Alternative Diagnostic Techniques Research Articles

Accuracy of respiratory event indices downloaded from positive airway pressure devices: can they be relied upon when making treatment decisions?

The gold standard for diagnosis and treatment of obstructive sleep apnea (OSA) is attended overnight polysomnography (PSG) in a sleep laboratory. Alternative diagnostic techniques are urgently needed for both diagnosis and treatment control when initiating positive airway pressure (PAP) in the home setting. Current PAP devices compute data such as residual AHI (apnea-hypopnea index) using their proprietary algorithms to provide an automatic event detection (AED). It was suggested that these should be labeled AHIFLOW. The current study situation shows an acceptable agreement with the tendency of mildly overestimating the AHI by the PAP devices. But, the literature is still limited in terms of accuracy, especially when considering the lack of standardization and different detection algorithms. A validation of PAP devices regarding the agreement of AHIFLOW compared to AHIPSG is extremely important, given that the device analysis is exclusively based on the measured flow. There are considerable concerns about assessing the PAP effectiveness in higher risk groups based on the AED function alone. Given these reservations, the use of PAP event detection can be an important addition to the diagnostic spectrum and, in combination with telemonitoring, offers promising potential.

Comparative membrane proteomic analysis of Tritrichomonas foetus isolates

Tritrichomonas foetus is a flagellated and anaerobic parasite able to infect cattle and felines. Despite its prevalence, there is no effective standardized or legal treatment for T. foetus-infected cattle; the vaccination still has limited success in mitigating infections and reducing abortion risk; and nowadays, the diagnosis of T. foetus presents important limitations in terms of sensitivity and specificity in bovines. Here, we characterize the plasma membrane proteome of T. foetus and identify proteins that are represented in different isolates of this protozoan. Additionally, we performed a bioinformatic analysis that revealed the antigenicity potential of some of those proteins. This analysis is the first study to identify common proteins at the plasma membrane of different T. foetus isolates that could be targets for alternative diagnostic or vaccine techniques in the future.

Alternatives for the Detection and Diagnosis of Osteoarticular Infections: An Exploratory Review.

The precise diagnosis of osteomyelitis, a bone infection, remains a significant challenge for healthcare professionals. This difficulty stems from the highly variable nature of its clinical presentation and disease course. Patients can exhibit a wide range of symptoms, making it easy to misdiagnose the condition. In turn, inaccurate diagnoses lead to inappropriate treatment regimens, potentially hindering a patient's recovery and causing unnecessary complications. Nuclear medicine offers a ray of hope in this fight against diagnostic ambiguity. It provides valuable tools, such as radiopharmaceutical imaging, that can significantly improve the accuracy of osteomyelitis diagnosis. However, limitations exist. This article explores the need for alternative diagnostic approaches within the specific context of Costa Rica. This exploration is particularly relevant due to the current regional shortage of gallium-67 (⁶⁷Ga), a radiopharmaceutical commonly used in osteomyelitis diagnosis. The article delves into the nature, function, and limitations of various nuclear medicine techniques, encompassing both independent radiopharmaceuticals like ⁶⁷Ga and those conjugated with specific targeting molecules to pinpoint areas of infection within the body. Given the scarcity of ⁶⁷Ga in Costa Rica, it becomes crucial to explore and implement viable alternative diagnostic techniques within the healthcare system. This article emphasizes the need for further investigation into these alternatives, with the goal of improving diagnostic accuracy and ensuring optimal patient care. By implementing these alternatives, healthcare professionals in Costa Rica can effectively combat the challenges posed by osteomyelitis and pave the way for better patient outcomes.

New reference nomograms for the study of ventricular size in preterm infants

IntroductionTransfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. MethodsA retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann–Whitney test were used for the comparison of samples. ResultsThe distribution of the right and left Levene indices was normal (Shapiro–Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index. ConclusionFrom the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

THE USE OF MANUKA HONEY AND LEMON AS A TREATMENT FOR BRONCHOPNEUMONIA IN LOCAL CATS

Bronchopneumonia is a respiratory disease caused by non-infectious or infectious agents to the respiratory tract, causing inflammation of the bronchi and alveoli. The case study aimed to find out alternative diagnostic and therapeutic techniques for cases of bronchopneumonia. Physical examination was carried out on a cat with complaints of sneezing accompanied by moist nose and eyes unilaterally since one month. Physical examination showed a high intensity of sneezing accompanied by a runny nose mucoid unilateral from the nose and unilateral mucopurulent discharge from the eyes with a lot of volume and crackles heard in the area of ​​the bronchi to the lungs during inspiration and expiration. X-ray results of the thoracic region show inflammation of the bronchial walls and lungs. The results of cytological examination of the runny nose and eyes found cells neutrophils. The results of the haematological examination showed rate increase white blood cell (WBC), granulocytes, and red distribution width (RDW-CV). Bacterial culture examination showed results staphylococcus sp. on nasal discharge and bacteria Enterobacter sp. on eye discharge. The therapy given to cat cases is causative, symptomatic, and supportive by utilizing natural ingredients. Honey is antibacterial and anti-inflammatory, while lemon water has antioxidant potential. Treatment is in the form of giving a combination of manuka honey and lemon water products with a total of 5 ml given orally twice a day for one month. The results of treatment for one month showed good progress in case animals with reduced frequency of runny nose and eyes and a significant decrease in the intensity of sneezing. Treatment in case animals can continue until the symptoms of runny nose and sneezing disappear completely

Abdominal compartment syndrome: what radiologist needs to know.

The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.

Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review

AbstractPurposeStress radiographs are an easily accessible, cost‐effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques.MethodsThe following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities.ResultsSixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm.ConclusionDespite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision‐making, and provide benchmark values for future investigations.Level of evidenceIII.

A general framework to support cost-efficient fecal egg count methods and study design choices for large-scale STH deworming programs-monitoring of therapeutic drug efficacy as a case study.

Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool. We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAKG2). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species (Ascaris lumbricoides, Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select (SS); screen, select and retest (SSR) and no selection (NS)) and number of subjects enrolled (100-5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design. Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAKG2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAKG2) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity. We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO (SS) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs. ClinicalTrials.gov NCT03465488.

Salivary IL-17 and IL-10 as Potential Diagnostic Biomarkers of Different Stages of Periodontitis in Smoker and Nonsmoker Patients.

The gold standard in the field of periodontal research currently is to find a valid biomarker that can reliably be used for diagnosing periodontal diseases. Given the limitations of the current diagnostic tools that stall to predict susceptible individuals and determine whether active tissue destruction is occurring, there is an increased urge to develop alternative diagnostic techniques that would compensate for the problems inherited in these available methods, such as measuring levels of biomarkers present in oral fluids such as saliva; so the aim of this study was to determine the diagnostic potential of interleukin-17 (IL-17) and IL-10 to differentiate periodontal health from smoker and nonsmoker periodontitis, and to differentiate among different stages (severities) of periodontitis. An observational case-control study was performed on 175 systemically healthy participants grouped into healthy as controls and periodontitis as cases. Periodontitis cases were divided according to the severity into stages I, II, and III, and each of the stages was further subdivided into smokers and nonsmokers patients. Unstimulated saliva samples were collected, clinical parameters were recorded, and salivary levels were assayed using enzyme-linked immunosorbent assay. Elevated levels of IL-17 and IL-10 were associated with stage I and II compared with the healthy controls. However, a significant decrease in stage III was observed compared with the control group for both biomarkers. Salivary IL-17 and IL-10 might be useful for distinguishing periodontal health from periodontitis; however, further research is needed to substantiate their use as potential biomarkers for the diagnosis of periodontitis.

Nuevos normogramas de referencia para el estudio de la talla ventricular en neonatos pretérmino

IntroductionTransfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. MethodsA retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann–Whitney test were used for the comparison of samples. ResultsThe distribution of the right and left Levene indices was normal (Shapiro–Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index. ConclusionFrom the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

Comparison of two home-based polysomnography tools for OSAS diagnosis: a cost-minimization analysis

Abstract Obstructive sleep apnoea syndrome (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming an important social problem since it is associated with a significant adverse impact on quality of life and life expectancy. Overnight polysomnography, performed in a sleep laboratory (LabPSG), is considered the diagnostic standard. Home complete PSG (HoPSG) could represent an alternative to LabPSG for patients who want to avoid the overnight stay at a sleep center. The aim of this study was to assess the economic impact of two alternative HoPSG diagnostic techniques in the diagnosis of OSAS: the standard one versus the telemonitoring approach. The observational study was designed as a cost-minimization analysis adopting a healthcare perspective. The time horizon was 6 months (January 2021 - June 2021), thus no discounting was necessary. Direct medical costs, expressed in 2021 euros, were estimated through a micro-costing method while indirect costs were quantified adopting the Human Capital Approach. To explore the uncertainty of critical parameters, a one-way sensitivity analysis was run. Considering the direct costs, the telemonitoring HoPSG was estimated to cost around €55 less than the standard approach. The cost savings sharply increases taking into account the indirect costs that amounted to €90 million and €365 million for the telemonitoring and the standard approach, respectively. Sensitivity analyses results did not significantly differ from the base-case scenario. The diagnosis of OSAS is presently time-consuming, labor-intensive and costly. The adoption of digital health solutions as telemedicine has the potentiality to ease the diagnosis, to improve the access to health services, to reduce both direct and indirect costs, and to enhance the efficiency of healthcare facilities becoming a crucial tool in addressing the actual public health challenges. Key messages The telemonitoring Home complete polysomnography is cost-saving compared with the standard approach. Telemedicine has the huge potential to overcome public health challenges as increases in chronic disease in an ageing society and the associated burden in healthcare costs.

Covid-19 Detection using Deep Convolutional Neural Networks from X-Ray Images

Abstract— The Novel Coronavirus generally, knows as COVID-19 which first appeared in Wuhan city of China in December 2019, spread quickly around the world and became a pandemic. It has caused an overwhelming effect on daily lives, Public health, and the global economy. Many people have been affected and have died. It is critical to control and prevent the spread of COVID-19 disease by applying quick alternative diagnostic techniques. COVID-19 cases are rising day by day around the world, the on-time diagnosis of COVID-19 patients is an increasingly long and difficult process. COVID-19 patient test kits are costly and not available for every individual in poor countries. For this purpose, screening patients with the established techniques like Chest X-ray images seems to be an effective method. This study used a deep learning data augmentation on a publicly available data set and train advanced CNN models on it. The proposed model was tested using a state-of-the-art evaluation measures and obtained better results. Our model, the COVID-19 images is available at (https://github.com/ieee8023/covid-chestxray-dataset) and for Non-COVID-19 images is available at (https://www.kaggle.com/paultimothymooney/chest-xray-pneumonia). The maximum accuracy achieved in the validation was 96.67%. Our model of COVID-19 detection achieved an average F measure of 98%, and an Area Under Curve (AUC) of 99%. The results demonstrate that deep learning proved to be an effective and easily deployable approach for COVID-19 detection.

Boosting Performance of Transfer Learning Model for Diagnosis of COVID-19 from Computer Tomography Scans

Early-stage rapid and accurate diagnosis of COVID-19 pneumonia is of great importance as a measure to the fight against the pandemic. Even if real-time reverse transcription-polymerase chain reaction (RT-PCR) test seems like a gold standard for determining COVID-19, the availability and the accuracy is still a challenge. Thus, alternative diagnostic techniques are required for controlling the spreading of the disease. Amongst the radiodiagnostic methods, the computer tomography (CT) technique is one of the most powerful candidates for screening COVID-19 pneumonia accurately. In this study, it is aimed to develop a reliable transfer learning-based CNN model tailored to detect the COVID-19 from chest CT scans with high accuracy and sensitivity to help to accelerate the application of the required treatment and taking of measures. The CT scan dataset used in the training process of the CNN model was obtained from “SARS-CoV-2 CT-Scan Dataset”. This dataset contains 1252 CT scans for positive COVID-19 case and 1230 CT scans for the non-COVID-19 case, 2482 CT scans in total, all data have been collected from real patients from hospitals in Sao Paulo, Brazil. ResNet18, ResNet50, VGG16, AlexNet, and SqueezeNet1_1 architectures were re-trained to extract COVID-19 classes by transfer learning. The highest classification performance parameters were obtained for ResNet50 architecture and were calculated as 99.80% accuracy, 99.61 % precision, and 100.00% sensitivity. The activation maps were created to highlight the crucial areas of the CT images and improve causality and intelligibility. The developed transfer learning model can be utilized for reliable clinical diagnosis of COVID-19 cases from CT images to accelerate the triaging and save critical time for disease control as well as assisting the radiologist to validate their initial diagnosis.

COVID-19 Threat to the World: Current and Possible Diagnostic/Treatment Strategies.

The outbreak of coronavirus disease 2019 (COVID-19) has resulted in a world-wide crisis. To contain the virus, it is important to find infected individuals and isolate them to stop transmission. Various diagnostic techniques are used to check for infection. With the havoc that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created, it is imperative to work on alternative diagnostic techniques that can be used at both point of care with little or no expertise and at mass testing (i.e., when screening). Despite extensive research, to this date no specific effective treatment or cure is available to neutralize this viral infection. Globally, researchers are working to develop effective treatments, and several vaccines have been approved for public use. We found the studies that we explored for this review using appropriate key words for indexing in PubMed and Google Scholar from 2019 to 2020. We compile various techniques that have been used worldwide to diagnose and treat SARS-CoV-2 and discuss novel methods that may be modified for use in diagnosis and treatment. It is crucial to develop a more specific serological test for diagnosis that can rule out the possibility of COVID-19 and be used for mass testing. An affordable, safe, targeted, effective treatment must be developed to cure this disease, which has created a public health emergency of international concern.

Diagnostic Accuracy of Microultrasound in Patients with a Suspicion of Prostate Cancer at Magnetic Resonance Imaging: A Single-institutional Prospective Study

BackgroundMultiparametric magnetic resonance imaging (MRI) represents the gold standard for the diagnosis of clinically significant prostate cancer (csPCa). The search for alternative diagnostic techniques is still ongoing. ObjectiveTo determine the accuracy of microultrasound (microUS) for the diagnosis of csPCa within prospectively collected cohort of patients with a suspicion of prostate cancer (PCa) according to MRI. Design, setting, and participantsA total of 320 consecutive patients with at least one Prostate Imaging Reporting and Data System (PIRADS) ≥3 lesion according to MRI were prospectively enrolled. InterventionAll patients received microUS before prostate biopsy using the ExactVu system; the Prostate Risk Identification using microUS (PRI-MUS) protocol was used to identify targets. The urologists were blinded to MRI results until after the microUS targeting was completed. All patients received both targeted (based on either microUS or MRI findings) and randomized biopsies. Outcome measurements and statistical analysisThe sensitivity and specificity of microUS to determine the presence of csPCa (defined as at least one core with a Gleason score ≥7 PCa) were determined. Multivariable logistic regression analysis was fitted to determine the predictors of csPCa. Results and limitationsClinically significant PCa was diagnosed in 116 (36.3%) patients. The sensitivity and negative predictive value of microUS for csPCa diagnosis were 89.7% and 81.5%, while specificity and positive predictive value were 26.0% and 40.8%, respectively. A combination of microUS-targeted and randomized biopsies would allow diagnosing the same proportion of csPCa as that diagnosed by an approach combining MRI-targeted and randomized biopsies (n = 113; 97.4%), with only three (2.6%) csPCa cases diagnosed by a microUS-targeted and three (2.6%) by an MRI-targeted approach. In a logistic regression model, an increasing PRI-MUS score was an independent predictor of csPCa (p ≤ 0.005). The main limitation of the current study is represented by the fact that all patients had suspicious MRI. ConclusionsMicroultrasound is a promising imaging modality for targeted prostate biopsies. Our results suggest that a microUS-based biopsy strategy may be capable of diagnosing the great majority of cancers, while missing only few patients with csPCa. Patient summaryAccording to our results, microultrasound (microUS) may represent an effective diagnostic alternative to magnetic resonance imaging for the diagnosis of clinically significant prostate cancer, providing high sensitivity and a high negative predictive value. Further randomized studies are needed to confirm the potential role of microUS in the diagnostic pathway of patients with a suspicion of prostate cancer.

Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment.

BACKGROUNDPost endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.AIMSTo study the published evidence and systematically review the literature on the prevention and treatment for PEP.METHODSA systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies.RESULTS726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results.CONCLUSIONPrevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.

Ultrasound of the midfoot ligaments, syndesmosis and bands of the deltoid

This presentation will predominantly bring together methods for scanning all regions of the ankle and midfoot to result in a thorough front-line approach to ligament injury in the acute setting. While alternative diagnostic techniques exist, each offering varying degrees of accuracy, expense and time, it is posited that ultrasound is an accurate, cost-effective, and efficient modality for front-line assessment in acute and subacute ankle sprains. Ultrasound examination is often confined to the lateral ligament complex due to operator inexperience or the ingrained perception that its use in other regions of the ankle is limited. However, if the scope of an ultrasound examination is not extended to include the midfoot, syndesmosis and medial ankle, more time-critical injuries may be missed leading to poor patient management and recovery. The following demonstrations will be given in support of this posit: 1. Correct probe positioning to find important midfoot ligaments 2.Correct dynamic stress-ultrasound for detection of tibiofibular diastasis in the setting of AITFL ligament disruption (high ankle sprain) 3. Correct patient positioning to optimally visualise the components of the medial ankle deltoid ligament. It will be seen that such ultrasound techniques can be used to obtain comparative views; allow for accurate appraisals of the tibiofibular syndesmosis, midfoot and deltoid ligaments (along with routine lateral ligament complex assessment). Dynamic positioning of the ankle or stress-ultrasound during assessment can assist with triage and ensure that best patient management is provided.

Ex-vivo study in nephroureterectomy specimens defining the role of 3-D upper urinary tract visualization using optical coherence tomography and endoluminal ultrasound.

Minimal invasive endoscopic treatment for upper urinary tract urothelial carcinoma (UUT-UC) is advocated in patients with low-risk disease and limited tumor volume. Diagnostic ureterorenoscopy combined with biopsy is the diagnostic standard. This study aims to evaluate two alternative diagnostic techniques for UUT-UC: optical coherence tomography (OCT) and endoluminal ultrasound (ELUS). Following nephroureterectomy, OCT, ELUS, and computed tomography (CT) were performed of the complete nephroureterectomy specimen. Visualization software (AMIRA®) was used for reconstruction and coregistration of CT, OCT, and ELUS. Finally, CT was used to obtain exact probe localization. Coregistered OCT and ELUS datasets were compared with histology. Coregistration with three-dimensional CT makes exact data matching possible in this ex-vivo setting to compare histology with OCT and ELUS. In OCT images of normal-appearing renal pelvis and ureter, urothelium, lamina propria, and muscularis were visible. With ELUS, all anatomical layers of the ureter could be distinguished, besides the urothelial layer. ELUS identified suspect lesions, although exact staging and differentiation between noninvasive and invasive lesions were not possible. OCT provides high-resolution imaging of normal ureter and ureter lesions. ELUS, however, is of limited value as it cannot differentiate between noninvasive and invasive tumors.

A Classification of Sleep Disorders with Optimal Features Using Machine Learning Techniques

Background: Sleep disorders become one of the early warnings of potential Non-Communicable Diseases (NCDs). Polysomnography (PSG) or sleep test is a formal method to diagnose sleep disorders. However, the PSG is limited in many hospitals due to its high costs. It also requires various sensors attached to a patient, which may cause inconvenience. Moreover, trained sleep specialists are required to interpret the gigantic PSG data. Researchers attempt to identify sleep disorders using alternative techniques. Method: This study proposed an alternative technique for sleep-related syndrome and sleep disorder classification with optimal features. Patient PSG datasets were retrieved from a hospital in the south of Thailand. In the data preprocessing stage, the datasets were analyzed and normalized using feature extraction and selection mechanisms. Optimal feature selection using the average information gain values was evaluated with the 10-fold cross validation. Four Machine Learning (ML) techniques, k MC, k NN, SVM and MLP, were used in our experiments. The selected ML techniques have been performed and evaluated with the 10-fold cross validation in data preprocessing and model construction phases. Results: The k NN achieved the highest overall classification results. The optimal features with k NN ( opf - k NN) was proposed. The selected features were PULSE, SAO2, CANR and CHEST. With the selected optimal features, only the ordinary oxygen oximeter and the ECG machine were required. Overall classification result of the opf-k NN achieved at 95.17%±3.91. Conclusion: Although the PSG is the formal sleep disorder diagnosis, alternative diagnostic techniques are beneficial especially to patients. Our study proposed the opf - k NN technique to classify sleep disorders with two concerns, the limited access to high-priced medical equipment and patient comfortability. Finally, sleep specialists also obtain benefits in optimizing bio-signal interpretations with only four optimal features.

Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome.

Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome.