Advances In Diagnostic Testing Research Articles

The James A. Rand Young Investigator’s Award: Keeping It Simple: Are All Musculoskeletal Infection Society Tests Useful to Diagnose Periprosthetic Joint Infection?

BackgroundCurrent data evaluating the clinical value and cost-effectiveness of advanced diagnostic tests for periprosthetic joint infection (PJI) diagnosis, including alpha-defensin and synovial C-reactive protein (CRP), is conflicting. This study aimed to evaluate the adequacy of preoperative and intraoperative PJI workups without utilizing these tests. MethodsThis retrospective analysis identified all patients who underwent revision total knee or hip arthroplasty (rTKA and rTHA, respectively) for suspected PJI between 2018 and 2020 and had a minimum follow-up of two years. Perioperative data and lab results were collected, and cases were dichotomized based on whether they met the 2018 Musculoskeletal Infection Society (MSIS) criteria for PJI. In total, 204 rTKA and 158 rTHA cases suspected of PJI were reviewed. ResultsNearly 100% of the cases were categorized as “infected” for meeting the 2018 MSIS criteria without utilization of alpha-defensin or synovial CRP (rTKA: n = 193, 94.6%; rTHA: n = 156, 98.7%). Most cases were classified as PJI preoperatively by meeting either the major MSIS or the combinational minor MSIS criteria of traditional lab tests (rTKA: n = 177, 86.8%; rTHA: n = 143, 90.5%). A subset of cases was classified as PJI by meeting combinational preoperative and intraoperative MSIS criteria (rTKA: 16, 7.8%; rTHA: 13, 8.2%). Only 3.6% of all cases were considered “inconclusive” using preoperative and intraoperative data. ConclusionGiven the high rate of cases satisfying PJI criteria during preoperative workup using our available tests, the synovial alpha-defensin and synovial CRP tests may not be necessary in the routine diagnostic workup of PJI. We suggest that the primary PJI workup process should be based on a stepwise algorithmic approach with the most economical testing necessary to determine a diagnosis first. The use of advanced, commercialized, and costly biomarkers should be utilized only when traditional testing is indeterminate.

Super-specialty Medical Teleconsultations to Remote Areas of Ladakh, India via E-Sanjeevani under Hub-and-Spoke Model: A Pilot Study

Objectives: To assess the feasibility, spectrum, outcomes and challenges of delivering super-specialty consultations to remote areas of the Union Territory (UT) of Ladakh through telemedicine. Design: Prospective, observational (descriptive), pilot study Methodology: Super-specialty medical teleconsultations were provided to healthcare providers in UT Ladakh by specialists in the Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh from October 2021 to May 2022, employing the hub-and-spoke model of the Ayushman Bharat Digital Mission. Doctor-to-doctor teleconsultations were initiated by treating doctors at healthcare facilities in UT Ladakh on the eSanjeevani™ platform. Audio-video model was used for teleconsultation and digitally signed prescriptions were shared. Setting: India – Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (hub) and healthcare providers in UT Ladakh (spokes) Participants: Healthcare providers in UT Ladakh and specialists in the Department of Telemedicine, PGIMER, Chandigarh Interventions: Super-specialty medical consultations using telemedicine (eSanjeevani™ platform) Main Outcome Measures: Demand and spectrum of superspecialty teleconsultations, outcome of consults (whether managed successfully at teleconsultation level, or required referral for in-person visits), and technical challenges faced. Results: A total of 26 super-specialty teleconsultations were provided; 14 (54%) were for women. Patient distribution was uniform across all age groups. The super-specialty-wise distribution of consultations was - 9 from endocrinology, 9 from neurology, 3 from hepatology, 2 from cardiology, and 3 from neonatology. Reasons for seeking consultation were assistance in diagnosis (3, 12%), optimization of therapy (10, 38%), or both diagnostic evaluation and treatment optimization (13, 50%). Five cases (19%) were referred for physical visits to a higher center for advanced diagnostic testing like liver biopsy, brain biopsy, upper GI endoscopy, etc.; other cases were managed remotely. Problems with audio-visual connectivity were encountered in three patients. Conclusion: This pilot study demonstrates that complex, super-specialty medical consultations can be effectively delivered to remote areas through telemedicine. Future research should focus on assessing long-term outcomes, patient satisfaction, and cost-effectiveness to better evaluate the impact of this model.

Genetic counseling for the dystrophinopathies-Practice resource of the National Society of Genetic Counselors.

The dystrophinopathies encompass the phenotypically variable forms of muscular dystrophy caused by pathogenic variants in the DMD gene. The dystrophinopathies include the most common inherited muscular dystrophy among 46,XY individuals, Duchenne muscular dystrophy, as well as Becker muscular dystrophy and other less common phenotypic variants. With increased access to and utilization of genetic testing in the diagnostic and carrier setting, genetic counselors and clinicians in diverse specialty areas may care for individuals with and carriers of dystrophinopathy. This practice resource was developed as a tool for genetic counselors and other health care professionals to support counseling regarding dystrophinopathies, including diagnosis, health risks and management, psychosocial needs, reproductive options, clinical trials, and treatment. Genetic testing efforts have enabled genotype/phenotype correlation in the dystrophinopathies, but have also revealed unexpected findings, further complicating genetic counseling for this group of conditions. Additionally, the therapeutic landscape for dystrophinopathies has dramatically changed with several FDA-approved therapeutics, an expansive research pathway, and numerous clinical trials. Genotype-phenotype correlations are especially complex and genetic counselors' unique skill sets are useful in exploring and explaining this to families. Given the recent advances in diagnostic testing and therapeutics related to dystrophinopathies, this practice resource is a timely update for genetic counselors and other healthcare professionals involved in the diagnosis and care of individuals with dystrophinopathies.

Development and validation of a simplified risk prediction model for preterm birth: a prospective cohort study in rural Ethiopia

Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer–Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the “Youden index” to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer–Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications.

Novel Biomarkers for Assessing Clinical Severity in Hereditary Spherocytosis - Application of Routine and Advanced Diagnostic Tests

Background: Hereditary spherocytosis (HS) is caused by pathogenic variants in genes encoding red blood cell (RBC) cytoskeletal and (trans)membrane proteins. This ultimately leads to instability of the RBC membrane and subsequent membrane loss, resulting in the transformation of the biconcave RBC into a poorly deformable spherocyte, which is susceptible to premature splenic clearance. The diagnosis of HS has substantially improved over the last years and new advanced techniques have been established, including osmotic gradient ektacytometry, eosin-5'-maleimide (EMA) binding test and next-generation sequencing (NGS). However, there is little knowledge on the applicability of these diagnostic outcome parameters as biomarkers for clinical severity in HS. Aim: To explore possible correlations between established and novel diagnostic outcome parameters and clinical severity in a well-defined cohort of HS patients. Methods: This monocenter retrospective cohort study involves patients diagnosed with HS upon referral to our department between 2012 and 2023. Clinical characteristics, routine and advanced diagnostic laboratory parameters, and genotype were evaluated. Clinical severity was classified as previously described, based on parameters such as hemoglobin, reticulocyte percentage and bilirubin 1. The following laboratory tests were included: routine hematological parameters (Cel-Dyn Sapphire or Alinity hq), EMA binding test, osmotic fragility test (OFT) and osmotic gradient ektacytometry (osmoscan, Lorrca MaxSis). The latter technique was also explored for other parameters than the commonly used EI max, O hyper and O min. NGS gene panel analysis was used for molecular diagnosis. Differences between groups were determined using either Chi-squared test, unpaired t-test or Mann-Whitney U test and correlations using point-biserial, Pearson's or Spearman's test via GraphPad Prism. Results: Eighty-two non-splenectomized patients were included. Thirty-five of these (42.7%) were classified as mild, and forty-seven as moderate-severe (57.3%)). Demographic characteristics nor genotype differed significantly, albeit SPTB variants occurred more frequently in the moderate-severe group (15 vs. 4 in the mild group). Expectedly, both reticulocyte count and EI max correlated with clinical severity. RBC distribution width (RDW) correlated moderately, suggesting greater RBC heterogeneity (r=0.606, p<0.0001) is associated with a more severe clinical phenotype. Similarly, EMA binding test results correlated with clinical severity (r=0.390, p<0.001), indicating more pronounced membrane loss in clinically more severe patients. We further evaluated three novel osmoscan parameters ( Figure 1): EI O290, the elongation index (EI) at physiologic isotonicity, which correlated with clinical severity (r=-0.500, p<0.0001), and also with EI max (r=0.856, p<0.0001). The O min-width and O max-width, defined as the difference in osmolality between the intersection points of y=EI min or EI max +/- 0.05 and the osmoscan curve. Thisassesses the effect of changes in osmolality on EI min or EI max, respectively. O min-width correlated with RDW (r-0.439, p<0.0001), OFT results (N=30, r=0.671, p<0.0001) and clinical severity (r=0.390, p<0.001). O max-width correlated with clinical severity (r=-0.375, p<0.001) and strongly with percentage of hyperchromic cells (N=76, r=-0.751, p<0.0001), yet weakly with RDW (-0.273, p<0.05). All significant correlations with clinical severity are displayed in Figure 2. Conclusion: In this study, a number of routine and advanceddiagnostic laboratory parameters were found to correlate with clinical severity in HS. O min-width and O max-width are novel osmoscan-derived biomarkers that correlated with RDW, hyperchromic cells (O max-width), OFT results (O min-width) and clinical severity. EI O290, another novel osmoscan-derived biomarker, also correlated with clinical severity, although not stronger than EI max and AUC. The biomarkers identified in this study, together with patient-reported outcome measures (PROMs), could be used to revise the previously established severity classification system and thereby aid in stratifying clinical severity and subsequent clinical decision-making.

Artificial intelligence in rheumatoid arthritis: potential applications and future implications.

The widespread adoption of digital health records, coupled with the rise of advanced diagnostic testing, has resulted in an explosion of patient data, comparable in scope to genomic datasets. This vast information repository offers significant potential for improving patient outcomes and decision-making, provided one can extract meaningful insights from it. This is where artificial intelligence (AI) tools like machine learning (ML) and deep learning come into play, helping us leverage these enormous datasets to predict outcomes and make informed decisions. AI models can be trained to analyze and interpret patient data, including physician notes, laboratory testing, and imaging, to aid in the management of patients with rheumatic diseases. As one of the most common autoimmune diseases, rheumatoid arthritis (RA) has attracted considerable attention, particularly concerning the evolution of diagnostic techniques and therapeutic interventions. Our aim is to underscore those areas where AI, according to recent research, demonstrates promising potential to enhance the management of patients with RA.

PAEDIATRIC-15 MANAGEMENT OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS BY A NEURO-ONCOLOGY MULTIDISCIPLINARY TEAM : OUR EXPERIENCE

Abstract The outcome of pediatric central nervous system tumors has improved over the past decades due to advances in diagnostic testing, treatment and increased understanding of the disease biology. Nevertheless, the probability of survival of this tumors remains much lower in low-to middle-income countries. The gaps that prevent optimal clinical management of brain tumors are multifactorial and mostly related to underdiagnosis; a lack of specialized and dedicated radiologic, histopathologic, neurosurgical, radiotherapeutic, and oncology services, and a deficiency of coordinated multidisciplinary care in many centers. The aim of this report was to evaluate the impact of multidisciplinary team meetings on the clinical management of pediatric central nervous system tumors in Abidjan (Côte d'Ivoire). We retrospectively reviewed the clinical data of pediatric patients (aged <15 years) with central nervous system tumors diagnosed and treated in the Neurosurgery Department and National Center of Radiotherapy between 2019 (the year a neuro-oncological multidisciplinary staff was established) and 2023. Data on patient demographics, clinical notes, imaging studies, tumor characteristics and multidisciplinary team decision were collected from the multidisciplinary team database. During the multidisciplinary team meetings era, 40 pediatric central nervous system tumors were diagnosed and treated. The median age at diagnosis was 8.5 years. The mostly histological types were high grade and low grade gliomas. Decision-making was largely consistent with available guidelines. Therapeutic were surgery, external beam radiation treatment with concurrent and adjuvant chemotherapy. Benefits of neuro-oncology multidisciplinary team include coordination, direction for complicated cases, education, and a forum for communication, and clinical trials.

Procalcitonin and Risk Prediction for Diagnosing Bacteremia in Hospitalized Patients: A Retrospective, National Observational Study.

Bacteremia is associated with significant morbidity and mortality. Timely, appropriate therapy may improve clinical outcomes, and therefore, determining which patients benefit from more comprehensive diagnostic strategies (i.e., direct specimen testing) could be of value. We performed an assessment of procalcitonin (PCT) and clinical characteristics in the discrimination of bacteremic hospitalizations. We analyzed 71,105 encounters and 14,846 visits of patients with bacteremia alongside 56,259 without an admission. The area under the receiver-operating characteristic (AUROC) curve for the prediction of bacteremia via procalcitonin was 0.782 (95% CI 0.779-0.787). The prediction modeling of clinical factors with or without PCT resulted in a similar performance to PCT alone. However, the clinically predicted risk of bacteremia stratified by PCT thresholds allowed the targeting of high-incidence bacteremia groups (e.g., ≥50% positivity). The combined use of PCT and clinical characteristics could be useful in diagnostic stewardship by targeting further advanced diagnostic testing in patients with a high predicted probability of bacteremia.

The DeOrio One Finger Test: Does a Patients Ability To Localize Their Pain Lead to Different Clinical and Patient Reported Outcomes Than Those That Cannot?

Category: Other Introduction/Purpose: A basic requirement during a history and physical examination, in a foot and ankle clinic, is the ability to pinpoint where a patient experiences discomfort. Infrequently, patients are unable to localize their pain and “paint” over a non- anatomic distribution or point to multiple, independent areas across the foot. The ability to diagnose and treat a problem become significantly more difficult in these circumstances. In this study, the treatment course, clinical and patient reported outcomes(PROs) of patients who can pinpoint where they feel pain and those that “paint” over a non-anatomic area are compared. We hypothesize that patients unable to pinpoint are more likely to require advanced imaging studies, additional diagnostic modalities, and also less likely to improve in PROs at conclusion of treatment. Methods: Patients who presented in a foot and ankle clinic with foot pain between August 2021 and August 2022 were prospectively enrolled in this IRB approved study. The senior author completed a questionnaire after consultation identifying the patient as “able to pinpoint location of pain” or “unable to pinpoint location of pain.” Patients were excluded if they were < 18 years old, had neuropathy, or had pain as a result of a trauma (where does a trimalleolar ankle fracture hurt for example?). In cases where patients couldn’t pinpoint, they were counseled on localizing their symptoms and seen again 6 weeks later and given another chance to pinpoint. Diabetic patients had monofilament exams during presentation to control for undiagnosed neuropathy. Patients were followed for clinical outcomes, need for advanced imaging, need for additional diagnostic testing and finally PROs. All statistical analysis was conducted using GraphPad Prism(Ver 9.0, GraphPad Software, San Diego CA USA). Results: Overall, 423 patients were included (342 patients pinpointed and 91 patients did not). Patients unable to pinpoint were more likely to smoke (odds ratio=1.46) and to be diabetic (odds ratio=3.0). Patients with rheumatoid arthritis were more likely to be able to pinpoint(odds ratio=0.82) Patients unable to pinpoint presented with lower initial PROMIS Physical Function (40.0 vs. 43.3, p< 0.01) and increased Pain Interference (56.3 vs. 53.3, p< 0.01) and Depression (50.4 vs. 43.3, p< 0.01) then those that could localize. These patients were more likely to require advanced imaging (p=0.039) and diagnostic testing(EMG/image-guided injection) (p=0.044). Patient reported outcomes, in addition to starting out worse at presentation, did not see the same improvements at the conclusion of treatment. See the table for a summary of the key study findings. Conclusion: The ability to localize pain during a history and physical examination has direct bearing on a patients’ treatment course and outcomes in this single center study. Patients unable to pinpoint a location have lower initial and final PROs and also require more advanced imaging and diagnostic testing. Practitioners should continue to strive to better elucidate patient symptoms in hopes of more efficiently treating these patients. However, further research is needed to truly identify whether this presenting characteristic is truly indicative of patient outcomes.

Increased Levels of miR-15b-5p and miR-20b-5p in Pancreatic Ductal Adenocarcinoma with Hepatic Metastases.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal forms of cancer. The symptoms appear in advanced stages, and diagnostic and prognostic tests for the early detection of PDAC and disease evolution are not available. The dysregulation of microRNAs (miRNAs) has been associated with cancer development and progression, and some miRNAs have been reported to promote specific metastasis. In this study we aimed to identify the miRNAs dysregulated in PDAC tumoral tissues and a subset of miRNAs associated with tumoral characteristics, mainly metastasis presence and site. For this, the expression of 84 miRNAs was evaluated by qPCR in 30 tumoral tissues and 16 samples of non-tumoral pancreatic tissues. The comparison revealed 32 dysregulated miRNAs (19 upregulated and 13 downregulated) in the PDAC group. Reactome pathway over-representation analysis revealed that these miRNAs are involved in several biological pathways, including "ESR-mediated signaling", "PIP3 activates AKT signaling", and "Regulation of PTEN", among others. Moreover, our study identified an upregulation of miR-15b-5p and miR-20b-5p in the tumoral tissues of patients with hepatic metastasis, outlining these miRNAs as potential markers for hepatic metastasis. No significant difference in miRNA expression was observed in relation to anatomic location, lymphovascular invasion, lung metastasis, and the presence of diabetes.

Blood analytes of hawksbill sea turtles (Eretmochelys imbricata) from Florida waters: reference intervals and size-relevant correlations

Assessments of health variables in wild animal populations have evolved into important tools for characterizing spatiotemporal population trends and fitness, effects of stressors, diseases, and ecosystem health. Blood as a sample matrix can be obtained fairly non-invasively in the field, with preservation and sample processing techniques that allow for readily available routine and advanced diagnostic testing of blood. For wild-caught hawksbill sea turtles (Eretmochelys imbricata) foraging in southeastern Florida, USA, the objectives of this study were to (1) establish reference intervals for hematological and 24 plasma biochemical analytes, (2) determine length-and body condition-specific relationships with blood analytes, and (3) determine how water temperature influenced plasma biochemical analytes. Reference intervals were established for clinically normal juvenile (n = 26) and subadult (n = 39) hawksbills, with descriptive data reported for adult turtles (n = 3). Although subadults (mainly captured at Palm Beach County) were heavier and larger with greater body depth, juveniles (mainly captured at Monroe County) had a higher body condition index. Positive length-specific correlations were identified for packed cell volume, eosinophils, aspartate aminotransferase, phosphorus, cholesterol, glutamate dehydrogenase, total protein, albumin, and globulins, with negative correlations including alkaline phosphatase, creatine kinase, calcium, calcium to phosphorus ratio, and glucose. Subadults had less frequent morphological features of red blood cell regeneration compared to juveniles. These findings provide insight into life-stage class differences regarding hematopoiesis, antigenic stimulation, somatic growth, dietary shifts, nutritional status, osmoregulation, metabolism, physical activity or stress levels, and possible habitat differences. Life-stage class is the likely driver for the observed blood analyte differences, in addition to influences from water temperature. The data herein offer baseline information for a snapshot in time for critically endangered hawksbills inhabiting the Florida reef system and for answering individual-and population-relevant questions of relevance to conservation and population management.

"Revolutionary Advances in Diagnostic Tests for Tuberculosis Infection and Disease"

"Revolutionary Advances in Diagnostic Tests for Tuberculosis Infection and Disease"

Differentiated Papillary NUT Carcinoma: An Unexpected, Deceptively Bland Presentation of a Sinonasal Carcinoma

BackgroundIn recent years, the list of tumor entities in the sinonasal tract has significantly expanded, requiring advanced diagnostic testing. We report the case of a 32-year-old patient with an unusual NUT carcinoma originating in the maxillary sinus, which showed extensive well-differentiated, papillary squamous morphology, similar to the spectrum of the recently described DEK::AFF2 fusion-associated carcinoma.MethodsWe performed immunohistochemical and molecular studies including EBV- and HPV-testing, as well as DNA/RNA next generation sequencing.ResultsThe tumor showed predominantly exophytic papillary growth with mature squamous differentiation. An additional component harbored atypical, less differentiated basaloid tumor cells with infiltration of the adjacent stroma. Conspicuous inflammation was evident. There was no evidence of HPV DNA or EBV RNA. Next-generation sequencing revealed a NUT::NSD3 gene fusion corresponding to (“speckled-type”) immunopositivity of NUT in the tumor cells.ConclusionsWe describe a NUT::NSD3 gene fusion-associated NUT carcinoma of the sinonasal tract with a deceptively well-differentiated papillary growth pattern, thus expanding the morphological spectrum of this typically poorly differentiated neoplasm.

Pearls & Oy-sters: Mitral Annular Calcification as a Cause of Ischemic Stroke: A Case Report.

Evaluation of stroke etiology is an important aspect of stroke care affecting secondary prevention measures. Despite recent advances in diagnostic testing, determining the stroke etiology can remain a challenging task particularly for less common causes of stroke such as mitral annular calcification. This case will review the benefit of histopathological clot evaluation after thrombectomy to identify uncommon causes of embolic stroke which may change management.

Videofluoroscopic swallow study abnormalities identify aerodigestive disorders in dogs with respiratory disease versus healthy controls

Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration. We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease. Client-owned dogs: RESP (n=45) and CON (n=15) groups. Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS. Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P=.01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P=.03). The RESP dogs with airway disease had higher PAS than CON dogs (P=.01) but not RESP dogs with parenchymal disease (P=.25). Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.

Automatic diagnostic system for segmentation of 3D/2D brain MRI images based on a hardware architecture

Magnetic resonance imaging is among the advanced diagnostic testing tools for brain health issues. This method captures a series of detailed head images. These images are then printed and diagnosed by a specialist doctor to demonstrate differences in the brain tissue. Accordingly, additional diagnostic information can be given to determine the extent of the damage and the appropriate treatment methods. In this paper, and in order to facilitate the work of the specialist doctor and help him, we propose an automated hardware architecture for 3D/2D segmentation on MRI images to diagnose differences in brain tissue. For this, we used the metaheuristic technique based on Particle Swarm Optimization (PSO); for which we proposed improvements both for the velocity and position equations and for the fitness function. The goal of the work is to develop a real time automatic system for MRI images segmentation with improved metrics such as accuracy, sensitivity, specificity, dice metrics, execution time and resources utilization. The proposed hardware architecture was synthetized and then co-simulated using Matlab-Vivado System (VSM) for Field Programmable Gate Array (FPGA). Results show that our 3D segmentation method benefited from 2D segmentation with 95.39% accuracy rate and 87.97% DSC similarity (for 5-level segmentation) with 4.57 ms execution time for the case of BraTS 2013 dataset of brain MRI Images.

Declining clinical skills in medical education: A perspective on its causes and potential solutions

The medical education is undergoing decline in clinical training during the last 40 years. The Medical Interview of the patient and Physical Examination to arrive at a provisional diagnosis are replaced mostly by advanced diagnostic tests and procedures, after enquiry of the symptoms. This is leading to wrong diagnoses, delayed diagnoses, increase in cost, unfavorable outcome and many a time litigation and compensation against the doctor and hospital. The article outlines cause of decline in clinical skill and points to possible solution.

The possible role of viral infections in acute pancreatitis: a review of literature.

Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, and abdominal pain, is known to range from a mild self-limiting state up to a more severe and lethal form. This review aims to provide a clearer picture to improve understanding the role of viral agents in the development of acute pancreatitis. Common databases including PubMed, Google Scholar, and Scopus were used for the literature search. In this review search terms including virus, viral, infection, and specific descriptive terms for a virus were considered in different combinations. Various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of acute pancreatitis cases, mainly viruses, among other factors, are thought to play a role in this regard. Once the pancreatitis diagnosis has been made, depending on the causative agent, the management approach and specific interventions affect the final outcome. Virus-induced acute pancreatitis in patients should be considered. Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help for a better understanding of the role of viruses in causing acute pancreatitis. Improvement in the tests will lead to timely diagnosis, treatment, and better management of pancreatitis.

KAN ALMA ÜNİTESİNDE KAN ÖRNEĞİ VERİRKEN BAYILAN HASTALAR VE BİR STRESS MEDYATÖRÜ: KORTİZOL

OBJECTIVE: Cortisol is a glucocorticoid and can be used as a stress mediator in association with adrenal insufficiency. A diagnosis of adrenal insufficiency is made when the episodically released cortisol levels are below 3 mcg/dl by making a single measurement at any time of the day. We aimed to determine the presence of underlying adrenal insufficiency by measuring cortisol levels in patients brought to the emergency room by the hospital code blue team that firstly performed their critical care, who fainted whilst giving blood samples in the blood collection unit. MATERIAL AND METHODS: Observational, prospective study; It consists of 28 patients brought to emergency department by Code Blue Team between 2017 and 2020. After physical examination and electrocardiogram(ECG) evaluation, samples were taken for complete blood count, biochemical parameters, venous blood gas, cardiac biomarkers and cortisol measurement. Obtained results were analyzed with SPSS 22. RESULTS: The lowest cortisol level was 9 mcg/dL, and the highest cortisol level was 40,4 mcg/dL. Cortisol levels were higher in women than men. But T-test analysis revealed that gender is not a determining factor in cortisol levels (p=0,26). The correlation between blood collection time and cortisol values was calculated close to zero (r2=0.09). The patient diagnosed with adrenal insufficiency with a single measurement was not defined in the study population. CONCLUSIONS: Patients with acute adrenal insufficiency may come to the emergency department with orthostatic hypotension, agitation, syncope, abdominal pain and fever, and may result in death if left untreated (1). Although emotional stress is 20% among the precipitating factors of adrenal crisis, no significant relationship was found between stress and cortisol in our study (2). The limitations of our study are that it can only be carried out during working hours, and advanced diagnostic tests can not be performed in the emergency room.

Metastatic Breast Cancer: Cytology Diagnosis with Implications for Treatment

Breast cancer is among the most frequent malignancies in women worldwide. While early detection and effective treatment provide many women with a cure and prevent their cancer from spreading, metastases to distant sites still occur in around 20% of women suffering from breast cancer. These relapses occur in many forms and locations and are as varied as the primary breast tumors. Metastatic spread makes a cancer incurable and potentially lethal, but new, targeted treatments can offer control of the cancer cells if the features of new targets are unlocked by advanced diagnostic testing. The article offers an overview of the pathomechanisms of metastatic progression and describes the types of metastases, such as hormone-receptor-positive and -negative breast cancers, and HER2-overexpressing or triple-negative types. Once distant metastatic spread occurs, cytology allows a precise diagnosis to confirm the breast origin. Other molecular targets include ESR1 and PIK3CA mutations, MSI, NTRK fusion, PD-L1 expression and others, which can be obtained also from cytology material and used to determine eligibility for emerging targeted therapeutic options. We outline the diagnostic features of metastatic breast cancer in cytology samples, together with validated and emergent biomarkers that may provide new, targeted treatment options.