Basic Clinical Tests Research Articles

Utilization Of The Complete Blood Count In Diagnosing Endemic Diseases In Pakistan.

Numerous infectious diseases, including enteric fever, malaria, dengue fever, and, most recently, coronavirus disease-2019, are prevalent in Pakistan. All these diseases have overlapping clinical symptoms and can present a diagnostic challenge for the general practitioner. Since definitive testing for these disorders is time-consuming and expensive, basic clinical testing, such as a complete blood count, should be utilised to supplement clinical diagnosis, when possible. The current narrative review was planned to present specific alterations in haematological parameters for each of these disorders. The review was intended as a guide for practising physicians in their decision-making.

Aggregation-induced electrochemiluminescence enhancement of Ag-MOG for amyloid β 42 sensing

This study aimed to introduce an immunosensor for measuring amyloid β 42 (Aβ42) levels by aggregation-induced enhanced electrochemiluminescence (ECL). Metal–organic gels (MOGs) are novel soft materials with advantages such as high gel stability, good light-emitting properties, and easy preparation. This study used silver nanoparticle metal–organic gel (Ag-MOG) as a substrate to connect Aβ42-Ab2 and the cathodoluminescent probe. Potassium persulfate was used as a co-reactant that could emit a high ECL signal. CuS@Au had the benefits of a relatively large surface area with excellent carrier function; therefore, it was used as a substrate to load a large amount of Aβ42-Ab1, significantly improving the immunosensor sensitivity. The ECL intensity of Aβ42 was linear in the range of 0.01 pg/mL to 250 ng/mL with a detection limit of 2.2 fg/mL (S/N = 3) under optimized detection conditions. This ECL immunosensor has been successfully applied to detect Aβ42 in human serum with the advantages of excellent stability and high selectivity. This method not only expands the potential applications of ECL immunosensors based on biological testing and clinical diagnosis but also provides a viable approach to basic clinical testing.

Artificial intelligence-enabled rapid and symptom-based medication recommendation system (COV-MED) for the COVID-19 patients

In a general COVID-19 population in Cox’s Bazar, Bangladesh, we developed a medication recommendation system based on clinical information from the electronic medical record (EMR). Our goal was also to enable deep learning (DL) strategies to quickly assist physicians and COVID-19 patients by recommending necessary medications. The general demographic data, clinical symptoms, basic clinical tests, and drug information of 8953 patients were used to create a dataset. The learning model in this COVID-MED model was created using Keras (an open-source artificial neural network library) to solve regression problems. In this study, a sequential model was adopted. In order to improve the prediction capability and achieve global minima quickly and smoothly, the COVID-MED model incorporates an adaptive optimizer dubbed Adam. The model calculated a mean absolute error of 0.0037, a mean squared error of 0.000035, and a root mean squared error of 0.0059. The model predicts the output medications, such as injections or other oral medications, with around 99% accuracy. These findings show that medication can be predicted using information from the EMR. Similar models allow for patient-specific decision support to help prevent medication errors in diseases other than COVID-19.

Aggregation-induced electrochemiluminescence resonance energy transfer with dual quenchers for the sensitive detection of prostate-specific antigen

Here, gold nanoclusters (AuNCs) were wrapped with 6-aza-2-thiothymine (ATT). The aggregation of AuNCs protected by ATT induced the electrochemiluminescence (ECL) enhancement of AuNCs. A new dual-quenching ECL immunosensor based on a solid-state ATT−AuNCs (SS−ATT−AuNCs) luminophore and aggregation-induced emission (AIE) was designed for the sensitive determination of prostate-specific antigen (PSA). The synthesized CeO2-PEI@Ag composite could be used as the carrier to immobilize secondary antibody (Ab2) and also to improve the efficiency of the ECL sensing platform based on resonance energy transfer between SS−ATT−AuNCs and CeO2-PEI@Ag. Under the optimal conditions, the prepared dual-quenching aggregation-induced electrochemiluminescence resonance energy transfer (AIECL-RET) immunosensor showed a linear range from 1 × 10−5 ng/mL to 200 ng/mL and a detection limit of 2.2 fg/mL (S/N = 3). The prepared AIECL-RET sensor was successfully applied to detect PSA in human serum with high stability and good selectivity. This study enriches ECL research strategies, provides a feasible method for basic clinical testing, and shows the potential applications of ECL sensors in clinical bioassays.

Students’ Perception towards the Usefulness and Satisfaction of Practical Biochemistry Skills in a Public University versus Private University in Khartoum, Sudan (2019)

Practical biochemistry skills (PBS) teaching sessions employ experiential learning techniques to promote medical students’ understanding and recall of essential concepts and basic clinical tests. Biochemistry Practical skill sessions constitute about 45% of the contact teaching hours and between 10% - 20% of the final assessment grades, in addition the students are unacquainted about the method of assessment used. This cross sectional institutional based study aimed to assess medical students’ perception towards the practical biochemistry skills (PBS). Medical students in one public (Al-Neelain) and one private (Al-Moughtarbeen) universities, in Khartoum State were involved. After ethical approval, the questionnaire was approved after using it in a pilot study. Data collected by a questionnaire were analyzed using (SPSS version 22).Private university students have more satisfaction (58% versus 18%, p<0.001), more positive perception with PBS (49.5% versus 15.1%, p<0.001) and are more convinced that it helps to retain knowledge (68.3% versus 12.9%, p<0.001). They are more satisfied with laboratory environment (p<0.001), PBS relation to theory (p<0.001) and more aware of PBS assessment and scores allocation (p≤0.002).Medical student satisfaction and engagement with Practical biochemistry skills is likely to be driven by the students’ awareness of the relevance of these sessions to other aspects of the curriculum, to their end-of-year assessment, and to their future clinical practice rather than the laboratory environment. In conclusion, we recommend updating Practical biochemistry skills contents and assessment methods and raising students’ awareness of its importance.

When Will My Patient Fall? Sensor-Based In-Home Walking Speed Identifies Future Falls in Older Adults.

Although there are known clinical measures that may be associated with risk of future falls in older adults, we are still unable to predict when the fall will happen. Our objective was to determine whether unobtrusive in-home assessment of walking speed can detect a future fall. In both ISAAC and ORCATECH Living Laboratory studies, a sensor-based monitoring system has been deployed in the homes of older adults. Longitudinal mixed-effects regression models were used to explore trajectories of sensor-based walking speed metrics in those destined to fall versus controls over time. Falls were captured during a 3-year period. We observed no major differences between those destined to fall (n = 55) and controls (n = 70) at baseline in clinical functional tests. There was a longitudinal decline in median daily walking speed over the 3 months before a fall in those destined to fall when compared with controls, p < .01 (ie, mean walking speed declined 0.1 cm s-1 per week). We also found prefall differences in sensor-based walking speed metrics in individuals who experienced a fall: walking speed variability was lower the month and the week just before the fall compared with 3 months before the fall, both p < .01. While basic clinical tests were not able to differentiate who will prospectively fall, we found that significant variations in walking speed metrics before a fall were measurable. These results provide evidence of a potential sensor-based risk biomarker of prospective falls in community living older adults.

Effects of passive Bi-axial ankle stretching while walking on uneven terrains in older adults with chronic stroke

Many people with stroke experience foot drop while walking. Further, walking on uneven surfaces is a common fall risk for these people that hinder with their daily life activities. In addition, a few years after a stroke, lower-limb exercises become less focused, especially the ankle joint movement. The objective of this study is to determine the gait performance of older adults with chronic stroke on an uneven surface in relation to ankle mobility after a four-week bi-axial ankle range of motion (ROM) exercise session. Fifteen older adults with chronic post-stroke hemiparesis (N = 15; mean age = 65 years) participated in a total of 12 bi-axial ankle ROM exercises that consisted of three 30-min training sessions per week for four weeks. Basic clinical tests and gait performance in even and uneven surfaces were evaluated before and after training. Participants with chronic post-stroke hemiparesis showed significantly improved ankle functions, decreased ankle stiffness (from 0.140 ± 0.059 to 0.128 ± 0.067 N·m/°; p = 0.025), and increased paretic ankle passive ROMs (dorsiflexion(DF)/plantarflexion(PF): from 27.3 ± 14.7° to 50.6 ± 10.3°, p < 0.001; inversion(INV)/eversion(EV): 21.7 ± 9.7° to 28.6 ± 9.9°; p = 0.033) after training. They exhibited significant improvements in the walking performance over an uneven surface, step kinematics (walking speed 0.257 ± 0.17 to 0.320 ± 0.178 m/s; p = 0.017; step length: 0.214 ± 0.109 to 0.243 ± 0.108 m; p = 0.009), and clinical balance and mobility (Berg balance scale: 47.2 ± 4.7 to 50.1 ± 3.9, p = 0.0001; timed-up and go test: 23.9 ± 10.3 to 20.2 ± 7.0 s, p = 0.0156). This study is the first research to investigate the walking performance on uneven surfaces in the elderly with chronic stroke in relation to the ankle biomechanical property changes.

Basic Neuro-Optometric Diagnostic Tests for Mild Traumatic Brain Injury/Concussion: A Narrative Review, Perspective, Proposed Techniques and Protocols

Vision problems are common in individuals with mild traumatic brain injury (mTBI)/concussion. However, a global conceptualization of the diagnostic process remains incomplete and practitioner dependent. Thus, a comprehensive diagnostic test battery is proposed to assist in the management of these patients. This battery includes a range of basic clinical tests of a sensory and motor nature, with all having a clinical and scientific rationale. These tests have been used by the authors for many years, with good success, and furthermore they have been found to be clinically useful and insightful.

A methodology for customizing clinical tests for esophageal cancer based on patient preferences.

Clinical tests for diagnosis of any disease may be expensive, uncomfortable, time consuming and can have side effects e.g. barium swallow test for esophageal cancer. Although we can predict non-existence of esophageal cancer with near 100% certainty just using demographics, lifestyle, medical history information, and a few basic clinical tests but our objective is to devise a general methodology for customizing tests with user preferences to avoid expensive or uncomfortable tests. We propose to use classifiers trained from electronic medical records (EMR) for selection of tests. The key idea is to design classifiers with 100% false normal rates, possibly at the cost of higher false abnormal. We find kernel logistic regression to be most suitable for the task. We propose an algorithm for finding the best probability threshold for kernel LR, based on test set accuracy tuning with help of a validation data set. Using the proposed algorithm, we describe schemes for selecting tests, which appear as features in the automatic classification algorithm, using preferences on costs and discomfort of the users i.e the proposed method is able to detect almost all true patients in the population even with user preferred clinical tests. We test our methodology with EMRs collected for more than 3000 patients, as a part of project carried out by a reputed hospital in Mumbai, India. We found that kernel SVM and kernel LR with a polynomial kernel of degree 3, yields an accuracy of 99.18% and sensitivity 100% using only demographic, lifestyle, patient history, and basic clinical tests. We demonstrate our test selection algorithm using two case studies, one using cost of clinical tests, and other using "discomfort" values for clinical tests. We compute the test sets corresponding to the lowest false abnormals for each criterion described above, using exhaustive enumeration of 12 and 15 clinical tests respectively. The sets turn out to be different, substantiating our claim that one can customize test sets based on user preferences.

Prediction of esophageal cancer using demographic, lifestyle, patient history, and basic clinical tests

An early detection of a disease can save many lives but it is impractical to undergo all medical tests for many prevalent diseases. Further these tests are costly, painful, time consuming and may have side effects. We have tried to predict esophageal cancer using demographics, lifestyle, medical history information, and basic clinical tests initially and later removed all clinical tests one after another to study the change of the accuracy without these clinical tests. It is well studied that no single classification technique turns out to be best for all the problems. Here, we test Naive Bayes classification, random forests, support vector machines (SVM) and logistic regression (LR), which perform similarly when all tests are used. However, as we reduce the number of tests, naive versions of these classifiers perform worse than kernelized versions of SVM and LR. We test our methodology with electronic medical record (EMR) of 3500 patients (approx.). The four methods described above, demonstrate a high accuracy with all features, including basic clinical test and show very low accuracy without the basic clinical tests measured by medical practitioner (MP). LR with a polynomial feature transformation of degree three yields an accuracy of 100% (approx), even without the MP features. Further dropping clinical tests one after another we see a decline in the accuracy of detection to 96%. We have also observed high sensitivity to 100% which indicates that no real patients are undetected in this experiment.

CAN WE LIMIT TRAINING DAYS LOST DUE TO OSGOOD SCHLATTERS DISEASE IN JUNIOR SQUASH ATHLETES?

BackgroundHigh-intensity sports like Squash expose immature athletes to the risk of developing Osgood-Schlatter's (OSD) disease during critical periods of growth. Acute OSD episodes have been associated with changes in training load and recognized as a common cause of lost training days.ObjectiveTo investigate the influence of periodic OSD monitoring and any subsequent alterations in training load on the number of training days lost.DesignProspective data analysis over 2 seasons (80 weeks), repeated measures.SettingElite youth sports academy.Patients (or Participants)Highly-trained adolescent Squash athletes (n=9) who were identified as being “at risk” based on; previous episodes of OSD, chronological age (12–15 years) and maturity status.Interventions (or Assessment of Risk Factors)On a weekly basis a physiotherapist graded each athlete on a scale of 5 (“free of OSD symptoms”) to 1 (“unable to train”). The grading was based on clinical assessments including; pain level over the tibial tuberosity during palpation, functional movements, and strength assessments of the Quadriceps and Hamstrings. When an athlete was rated ≤3 coaching staff were advised to reduce the training load for the subsequent week. Training load was quantified using Edwards Training Impulse calculated from heart rate data.Main Outcome MeasurementsThe number of training days lost due to OSD. Any alterations in training load following a rating of ≤3.ResultsOver the intervention period there were 24 ratings of ≤3. Weekly training load following a rating of ≤3 was significantly lower than the average weekly load (245.4±231.2 Vs. 658.5±154.7 arbitrary units, P&lt;0.001). Five training days lost due to OSD were recorded during the intervention period.ConclusionsPeriodic monitoring of OSD symptoms, with basic clinical tests, appear to alert the medical staff about potential acute onsets. Subsequent recommendations to reduce training load resulted in low training days lost due to OSD.

THE INFLUENCE OF ENDOTHELIUM-DEPENDENT MECHANISMS OF VESSEL TONE REGULATION ON THE TISSUE OXYGENATION PARAMETERS IN PATIENTS WITH ISCHEMIC STROKE AT THE BACKGROUND OF ARTERIAL HYPERTENSION SYNDROME

Aim. To study properties of tissue oxygenation and role of nitricoxyde-ergic reactions of circulation in ischemic stroke at the background of arterial hypertension. Material and methods. Totally 62 men and women included with the diagnosis of ischemic stroke. All patients underwent CT and MRI of the brain; cerebral flow was studied by extra- and transcranial ultrasound dopplerography, central hemodynamics was assessed by echocardiography, the basic clinical tests performed, and neurological and neuroophthalmological examination. Study of oxygen transport on the microcirculatory level was performed by polarographic method by transcutaneous measurement of oxygen pressure in tissues. Gases of the blood were measured on the analyzer Easy Stat "Medica Corporation" (USA). For the evaluation of nitric oxide (NO) level, we used the measurements of its stabile metabolites on blood — nitrites and nitrates. Neurological status was examined with the NIHSS score (The Score of the National Health Institute of the US, by T Brot, H.R Adams, 1989). All patients studied were then grouped into 3 groups according to severity of the stroke. Mathematical analysis was performed using software "Statistica 6.0" with non-parametric criteria of Mann-Whitney. Significant were the data with p&lt;0,05. Results. In patients with ischemic stroke, there were disorders of nitricoxide-ergic mechanism of the vessels. Decrease of the level of stable NO metabolites and impairment of tissue oxygenation were linked to the severity of the disease and prominence of neurologic deficiency. Conclusion. In ischemic stroke, there are structural and functional changes in cerebral vessels, which do worsen by the impairment of systemic circulation, increase of systemic pressure, those then lead to tissue hypoxia and neurologic deficiency progression.

Variability of Selected Biochemical Parameters in Young Stallions During the 100-day Performance Test

The aim of the study was to evaluate variations in biochemical blood parameters of stallions during a 100-day performance test. The study was carried out with 20 clinically healthy stallions aged 3-4 years. The degree of adaptation to exercise loads during a 100-day performance test was assessed three times: (I) on the first day of training, (II) on the 46th day of training, and (III) on the 97th day of training. Sample collection and basic clinical tests were performed before training (1), directly after training (2), and after a 30-minute rest (3). Venous blood samples were analyzed for the concentration of total protein, glucose (GLU), and lactate, the activity of lactate dehydrogenase (LDH), and creatine kinase (CK), and total antioxidant status (TAS). Postexercise changes in the analyzed parameters showed that the loads were of moderate intensity. As a result of the 100-day training, postexercise variation in GLU concentration and CK and LDH activity was lower than at the beginning, which indicates that the body was stimulated to adapt to performing exercise tasks. The resting level of TAS was also found to increase. The results obtained suggest that the stallions are well prepared for increasing exercise loads.

Ciliary injection:

This case presents the challenge of how to accurately assess the unilateral painful red eye with ciliary injection. The diagnosis can be clarified with careful clinical observation and a few basic clinical tests. Physical examination should focus on visual acuity; presence of pain; location of redness; shape, size, and reaction of the pupil; and the IOP, if it can be obtained safely. If a slit lamp is available, the diagnosis can be made more definitively. Because the diagnosis in a situation like this is usually made by an eye specialist, a clinical presentation of unilateral painful red eye will normally be referred after an initial examination and early management commences. A crucial role for the physician assistant or other primary care provider is to carefully observe the physical findings, accurately describe the signs and symptoms, and initiate appropriate management. These steps will facilitate the referral to an eye specialist and optimize resolution of these potentially sight-threatening conditions.

Shoulder Impingement Syndrome

Although there has been much research about imaging methods for shoulder impingement syndrome, the clinical information and upper limb level of disability have been generally ignored. The purpose of this study was to detect the relationships between clinical, functional, and radiologic variables in patients with shoulder impingement syndrome. A cross-sectional, clinical, and radiologic study was planned and 59 shoulders of 58 consecutive patients waiting for physical therapy because of a clinically suspected shoulder impingement syndrome were included into this study. Comprehensive clinical examination, radiography, shoulder ultrasonography, and magnetic resonance imaging were performed in the same month. Despite the high sensitivities of ultrasonography for diagnosing rotator cuff tears (98.1%) and biceps pathologies (100%), magnetic resonance imaging was superior to ultrasonography in many important shoulder structures such as a glenoid labral tear and subacromial bursal effusion/hypertrophy (P < 0.01). These structures were the determinants of the shoulder's disability measured by disabilities of the arm, shoulder, and hand questionnaire. Ultrasonography and magnetic resonance imaging had comparable high accuracy for identifying the biceps pathologies and rotator cuff tears. The basic clinical tests had modest accuracy in both disorders. The choice of which imaging test to perform should be based on the patient's clinical information (regarding lesion of glenoid labrum, joint capsule, muscle, and bone), cost, and imaging experience of the radiology department.

The next 15 years: Taking plant‐made vaccines beyond proof of concept

Significant potential advantages are associated with the production of vaccines in transgenic plants; however, no commercial product has emerged. An analysis of the strengths, weaknesses, opportunities and threats for plant-made vaccine technology is provided. The use of this technology for human vaccines will require significant investment and developmental efforts that cannot be supported entirely by the academic sector and is not currently supported financially by industry. A focus on downstream aspects to define potential products, conduct of additional basic clinical testing, and the incorporation of multidisciplinary strategic planning would accelerate the potential for commercialization in this field. Estimates of production cost per dose and volume of production are highly variable for a model vaccine produced in transgenic tomato, and can be influenced by the optimization of many factors. Commercialization of plant-made vaccine technology is likely to be led by the agricultural biotechnology sector rather than the pharmaceutical sector due to the disruptive nature of the technology and the complex intellectual property landscape. The next major milestones will be conduct of a phase II human clinical trial and demonstration of protection in humans. The achievement of these milestones would be accelerated by further basic investigation into mucosal immunity, the codevelopment of oral adjuvants, and the integration of quality control standards and good manufacturing practices for the production of preclinical and clinical batch materials.

A combination of tests for the diagnosis of dementia had a significant diagnostic value

ObjectiveTo study the diagnostic parameters of a number of instruments for a diagnosis of dementia in general practice and the added diagnostic value of these tests. Study design and settingCross-sectional diagnostic research in general practice. Participants: 152 persons aged 65 plus. The Mini-Mental State Examination (MMSE), the Clock Drawing Test, the ADMP scale, the Timed Up and Go Test, the Extrapyramidal Sign Scale, the Behavior Observation Scale, the Poon–Baro–Wens computer battery, and the Cognitive Drug Research Computerized Assessment System were evaluated against the Dutch version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX-N). Diagnostic characteristics were calculated with their 95% CI. Using forward stepwise logistic regression analysis, a model was built with CAMDEX-N as the dependent variable and the tests under study as independent variables. Area under the curve was the main parameter for the comparisons. ResultsThe main diagnostic gain results from age and ADMP, followed by the Clock Drawing Test. Subsequent addition of the MMSE and computer tests results in modest additional gain only. The final model including five tests has an area under the curve of 0.95. ConclusionSophisticated neuropsychological computerized tests have little added value in the diagnostic work-up of dementia in general practice. Basic clinical tests used in an appropriate sequence can be very valuable in establishing the diagnosis of dementia.

Peripheral nerve entrapment, occupation-related syndromes, and sports injuries.

The use of magnetic resonance imaging to detect nerve entrapment disorders is described in this review as well as more basic clinical tests for the carpal tunnel syndrome. Overuse syndrome remains controversial. Symptoms may arise from overuse outside the workplace; prospective electrodiagnostic study of median nerve latency shows no difference between persons doing repetitive hand tasks and those applying for these jobs. Conditioning for young and old sports participants is reviewed as well as the injuries they suffer. Magnetic resonance imaging of asymptomatic knees reveals meniscus lesions more often than not.