Current Aspects Of Diagnosis Research Articles

Bacterial Conjunctivitis: Current Aspects of Diagnosis and Therapy

Bacterial conjunctivitis is a leading cause of infectious conjunctivitis in children and second most common cause in adults. Although often self-limiting, it can lead to complications like corneal scarring and systemic infections in high-risk groups including newborns and immunocompromised patients. Thus, prompt diagnosis and treatment are essential for these vulnerable populations. Common bacterial causes are Staphylococcus aureus and Streptococcus pneumoniae in adults and Haemophilus influenzae and Moraxella catarrhalis in children. Clinical features alone do not reliably identify the causative pathogen. Microbiological testing is necessary for persistent or severe cases. Topical antibiotics like azithromycin or fluorochinolones are usually prescribed. However, gonococcal and chlamydial conjunctivitis warrant systemic antibiotics due to their potential for severe complications. Increasing antibiotic resistance might even necessitate tailored therapy based on antibiotic susceptibility profiles. Screening and treating pregnant women is an effective prevention strategy by reducing perinatal transmission (especially of gonococcal and chlamydial infections). In summary, while often self-limiting, potential complications and rising antibiotic resistance underscore the importance of timely diagnosis and treatment of bacterial conjunctivitis. Preventive measures including maternal screening are crucial public health initiatives to curb the risks associated with this common eye infection.

Keratoconus: current aspects of diagnosis and classification

Keratoconus (KC) is a progressive non-inflammatory ectatic corneal disease typified by corneal thinning and conical protrusion, as well as irregular astigmatism with a varying-degree visual impairment. A literature review on the disease epidemiology, classification and diagnosis is presented. Current clinical practice most commonly relies on the Krumeich’s adaptation of ABCD grading system by M. Belin and M. Amsler. The KC diagnosis requires a comprehensive approach that integrates a variety of methods. Scheimpflug imaging with the corneal biochemistry assessment is performed with a Pentacam Oculus keratotomograph in combination with a Corvis ST device. The result is expressed as diagnostic indices, CBI (Corvis Biomechanical Index), BAD-D (Belin/Ambrósio Enhanced Ectasia Index total deviation) and TBI (Tomographic Biomechanical Index). The use of optical coherence tomography is necessary to perform corneal epithelial thickness mapping as well as pachymetry to rule out hidden stromal thinning.

Current aspects of diagnosis and treatment of patients with neuroendocrine tumors

The article presents modern possibilities and existing problematic aspects of the choice of therapeutic and diagnostic tactics in patients with neuroendocrine tumors of the gastrointestinal tract and pancreas are presented. The asymptomatic course of neuroendocrine tumors of the gastrointestinal tract and pancreas was established in 18.5% and 24.6% of cases, respectively. Carcinoid syndrome was detected in 12.9%. The sensitivity rates of chromogranin A and neuron-specific enolase in the diagnosis of tumors were 54% and 13%, respectively. The levels of cancer-embryonic antigen in G-1/G-2 and G-3 tumors were 5 ng/ml and 8.9 ng/ml, respectively (p 0.001). A pathognomonic sign of neuroendocrine tumors of the small intestine is a mesentery tumor conglomerate, and the sensitivity rates of computed tomography and positron emission tomography with 68Ga to detect this sign were 92.3% and 92.9%, respectively (p 0.05). The computed tomographic density of neuroendocrine pancreatic tumors G-1/G-2 in the arterial phase was 112.1 40.2 HU and that of G-3 tumors was 54.0 10.4 HU (p = 0.025). Surgical treatment was performed in 259 (79.7%) patients. Postoperative complications that developed in localized and locally distributed neuroendocrine tumors of the gastrointestinal tract and of the pancreas were found in 3.5% and 8.8%, and in 58.1% and 40% of the cases, respectively, and those of generalized tumors were noted in 20%. The tumor-specific 5-year survival rates of patients with localized neuroendocrine tumors of the gastrointestinal tract and pancreas were 92.5% and 94.4%, those with locally distributed tumors had 66.8% and 77.8%, and those with generalized tumors had 51.8% and 47.1%, respectively. In patients with generalized tumors, the 5-year survival rates after cytoreduction and removal of the primary tumor were 88.2% and 64.6%, respectively (p = 0.097), and the rate after drug therapy was 28.8% (p 0.001). The prognosis of the 5-year survival of patients is determined by the degree of malignancy and tumor localization, treatment method, and patient age. In general, neuroendocrine tumors are a heterogeneous group of neoplasms that require a multidisciplinary approach to diagnosis and choice of therapeutic strategies.

Mild Cognitive Impairment: Current Aspects of Diagnosis and Treatment

Mild Cognitive Impairment: Current Aspects of Diagnosis and Treatment

Evaluation of a New Histoplasma spp. Quantitative RT-PCR Assay

Laboratory diagnosis of histoplasmosis is based on various methods, including microscopy, culture, antigen, and DNA detection of Histoplasma capsulatum var. capsulatum or Histoplasma capsulatum var. duboisii. To improve sensitivity of existing real-time quantitative PCR (qPCR) assays, we developed a new RT-qPCR assay that allows amplification of whole nucleic acids of Histoplasma spp. validated on suspected cases. The limit of detection was 20 copies, and the specificity against 114 fungal isolates/species was restricted to Histoplasma spp. Whole nucleic acids of 1319 prospectively collected consecutive samples from 907 patients suspected of having histoplasmosis were tested routinely between May 2015 and May 2019 in parallel with standard diagnostic procedures performed in parallel. Forty-four had proven histoplasmosis attributable to H. capsulatum var. capsulatum (n = 40) or H.capsulatum var. duboisii (n = 4) infections. The results of RT-qPCR were positive in 43 of 44 patients (97.7% sensitivity) in at least one specimen. Nine of 863 cases (99% specificity) were RT-qPCR positive and therefore classified as possible cases. RT-qPCR was positive in 13 of 30 (43.3%) blood samples tested in proven cases. A positive RT-qPCR result in blood was significantly associated with H. capsulatum var. capsulatum progressively disseminated histoplasmosis with a positive RT-qPCR result in 92.3% of the immunocompromised patients with disseminated disease. This new Histoplasma RT-qPCR assay enabling amplification of H. capsulatum var. capsulatum and H. capsulatum var. duboisii is highly sensitive and allows the diagnosis of histoplasmosis advantageously from blood and bronchoalveolar lavage fluid.

Current aspects of diagnosis and treatment of adult GH-deficiency

Adult growth hormone (GH) deficiency (AGHD) is a condition characterized by alterations in body composition, lipid and carbohydrate metabolism, bone mineral density and poor quality of life; however, clinical presentations of AGHD are mostly non-specific. Untreated AGHD is associated with increased cardiovascular morbidity and mortality. Stimulation tests are used for the diagnosis: insulin tolerance test, glucagon stimulation test, growth-hormone releasing hormone and arginine stimulation test. Moreover, in 2017 FDA approved the use of macimorelin (oral GH secretagogue) for the diagnosis of AGHD. In childhood GH-deficiency, apolipoprotein A-IV, CFHR4 (complement factor H-related protein 4) and PBP (platelet basic protein) were identified as potential biomarkers of the disease, however, this was not investigated in AGHD. GH treatment starts from the minimal dose, which allows minimizing the adverse effects. According to published meta-analyses, AGHD treatment generally does not lead to increased risk of malignancy and recurrence of sellar neoplasms in adult patients. Published data on GH receptor polymorphism associations with treatment efficacy remains controversial. Development of long-acting GH formulations is a currect perspective for the increase of treatment compliance.

Current Aspects of Diagnosis and Therapeutics of Histoplasmosis and Future Trends: Moving onto a New Immune (Diagnosis and Therapeutic) Era?

After more than a century of the first description of a histoplasmosis case, its diagnosis is still a difficult task, and an imperative step for directing the therapeutic choice. Direct examination and fungal culturing from clinical samples are still the gold-standard methodologies; however, they lack sensitivity/specificity. Immunodiagnosis techniques, such as antibody (ELISA and Western blot) and antigen detection (RIA and ELISA), usually display better parameters than classical methodologies. However, they assist as presumptive diagnosis tool and cross-reactivity with antibodies/antigens from other mycosis that are still to be overcome. New molecular diagnosis methodologies, such as PCR and LAMP, are fast tools and display excellent results. After diagnosing, the most used drugs in therapy, depending on the clinical forms of histoplasmosis, are Amphotericin B and itraconazole, and distinct regimens have been proposed. In this review, we cover traditional and new options for diagnosis and therapeutics of histoplasmosis, and new advances in both areas.

Idiopathic pulmonary arterial hypertension: current approach to diagnosis and pharmacological treatment

Current aspects of diagnosis, classification and therapy of pulmonary hypertension (PH) were reviewed in the article. A new classification, including all known clinical variants of PH, and functional classification were presented. A diagnostic algorithm with routine diagnostic methods and highly sensitive innovative techniques (CT-angiography of the lungs, perfusion scintigraphy, the right heart catheterization, etc.) was shown. The author discussed prognostic factors of 1-year survival, general pathogenic mechanisms including endothelin and prostacyclin pathways and a role of nitric oxide and soluble guanylate cyclase stimulators. Assessment criteria of acute vasoreactivity test results were reviewed. Typical therapeutic approaches including calcium channel blockers, oxygen, anticoagulants and diuretics were described. Main classes of specific drugs were listed such as endothelin receptor antagonists, prostacyclins, soluble guanylate cyclase stimulators, phosphodiesterase 5 inhibitors, selective prostacyclin receptor agonists. Current investigations are directed to searching new effective and safe drugs that could improve outcomes, slow down progression of the disease and improve quality of the patient’s life.

Rhinitis in Children: Current Aspects of Diagnosis and Treatment

The article is devoted to one of the most urgent problems of pediatrics — rhinitis in children. The difficulty of nasal breathing, being one of the most frequent complaints to pediatricians, can be caused by a banal respiratory infection, as well as be one of the systemic pathology’s symptoms. The economic burden of rhinitis is great for any health budget, the total direct and indirect costs are huge. The article shows the main phenotypic characteristics of rhinitis depending on the etiological factor; gives the modern principles of differential diagnostic search; points studies, use of which is not recommended in routine practice. The authors reflect the key components of a complex therapy and discuss in detail the tactics and possible pharmacological treatment strategies.

Livedoid vasculopathy – current aspects of diagnosis and treatment of cutaneous infarction

Livedoid vasculopathy is a rare, chronic, recurrent disease of the cutaneous microcirculation. Its typical clinical manifestation is a triad which consists of livedo racemosa of the skin, episodic painful ulcerations of the distal aspects of the legs and a healing process leaving small porcelain-white scars called atrophie blanche. As an important result of recent research, livedoid vasculopathy has been defined as a coagulation disorder classified as a vasculopathy different from inflammatory vasculitis. This differentiation adds to the current pathophysiologic understanding and supports the therapeutic rationale with respect to the use of new systemic anticoagulants. The prevention of irreversible residual scarring and the improvement of patientsí quality of life are the main goals in treating cutaneous infarction and require early and consequent treatment. This article presents current knowledge on diagnosing this rare disease and offers practical guidance on its therapy.

Urogenic reactive arthritis: current aspects of diagnosis and treatment

The paper gives an update on urogenic reactive arthritis, which will be useful for practitioners during their work with patients with articular pathology.

Ascites. Current aspects of diagnosis and therapy

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Secondary prevention of cervical cancer: current aspects of diagnosis

Trotz wesentlicher Reduktion von Inzidenz und Mortalitat des Zervixkarzinoms ist die zytologische Krebsvorsorge an ihre Grenze gestosen. Im Screening kann der molekularbiologische HPV-DNA Nachweis zu einer Verbesserung der Sensitivitat fuhren und fur die Abklarung von Frauen mit atypischem zytologischen Ergebnis oder Zustand nach behandelter zervikaler intraepithelialer Neoplasie eingesetzt werden. Die Dunnschicht-Zytologie ergibt eine verbesserte Auswertbarkeit der Praparate, aber eine bessere Ergebnisqualitat ist bisher nicht eindeutig belegt. Bezuglich der Einschatzung des Progressionspotenzials von HPV-Infektionen oder zervikalen Prakanzerosen stehen eine Reihe von HPV-assoziierten und HPV-unabhangigen Biomarkern zur Verfugung. Der Nachweis von p16-Uberexpression ist ein vielversprechender Marker, der sowohl im Screening als auch fur die Einstufung der Prognose Bedeutung finden wird.

Conjoined lumbosacral nerve roots: current aspects of diagnosis

Conjoined lumbosacral nerve roots (CLNR) are the most common anomalies involving the lumbar nerve structures which can be one of the origins of failed back syndromes. They can cause sciatica even without the presence of a additional compressive impingement (such as disc herniation, spondylolisthesis or lateral recess stenosis), and often congenital lumbosacral spine anomalies (such as bony defects) are present at the "conjoined sheaths". This congenital anomaly has been reported in 14% of cadaver studies, but myelographic or computed tomographic studies have revealed an incidence of approximately 4% only. Diagnostic methods such as magnetic resonance imaging (MRI) are helpful for determination of the exact anatomical relations in this context. We present five typical cases of conjoined nerve roots observed during a 1 year period, equivalent to 6% of our out-patients without a history of surgical treatment on the lumbar spine. In all cases with suspicious radiological findings MRI or lumbar myelography combined with CT and multiplanar reconstructions is recommended.

Current aspects of diagnosis and treatment of cytomegalovirus infections in infants

Background: Human cytomegalovirus (CMV) is the most common cause of congenital and perinatal infections throughout the world. High prevalence of CMV infection is associated mainly with universal breast feeding practices rather than with crowding or poverty. Perinatal CMV infection usually follows a benign course in immunocompetent individuals, but the virus remains latent or persistent in the host cell thereafter. Objective: As a clinical diagnosis of CMV infection is generally not easy, rapid and accurate laboratory diagnosis of CMV infection is required for appropriate patient management. Numerous anti-CMV compounds including ganciclovir, foscarnet and cidofovir have been reported, most of them are unlikely in a clinical trial for perinatal CMV infection in immunocompetent individuals. Understanding the epidemiology of CMV is a key element in the development of strategies for prevention and treatment of infection. Study design: This review focuses on recent advances in the diagnosis and treatment of perinatal CMV infections in infants. Conclusions: Entirely new approaches to prevention and treatment of CMV infections in infants are necessary, including antiviral interventions and the development of a vaccine strategy.

Current aspects of diagnosis and therapy of tubal sterility

Current aspects of diagnosis and therapy of tubal sterility