Contemporary Diagnosis Research Articles

Contemporary prenatal diagnosis of congenital heart disease in a regional perinatal center lacking onsite pediatric cardiac surgery: obstetrical and neonatal outcomes.

Determine obstetrical and neonatal outcomes in neonates with major CHD delivered at a level IV neonatal intensive care units (NICU) center lacking onsite pediatric cardiac surgery. A 10- year retrospective review of all neonates admitted to our level IV NICU, with CHD between January 1st, 2011 and December 31st, 2021. Births and NICU charts were cross queried with those from our perinatal center which include pediatric cardiology records. Terminations and stillbirths were excluded. A total of 285 neonates with major CHD and 78 withminor defects were included. In the major CHD group, 82.8 % had an isolated cardiac anomaly and 17.2 % had an extracardiac anomaly. Type of extracardiac anomaly had noimpact on neonatal survival. Prenatal diagnosis of aneuploidy did not impact survival in major CHD. Truncus arteriosus had the highest NICU mortality at 34.0 % followed by hypoplastic left heart syndrome (HLHS) at 31.6 %. Double outlet right ventricle with transposition of the great vessels and interrupted aortic arch (both types) had a 25 % mortality. Neonates with truncus arteriosus and total anomalous pulmonary venous returns were likely to have 5-min Apgar score<7. Transfer rate of neonates with major CHD for cardiac surgery was 58.6 %. Of those 81.5 % were discharged home, 14.3 % expired before discharge, and 1 % were transferred elsewhere post-operatively for higher level of care. Neonates with major CHD can deliver safely at a level IV NICU lacking onsite pediatric cardiac surgery. Our neonatal mortality was high for HLHS and truncus arteriosus, however comparable to other centers with proximate pediatric cardiac surgery.

Relative contribution of imaging techniques for the contemporary diagnosis of infective endocarditis: a single-center experience

Abstract Introduction In developed countries, the incidence of infective endocarditis (IE) is up to 6 cases per 100,000 individuals and in-hospital mortality rates are reported to reach 30%. The diagnostic recommendations for IE have been revised in the new ESC guidelines emphasizing the use of transesophageal echocardiography (TEE) and advanced imaging techniques (computed tomography [CT], magnetic resonance [MR], positron emission tomography [PET] and white blood cell scintigraphy [WBC-SPECT]). Aims This research aims to investigate the practical applicability of established clinical guidelines in a real-world population with suspected IE. Methods We reviewed the hospital database from 06/2021 to 06/2023 using the international classification of disease codification (ICD-10) for IE. Only patients admitted to Cardiology or Cardiac Surgery departments were included. Diagnosis of IE was defined according to the modified Duke criteria. Firstly, we identified individuals in whom diagnosis was performed by clinical presentation, blood cultures and transthoracic echocardiogram (TTE). Subsequently, we identified those who required further imaging diagnostic investigation. Results A total of 63 patients were included [mean age 64 ±14 years; 76% male (n=48)]. Native IE was diagnosed in 53 (84%) patients, prosthetic IE in 7 (11%) and cardiac implantable electronic devices-related IE in 3 (5%). A total of 26 (41%) patients had at least one predisposing risk factor, 48 (76%) presented with fever, 24 (38%) suffered an embolic event and 1 (2%) had an immunological phenomenon. Out of 49 positive blood cultures (78%), typical microorganisms consistent with IE were isolated in 25 (78%) of samples: 13 (34%) staphylococcus aureus, 10 (26%) oral streptococci, 9 (24%) enterococcus faecalis, 5 (13%) streptococcus gallolyticus and 1 (3%) HACEK group. Overall, in 22 (34%) patients, a definitive diagnosis of IE was established by means of clinical presentation, blood cultures and TTE. In the remaining, TEE was performed in 86% (n=36). Of those, a definite diagnosis was established in 52% (n=22). Brain and whole-body imaging upgraded the diagnosis from possible to definite in 3 (5%) patients. In the one patient in which a comprehensive clinical evaluation including TTE and TEE rejected IE, the diagnosis was ultimately established by means of PET. The median time from admission to the definite/possible diagnosis of IE was 6 (IQR 2-17) days. A total of 47 (75%) patients underwent surgery, with the most frequent indications being heart failure 46% (n=21) and uncontrolled infection 28% (n=13). Time from diagnosis to surgery was 10 (2-19) days, hospital length of stay was 45 (35-70) days and in-hospital mortality 21%. Conclusion Clinical presentation, blood cultures and TTE plus TEE established the definite or possible diagnosis of IE in most patients with suspected IE. Advanced imaging techniques allowed the establishment of definite diagnosis in only 6% of patients.

Morphological characteristics of talocalcaneal coalitions: Anatomical observation, finite element analysis and clinical application

BackgroundThe intricate anatomical structure of talocalcaneal coalitions (TCCs) presents significant challenges for clinicians in both diagnosis and treatment. This study aimed to investigate the anatomy, imaging characteristics, and biomechanical properties of TCCs, providing essential references for contemporary clinical diagnosis, treatment, scientific research, and education regarding TCCs. MethodsThe morphologies of TCCs were examined and classified in intact dry osseous specimens from 131 Asian adults. The imaging characteristics of TCCs were summarized by carefully observing the X-rays and CT scans. Additionally, finite element models of TCCs were established and validated, allowing for the simulation and analysis of stress and strain. ResultsThe TCCs were primarily located in the region between the posterior end of sustentaculum tali (ST), the medial port of the tarsal canal, and the medial edge of the posterior talar articular surface (PTF). In comparison to specimens with cartilage and ligament connections, the medial tubercle of osseous connections exhibited significant inward and downward protrusion, while the ST was longer and thicker. Statistically significant differences were noted in the widths of the calcaneus and talus, as well as in the thickness and length of the ST (P < 0.05). CT imaging provided an accurate determination of TCCs’ locations, while X-rays revealed the presence of the “C sign” and “duck beak sign” in all osseous connection specimens. Finite element model analysis indicated that stress was primarily concentrated at the osseous connection, which also reduced displacement of the subtalar joint. ConclusionsThe comprehension of the precise location, anatomical morphological characteristics, imaging features and finite element mechanical properties of TCCs is instrumental in enhancing the diagnosis and treatment of TCCs.

Contemporary diagnosis and treatment of tricuspid regurgitation: from neglected valve to primetime

Tricuspid insufficiency has long been considered an entity with low prognostic importance and associated with symptoms and signs only secondarily to left heart pathology. Scientific research in recent years has debunked this myth, demonstrating a key role in determining symptoms and signs of right heart failure, even in advanced stages. In parallel, advances in transcatheter technologies have opened up treatment options even for patients with increased surgical risk, who were previously excluded from traditional surgical options, with increasingly convincing results in reducing symptoms and improving the quality of life of our patients. The contemporary challenge is to translate these messages into everyday clinical practice and to encourage the centralization of patients in centers that currently have the expertise for feasibility evaluation and subsequent treatment. In this Review, we will analyze the most recent evidence on the pathophysiology and diagnosis of tricuspid insufficiency, the latest recommendations from European guidelines, and we will try to illustrate the most common technologies for percutaneous treatment and the abundant evidence supporting them.

“We are a rehabilitation unit, at least on paper” – Competing representations of recovery-oriented rehabilitation in dual diagnosis treatment policy and practice

Within dual diagnosis treatment, principles of recovery are increasingly acknowledged. Nevertheless, recovery-oriented rehabilitation often becomes an abstract concept, leaving professionals in various dilemmas. This article examines competing representations of recovery-oriented rehabilitation across Danish dual diagnosis treatment policy and practice from a post-structural, analytical perspective inspired by governmentality and problematization studies. The empirical foundation consists of a qualitative ethnographic study including conducting and examining 12 national policies relevant to contemporary Danish dual diagnosis treatment practice and 23 interviews with health/welfare professionals employed at a Danish in-patient, dual diagnosis rehabilitation unit. The analysis points to a complexity between three sets of competing representations reflected in 1) the conceptual relationship between rehabilitation and recovery, 2) perceptions of knowledge based on experience or evidence, and 3) ideals of optimization and emancipation. Finally, the article discusses convergences between the competing and, at times, conflictual ideals, attempting to explain the conceptual fluffiness, discrepancies, and dilemmas experienced by professionals in dual diagnosis treatment within broader epistemological and ideological debates in social sciences and humanities.

Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients: A mini review for clinicians

Among critically ill patients, severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality. Yet, it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease. In addition, management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions, drug-disease interactions, and adverse drug reactions. To help clinicians acquire an up-to-date approach to severe tuberculosis, this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.

Contemporary diagnosis and management of mild TBI (concussions): What you need to know.

Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.

Contemporary Diagnosis of Very Low-risk Prostate Cancer in a Multihospital Health Care System

The National Comprehensive Cancer Network (NCCN) very low risk (VLR) category for prostate cancer (PCa) represents clinically insignificant disease, and detection of VLR PCa contributes to overdiagnosis. Greater use of magnetic resonance imaging (MRI) and biomarkers before patient selection for prostate biopsy (PBx) reduces unnecessary biopsies and may reduce the diagnosis of clinically insignificant PCa. We tested a hypothesis that the proportion of VLR diagnoses has decreased with greater use of MRI-informed PBx using data from our 11-hospital system. From 2018 to 2023, 351/3197 (11%) men diagnosed with PCa met the NCCN VLR criteria. The proportion of VLR diagnoses did not change from 2018 to 2023 (p = 0.8) despite an increase in the use of MRI-informed PBx (from 49% to 82%; p < 0.001). Of patients who underwent combined systematic and targeted PBx and were diagnosed with VLR disease, cancer was found in systematic PBx regions in 79% of cases and in targeted PBx regions in 31% of cases. When performing both systematic and targeted PBx, prebiopsy MRI-based risk calculators could limit VLR diagnosis by 41% using a risk threshold of >5% for Gleason grade group ≥3 PCa to recommend biopsy; the reduction would be 77% if performing targeted PBx only. These findings suggest that VLR disease continues to account for a significant minority of PCa diagnoses and could be limited by targeted PBx and risk stratification calculators. Patient summaryWe looked at recent trends for the diagnosis of very low-risk (VLR) prostate cancer. We found that VLR cancer still seems to be frequently diagnosed despite the use of MRI (magnetic resonance imaging) scans before biopsy. The use of risk calculators to identify men who could avoid biopsy and/or biopsy only for lesions that are visible on MRI could reduce the overdiagnosis of VLR prostate cancer.

Contemporary diagnosis and management of colorectal injuries: What you need to know.

Colorectal injuries are commonly encountered by trauma surgeons. The management of colorectal injuries has evolved significantly over the past several decades, beginning with wartime experience and subsequently refining with prospective randomized studies. Colon injuries were initially nonoperative, evolved toward fecal diversion for all, and then became anatomic based with resection and primary anastomosis with selective diversion, and now primary repair, resection with primary anastomosis, and delayed anastomosis after damage-control laparotomy are all commonplace. Rectal injuries were also initially considered nonoperative until diversion came into favor. Diversion in addition to direct repair, presacral drain placement, and distal rectal washout became the criterion standard for extraperitoneal rectal injuries until drainage and washout fell out of favor. Despite a large body of evidence, there remains a debate on the optimal management of some colorectal injuries. This article will focus on how to diagnose and manage colorectal injuries. The aim of this review is to provide an evidence-based summary of the contemporary diagnosis and management of colorectal injuries.

Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome.

Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.

Same-session endoscopic diagnosis and symptom palliation in pancreato-biliary malignancies: Clinical impact of rapid on-site evaluation (ROSE).

Background and study aims Besides increasing adequacy, rapid on-site evaluation (ROSE) during endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) may impact choices and timing of subsequent therapeutic procedures, yet has been unexplored. Patients and methods This was a retrospective evaluation of a prospectively maintained database of a tertiary, academic centre with availability of ROSE and hybrid EUS-ERCP suites. All consecutive patients referred for pathological confirmation of suspected malignancy and jaundice or gastric outlet obstruction (GOO) between Jan-2020 and Sep-2022 were included. Results Of 541 patients with underlying malignancy, 323 (59.7%) required same-session pathological diagnosis (male: 54.8%; age 70 [interquartile range 63-78]; pancreatic cancer: 76.8%, biliary tract adenocarcinoma 16.1%). ROSE adequacy was 96.6%, higher for EUS versus ERCP. Among 302 patients with jaundice, ERCP-guided stenting was successful in 83.1%, but final drainage was completed in 97.4% thanks to 43 EUS-guided biliary drainage procedures. Twenty-one patients with GOO were treated with 15 EUS-gastroenterostomies and six duodenal stents. All 58 therapeutic EUS procedures occurred after adequate ROSE. With ERCP-guided placement of stents, the use of plastic stents was significantly higher among patients with inadequate ROSE (10/11; 90.9%) versus adequate sampling (14/240; 5.8%) P <0.0001; OR 161; 95%CI 19-1352). Median hospital stay for diagnosis and palliation was 3 days (range, 2-7) and median time to chemotherapy was 33 days (range, 24-47). Conclusions Nearly two-thirds of oncological candidates for endoscopic palliation require contemporary pathological diagnosis. ROSE adequacy allows, since the index procedure, state-of-the-art therapeutics standardly restricted to pathologically confirmed malignancies (e.g. uncovered SEMS or therapeutic EUS), potentially reducing hospitalization and time to oncological treatments.

Contemporary diagnosis of very low risk prostate cancer in a multi-centered hospital system.

274 Background: NCCN very low risk (VLR) prostate cancer is frequently clinically insignificant and thus over-diagnosed. Use of MRI prior to patient selection for prostate biopsy and to inform biopsy targeting can reduce the diagnosis of VLR disease. Indeed, a recent publication has reported no VLR diagnoses since 2018. We sought to better understand the incidence of VLR disease in our multi-hospital institutional cohort. Methods: We retrospectively identified 3197 patients who were newly diagnosed with prostate cancer at our eleven-hospital system from January 2018 – June 2023. Within this cohort, we identified patients who met VLR criteria. Patient clinical, pathological, and imaging characteristics were collected for analysis. Biopsies were considered MRI-informed if MRI was performed within two years prior to prostate biopsy. Biopsies were considered targeted if at least one region of interest was designated on pathology. Patients who had incomplete clinical records (n=2) were excluded from analysis. Active surveillance as initial disease management was defined as no treatment within one year of diagnosis. Welch’s two-sample t-test, Pearson’s chi-squared test, and Fisher’s exact tests were performed to compare clinical characteristics. PSA was log transformed for analysis. Results: In the study period, 11% (351/3195) of men diagnosed with prostate cancer were classified as NCCN very low risk. The incidence of VLR diagnoses was steady from 2018-2023 (p=0.8) despite increased usage of MRI-informed biopsies (p&lt;0.001). Use of MRI-informed biopsy was similar for detection of VLR and higher risk disease (68% vs 72%, p=0.07). Of VLR patients who received a targeted biopsy, 69% (127/184) of disease was found in systematic regions only, 21% (39/184) was found in targeted regions only, and 10% (18/184) was found both systematically and in targeted regions. On multivariable analysis, black race, logPSA, and PIRADS 4 and 5 regions were negatively associated with VLR disease (Table). 86% (304/351) of VLR patients chose active surveillance as their initial disease management. Conclusions: VLR disease comprises a significant minority of prostate cancer diagnoses. The incidence of VLR has remained unchanged despite increased utilization of MRI-informed biopsies in our hospital system. In the majority of cases the diagnosis of VLR is made from the template biopsy (whether MRI-informed or not). Patients should, and frequently do, choose active surveillance to manage their disease. Use of nomograms and limiting biopsy of PI-RADS 3 lesions may decrease the incidence of VLR prostate cancer.[Table: see text]

A review of recent advances in fault diagnosis based on deep neural networks

Bearings are essential components in mechanical systems, supporting the rotation of various machine parts in motors, wind turbines, vehicles, and industrial robots, making their health critical for system performance and reliability. Traditional diagnosis methods, such as vibration and acoustic analysis, along with temperature monitoring, often demand expertise and may struggle to detect early faults. However, the introduction of deep learning technology has created new opportunities for more effective bearing fault diagnosis. The application of deep learning-based bearing fault diagnosis in the industrial sector has gained significant attention and multiple types of deep learning networks have already been successfully implemented. This paper aims to provide a clear review of bearing fault diagnosis based on deep learning algorithms. This essay focuses on two of the most popular deep learning networks, Autoencoder and Convolutional Neural Networks. Their mechanism and applications are analyzed based on essays and research paper related to the field of bearing fault diagnosis. Finally, conclusions are presented to summarize the current development and point out faced challenges and future trends of these deep learning networks. It is also expected that this narrative not only serves as a cogent overview of the contemporary fault diagnosis technologies but also provides convenience and inspiration for further study in this field.

Panchakarma and Satvavajaya chikitsa in the management of Pittodara caused by fast food addiction: A case report

Fast food is often consumed not as a requirement for hunger but to continuously satiate the taste buds with appealing flavors, which creates an addictive behavior. This addiction represents “Asatmendriyartha samyoga” (~improper use of sensory organs) of Rasanendriya (~sensory faculty of tongue). Toxins present in fast food can act as Dushivisha (~artificial poison) and Garavisha (~combination of non-poisonous substances) leading to Udara roga (~diseases of the abdomen). The present case followed a typical presentation of Pittodara (~Udara roga due to Pitta dosha) in a 19-year-old female, who was habituated to fast-food consumption. The patient had developed pain in the abdomen, and yellowish discoloration of eyes, urine, and stools for two weeks. Fever was the first symptom to develop followed by vomiting, causing severe weakness. The contemporary diagnosis had suspected the case to be an acute liver failure, requiring a liver transplantation. Based on Nidana (~etiology), Samprapti (~pathogenesis), and Lakshanas (~symptoms), the case was diagnosed as Pittodara. Considering the Vaya (~age), Bala (~physical endurance), Agni (~digestive/metabolic factors), and Satva (~psychic condition) of the patient, Dosha nirharana chikitsa (~evacuation of accumulated toxins), and Shothahara chikitsa (~reduction of inflammation and swelling) were planned through Nitya virechana (~therapeutic purgation on daily basis) by Gandharva hastadi eranda taila, Nasya (~medication through nasal route) with Gudanagara, Parisheka (~therapeutic streaming) with Dashamoola kwatha and Udaralepa (~application of medicated paste over abdomen). The patient was provided counseling along with specific advice on a planned diet and daily routine. A combination of Yukti vyapashraya (~logic-based treatment) and Satvavajaya chikitsa (~subjugation of mind/counsel) resulted in the reduction in yellowish discoloration of eyes, bilirubin levels, abdominal girth, pedal edema, and pain per abdomen. This case depicts the hazards of fast-food addiction among the young population, the utility of Panchakarma chikitsa in treating liver disorders, and the need for social policies to control the growth of fast-food outlets in India.

Contemporary diagnosis and management of gallbladder polyps

Gallbladder (GB) polyps are present in 5%–10% of the general population and consist of true neoplastic polyps (adenomas) and pseudopolyps (predominantly cholesterol, inflammatory, hyperplastic, focal adenomyomatosis). True polyps, although relatively rare neoplastic lesions (0.5%) are considered an important factor in malignant transformation and cancer development (5%) when their size is ≥ 1 cm. Given that it is essential to diagnose GB adenocarcinoma at an early stage to optimize therapeutic management, controversy exists about whether cholecystectomy is always necessary. Their imaging characteristics, size ≥ 1 cm, age &gt; 50 years and genetic predisposition determine the indications for immediate cholecystectomy. In younger patients with polyps &lt; 1 cm in size and without a familial history of GB carcinoma, imaging follow-up by ultrasound (US) seems to be a reasonable recommended policy. A scoring system by multivariate analysis (cross-sectional area &gt; 123 mm2, positive blood flow signal, age &gt; 55.5 years, alanine aminotransferase (ALT) levels &gt; 50 U/L and an ALT/AST (aspartate aminotransferase) ratio &gt; 0.77) can accurately predict true polyps. The widely accepted size threshold for US follow-up is 7 mm, and for intervention, it is 10 mm. Computed tomography or better magnetic resonance imaging can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations. In challenging cases, high-resolution US, novel three-dimensional US, endoscopic US or contrast-enhanced endoscopic US could be helpful. Novel microflow imaging can safely predict polyps. Risk factors for malignancy include age &gt; 60 years, large gallstones, primary sclerosing cholangitis, Asian ethnicity and sessile polyps accompanied by focal gallbladder wall thickening &gt; 4 mm. For polyps sized 6–9 mm, the absence of growth at recommended follow-up (6 months, one year, and two years) indicates treatment discontinuation; however, it is not required for size &lt; 5 mm without risk factors. In addition to laparoscopic cholecystectomy, the standard management, novel interventional modalities preserving the GB in selected cases include per-oral transmural endoscopic resection of GB polyps after a bridge of endoscopic US-guided cholecystostomy or laparoscopic gallbladder-preserving polypectomy. Generally, there are still no precise and strong evidence-based guidelines; thus, the management policy of GB polyps should be individualized in ambiguous cases.

DEVELOPMENT OF A STRATIFICATION SYSTEM FOR SEVERE ACUTE PANCREATITIS IN THE FIRST DAY OF ITS ONSET

Introduction. Acute pancreatitis stands as one of the prevalent acute inflammatory diseases of the abdominal cavity, marked by a diverse range of clinical presentations and the risk of developing persistent organ failure is too high even in its early stages. At present, the widely adopted framework for assessing acute pancreatitis is the 2012 revised Atlanta classification. However, distinguishing between moderately severe and severe acute pancreatitis within this classification necessitates a minimum of 48 hours to determine the persistence of organ failure. Consequently, the primary challenge in contemporary acute pancreatitis diagnosis and treatment lies in the imperative task of early-stage prognosis and effective stratification of disease severity.&#x0D; Objective of this investigation is to determine the availability of optimal parameters of clinical and instrumental examination methods in order to predict the course of acute pancreatitis in the first day of its onset by conducting a statistical analysis of the studies performed.&#x0D; Materials and methods. The assessment the state of microcirculation in patients by the method of laser Doppler flowmetry was carried out using the LAKK-02 device according to the specified methodology. Patients were also subjected to general clinical and instrumental examination. In order to study the influence of indicators on the severity of the disease, the paired correlation coefficients of each of them were calculated, after which, for the parameters with the closest connection, a multiple linear correlation-regression model was built and the multiple correlation coefficient with the severity of the disease was calculated.&#x0D; Results. The following parameters have the most significant influence on the severity of the disease on the first day: findings of laser Doppler flowmetry C (A/M), systemic inflammatory response syndrome criteria, hematocrit, hydrothorax/peritonitis. In the complex analysis, the multiple correlation coefficient is 0.803, which indicates a significant relationship between the factors included in the model and the degree of severity. The coefficient of determination points out that the degree of severity is 64.5% dependent on the indicators included in the model.&#x0D; Conclusions. The obtained results of the study indicate the presence of a complex influence of the criteria of laser Doppler flowmetry C (A/M), criteria of the systemic inflammatory response syndrome, hematocrit, hydrothorax/peritonitis on the severity of the disease in patients with acute pancreatitis within the first day of the disease onset that underscores the potential for early-stage preliminary stratification of acute pancreatitis severity based on these criteria.

Contemporary issues in the management of dental trauma.

Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.

Contemporary diagnosis and management of congenital microtia and aural atresia : Part2: Overview of therapeutic approaches

Congenital malformations of the pinna and aural atresia can result in major aesthetic and functional deficits. Knowledge about embryologic developments and established classification systems is an essential requirement when dealing with affected patients. Early detection of deficiencies and introduction of appropriate diagnostic measures is vital to initiate adequate therapies and prevent long-term disabilities. Treatment for malformations of the pinna-if requested-is mostly surgical, infrequently an epithesis is applied. As in other surgical fields, tissue engineering will likely play acrucial role in the future. Treatment of aural stenosis and atresia aims at improvement of hearing levels and prevention of secondary complications like cholesteatoma and chronic otorrhea. Auditory rehabilitation comprises aspectrum from conventional hearing aids to invasive hearing implants, the latter being favored in recent years.

Association of contemporary dementia diagnosis rate with clinician characteristics: Evidence from Medicare claims

AbstractBackgroundPopulation‐level gap and disparities are documented for the dementia diagnosis. Little is known, however, the extent to which clinician’s characteristics, including the characteristics of the patient population they serve, are associated with their likelihood of adequately diagnosing dementia, after accounting for patient characteristics.MethodWe used the 100% Medicare fee‐for‐service and Advantage Plan data from 2017 to 2019. Patients were attributed to primary care clinicians based on plurality of office visits. We determined each clinician’s observed number of patients with a diagnosis of dementia of any etiology and estimated the expected number of cases with a predictive model using patient characteristics (age, sex, race/ethnicity, whether dually eligible for Medicare and Medicaid). The ratio between the clinician’s observed and expected diagnosis rates (O/E ratio) serves as performance measure for diagnostic accuracy. We calculated 95% confidence intervals (CI) around those O/E ratios and categorized those whose 95% CI included 1 as diagnosing dementia at an adequate rate and those whose 95% CI did not reach 1 as underdiagnosing dementia. We then used logistic regression to predict a clinician’s likelihood of having adequate diagnosing compared to under‐diagnosing using clinician characteristics: their attributed patient panel’s composition on race/ethnicity, dually eligible, and having had annual wellness visit, urban‐rural location of the practice, the clinician’s specialty, and state fixed effects.ResultAmong 194,699 included clinicians, those serving more White (Odds Ratio [OR] = 1.50 for 10 percentage points [pp] increase, p&lt;0.001), fewer Black (OR = 0.94 for 10 pp increase, p&lt;0.001) or Hispanic patients (OR = 0.98 for 10 pp increase, p = 0.003), and fewer duals (OR = 0.82 for 10 pp increase, p&lt;.001) were more likely to have an adequate diagnosis rate than under‐diagnosing. Clinicians who practiced outside of metropolitan areas were less likely to have an adequate diagnosis rate (compared to metropolitan, OR = 0.91, p = 0.025 for micropolitan; OR = 0.75, p&lt;0.001 for small town; OR = 0.63, p&lt;0.001 for rural areas). No association is seen with percent of patients having annual wellness visit (OR = 1.00 for 10 pp increase, p = 0.913).ConclusionPrimary care clinicians who serve racial/ethnic minority or dually eligible patients and practice outside of big cities may under‐detect dementia cases.

Pre-Existing Myeloid Subclones May Account for a Subset of Acute Myeloid Leukemias and Myelodysplastic Neoplasms in Patients with Pre-Existing or Contemporary Lymphoid Disorders

Background: Myelodysplastic neoplasms (MDS) and acute myeloid leukemia (AML) are occasionally observed in association with lymphoid tumors. Most cases of myeloid disorders detected in patients with lymphoid tumors are attributed to chemotherapy, however, there is a subset of patients who receive a contemporary diagnosis of myeloid and lymphoid disease, and it is well known that, even in patients who were exposed to chemotherapy, the myeloid disease may both arise from clonal hematopoiesis substrate or harbor chemotherapy signature (Diamond, Blood 2023). Biological differences justified by the ontogenesis of the myeloid disease may justify prognosis and suggest appropriate intervention methods. Methods: We searched our patient database for AML and MDS which were diagnosed together with lymphoid diseases. Data was collected under the study NCT04298892, after approval of the ethical committee. Statistics were performed with Kaplan-Meyer estimation. Nonparametric tests were used as appropriate. Results: Out of 164 patients who were referred to our service from May 2021 to Jul 2023 for MDS or AML, 11 patients were diagnosed with AML or MDS together with a concomitant or previous lymphoid disease. In this population, the median age at AML or MDS diagnosis was 67 (range 58 - 82); 9/11 (82%) patients were male. Four out of 11 (36%) patients were diagnosed with AML, 7/11 with MDS (6 with blast &amp;lt; 5% and 1 with blast ≥ 5%). The diagnosis of myeloid and lymphoid diseases was concomitant in 2 patients (18%) and sequential in 9 patients (82%). The lymphoid diseases were smoldering multiple myeloma (3/11, 27%), multiple myeloma (5/11, 45%), diffuse large B-cell lymphoma (1/11, 9%), mantle cell lymphoma (1/11, 9%), marginal zone lymphoma (1/11, 9%). Eight out of 11 patients (73%) with lymphoid and myeloid disease had a history of chemotherapy before the diagnosis of MDS or AML; 5 patients (45%) were exposed to high-dose alkylating agents, 2 (18%) low-dose alkylating agents, 2 (18%) anthracyclines. Interestingly, 7 patients (64%) were diagnosed while they were receiving lenalidomide after a median exposure to lenalidomide of 8.8 months (4.9 - 30.73). In the 9 patients with consecutive lymphoid and myeloid disease diagnosis, AML or MDS were diagnosed after a median of 23 months (range 8 - 76; history of patients is plotted in figure 1). Regarding the AML or MDS, 3/11 patients (27%) had complex karyotype of which 1 had t(3;21)(q26;q22) RUNX1/MECOM rearrangement, 2/11 had TP53 mutation (both also had complex karyotype). The remaining patients mainly harbored methylation or splicing mutations and normal karyotype or karyotype single non-high-risk alterations. When compared, patients with complex alterations had similar times of onset from their first tumor and baseline characteristics; those patients however had an increased risk of death. Conclusions: The incidence of AML or MDS associated with lymphoid disease is low.Furthermore, the population is remarkably heterogeneous. The characteristics and the timing of onset of the disease account for different ontogenesis; a portion of the patient has a disease that harbors complex alterations, while the most frequent origin of AML and MDS can be researched in pre-existing or contemporary hematopoietic clones, that overall account for a whole bone-marrow disease. The relation between chemotherapy exposition and the biology of the AML or MDS is not univocal. This difference could be therapeutically relevant.