Clinical Assessment Procedures Research Articles

Progression from healthy periodontium to gingivitis and periodontitis: Insights from bioinformatics-driven proteomics - A systematic review with meta-analysis.

The current study aimed to: (1) systematically review the published literature regarding the proteomics analyses of saliva and gingival crevicular fluid (GCF) in healthy humans and gingivitis and/or periodontitis patients; and (2) to identify the differentially expressed proteins (DEPs) based on the systematic review, and comprehensively conduct meta-analyses and bioinformatics analyses. An online search of Web of Science, Scopus, and PubMed was performed without any restriction on the year and language of publication. After the identification of the DEPs reported by the included human primary studies, gene ontology (GO), the Kyoto encyclopedia of genes and genomes pathway (KEGG), protein-protein interaction (PPI), and meta-analyses were conducted. The risk of bias among the included studies was evaluated using the modified Newcastle-Ottawa quality assessment scale. The review identified significant differences in protein expression between healthy individuals and those with gingivitis and periodontitis. In GCF, 247 proteins were upregulated and 128 downregulated in periodontal diseases. Saliva analysis revealed 79 upregulated and 70 downregulated proteins. There were distinct protein profiles between gingivitis and periodontitis, with 159 and 31 unique upregulated proteins in GCF, respectively. Meta-analyses confirmed significant upregulation of various proteins in periodontitis, including ALB and MMP9, while CSTB and GSTP1 were downregulated. AMY1A and SERPINA1 were upregulated in periodontitis saliva. HBD was upregulated in gingivitis GCF, while DEFA3 was downregulated. PPI analysis revealed complex networks of interactions among DEPs. GO and KEGG pathway analyses provided insights into biological processes and pathways associated with periodontal diseases. The ongoing MS-based proteomics studies emphasize the need for a highly sensitive and specific diagnostic tool for periodontal diseases. Clinician acceptance of the eventual diagnostic method relies on its ability to provide superior or complementary information to current clinical assessment procedures. Future research should prioritize the multiplex measurement of multiple biomarkers simultaneously to enhance diagnostic accuracy and large study cohorts are necessary to ensure the validity and reliability of research findings.

Biosignal comparison for autism assessment using machine learning models and virtual reality

Clinical assessment procedures encounter challenges in terms of objectivity because they rely on subjective data. Computational psychiatry proposes overcoming this limitation by introducing biosignal-based assessments able to detect clinical biomarkers, while virtual reality (VR) can offer ecological settings for measurement. Autism spectrum disorder (ASD) is a neurodevelopmental disorder where many biosignals have been tested to improve assessment procedures. However, in ASD research there is a lack of studies systematically comparing biosignals for the automatic classification of ASD when recorded simultaneously in ecological settings, and comparisons among previous studies are challenging due to methodological inconsistencies. In this study, we examined a VR screening tool consisting of four virtual scenes, and we compared machine learning models based on implicit (motor skills and eye movements) and explicit (behavioral responses) biosignals. Machine learning models were developed for each biosignal within the virtual scenes and then combined into a final model per biosignal. A linear support vector classifier with recursive feature elimination was used and tested using nested cross-validation. The final model based on motor skills exhibited the highest robustness in identifying ASD, achieving an AUC of 0.89 (SD = 0.08). The best behavioral model showed an AUC of 0.80, while further research is needed for the eye-movement models due to limitations with the eye-tracking glasses. These findings highlight the potential of motor skills in enhancing objectivity and reliability in the early assessment of ASD compared to other biosignals.

PCOS Detection and Breast Cancer Detection

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder that affects people with ovaries, typically during their reproductive years. Detecting PCOS is crucial for timely intervention and management. PCOS detection involves a multifaceted approach, encompassing both clinical and laboratory methods. Clinical assessment of PCOS often begins with a comprehensive medical history, physical examination, and evaluation of symptoms, such as irregular menstruation, excess hair growth, and acne. Transvaginal ultrasound is commonly employed to visualize the ovaries and identify the characteristic cysts. Blood tests, measuring hormone levels like testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), aid in the diagnosis. Additionally, insulin resistance and glucose tolerance tests may be conducted, as PCOS is frequently associated with metabolic disturbances. Breast Cancer Detection: Breast cancer is a significant global health concern, and early detection is essential for improved prognosis and survival rates. Various techniques are employed for breast cancer detection, combining clinical assessment, imaging, and biopsy procedures. Clinical breast examination involves a physical assessment by a healthcare professional to identify any palpable lumps, changes in breast shape, or skin abnormalities. Mammography, a low-dose X-ray, is a primary imaging modality for breast cancer screening. Other imaging techniques, such as ultrasound and magnetic resonance imaging (MRI), are used for supplemental evaluation. In cases where abnormalities are detected, a biopsy is performed to confirm the presence of cancer cells. Biopsies may include fine-needle aspiration, core needle biopsy, or surgical biopsy, providing definitive evidence of malignancy. Advances in technology, such as digital mammography and the development of artificial intelligence algorithms for image analysis, continue to enhance the precision and efficiency of breast cancer detection, thereby contributing to early diagnosis and effective treatment.

CDC Guidelines for the Prevention and Treatment of Anthrax, 2023.

Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis. B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: a qualitative study

Introduction: In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods: Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. All interviews were conducted between 26th April 2020 and 8th January 2021. Data was analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results: Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion: The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Vesicovaginal Fistulas (VVF): New Dilemmas and Prospectives Review of the Literature

Although they were first described in 2050 BC in Egypt, Vesicovaginal Fistulas (VVF) still remain a challenging entity for both patients and healthcare services. They often result in the continuous, involuntary leakage of urine into the vaginal canal, leading to significant physical discomfort, psychological distress, and social isolation for the affected individuals. Etiology of VVF remains miscellaneous, with the most common etiology being based on obstetric complications during prolonged labor, particularly in developing and low-resource settings. Other causes include pelvic surgery, radiation therapy, trauma, congenital and underlying medical conditions. Effective diagnosis of VVF relies on the combination of clinical assessment, medical history, physical examination, and diagnostic procedures such as cystoscopy, imaging techniques, and dye tests. Proper detection consists crucial concerning successful treatment and can significantly improve the patient's quality of life. Therapeutic mapping approaches for VVF include both surgical and non-surgical interventions. Conservative management may include catheterization, proper nutrition, and the use of vaginal pessaries. However, surgical intervention remains primary treatment option for most cases, aiming the repair of the fistula and restore normal urinary and reproductive function. Surgical techniques range from simple suturing to complex reconstructive procedures, and the choice of approach depends on the size, location, and complexity of the fistula. While surgical repair offers high success rates, comprehensive postoperative care is vital to ensure optimal outcomes. Additionally, supportive care, including counseling, social reintegration, and rehabilitation, plays a crucial role in the overall recovery process. Aim of our study consists assiduous understanding and knowledge of vesicovaginal fistula. The awareness and attention of the scientific society and healthcare providers need to be aroused regarding new prospectives, strategies and methods of detection and management of VVF.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: a qualitative study

Introduction: In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods: Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. Data was analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results: Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion: The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Translation of surface electromyography to clinical and motor rehabilitation applications: The need for new clinical figures.

Advanced sensors/electrodes and signal processing techniques provide powerful tools to analyze surface electromyographic signals (sEMG) and their features, to decompose sEMG into the constituent motor unit action potential trains, and to identify synergies, neural muscle drive, and EEG-sEMG coherence. However, despite thousands of articles, dozens of textbooks, tutorials, consensus papers, and European and International efforts, the translation of this knowledge into clinical activities and assessment procedures has been very slow, likely because of lack of clinical studies and competent operators in the field. Understanding and using sEMG-based hardware and software tools requires a level of knowledge of signal processing and interpretation concepts that is multidisciplinary and is not provided by most academic curricula in physiotherapy, movement sciences, neurophysiology, rehabilitation, sport, and occupational medicine. The chasm existing between the available knowledge and its clinical applications in this field is discussed as well as the need for new clinical figures. The need for updating the training of physiotherapists, neurophysiology technicians, and clinical technologists is discussed as well as the required competences of trainers and trainees. Indications and examples are suggested and provide a basis for addressing the problem. Two teaching examples are provided in the Supplementary Material.

Revisited Otsu Algorithm for Skin Cancer Segmentation

Computer-aided technology can be used to perform a quantitative and objective evaluation of pigmented skin lesions during the clinical assessment procedure. This helps to expedite the procedure. The growing development of non-invasive techniques can be of significant benefit in the early identification of malignant melanoma, which can, in turn, help to minimize the necessity for invasive biopsies. The system is primarily focused on two principal schemes: Establishing an effective lesion border detection method and then creating an efficient classification scheme. We address two primary areas in this work. First, we study skin lesion detection to analyze any sign of malignancy for skin cancer diagnosis. This is followed by the system implementation of a color-based method for all the images from the RGB color space using a revisited OTSU thresholding segmentation scheme. The results proved to be promising with at least an 80% accuracy detection rate for a wide range of clinical skin lesion images.

Evaluation of occlusal pattern in periodontitis patients using T-scan analysis.

Occlusal analysis is important to analyze any disharmony in occlusion. Atraumatic dental occlusion leads to evolution of T-scan. T-scan gives a valuable procedure for clinical assessment and perception of occlusal problems. T-scan can also be used in periodontitis patients for checking the occlusal pattern. Occlusal problems and periodontal disease relationship remains controversial. Further research is needed to determine whether occlusal adjustment is necessary for periodontal treatment. The main aim of the study was to assess the occlusal pattern using T-scan in periodontitis patients. Thirty periodontitis subjects were taken and checked for occlusion using T-scan. The subject's age group was 35-55 years. The study included 15 males and 15 females. Plaque index, gingival index, attachment loss, probing depth, centric occlusion (CO), protrusion, right lateral, and left lateral were the parameters studied. Occlusal adjustments were needed to decrease and dissipate the abnormal occlusal forces. The significance of statistical tests for various movements are as follows: CO (right and left) (P = 0.077) P > 0.05; protrusion (right and left) (P = 0.09) P > 0.05; left side lateral (right side and left side) (P = 0.01) P < 0.05; right lateral (right side and left side) (P = 0.00) P < 0.05. CO and protrusion (right, left) for males and females are not significant. Left lateral and right lateral (right, left) for males and females were significant. The T-scan manages adequate specificity and sensitivity. Hence, these act as a distinctive tool for diagnosis and better unreliable when used intraorally. The T-scan method is definitely a valuable tool for examining and evaluating the occlusal contacts during maximal intercuspation.

DEPTWEET: A typology for social media texts to detect depression severities

Mental health research through data-driven methods has been hindered by a lack of standard typology and scarcity of adequate data. In this study, we leverage the clinical articulation of depression to build a typology for social media texts for detecting the severity of depression. It emulates the standard clinical assessment procedure Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and Patient Health Questionnaire (PHQ-9) to encompass subtle indications of depressive disorders from tweets. Along with the typology, we present a new dataset of 40191 tweets labeled by expert annotators. Each tweet is labeled as ‘non-depressed’ or ‘depressed’. Moreover, three severity levels are considered for ‘depressed’ tweets: (1) mild, (2) moderate, and (3) severe. An associated confidence score is provided with each label to validate the quality of annotation. We examine the quality of the dataset via representing summary statistics while setting strong baseline results using attention-based models like BERT and DistilBERT. Finally, we extensively address the limitations of the study to provide directions for further research.

Systematic Approach of Using Body Painting Method for Anatomy Teaching and Practical via Online Platform

In the context of medical education, body painting refers to the schematic portrayal of internal organs on the body’s surface. Body painting session has been reported to be fun and engaging, and it encourages learning through easy visualisation of underlying anatomical structures. Besides improving anatomical knowledge retention, body painting is particularly effective for learning surface anatomy and complementing the teaching of clinical skills and peer assessment procedures such as palpation. Indeed, the clinical relevance of the gross anatomy can be conveyed to students by bringing cadaveric anatomy to life body painting. In educational perspective, the delivery of body painting method is in line with the active learning approach and collaborative learning principle; and its instructional design follows the principles of the cognitive load theory. In this article, we provide a systematic approach for a successful body painting session for anatomy teaching via online platform, which cater for remote learning needs amidst the COVID-19 pandemic.

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients' Assessment.

Bullous pemphigoid (BP) is the most frequent autoimmune bullous disease mainly affecting elderlies. Diagnosis usually results from clinical features, histological examination, and the quantification of circulating typical autoantibodies, due to its higher incidence in elderly patients, bullous pemphigoid treatment and management still represents a challenge due to the higher frequency of several comorbidities in this group of patients, which may also be linked to a reduced tolerance to BP treatments. Hence, an early diagnosis and a prompt correct treatment are mandatory to reach better clinical outcomes and improve as much as possible BP outcomes. Herein, we carried out a comprehensive literature review about the known clinical presentations, diagnosis, assessment and monitoring procedures used in daily clinical practice in patients with BP, to better define strategies to improve as much as possible BP clinical outcomes.

Change in Balance and Neuropsychological Measures Post-Lumbar Drain Trial in Patients with Suspected Normal Pressure Hydrocephalus

Objective: Ventriculoperitoneal (VP) shunting is commonly used to treat normal pressure hydrocephalus (NPH). Assessment of cognition and balance pre- and post-lumbar drain (LD) can be used to provide objective metrics which may help determine the potential benefit of VP shunting. The aim of this investigation was to determine which measures identify clinical change as a result of a LD trial and to develop recommendations for standard NPH clinical assessment procedures. Methods: The Berg Balance Scale (BBS) and a brief battery of commonly used neuropsychological tests pre- and post-LD (MMSE, trail making test, animal fluency, Hopkins Verbal Learning Test – Revised, and digit span) were administered to 86 patients with a diagnosis of NPH. Subjects were divided into groups based on whether or not clinical change was present, and thus, VP shunting was recommended post-LD, and predictors of group membership were examined. Results: Significant improvements (p < 0.05) were seen on the BBS and Trail Making Part B in the VP shunt-recommended group, with no other significant changes over time in either group. Regression analyses found that VP shunt recommendation was accurately predicted for 80% of the sample using the BBS score alone, with accuracy increasing to 85% when Trails B was added. Conclusions: Scores from the BBS and Trails B were most likely to change in those chosen to undergo VP shunting post-LD. Given that the typical clinical presentation of NPH includes gait disturbance and cognitive impairment, it is recommended that a standard pre-/post-LD evaluation include the BBS and trail making test.

Follow-through care for high-risk infants during the COVID-19 pandemic: lessons learned from the Vermont Oxford Network.

ObjectiveThe COVID-19 pandemic has altered the delivery of follow-up care for high-risk infants. We performed an audit to characterize programmatic responses in a quality improvement network.Study designWe audited 43 North American-based follow-up programs of the Vermont Oxford Network Extremely Low Birth Weight Follow-up Study Group in October, 2020. Our electronic survey included yes/no, agree/disagree, and free text response items.ResultThe response rate was 67.4%. Most programs altered capacity and the timing, frequency, or content of clinical assessments. Most perceived practice changes compromised their ability to ascertain infants’ medical and developmental needs. There was a rapid uptake of telemedicine services. Despite challenges with implementation, many endorsed improved connectedness with families.ConclusionPrograms adapted rapidly to meet the needs of high-risk infants during the pandemic. Clinical operations, assessment procedures, and quality metrics will also need to evolve. Quality improvement study group collaboratives are well-positioned to coordinate such work.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Validity of the STarT Back Tool in Patients with Low-Back Pain Using Spinal Flexibility Measures

Background: Correlation between prediction tools of disability and traditional physical performance tests in ascertaining disability risks remains unexplored. Objectives: The present study aimed to assess the convergent validity of the STarT back tool (SBT) for predicting disability risk using the spinal range of motion (ROM). Methods: Thirty patients with low-back pain (LBP) volunteered for this study. We used the SBT and Dual inclinometers to assess the future risk for disability and spinal ROM, as well as Anthropometric factors and pain intensity. Results: Poor and moderate spinal ROM for forward (93.3%, 6.7%), left lateral (63.30%, 36.70%) and right lateral (80.00%, 20.00%) flexion respectively were common among the participants. Backward extension ROM (36.70%, 46.70%) was mostly good and very good. There was a 60% medium risk for future physical disability based on SBT. There was no significant association between spinal ROM and SBT future disability prediction (χ2 = 3.367, P &gt; 0.05). Conclusions: The SBT and spinal ROM assessment are independent measures of functional disability. They should complement one another in clinical assessment procedures for effective outcomes in the treatment of LBP.

The utility of the Wisconsin card sorting test, 64-card version to detect noncredible attention-deficit/hyperactivity disorder

Clinicians who evaluate patients with concerns related to attention-deficit/hyperactivity disorder (ADHD) are encouraged to include validity indicators throughout clinical assessment procedures. To date, no known previous literature has examined the Wisconsin Card Sorting Test (WCST) specifically to address noncredible ADHD, and none has attempted to identify an embedded PVT within the 64-card version. The present study sought to address these gaps in the literature with a simulation study. Sixty-seven undergraduate participants (M age = 19.30) were grouped as credible (combining healthy controls and individuals with ADHD) or noncredible (combining coached and uncoached participants simulating ADHD-related impairment) and administered a battery of neuropsychological tests. Results revealed the noncredible group performed significantly worse on several WCST-64 variables, including failure to maintain set, number of trials to first category, and total categories. Raw scores from these variables were entered as predictors as one set in a logistic regression (LR) with group membership as the outcome variable. An exponentiated equation (EE) derived from LR results yielded acceptable discriminability (area under receiver operating characteristic curve = .73) with modest sensitivity (.38) while maintaining ideal specificity (.91), generally commensurate with a standalone forced-choice memory PVT and better than an embedded attention-based PVT. These findings suggested the WCST-64 may be sensitive to noncredible performance in the context of ADHD and reiterates the importance of considering tests of various cognitive abilities in the evaluation of performance validity. Implications of these findings, limitations of the present study, and directions for future inquiry, including cross-validation in clinical samples, were discussed.

A DvT-based clinical assessment of toxic stress in young children

A clinical assessment procedure is described for identifying possible sources of toxic stress among young children (ages 3–10), using a semi-structured modification of Developmental Transformations. This modification consists of improvisational play combined with a pre-determined sequence of roles symbolic of common adverse childhood experiences of neglect or emotional or physical threat. While conducting this procedure, the therapist carefully observes the client’s responses within the play to note the presence of play disruptions (e.g. hesitation, shift of scene and/or emotional arousal). These shifts may arise from prior experiences that remain distressing to the client and might merit further exploration. A review of the literature concerning toxic stress and assessments of children (particularly those that are play-based), along with an illustration of the clinical assessment, are presented. Strategies for follow-up and early intervention possibilities are highlighted. Key ethical considerations of this procedure are also discussed.

Position Statement of Transplant Activity in the Middle East in Era of COVID-19 Pandemic.

Position Statement of Transplant Activity in the Middle East in Era of COVID-19 Pandemic.