推广。%Objective To compare the value of hysteroscopy and traditional diagnostic curettage applied to the diagnosis of abnor_mal uterine bleeding. Methods 54 cases with abnormal uterine bleeding admitted in our hospital from January 2012 to March 2014 were selected. All the patients underwent the diagnostic curettage and treated by hysteroscopy. And the diagnostic result of these two methods was compared with that of postoperative pathologic diagnosis; the diagnostic accordance rate was compared be_tween the two methods. Results Of the 54 patients with abnormal uterine bleeding, 32 cases were diagnosed with endometrial polyp and 20 cases with submucosal myoma of uterus by pathology. Compared with the pathological diagnosis, the diagnostic ac_cordance rate of hysteroscopy(90.6%) was much higher than that of diagnostic curettage(68.8%)(P<0.05); the diagnostic accordance rate of hysteroscopy for submucosal myoma of uterus(85.0%) was obviously higher than that of the diagnostic curettage(65.0%), the difference between the data of the two groups was statistically significant(P<0.05). Conclusion The examination and treatment un_der hysteroscope for the

  11. Towards a precise test for malaria diagnosis in the Brazilian Amazon: comparison among field microscopy, a rapid diagnostic test, nested PCR, and a computational expert system based on artificial neural networks

    Directory of Open Access Journals (Sweden)

    Fukutani Kiyoshi F

    2010-05-01

    Full Text Available Abstract Background Accurate malaria diagnosis is mandatory for the treatment and management of severe cases. Moreover, individuals with asymptomatic malaria are not usually screened by health care facilities, which further complicates disease control efforts. The present study compared the performances of a malaria rapid diagnosis test (RDT, the thick blood smear method and nested PCR for the diagnosis of symptomatic malaria in the Brazilian Amazon. In addition, an innovative computational approach was tested for the diagnosis of asymptomatic malaria. Methods The study was divided in two parts. For the first part, passive case detection was performed in 311 individuals with malaria-related symptoms from a recently urbanized community in the Brazilian Amazon. A cross-sectional investigation compared the diagnostic performance of the RDT Optimal-IT, nested PCR and light microscopy. The second part of the study involved active case detection of asymptomatic malaria in 380 individuals from riverine communities in Rondônia, Brazil. The performances of microscopy, nested PCR and an expert computational system based on artificial neural networks (MalDANN using epidemiological data were compared. Results Nested PCR was shown to be the gold standard for diagnosis of both symptomatic and asymptomatic malaria because it detected the major number of cases and presented the maximum specificity. Surprisingly, the RDT was superior to microscopy in the diagnosis of cases with low parasitaemia. Nevertheless, RDT could not discriminate the Plasmodium species in 12 cases of mixed infections (Plasmodium vivax + Plasmodium falciparum. Moreover, the microscopy presented low performance in the detection of asymptomatic cases (61.25% of correct diagnoses. The MalDANN system using epidemiological data was worse that the light microscopy (56% of correct diagnoses. However, when information regarding plasma levels of interleukin-10 and interferon-gamma were inputted

  12. The Diagnostic Value of Flow Cytometry Imunophenotyping in an Albanian Patient Population with a Preliminary Clinical Diagnosis of Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Valentina Semanaj

    2014-03-01

    Conclusion: Flow cytometry immunophenotyping is a fundamental examination for the final diagnosis of chronic lymphocytic leukemia. The expression of CD38+ in CLL patients stands for a more advanced clinical stage.

  13. An Investigation of Adherence to Diagnostic Criteria, Revisited: Clinical Diagnosis of the DSM-IV/DSM-5 Section II Personality Disorders.

    Science.gov (United States)

    Morey, Leslie C; Benson, Kathryn T

    2016-02-01

    In an initial investigation by Morey and Ochoa (1989), adherence to DSM-III personality disorder diagnostic criteria was examined as an agreement rate between clinician (global) diagnoses and diagnoses algorithmically generated from DSM-III criteria rules. Morey and Ochoa (1989) findings suggested significant clinician-criterion diagnostic incongruity, a result that cross-validated in a DSM-III-R replication performed by Blashfield and Herkov (1996). The current study examined such adherence, utilizing DSM-IV decision rules, in a national sample of 337 clinicians and their target patients. The results of the current study are largely consistent with the earlier findings, with clinician-criterion agreement rates comparable to those commonly reported for interdiagnostician reliability. Ramifications for the future of personality disorder diagnostic classification are discussed.

  14. Molecular diagnostic technique in the diagnosis of cardiovascular disease:application and challenge%分子诊断技术在心血管疾病诊疗中的应用与挑战

    Institute of Scientific and Technical Information of China (English)

    黄山; 张春阳

    2015-01-01

    Application ofmolecular diagnostic technique has shown greatpotential and technical advantages in the diagnosis and treatment of cardiovascular disease ( CVD ) .It can be used toscreening , diagnosis , treatment and prognostic evaluation of CVD disease .Early screening helps to notice the risk of the disease, make us take appropriate measures to reduce the health care costs and improve outcomes .To achieve the highest diagnostic efficiency by applying different molecular diagnostic strategies in different diseases.In term of treatment, molecular diagnostic technologies are mainly used in the drug discovery , personalized drug therapy and treatment options; In addition, prognostic assessment of CVD is also an important development direction of molecular diagnostic technique .However, there are severe challenges remained in applying molecular diagnostic techniques in CVD disease , such as the basic andclinicalapplication research and the quality control , etc.%分子诊断技术在心血管疾病诊疗上的应用,已经显示了巨大的潜力和技术优势,可用于心血管疾病的筛查、诊断、治疗和预后评价。筛查有助于预告疾病风险、提早采取相应措施降低医疗成本和改善预后;对不同的疾病采用不同的分子诊断策略,可以达到最佳的诊断效能;分子诊断技术在治疗方面主要应用于新药研发、个性化药物治疗和治疗方案选择;对心血管疾病进行预后评估也是分子诊断技术的重要发展方向。分子诊断技术在心血管疾病的基础和临床应用研究、质量管理等方面,也存在着严峻的挑战。(中华检验医学杂志,2015,38:433-435)

  15. The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study

    Directory of Open Access Journals (Sweden)

    Krishnamoorthy ES

    2008-06-01

    Full Text Available Abstract Background The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba. Methods The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study. Results The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia. Conclusion The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.

  16. The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study

    Science.gov (United States)

    Prince, Martin J; de Rodriguez, Juan Llibre; Noriega, L; Lopez, A; Acosta, Daisy; Albanese, Emiliano; Arizaga, Raul; Copeland, John RM; Dewey, Michael; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Jacob, KS; Krishnamoorthy, ES; McKeigue, Paul; Sousa, Renata; Stewart, Robert J; Salas, Aquiles; Sosa, Ana Luisa; Uwakwa, Richard

    2008-01-01

    Background The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba. Methods The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study). Results The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia. Conclusion The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder. PMID:18577205

  17. Three-phase bone scintigraphy for diagnosis of Charcot neuropathic osteoarthropathy in the diabetic foot - does quantitative data improve diagnostic value?

    DEFF Research Database (Denmark)

    Fosbol, M.; Reving, S.; Petersen, E. H.

    2017-01-01

    Aim To investigate whether inclusion of quantitative data on blood flow distribu-tion compared with visual qualitative evaluation improve the reliability and diag-nostic performance of99 mTc-hydroxymethylene diphosphate three-phase bonescintigraphy (TPBS) in patients su spected for charcot neuropa...

  18. How can students' diagnostic competence benefit most from practice with clinical cases? the effects of structured reflection on future diagnosis of the same and novel diseases

    NARCIS (Netherlands)

    Mamede, Sílvia; Van Gog, Tamara; Sampaio, Alexandre Moura; De Faria, Rosa Malena Delbone; Maria, José Peixoto; Schmidt, Henk G.

    2014-01-01

    PURPOSE: To develop diagnostic competence, students should practice with many examples of clinical problems to build rich mental representations of diseases. How to enhance learning from practice remains unknown. This study investigated the effects of reflection on cases compared with generating a

  19. sA Comparison of DSM-IV-TR and DSM-5 Diagnostic Classifications in the Clinical Diagnosis of Autistic Spectrum Disorder

    Science.gov (United States)

    Yaylaci, Ferhat; Miral, Suha

    2017-01-01

    Aim of this study was to compare children diagnosed with Pervasive Developmental Disorder (PDD) according to DSM-IV-TR and DSM-5 diagnostic systems. One hundred fifty children aged between 3 and 15 years diagnosed with PDD by DSM-IV-TR were included. PDD symptoms were reviewed through psychiatric assessment based on DSM-IV-TR and DSM-5 criteria.…

  20. How can students' diagnostic competence benefit most from practice with clinical cases? the effects of structured reflection on future diagnosis of the same and novel diseases

    NARCIS (Netherlands)

    Mamede, Sílvia; Van Gog, Tamara; Sampaio, Alexandre Moura; De Faria, Rosa Malena Delbone; Maria, José Peixoto; Schmidt, Henk G.

    2014-01-01

    PURPOSE: To develop diagnostic competence, students should practice with many examples of clinical problems to build rich mental representations of diseases. How to enhance learning from practice remains unknown. This study investigated the effects of reflection on cases compared with generating a s

  1. Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): The Polish version of a dual-axis system for the diagnosis of TMD.* RDC/TMD form

    NARCIS (Netherlands)

    Osiewicz, M.A.; Lobbezoo, F.; Loster, B.W.; Wilkosz, M.; Naeije, M.; Ohrbach, R.

    2013-01-01

    Aim of the study. To describe steps taken to conduct a formal forward translation/back-translation from English to Polish, and to establish the cultural equivalence of the Polish version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). This will be preceded by a brief h

  2. sA Comparison of DSM-IV-TR and DSM-5 Diagnostic Classifications in the Clinical Diagnosis of Autistic Spectrum Disorder

    Science.gov (United States)

    Yaylaci, Ferhat; Miral, Suha

    2017-01-01

    Aim of this study was to compare children diagnosed with Pervasive Developmental Disorder (PDD) according to DSM-IV-TR and DSM-5 diagnostic systems. One hundred fifty children aged between 3 and 15 years diagnosed with PDD by DSM-IV-TR were included. PDD symptoms were reviewed through psychiatric assessment based on DSM-IV-TR and DSM-5 criteria.…

  3. Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection

    Directory of Open Access Journals (Sweden)

    Perka Carsten

    2008-07-01

    Full Text Available Abstract Background The correct diagnosis of a prosthetic joint infection (PJI is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective study was performed to evaluate a variety of pre- and intraoperative investigations. Furthermore a detailed evaluation of concordance of each preoperative diagnosis was performed, together with a final diagnosis to assess the accuracy of the pre-operative assumption of PJI. Methods Between 01/2005 and 02/2007, a prospective analysis was performed in 50 patients, who had a two stage revision because of assumed PJI. Based on clinical presentation, radiography, haematological screening, or early failure, infection was assumed and a joint aspiration was performed. Depending upon these findings, a two stage revision was performed, with intra-operative samples for culture and histological evaluation obtained. Final diagnosis of infection was based upon the interpretation of the clinical presentation and the pre- and intraoperative findings. Results In 37 patients a positive diagnosis of PJI could be made definitely. The histopathology yielded the highest accuracy (0.94 in identification of PJI and identified 35 of 37 infections (sensitivity 0.94, specificity 0.94, positive-/negative predictive value 0.97/0.86. Intra-operative cultures revealed sensitivities, specificities, positive-/negative predictive values and accuracy of 0.78, 0.92, 0.96, 0.63 and 0.82. These values for blood screening tests were 0.95, 0.62, 0.88, 0.80, and 0.86 respectively for the level of C-reactive protein, and 0.14, 0.92, 0.83, 0.29 and, 0.34 respectively for the white blood-cell count. The results of aspiration were 0.57, 0.5, 0.78, 0.29, and 0.54. Conclusion The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI

  4. Elementwise Business Diagnosis of Enterprise Activity

    OpenAIRE

    Skrynkovskyy Ruslan M.

    2016-01-01

    The article presents methodological and indicator apparatus for elementwise business diagnosis of enterprise activity directed at achieving such elementwise diagnostic objectives: diagnosis of return on assets; diagnosis of return on equity capital; diagnosis of production profitability; diagnosis of gross profit margin of product sales; diagnosis of operating margin of product sales; diagnosis of net margin of product sales; diagnosis of absolute liquidity; diagnosis of ins...

  5. 弓形虫病免疫诊断用重组抗原及检测方法研究进展%Research progress on recombinant antigen and diagnostic technique for immunological diagnosis of toxoplasmosis

    Institute of Scientific and Technical Information of China (English)

    杨永刚; 曹利民; 朱荫昌

    2010-01-01

    Toxoplasma is a kind of parasitic protozoa that can infect all warm blooded animals including humans and cause toxoplasmosis manifesting various symptoms. Diagnosis for toxoplasmosis include etiology,immunology, and molecular biology methods. Immunological diagnostic methods are common for Toxoplasma infection. This article reviewed research progress on recombinant antigen and diagnostic technique development for immunological diagnosis of toxoplasmosis.%弓形虫是一种寄生原虫,可感染人在内的所有温血动物,并会引发表现为多种症状的弓形虫病.弓形虫病的诊断方法有病原学、免疫学、分子生物学等方法.免疫学诊断是进行弓形虫感染检测的常用方法.该文就弓形虫感染的免疫诊断用重组抗原及检测方法的应用和研究进展作一综述.

  6. Diagnosis of Osteoporosis.

    Science.gov (United States)

    Wahner, H. W.

    1987-01-01

    Early recognition of osteoporosis is difficult because symptoms are lacking and there are no distinct, readily accessible diagnostic features. This article reviews the standard approach, radiographic and laboratory diagnosis, bone mass measurement techniques, and interpretation of bone mineral data. (MT)

  7. Diagnosis of Parasitic Diseases

    Science.gov (United States)

    ... Laboratory Diagnostic Assistance [DPDx] Parasites Home Diagnosis of Parasitic Diseases Recommend on Facebook Tweet Share Compartir On this ... the United States cannot diagnose parasites? How are parasitic diseases diagnosed? Many kinds of lab tests are available ...

  8. A diagnostic approach to test priorization

    NARCIS (Netherlands)

    Gonzalez-Sanchez, A.; Abreu, R.; Gross, H.; Van Gemund, A.

    2010-01-01

    In development processes with high code production rates testing typically triggers fault diagnosis to localize the detected failures. However, current test prioritization algorithms are tuned for failure detection rate rather than diagnostic information. Consequently, unnecessary diagnostic effort

  9. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications.

    NARCIS (Netherlands)

    Meij, van der E.H.; Waal, van der I.

    2003-01-01

    INTRODUCTION: Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation

  10. Specific diagnosis of neural crest tumours by MIBG scintigraphy; Diagnostic specifique des tumeurs issues de la crete neurale par la scintigraphie a la MIBG

    Energy Technology Data Exchange (ETDEWEB)

    Hoefnagel, C.A. [Het Nederlands Kanker Instituut, Amsterdam (Netherlands)

    1995-12-31

    MIBG scintigraphy has been used since 1981 as a diagnostic tool in pheochromocytoma and subsequently in a wide variety of neural crest tumors. The authors give the criteria for the choice between {sup 123}I and {sup 123}I-MIBG, remind drug interactions, report sensitivity and specificity values in main indications and discuss the relative merits of MIBG and pentetreotide scintigraphy. (author). 7 refs., 4 figs., 1 tab.

  11. The diagnostic accuracy of two human epididymis protein 4 (HE4) testing systems in combination with CA125 in the differential diagnosis of ovarian masses

    OpenAIRE

    Lenhard, Miriam; Stieber, Petra; Hertlein, Linda; Kirschenhofer, Angela; Fuerst, Sophie; Mayr, Doris; Nagel, Dorothea; Hofmann, Karin; Krocker, Katja; Burges, Alexander

    2011-01-01

    Background: Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. Methods: We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n = 78, leimyoma: n = 66, endometriosis: n = 52, functional ovarian cysts: n = 79, other: n = 10), 16 low malignant potential (LMP) ovarian tum...

  12. Melioidosis Diagnostic Workshop, 20131

    Science.gov (United States)

    AuCoin, David; Baccam, Prasith; Baggett, Henry C.; Baird, Rob; Bhengsri, Saithip; Blaney, David D.; Brett, Paul J.; Brooks, Timothy J.G.; Brown, Katherine A.; Chantratita, Narisara; Cheng, Allen C.; Dance, David A.B.; Decuypere, Saskia; Defenbaugh, Dawn; Gee, Jay E.; Houghton, Raymond; Jorakate, Possawat; Lertmemongkolchai, Ganjana; Limmathurotsakul, Direk; Merlin, Toby L.; Mukhopadhyay, Chiranjay; Norton, Robert; Peacock, Sharon J.; Rolim, Dionne B.; Simpson, Andrew J.; Steinmetz, Ivo; Stoddard, Robyn A.; Stokes, Martha M.; Sue, David; Tuanyok, Apichai; Whistler, Toni; Wuthiekanun, Vanaporn; Walke, Henry T.

    2015-01-01

    Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. PMID:25626057

  13. Fault diagnosis

    Science.gov (United States)

    Abbott, Kathy

    1990-01-01

    The objective of the research in this area of fault management is to develop and implement a decision aiding concept for diagnosing faults, especially faults which are difficult for pilots to identify, and to develop methods for presenting the diagnosis information to the flight crew in a timely and comprehensible manner. The requirements for the diagnosis concept were identified by interviewing pilots, analyzing actual incident and accident cases, and examining psychology literature on how humans perform diagnosis. The diagnosis decision aiding concept developed based on those requirements takes abnormal sensor readings as input, as identified by a fault monitor. Based on these abnormal sensor readings, the diagnosis concept identifies the cause or source of the fault and all components affected by the fault. This concept was implemented for diagnosis of aircraft propulsion and hydraulic subsystems in a computer program called Draphys (Diagnostic Reasoning About Physical Systems). Draphys is unique in two important ways. First, it uses models of both functional and physical relationships in the subsystems. Using both models enables the diagnostic reasoning to identify the fault propagation as the faulted system continues to operate, and to diagnose physical damage. Draphys also reasons about behavior of the faulted system over time, to eliminate possibilities as more information becomes available, and to update the system status as more components are affected by the fault. The crew interface research is examining display issues associated with presenting diagnosis information to the flight crew. One study examined issues for presenting system status information. One lesson learned from that study was that pilots found fault situations to be more complex if they involved multiple subsystems. Another was pilots could identify the faulted systems more quickly if the system status was presented in pictorial or text format. Another study is currently under way to

  14. Diagnostic imaging of venous disease. Pt. I. Methods in the diagnosis of veins and thrombosis; Bildgebende Diagnostik von Erkrankungen der Venen. T. 1. Methoden der Venendiagnostik und Diagnostik der Thrombose

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, K. [Vivantes Humboldt-Klinikum, Institut fuer Radiologie und Interventionelle Therapie, Berlin (Germany); Wildberger, J. [Helios Klinikum Berlin-Buch, Institut fuer Roentgendiagnostik, Berlin (Germany); Haage, P. [Helios Klinikum Wuppertal, Klinik fuer Diagnostische und Interventionelle Radiologie, Wuppertal (Germany); Landwehr, P. [Diakoniekrankenhaus Henriettenstiftung, Klinik fuer Diagnostische und Interventionelle Radiologie, Hannover (Germany)

    2008-10-15

    Diseases of the venous system are common. A variety of diagnostic imaging methods are available. Of these, ultrasound with color-coded duplex sonography is the preferred method in the diagnosis of vein diseases, especially in patients with suspected deep venous thrombosis (DVT) and varicosis. Compression sonography is a very accurate test in the diagnosis of DVT of the lower and upper extremities in symptomatic patients. Still today, phlebography is an important tool in the diagnosis of venous diseases. Computed tomography (CT) plays an important role in disorders of the superior and inferior vena cava and of the iliac vein. Today, the role of MR venography in vein diseases is limited. (orig.) [German] Erkrankungen des Venensystems betreffen grosse Teile der Bevoelkerung. Verschiedene bildgebende Verfahren stehen in der Diagnostik zur Verfuegung. Unter diesen ist die Sonographie, ergaenzt durch die farbkodierte Duplexsonographie, die Methode der Wahl. Dies gilt insbesondere fuer die haeufigsten Venenerkrankungen: die Phlebothrombose und die Varicosis. Die Kompressionssonographie weist bei symptomatischen Patienten eine hohe Sensitivitaet und Spezifitaet in der Diagnostik der Thrombose der tiefen Venen der oberen und unteren Extremitaet auf. Die Phlebographie stellt trotz der Bedeutung der Sonographie auch zum gegenwaertigen Zeitpunkt noch eine wichtige Methode in der Diagnostik von Venenerkrankungen dar. Die Computertomographie wird ueberwiegend fuer die Diagnostik der Koerperstammvenen eingesetzt. Die MR-Phlebographie hat bislang keinen breiten Einsatz in der Routinediagnostik der Venen finden koennen. (orig.)

  15. Neuropsychological diagnostics in Ethiopia - challenges and ...

    African Journals Online (AJOL)

    Neuropsychological diagnostics in Ethiopia - challenges and chances among ... Abstract. Background Neuropsychological tests can provide crucial information regarding the consideration of psychiatric differential diagnosis. ... Article Metrics.

  16. Scintigraphic diagnosis of pulmonary embolism: retrospective and emergency interpretation; Diagnostic scintigraphique d`embolie pulmonaire: comptes rendus d`urgence et interpretations retrospectives

    Energy Technology Data Exchange (ETDEWEB)

    Hadjikostova, H.; Bonnin, F.; Vera, P.; Bok, B.; Jebrak, G.; Seknadji, P. [Hopital Beaujon, 92 - Clichy (France)

    1997-12-31

    A series of 83 consecutive patients referred to LS for suspicion of PE was studied to intercompare several ways of performing and reading LS images. The final diagnosis (truth) was established independently by a separate panel with all available information, including evolution. LS including perfusion (Q) and ventilation (Technegas) (V) views were classified according to PIOPED criteria immediately by the physician on duty; retrospectively by a blinded panel for Q alone and Q+V scans. A positive (19) or negative (61) diagnosis of PE could be achieved in 80 patients, the prevalence of PE being 0.24. Emergency and retrospective interpretations of LS showed an overall good agreement (value of k = 0.4). Interpreting the V+Q scans was more conclusive, the number of `indeterminate probably` cases dropping down from 33 to 21 and airdrop, on a subjective scale, much easier (p < 0.001) than when the Q scan was only available. (authors)

  17. Local energy policies: Planning devices and coaching tools - Example of the French case; Politiques energetiques locales: Dispositifs de planification et outils d'accompagnement - Exemple du cas francais

    Energy Technology Data Exchange (ETDEWEB)

    Chanard, Camille; de Sede-Marceau, Marie-Helene

    2010-09-15

    Collectivities traditionally have multiple responsibilities linked to energy. They act directly on the energy chain (production-distribution-consumption) through their heritage, but also on the tripych space-environment-society, in particular through their planning choices. Hence, all the public policies are concerned by the energy theme. However, collectivities seem to suffer from an information deficit, both on planning devices that can be mobilized and on the territory features. This article proposes to realise an overview tour of the coaching tools that can be used by the French territories collectivities to build efficient energy policies. [French] Les collectivites ont traditionnellement des responsabilites multiples en lien avec l'energie. Elles agissent directement sur la chaine energetique (production-distribution-consommation) a travers leur patrimoine, mais aussi sur le triptyque espace-environnement-societe, en particulier a travers leurs choix d'amenagement. Ainsi, toutes les politiques publiques sont concernees par la thematique ' energie '. Cependant, les collectivites semblent souffrir d'un deficit d'information, tant sur les dispositifs de planification pouvant etre mobilises que sur les caracteristiques du territoire. Cet article propose de realiser un tour d'horizon de l'ensemble des outils d'accompagnements pouvant etre mobilises par les collectivites territoriales francaises pour construire des politiques energetiques efficaces.

  18. The Early Diagnosis of Boys and Girls in Academic Risk Using the Perceptual-Motor Diagnostic System: A Longitudinal Retrospective Study of Evidences of its Effectiveness

    OpenAIRE

    Emmanuel Herrera-González; Gerardo Alonso Araya-Vargas; Harry Fernández-Sagot; María Morera-Castro; Héctor Fonseca-Schmidt

    2015-01-01

    The main objective in this study is to evidence the efficiency of the Peques System as a useful tool to diagnose, at an early stage, possible difficulties which will affect the academic performance. In a 3-year longitudinal study, the Perceptual-Motor Diagnostic System (Peques) was applied to a sample of 149 participants (77 boys and 72 girls), who were beginning preschool education. Peques classified 38 children with a high risk to lose a year at primary school level. After a three-year foll...

  19. A Systematic Review of Bovine Respiratory Disease Diagnosis Focused on Diagnostic Confirmation, Early Detection, and Prediction of Unfavorable Outcomes in Feedlot Cattle.

    Science.gov (United States)

    Wolfger, Barbara; Timsit, Edouard; White, Brad J; Orsel, Karin

    2015-11-01

    A large proportion of newly arrived feedlot cattle are affected with bovine respiratory disease (BRD). Economic losses could be reduced by accurate, early detection. This review evaluates the available literature regarding BRD confirmatory diagnostic tests, early detection methods, and modalities to estimate post-therapeutic prognosis or predict unfavorable or fatal outcomes. Scientific evidence promotes the use of haptoglobin to confirm BRD status. Feeding behavior, infrared thermography, and reticulorumen boluses are promising methods. Retrospective analyses of routinely collected treatment and cohort data can be used to identify cattle at risk of unfavorable outcome. Other methods have been reviewed but require further study.

  20. A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Thabane Lehana

    2004-06-01

    Full Text Available Abstract Background Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. Methods We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. Results Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition: the sensitivities for detection of pheochromocytoma were 96%–100% (95% CI ranged from 82% to 100%, whereas the specificities were 85%–100% (95% CI ranged from 78% to 100%. Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p Conclusion Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.

  1. Malignancy rates and diagnostic performance of the Bosniak classification for the diagnosis of cystic renal lesions in computed tomography - a systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Sevcenco, Sabina; Shariat, Shahrokh F. [Medical University of Vienna, Department of Urology, Vienna (Austria); Spick, Claudio; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, General Hospital Vienna, Vienna (Austria); Heinz, Gertraud [University Hospital of Sankt-Poelten, Department of Radiology, Poelten (Austria); Klingler, Hans C. [Wilhelminenspital, Department of Urology, Vienna (Austria); Rauchenwald, Michael [Donauspital, Department of Urology, Vienna (Austria)

    2017-06-15

    To systematically review the literature on the Bosniak classification system in CT to determine its diagnostic performance to diagnose malignant cystic lesions and the prevalence of malignancy in Bosniak categories. A predefined database search was performed from 1 January 1986 to 18 January 2016. Two independent reviewers extracted data on malignancy rates in Bosniak categories and several covariates using predefined criteria. Study quality was assessed using QUADAS-2. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias. A total of 35 studies, which included 2,578 lesions, were investigated. Data on observer experience, inter-observer variation and technical CT standards were insufficiently reported. The pooled rate of malignancy increased from Bosniak I (3.2 %, 95 % CI 0-6.8, I{sup 2} = 5 %) to Bosniak II (6 %, 95 % CI 2.7-9.3, I{sup 2} = 32 %), IIF (6.7 %, 95 % CI 5-8.4, I{sup 2} = 0 %), III (55.1 %, 95 % CI 45.7-64.5, I{sup 2} = 89 %) and IV (91 %, 95 % CI 87.7-94.2, I{sup 2} = 36). Several study design-related influences on malignancy rates and subsequent diagnostic performance indices were identified. The Bosniak classification is an accurate tool with which to stratify the risk of malignancy in renal cystic lesions. (orig.)

  2. Molecular diagnostics of myeloproliferative neoplasms

    DEFF Research Database (Denmark)

    Langabeer, S. E.; Andrikovics, H.; Asp, J.;

    2015-01-01

    identified. These discoveries have been rapidly incorporated into evolving molecular diagnostic algorithms. Whilst many of these mutations appear to have prognostic implications, establishing MPN diagnosis is of immediate clinical importance with selection, implementation and the continual evaluation...... of the appropriate laboratory methodology to achieve this diagnosis similarly vital. The advantages and limitations of these approaches in identifying and quantitating the common MPN-associated mutations are considered herein with particular regard to their clinical utility. The evolution of molecular diagnostic...

  3. [Cluster headache differential diagnosis].

    Science.gov (United States)

    Guégan-Massardier, Evelyne; Laubier, Cécile

    2015-11-01

    Cluster headache is characterized by disabling stereotyped headache. Early diagnosis allows appropriate treatment, unfortunately diagnostic errors are frequent. The main differential diagnoses are other primary or essential headaches. Migraine, more frequent and whose diagnosis is carried by excess, trigeminal neuralgia or other trigemino-autonomic cephalgia. Vascular or tumoral underlying condition can mimic cluster headache, neck and brain imaging is recommended, ideally MRI.

  4. Build together the problem, obligatory passage for the conception of acceptable energy solutions?; Construire ensemble le probleme, passage oblige pour la conception de solutions energetiques acceptables?

    Energy Technology Data Exchange (ETDEWEB)

    Fortin, Marie-Jose; Le Floch, Sophie

    2010-09-15

    Social acceptance is a condition in performing energy projects. This notion is however complex: just like 'build', it is based on several factors and is changing. We would like to show that its construction requires that some time be spend at a stage often neglected, that of the formulation of the problem. So that the 'awareness' would be aimed not only to the public, but also to the decision makers and promoters, so that everyone has a good knowledge of the concerns of the others, and of their limits. To this end, the 'participation' could take several forms, complementary to the 'public' one generally accepted. [French] L'acceptabilite sociale est une condition de realisation de projets energetiques. Cette notion est toutefois complexe : comme 'construit', elle se fonde sur plusieurs facteurs et est evolutive. Nous voudrions montrer que sa construction exige qu'un temps soit consacre a une etape souvent negligee, celle de la formulation du probleme. Ainsi, la 'sensibilisation' serait destinee non seulement au grand public, mais aussi aux decideurs et promoteurs, afin que tous aient une bonne connaissance des preoccupations des uns et des autres, comme de leurs contraintes. A cette fin, la 'participation' pourrait prendre plusieurs formes, complementaires a celle 'publique' generalement adoptee.

  5. Malaria over-diagnosis in Cameroon: diagnostic accuracy of Fluorescence and Staining Technologies (FAST) Malaria Stain and LED microscopy versus Giemsa and bright field microscopy validated by polymerase chain reaction.

    Science.gov (United States)

    Parsel, Sean M; Gustafson, Steven A; Friedlander, Edward; Shnyra, Alexander A; Adegbulu, Aderosoye J; Liu, Ying; Parrish, Nicole M; Jamal, Syed A; Lofthus, Eve; Ayuk, Leo; Awasom, Charles; Henry, Carolyn J; McArthur, Carole P

    2017-04-04

    Malaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens Advance(TM) microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS). Peripheral blood samples from 522 patients with a clinical diagnosis of "suspected malaria" were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Four hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM. The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians' clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM

  6. LLC: critérios diagnósticos, imunofenotipagem e diagnóstico diferencial CLL: diagnostic criteria, immunophenotyping and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Irene Lorand-Metze

    2005-12-01

    Full Text Available O diagnóstico da LLC é baseado em dados do hemograma e da imunofenotipagem dos linfócitos periféricos: linfocitose acima de 5 (ou 10 x 10(9/L com fenótipo CD19, CD5, CD23 e expressão fraca de imunoglobulinas de superfície monoclonais. A expressão de CD38 ocorre em cerca da metade dos casos e tem relação com o estado não mutado de Ig V. A biópsia de medula só deverá ser realizada antes do tratamento ou quando os dois exames acima não permitirem um diagnóstico definitivo. O diagnóstico diferencial é com os outros linfomas B indolentes, que freqüentemente apresentam células neoplásicas circulantes. Este diagnóstico diferencial é baseado na imunofenotipagem, biópsia de medula ou linfonodo.The diagnosis of CLL is based on the finding of peripheral lymphocytosis of over 5 (or 10 x 10(9/L presenting the CD19, CD5, CD23 phenotype and a weak monoclonal expression of membrane immunoglobulins. The CD38 expression is observed in half of the cases and is correlated with the unmutated status of the Ig V gene. Bone marrow biopsy should only be performed before starting treatment or if necessary for the differential diagnosis with other low-grade lymphomas. This differential diagnosis is based on the morphology of circulating lymphocytes, their immunophenotypes and pattern of bone marrow infiltration.

  7. Accuracy of erythrogram and serum ferritin for the maternal anemia diagnosis (AMA): a phase 3 diagnostic study on prediction of the therapeutic responsiveness to oral iron in pregnancy

    OpenAIRE

    Bresani, Cristiane Campello; Braga, Maria Cynthia; Felisberto, Daniel Falcão; Tavares-de-Melo, Carlos Eduardo Lopes; Salvi, Debora Bresani; Batista-Filho,Malaquias

    2013-01-01

    Background Pregnancy anemia remains as a public health problem, since the official reports in the 70’s. To guide the treatment of iron-deficiency anemia in pregnancy, the haemoglobin concentration is the most used test in spite of its low accuracy, and serum ferritin is the most reliable test, although its cutoff point remains an issue. Methods/design The aim of this protocol is to verify the accuracy of erythrocyte indices and serum ferritin (studied tests) for the diagnosis of functional ir...

  8. Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms.

    Science.gov (United States)

    Riboli, Danilo Flávio Moraes; Lyra, João César; Silva, Eliane Pessoa; Valadão, Luisa Leite; Bentlin, Maria Regina; Corrente, José Eduardo; Rugolo, Ligia Maria Suppo de Souza; da Cunha, Maria de Lourdes Ribeiro de Souza

    2014-05-22

    Catheter-related bloodstream infections (CR-BSIs) have become the most common cause of healthcare-associated bloodstream infections in neonatal intensive care units (ICUs). Microbiological evidence implicating catheters as the source of bloodstream infection is necessary to establish the diagnosis of CR-BSIs. Semi-quantitative culture is used to determine the presence of microorganisms on the external catheter surface, whereas quantitative culture also isolates microorganisms present inside the catheter. The main objective of this study was to determine the sensitivity and specificity of these two techniques for the diagnosis of CR-BSIs in newborns from a neonatal ICU. In addition, PFGE was used for similarity analysis of the microorganisms isolated from catheters and blood cultures. Semi-quantitative and quantitative methods were used for the culture of catheter tips obtained from newborns. Strains isolated from catheter tips and blood cultures which exhibited the same antimicrobial susceptibility profile were included in the study as positive cases of CR-BSI. PFGE of the microorganisms isolated from catheters and blood cultures was performed for similarity analysis and detection of clones in the ICU. A total of 584 catheter tips from 399 patients seen between November 2005 and June 2012 were analyzed. Twenty-nine cases of CR-BSI were confirmed. Coagulase-negative staphylococci (CoNS) were the most frequently isolated microorganisms, including S. epidermidis as the most prevalent species (65.5%), followed by S. haemolyticus (10.3%), yeasts (10.3%), K. pneumoniae (6.9%), S. aureus (3.4%), and E. coli (3.4%). The sensitivity of the semi-quantitative and quantitative techniques was 72.7% and 59.3%, respectively, and specificity was 95.7% and 94.4%. The diagnosis of CR-BSIs based on PFGE analysis of similarity between strains isolated from catheter tips and blood cultures showed 82.6% sensitivity and 100% specificity. The semi-quantitative culture method showed higher

  9. [Diagnostics in osteology].

    Science.gov (United States)

    Jakob, F; Genest, F; Seefried, L; Tsourdi, E; Lapa, C; Hofbauer, L C

    2016-07-01

    Clinical diagnostics in metabolic bone diseases cover a broad spectrum of conventional and state of the art methods ranging from the medical history and clinical examination to molecular imaging. Patient treatment is carried out in an interdisciplinary team due to the multiple interactions of bone with other organ systems. Diagnosis of osteoporosis is supported by high level national guidelines. A paradigm shift concerning the clinical relevance of bone mineral density measurement renders this now to be a strong risk factor rather than a diagnostic parameter, while strengthening the value of other clinical factors for risk assessment. The impact of parameters for muscle mass, structure and function is steadily increasing in all age groups. In order to identify underlying diseases that influence bone metabolism a panel of general laboratory diagnostic parameters is recommended. Markers for bone formation and resorption and specific parameters for the regulation of calcium and phosphate metabolism should be evaluated by specialists because they require diligence in preanalytics and experience in interpretation. Genetic diagnosis is well established for rare bone diseases while diagnostic panels are not yet available for routine diagnostics in polygenetic diseases such as osteoporosis. Conventional radiology is still very important to identify, e. g. fractures, osteolytic and osteoblastic lesions and extraosseous calcifications; however tomography-based methods which combine, e. g. scintigraphy or positron emission technologies with anatomical imaging are of increasing significance. Clinical diagnostics in osteology require profound knowledge and are subject to a dynamic evolution.

  10. Anti-citrullinated protein antibodies in the diagnosis of rheumatoid arthritis (RA): diagnostic performance of automated anti-CCP-2 and anti-CCP-3 antibodies assays.

    Science.gov (United States)

    Vos, Ine; Van Mol, Christof; Trouw, Leendert A; Mahler, Michael; Bakker, Jaap A; Van Offel, Jan; De Clerck, Luc; Huizinga, Tom W

    2017-07-01

    This study compares the diagnostic performance of a second generation anti-cyclic citrullinated peptide antibody (CCP2) with a third generation anti-CCP antibodies assay (CCP3), as well as the combination of both tests. Serum samples of 127 patients were analyzed. IgG anti-CCP 2 and IgM rheumatoid factor were determined by EliA™ technique on a Phadia 250 instrument (Thermo Fisher Scientific), anti-CCP3 by the Quanta Flash™ anti-CCP3 IgG kit, BIO-FLASH Rapid Response Chemiluminscence Analyzer (INOVA Diagnostics). Diagnostic performance was compared using ROC-curves, sensitivity, specificity, likelihood ratios, and predictive values. Logistic regressions were used to investigate whether using both tests (anti-CCP2 and anti-CCP3) gives a better prediction of rheumatoid arthritis. At the manufacturer's cut-offs sensitivity and specificity were 79.4 and 61.0% for CCP3 and 80.9 and 69.5% for CCP2. No significant differences could be observed regarding the areas under the curve (AUC) of both ROC-curves. The optimal cut-off point for CCP2 was 10.5 U/ml (sensitivity of 75.0% and specificity of 80.0%) and 5.6 U/ml for CCP3 (sensitivity of 86.9% and specificity of 61.0%). Binary logistic regressions indicated that the likelihood of having rheumatoid arthritis (RA) is significantly higher when testing positive on both CCP2 and CCP3 compared to CCP2 or CCP3 alone. In our cohort, comparable performance was found between the two CCP assays. Positivity for both CCP2 and CCP3 resulted in the most specific identification of RA patients. In patients with joint complaints suspected of having RA and with a weakly positive CCP 2 (≥7 and ≤16 U/ml) CCP3 testing could be of additive value for diagnosing RA.

  11. Assessment of the diagnostic sensitivity and specificity of an indirect ELISA kit for the diagnosis of Brucella ovis infection in rams

    Directory of Open Access Journals (Sweden)

    Praud Anne

    2012-07-01

    Full Text Available Abstract Background Brucella ovis causes an infectious disease responsible for infertility and subsequent economic losses in sheep production. The standard serological test to detect B. ovis infection in rams is the complement fixation test (CFT, which has imperfect sensitivity and specificity in addition to technical drawbacks. Other available tests include the indirect enzyme-linked immunosorbent assays (I-ELISA but no I-ELISA kit has been fully evaluated. The study aimed to compare an I-ELISA kit and the standard CFT. Our study was carried out on serum samples from 4599 rams from the South of France where the disease is enzootic. A Bayesian approach was used to estimate tests characteristics (diagnostic sensitivity, Se and diagnostic specificity, Sp. The tests were then studied together in order to optimise testing strategies to detect B. ovis. Results After optimising the cut-off values in order to avoid doubtful results without deteriorating the concordance between the results of the two tests, the I-ELISA appeared to be slightly more sensitive than CFT (Se I-ELISA = 0.917 [0.822; 0.992], 95% Credibility Interval (CrI compared to Se CFT = 0.860 [0.740; 0.967], 95% CrI. However, CFT was slightly more specific than I-ELISA (Sp CFT = 0.988 [0.947; 1.0], 95% CrI compared to Sp I-ELISA =0.952 [0.901; 1.0], 95% CrI. The tests were then associated with two different interpretation schemes. The series association increased the specificity of screening and could be used for pre-movement testing in rams from uninfected flocks. The parallel association increased sequence sensitivity, thus appearing more suitable for eradicating the disease in infected flocks. Conclusions The high sensitivity and acceptable specificity of this I-ELISA kit support its potential interest to avoid the limitations of CFT. The two tests could also be used together or combined with other diagnostic methods such as semen culture to improve the testing strategy

  12. Pyomyositis tropicans: a diagnostic dilemma.

    Science.gov (United States)

    Chaitow, J; Martin, H C; Knight, P; Buchanan, N

    1980-11-01

    Pyomyositis tropicans is a rare disease in non-tropical climates and thus presents diagnostic difficulties. Two children with single staphylococcal psoas muscle abscesses were recently successfully treated. Computerized axial tomography was found to be a useful diagnostic aid, allowing exact localization of the lesion. The diagnosis and therapy of these abscesses are discussed.

  13. Dual Processing and Diagnostic Errors

    Science.gov (United States)

    Norman, Geoff

    2009-01-01

    In this paper, I review evidence from two theories in psychology relevant to diagnosis and diagnostic errors. "Dual Process" theories of thinking, frequently mentioned with respect to diagnostic error, propose that categorization decisions can be made with either a fast, unconscious, contextual process called System 1 or a slow, analytical,…

  14. Diagnostic accuracy of fat-saturated T2-weighted magnetic resonance imaging in the diagnosis of perforation of the articular disc of the temporomandibular joint.

    Science.gov (United States)

    Yura, Shinya; Nobata, Koji; Shima, Tsuyoshi

    2012-06-01

    The accuracy of diagnosing a perforation of the articular disc of the temporomandibular joint (TMJ) is poor with conventional magnetic resonance imaging (MRI). We recently reported that a high signal-intensity area is usually found on fat-saturated T2-weighted MRI in the joint space between the articular disc and cartilage surface in joints in which the disc is displaced. A discrete image with an area of high signal-intensity in the middle of the articular disc may indicate perforation or rupture. The purpose of this study was to compare the accuracy of diagnosis of a perforated articular disc by fat-saturated T2-weighted MRI with that of arthroscopy. We studied 50 joints in 50 patients with closed lock of the TMJ who were examined with MRI and then by arthroscopy using an ultra-thin arthroscope. The agreement between the two methods of diagnosis was assessed using the κ coefficient. Evidence of perforation of the disc on MRI and arthroscopically was found in the same 7 joints; there was complete concordance (κ=1.00, pfat-saturated MRI was therefore the same as that by arthroscopy using an ultra-thin arthroscope.

  15. [Compared diagnostic performances of CKMB measurements by immuno-inhibition and three immunoenzyme methods for the early diagnosis of myocardial infarction].

    Science.gov (United States)

    Berny, C; Chapuis, F; Fournier, G; Mialon, A; Fontanille, P; Manchon, M

    1995-01-01

    In 98 patients consecutively admitted in a medical intensive care unit, an aliquot taken from the blood sample withdrawn for the cardiac enzyme admission request has been frozen. After thawing of these 98 aliquots total CK and the creatine kinase MB isoenzyme were measured on the same day. For this last determination, four methods were used and compared: an immunoinhibition method (Merck) and three immunoenzymatic assays (Abbott on IMX; Baxter on Stratus II; Hybritech on single use Icon cylinder). In 19 out of the 98 patients studied the diagnosis of myocardial infarction was made retrospectively by a cardiologist. This diagnosis was established according to the criteria defined by the WHO. The clinical performances (sensitivity, specificity, positive predictive value, negative predictive value) have been calculated for each test according to the following criteria: on the one hand, a cut-off of 8% (reference range of our laboratory) for the immunoinhibition technique; on the other hand, a cut-off defined by the manufacturer together with a cut-off obtained from the ROC curves for the three immunoenzymatic assays. Our results clearly demonstrate that the clinical performances of the three immunoenzymatic CKMB assays are very comparable and appear to be much better than the immunoinhibition method which should be abandoned.

  16. The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Chong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, 88 Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Kim, Kyung Won; Shin, Yong Moon; Kim, Pyo Nyun [Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Gene Young [University of Missouri, School of Medicine, Columbia (United States); Park, Seong Ho [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, 88 Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-04-01

    We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value. A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma. A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90-97%), 99% (95% CI, 97-100%), and 97% (95% CI, 95-99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47-74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1-97.1%) and a specificity of 95.3% (95% CI, 88.4-98.7%). High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH. (orig.)

  17. 超声对类风湿关节炎的诊断价值%Prediction and diagnostic value of ultrasound in the diagnosis of rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    白超; 赵娜; 李霞; 张文焕; 蒋雪梅

    2016-01-01

    Objective:To observe the changes of Doppler ultrasound in patients with rheumatoid arthritis (RA),and to evaluate the predictive value of Doppler ultrasound parameters in the joint inflammation. Methods:We performed a retrospective analysis of 54 cases of suspected patients with RA,using high frequency ultrasound scanning metacarpophalangeal joints,wrists joints, proximal interphalangeal joint,double ankle,knee joints,evaluated the synovial thickness,joint effusion,blood flow signals and the degree of bone erosion. Results:1188 joints of 54 cases were scaned. Statistics of the joints of the lesions:MCP 87/432 (20%), PIP 76/432 (17.6%),wrists joints 61/108 (56%),double ankle 50/108 (46%),double knee joints 66/108 (61%). US examina-tion showed 37 cases of RA,17 cases of non-RA. There were 4 cases of US examination showed no obvious RA signs,but the clinical diagnosis was RA. The clinical diagnosis was 39 cases of RA,15 cases of non-RA. The sensitivity of RA was 89.7%(35/39),specificity was 73.3% (11/15),RA forecast value 94.5% (35/37),non-RA forecast value 76.5% (13/17). The compara-tive analysis of US diagnosis and clinical diagnosis showed:Kappa=0.734 (0.7diagnosis and clinical diagnosis) had high consistency. Conclusion:①Ultrasound has a strong sensitivity to early RA inflammatory activity,and its method is reliable,convenient and safe. The results of the assessment are of predictive value in the diagnosis of disease activity and imaging findings. ②The results of ultrasound assessment are highly similar with the clinical evaluation results. ③In the identification of patients with RA,Doppler ultrasound combined with clinical assessment can more accurately reflect the disease activity of inflammation.%目的:观察类风湿关节炎(rheumatoid arthritis,RA)患者各关节的多普勒超声改变,评估多普勒超声对关节炎的诊断价值。方法:回顾性分析54例疑似RA患

  18. Diagnosis of soils polluted by aromatic hydrocarbons; Diagnostic de sols pollues par des hydrocarbures aromatiques polycycliques (HAP) a l'aide de la spectrophotometrie UV

    Energy Technology Data Exchange (ETDEWEB)

    Crone, M.

    2000-01-28

    Polycyclic aromatic hydrocarbons (PAHs) were produced by many pyrolytic or combustion processes. They were found in soils, often in high concentrations. Remediation of industrial sites contaminated by PAHs requires an initial diagnosis of the pollution. In this perspective, an analytical procedure based on UV spectrophotometry was developed and validated with about 80 soil samples. Different exploitation methods of the samples UV spectra enable to develop simple and rapid characterisation tools. A PAH UV index is proposed for the estimation of global PAH concentration. A more accurate exploitation of the spectra gives an indication on the presence or the absence of some individual PAH like benzo[a]pyrene. A maturity index based on a two wavelength approach constitutes an indicator of the potential evolution of soil contamination in natural conditions. Laboratory methodology was adapted to field analyses and a test kit was designed for this purpose. The test duration is 20 minutes. (author)

  19. Interest of nuclear medicine in the diagnosis of congenital and childhood hypothyroidism; Apports de la medecine nucleaire au diagnostic des hypothyroidies congenitales et de l'enfant

    Energy Technology Data Exchange (ETDEWEB)

    Clerc, J. [Hopital Necker, Medecine Nucleaire, 75 - Paris (France)

    2002-08-01

    The paediatric thyroid scan (PTS) remains a cornerstone test in guiding the etiological diagnosis of congenital hypothyroidism (CH). In hypothyroid babies, thyroxine therapy must be started immediately. A reliable PTS can be obtained in the following days even under T4 therapy. {sup 123}I is the isotope of choice since it provides quantitated images and a clinically relevant grading of dys-hormonal-genetic disorders. The dosimetry of {sup 123}I is lower than usually considered because iodine uptake is absent or low in most cases of CH and because the energy deposited within the colloid has no expected radiobiological detriment. PTS is a highly contributive, sensitive and reproducible test in identifying thyroid dysgenesis the most frequent etiology (70%) of permanent CH. Since agenesis requires a very careful T4 therapy monitoring, PTS is also of therapeutic interest. PTS can distinguish 3 types of dys-hormonal-genetic disorders (10%). In type 1, low uptake indicates a defective R-TSH or a NIS defect when {sup 123}I gastric uptake is absent. Type 2 - high uptake, goiter and positive perchlorate discharge test (PDT) - refers to organification defects (TPO, THOX1,2, Pendrin). Type 3 (goiter, high uptake, negative PDT) includes coupling defects, thyroglobulin abnormalities and dehalogenase deficiency. Main transient aetiologies (20%) of CH are iodine overload and blocking anti hR-TSH antibodies, while thyroiditis and dietary iodine overload are more frequent thereafter The molecular understanding of the defects involved in CH rapidly develops. However, precocious diagnosis, appropriate T4 therapy and sorting out the etiology are the most relevant parameters which determine the final clinical prognosis. (author)

  20. The Early Diagnosis of Boys and Girls in Academic Risk Using the Perceptual-Motor Diagnostic System: A Longitudinal Retrospective Study of Evidences of its Effectiveness

    Directory of Open Access Journals (Sweden)

    Emmanuel Herrera-González

    2015-09-01

    Full Text Available The main objective in this study is to evidence the efficiency of the Peques System as a useful tool to diagnose, at an early stage, possible difficulties which will affect the academic performance. In a 3-year longitudinal study, the Perceptual-Motor Diagnostic System (Peques was applied to a sample of 149 participants (77 boys and 72 girls, who were beginning preschool education. Peques classified 38 children with a high risk to lose a year at primary school level. After a three-year follow-up (first primary school level, it was determined that 23 of the 127 who remained in the study (18%, had failed the first, second or third school year. From the high-risk group diagnosed by the Peques System, an 83% indeed lost a school year. These boys and girls had difficulties in different aspects, such as their information processing capacity, motor development, corporal image, Gestalt development and corporal coordination. We concluded that Peques System was able to predict the academic failure in the primary school level, based on the perceptual-motor development reached at preschool level. Further, based on this experience it is recommended to pay special attention to perceptual-motor development, since it plays a basic role in the academic success of boys and girls.

  1. Diagnostic and interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie

    2016-08-01

    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  2. Diagnostic stability in pediatric bipolar disorder

    DEFF Research Database (Denmark)

    Vedel Kessing, Lars; Vradi, Eleni; Andersen, Per Kragh

    2015-01-01

    BACKGROUND: The diagnostic stability of pediatric bipolar disorder has not been investigated previously. The aim was to investigate the diagnostic stability of the ICD-10 diagnosis of pediatric mania/bipolar disorder.METHODS: All patients below 19 years of age who got a diagnosis of mania...

  3. [Diagnostic approach to infectious endocarditis].

    Science.gov (United States)

    Parize, Perrine; Mainardi, Jean-Luc

    2012-04-01

    Major advances in imaging and microbiological procedures have changed the diagnostic approach of infective endocarditis. New imaging tools have improved the search of local complications, systemic embolism and diagnosis of infection of cardiac devices. Moreover, microbiological diagnosis has been transformed by molecular techniques as long as these procedures have highlighted microorganisms thus far neglected by classical techniques. Despite these advances, endocarditis remained a clinical diagnosis which still depends on a high index of clinical suspicion.

  4. Lab-on-a-chip enabled HLA diagnostic: combined sample preparation and real time PCR for HLA-B57 diagnosis

    Science.gov (United States)

    Gärtner, Claudia; Becker, Holger; Hlawatsch, Nadine; Klemm, Richard; Moche, Christian; Schattschneider, Sebastian; Frank, Rainer; Willems, Andreas

    2015-05-01

    The diverse human HLA (human leukocyte antigen) system is responsible for antigen presentation and recognition. It is essential for the immune system to maintain a stable defense line, but also is also involved in autoimmunity as well as metabolic disease. HLA-haplotype (HLA-B27), for instance, is associated with inflammatory diseases such as Bechterew's disease. The administration of the HIV drug Abacavir in combination with another HLA-haplotype (HLAB57) is associated with severe hypersensitivity reactions. Accordingly, the HLA status has to be monitored for diagnosis or prior to start of therapy. Along this line, a miniaturized microfluidic platform has been developed allowing performing the complete analytical process from "sample-in" to "answer-out" in a point-of-care environment. The main steps of the analytical cascade inside the integrated system are blood cell lysis and DNA isolation, DNA purification, real-time PCR and quantitative monitoring of the rise of a fluorescent signal appearing during the PCR based sequence amplification. All bio-analytical steps were intended to be performed inside one chip and will be actuated, controlled and monitored by a matching device. This report will show that all required processes are established and tested and all device components work well and interact with the functional modules on the chips in a harmonized fashion.

  5. Diagnostic criteria of {sup 99m}Tc-diethylenetriaminepentaacetic acid captopril renal scan for the diagnosis of renovascular hypertension by unilateral renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Jin; Hong, Il Ki; Chang, Jae Won; Park, Su Kil; Moon, Dae Hyuk [Asan Medical Center, Seoul (Korea, Republic of)

    2004-12-01

    We compared captopril renal scintigraphic criteria for the diagnosis of renovascular hypertension by unilateral renal artery stenosis. The study group consisted of 24 patients (m/f = 16/8, age: 39{+-}18 years) with unilateral renal artery stenosis who underwent renal artery revascularization and captopril renal scintigraphy with {sup 99m}Tc-diethylenetriaminepentaacetic acid between May 1995 and April 2004. The blood pressure response was classified as cure/improvement or failure. We evaluated captopril-induced changes in relative function (BCfun) and renogram grade (0 to 5: 0 = normal, and 5 = renal failure pattern without measurable uptake) (CBren) and the difference of renograms between the normal and stenotic kidney on captopril scan (CNren). Eight of 24 patients were cured and 11 improved and 5 patients were classified as failed revascularization. Significant predictors of a cure or improvement of blood pressure were younger age, stenosis by fibromuscular dysplasia or arteritis, BCfun, CBren and CNren. Areas under the receiver operating characteristic curve of age, BCfun, CBren and CNren were not significantly different. Positive and negative predictive values of predictors were 100% and 42% (age {<=} 38); 92% and 50% (BCfun{>=} 1 %); 92% and 75% (CBren{>=} 1), and 90% and 60% (CNren{>=} 1), respectively. Captopril induced changes in renal function and renogram can reliably predict hypertension response to revascularization. Renogram pattern on captopril scan can diagnose renovascular hypertension without baseline data in patients with unilateral renal artery stenosis.

  6. System diagnosis using finite memory observers: Common Rail application; Diagnostic des systemes a l'aide d'observateurs a memoire finie: application au Common Rail

    Energy Technology Data Exchange (ETDEWEB)

    Graton, G.

    2005-12-15

    The aim of this work was to propose a fault detection method on the high pressure direct injection system (called Common Rail system) set up on Diesel vehicles. The importance of the fault detection procedure implementation was highlighted thanks to the description of the stakes (lowers consumption, reduction in the pollutant emissions and sound, increase of performances) and constraints dependent on Common Rail (high pressure, high frequency, gas oil lubrication, high precision machining, standards EURO respect,...) but also through a listing of failures which can occur on Common Rail. A synthesis on the different diagnosis methods of systems contributed to select a fault detection method with expected performances (detection of fault beginning, detection speed, isolation and characterization of detected fault and minimizing false alarm and bad detections). After a detailed study (properties, sequential formulations and sensitivity study) of the selected detection method (finite memory observers) and a modeling of the Common Rail various bodies behavior, the algorithm of detection was tested on three different models of the system Common Rail. Moreover, the comparison between the finite memory observer and a Luenberger observer and a Kalman filter allow to appreciate the residual robustness degree. Obtained results allow to conclude on good detection of actuator and sensor faults. (author)

  7. Diagnostic accuracy of unenhanced, contrast-enhanced perfusion and angiographic MRI sequences for pulmonary embolism diagnosis: results of independent sequence readings

    Energy Technology Data Exchange (ETDEWEB)

    Revel, Marie Pierre [Hopital Europeen Georges Pompidou, APHP, Departments of Radiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); Hotel-Dieu, Service de Radiologie, Paris (France); Sanchez, Olivier; Meyer, Guy [Hopital Europeen Georges Pompidou, APHP, Respiratory and intensive care and, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); INSERM Unite 765, Paris (France); Lefort, Catherine; Couchon, Sophie; Hernigou, Anne; Frija, Guy [Hopital Europeen Georges Pompidou, APHP, Departments of Radiology, Paris (France); Niarra, Ralph [Hopital Europeen Georges Pompidou, APHP, Clinical Epidemiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); Chatellier, Gilles [Hopital Europeen Georges Pompidou, APHP, Clinical Epidemiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); INSERM CIC-EC E4, Paris (France)

    2013-09-15

    To independently evaluate unenhanced, contrast-enhanced perfusion and angiographic MR sequences for pulmonary embolism (PE) diagnosis. Prospective investigation, including 274 patients who underwent perfusion, unenhanced 2D steady-state-free-precession (SSFP) and contrast-enhanced 3D angiographic MR sequences on a 1.5-T unit, in addition to CTA (CT angiography). Two independent readers evaluated each sequence independently in random order. Sensitivity, specificity, predictive values and inter-reader agreement were calculated for each sequence, excluding sequences judged inconclusive. Sensitivity was also calculated according to PE location. Contrast-enhanced angiographic sequences showed the highest sensitivity (82.9 and 89.7 %, reader 1 and reader 2, respectively), specificity (98.5 and 100 %) and agreement (kappa value 0.77). Unenhanced angiographic sequences, although less sensitive overall (68.7 and 76.4 %), were sensitive for the detection of proximal PE (92.7 and 100 %) and showed high specificity (96.1 and 99.1 %) and good agreement (kappa value 0.62). Perfusion sequences showed lower sensitivity (75.0 and 79.3 %), specificity (84.8 and 89.7 %) and agreement (kappa value 0.51), and a negative predictive value of 84.8 % at best. Compared with contrast-enhanced angiographic sequences, unenhanced sequences demonstrate lower sensitivity, except for proximal PE, but high specificity and agreement. The negative predictive value of perfusion sequences was insufficient to safely rule out PE. (orig.)

  8. Diagnostic efficacy of the ELISA test for the detection of deamidated anti-gliadin peptide antibodies in the diagnosis and monitoring of celiac disease.

    Science.gov (United States)

    Tonutti, Elio; Visentini, Daniela; Picierno, Alessia; Bizzaro, Nicola; Villalta, Danilo; Tozzoli, Renato; Kodermaz, Graziano; Carroccio, Antonio; Iacono, Giuseppe; Teresi, Saverio; La Chiusa, Stella Maria; Brusca, Ignazio

    2009-01-01

    We evaluated the diagnostic performance of an ELISA test for anti-gliadin IgA and IgG antibodies, which uses synthetic deamidated gliadin peptides (anti-gliadin antibodies, AGAs) as coating; the results were compared with a test that uses extracted gliadin (AGAe). The study was conducted on the sera of 144 patients suffering from celiac disease (CD), including 20 patients with IgA deficiency and 9 who were following a gluten-free diet (GFD), and 129 controls. In the 115 CD patients (without IgA deficiency), the sensitivity of AGAe IgA and IgG was 32.2 and 60.9%, whereas that of AGAs IgA and IgG was 59.1 and 72.2%. The specificity for AGAe IgA and IgG, and AGAs IgA and IgG was 93.8 and 89.9%, and 96.9% and 99.2%, respectively. Of the 20 patients with CD and IgA deficiency, 7 tested positive for AGAe IgG and 14 for AGAs IgG. The test using deamidated gliadin peptides performed better in terms of sensitivity and specificity than the AGA tests with extracted antigen. The very high specificity of the AGAs IgG test (99.2%) also suggests that patients who test positive with this assay require a thorough followup, even if the anti-tissue transglutaminase antibodies (anti-tTG) and anti-endomysial autoantibodies (EMA) assays are negative. Copyright 2009 Wiley-Liss, Inc.

  9. Assessment of Diagnostic Value of Single View Dynamic Technique in Diagnosis of Developmental Dysplasia of Hip: A Comparison with Static and Dynamic Ultrasond Techniques.

    Science.gov (United States)

    Alamdaran, Seyed Ali; Kazemi, Sahar; Parsa, Ali; Moghadam, Mohammad Hallaj; Feyzi, Ali; Mardani, Reza

    2016-10-01

    Developmental dysplasia of hip (DDH) is a common childhood disorder, and ultrasonography examination is routinely used for screening purposes. In this study, we aimed to evaluate a modified combined static and dynamic ultrasound technique for the detection of DDH and to compare with the results of static and dynamic ultrasound techniques. In this cross-sectional study, during 2013- 2015, 300 high-risk infants were evaluated by ultrasound for DDH. Both hips were examined with three techniques: static, dynamic and single view static and dynamic technique. Statistical analysis was performed using SPSS version 11.5. Patients aged 9 days to 83 weeks. 75% of the patients were 1 to 3 months old. Among 600 hip joints, about 5% were immature in static sonography and almost all of them were unstable in dynamic techniques. 0.3% of morphologically normal hips were unstable in dynamic sonography and 9% of unstable hips had normal morphology. The mean β angle differences in coronal view before and after stress maneuver was 14.43±5.47° in unstable hips. Single view static and dynamic technique revealed that all cases with acetabular dysplasia, instability and dislocation, except two dislocations, were detected by dynamic transverse view. For two cases, Ortolani maneuver showed femoral head reversibility in dislocated hips. Using single view static and dynamic technique was indicative and applicable for detection of more than 99% of cases. Single view static and dynamic technique not only is a fast and easy technique, but also it is of high diagnostic value in assessment of DDH.

  10. Diagnostic hematology of reptiles.

    Science.gov (United States)

    Stacy, Nicole I; Alleman, A Rick; Sayler, Katherine A

    2011-03-01

    The hematologic evaluation of reptiles is an indispensable diagnostic tool in exotic veterinary practice. The diversity of reptile species, their characteristic physiologic features, and effects of intrinsic and extrinsic factors present unique challenges for accurate interpretation of the hemogram. Combining the clinical presentation with hematologic findings provides valuable information in the diagnosis and monitoring of disease and helps guide the clinician toward therapy and further diagnostic testing. This article outlines the normal and pathologic morphology of blood cells of reptile species. The specific comparative aspects of reptiles are emphasized, and structural and functional abnormalities in the reptilian hemogram are described.

  11. [Molecular diagnostics and imaging].

    Science.gov (United States)

    Fink, Christian; Fisseler-Eckhoff, Annette; Huss, Ralf; Nestle, Ursula

    2009-01-01

    Molecular diagnostic methods and biological imaging techniques can make a major contribution to tailoring patients' treatment needs with regard to medical, ethical and pharmaco-economic aspects. Modern diagnostic methods are already being used to help identify different sub-groups of patients with thoracic tumours who are most likely to benefit significantly from a particular type of treatment. This contribution looks at the most recent developments that have been made in the field of thoracic tumour diagnosis and analyses the pros and cons of new molecular and other imaging techniques in day-to-day clinical practice.

  12. Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score?

    Science.gov (United States)

    Gatselis, Nikolaos K; Zachou, Kalliopi; Papamichalis, Panagiotis; Koukoulis, George K; Gabeta, Stella; Dalekos, George N; Rigopoulou, Eirini I

    2010-11-01

    The International Autoimmune Hepatitis Group developed a simplified score for autoimmune hepatitis. We assessed this "new scoring system" and compared it with the International Autoimmune Hepatitis Group original revised score. 502 patients were evaluated namely, 428 had liver diseases of various etiology [hepatitis B (n=109), hepatitis C (n=100), hepatitis D (n=4), alcoholic liver disease (n=28), non-alcoholic fatty liver disease (n=55), autoimmune cholestatic diseases (n=77), liver disorders of undefined origin (n=32) and miscellaneous hepatic disorders (n=23)], 13 had autoimmune hepatitis/overlap syndromes, 18 had autoimmune hepatitis/concurrent with other liver diseases and 43 had autoimmune hepatitis. The specificity of the simplified score was similar to that of the revised score (97% vs. 97.9%). The sensitivity in unmasking autoimmune hepatitis in autoimmune hepatitis/overlap syndromes was also similar in both systems (53.8% and 61.5%). However, the sensitivity for autoimmune hepatitis diagnosis in autoimmune hepatitis patients with concurrent liver disorders was lower by the new score (p=0.001). Liver biopsy proved to be the only independent factor for unmasking autoimmune hepatitis component among patients (p=0.003). The simplified score is a reliable and simple tool for excluding autoimmune hepatitis. However, both systems cannot unmask autoimmune hepatitis component efficiently in autoimmune hepatitis patients with concurrent autoimmune or non-autoimmune liver diseases. This study also strongly reiterates the importance of liver biopsy in the work-up of patients. Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  13. Unmet Diagnostic Needs in Infectious Disease

    Science.gov (United States)

    Blaschke, Anne J.; Hersh, Adam L.; Beekmann, Susan E.; Ince, Dilek; Polgreen, Philip M.; Hanson, Kimberly E.

    2014-01-01

    Accurate diagnosis is critical to providing appropriate care in infectious diseases. New technologies for infectious disease diagnostics are emerging, but gaps remain in test development and availability. The Emerging Infections Network surveyed Infectious Diseases physicians to assess unmet diagnostic needs. Responses reflected the urgent need to identify drug-resistant infections and highlighted the potential for early diagnosis to improve antibiotic stewardship. Information gained from this survey can help inform recommendations for new diagnostic test development in the future. PMID:25456043

  14. 超声在婴幼儿肠套叠诊断及治疗中的价值%Diagnostic value of ultrasound in diagnosis and treatment of intussusception in infants

    Institute of Scientific and Technical Information of China (English)

    祁艳征; 张培霞

    2015-01-01

    Objective:To investigate the ultrasound value in the diagnosis and treatment of intussusception in infants. Methods:ALO-KAa10 and GE LOGIQ 7PRO color ultrasonography of the 76 cases of infant intussusceptionultrasonographic findings were retrospectively analyzed. Results:In the 76 cases,57 cases of low frequency ultrasound tip suspected intussusception signs, 73 cases of high frequency ul-trasonography have clear signs of intussusception, 2cases misdiagnosis, missed diagnosis in 1 cases;all the cases were confirmed byenema reduction or surgery confirmed. Conclusion:Ultrasound diagnosis ofintussusception should be non-invasive, high sensitivity and specifici-ty, low frequency and high frequency ultrasound and color Doppler ultrasound technology in combination coud improve the diagnostic ac-cordance rate, for the early clinical diagnosis and early treatment can provide valuable basis.%目的::探讨超声在婴幼儿肠套叠诊断及治疗中的价值。方法:应用ALOKAa10及GE LOGIQ 7 PRO彩色超声诊断仪对76例婴幼儿肠套叠超声声像表现进行回顾性分析。结果:76例中有57例低频超声提示可疑肠套叠征象,73例高频超声均有明确肠套叠征象,误诊2例,漏诊1例;所有病例均经灌肠复位或者手术证实。结论:超声诊断肠套叠具有无创性、高度敏感性和特异性,低频与高频超声及彩色多普勒超声技术相结合可提高诊断符合率,为临床早期诊断、早期治疗提供有价值的依据。

  15. DIAGNOSTIC VALUE OF SERUM VEGF, CEA AND NSE IN DIAGNOSIS OF NON-SMALL CELL LUNG CANCER%血清VEGF、CEA、NSE在非小细胞肺癌诊断中应用价值研究

    Institute of Scientific and Technical Information of China (English)

    郑立平; 林海峰

    2011-01-01

    [目的]探讨血清血管内皮生长因子(VEGF)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)在非小细胞肺癌(NSCLC)诊断中的应用价值,旨在为肺癌的诊治提供理论参考.[方法]采用ELISA方法测定100例NSCLC患者和50例健康查体者血清VEGF、CEA、NSE水平,并分析其与病理分型和临床分期的关系.[结果]肺癌组血清CEA、NSE、VEGF水平均显著高于对照组,相比较差异有统计学意义(P<0.05);鳞癌患者血清CEA和NSE水平显著高于腺癌,相比较差异有统计学意义(P<0.05);而血清VEGF水平在鳞癌和腺癌患者中差异无统计学意义(P>0.05);血清VEGF、CEA、NSE水平随着临床分期的递增而显著上升,其血清水平为Ⅳ期>Ⅲ期>I~Ⅱ期,3组之间比较差异有统计学意义(P<0.05).[结论]联合检测肺癌患者血清中VEGF、CEA、NSE水平的变化,对NSCLC的早期诊断和鉴别具有重要的临床价值.%[Objective] To explore diagnostic value of serum vascular endotbelial growth factor (VEGF), earcinoembry-onic antigen (CEA) and neuron-specific enolase (NSE) for diagnosis of the non-small cell lung cancer (NSCLC), and to provide theoretical reference for diagnosis and treatment of NSCLC. [Methods] 100 cases of patients with NSCLC and 50 cases of healthy people were determined by ELJSA, and their relationship with pathological type and clinical stage were analyzed. [ Results ] The serum CEA, NSE and VEGF levels of the lung cancer group were significantly higher than that of control group, the difference was significant (P 0.05); The serum VEGF, CEA and NSE levels significantly increased with increasing clinical stage, the difference was significant among the three groups (P< 0.05). [Conclusion] Combined detection of the serum VEGF, CEA and NSE levels has important clinical value for the early diagnosis and diagnosis of NSCLC.

  16. Hyperthyroidism and thyroid cancer: the diagnosis is not always what is expected. contribution of the SPECT-T.D.M. in the diagnosis; Hyperthyroidie et cancer thyroidien: le diagnostic n'est pas toujours celui attendu. Apport de la TEMP-TDM dans le diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    Chabert, C.; Garby, L.; Scheiber, C.; Bournaud, C. [Centre de medecine nucleaire, groupement hospitalier Est, Lyon, (France); Picq, R. [service d' endocrinologie, clinique Saint-Charles, Roussillon, (France); Chaix, P.A. [HFME, service de chirurgie gynecologique, (France)

    2009-05-15

    The objective is to illustrate the interest of a tomo-scintigraphy coupled to computed tomography (SPECT-T.D.M.) in the scintigraphy with iodine 131. Conclusions: The ovarian mature teratomas of several tissues are germinal tumors more often benign ones, able to include some thyroid tissue. This one is in the most of case, non functional and of gynecological presentation. Exceptionally, the thyroid contingent is responsible of a hyperthyroidism whom diagnosis is often delayed. The contribution of hybrid imaging allowed an immediate diagnosis and a fast management of the patient. (N.C.)

  17. Control and diagnosis oriented modelling of the compression ignition engine; Modelisation du moteur a allumage par compression dans la perspective du controle et du diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    Grondin, O.

    2004-12-15

    This thesis has described an investigation into the modelling of compression ignition engine for control and diagnosis purpose. The Diesel engine is the most efficient and clean internal combustion engine due to modem electromechanical actuators. However, pollutant emission regulations are much more stricter, thus, these complex systems need sophisticated and efficient control algorithms to reach very low emission levels. For this task, engine models are required at each step of the control system development: control laws synthesis, simulation and validation. The system under study is a six cylinder direct injection Diesel engine fitted with a turbocharger. The model of this system is based on physical laws for some parts of the engine such as cylinders, manifolds, turbocharger and crank-slider system. In order to reduce computing time we choose to model heat transfer and heat release during combustion using simple empirical correlations. Resulting model has been implemented in the Matlab-Simulink environment and it can predict variables of interest for control purpose with one degree crank angle resolution. The model has been tested numerically and compared with an industrial engine simulation code with good results. Moreover, model output variables are in good agreement with experimental data recorded on a heavy-duty research engine. The engine model has been embedded on a board providing enough computing performances to perform real-time simulations, this will be helpful for 'hardware-in-the-loop' simulations. Another part of this study is dedicated to the combustion process modelling using a non linear phenomenological model: the NARMAX model. The goal is to predict the in-cylinder pressure evolution using other measurements available on the engine. The NARMAX model parameters have been identified using input-output data carried out from the experimental engine. Such model is well suited for real-time applications compare to numerically cost

  18. Incremental value of right atrial strain for early diagnosis of hemodynamic deterioration in pulmonary hypertension: a new noninvasive tool for a more comprehensive diagnostic paradigma.

    Science.gov (United States)

    Piccinino, Cristina; Giubertoni, Ailia; Zanaboni, Jacopo; Gravellone, Miriam; Sola, Daniele; Rosso, Roberta; Ferrarotti, Lorena; Marino, Paolo Nicola

    2017-11-01

    identify right atrial functional impairment before structural changes and may be implemented in a comprehensive, noninvasive right heart assessment for diagnosis and follow-up of pulmonary hypertension patients.

  19. Diagnostic performance of a seven-marker serum protein biosignature for the diagnosis of active TB disease in African primary healthcare clinic attendees with signs and symptoms suggestive of TB.

    Science.gov (United States)

    Chegou, Novel N; Sutherland, Jayne S; Malherbe, Stephanus; Crampin, Amelia C; Corstjens, Paul L A M; Geluk, Annemieke; Mayanja-Kizza, Harriet; Loxton, Andre G; van der Spuy, Gian; Stanley, Kim; Kotzé, Leigh A; van der Vyver, Marieta; Rosenkrands, Ida; Kidd, Martin; van Helden, Paul D; Dockrell, Hazel M; Ottenhoff, Tom H M; Kaufmann, Stefan H E; Walzl, Gerhard

    2016-09-01

    User-friendly, rapid, inexpensive yet accurate TB diagnostic tools are urgently needed at points of care in resource-limited settings. We investigated host biomarkers detected in serum samples obtained from adults with signs and symptoms suggestive of TB at primary healthcare clinics in five African countries (Malawi, Namibia, South Africa, The Gambia and Uganda), for the diagnosis of TB disease. We prospectively enrolled individuals presenting with symptoms warranting investigation for pulmonary TB, prior to assessment for TB disease. We evaluated 22 host protein biomarkers in stored serum samples using a multiplex cytokine platform. Using a pre-established diagnostic algorithm comprising of laboratory, clinical and radiological findings, participants were classified as either definite TB, probable TB, questionable TB status or non-pulmonary TB. Of the 716 participants enrolled, 185 were definite and 29 were probable TB cases, 6 had questionable TB disease status, whereas 487 had no evidence of TB. A seven-marker biosignature of C reactive protein, transthyretin, IFN-γ, complement factor H, apolipoprotein-A1, inducible protein 10 and serum amyloid A identified on a training sample set (n=491), diagnosed TB disease in the test set (n=210) with sensitivity of 93.8% (95% CI 84.0% to 98.0%), specificity of 73.3% (95% CI 65.2% to 80.1%), and positive and negative predictive values of 60.6% (95% CI 50.3% to 70.1%) and 96.4% (95% CI 90.5% to 98.8%), respectively, regardless of HIV infection status or study site. We have identified a seven-marker host serum protein biosignature for the diagnosis of TB disease irrespective of HIV infection status or ethnicity in Africa. These results hold promise for the development of a field-friendly point-of-care screening test for pulmonary TB. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. X 线与 CT 诊断对成软骨细胞瘤的诊断价值分析%Diagnostic value of X-ray and CT in diagnosis of chondroblastoma

    Institute of Scientific and Technical Information of China (English)

    税永平

    2013-01-01

    Objective X-ray and CT diagnostic value of chondroblastoma were discussed, and improve the imaging diagnostic level . Methods in January 2009-2013 in our hospital between January by X-ray or CT diagnosis of 62 cases of chondroblastoma patients were randomly divided into X-ray plain film in the diagnosis of group (group A) and the CT group (group B), each group of 31 cases, ultimately, all cases of surgical treatment and confirmed by pathology. Results A group of 31 patients, preoperative diagnosis of chondroblastoma 18 cases, 8 cases diagnosed as giant cell tumors of bone, cartilage myxoid fibroma, 4 cases were diagnosed as tumor, 1 case was diagnosed as bone X-ray diagnosis accuracy rate 58%, the misdiagnosis rate was 42% in group B, 31 patients, preoperative diagnosis of chondroblastoma 25 cases, 3 cases were diagnosed as aneurysm bone cyst, 2 cases were diagnosed as giant cell tumors of bone, 1 case was misdiagnosed as fibrosarcoma, CT diagnostic accuracy of 80%, the misdiagnosis rate 20% X-ray showed lesions were round or irregular limitations of bone destruction area, CT showed lesions with different degree of lobulated, border and clear, half annular calcification. Conclusion due to the density resolution higher than X-ray plain film, CT can discern subtle bone destruction, and can be found that damage zone calcifications, and to destroy the organization composition CT value in the measurement, so the diagnostic accuracy of chondroblastoma is significantly higher than X-ray plain film, worthy of clinical popularization and application.%目的:对 X 线与 CT 诊断成软骨细胞瘤的价值进行探讨,提高对本病影像诊断水平。方法将2009年1月至2013年1月间在我院经 X 线或 CT 诊断的62例成软骨细胞瘤患者随机分为 X 线平片诊断组(A 组)和经 CT 诊断组(B 组),每组各31例,所有病例最终均行手术治疗并经病理证实。结果 A 组31例患者,术前诊断为成软骨细胞瘤18例,8

  1. Conventional combination of ultrasonic elastography diagnostic system in the diagnosis of breast cancer%常规超声结合弹性成像对乳腺癌的诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘军杰

    2013-01-01

    Objective:Inquiry in to the conventional combination of ultrasonic elastography in patients with breast cancer diagnosis system on the clinical value of diseases.Methods:Interception May 2010-November 2011,a total of 502 patients in our hospital,a total of 567 lumps into this research,by organizational group of benign and malignant form were divided into benign and malignant groups,comparing differences between two sets of patient clinical data.Results:Ultrasonic diagnostic system (conventional ultrasound combined with UE) diagnostic sensitivity of breast cancer 93.8 %,specificity of 88.1 %,the accuracy of 90.3%,sensitivity and accuracy were higher than conventional ultrasound,differences were statistically significant (x2 =369.5,P<0.001),but also higher than individual UE(x2 =332.2,P<0.001).Conclusion:The standard scoring indicators under the premise of establishing evaluation system of ultrasonic (UT joint UE) for differential diagnosis of benign and malignant breast masses with high clinical value,you can improve the sensitivity and accuracy of diagnosis of breast cancer,early diagnosis and preoperative staging of breast cancer with important reference value.%目的:探讨常规超声结合弹性成像(ultrasonic elastography,UE)对乳腺癌诊断的临床价值.方法:502例患者,共567个肿块纳入本研究,分为良性组及恶性组,对比2组患者间临床资料差异有无统计学意义.结果:常规超声联合UE诊断乳腺癌的敏感性为93.8%,特异性为88.1%,准确性为90.3%,敏感性和准确性均高于常规超声,差异有统计学意义(x2=369.5,P<0.001),同时也高于单项UE(x2 =332.2,P<0.001).结论:在规范评分指标的前提下常规超声联合UE对鉴别乳腺良恶性肿块具有较高的临床应用价值,可提高诊断乳腺癌的敏感性和准确性,对乳腺癌的早期诊断及术前分期具有重要参考价值.

  2. 应用RDC/TMD评估我国颞下颌关节紊乱病患者轴Ⅱ诊断的研究%Research diagnostic criteria for temporomandibular disorders for evaluating axis diagnosis of TMD patients in China

    Institute of Scientific and Technical Information of China (English)

    陈伟生; 郑有华; 林雪峰

    2013-01-01

    Objective To assess the axisⅡdiagnosis of TMD patients in China who seek treatment for TMD using Re-search Diagnostic Criteria for TMD(RDC/TMD). Methods Clinical data of the TMD patients were collected using the RDC/TMD. Results A total of 142 TMD patients were surveyed and examined clinically. There were 133 valid scales involving 9 with missing data. There were 38 men and 95 women with the ratio of 1:2.5. Patients suffered from TMD were commonly seen at the age between 18 and 44,and 67.7%of TMD patients received college education;the income of 84.2% TMD patients were below 5000yuan. The axis diagnosis indicated that there were psychological distress and psychosocial dysfunction in TMD patients with no statistical significance among different demography situation (P >0.05). The TMD patients’depressive symptoms were clearly associated with widespread non-specific physical symptoms even when pain items were excluded from the calculation to reduce the effects of pain co-morbidity(P0.05);抑郁症状与非特异性生理症状相关性分析显示,二者呈正相关(P<0.05)。结论 TMD患者存在不同程度抑郁症状和非特异性生理症状;TMD主要影响颌骨的咀嚼、吃硬食物和打呵欠等功能;TMD患者的抑郁症状与非特异性生理症状呈正相关关系。

  3. Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

    Directory of Open Access Journals (Sweden)

    Salvatore Gizzo

    2014-01-01

    Full Text Available The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT. 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known. The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s., underdiagnosis in 25.6% versus 41.4% (P<0.05, and overdiagnosis in 11.6% versus 0% (P<0.01. Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13, laparoscopic approach (OR: 2.18, mucinous histotype (OR: 2.23, low grading (OR: 1.30, and FIGO stage I (OR: 2.53. Ultrasound detection of papillae (OR: 0.29, septa (OR: 0.39, atypical vascularization (OR: 0.34, serum He4 assay (OR: 0.39, and ROMA score assessment (OR: 0.44 decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

  4. Terminology and details of the diagnostic process for testis cancer.

    LENUS (Irish Health Repository)

    Connolly, Stephen S

    2011-03-01

    We examined the process and causes of diagnostic delay, defined as the interval from symptom onset to diagnosis, for testis (germ cell) cancer and the change with time. Diagnostic delay influences disease burden and may be subdivided into symptomatic interval, defined as symptom onset to first presentation, and diagnostic interval, defined as first presentation to diagnosis.

  5. Diagnosis, assessment, and treatment of hypersexuality.

    Science.gov (United States)

    Kaplan, Meg S; Krueger, Richard B

    2010-03-01

    This article reviews the current evidence base for the diagnosis, assessment, and treatment of hypersexual conditions. Controversy concerning this diagnosis is discussed. Terminology and diagnostic criteria, as well as psychological, psychopharmacological, and other treatment approaches, are presented.

  6. Human conjunctivitis. I. Diagnostic evaluation.

    Science.gov (United States)

    Leibowitz, H W; Pratt, M V; Flagstad, I J; Berrospi, A R; Kundsin, R

    1976-10-01

    One hundred forty-three patients (207 eyes) with conjunctivitis or blepharoconjunctivitis were studied. Attempts were made to establish an etiologic diagnosis by clinical and laboratory methods. The etiologic diagnosis that was made on the basis of the initial clinical examination correlated poorly with the results of standard laboratory tests. Conversely, the standard laboratory evaluation failed to establish a definitive diagnosis in the majority of cases. These findings suggest that the diagnostic dogmatism prevalent in conjunctivitis is unwarranted. Morphologic signs and routine laboratory tests leave us without a verified etiologic diagnosis in a substantial number of cases.¿

  7. Diagnostic value of medical thoracoscopy for improvement diagnosis accuracy in pleural effusion%内科胸腔镜在提高胸腔积液诊断率中的价值

    Institute of Scientific and Technical Information of China (English)

    侯刚; 王玮; 胡雪君; 王秋月; 李振华; 康健

    2012-01-01

    cytological examinations of pleura] effusion was evaluated. Twenty-seven patients whose diagnosis were not obtained by thoracocentesis and cellular examinations, and 2 cases of malignant pleura) effusion without pathologically determined diagnosis received medical thoracoscopy. The combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations were compared. Results Among the 311 patients, 30 cases were diagnosed as malignant pleural effusion; the other 231 cases had not diagnosed by cytological examinations, but finally confirmed by the methods of individual conditions, medical thoracoscopy and/or bronchoscopy, pulmonary artery CT scan and clinical information. The diagnosis of 231 cases were as follows: 106 cases of malignant pleural effusion, 91 cases of benign pleural effusion, 34 cases were undetermined. The positive diagnosis rate of pleural effusion by cytological examinations only was 28.9 % (80/277). Among twenty-nine cases received medical thoracoscopy, 25 cases got the definite diagnosis with positive diagnosis rate as 86.2 %. The total positive diagnosis rate was improved by the combination of medical thoracoscopy and the method of thoracocentesis and cellular examinations by 37.9 % (105/277), which was significantly higher than that of simple cellular examination (P = 0.024). The diagnosis rate was not improved in pleural effusion cytology of more than 3 times than 2 times, but the expense was higher than that of medical thoracoscopy. Conclusion It is demonstrated that medical thoracoscopy is a safe and effective method to diagnose the pleural effusion of unknown origin with relative high positive diagnostic rate. When twice thoracentesis and cytological examinations have not produced positive diagnosis, medical thoracoscopy should be performed if there is no contraindications exist.

  8. Applications of unity-axial and multiaxial diagnostic system in the diagnosis of personality disorder%等级诊断和多轴诊断体系在人格障碍诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    张天宏; 蒋文晖; 王兰兰; 肖泽萍; 戴云飞; 张海音; 仇剑崟; 王振; 俞峻翰; 吴艳茹

    2011-01-01

    目的 了解等级诊断和多轴诊断体系在人格障碍诊断中的应用.方法 对随机抽样的3075例精神科门诊患者进行人格障碍调查.以人格障碍诊断问卷为筛查工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)配套的轴Ⅱ人格障碍临床访谈(SCID-Ⅱ)对筛查阳性者进行面检并作出诊断.同时,根据中国精神障碍分类与诊断标准(CCMD-3)对患者的PD患病情况作出临床诊断.结果 根据DSM-IV多轴诊断体系,3075例门诊患者中982例(31.93%)符合人格障碍诊断标准,以回避型(8.10%)和强迫型(7.58%)人格障碍最为常见,其中44.40%(436/982)合并两种或以上人格障碍.而根据CCMD-3诊断体系明确诊断人格障碍的仅9例(0.3%).结论 精神专科医院门诊患者中人格障碍较为常见,DSM-Ⅳ诊断体系对人格障碍的诊断较国内目前的临床诊断体系敏感.%Objective To explore the applications of unity-axial and multiaxial diagnostic system in the diagnosis of personality disorder ( PD) in psychiatric outpatient clinics in China. Methods Three thousand seventy five patients were randomly sampled from psycho-counselling and psychiatric clinics in Shanghai. PDs were assessed by using personality diagnostic questionnaire ( PDQ4 + ) and structured clinical interview for DSM-IV Axis II ( SCID-II) . The clinical diagnoses of outpatients were made according to the CCMD-3 diagnosis criterion. Results According to DSM-IV, the prevalence of PD was 31. 93% (982 subjects) , and avoidant (8. 10% ) and obsessive-compulsive (7. 58% ) PD were the most prevalent types. 44. 40% ( 436/982) outpatients had more than two types of PD, while only 9 outpatients had PD diagnosed by CCMD-3. Conclusions There is higher prevalence rate of DSM-IV PDs in psychiatric: outpatients, suggesting that DSM-IV diagnostic system may he more sensitive than CCMD-3 in identifying PDs in outpatient clinics.

  9. Analysis of the diagnostic value and missed diagnosis of old myocardial infarction electrocardiogram%心电图对陈旧性心肌梗死的诊断价值及漏诊原因分析

    Institute of Scientific and Technical Information of China (English)

    程阳

    2015-01-01

    目的:探讨心电图对陈旧性心肌梗死的诊断价值以及其漏诊的原因,为临床合理利用心电图提供理论依据。方法:收治陈旧性心肌梗死患者80例为研究组,对其临床资料进行回顾性分析,另收治非心肌梗死患者80例为对照组,两组患者均采用心电图进行检测并记录12导心电图数据、图形,探讨心电图对陈旧性心肌梗死诊断的准确性、特异性以及敏感性。结果:心电图对陈旧性心肌梗死诊断的准确性、特异性以及敏感性分别是63.13%、70%、56.25%,在冠脉病变程度上诊断正确和漏诊患者之间差异有统计学意义(P<0.05)。结论:心电图对陈旧性心肌梗死的诊断的特异性高,但是敏感性及准确性都较低,易出现漏诊状况,造成漏诊的原因与冠脉病变程度密不可分。%Objective:To discuss the diagnostic value and missed diagnosis of old myocardial infarction electrocardiogram,to provide a theoretical basis for clinical rational use of electrocardiogram.Methods:80 patients with old myocardial infarction were selected as the research group.80 patients with non-myocardial infarction were selected as the control group.Two groups of patients with ECG were detected and recorded 12 lead ECG data,graphics,investigating the electrocardiogram on old myocardial infarction diagnosis accuracy,specificity and sensitivity.Results:Electrocardiogram in old myocardial infarction diagnosis accuracy, specificity and sensitivity were 63.13%,70%,56.25%.The correct diagnosis group and the misdiagnosis group had statistically significant difference between the degree of coronary artery disease (P<0.05).Conclusion:The specificity of ECG diagnosis of old myocardial infarction is high,but the sensitivity and accuracy are low.Proning to misdiagnosis condition,causing the misdiagnosis reasons and the severity of coronary artery disease are closely related.

  10. Diagnosis of urticaria.

    Science.gov (United States)

    Schoepke, Nicole; Doumoulakis, Georgios; Maurer, Marcus

    2013-05-01

    Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism.

  11. Diagnosis of urticaria

    Directory of Open Access Journals (Sweden)

    Nicole Schoepke

    2013-01-01

    Full Text Available Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism.

  12. Diagnosis of urticaria

    OpenAIRE

    Nicole Schoepke; Georgios Doumoulakis; Marcus Maurer

    2013-01-01

    Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism.

  13. Diagnosis of urticaria

    Science.gov (United States)

    Schoepke, Nicole; Doumoulakis, Georgios; Maurer, Marcus

    2013-01-01

    Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism. PMID:23723473

  14. [Diagnosis: synovial fluid analysis].

    Science.gov (United States)

    Gallo Vallejo, Francisco Javier; Giner Ruiz, Vicente

    2014-01-01

    Synovial fluid analysis in rheumatological diseases allows a more accurate diagnosis in some entities, mainly infectious and microcrystalline arthritis. Examination of synovial fluid in patients with osteoarthritis is useful if a differential diagnosis will be performed with other processes and to distinguish between inflammatory and non-inflammatory forms. Joint aspiration is a diagnostic and sometimes therapeutic procedure that is available to primary care physicians. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  15. A comparison between dopamine transporters imaging and perfusion SPECT with HMPAO-{sup 99m}Tc in the diagnosis of dementia with Lewy bodies; Comparaison des performances de l'imagerie des transporteurs dopaminergiques et de la tomoscintigraphie de perfusion cerebrale a l MPAO-{sup 99m}Tc dans le diagnostic de maladie a corps de Lewy diffus

    Energy Technology Data Exchange (ETDEWEB)

    Voitota, J.B.; Emptaz, A.; Szurhaj, W.; Steinling, M. [Unite d' Imagerie Fonctionnelle Cerebrale du Service Central de Medecine Nucleaire (France); Bombois, St.; Pasquier, F. [Hopital Roger-Salengro, CHRU de Lille, Centre Memoire de Ressources et de Recherche, 59 - Lille (France)

    2007-06-15

    Scintigraphic imaging of dementia relies today essentially on the study of brain single photo emission computed tomography (SPECT) perfusion, after intravenous injection of {sup 99m}Tc radiopharmaceutical. This paper is based on the guidelines published in October 2001 by the European Association of Nuclear medicine (http:// eanm.org). Dementia with Lewy bodies is the second cause of degenerative dementia. Differential diagnosis may be difficult, in spite of the emergence of standardized diagnostic criteria. Tomo-scintigraphy using iodine 123-labelled FP-CIT (DaTSCAN) could play a role in this process. Cerebral perfusion SPECT imaging is an important step of demented patient evaluation. We compared the diagnostic performance of both of these procedures in the diagnosis of dementia with Lewy bodies. We studied 15 patients; ten DaTSCAN and 14 cerebral perfusion studies were performed. Clinical diagnosis at the end of follow-up was established as the diagnostic reference. Cerebral perfusion SPECT showed a very low sensitivity (20%) and a good specificity (89%); considering a prevalence of dementia with Lewy bodies of 20%, positive predictive value (PPV) was 31% and negative predictive value (NPV) 82%. Performances of DaTSCAN tomo-scintigraphy were more encouraging, (sensitivity and specificity of 100%); predictive values are both of 100%. As a conclusion, DaTSCAN tomo-scintigraphy performs better than cerebral perfusion SPECT in the diagnosis of dementia with Lewy bodies and no conjoint or sequential use of those tests can be recommended. (authors)

  16. Pitfalls in diagnostic radiology

    Energy Technology Data Exchange (ETDEWEB)

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology

    2015-04-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  17. MJO Simulation Diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Waliser, D; Sperber, K; Hendon, H; Kim, D; Maloney, E; Wheeler, M; Weickmann, K; Zhang, C; Donner, L; Gottschalck, J; Higgins, W; Kang, I; Legler, D; Moncrieff, M; Schubert, S; Stern, W; Vitart, F; Wang, B; Wang, W; Woolnough, S

    2008-06-02

    The Madden-Julian Oscillation (MJO) interacts with, and influences, a wide range of weather and climate phenomena (e.g., monsoons, ENSO, tropical storms, mid-latitude weather), and represents an important, and as yet unexploited, source of predictability at the subseasonal time scale. Despite the important role of the MJO in our climate and weather systems, current global circulation models (GCMs) exhibit considerable shortcomings in representing this phenomenon. These shortcomings have been documented in a number of multi-model comparison studies over the last decade. However, diagnosis of model performance has been challenging, and model progress has been difficult to track, due to the lack of a coherent and standardized set of MJO diagnostics. One of the chief objectives of the US CLIVAR MJO Working Group is the development of observation-based diagnostics for objectively evaluating global model simulations of the MJO in a consistent framework. Motivation for this activity is reviewed, and the intent and justification for a set of diagnostics is provided, along with specification for their calculation, and illustrations of their application. The diagnostics range from relatively simple analyses of variance and correlation, to more sophisticated space-time spectral and empirical orthogonal function analyses. These diagnostic techniques are used to detect MJO signals, to construct composite life-cycles, to identify associations of MJO activity with the mean state, and to describe interannual variability of the MJO.

  18. Energy efficiency; Efficacite energetique

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-06-15

    This road-map proposes by the Group Total aims to inform the public on the energy efficiency. It presents the energy efficiency and intensity around the world with a particular focus on Europe, the energy efficiency in industry and Total commitment. (A.L.B.)

  19. Invasive mycoses: diagnostic challenges.

    Science.gov (United States)

    Ostrosky-Zeichner, Luis

    2012-01-01

    Despite the availability of newer antifungal drugs, outcomes for patients with invasive fungal infections (IFIs) continue to be poor, in large part due to delayed diagnosis and initiation of appropriate antifungal therapy. Standard histopathologic diagnostic techniques are often untenable in at-risk patients, and culture-based diagnostics typically are too insensitive or nonspecific, or provide results after too long a delay for optimal IFI management. Newer surrogate markers of IFIs with improved sensitivity and specificity are needed to enable earlier diagnosis and, ideally, to provide prognostic information and/or permit therapeutic monitoring. Surrogate assays should also be accessible and easy to implement in the hospital. Several nonculture-based assays of newer surrogates are making their way into the medical setting or are currently under investigation. These new or up-and-coming surrogates include antigens/antibodies (mannan and antimannan antibodies) or fungal metabolites (d-arabinitol) for detection of invasive candidiasis, the Aspergillus cell wall component galactomannan used to detect invasive aspergillosis, or the fungal cell wall component and panfungal marker β-glucan. In addition, progress continues with use of polymerase chain reaction- or other nucleic acid- or molecular-based assays for diagnosis of either specific or generic IFIs, although the various methods must be better standardized before any of these approaches can be more fully implemented into the medical setting. Investigators are also beginning to explore the possibility of combining newer surrogate markers with each other or with more standard diagnostic approaches to improve sensitivity, specificity, and capacity for earlier diagnosis, at a time when fungal burden is still relatively low and more responsive to antifungal therapy.

  20. [Diagnostic criteria. Benefits of early diagnosis].

    Science.gov (United States)

    Gil Gregorio, Pedro

    2016-06-01

    Almost 36 million persons live with dementia worldwide. This figure is set to double by 2030, with 66 million patients, and by 2050 there will be 116 million affected persons. Dementia has an economic impact on individuals and health services and affects the global economy. It is important to evaluate costs to plan social services and healthcare and to provide information on the cost-effectiveness of treatments. The economic cost of dementia was around 604 billion dollars in 2010 and estimates are obviously set to rise. Copyright © 2016 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Peritoneal tuberculosis: radiographic diagnosis

    Directory of Open Access Journals (Sweden)

    Carolina Ospina-Moreno

    2014-12-01

    Full Text Available Peritoneal tuberculosis (TB is an extrapulmonary form of presentation of tuberculosis. HIV infection is a primary risk factor for this condition. Diagnosis requires microbiological or histopathological confirmation in addition to supporting radiological imaging studies. Abdominal ultrasonography and CT are useful to obtain a radiographic diagnosis, with typical findings including diffuse peritoneal thickening, presence of ascites in varying volumes, adenopathies, and caseating nodes. We report 2 cases of patients with ascites and nodular peritoneal thickening on diagnostic images, as well as high CA-125 levels in laboratory tests. In both patients, a diagnosis of peritoneal tuberculosis was reached following a US-guided peritoneal biopsy.

  2. Lupus vulgaris: difficulties in diagnosis.

    Science.gov (United States)

    Rhodes, Julia; Caccetta, Tony Philip; Tait, Clare

    2013-05-01

    Lupus vulgaris is one of the most common forms of cutaneous tuberculosis. It presents a diagnostic challenge due to its paucibacillary nature. This is a report of a case of a delayed diagnosis of lupus vulgaris, presenting as perianal and peristomal plaques, followed by a review of the diagnostic tools for lupus vulgaris and their limitations.

  3. Diagnostics of halitosis complaints by a multidisciplinary team

    NARCIS (Netherlands)

    Baat, Cees de; Mulder, J.; Broek, A.M. van den; Feenstra, L.

    2014-01-01

    AIM: The study objective was to collect diagnostic data, to explore correlations between diagnostic variables, to provide an accurate initial diagnosis, and to provide appropriate management in consecutive subjects consulting with a multidisciplinary halitosis team because of a halitosis complaint.

  4. Diagnostics of halitosis complaints by a multidisciplinary team

    NARCIS (Netherlands)

    Baat, Cees de; Mulder, J.; Broek, A.M. van den; Feenstra, L.

    2014-01-01

    AIM: The study objective was to collect diagnostic data, to explore correlations between diagnostic variables, to provide an accurate initial diagnosis, and to provide appropriate management in consecutive subjects consulting with a multidisciplinary halitosis team because of a halitosis complaint.

  5. Differential diagnostic algorithm for diseases manifested with heart murmurs syndrome.

    Science.gov (United States)

    Naumov, Leonid B

    2009-08-01

    Diagnostic interpretation at auscultation of heart murmurs is accompanied by frequent errors. It creates serious clinical, pedagogical, organizational and social problems. The standard nosological principle of a clinical information description from the diagnosis (a disease name) to the description of symptoms/signs contradicts to real clinical practice from revealing of symptoms through differential diagnostics to a diagnosis establishment. The differential diagnostic algorithm or diagnostic algorithm developed by the author, is based on the opposite syndromic principle of thinking - from the signs to the diagnosis. It completely corresponds to the practical purposes of reliable diagnostics of 35 illnesses, manifested by heart murmurs at a heart auscultation.

  6. [Diagnosis of functional bowel diseases].

    Science.gov (United States)

    Kruis, W

    2007-02-28

    Functional bowel disorders cause frequent doctor visits. The term comprises various disease entities. Most frequent are the irritable bowel syndrome, functional constipation and functional diarrhea. An exact history plays an outstanding role for the diagnosis of all these entities. History either confirms a positive diagnosis or initiates some complementary investigations. Redundant and dangerous technical procedures should be avoided in the diagnostic work up.

  7. Diagnostic approaches for cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine- needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.

  8. Diagnosis of Pompe disease

    DEFF Research Database (Denmark)

    Vissing, John; Lukacs, Zoltan; Straub, Volker

    2013-01-01

    of the methods used in the diagnosis and differential diagnosis of late-onset Pompe disease. Muscle biopsy is commonly used as an early diagnostic tool in the evaluation of muscle disease. However, experience has shown that relying solely on visualizing a periodic acid-Schiff-positive vacuolar myopathy...... will improve patient outcomes as care standards including enzyme replacement therapy can be applied and complications can be anticipated. Increased awareness of the clinical phenotype of Pompe disease is therefore warranted to expedite diagnostic screening for this condition with blood-based enzymatic assays.......The diagnosis of Pompe disease (acid maltase deficiency, glycogen storage disease type II) in children and adults can be challenging because of the heterogeneous clinical presentation and considerable overlap of signs and symptoms found in other neuromuscular diseases. This review evaluates some...

  9. [Polar body diagnosis].

    Science.gov (United States)

    Montag, M; van der Ven, K; van der Ven, H

    2009-01-01

    Polar body diagnosis (PBD) is a diagnostic method for the indirect genetic analysis of oocytes. Polar bodies are by-products of the meiotic cell cycle which have no influence on further embryo development. The biopsy of polar bodies can be accomplished either by zona drilling or laser drilling within a very short time period. The paternal contribution to the genetic constitution of the developing embryo cannot be diagnosed by PBD. The major application of PBD is the detection of maternally derived chromosomal aneuploidies and translocations in oocytes. For these indications, PBD may offer a viable alternative to blastomere biopsy as the embryo's integrity remains unaffected in contrast to preimplantation genetic diagnosis by blastomere biopsy. The fast development in the field of molecular diagnostics will also influence PBD and probably allow a more general diagnosis in the future.

  10. 毛细管电泳在产前诊断地中海贫血中的应用%DIAGNOSTIC UTILITY OF CAPILLARY ELECTROPHORESIS IN PRENATAL DIAGNOSIS SCREENING FOR THALASSEMIA

    Institute of Scientific and Technical Information of China (English)

    郭浩; 郭莉; 唐斌; 陈汉彪; 杜丽; 王奕霞

    2015-01-01

    Objective To study the diagnostic utility of capillary electrophoresis in prenatal diagnosis screening for thalassemia .Methods Between January 2013 and June 2014, 286 pregnant women were recruited who attended the prenatal diagnosis screening for thalassemia with hemoglobin electrophoresis and genetic testing at third term.Results With the genetic testing , 83 cases were normal;21 cases were homozygous α-thalassemia;13 cases wereα-thalassemia intermedia;86 cases were mildα-thalassemia;11 cases were'silent'α-thalassemia.Besides, 15 cases were homozygous β-thalassemia;51 cases were heterozygotes β-thalassemia;6 cases were compound het-erozygotes mutation of the αand β-globin chain gene .The results showed that increased Hb Bart's level or the pro-portion of Hb A in fetuses could be induced by the severity of thalassemia .Conclusion Capillary electrophoresis was definitely helpful in prenatal diagnosis screening for thalassemia at the third term .%目的:探讨毛细管电泳技术在产前诊断地中海贫血中的应用价值。方法2013年1月~2014年6月期间在本院因夫妇双方为同型地中海贫血为产前诊断指征且孕周为24~34周的就诊病例286例。对脐带穿刺后获取的脐血标本进行血红蛋白毛细管电泳和地中海贫血基因诊断。结果286例标本中,正常83例,巴氏水肿胎21例, Hb H 13例,轻型α-地贫86例,静止型α-地贫11例,重型β-地贫15例,轻型β-地贫51例,α复合β-地贫6例。脐血血红蛋白组成分析显示α-地贫胎儿脐血Hb Bart ’ s百分含量随受累α-珠蛋白基因个数的增加而增多,β-地贫胎儿脐血Hb A百分含量随受累β-珠蛋白基因个数的增加而减少。结论毛细管电泳能辅助诊断孕晚期胎儿α地中海贫血及β地中海贫血。

  11. Diagnostic interval and mortality in colorectal cancer

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Frydenberg, Morten; Hamilton, William;

    2012-01-01

    Objective To test the theory of a U-shaped association between time from the first presentation of symptoms in primary care to the diagnosis (the diagnostic interval) and mortality after diagnosis of colorectal cancer (CRC). Study Design and Setting Three population-based studies in Denmark...... presentation, the association between the length of the diagnostic interval and 5-year mortality rate after the diagnosis of CRC was the same for all three types of data: displaying a U-shaped association with decreasing and subsequently increasing mortality with longer diagnostic intervals. Conclusion Unknown...... confounding and in particular confounding by indication is likely to explain the counterintuitive findings of higher mortality among patients with very short diagnostic intervals, but cannot explain the increasing mortality with longer diagnostic intervals. The results support the theory that longer...

  12. Painful Shoulder in Swimmers: A Diagnostic Challenge.

    Science.gov (United States)

    McMaster, William C.

    1986-01-01

    This article discusses the incidence, diagnosis, and treatment of painful shoulder in swimmers, including: regional problems that can cause shoulder pain; physical, clinical, and laboratory tests for diagnostic use; and approaches to management of the problem. (Author/CB)

  13. Diagnostic evaluation of dysphagia.

    Science.gov (United States)

    Cook, Ian J

    2008-07-01

    Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

  14. Nanobiosensors in diagnostics

    Directory of Open Access Journals (Sweden)

    Alejandro Chamorro-Garcia

    2016-11-01

    Full Text Available Medical diagnosis has been greatly improved thanks to the development of new techniques capable of performing very sensitive detection and quantifying certain parameters. These parameters can be correlated with the presence of specific molecules and their quantity. Unfortunately, these techniques are demanding, expensive, and often complicated. On the other side, progress in other fields of science and technology has contributed to the rapid growth of nanotechnology. Although being an emerging discipline, nanotechnology has raised huge interest and expectations. Most of the enthusiasm comes from new possibilities and properties of nanomaterials. Biosensors (simple, robust, sensitive, cost-effective combined with nanomaterials, also called nanobiosensors, are serving as bridge between advanced detection/diagnostics and daily/routine tests. Here we review some of the latest applications of nanobiosensors in diagnostics field.

  15. Cardiovascular modeling and diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Kangas, L.J.; Keller, P.E.; Hashem, S.; Kouzes, R.T. [Pacific Northwest Lab., Richland, WA (United States)

    1995-12-31

    In this paper, a novel approach to modeling and diagnosing the cardiovascular system is introduced. A model exhibits a subset of the dynamics of the cardiovascular behavior of an individual by using a recurrent artificial neural network. Potentially, a model will be incorporated into a cardiovascular diagnostic system. This approach is unique in that each cardiovascular model is developed from physiological measurements of an individual. Any differences between the modeled variables and the variables of an individual at a given time are used for diagnosis. This approach also exploits sensor fusion to optimize the utilization of biomedical sensors. The advantage of sensor fusion has been demonstrated in applications including control and diagnostics of mechanical and chemical processes.

  16. Astrovirus Diagnostics

    Science.gov (United States)

    Pérot, Philippe; Lecuit, Marc; Eloit, Marc

    2017-01-01

    Various methods exist to detect an astrovirus infection. Current methods include electron microscopy (EM), cell culture, immunoassays, polymerase chain reaction (PCR) and various other molecular approaches that can be applied in the context of diagnostic or in surveillance studies. With the advent of metagenomics, novel human astrovirus (HAstV) strains have been found in immunocompromised individuals in association with central nervous system (CNS) infections. This work reviews the past and current methods for astrovirus detection and their uses in both research laboratories and for medical diagnostic purposes. PMID:28085120

  17. Diagnostic Criteria for Pediatric MS

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2013-06-01

    Full Text Available Investigators at Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago review the diagnostic criteria for pediatric multiple sclerosis, the differential diagnosis, the 2010 McDonald criteria, and Callen criteria.

  18. Diagnosis of skeletal muscle channelopathies.

    Science.gov (United States)

    Spillane, Jennifer; Fialho, Doreen; Hanna, Michael G

    2013-11-01

    Skeletal muscle channelopathies are rare disorders of muscle membrane excitability. Their episodic nature may result in diagnostic difficulty and delays in diagnosis. Advances in diagnostic clinical electrophysiology combined with DNA-based diagnosis have improved diagnostic accuracy and efficiency. Ascribing pathogenic status to identified genetic variants in muscle channel genes may be complex and functional analysis, including molecular expression, may help with this. Accurate clinical and genetic diagnosis enables genetic counselling, advice regarding prognosis and aids treatment selection. An approach to accurate and efficient diagnosis is outlined. The importance of detailed clinical evaluation including careful history, examination and family history is emphasised. The role of specialised electrodiagnostics combined with DNA testing and molecular expression is considered. New potential biomarkers including muscle MRI using MRC Centre protocols are discussed. A combined diagnostic approach using careful clinical assessment, specialised neurophysiology and DNA testing will now achieve a clear diagnosis in most patients with muscle channelopathies. An accurate diagnosis enables genetic counselling and provides information regarding prognosis and treatment selection. Genetic analysis often identifies new variants of uncertain significance. In this situation, functional expression studies as part of a diagnostic service will enable determination of pathogenic status of novel genetic variants.

  19. Audiologic diagnostics of vestibular schwannoma

    Directory of Open Access Journals (Sweden)

    Komazec Zoran

    2004-01-01

    Full Text Available Introduction Vestibular schwannoma (acoustic neuroma is a rare, but important cause of sensorineural hearing loss. Patients with asymmetric hearing loss, or unilateral tinnitus should be evaluated expeditiously, to prevent further neurological damage. Audiologic diagnostics Audiologic diagnostics represents the basic diagnosis for early detection of vestibular schwannoma. Patients with vestibular schwannomas may present with a variety of clinical features, including retrocochlear pattern of sensorineural hearing loss. Supraliminary audiometry, tympano- metry, stapedius reflex and otoacoustic emissions as well as vestibular response to caloric testing are methods for selection of patients with suspicion of this tumor. Conclusion The golden standard for audiologic diagnostics of vestibular schwannoma is BAEP (Brainstem Auditory Evoked Potentials. Patients with pathological findings of BAEP should undergo MRI of the posterior fossa. Gadolinium-enhanced magnetic resonance imaging is the best and final tool for making a diagnosis of vestibular schwannoma.

  20. Improving tuberculosis diagnostics with biomarkers

    Directory of Open Access Journals (Sweden)

    Shu CC

    2015-05-01

    Full Text Available Chin-Chung Shu,1,2 Jann-Yuan Wang,2 Li-Na Lee,2,3 Chong-Jen Yu,2 Kwen-Tay Luh3 1Department of Traumatology, 2Department of Internal Medicine, 3Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan Abstract: Although many laboratory methods have been developed to expedite the diagnosis of active tuberculosis (TB and Mycobacterium tuberculosis (Mtb infection, delays in diagnosis remain a major problem in clinical practice. Biomarkers may contribute favorably or unfavorably to TB diagnosis in a clinical suspect TB case with inconclusive diagnostic findings. A good understanding of the effectiveness and practical limitations of these biomarkers is important to improve diagnosis. This review summarizes currently used biomarkers, mainly as validation, and focuses on latent TB infection, active pulmonary TB, and tuberculous pleural effusion. Keywords: tuberculosis, biomarker, diagnosis, latent tuberculosis infection, pleural effusion 

  1. Timely Diagnostic Feedback for Database Concept Learning

    Science.gov (United States)

    Lin, Jian-Wei; Lai, Yuan-Cheng; Chuang, Yuh-Shy

    2013-01-01

    To efficiently learn database concepts, this work adopts association rules to provide diagnostic feedback for drawing an Entity-Relationship Diagram (ERD). Using association rules and Asynchronous JavaScript and XML (AJAX) techniques, this work implements a novel Web-based Timely Diagnosis System (WTDS), which provides timely diagnostic feedback…

  2. Timely Diagnostic Feedback for Database Concept Learning

    Science.gov (United States)

    Lin, Jian-Wei; Lai, Yuan-Cheng; Chuang, Yuh-Shy

    2013-01-01

    To efficiently learn database concepts, this work adopts association rules to provide diagnostic feedback for drawing an Entity-Relationship Diagram (ERD). Using association rules and Asynchronous JavaScript and XML (AJAX) techniques, this work implements a novel Web-based Timely Diagnosis System (WTDS), which provides timely diagnostic feedback…

  3. [Progresses in the diagnosis of allergy].

    Science.gov (United States)

    Nieto, Antonio; Nieto, María; Mazón, Angel

    2014-01-01

    The traditional diagnosis of allergy by Prick tests and/or RAST offers very limited information about the real nature of allergic problems and of their clinical, therapeutic and prognostic implications. The diagnosis by allergic components (natural or recombinant) suppose a great qualitative step leading a great improving in the diagnosis and treatment of allergic patients, because its use with clinical history and other diagnostic in vivo or in vitro methods improve importantly the diagnostic accuracy.

  4. Diagnostic Delay in Women with Endometriosis

    Institute of Scientific and Technical Information of China (English)

    Xiao-man Ding; Jing-he Lang

    2005-01-01

    @@ Women affected by endometriosis claim that delayed diagnosis of endometriosis is a great problem. Studies have shown a delay from 3 to 11 years between the onset of pain symptom and the final diagnosis of endometriosis. But the diagnostic time of Chinese patients has not been reported.

  5. The Autism Diagnostic Experiences of French Parents

    Science.gov (United States)

    Chamak, Brigitte; Bonniau, Beatrice; Oudaya, Lila; Ehrenberg, Alain

    2011-01-01

    This survey focused on French parents' views of the diagnostic process relating to their child with autism. Data were collected on the age at diagnosis, the time taken to obtain a diagnosis and the difficulties encountered. Questionnaires filled in by the parents (n = 248) and in-depth interviews (n = 43) were analyzed in order to obtain…

  6. Comparison of tomodensitometry in helicoidal mode with echo endoscopy in the diagnosis and the result of pancreas adenomas; Comparaison de la tomodensitometrie en mode helicoidal et de l`echoendoscopie dans le diagnostic et le bilan des adenomes du pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Dufor, B.; Zins, M.; Vilgrain, V.; Levy, P.; Bernardes, P.; Menu, Y. [Hopital Beaujon, 92 - Clichy (France)

    1997-09-01

    This study confirms the complementarity of the tomodensitometry in helical mode and echo endoscopy in the diagnosis of pancreas adenocarcinomas. It suggests that the tomodensitometry in helical mode is superior to echo-endoscopy for the diagnosis of malignancy and vascular invasion and echo-endoscopy is superior to tomodensitometry in helical mode for the diagnosis of ganglions invasion. The results have to be confirmed by a prospective study bearing on a big number of operated patients. (N.C.).

  7. Chronic Meningitis: Simplifying a Diagnostic Challenge.

    Science.gov (United States)

    Baldwin, Kelly; Whiting, Chris

    2016-03-01

    Chronic meningitis can be a diagnostic dilemma for even the most experienced clinician. Many times, the differential diagnosis is broad and encompasses autoimmune, neoplastic, and infectious etiologies. This review will focus on a general approach to chronic meningitis to simplify the diagnostic challenges many clinicians face. The article will also review the most common etiologies of chronic meningitis in some detail including clinical presentation, diagnostic testing, treatment, and outcomes. By using a case-based approach, we will focus on the key elements of clinical presentation and laboratory analysis that will yield the most rapid and accurate diagnosis in these complicated cases.

  8. Use of general practice, diagnostic investigations and hospital services before and after cancer diagnosis - a population-based nationwide registry study of 127,000 incident adult cancer patients

    DEFF Research Database (Denmark)

    Christensen, Karina Garnier; Fenger-Grøn, Morten; Flarup, Kaare Rud;

    2012-01-01

    ,272,100 controls. Monthly consultation frequencies, monthly proportions of persons receiving health services and three-month incidence rate ratios for one year before and one year after the cancer diagnosis were calculated. Data were analysed separately for women and men. RESULTS: Three months before...... one month after diagnosis and the number of hospital contacts three months after diagnosis. The proportion of cancer patients receiving each of these three types of health services remained more than 10% above that of the reference population from two months before diagnosis until the end of the study...

  9. [Novel methods for dementia diagnostics].

    Science.gov (United States)

    Wiltfang, J

    2015-04-01

    Novel diagnostic methods, such as cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) and [18F] amyloid positron emission tomography (PET) are meanwhile recommended for specific indications by international guidelines for the improved early and differential diagnostics of multigenic (sporadic) Alzheimer's dementia (AD). In the case of CSF-NDD the German neuropsychiatric guidelines have already been validated on the S3 level of evidence (http://www.DGPPN.de) and the additional consideration of [18F] amyloid-PET in the current update of the guidelines is to be expected. By means of CSF-NDD and/or [18F] amyloid-PET a predictive diagnosis of incipient (preclinical) AD is also possible for patients at high risk for AD who are in prodromal stages, such as mild cognitive impairment (MCI). As accompanying (secondary) preventive therapy of AD cannot be offered a predictive molecular dementia diagnostics is not recommended by the German neuropsychiatric dementia guidelines (http://www.DGPPN.de). However, novel diagnostic approaches, which offer molecular positive diagnostics of AD have already gained high relevance in therapy research as they allow promising preventive treatment avenues to be validated directly in the clinical trial. Moreover, future blood-based dementia diagnostics by means of multiplex assays is becoming increasingly more feasible; however, so far corresponding proteomic or epigenetic assays could not be consistently validated in independent studies.

  10. Diagnosis of acute neuropathies

    DEFF Research Database (Denmark)

    Crone, Clarissa; Krarup, Christian

    2007-01-01

    Acute and subacute polyneuropathies present diagnostic challenges since many require prompt initiation of treatment in order to limit axonal degeneration and since an exact and detailed diagnosis is a prerequisite for making the correct choice of treatment. It is for instance of utmost importance...... to recognize whether the underlying pathological changes are due to demyelination or to axonal degeneration and electrodiagnostic tests can thus in most cases contribute considerably to the securing of an exact diagnosis. The specific and characteristic electrophysiological findings in the different types...

  11. Teaching Posttraining : Influencing Diagnostic Strategy with Instructions at Test

    Science.gov (United States)

    Kulatunga-Moruzi, Chan; Brooks, Lee R.; Norman, Geoffrey R.

    2011-01-01

    It is believed that medical diagnosis involves two complementary processes, analytic and similarity-based. There is considerable debate as to which of these processes defines diagnostic expertise and how best to teach clinical diagnosis and reduce diagnostic errors. The purpose of these studies is to document the use of these strategies in medical…

  12. Teaching Posttraining : Influencing Diagnostic Strategy with Instructions at Test

    Science.gov (United States)

    Kulatunga-Moruzi, Chan; Brooks, Lee R.; Norman, Geoffrey R.

    2011-01-01

    It is believed that medical diagnosis involves two complementary processes, analytic and similarity-based. There is considerable debate as to which of these processes defines diagnostic expertise and how best to teach clinical diagnosis and reduce diagnostic errors. The purpose of these studies is to document the use of these strategies in medical…

  13. Diagnostic complexities of eosinophilia.

    Science.gov (United States)

    Montgomery, Nathan D; Dunphy, Cherie H; Mooberry, Micah; Laramore, Andrew; Foster, Matthew C; Park, Steven I; Fedoriw, Yuri D

    2013-02-01

    The advent of molecular tools capable of subclassifying eosinophilia has changed the diagnostic and clinical approach to what was classically called hypereosinophilic syndrome. To review the etiologies of eosinophilia and to describe the current diagnostic approach to this abnormality. Literature review. Eosinophilia is a common, hematologic abnormality with diverse etiologies. The underlying causes can be broadly divided into reactive, clonal, and idiopathic. Classically, many cases of eosinophilia were grouped together into the umbrella category of hypereosinophilic syndrome, a clinical diagnosis of exclusion. In recent years, an improved mechanistic understanding of many eosinophilias has revolutionized the way these disorders are understood, diagnosed, and treated. As a result, specific diagnoses can now be assigned in many cases that were previously defined as hypereosinophilic syndrome. Most notably, chromosomal rearrangements, such as FIP1L1-PDGFRA fusions caused by internal deletions in chromosome 4, are now known to be associated with many chronic eosinophilic leukemias. When present, these specific molecular abnormalities predict response to directed therapies. Although an improved molecular understanding is revolutionizing the treatment of patients with rare causes of eosinophilia, it has also complicated the approach to evaluating and treating eosinophilia. Here, we review causes of eosinophilia and present a framework by which the practicing pathologist may approach this diagnostic dilemma. Finally, we consider recent cases as clinical examples of eosinophilia from a single institution, demonstrating the diversity of etiologies that must be considered.

  14. Neuroleptic malignant syndrome: the diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Ivana Stasevic Karlicic

    2016-07-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a life-threatening, often fatal idiosyncratic reaction to neuroleptic or other drug therapies that antagonise the central dopaminergic neurotransmission. The clinical presentation of NMS is very heterogeneous. The lack of specific levels of symptom severity in currently used diagnostic criteria dims the diagnosis of NMS. Therefore differential diagnosis is of priority, because NMS is a diagnosis of exclusion. The aim of this paper is to present a complex clinical picture in a patient that after a differential diagnostic exclusion of other medical conditions and intoxications is diagnosed as NMS. Case reports such as these help raise awareness of this clinical issue.

  15. Diagnostic Challenges in AIH

    Directory of Open Access Journals (Sweden)

    A Taghavi Ardakani

    2014-04-01

    Full Text Available Autoimmune hepatitis is a chronic hepatitis that occurs in children and adults of all ages. Diagnosis is based upon characteristic serologic and histologic findings and the exclusion of other forms of chronic liver disease. Guidelines issued by the AASLD suggest the following diagnostic considerations: The diagnosis should be made in patients with compatible clinical signs, symptoms, and laboratory abnormalities. Other conditions that can cause chronic hepatitis should be excluded. In unclear cases a standardized scoring system should be used in the assessment. In those who are negative for conventional autoantibodies, additional autoantibodies should be sought. All patients with autoimmune hepatitis and inflammatory bowel disease should undergo cholangiographic studies to exclude primary sclerosing cholangitis.   Scoring systems- A scoring system developed and subsequently revised by the International Autoimmune Hepatitis Group to standardize the diagnosis with using simplified criteria based upon titers of autoantibodies, IgG levels, liver histology, and the exclusion of viral hepatitis. Autoantibodies: assign one point if the ANA or SMA are 1:40 OR assign two points if the ANA or SMA are ≥1:80 (OR if the LKM ≥1:40 OR if the SLA is positive. IgG: assign one point if the IgG is > the upper limit of normal OR assign two points if the IgG is >1.10 times the upper limit of normal. Liver histology: assign one point if the histological features are compatible with autoimmune hepatitis OR two points if the histological features are typical of autoimmune hepatitis. Absence of viral hepatitis A probable diagnosis of autoimmune hepatitis is made if the total points are six, while a definite diagnosis is made if the total points are ≥seven.  

  16. MAT FOR LEPTOSPIROSIS DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Esti Rahardianingtyas.

    2014-06-01

    Full Text Available Leptospirosis is a disease caused by bacterial infection leptospira interrogans.Leptospira bacteria is a spiral bacterium with solid strands with two flagella periplasmik.Septicaemic phase patient samples taken from the blood and cerebrospinal fluid, whereassamples taken at phase immune extracted from urine. The diagnosis of leptospirosis occurdirectly or indirectly. Diagnosis is done by directly isolate and identify the causative agents ofthe agent. Diagnosis is done indirectly by detecting specific antibodies from the patient's body.Gold Standard of the diagnosis of leptospirosis is MAT. Mat made by reacting antibodies toleptospira antigen. Positive results seen with clump formed.Key words: Leptospirosis, Leptospirosis Diagnostic, MAT (Microscopic Agglutination Test Leptospirosis merupakan penyakit yang disebabkan karena infeksi bakteri leptospirainterrogans. Bakteri leptospira merupakan bakteri spiral dengan untaian yang padat dengan duaflagella periplasmik. Sampel pasien pada fase septicaemic diambil dari darah dan cairanserebrospinal, sedangkan sampel yang diambil pada fase immune diambil dari urine. Diagnosisleptospirosis dilakukan secara langsung maupun tidak langsung. Diagnosis secara langsungdilakukan dengan cara mengisolasi agen penyebab dan mengidentifikasi agen tersebut. Diagnosissecara tidak langsung dilakukan dengan cara mendeteksi antibodi spesiflk dari dalam tubuhpasien. Gold Standart dari diagnosis leptospirosis adalah MAT. Mat dilakukan dengan caramereaksikan antibodi dengan antigen leptospira. Hasil positif dilihat dengan terbentuk gumpalanagglutinasiKata kunci: Leptospirosis, Leptospira, Leptospirosis Diagnosis.

  17. PET with {sup 18}F-F.D.G. in the diagnosis and the evolutionary follow up of solitary plasmocytomas; La TEP au {sup 18}F-FDG dans le diagnostic et le suivi evolutif des plasmocytomes solitaires

    Energy Technology Data Exchange (ETDEWEB)

    Adib, S.; Huglo, D.; Steinling, M. [Hopital Huriez, CHU de Lille, Service de medecine nucleaire, 59 (France); Leleu, X.; Robu, D. [Hopital Huriez, CHU de Lille, service des maladies du sang, 59 (France)

    2010-07-01

    Purpose: evaluate the contribution of PET with {sup 18}F-F.D.G. in the diagnostic assessment, post therapy evaluation and evolutionary follow-up of solitary plasmocytomas. Conclusions: the PET with {sup 18}F-F.D.G. seems to be an efficient diagnostic tool in the staging of solitary plasmocytomas and allows also to detect infra clinical injuries unknown by other imaging techniques. (N.C.)

  18. Optical Diagnostics in Medicine

    Science.gov (United States)

    Iftimia, Nicusor

    2003-03-01

    Light has a unique potential for non-invasive tissue diagnosis. The relatively short wavelength of light allows imaging of tissue at the resolution of histopathology. While strong multiple scattering of light in tissue makes attainment of this resolution difficult for thick tissues, most pathology emanates from epithelial surfaces. Therefore, high-resolution diagnosis of many important diseases may be achieved by transmitting light to the surface of interest. The recent fiber-optic implementation of technologies that reject multiple scattering, such as confocal microscopy and optical low coherence interferometry, have brought us one step closer to realizing non-invasive imaging of architectural and cellular features of tissue. Optical coherence tomography (OCT) can produce high-resolution cross-sectional images of biological structures. Clinical OCT studies conducted in the gastrointestinal tract and cardiovascular system have shown that OCT is capable of providing images of the architectural (> 20 µm) microanatomy of a variety of epithelial tissues, including the layered structure of squamous epithelium and arterial vessels. Fine Needle Aspiration- Low Coherence Interferometry (FNA-LCI) is another optical diagnostics technique, which is a suitable solution to increase the effectiveness of the FNA procedures. LCI is capable of measuring depth resolved (axial, z) tissue structure, birefringence, flow (Doppler shift), and spectra at a resolution of several microns. Since LCI systems are fiber-optic based, LCI probes may easily fit within the bore of a fine gauge needle, allowing diagnostic information to be obtained directly from the FNA biopsy site. Fiber optic spectrally encoded confocal microscopy (SECM) is a new confocal microscopy method, which eliminates the need for rapid beam scanning within the optical probe. This advance enables confocal microscopy to be performed through small diameter probes and will allow assessment of internal human tissues in vivo at

  19. Differentiating small (≤1 cm) focal liver lesions as metastases or cysts by means of computed tomography: a case-study to illustrate a fuzzy logic-based method to assess the impact of diagnostic confidence on radiological diagnosis.

    Science.gov (United States)

    Girometti, Rossano; Fabris, Francesco; Sgarro, Andrea; Zanella, Gloria; Pullini, Serena; Cereser, Lorenzo; Como, Giuseppe; Zuiani, Chiara; Bazzocchi, Massimo

    2014-01-01

    To quantify the impact of diagnostic confidence on radiological diagnosis with a fuzzy logic-based method. Twenty-two oncologic patients with 20 cysts and 30 metastases ≤1 cm in size found at 64-row computed tomography were included. Two readers (R1/R2) expressed diagnoses as a subjective level of confidence P(d) in malignancy within the interval [0,1] rather than on a "crisp" basis (malignant/benign); confidence in benignancy was 1 - p(d). When cross-tabulating data according to the standard of reference, 2 × 2 table cells resulted from the aggregation between p(d)/1 - p(d) and final diagnosis. We then assessed (i) readers diagnostic performance on a fuzzy and crisp basis; (ii) the "divergence" δ(F, C) (%) as a measure of how confidence impacted on crisp diagnosis. Diagnoses expressed with lower confidence increased fuzzy false positives compared to crisp ones (from 0 to 0.2 for R1; from 1 to 2.4 for R2). Crisp/fuzzy accuracy was 94.0%/93.6% (R1) and 94.0/91.6% (R2). δ(F, C) (%) was larger in the case of the less experienced reader (R2) (up to +7.95% for specificity). According to simulations, δ(F, C) (%) was negative/positive depending on the level of confidence in incorrect diagnoses. Fuzzy evaluation shows a measurable effect of uncertainty on radiological diagnoses.

  20. Cytological Punctures in the Diagnosis of Renal Tumours: A Study on Accuracy and Reproducibility

    DEFF Research Database (Denmark)

    Kümmerlin, Intan P E D; Smedts, Frank; ten Kate, Fiebo J W;

    2009-01-01

    BACKGROUND: Fine needle aspiration (FNA) cytology is under consideration as an auxiliary preoperative diagnostic technique in the diagnosis of renal masses. However, reports for FNA are contradictory with regard to diagnostic accuracy and applicability. OBJECTIVE: To evaluate the diagnostic accur...

  1. How to appraise a diagnostic test.

    Science.gov (United States)

    Manikandan, Ramanitharan; Dorairajan, Lalgudi N

    2011-10-01

    Urologists frequently encounter problems in making a clinical diagnosis whose resolution requires the use of diagnostic tests. With an ever increasing choice of investigations being available, the urologist often has to decide which diagnostic test(s) will best resolve the patient's diagnostic problem. In this article, we aim to help the urologist understand how to critically appraise studies on diagnostic tests and make a rational choice. This article presents the guiding principles in scientifically assessing studies on diagnostic tests by proposing a clinical scenario. The authors describe a standardized protocol to assess the validity of the test and its relevance to the clinical problem that can help the urologist in decision making. The three important issues to be considered when evaluating the validity of the study are to identify how the study population was chosen, how the test was performed and whether there is a comparison to the gold standard test so as to confirm or refute the diagnosis. Then, the urologist would need to know the probability of the test in providing the correct diagnosis in an individual patient in order to decide about its utility in solving the diagnostic dilemma. By performing the steps described in this article, the urologist would be able to critically appraise diagnostic studies and draw meaningful conclusions about the investigations in terms of validity, results and its applicability to the patient's problem. This would provide a scientific basis for using diagnostic tests for improving patient care.

  2. [Diagnosis of hereditary angioedema].

    Science.gov (United States)

    Bouillet, Laurence

    2015-01-01

    Hereditary angioedema is a rare disease, potentially life-threatening. It requires a specific treatment. Angioedema without wheals associated with abdominal attacks are very specific of this disease. Antigenemy and functional C1Inhibitor assays are necessary for the diagnosis. The hereditary angioedema with normal C1Inh (type III) is a diagnostic challenge. Bradykinin, secondary to kallikrein-kinin system activation is the key mediator of hereditary angioedema. Female are more symptomatic. Attacks can be induced by menstruations, pregnancies or contraceptive pills.

  3. Diagnostic imaging in bovine orthopedics.

    Science.gov (United States)

    Kofler, Johann; Geissbühler, Urs; Steiner, Adrian

    2014-03-01

    Although a radiographic unit is not standard equipment for bovine practitioners in hospital or field situations, ultrasound machines with 7.5-MHz linear transducers have been used in bovine reproduction for many years, and are eminently suitable for evaluation of orthopedic disorders. The goal of this article is to encourage veterinarians to use radiology and ultrasonography for the evaluation of bovine orthopedic disorders. These diagnostic imaging techniques improve the likelihood of a definitive diagnosis in every bovine patient but especially in highly valuable cattle, whose owners demand increasingly more diagnostic and surgical interventions that require high-level specialized techniques.

  4. [The diagnostic possibilities of saliva].

    Science.gov (United States)

    Kochurova, E V; Kozlov, S V

    2014-01-01

    Saliva is a clinically informative biological fluid which contains multitude of bio-markers. This characteristic makes it possible to carry out numerous analyzes for developing mode to test patient in situ, express-tests included. The diagnostic by saliva is a new area of more simple application both markers and analyzers that can be useful in diagnostic of diseases of oral cavity, oncological diseases included. The using of saliva expands perspectives for making clinical diagnosis and establishment of dynamics and monitoring of disease.

  5. Saliva: A fluid in search of a diagnostic use

    Directory of Open Access Journals (Sweden)

    Jia Liu

    2015-01-01

    Full Text Available Since saliva has been studied for more than 50 years and is relatively easy to collect, it is reasonable to ask why saliva is not in wider use as a diagnostic fluid. Here we discuss the criteria for diagnostic tests for diseases, barriers to use saliva for diagnostic testing, and the possibility of overcoming barriers to acceptance of saliva for diagnosis.

  6. [Differential diagnosis of hoarseness].

    Science.gov (United States)

    Voigt-Zimmermann, S; Lampe, K; Arens, C

    2014-04-01

    Hoarseness can be the leading symptom of dysphonia. In combination with impaired vocal performance and subjective voice-related discomfort, it can represent an individually different handicap for patients and lead to limited participation in social and professional life. Since the reasons for dysphonia may be not only functional but also organic with a potentially poor prognosis, hoarseness must be clarified using differential diagnosis. In addition to the knowledge of possible diseases, pathogenesis, and treatment options for dysphonia, the differential diagnostic approach requires profound knowledge of the various diagnostic methods, and of the interpretation of the results in particular. The etiology of dysphonia is very diverse and rarely monocausal. Therefore, a team-based and interdisciplinary differential diagnostic approach is recommended.

  7. The Psychodynamic Diagnostic Manual (PDM): rationale, conception, and structure.

    Science.gov (United States)

    Wallerstein, Robert S

    2011-02-01

    The declaredly atheoretical DSM-III (and its successors), the diagnostic manual of the American Psychiatric Association, was created to enhance diagnostic reliability for research, epidemiological survey, and governmental and insurance categorization and reimbursement purposes. It has, however, exhibited many inadequacies for psychodynamic diagnosis and case formulation for treatment planning and outcome assessment, and its claimed diagnostic reliability has turned out to be less than originally projected. The psychoanalytically sponsored Psychodynamic Diagnostic Manual (PDM) marks a return to a theoretically (psychoanalytically) based diagnostic frame and was created as a supplement to, or replacement for, DSM (depending on the precise clinical need), for use in psychodynamic diagnosis and treatment planning.

  8. Application of Western Medicine Diagnostic Techniques in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM%西医诊断技术在现行中医病证诊断及疗效标准中的应用研究

    Institute of Scientific and Technical Information of China (English)

    马国平; 王博; 李红方; 姚晓光; 梁文杰

    2012-01-01

    目的 探讨西医诊断技术在现行中医病证诊断及疗效标准中的应用,分析其对于中医诊疗的价值.方法 参阅国家中医药管理局颁布的现行,提取分析其中的西医诊断学内容并计算涉及学科的百分比.结果 9个中医学科"诊断依据"和"疗效评定"标准的设定均涉及西医诊断技术,但仅4个学科的"证候分类"标准涉及.397个病种中有77.3%(307/397)的"诊断依据"涉及西医诊断技术,有38.3%(152/397)的"疗效评定"涉及,但仅7.6%(30/397)的"证候分类"涉及.不同中医学科之间涉及率有较大差异,骨伤科的"诊断依据"涉及西医诊断技术最多,涉及率为98.2%(111/113);肛肠科的"疗效评定"涉及最多,涉及率为82.4%(14/17);骨伤科的"证候分类"涉及最多,涉及率为18.6%(21/113).不同诊断技术之间涉及率亦有较大差异,在"诊断依据"中,影像诊断涉及最多,涉及率为43.6%(173/397),其次是实验诊断与物理诊断;在"疗效评定"中,物理诊断涉及最多,涉及率为21.9%(87/397),其次是实验诊断与影像诊断.检查项目分别以X线成像、血液细胞分析及触诊等应用最多.结论 西医诊断技术在现行中医病证诊断及疗效标准中的应用具有普遍性和差异性,尤其对于中医辨病诊断及疗效评定有重要价值并渐趋成熟,但在辨证中的作用尚需进一步研究.%Objective To investigate the application and value of western medicine diagnostic techniques in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM. Methods Western medicine diagnoses in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM issued by State Administration of TCM were extracted and analyzed. Results The " diagnostic evidence" and " therapeutic effect evaluation" criteria in all the nine TCM subjects, and " syndrome classification" criteria in four subjects involved western medicine diagnostic techniques. The " diagnostic evidence

  9. SMART-COP评分对重症社区获得性肺炎的诊断价值%Diagnostic value of SMART-COP score in diagnosis of severe community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    许莉; 韩娟; 颜浩

    2015-01-01

    Objective To explore the value of SMART-COP score in diagnosis of severe communityacquired pneumonia patients (SCAP).Methods Totally 180 patients of community-acquired pneumonia (CAP),including 90 cases of SCAP and 90 cases of common CAP,were retrospectively analyzed.The SMART-COP score was assessed.The receiver operating characteristic (ROC) curve of SMART-COP score in diagnosing SCAP was drawn by taking the standard of American Thoracic Society/Infectious Diseases Society of America statement as gold standard,and the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and Youden index were obtained.Results Taking 4 scores as cut-off value,the value of SMART-COP in diagnosing SCAP was high,with sensitivity of 78.9%,specificity of 80.0%,positive likelihood ratio of 3.944,negative likelihood ratio of 0.264 and Youden index of 0.589.Conclusion The sensitivity and specificity of SMART-COP score in diagnosing SCAP is high with cut-off value of 4.%目的 探讨SMART-COP评分对重症社区获得性肺炎(SCAP)的诊断价值.方法 回顾性分析2011年1月至2013年12月成都市第二人民医院社区获得性肺炎(CAP)患者180例,其中SCAP 90例,普通CAP90例,对2组进行SMART-COP评分,以美国胸科学会/美国感染病学会2007年SCAP诊断标准作为金标准绘制SMART-COP评分诊断SCAP的受试者工作特征曲线,获得SMART-COP评分诊断SCAP界值及相应的敏感度、特异度、阳性似然比、阴性似然比和Youden指数.结果 以4分为界值,SMART-COP评分诊断SCAP的效能最高,其敏感度为78.9%,特异度为80.0%,准确率为79.4%,阳性似然比为3.944,阴性似然比为0.264,Youden指数为0.589.结论 根据SMART-COP评分诊断重症肺炎敏感度及特异度均较好,最佳临界值为4分.

  10. Interest of myocardium tomo-scintigraphy with Mibg coupled to the perfusion in the diagnosis of multi systematized atrophy; Interet de la tomoscintigraphie myocardique au MIBG couplee a la perfusion dans le diagnostic de l'atrophie multisystematisee

    Energy Technology Data Exchange (ETDEWEB)

    Andriamisandratsoa, N.; Constantinesco, A.; Grucker, D.; Namer, I.J. [Service de biophysique et medecine nucleaire, Strasbourg, (France); Anheim, M.; Tranchant, C. [service de neurologie, Strasbourg, (France)

    2009-05-15

    The objective of this prospective study is to evaluate the diagnosis pertinence of the myocardium tomo-scintigraphy with Mibg-{sup 123}I coupled to the perfusion in comparison with the initial clinical data, the tests with L-DOPA and to the clonidine in the frame of differential diagnosis between multi systematized atrophy and the idiopathic Parkinson disease. The conclusions: In comparison with the biological tests, our results show a better concordance between the diagnosis asserted with {sup 123}I-mibg and the clinical evolution. (N.C.)

  11. Diagnostic tools for neuropathic pain

    Directory of Open Access Journals (Sweden)

    CHEN Xiang-jun

    2013-09-01

    Full Text Available Neuropathic pain (NP is a kind of chronic, severe and persistent pain syndrome. Due to the underlying mechanisms, the treatment for NP differs from that of nociceptive pain. An accurate diagnosis of NP is very important. However, the present diagnostic process which mainly depends on clinical and neurophysiological assessments is quite time-consuming and low efficient. In recent years, various screening tools and drug efficacy assessments for NP have been developed and validated. They become very useful in the diagnosis and treatment of NP, as well as in epidemiological study. These tools are also very useful in elucidating the underlying mechanism of NP.

  12. Contribution of imaging studies and neuro physiologic investigations to the diagnosis of Huntington`s chorea; L`imagerie medicale et les explorations neuro-physiologiques dans le diagnostic de la choree de Huntington

    Energy Technology Data Exchange (ETDEWEB)

    Paquet, J.M.; Turpin, J.CI. [Centre Hospitalier Universitaire, 51 - Reims (France)

    1997-05-01

    Although Huntington`s disease was described in 1872, its diagnosis continues to rest on clinical grounds. Recently developed techniques for imaging the brain (computed tomography and magnetic resonance imaging) or studying its function (single photon emission computed tomography and positron emission tomography) have demonstrated only non specific abnormalities at the early stages of the disease, thus failing to improve the pre-symptomatic diagnosis. Neuro-physiologic investigations (evoked potentials, electromyogram, electroencephalogram) have been similarly unrewarding. Investigations are useful only as an laid to the differential diagnosis. Molecular biology technology is the only available tool for identifying high-risk individuals and establishing a definitive diagnosis of Huntington`s disease. (authors). 10 refs.

  13. Diagnostic indices for vertiginous diseases

    Directory of Open Access Journals (Sweden)

    Warninghoff Jan-Christian

    2010-10-01

    Full Text Available Abstract Background Vertigo and dizziness are symptoms which are reported frequently in clinical practice. We aimed to develop diagnostic indices for four prevalent vertiginous diseases: benign paroxysmal positional vertigo (BPPV, Menière's disease (MD, vestibular migraine (VM, and phobic postural vertigo (PPV. Methods Based on a detailed questionnaire handed out to consecutive patients presenting for the first time in our dizziness clinic we preselected a set of seven questions with desirable diagnostic properties when compared with the final diagnosis after medical workup. Using exact logistic regression analysis diagnostic scores, each comprising of four to six items that can simply be added up, were built for each of the four diagnoses. Results Of 193 patients 131 questionnaires were left after excluding those with missing consent or data. Applying the suggested cut-off points, sensitivity and specificity were 87.5 and 93.5% for BPPV, 100 and 87.4% for MD, 92.3 and 83.7% for VM, 73.7 and 84.1% for PPV, respectively. By changing the cut-off points sensitivity and specificity can be adjusted to meet diagnostic needs. Conclusions The diagnostic indices showed promising diagnostic properties. Once further validated, they could provide an ease to use and yet flexible tool for screening vertigo in clinical practice and epidemiological research.

  14. Saliva as a diagnostic fluid.

    Science.gov (United States)

    Samaranayake, Lakshman

    2007-10-01

    The use of saliva as a diagnostic fluid for various human ailments is gaining popularity as it offers distinct advantages over serum. These include the non-invasive nature of saliva collection compared with phlebotomy, simplicity of collection even for individuals with a modest training and the cost-effective applicability for screening large populations. Whole saliva is most frequently used for diagnosis of systemic diseases since it is readily collected and contains serum constituents while gland-specific saliva is useful for investigating pathology of major salivary glands. Broadly, saliva analysis is currently used for the diagnosis of infectious and malignant diseases, hereditary disorders, autoimmune diseases, and endocrine disorders, as well as for the assessment of therapeutic drug levels, particularly in monitoring drug abuse. This review addresses the current status of salivary diagnostics and their future potential.

  15. Rotorcraft Diagnostics

    Science.gov (United States)

    Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James

    2012-01-01

    Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer

  16. Human prenatal diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Filkins, K.; Russo, R.J.

    1985-01-01

    The multiauthor text is written as a ''guide to rationalize and clarify certain aspects of diagnosis, general counseling and intervention'' for ''health professionals who provide care to pregnant women.'' The text is not aimed at the ultrasonographer but rather at the physicians who are clinically responsible for patient management. Chapters of relevance to radiologists include an overview of prenatal screening and counseling, diagnosis of neural tube defects, ultrasonographic (US) scanning of fetal disorders in the first and second trimesters of pregnancy, US scanning in the third trimester, multiple gestation and selective termination, fetal echo and Doppler studies, and fetal therapy. Also included are overviews of virtually all currently utilized prenatal diagnostic techniques including amniocentesis, fetal blood sampling, fetoscopy, recombinant DNA detection of hemoglobinopathies, chorionic villus sampling, embryoscopy, legal issues, and diagnosis of Mendelian disorders by DNA analysis.

  17. Laboratory Diagnosis of Carbohydrate Metabolism Disorders. Diagnosis Algorithm in Hyperglycemic States

    Directory of Open Access Journals (Sweden)

    V.I. Pankiv

    2014-06-01

    Full Text Available The article is devoted to the laboratory diagnosis of disorders of carbohydrate metabolism. Presents criteria for diagnosis of diabetes, an algorithm for oral glucose tolerance test, determine type of diabetes based on clinical and laboratory data. The article also raised the issues of diagnosis of gestational diabetes and a diagnostic algorithm of hyperglycemia conditions during pregnancy.

  18. Myocardial Markers Detection of Acute Myocardial Infarction(Mi)Rapid Diagnostic Value Significance of Rapid Diagnosis of Cardiac Markers in the Clinical Diagnosis of Myocardial Infarction%心肌标志物检测对急性心肌梗死的快速诊断价值

    Institute of Scientific and Technical Information of China (English)

    郭静; 梁文龙; 樊鹏鹏

    2015-01-01

    目的:探析心肌标志物检测对急性心肌梗死的快速诊断价值。方法选取2014年2月~2015年1月我院收治的79例急性心肌梗死患者为观察组,并选取此期间在我院检查身体的79例健康人为对照组。对两组患者肌钙蛋白、肌红蛋白和肌酸激酶同工酶进行检测,并评价心肌标志物检测对急性心肌梗死的快速诊断价值。结果观察组患者的肌钙蛋白、肌红蛋白和肌酸激酶同工酶水平均高于对照组(P<0.05),5~8 h内肌钙蛋白联合肌红蛋白检测与3种标志物联合联合检测的真阳性率均为98.73%。结论在急性心肌梗死的临床诊断中采用肌钙蛋白、肌红蛋白和肌酸激酶同工酶3种心肌标志物进行检测,可缩短治疗时间,减轻患者及其家庭的经济压力。%Objective Analysis of myocardial markers detection of acute myocardial infarction(mi)rapid diagnostic value.Methods From February 2014 to January 2015 of our hospital,79 cases of patients with acute myocardial infarction(mi)as the observation group,and selectd the period in the hospital check body,79 cases of healthy control group. On two groups of patients,myoglobin,troponin testing creatine kinase isoenzyme,and evaluated myocardial markers detection of acute myocardial infarction(mi)rapid diagnostic value. ResultsObservation group of patients with troponin, myoglobin and creatine kinase isozyme level were higher than control group(P<0.05),5~8 hours,troponin myoglobin detection with a combination of three markers joint united detection of true positive rate were 98.73%.Conclusion In clinical diagnosis of acute myocardial infarction using troponin,myoglobin and creatine kinase isozyme three myocardial markers for testing,can shorten the treatment time,reduce the economic pressure of patients and their families.

  19. COMPARATIVE ANALYSES OF DIAGNOSTIC METHODS IN KNEE INJURIES

    Directory of Open Access Journals (Sweden)

    Džoleva-Tolevska Roza

    2016-03-01

    Full Text Available Objective:This study is analyzing the role and significance of the three diagnostic methods (clinical diagnosis, magnetic resonance imaging (MRI and arthroscopy, in establishing accurate diagnosis in knee injuries. The goal is to determine the diagnostic accuracy of each diagnostic method, using arthroscopy as gold standard. Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using patient’s history and positive clinical tests for meniscal lesions, ACL injury and articular cartilage lesions. All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for making the final diagnosis. Results: We analyzed the results of clinical tests for meniscal, ligamentous and articular cartilage injuries of the patients in both groups. Validity of the clinical tests was compared to the results got from MRI and arthroscopy. Accuracy of clinical diagnosis versus MRI diagnosis for medial(69.6% vs. 68.5% and lateral (84% vs. 82.6%meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of MRI diagnosis for ACL injuries was higher (91.3% vs. 81.4%. Accuracy (85.5% vs. 72.8% of clinical diagnosis versus MRI diagnosis for articular cartilage lesions was better. Conclusion: Affirmation of clinical diagnosis in this study is a result of usage of standard clinical signs and tests which are fundamental in establishing clinical diagnosis of knee injuries. MRI is a diagnostic method which enriches the diagnostic process. Arthroscopy is defined as superior diagnostic method, also a gold standard for comparison of the other two diagnostic methods.

  20. DNA Sensors for Malaria Diagnosis

    DEFF Research Database (Denmark)

    Hede, Marianne Smedegaard; Fjelstrup, Søren; Knudsen, Birgitta R.

    2015-01-01

    In the field of malaria diagnosis much effort is put into the development of faster and easier alternatives to the gold standard, blood smear microscopy. Nucleic acid amplification based techniques pose some of the most promising upcoming diagnostic tools due to their potential for high sensitivi......, robustness and user-friendliness. In the current review, we will discuss some of the different DNA-based sensor systems under development for the diagnosis of malaria....

  1. Diagnosis of invasive fungal infections

    Directory of Open Access Journals (Sweden)

    Anna Maria Barbui

    2013-01-01

    Full Text Available A proper diagnostic strategy of invasive fungal infections (IFI is a very important component in the management of infectious complications in hematological patients. A good diagnostic approach should be adapted to the patient in relation to the underlying disease, stage of disease, localization of infection and immune status. None of the diagnostic markers can be entirely adopted for medical decision making, and sometimes it’s useful to use the combination of several microbiological tests.The diagnosis of IFI must therefore have a multidisciplinary approach that includes clinical suspicion, microbiological results and radiological evidence.

  2. Molecular diagnostics of neurodegenerative disorders

    Directory of Open Access Journals (Sweden)

    Megha eAgrawal

    2015-09-01

    Full Text Available Molecular diagnostics provide a powerful method to detect and diagnose various neurological diseases such as Alzheimer’s and Parkinson’s disease. The confirmation of such diagnosis allows early detection and subsequent medical counseling that help specific patients to undergo clinically important drug trials. This provides a medical pathway to have better insight of neurogenesis and eventual cure of the neurodegenerative diseases. In this short review, we present recent advances in molecular diagnostics especially biomarkers and imaging spectroscopy for neurological diseases. We describe advances made in Alzheimer’s disease, Parkinson’s disease, Amyotrophic lateral sclerosis and Huntington’s disease, and finally present a perspective on the future directions to provide a framework for further developments and refinements of molecular diagnostics to combat neurodegenerative disorders.

  3. A Diagnostic Approach to Hemochromatosis

    Directory of Open Access Journals (Sweden)

    Anthony S Tavill

    2006-01-01

    Full Text Available In the present clinical review, a diagnostic approach to hemochromatosis is discussed from the perspective of two clinicians with extensive experience in this area. The introduction of genetic testing and large-scale population screening studies have broadened our understanding of the clinical expression of disease and the utility of biochemical iron tests for the detection of disease and for the assessment of disease severity. Liver biopsy has become more of a prognostic test than a diagnostic test. The authors offer a stepwise, diagnostic algorithm based on current evidence-based data, that they regard as most cost-effective. An early diagnosis can lead to phlebotomy therapy to prevent the development of cirrhosis.

  4. A GPA diagnostic system for aeroengine applications

    Institute of Scientific and Technical Information of China (English)

    Yi-Guang Li

    2007-01-01

    In this research,a GPA(Gas Path Analysis)diagnostic system enhanced with GPA Index is described for gas path sensor and component fault diagnosis.A method of measurement correction is used in order that the measurement data obtained at un-standard ambient and operating conditions can be used for diagnostic analysis.The developed diagnostic system has been implemented into a Cranfield University gas turbine performance and diagnostic analysis software PYTHIA for gas turbine performance degradation analysis.The developed method and software have been applied to a model aero gas turbine engine to test the effectiveness of the system.The analysis shows that the developed diagnostic system can diagnose degraded sensor and components effectively using performance deviation measured at un-standard ambient and operational conditions.Theoretically,the idea of the diagnostic approach can be applied to different gas turbine engines.

  5. Diagnostics procedures in rabies

    Directory of Open Access Journals (Sweden)

    Malovrh Tadej

    2005-01-01

    Full Text Available Rabies is a major zoonosis for which diagnostic techniques can only be performed in the laboratory. Laboratory techniques are preferably oriented on tissue removed from the cranium: hippocampus (Ammon's horn, cerebellum and the medulla oblongata or tissue liquids. Clinical observation may only lead to a suspicion of rabies. The only way to perform a reliable diagnosis of the disease is to identify the virus or some of its specific components using laboratory tests such as histological identification of characteristic cell lesions, immunochemical identification of rabies virus antigen and virus isolation. Serological tests are rarely used in epidemiological surveys but much more frequently in control of the vaccination programs (e.g. oral vaccination. Most commonly used serological tests are the virus neutralization test on cell culture (FAVN, virus neutralization in mice and ELISA.

  6. Efficient RT-Level Fault Diagnosis

    Institute of Scientific and Technical Information of China (English)

    Ozgur Sinanoglu; Alex Orailoglu

    2005-01-01

    Increasing IC densities necessitate diagnosis methodologies with enhanced defect locating capabilities. Yet the computational effort expended in extracting diagnostic information and the stringent storage requirements constitute major concerns due to the tremendous number of faults in typical ICs. In this paper, we propose an RT-level diagnosis methodology capable of responding to these challenges. In the proposed scheme, diagnostic information is computed on a grouped fault effect basis, enhancing both the storage and the computational aspects. The fault effect grouping criteria are identified based on a module structure analysis, improving the propagation ability of the diagnostic information through RT modules. Experimental results show that the proposed methodology provides superior speed-ups and significant diagnostic information compression at no sacrifice in diagnostic resolution, compared to the existing gate-level diagnosis approaches.

  7. Choledochal cyst as a diagnostic pitfall: a case report

    Directory of Open Access Journals (Sweden)

    Waidner Uta

    2008-01-01

    Full Text Available Abstract Introduction Choledochal cysts are rare congenital anomalies. Their diagnosis is difficult, particulary in adults. Case presentation This case report demonstrates the diagnostic and therapeutic pitfalls. Conclusion To prevent cost-intensive and potentially life-threating complications, a choledochal cyst must be considered in the differential diagnosis whenever the rather common diagnosis of a hepatic cyst is considered.

  8. Helicobacter pylori infection- recent developments in diagnosis

    National Research Council Canada - National Science Library

    Ana Isabel Lopes Filipa F Vale Mónica Oleastro

    2014-01-01

    Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication...

  9. Diagnostic testing and educational assessment.

    Science.gov (United States)

    Tweed, Mike; Wilkinson, Tim

    2012-10-01

    Clinicians are familiar with making diagnostic decisions based on information gathered from history, clinical examination and diagnostic tests. Although many clinicians assess students, they may be less familiar with ways to assimilate assessment information to inform educational decisions. We draw parallels between the processes used to make a clinical diagnosis and the similar processes needed to make an educational decision. There are several indices that describe the performance and utility of diagnostic tests, which we have extrapolated to educational assessment. We provide a clinical diagnostic question and an education assessment question, and use examples of indices of performance and utility for both of these situations to explore: reliability, indeterminate results, certainty in decisions, acceptable levels of sensitivity and specificity, pre-test probability and dealing with limitations. Test reliability requires adequate sampling and consistency between observers. Seeking more information should be targeted to situations where decisions are not certain. Altering score cut-points alters test sensitivity and specificity, which in assessment will alter the numbers of falsely passing or falsely failing candidates. Just as the pre-test probability of a diagnosis influences how to interpret diagnostic tests, so too does the pre-test probability of failure alter the performance characteristics of assessments. In clinical situations, a 'wait and see' approach may be limited by clinical urgency. Likewise, in assessment the 'wait and see' approach may be limited by a duty to society. Clinicians familiar with the performance and utility of diagnostic tests can extrapolate that knowledge to make better interpretations of educational assessments. © Blackwell Publishing Ltd 2012.

  10. Paediatric diagnostic audiology testing in South Africa.

    Science.gov (United States)

    Moodley, Selvarani

    2016-03-01

    With the increased emphasis on the importance of early identification of paediatric hearing loss within developing countries such as South Africa and Nigeria there has been a recognition of the ethical obligation to ensure access to timely diagnostic and intervention services for children identified with hearing loss; regardless of their geographic or socioeconomic status. There are limited studies on diagnosis of paediatric hearing loss in a developing world context. The objective of this study was to determine processes used for diagnosis of paediatric hearing loss in South Africa, across the private and public healthcare sectors, and to profile the age of testing for each component of the diagnostic test battery. Diagnostic audiology testing data of 230 children enrolled in an early intervention programme was analysed to profile the reporting of diagnostic audiology testing as well as diagnostic audiology procedures employed. Results were analysed according to province as well as healthcare sector to compare diagnostic services across regions as well as healthcare sectors. The differences in audiology practice and tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape indicates that services across regions and across the public and private sector are not equitable. Each region is equally unlikely to complete a full, comprehensive diagnostic evaluation on paediatric clients. The age of testing highlights the increased age of diagnosis of hearing loss. Paediatric diagnostic audiology is a section of Early Hearing Detection and Intervention services that requires attention in terms of the appropriateness of procedures as well as equity of services. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to international best practice guidelines for paediatric diagnostic audiology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Current advances in diagnostic methods of Acanthamoeba keratitis

    Institute of Scientific and Technical Information of China (English)

    Wang Yuehua; Feng Xianmin; Jiang Linzhe

    2014-01-01

    Objective The objective of this article was to review the current advances in diagnostic methods for Acanthamoeba keratitis (AK).Data sources Data used in this review were retrieved from PubMed (1970-2013).The terms "Acanthamoeba keratitis" and "diagnosis" were used for the literature search.Study selection Data from published articles regarding AK and diagnosis in clinical trials were identified and reviewed.Results The diagnostic methods for the eight species implicated in AK were reviewed.Among all diagnostic procedures,corneal scraping and smear examination was an essential diagnostic method.Polymerase chain reaction was the most sensitive and accurate detection method.Culturing of Acanthamoeba was a reliable method for final diagnosis of AK.Confocal microscopy to detect Acanthamoeba was also effective,without any invasive procedure,and was helpful in the early diagnosis of AK.Conclusion Clinically,conjunction of various diagnostic methods to diagnose AK was necessary.

  12. 三种分子生物学诊断技术对结核病诊断价值的比较%A study of the value of three molecular diagnostic techniques in the diagnosis of tuberculosis

    Institute of Scientific and Technical Information of China (English)

    黄芳; 党丽云; 孙惠平; 杨翰; 邬霞

    2015-01-01

    Objective To evaluate the diagnostic value of real-time fluorescent RNA isothermal amplification detection technology (simultaneous amplification and testing,SAT),Mycobacterium nucleic acid detection (PCR-fluorescence probe)method (TB-NTM-PCR) and Xpert MTB/RIF detection in the diagnosis of tuberculosis.Methods A total of 378 sputum specimens from pulmonary tuberculosis patients were collected between April to July 2014 in Xi' an Thoracic Tumor and Tuberculosis Hospital.The specimens were detected by 5 methods at the same time including acid-fast stain,SAT method,TB-NTM-PCR method,TB 960 rapid liquid culture and Xpert MTB/RIF.The sensitivity and specificity of SAT method,TB-NTM-PCR method and Xpert MTB/RIF were calculated according to the results of TB 960 rapid liquid culture and staining.The difference among all the 3 methods was analyzed by Chi-squared test.Results The positive rate of SAT-TB,TB-NTM-PCR and Xpert MTB/RIF were 37.6% (142/378),37.8% (143/378)and 53.4% (202/378),respectively.In specimens both positive for acid-fast stain and culture,the positive rate of SAT method was 84.6% (77/91),that of TB-NTM-PCR was 91.2% (83/91),and that of Xpert MTB/RIF was 96.7% (88/91),the difference being significant (P =0.018 2).In specimens negative for acid-fast stain but positive for culture,the positive rate of SAT method was 61.9%(60/97),that of TB-NTM-PCR was 44.3% (43/97),and that of Xpert MTB/RIF was 80.4% (78/97),the difference being significant (P < 0.000 1).In specimens both negative for acid-fast stain and culture,the positive rate of SAT method was 1.6% (3/185),that of TB-NTM-PCR was 6.5% (12/185),and that of Xpert MTB/RIF was 16.8% (31/185),the difference being significant (P =0.018).In specimens positive for acid-fast stain but negative for culture,the number of positive samples of SAT,TB-NTM-PCR and Xpert MTB/RIF were 3 (3/5),5 (5/5),and 5 (5/5),respectively.With the result of TB 960 rapid liquid culture and staining as the

  13. Trends in Laboratory Diagnostic Methods in Periodontology

    Directory of Open Access Journals (Sweden)

    Beáta Bolerázska

    2016-04-01

    Full Text Available This work presents a summary of current knowledge on the laboratory diagnosis of periodontitis. It focuses on the theoretical foundations and is supplemented with new knowledge. It subsequently describes specifically the laboratory diagnosis methods of periodontitis: the protein expression of inflammation, oral microbiology and molecular diagnostics. Periodontitis is a serious disease worldwide and its confirmed association with systemic diseases means its severity is increasing. Its laboratory diagnosis has the potential to rise to the level of clinical and diagnostic imaging. The transfer of diagnostic methods from laboratory to clinical use is increasingly used in the prevention and monitoring of the exacerbation and treatment of periodontal disease, as well as of its impact on systemic disease.

  14. Modified diagnosis of cardiovascular diseases: Application and comparison of diagnostic techniques in clinical medicine, radiology, ultrasonography and nuclear medicine. Final report. Einsatz und Vergleich klinischer, roentgenologischer, sonographischer und nuklearmedizinischer Methoden zur abgestuften Diagnostik von Herzkrankheiten. Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Adam, W.; Boettcher, D.; Christl, H.; Baew-Christow, T.; Holper, H.; Meindl, S.; Meyer, U.; Pfannenstiel, P.

    1985-01-01

    The main point of interest of the project is the question whether ultrasonography, myocardial scintiscanning, and radionuclide angiocardiography can replace the invasive techniques of cardiovascular diagnosis, and thus save costs at that. The results show that the above non-invasive techniques are indispensable in case of a diagnosis for cardiosurgery, almost sufficient in case of valvular heart disease, and sufficient in all cases of cardiomyopathy. Optimally planned application of the non-invasive methods could save about DM 7.3 millions a year in the FRG. (TRV).

  15. ULTRASOUND DIAGNOSTICS OF RETROCERVICAL ENDOMETRIOSIS

    Directory of Open Access Journals (Sweden)

    R. A. Barto

    2015-01-01

    Full Text Available Background: Endometriosis is one of the major problems in current gynecology due to steady increase of its incidence, involvement of young females, high frequency of infertility and difficulties with diagnostics and treatment. Confirmation of diagnosis of advanced endometriosis is still within the competence of research centers and big federal treatment establishments.Aim: To improve ultrasound diagnostics and to develop an algorithm of assessment in retrocervical endometriosis.Materials and methods: Seventy two females were assessed laparoscopically due to a gynecology disorder or infertility. Based on intraoperational data and results of pathomorphological assessments, two groups were formed: group 1 (control group, n = 26 comprised patients in reproductive age who had been admitted for elective surgery due to a gynecological disorder. Group 2 (main group, n = 46 included patients with various types of endometriosis. Patients from group 2 were divided into 3 subgroups: 2а (n = 17 – with superficial forms of external genital endometriosis; 2b (n = 18 – with endometrioid cysts; 2c (n = 11 – with deep infiltrative types of endometriosis.Results: Patients with superficial external genital endometriosis were characterized by positive symptom of “folding” (“freezing” of posterior uterine surface and of the walls of adjacent intestine. In endometriosis of posterior surface of cervix uteri, the diagnosis made by an ultrasound assessmentin 100% matched the diagnosis set during surgery, whereas if sacrouterine ligaments were involved, the diagnostic match was only 3%. In the group of patients with endometrioid cysts, in most of cases the cysts had specific ultrasound signs; coincidence of an ultrasound and a morphological diagnosis was seen in 98% of cases. Most cases of deep infiltrative endometriosis showed involvement of sacrouterine ligaments (72% and of parametrium (81%. There was a positive folding sign and a “Indian headdress

  16. Diagnostic criteria of familial Mediterranean fever.

    Science.gov (United States)

    Berkun, Yackov; Eisenstein, Eli M

    2014-01-01

    Familial Mediterranean fever (FMF) is the most prevalent monogenic autoinflammatory disease, mainly affecting ethnic groups living at Mediterranean basin. FMF is characterized by recurrent, self-limited episodes of fever and serositis. The diagnosis is difficult in the presence of atypical signs, which may result in significant delay in initiating treatment. As autoinflammatory diseases may have overlapping symptoms, strict diagnostic criteria are essential. Since the discovery that mutations in the gene MEFV underlie FMF, molecular genetic testing has been used as a diagnostic adjunct, especially in atypical cases. However, despite progress in the understanding of FMF disease mechanisms during the past 15 years; the diagnosis is still based on clinical criteria. Several sets of diagnostic criteria have been proposed and used. Existing diagnostic criteria should be modified to include genetic data, and need to be more widely validated. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Diagnostic and Prognostic Biomarkers in Melanoma

    Science.gov (United States)

    Leininger, Jennifer; Hamby, Carl; Safai, Bijan

    2014-01-01

    Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma. PMID:25013535

  18. Alternative diagnostic technique for carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, Katsuhiko; Nakane, Takashi [Aiko Orthopaedic Hospital, Nagoya (Japan); Kobayashi, Shigeru; Shibata, Kunio [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine

    2002-10-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

  19. Gonorrhoea diagnostics: An update

    Directory of Open Access Journals (Sweden)

    R Verma

    2016-01-01

    Full Text Available Diagnosis of gonorrhoea is an ongoing challenge. The organism is fastidious requiring meticulous collection and transport for successful cultivation. Asymptomatic infections are common which go undetected by conventional methods thereby leading to continued transmission and the risk of complications. The nucleic acid amplification tests, now increasingly used in developed countries, offer improved sensitivity compared to bacterial culture. However, these continue to suffer sequence related problems leading to false positive and false negative results. Further, these cannot be used for generation of data on antibiotic susceptibility because genetic markers of antibiotic resistance to recommended therapies have not been fully characterised. They are unaffordable in a setting like ours where reliance is placed on syndromic approach for sexually transmitted infection (STI management. The use of syndromic approach has resulted in a considerable decline in the number of Neisseria gonorrhoeae isolates that have been cultured for diagnostic purposes. Many laboratories formerly doing so are no longer performing culture for gonococci, and the basic skills have been lost. There is a need to not only revive this skill but also adopt newer technologies that can aid in accurate diagnosis in a cost-effective manner. There is room for innovation that can facilitate the development of a point-of-care test for this bacterial STI.

  20. Differential Diagnosis and Treatment of Career Indecision.

    Science.gov (United States)

    Fuqua, Dale R.; Hartman, Bruce W.

    1983-01-01

    Discusses the need for a better diagnostic approach to career indecision. Suggests a model for differential diagnosis and treatment containing three career indecision types or perspectives, i.e., developmental tasks, acute situational reactions, and chronic psychological concerns. Discusses problems of diagnostic measurement. (WAS)

  1. Diagnostic vitrectomy for infectious uveitis

    Science.gov (United States)

    Jeroudi, Abdallah; Yeh, Steven

    2014-01-01

    The identification of an infectious or noninfectious uveitis syndrome is important to determine the range of therapeutic and prognostic implications of that disease entity. Diagnostic dilemmas arise with atypical history, atypical clinical presentations, inconclusive diagnostic workup, and persistent or worsened inflammation despite appropriate immunosuppression. More invasive intraocular testing is indicated in these situations particularly in infectious uveitis where a delay in treatment may result in worsening of the patient’s disease and a poor visual outcome. Laboratory analysis of vitreous fluid via diagnostic pars plana vitrectomy is an important technique in the diagnostic armamentarium, but the most important aspects of sample collection include rapid processing, close coordination with an ophthalmic pathology laboratory, and directed testing on this limited collected sample. Culture and staining has utility in bacterial, fungal, and nocardial infection. Polymerase chain reaction (PCR) analysis has shown promising results for bacterial endophthalmitis and infection with mycobacterium tuberculosis whereas PCR testing for viral retinitides and ocular toxoplasmosis has a more established role. Antibody testing is appropriate for toxoplasmosis and toxocariasis, and may be complementary to PCR for viral retinitis. Masquerade syndromes represent neoplastic conditions that clinically appear as infectious or inflammatory conditions and should be considered as part of the differential diagnosis. Diagnostic vitrectomy and chorioretinal biopsy are thus critical tools for the management of patients in whom an infectious etiology of uveitis is suspected. PMID:24613892

  2. Immunity-based diagnosis for a motherboard.

    Science.gov (United States)

    Shida, Haruki; Okamoto, Takeshi; Ishida, Yoshiteru

    2011-01-01

    We have utilized immunity-based diagnosis to detect abnormal behavior of components on a motherboard. The immunity-based diagnostic model monitors voltages of some components, CPU temperatures, and fan speeds. We simulated abnormal behaviors of some components on the motherboard, and we utilized the immunity-based diagnostic model to evaluate motherboard sensors in two experiments. These experiments showed that the immunity-based diagnostic model was an effective method for detecting abnormal behavior of components on the motherboard.

  3. Immunity-Based Diagnosis for a Motherboard

    OpenAIRE

    Yoshiteru Ishida; Takeshi Okamoto; Haruki Shida

    2011-01-01

    We have utilized immunity-based diagnosis to detect abnormal behavior of components on a motherboard. The immunity-based diagnostic model monitors voltages of some components, CPU temperatures, and fan speeds. We simulated abnormal behaviors of some components on the motherboard, and we utilized the immunity-based diagnostic model to evaluate motherboard sensors in two experiments. These experiments showed that the immunity-based diagnostic model was an effective method for detecting abnormal...

  4. Immunity-Based Diagnosis for a Motherboard

    OpenAIRE

    Yoshiteru Ishida; Takeshi Okamoto; Haruki Shida

    2011-01-01

    We have utilized immunity-based diagnosis to detect abnormal behavior of components on a motherboard. The immunity-based diagnostic model monitors voltages of some components, CPU temperatures, and fan speeds. We simulated abnormal behaviors of some components on the motherboard, and we utilized the immunity-based diagnostic model to evaluate motherboard sensors in two experiments. These experiments showed that the immunity-based diagnostic model was an effective method for detecting abnormal...

  5. Intelligent systems in technical and medical diagnostics

    CERN Document Server

    Korbicz, Jozef

    2013-01-01

    For many years technical and medical diagnostics has been the area of intensive scientific research. It covers well-established topics as well as emerging developments in control engineering, artificial intelligence, applied mathematics, pattern recognition and statistics. At the same time, a growing number of applications of different fault diagnosis methods, especially in electrical, mechanical, chemical and medical engineering, is being observed. This monograph contains a collection of 44 carefully selected papers contributed by experts in technical and medical diagnostics, and constitutes

  6. [Spigelian hernia: clinical, diagnostic and therapeutical aspects].

    Science.gov (United States)

    Versaci, A; Rossitto, M; Centorrino, T; Barbera, A; Fonti, M T; Broccio, M; Ciccolo, A

    1998-01-01

    The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

  7. [Recent development of microfluidic diagnostic technologies].

    Science.gov (United States)

    Li, Haifang; Zhang, Qianyun; Lin, Jin-Ming

    2011-04-01

    Microfluidic devices exhibit a great promising development in clinical diagnosis and disease screening due to their advantages of precise controlling of fluid flow, requirement of miniamount sample, rapid reaction speed and convenient integration. In this paper, the improvements of microfluidic diagnostic technologies in recent years are reviewed. The applications and developments of on-chip disease marker detection, microfluidic cell selection and cell drug metabolism, and diagnostic micro-devices are discussed.

  8. Respiratory Disease: Diagnostic Approaches in the Horse.

    Science.gov (United States)

    Hewson, Joanne; Arroyo, Luis G

    2015-08-01

    Evaluation of the upper and lower respiratory tract of horses requires strategic selection of possible diagnostic tests based on location of suspected pathologic lesions and purpose of testing and must also include consideration of patient status. This article discusses the various diagnostic modalities that may be applied to the respiratory system of horses under field conditions, indications for use, and aspects of sample collection, handling, and laboratory processing that can impact test results and ultimately a successful diagnosis in cases of respiratory disease.

  9. Interest of the cardiac scintigraphy with {sup 123}I-Mibg in the diagnosis of multi-systematized atrophies; Interet de la scintigraphie cardiaque a l'{sup 123}I-MIBG dans le diagnostic des atrophies multisystematisees

    Energy Technology Data Exchange (ETDEWEB)

    Thelu-Vanysacker, M.; Hossein-Foucher, C.; Semah, F.; Marchandise, H. [CHRU de Lille, Service de medecine nucleaire, hopital Salengro, 59 (France); Defebvre, L. [CHRU de Lille, Service de neurologie, hopital Salengro, 59 (France)

    2010-07-01

    An abnormal cardiac scintigraphy with {sup 123}I-Mibg could exclude the diagnosis of multi-systematized atrophy (M.S.A.) for a patient with a Parkinson syndrome in our preliminary study and could be used as an index of functional integrity of post ganglion cardiac neuronal innervation. (N.C.)

  10. Comparative evaluation of validity and cost-benefit analysis of rapid diagnostic test (RDT kits in diagnosis of dengue infection using composite reference criteria: A cross-sectional study from south India

    Directory of Open Access Journals (Sweden)

    Shubhanker Mitra

    2016-01-01

    Conclusion: It was concluded that in dengue outbreak, Panbio IgM capture RDT alone is reliable and easily available test which can be used in acute phase of dengue infection in any resource limited set up. NS1 capture rates by any of the other three RDTs might not be reliable for the diagnosis of acute dengue infection.

  11. Diagnosis of a severe attack of inflammatory bowel disease by [sup 99m]Tc-HMPAO granulocyte scan. Diagnostic d'un cas de colite grave cryptogenetique par scintigraphie aux polynucleaires marques au [sup 99m]Tc-HMPAO

    Energy Technology Data Exchange (ETDEWEB)

    Beades, E.; Devaux, J.Y.; Kerrou, K.; Richard, B.; Guimbaud, R.; Sogni, P.; Chaussade, S. (Hopital Cochin, 75 - Paris (France)); Morelec, I. (Centre Hospitalier Universitaire, 14 - Caen (France))

    1994-01-01

    Severe attack of inflammatory bowel disease is an emergency. The diagnosis is currently made by two invasive techniques: colonoscopy and barium enema. We report on one case of severe attack of inflammatory bowel diagnosed by [sup 99m]Tc-HMPAO (Hexa Methyl Propylene Amino Oxine) granulocyte scan with a double-track specific image. 51 refs., 5 figs.

  12. Clinical diagnosis of pandemic A(H1N1) 2009 influenza in children with negative rapid influenza diagnostic test by lymphopenia and lower C-reactive protein levels

    Science.gov (United States)

    Wang, Lin; Chang, Ling-Sai; Lee, Ing-Kit; Tang, Kuo-Shu; Li, Chung-Chen; Eng, Hock-Liew; You, Huey-Ling; Yang, Kuender D

    2014-01-01

    Background The sensitivity of rapid influenza diagnostic test (RIDT) of children with influenza-like illness (ILI) remains low. Objective We compare the parameters between pandemic A(H1N1) 2009 influenza with negative RIDT and ILI not H1N1 for improving the low sensitivity of RIDT for children with ILI. Methods In a cohort of consecutive laboratory-confirmed H1N1 influenza, we identified 150 H1N1 children with positive RIDT, 152 H1N1 children with negative RIDT, and 75 children with ILI not H1N1. Viral load in throat, complete blood count (CBC), and C-reactive protein (CRP) levels between H1N1 children with negative RIDT and children with ILI not H1N1 were assessed. Results The diagnostic sensitivity of the RIDT was 45·5%. An analysis of CBC and CRP levels indicated that H1N1 children with negative RIDT had lower total leukocyte, neutrophil, lymphocyte, and basophil counts, and serum CRP levels (P < 0·01). Lymphocyte counts less than 1500 cells/mm3 and CRP levels <15 mg/l, determined by a receiver operating characteristic curve, showed a diagnostic sensitivity of 52·5% and 80·7%, respectively. Combining the lymphocyte counts and CRP levels provided a diagnostic sensitivity of 91·5%. Moreover, H1N1 children with negative RIDT had a lower viral load than those with positive RIDT (3·33 versus 4·48 log10 copies/ml, P < 0·001); the viral load was negatively correlated to the lymphocyte count (P < 0·001). Conclusions A combination of a low lymphocyte count and a low CRP level could, in the early disease phase, provide a useful screening for H1N1 children with false-negative RIDT, potentially facilitating differential diagnoses. PMID:24373294

  13. Diagnosis of Hymenoptera venom allergy

    NARCIS (Netherlands)

    Bilo, BM; Rueff, F; Mosbech, H; Bonifazi, F; Oude Elberink, JNG

    2005-01-01

    The purpose of diagnostic procedure is to classify a sting reaction by history, identify the underlying pathogenetic mechanism, and identify the offending insect. Diagnosis of Hymenoptera venom allergy thus forms the basis for the treatment. In the central and northern Europe vespid (mainly Vespula

  14. DNA Sensors for Malaria Diagnosis

    DEFF Research Database (Denmark)

    Hede, Marianne Smedegaard; Fjelstrup, Søren; Knudsen, Birgitta R.

    2015-01-01

    In the field of malaria diagnosis much effort is put into the development of faster and easier alternatives to the gold standard, blood smear microscopy. Nucleic acid amplification based techniques pose some of the most promising upcoming diagnostic tools due to their potential for high sensitivity...

  15. BIOANALYTICAL STANDARDIZING FOR SEROLOGICAL DIAGNOSTIC MEDICAL DEVICES

    Directory of Open Access Journals (Sweden)

    A. Yu. Galkin

    2015-04-01

    Full Text Available In article we analyzed national and international regulations concerning the quality and safety of medical devices for in vitro diagnostics. We discussed the possibility of a partial application of the recommendations of the State Pharmacopoeia of Ukraine to this type of product. The main guiding regulatory documents establishing requirements for quality and safety tools for the serological diagnosis products are The technical regulation on medical devices for the diagnosis in vitro, DSTU ISO 13485 “Medical devices. Quality management system. Regulatory requirements”, and DSTU ISO/IEC 17025 “General requirements for the competence of testing and calibration laboratories”. Similar requirements of the State Pharmacopoeia of Ukraine which are used for drug standardization can not be directly applied to the medical devises for in vitro diagnostics due to a number of features, namely, the serological diagnosis products pre-designed to determine the unknown concentration of a particular analyte in a biological material, the diagnostic kits has to include the control samples (internal standard systems that need to be calibrated. It was determined following parameters of bioanalytical standardization and validation characterization for of qualitative (semi quantitative test-kits for serological diagnosis: precision (convergence, intralaboratory precision and reproducibility, diagnostic and analytical specificity, diagnostic sensitivity. It’s necessary to inspect additional parameters for quantitative test-kits such as accuracy (precision, linearity, analytical sensitivity and range.

  16. Culture and psychiatric diagnosis.

    Science.gov (United States)

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. Copyright © 2013 APA*

  17. [Diagnostic criteria for neuromyelitisoptica spectrum disorders].

    Science.gov (United States)

    Belova, A N; Boiko, A N; Belova, E M

    2016-01-01

    The review is devoted to revised international diagnostic criteria for neuromyelitisoptica spectrum disorders (NMOSD).Current diagnostic criteria allow NMOSD diagnosis not only for serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG)-seropositive patients but for AQP4-IgG-seronegative patients as well. New criteria are expected to make NMOSD diagnosis earlier and more accurate as well as to facilitate the differentiation with multiple sclerosis. Furthermore, unify international criteria should help to perform comparable epidemiologic studies and clinical trials of new drugs for NMOSD.

  18. The usefulness of the consensus clinical diagnostic criteria in Brugada syndrome

    NARCIS (Netherlands)

    Sarkozy, A.; Paparella, G.; Boussy, T.; Casado-Arroyo, R.; Yazaki, Y.; Chierchia, G.B.; Asmundis, C. de; Bayrak, F.; Namdar, M.; Richter, S.; Brugada, J.; Brugada, P.

    2013-01-01

    BACKGROUND: Consensus statements were proposed for the diagnosis of Brugada syndrome (BS). The clinical diagnostic criteria were defined as documented ventricular fibrillation or ventricular tachycardia (VT), family history of sudden cardiac death at <45 years, diagnostic ECGs of family members,

  19. Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Munck, L K; Andersen, J R

    1985-01-01

    The irritable bowel syndrome is the commonest diagnosis in gastroenterological clinics, although diagnostic criteria and investigatory programs vary. To elucidate the diagnostic safety and prognosis of the syndrome, a retrospective study was conducted. One hundred and twelve consecutive patients ...

  20. Organizational Diagnosis: Its Role in Organizational Learning.

    Science.gov (United States)

    Beer, Michael; Spector, Bert

    1993-01-01

    Sees diagnosis as process that helps organizations enhance their capacity to assess and change dysfunctional aspects of culture and patterns of behavior as basis for developing greater effectiveness and ensuring continuous improvement. Presents framework for understanding "learning diagnosis" in which diagnostic process is part of large-scale…

  1. DIFFERENTIAL DIAGNOSTICS OF INFECTIOUS EXANTHEMAS IN CHILDREN

    OpenAIRE

    D. Yu. Ovsyannikov

    2015-01-01

    The lecture is devoted to the problem of differential diagnosis of infectious exanthemas in children. Information about differential-diagnostic sings of infectious and non-infectious exanthemas is present. Differential diagnosis is proposed on the basis of morphological elements identified in objective research. Presents possible infectious and non-infectious causes of rashes which are characterized by different primary (spot, papula, blister, knob, knot, bubble, abscess, bladder) and seconda...

  2. DIFFERENTIAL DIAGNOSTICS OF INFECTIOUS EXANTHEMAS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    D. Yu. Ovsyannikov

    2015-01-01

    Full Text Available The lecture is devoted to the problem of differential diagnosis of infectious exanthemas in children. Information about differential-diagnostic sings of infectious and non-infectious exanthemas is present. Differential diagnosis is proposed on the basis of morphological elements identified in objective research. Presents possible infectious and non-infectious causes of rashes which are characterized by different primary (spot, papula, blister, knob, knot, bubble, abscess, bladder and secondary (scale, erosion, ulcer morphological elements.

  3. General Diagnosis

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    2011264 Diagnostic accuracy of dual-source CT coronary angiography with prospective electrocardiography-triggering in patients with higher heart rate. SUN Mingli(孫明利),et al.Dept Radiol,Cardiovasc Instit & Fuwai Hosp,PUMC & CAMS,Beijing 100037. Abstract:Objective To evaluate the diagnostic accuracy of dual-source CT(DSCT) prospective ECG-triggering coronary angiography in patients with

  4. 强直性脊柱炎早期骶髂关节炎的磁共振诊断价值%Diagnostic Value of MRI in the Diagnosis of Sacroilitis for Early Ankylosing Spondylitis

    Institute of Scientific and Technical Information of China (English)

    郭海燕; 詹浩辉; 李卫新

    2012-01-01

    Objective To evaluate the value of MRI in the diagnosis of sacroilitis for early ankylosing spondylitis. Method 75 questionable ankylosing spondylitis patients were scanned by CT and MRI of the sacroiliac joints within a week. According to the New York criteria for patients Classification, it can be divided into two groups , which are early stage ( 0- Ⅱ grade ) and late stage ( Ⅲ - Ⅳ). Data from both groups were performed with chi-square test. Results There is no significant different between MRI and CT in the diagnosis of late stage SIJ whereas significant different has displayed in the diagnosis of sacroilitis for early ankylosing spondylitis has obvious superiority,which has statistical significanceetween MRI and CT. Conclusion MRI is more advanced in the diagnosis of SIJ.%目的 探讨磁共振成像(MRI)对强直性脊柱炎(AS)早期骶髂关节炎诊断的临床应用价值.方法 对75例到本院进行特殊疾病鉴定的可疑AS患者,在1周内分别行双侧骶髂关节MRI和CT检查,依据纽约标准进行分级,分为早期(0~Ⅰ级)和晚期(Ⅲ~ Ⅳ级)两组,分别进行x 2检验.结果 CT和MRI对晚期(Ⅲ~Ⅳ级)骶髂关节炎炎的判断无明显统计学差异,对(0~Ⅱ级)的判断二者相差较大,对于AS的早期骶髂关节炎炎诊断MRI明显优于CT,具有统学计意义.结论 MRI对AS早期骶髂关节炎的诊断具有明显优越性.

  5. Diagnostic criteria for autoimmune chronic pancreatitis revisited

    Institute of Scientific and Technical Information of China (English)

    Kyu-Pyo Kim; Myung-Hwan Kim; Jong Cheol Kim; Sang Soo Lee; Dong Wan Seo; Sung Koo Lee

    2006-01-01

    Autoimmune chronic pancreatitis (AIP) is increasingly being recognized worldwidely, as knowledge of this entity builds up. Above all, AIP is a very attractive disease to clinicians in terms of its dramatic response to the oral steroid therapy in contrast to ordinary chronic pancreatitis. Although many characteristic findings of AIP have been described, definite diagnostic criteria have not been fully established. In the year 2002, the Japan Pancreas Society published the diagnostic criteria of AIP and many clinicians around the world use these criteria for the diagnosis of AIP. The diagnostic criteria proposed by the Japan Pancreas Society, however, are not completely satisfactory and some groups use their own criteria in reporting AIP. This review discusses several potential limitations of current diagnostic criteria for this increasingly recognized condition. The manuscript is organized to emphasize the need for convening a consensus to develop improved diagnostic criteria.

  6. Diagnostic interventions in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Thrall, J.H.; Swanson, D.P.

    1989-01-01

    Diagnostic interventions in nuclear medicine may be defined as the coadministration of a nonradioactive drug or application of a physical stimulus or physiologic maneuver to enhance the diagnostic utility of a nuclear medicine test. The rationale for each interventional maneuver follows from the physiology or metabolism of the particular organ or organ system under evaluation. Diagnostic inference is drawn from the pattern of change in the biodistribution of the tracer in response to the intervention-induced change in metabolism or function. In current practice, the most commonly performed interventional maneuvers are aimed at studies of the heart, genitourinary system, hepatobiliary system, and gastrointestinal tract. The single most commonly performed interventional study in the United States is the stress Thallium-201 myocardial perfusion scan aimed at the diagnosis of coronary artery disease. The stress portion of the study is accomplished with dynamic leg exercise on a treadmill and is aimed at increasing myocardial oxygen demands. Areas of myocardium distal to hemodynamically significant lesions in the coronary arteries become ischemic at peak stress due to the inability of the stenotic vessel to respond to the oxygen demand/blood flow needs of the myocardium. Ischemic areas are readily recognized as photopenic defects on scans obtained immediately after exercise, with normalization upon delayed imaging. Diuresis renography is aimed at the differential diagnosis of hydroureteronephrosis. By challenging the urinary tract collecting structures with an augmented urine flow, dilated, unobstructed systems can be differentiated from systems with significant mechanical obstruction. 137 references.

  7. Achieving diagnosis by consensus

    LENUS (Irish Health Repository)

    Kane, Bridget

    2009-08-01

    This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

  8. Diagnosis of pediatric urinary tract infections

    Directory of Open Access Journals (Sweden)

    Jeng-Daw Tsai

    2016-09-01

    Full Text Available Urinary tract infection (UTI is the second common infection in children. The diagnosis of UTI in infants and children can be difficult. Good history taking and physical examination are corner stones of good care of UTI. In addition, this article reviewed current evident on the methods of urine specimen collection and various diagnostic criteria to reach the diagnosis of UTI. Asian Guideline for UTI in children is highlighted to increase consensus of the diagnosis of UTI.

  9. Thrombocytopenic purpura: Importance of early diagnosis

    OpenAIRE

    Linklater, David M.; Voth, Arnold

    1996-01-01

    Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are important diagnostic considerations for family physicians because therapy can be lifesaving. Treatment with plasmapheresis is usually successful. Therefore, early diagnosis is essential. A patient with microangiopathic hemolytic anemia is described. Diagnosis of Hodgkin's disease was confirmed after the initial episode. The case highlights the important role of family physicians in the diagnosis and treatment of uncommon he...

  10. [Vasculitis - diagnostic and therapeutic advances].

    Science.gov (United States)

    De Albuquerque, R; Machado, Filipa

    2014-01-01

    Vasculitis is characterized by inflammation and necrosis of blood vessels walls. It represents a heterogeneous group of conditions, whose etiopathogenic mechanisms remain unclear. Although uncommon, with an annual incidence of 40-54 cases per 1.000.000 persons, this is an important cause of multiorganic dysfunction and premature mortality. Depending on the affected vessels, it can cause diverse clinical presentations, which makes difficult its recognition. It is therefore a challenge for any clinician. This paper reviews the diagnostic and therapeutic advances of the most common forms of vasculitis, in order to optimize the approach and management of this clinical entity. We have conducted a search in Medline database on articles written in English, published for the last 10 years using the keywords: vasculitis, epidemiology, classification, diagnosis and treatment. To minimize the impact of vasculitis it is essential an early diagnosis, allowing a timely institution of the appropriate treatment. The diagnosis depends on the integration of clinical, laboratory, imaging and histopathologic data. According to the clinical condition, it may be indicated the removal of the offending antigen, the treatment of the underlying disease or specific treatment of the primary vasculitis. The introduction of immunosuppressive therapy with glucocorticoids and cyclophosphamide has revolutionized the prognosis of these patients but, despite its efficacy, it is associated with frequent relapses and significant toxicity. The study of the pathogenesis has been providing more effective and safer diagnostic and therapeutic options, for example B-cell depleting agents, but additional studies are needed to confirm the potential of these alternatives.

  11. [Urticaria: diagnosis and treatment].

    Science.gov (United States)

    Soria, A; Francès, C

    2014-09-01

    Urticaria is a common inflammatory skin disease. It is clinically defined as the occurrence of transient papular skin and/or mucosal lesions or subcutaneous lesions called angioedema. Chronic urticaria is defined as a clinical course over more than 6weeks. Different clinical forms of urticaria can coexist in the same patient. Urticaria results of mast cell activation. The diagnosis of urticaria is based on clinical examination. An allergic etiology for acute urticaria, although rare, is always to find and remove. Chronic urticaria is not allergic. Diagnosis is based on questioning and a careful clinical examination to rule out differential diagnoses. Few diagnostic tests are necessary for diagnosis and management, and are especially useful in case of doubtful diagnosis. The treatment of urticaria is symptomatic and based on anti-H1 second generation antihistamines as first-line therapy. In some chronic urticarial, antihistamines up dosing may be necessary. In the majority of patients, this treatment is sufficient to control chronic urticaria. In case of antihistamines failure, other treatment particularly immunomodulatory treatments can be offered in specialized departments.

  12. [Expanded anamnesis and psychodiagnostic classification in psychosomatic rheumatic patients. II: A recommendation for diagnostic classification of psychosomatic disorders of the locomotor system].

    Science.gov (United States)

    Eich, W

    1993-01-01

    This paper tries to associate psychosomatic manifestations of the locomotion-system to one of the following four diagnosis: 1) conversion disorder, 2) anxiety disorder, 3) depressive mood disorder, 4) somatization disorder. For each of these diagnosis definition, clinical manifestation, diagnostic and differential-diagnostic criteria are mentioned. The diagnostic criteria can easily be associated to the new ICD-10 (V)F diagnosis.

  13. Diagnosis methodology applied to the preventive maintenance of power generation units in isolated sites; Methodologie de diagnostic appliquee a la maintenance preventive d'unites de production d'electricite en sites isoles

    Energy Technology Data Exchange (ETDEWEB)

    Marie-Joseph, M.

    2003-04-01

    Todays, overseas territories gather more than 25% of the photovoltaic systems of the French territory. More than 600 kWc of this photovoltaic park is located in French Guiana and 75% in isolated areas. This leads to the problem of implementation of a convenient maintenance policy mainly because of the problem of supply of replacement parts, of the lack of qualified local manpower, and of the complexity of a fast diagnosis of the installations. Therefore, the development of a diagnosis tool for the different kinds of failures and defects that can occur on a photovoltaic power system is of prime importance. Starting from the elements of preventive maintenance philosophy developed in the thesis of S. Salvat, this work describes the development of a functional simulation tool allowing the validation of these first results. Using models for the simulation of each sub-part of the system, involving a statistical modeling of the solar resource and of the connected load, a detailed analysis of the operation defects is presented. This tool, which is a key element of the elaboration of the diagnosis, allows the use of detection methods based on pattern recognition principle. The supervised learning makes a classification using the search for a parametric discriminating function minimizing the quadratic error on the base. The algorithms performing the real-time monitoring of the system in the presence of defects are fitted in an experimental kit representing the production of an individual generator at a reduced scale. The experimental detection procedures are then tested on production and regulation defects and then compared to those obtained from simulations performed in the same operating conditions. (J.S.)

  14. Decision support tools as alternative options to improve diagnostic ...

    African Journals Online (AJOL)

    Mo

    In a bid to improve diagnostic services for endemic bovine diseases in Uganda that are deteriorating as a result of non- functional ... Bovine disease, field diagnosis, veterinary services, Uganda. Introduction ..... Addison-Wesley, Reading,.

  15. Controversies in the diagnosis of venous thromboembolism.