Clinical Assessment In Diagnosis Research Articles

Aesthetic Chin Lines: A Novel Clinical Assessment for Diagnosis and Treatment of Chin Deformities

The chin represents an important component in facial aesthetics. A wide range of facial deformities may alter the chin’s position and may bring along aesthetic and functional implications. It is imperative to consider the current aesthetic ideals, while diagnosing and creating a patient’s treatment plan, instead of using the usual cephalometric analysis. The principal objective of this study was to evaluate the chin’s position in a group of male individuals considered to be facially attractive. Material and methods: This is an observational, longitudinal, and descriptive study, in which 100 high quality photographs of male individuals were collected. Images included a lateral facial view of the subject with the head oriented in a natural position and smiling until exposing at least the upper central incisive teeth. The models were described as facially attractive on specialized web site. Exclusion criteria included excessive facial hair and the presence of jewelry or accessories that made it difficult to identify facial landmarks. Two true vertical lines were traced in each photo, the first one passed through the Subnasale and the other one passed through the vestibular aspect of the upper central incisor, these lines were named “Aesthetic Chin Lines,” subsequently the position of the Pogonion was determined in relation to both lines. Results: In 84 cases (84%) the Pogonion was found between the Aesthetic Chin Lines. In 15 cases (15%) it was found behind the Upper Central Incisor line, and in 1 case (1%) it was found in front of the Subnasal line. Conclusion: With the results obtained in this study, we can determine that the “Aesthetic Chin Lines” described in this manuscript are a diagnostic resource than may help with the treatment plan of dentofacial and chin deformities in male patients.

CD15: Comparison of photographic photonic assessment and conventional clinical assessment in diagnosis of contact allergy with patch testing: a pilot study

CD15: Comparison of photographic photonic assessment and conventional clinical assessment in diagnosis of contact allergy with patch testing: a pilot study

Oral pathology in paediatric patients-mini-systematic review

The lesions presenting in the oral cavity of neonates are considerably significant in pediatric dentistry. Although they pertain to the oral cavity they may reflect an underlying systemic condition. These may be clinically misdiagnosed or left untreated owing to lack of parental education, awareness and resources. Their managementrequires thorough knowledge of the various lesions and accurate clinical assessment for diagnosis, prognosis, reatment and parental counselling. Majority lesions are asymptomatic and benign hence resolve without any intervention. This review article is an overview for recognition and management of oral lesions prevalent in neonates.

Feasibility, Reliability, and Validity of the Vietnamese Version of the Clinical Dementia Rating

Introduction: In Vietnam, Alzheimer’s disease (AD) and other dementias have become an increasingly important public health problem among the elderly. Achieving a diagnosis tool with high reliability and validity is essential. The Clinical Dementia Rating (CDR) is a global clinical scale with established diagnostic and severity-ranking utility that has been widely employed in epidemiological studies in an international context. Objective: The aims of this study were to establish the Vietnamese version of the CDR (V-CDR) and evaluate the feasibility, reliability, and validity of this version for diagnosing and classifying cognitive functions in the elderly. Method:One hundred and fifty-three elderly outpatients at a clinic of Cho Ray Hospital, Vietnam, were screened with the Mini Mental State Examination (MMSE) for potential cognitive impairment. All those who scored ≤26 points were included in the study and were subsequently remitted to the V-CDR and clinical assessment for diagnosis. Reliability was assessed through internal consistency (Cronbach α), intra- and interrater reliability (weighted κ). Concurrent and discriminative validity of the V-CDR were assessed. Results: The V-CDR had an excellent internal consistency for each of the 2 raters (Cronbach α 0.90 and 0.96) and excellent agreement in both intra- and interrater reliability (weighted κ 0.84 [95% CI 0.74–0.94] and 0.82 [95% CI 0.72–0.93], respectively). The sensitivity and specificity for detecting dementia were 93.6 and 100%, respectively. The positive and negative predictive value were 100 and 96.4%, respectively. The agreement of V-CDR and clinical assessment was excellent (weighted κ 0.94 [95% CI 0.88–0.99]). V-CDR was substantially better than MMSE at distinguishing between mild cognitive impairment and normal cognitive function (AUC = 0.957, 95% CI 0.893–1.000 vs. AUC 0.594, 95% CI 0.441–0.746). Conclusions: The V-CDR is a feasible, reliable, and valid instrument which should be used in clinical practice for diagnosing and classifying the different dementia stages in the elderly.

PC080 Ultrasound-Guided Scalene Blocks Decrease Radiation Exposure in Patients and Staff While Preserving Quality of Clinical Assessment in Diagnosis and Treatment of Neurogenic Thoracic Outlet Syndrome

PC080 Ultrasound-Guided Scalene Blocks Decrease Radiation Exposure in Patients and Staff While Preserving Quality of Clinical Assessment in Diagnosis and Treatment of Neurogenic Thoracic Outlet Syndrome

Assessment of clinical diagnosis, age, gender and seasonal differences of children admitting to a dermatology clinic of a secondary health care institution

Assessment of clinical diagnosis, age, gender and seasonal differences of children admitting to a dermatology clinic of a secondary health care institution

Role of Histopathology in Medical Autopsies: A 5 Year Study in a Tertiary Care Hospital

The term autopsy is derived from the greek word autopsies “to see for oneself” derives from autos (one self) and opsis (“eye”). It is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause of death, assessment of clinical diagnosis as well as a key educational tool. Various histopathological findings, unrelated to the cause of death are noticed in the routine histopathological examination of the medical autopsies. Present study was conducted on 100 medicolegal cases received in the department of Pathology at GGS medical college, Faridkot in last 5 years (2011–2015). The study highlights the utility and indispensability of histopathological examination of autopsies, without which a complete and accurate diagnosis cannot be made.

Diagnostische Fehler in der Medizin

The recognition of diagnostic errors in everyday practice can help improve patient safety. The most common diagnostic errors are the cognitive errors, followed by system-related errors and no fault errors. The cognitive errors often result from mental shortcuts, known as heuristics. The rate of cognitive errors can be reduced by a better understanding of heuristics and the use of checklists. The autopsy as a retrospective quality assessment of clinical diagnosis has a crucial role in learning from diagnostic errors. Diagnostic errors occur more often in primary care in comparison to hospital settings. On the other hand, the inpatient errors are more severe than the outpatient errors.

THU0353 The Accordance of Changes between Ultrasound and MRI in Patients with Shoulder Pain

BackgroundUltrasound (US) and magnetic resonance imaging (MRI) are valid diagnostic modalities in detecting, characterizing and discriminating the rotator cuff disorders, with no significant comparable difference [1]. MRI is the procedure...

Assessment of Clinical Diagnosis, Microscopy, Rapid Diagnostic Tests, and Polymerase Chain Reaction in the Diagnosis of Plasmodium falciparum in Nigeria

This study compares the performance of clinical diagnosis and three laboratory diagnostic methods (thick film microscopy (TFM), rapid diagnostic test (RDT), and polymerase chain reaction (PCR)) for the diagnosis of Plasmodium falciparum in Nigeria. Using clinical criteria, 217 children were recruited into the study out of which 106 (48.8%) were positive by TFM, 84 (38.7%) by RDT, and 125 (57.6%) by PCR. Using a composite reference method generated from the three diagnostic methods, 71 (32.7%) patients were found to be truly infected and 90 (41.5%) truly uninfected, while 56 (25.8%) were misidentified as infected or noninfected. When each of the 3 diagnostic methods was compared with the composite reference, PCR had sensitivity of 97.3%, specificity of 62.5%, positive predictive value (PPV) of 56.8%, and negative predictive value (NPV) of 97.8%; microscopy had sensitivity of 77.2%, specificity of 72%, PPV of 66.9%, and NPV of 81.1%, while RDT had sensitivity of 62.3%, specificity of 87.4%, PPV of 67.7%, and NPV of 84.5%. PCR test performed best among the three methods followed by TFM and RDT in that order. The result of this study shows that clinical diagnosis cannot be relied upon for accurate diagnosis of P. falciparum in endemic areas.

Clinical application of the multigene analysis test in discriminating between ulcerative colitis and Crohn's disease: a retrospective study

Methods.The newly described – multigene analysis test (DiBiCol) identifying 7 inflammatory bowel disease (IBD)-specific genes in colonic mucosal biopsy differentiating between ulcerative colitis (UC) and Crohn's disease (CD) with active inflammation – is a new addition to existing methods with a higher stated sensitivity and specificity. Method biopsy material from 78 patients with a complicated course diagnosed as most probably UC in 38, CD in 18 and inflammatory bowel disease unclassified (IBDU) in 22 were investigated by DiBiCol. Results. DiBiCol showed a pattern consistent with CD in 13 patients with UC and led to change of diagnosis in 3 patients and a strong suggestion of CD in 8 patients. A total of 2 patients remained as UC. DiBiCol showed a pattern of UC in 4 patients of 18 with CD leading to a changing of diagnosis to UC in 3 patients, but the fourth remained as CD. In 22 patients with IBDU DiBiCol showed a pattern consistent with UC in 7 cases and with CD in 13 cases. A new evaluation 1 year after the DiBiCol allowed the assessment of clinical diagnosis in 10 patients confirmed in 9 of 10 patients by DiBiCol. In patients with acute flare of colitis the clinical diagnosis corresponded in 10 of 12 UC and in 5 of 6 CD cases. Summary.Adopting the DiBiCol test led to a change of the primary diagnosis in a significant number of patients with the initial diagnosis of UC and CD and suggested a clinically probable diagnosis in most of the patients with IBDU and in those with an acute flare of colitis.

Surgical treatment of thoracic outlet syndrome; by supraclavicular approach

Background: Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the supraclavicular approach in management of neurovascular compression at the thoracic outlet. Materials and Methods: Twenty patients (15 females and 5 males) with mean age of 20 years (ranging from 18 to 40 years) underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression (C8 - T1). Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. Results: After 35 months of follow-up, 17 patients showed excellent results, two cases had good results and one case had fair results according to the visual analog scale, and nerve conduction velocities. Conclusions: We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow-up, and supraclavicular approach in neurogenic decompression which is relatively safe and effective.

The clinical use of structural MRI in Alzheimer disease.

Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment.

Point of Care Biomarker Assays Are Superior to Clinical Assessment for Diagnosis of Heart Failure in Australian Emergency Departments: TRIAGED Study

Point of Care Biomarker Assays Are Superior to Clinical Assessment for Diagnosis of Heart Failure in Australian Emergency Departments: TRIAGED Study

Magnetic resonance analysis of amygdalar volume in Alzheimerʼs disease

With the rising prevalence of Alzheimer's disease, there is an increasing need for better comprehension of its pathophysiology. The purpose of this article is to review recent studies investigating the association between amygdalar volume and clinical symptoms in Alzheimer's disease. The first part describes the technique of MRI segmentation of amygdala. The advantages and risks of various segmentation techniques are noted. In the second part, the role of amygdalar volume in the assessment of clinical diagnosis is discussed. The third part encounters the relationship between the amygdalar atrophy and its neuropsychological correlates. Numerous MRI studies showed the same degree of hippocampal and amygdalar volume loss. MRI volumetry of the amygdala may be relevant as a marker of dementia severity in Alzheimer's disease. Asymmetry in amygdalar atrophy is useful in separating Alzheimer's disease and frontotemporal lobar degeneration. There has been a lack of direct relationship between the atrophy of amygdala and neuropsychiatric symptoms in Alzheimer's disease. Although time-consuming, the manual tracing represents the golden standard in MRI volumetry of amygdala. The pathogenesis of neuropsychiatric symptoms in Alzheimer's disease is complex and their manifestation is therefore not attributable to the amygdalar atrophy only.

Les capacités d'élaboration : concept transdimensionnel

In everyday clinical practice, the term “ability of elaboration”, an empirical concept, is supposed to assess the mind's construction and structure. In psychiatric literature, terms with similar meaning exist, but they are not clearly defined. Does ability of elaboration have a conceptual strength? If so, is it a trans-dimensional concept? The empirical state of this concept frequently used at the end of a psychiatric examination justifies language, the translation of the patient's symbolic activity, to be considered as the beginning of our reflection. Subjects use symbolization to attribute subjective meanings to traumatic or non-traumatic events, language being the usual way of expression of this symbolization. It could result from the patient's ability to adapt. It would vary because of structural and contextual factors as affective maturation or emotional, psychological and physiological contexts. The way symbolization is processed can be modelled in different ways according to main psychiatric currents. Considering psychoanalysis theories, symbolization would result of complex mechanisms (meaning, coherence, psychic development). Psychic development links signifier to signified, restores symbolic activity, its main expression being language. Language gives the subject the possibility to transmit his psychic work. In clinical practice, psychic elaboration is predominant because trauma is intrinsically meaningless and cannot be spontaneously symbolized. Defence mechanisms could operate to make this trauma meaningful. The ability to put words on traumas would be a consequence of the ability of elaboration. But the ability would be insufficient or absent if language did not permit intelligibility. There would then be other ways to express elaboration: psychosomatic or behavioural signs. Ability of elaboration should be considered as the result of dynamic and protean tools. These tools would be necessary to resolve internal or external psychic conflicts. They would help to constantly adapt the subject to his environment. This would justify their importance in clinical assessment for diagnosis and prognosis. Ability of elaboration, empirically used, may finally be a trans-dimensional concept.

Thorn Prick Osteomyelitis of the Foot in Barefoot Walkers: A Report of Four Cases

Walking barefoot is common in developing countries and the feet are therefore exposed to a variety of trivial injuries, some of which lead to cellulitis or abscess formation. If left untreated or improperly managed, osteomyelitis or septic arthritis, usually involving the heel or metatarsals, may follow. In countries with limited resources, the emphasis should be on clinical assessment for diagnosis, and good surgical technique for treatment. We report 4 patients with thorn prick osteomyelitis of the foot due to walking barefoot. All were treated with thorn removal, surgical debridement, and oral ofloxacin. Surgical removal of the thorn is the key to successful treatment and to avoiding recurrent infection.

Benign lesions of the vocal folds: uniformity in assessment of clinical diagnosis

The names given to a number of benign lesions of the vocal folds are not well standardized and lead to difficulties in comparing treatment. In the present study photographs of benign lesions of the larynx were presented to groups of clinicians together with a questionnaire, and the answers analysed. The results show great variation between clinicians in interpretation and naming of these lesions. Definitions are suggested for different benign conditions in order to standardize the nomenclature.

C-reactive protein and bacterial infection in preterm infants

Serum C-reactive protein (CRP) concentration was measured by a new solid phase ligand-binding radiometric monoclonal antibody immunoassay in a prospective study of 193 consecutively born preterm infants. In 104 with no clinical or laboratory evidence of infection the median CRP in cord serum was 0.125 mg/l (range 0.011-6.0 mg/l), at 24 h it was 1 mg/l (0.016-7.0) and at 48 h 2 mg/l (0.400-8.0). The present highly sensitive assay has enabled these normal ranges to be defined for the first time, at levels below the threshold of non-labelled immunoassays and of all commercially available CRP assays. The values in cord serum were significantly lower than in normal healthy adults (median 0.8 mg/l, range 0.07-29 mg/l, n = 468). Arterial catheterisation and endotracheal intubation, in the absence of infection, did not appear to elevate CRP, nor did cerebral germinal layer or intraventricular haemorrhage. Among nine infants with confirmed septicaemia eight had a serum CRP level raised at least once during the first 48 h and serum CRP in the other one increased 250-fold in 24 h before treatment was started. Using this assay, serum CRP is a useful and rapidly available adjunct to clinical assessment in diagnosis and exclusion of bacterial infection in the early neonatal period, has encouraged us to withhold or discontinue antibiotics and also has a role in monitoring response to treatment.

Measurement for Serum Thyroxine-Binding Globulin (TBG) and Its Clinical Assessment in Diagnosis of Thyroid States

一抗体RIA法により測定された血中TBG濃度は甲状腺機能亢進症では正常値で, 甲状腺機能低下症および妊娠の中期・後期では高値を示し, さらに, 正常機能とみられる慢性甲状腺炎においても有意の高値を示した。先天性TBG欠損症の一例ではTBGは検出されなかった。TBG値はT3U値と有意の負の相関を示し, また, 正常人および妊娠では血中T4値と有意の正の相関を示した。T4/TBG比は, 甲状腺機能亢進症および低下症の鑑別, ならびにTBG増多に伴う高T4血症の診断に有用であった。