Diagnosis Research Articles

Diagnosing gastrointestinal infections based on cycle threshold cut-offs of PCR.

This study compared the performance of molecular vs stool culture assays for gastrointestinal infection (GII) detection, with focus on defining cycle threshold (Ct) cut-off values for positive culture results. A total of 6,000 records of patients with suspected GII between October 2022 and February 2023 and registered at Clalit HealthCare Services in Haifa, Israel, were reviewed. Stool samples were collected from all patients with suspected GII. PCR was performed with the Seegene Allplex GI-Bacteria (I) assay kit. PCR-positive samples were cultured on bacteria-specific agar media. Out of 356 PCR-positive samples, 196 (55.1%) were culture-positive. Significant differences were noted between the mean Ct of culture-positive vs culture-negative samples for Shigella spp. (P < 0.0001), E. coli O157 (P = 0.0001), and Campylobacter spp. (P = 0.004). Shigella had the lowest Ct cutoff (27.14). Negative culture results for PCR-positive samples may result from low bacterial load. At the same time, false-positive PCR results may exist. Thus, PCR result should be considered along with clinical presentation and with Ct value consideration.IMPORTANCEGII diagnostic procedures have shifted from traditional- to molecular-based assays, which may increase missdiagnosis due to the high PCR sensitivity and false positives. This study suggests to consider a Ct threshold for each pathogen in order to reduce inaccurate diagnosis. Alternatively, culture should be performed for PCR-positive samples.

How can effective communication help radiographers meet the expectations of patients-COMMUNICATION-a joint statement by the ESR & EFRS.

The Patient Advisory Group (PAG) of the European Society of Radiology, in collaboration with the European Federation of Radiographer Societies (EFRS), aims to highlight, in this short paper, the important role that communication plays when trying to meet patients' expectations throughout their imaging journey in a radiology department. The interactions with radiography professionals carrying out diagnostic or interventional procedures are critical in supporting high-quality patient care and patients' expectations. The key areas of consideration have been summarised in an easy-to-remember mnemonic: COMMUNICATION. There are different healthcare systems and medical imaging services across Europe, and healthcare providers should be mindful, when setting up new operational procedures, of the need for processes and systems to support the delivery of patient-centred care. At times when new or improved technology is being introduced, such as artificial intelligence applications, telemedicine, robotisation of interventional procedures, and digitised records, the impact on patient-radiographer communication and interactions should be considered. CRITICAL RELEVANCE STATEMENT: Effective communication helps radiographers meet patients' expectations by ensuring clear explanations, reducing anxiety, fostering trust, and improving cooperation during procedures. This enhances patient satisfaction, safety, and the overall quality of care, aligning with professional standards and patient-centred healthcare. KEY POINTS: Patient-centred imaging services are key to meeting patients' demands. Radiography professionals in radiology departments and medical imaging services should always communicate effectively with patients. This ESR-Patient Advisory Group publication attempts to summarise the key areas that should be embedded in patient communication. The 'COMMUNICATION' statement can be used as a reminder to all radiography professionals to work to improve patient-radiographer interactions and provide patient-focused services.

The SLaM Brain Health Clinic: remote biomarker enhanced memory clinic for people with mild cognitive impairment within a National Health Service mental health trust.

The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI). To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures. We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments. We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group. The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.

Adherence to the Swedish paediatric guidelines for urinary tract infections.

To audit adherence to the Swedish paediatric guidelines for urinary tract infections (UTIs) in infants. Secondary objectives were to compare findings on imaging performed according to the guidelines with imaging without guideline support and to identify predictors of non-adherence. A prospective multicentre study of infants <1 year treated at paediatric hospitals for their first UTI. Adherence to recommendations was assessed for diagnosis, treatment, and imaging of the urinary tract with a follow-up period of 1 year. Vesicoureteral reflux on voiding cystourethrography and findings on renal scintigraphy according to recommendations were compared to imaging without recommendation. A total of 1357 infants were included. Adherence to recommended diagnostic procedures, antibiotic treatment, and imaging was 86.1%, 91.0% and 64.2%, respectively. Non-adherence to imaging recommendations was associated with inpatient management and smaller hospitals but was also more often due to excessive rather than refrained imaging. High adherence rates to diagnostic and treatment recommendations indicate careful attention to infant UTI among paediatricians. Lower adherence to imaging recommendations raises concerns regarding the guideline algorithm; particularly, early DMSA scans seem to be challenging for smaller hospitals.

Emerging Aeromonas spp. infections in Europe: characterization of human clinical isolates from German patients

Bacteria of the genus Aeromonas are widely distributed in water bodies around the world. Some Aeromonas species have been identified as human pathogens causing intestinal and a variety of extraintestinal infections. In Germany, information on diseases caused by Aeromonas is rare, because Aeromonas infections are not notifiable in Germany. To address this information gap and gain better insights, a successful collaboration with human medical diagnostic laboratories within Germany was established and several Aeromonas isolates from diseased patients were sent to the Aeromonas laboratory of the German Federal Institute for Risk Assessment. 52 clinical Aeromonas isolates, of which anonymized patients’ data were available, were selected for further characterization by MALDI-TOF MS, biochemical testing, and whole genome sequencing (WGS). Nearly half of the isolates were from patients older than 60 years, whereas only four isolates were from patients aged up to 10 years. 30 isolates originated from stools of patients with diarrhea/(gastro-)enteritis and 22 strains were from patients with diverse extraintestinal infections, such as wound infection, septicemia, bursitis, abscesses, cholangitis, urinary tract infections, and pneumonia. Taxonomical identification revealed following predominant species: A. veronii biovar sobria (18 isolates), A. caviae (17 isolates), and A. hydrophila (nine isolates). Two A. salmonicida isolates and one isolate each of A. dhakensis, A. bestiarum, and A. encheleia were also identified. Three closely related intestinal isolates could not be assigned to a recognized Aeromonas species. The clustering of strains based on virulence factor profile resulted in a grouping that closely resembles the clustering of the phylogenetic tree suggesting that the profiles are specific for each species. Our study on clinical Aeromonas isolates characterizes for the first time human pathogenic strains isolated in Germany. These bacteria are important microorganisms within the One Health context because of their ubiquitous presence in the environment and as a cause of opportunistic infections in humans and animals. Infections caused by Aeromonas bacteria show a seasonality with increased infection rates in warmer periods. In view of climate change, Aeromonas bacteria are regarded as emerging pathogens and research is required to determine the reservoirs in One Health sources from which human infections may arise.

Are Healthcare Resource Utilization Patterns for Pain Management Specific to Post-Acute COVID-19 Syndrome? A Study of Survivors from the First French Pandemic Wave

Objectives: Chronic pain is a common symptom in Post-Acute COVID-19 Syndrome (PACS), affecting 11–60% of patients, but the link between COVID-19 and chronic pain remains unclear. This study assesses healthcare resource utilization (HRU) for pain management among French COVID-19 survivors, using the National French Claims Database (SNDS). We analyzed medical consultations, rehabilitation services, diagnostic procedures, and medication dispensing to identify PACS-related pain patterns and their impact on the healthcare system. Methods: The cohort included 68,822 patients hospitalized during the first COVID-19 wave (March–June 2020), with 13,939 ICU survivors. HRU was assessed for six months pre- and post-hospitalization in four areas: (1) medical consultations and rehabilitation; (2) pain-related medication dispensing; (3) neuropathic diagnostic procedures; (4) hospital admissions for chronic pain. A post–pre ratio (PP-Ratio) compared post-COVID to pre-COVID HRU. Results: Significant changes in HRU were observed, particularly for ICU survivors. Neurology consultations (PP-Ratio 1.41) and outpatient physical therapy (PP-Ratio 1.69) increased. Dispensing of strong opioids, antiepileptics, anxiolytics, and hypnotics rose, while NSAID use decreased. Hospitalizations for chronic pain also increased (PP-Ratio 1.52). Similar trends were seen among ICU survivors, with notable increases in opioid and antiepileptic use. No distinct PACS-related pain patterns emerged. Conclusions: Non-specific increases in HRU for pain management were found following COVID-19 hospitalization, likely due to disease severity and ICU care rather than PACS-related chronic pain. Further research is needed to explore long-term pain outcomes in this population.

Vesicovaginal fistula post-vaginal delivery late revelation: A case report

Introduction: This study presents a compelling clinical case involving a 43-year-old woman who encountered a vesicovaginal fistula subsequent to vaginal delivery. The narrative encompasses the occurrence, diagnosis, and subsequent management of this rare postpartum complication. Case Report: A 43-year-old woman with an unscarred uterus experienced the conventional signs of postpartum recovery but developed hematuria and vaginal urinary leakage on the seventh postpartum day. Clinical assessment confirmed a vesicovaginal fistula due to partial uterine dehiscence. Diagnostic procedures and the subsequent successful surgical intervention are detailed, followed by the postoperative surveillance strategy and a one-month post-surgery evaluation. Conclusion: This case study demonstrates the successful management of a postpartum vesicovaginal fistula through surgical intervention, resulting in complete closure of the fistula and significant improvement in urinary symptoms. It highlights the importance of timely diagnosis and appropriate surgical intervention in managing such rare complications following vaginal delivery.

HEMATOLOGY AND BIOCHEMICAL REFERENCE INTERVALS AND SEROPREVALENCE OF HEMORRHAGIC DISEASES FOR FREE-RANGING MULE DEER (ODOCOILEUS HEMIONUS) IN WEST TEXAS.

Wildlife species are routinely captured for translocation, general health monitoring, and research-based pursuits to guide wildlife management. Mule deer (Odocoileus hemionus) were captured for various research projects and management actions in the Trans-Pecos and Panhandle regions of Texas from 2015 to 2019. The objective of this study was to develop hematologic and biochemical parameters for free-ranging mule deer in Texas and to develop a health monitoring system for current and future mule deer population management. Blood samples were collected from 364 mule deer (male = 81; female = 283) and complete blood counts and serum biochemical profiles were performed by Texas Veterinary Medical Diagnostic Laboratory. A subset of 263 individuals, deemed healthy based on several inclusion criteria, were used to establish normal reference intervals for the species. The deer were also tested for serologic evidence of previous exposure to bluetongue virus (BTV) and/or epizootic hemorrhagic disease virus (EHDV) to further characterize the health status of the population. Several variables associated with deer capture and/or health status, including the use of anesthetic drugs, elevated body temperature, capture location, and sex, affected mean blood values; however, the development of separate reference intervals by class was not warranted because of the lack of any clinically relevant change. Antibodies to BTV and EHDV were identified in 76% (277/364) and 78% (285/364) of the population, respectively, and 71% (258/364) had antibodies to both diseases. This study provides hematologic and biochemical reference intervals based on a subpopulation of apparently healthy free-ranging mule deer that should guide wildlife managers in decision-making for future conservation and restoration objectives.

Surgery for blood culture-negative infective endocarditis: outcomes and the role of molecular biological imaging as diagnostic approach.

The study aimed to analyze outcomes of surgery for blood culture-negative infective endocarditis (BCNIE) and to evaluate the role of molecular biological imaging. Patients undergoing surgery for native or prosthetic valve endocarditis from 2013 to 2022 were analyzed regarding blood culture-positive infective endocarditis (BCPIE) and BCNIE. For laboratory diagnostics in BCNIE, excised valves or prostheses underwent conventional microbiological culture and fluorescence in situ hybridization combined with 16S rRNA-gene polymerase chain reaction and sequencing (FISHseq). Of 521 patients overall, we identified 473 patients (342 males, mean age 63 ± 14.4 years) with preoperative blood cultures: 396 with BCPIE (83.7%) and 77 with BCNIE (16.3%).Preoperative characteristics and operative procedures were comparable between groups and the calculated perioperative risk (EuroSCORE II) was identical (BCNIE: 12.2 ± 8.8%, BCPIE: 12.9 ± 11.9%, p = 0.788). At surgery, signs of infective endocarditis were present in 71%, missing in 18%, and inconclusive in 10% of patients with BCNIE. While valve cultures alone identified pathogens in 32% of BCNIE patients, the combination with FISHseq confirmed the infective etiology in 98% and identified causative pathogens in 52%. Overall, early mortality was similar in BCNIE (16.9%) and BCPIE (18.2%, p = 0.620), but increased in 37 BCNIE patients without pathogen identification compared to 40 patients with pathogen identification (27.0% versus 7.5%, p = 0.032). Integrating FISHseq as molecular biological imaging technique into valve analysis algorithms in patients undergoing surgery for BCNIE increases diagnostic gain and potentially improves outcome.

Medical and legal significance of assessing the probability of brain death in patients after intraoperative cardiac arrest and successful cardiopulmonary resuscitation

Background. After successful cardiopulmonary resuscitation for intraoperative cardiac arrest, most patients die in the Intensive Care Unit from multiple organ failure, cardiovascular complications that develop after hypoxic-ischemic damage to the central nervous system. In some patients whose heart is still beating in conditions of mechanical ventilation, a complete and irreversible cessation of all brain functions may occur, that is, brain death.Objective. Based on clinical criteria, we made an attempt to assess the likelihood of developing a condition consistent with the diagnosis of brain death in those who sustained cardiac arrest during surgery or other medical manipulation and underwent successful cardiopulmonary resuscitation, but died later in the Intensive Care Unit.Material and methods. A retrospective analysis of medical records related to 45 clinical cases was performed to assess the likelihood of brain death according to the Quality Assurance Programme in the Deceased Donation Process (QAPDD) methodology, which has been used during an external audit in hospitals of Spain and specifically focused on the donation process after brain death.Results. In 30 (66.7%) patients, based on the proposed criteria, a high probability of developing brain death was noted. At the same time, in 27 (90%) cases, clinical signs of brain death were noted within the first 6 days after cardiopulmonary resuscitation. Biological death in these patients was ascertained within 1 to 119 days from the moment of the development of clinical signs of brain death.Inference. The concept of brain death has serious medical, economic, legal, and ethical implications. When clinical suspicion of brain death arises, it is important that all such undergo standard diagnostic procedures to objectively rule out or confirm the diagnosis of brain death.Conclusion. The probability brain death occurrence in patients after intraoperative cardiac arrest and successful cardiopulmonary resuscitation is statistically siqnificant at 66.7% (p=0.0196).

Patient and physician exposure to X-rays at pediatric interventional cardiology - from world to Poland.

Ionizing radiation is considered as a harmful factor to health. However, X‑rays are widely used in diagnostic and therapeutic procedures such as those performed during cardiac interventions. Their use is particularly invaluable in saving life procedures when the risk of adverse effects of radiation is relatively low compared to the consequences of non-treated or treated with other invasive methods diseases. One branch of these types of medical procedures is interventional cardiology in pediatrics due to possible higher than in adults risks of developing cancer in exposed to ionizing radiation children. On the other hand, medical staff in particular physician, may be exposed to relatively high radiation levels during their work. Parallel with enlarging workload (growing number of procedures per year), high levels of cumulative doses to most exposed, and often not protected, parts of operator's body as eye lenses and brain may be achieved. Exposure to X‑rays in pediatric interventional cardiology is a worldwide point of scientific interest from around 65 years, however assessment and simulating low level doses is still developing. In this review found data presents various trials of evaluating doses or levels of exposure to both medical staff and patient as well as methods of optimization and protection against X‑rays in pediatric cardiac interventional procedures. The issue of establishing diagnostic reference levels was also taken into consideration during analysis. Thirty papers from period 2013 to 2023 were analyzed. The main assumption of this condensed review is to reveal radiation protection methods worldwide and in Poland. Int J Occup Med Environ Health. 2024;37(6):569-80.

Practical guide for the diagnosis and treatment of localized and generalized cutaneous pruritus (chronic itch with no underlying pruritic dermatosis).

Itch, also known as pruritus, is one of the most prevalent symptoms observed in dermatological practices. Itch frequently arises from primary pruritic dermatoses, although it may also manifest in the absence of a primary pruritic skin rash. The latter itchy condition is referred to as "cutaneous pruritus" in the Japanese guidelines published in 2020. Cutaneous pruritus can be classified into two categories based on its distribution: localized cutaneous pruritus and generalized cutaneous pruritus. Localized cutaneous pruritus is indicative of a neuropathic cause, whereas generalized cutaneous pruritus suggests underlying systemic disease(s), drug-induced itch, psychogenic itch (also known as functional itch disorder), or chronic pruritus of unknown origin (CPUO). Systemic diseases associated with cutaneous pruritus include disorders of iron metabolism, chronic kidney disease, chronic liver disease (especially cholestasis), endocrine/metabolic diseases, hematological disorders, and malignant solid tumors. CPUO is a term used to describe chronic itch that is often generalized and for which no underlying cause can be identified despite a comprehensive and careful diagnostic workup. A variety of treatment approaches are available for cutaneous pruritus, including device-based physical therapies (such as phototherapy) and medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain. This review presents an overview of the current knowledge regarding cutaneous pruritus, from its underlying pathophysiologic mechanisms to the diagnostic procedures and treatment approaches that are currently available.

Unusual urinary discoloration: A case report of blue urine in a patient with advanced Prostate cancer

Here, we present a case of blue urine in an 89 -year-old male with advanced prostate cancer and difficult to control hypertension as well as comorbid type II diabetes mellitus (T2DM), hyperlipidemia and chronic urinary retention. The patient was newly diagnosed with COVID-19 and returned to our hospital after 30 days of first admission, this time in respiratory failure. Administration of Urogesic-Blue (methenamine, sodium phosphate, methylene blue and hyoscyamine) can cause this discolorization due to its content in part of methelyene blue as evidenced by the presence after analysis. These cases emphasize the importance of being aware that this is a potential harmless side effect to avoid unnecessary diagnostic procedures. Prostate Cancer, especially when it comes with bone metastasis, increases complexity and difficulty in managing the patient. Comorbidity in the patient and attendant polypharmacy made treatment planning difficult, given that one had to be very cautious about drug-drug interactions so as not only manage mental health effectively but also treat actively existing medical conditions. The situation escalated following the recent COVID-19 infection, which required hospitalization for final comprehensive monitoring and supportive care. High levels of proBNP suggest that the heart was under some stress, probably further increased by the presence of a virus making this case complex and certainly multidisciplinary. This case informs the need for a complete medication history and patient counseling in cases of strange clinical presentations. Recognition of Urogesic-Blue as the agent in bluish urine permits health care providers to reassure patients and avoid unnecessary diagnostic work-ups. This report gives an insight into avoidable handling of intricate past medical history and multi-morbidity and adds knowledge on the bedside approach regarding blue urine. Keywords:Blue Urine, Prostate Cancer, Methylene Blue, Urogesic-Blue, COVID-19 Complications

Implementation and validation of a new qPCR assay to detect imported human Plasmodium species.

Diagnosis of imported malaria is based on microscopic examination of blood smears (BS), detection of circulating plasmodial antigen by immunochromatography (ICT), or detection of Plasmodium spp. DNA by loop mediated isothermal amplification. We have developed duplex (Plasmodium spp. and Plasmodium falciparum) real-time PCR (qPCR) and species-specific qPCR assays for the identification and quantification of human Plasmodium species. Whole nucleic acids from 523 samples prospectively collected from 410 patients suspected of malaria between June 2016 and March 2021 were tested by qPCRs and compared to standard diagnostic procedures. All qPCRs were designed on 18S ribosomal ribonucleic acid. The limit of detection of duplex qPCR was 8 copies/reaction, and analytical specificity of species-specific qPCRs was 100%. Seventy-nine patients diagnosed for single species malaria involving P. falciparum, P. vivax, P. ovale, and P. malariae were positive with duplex and species-specific qPCRs. P. knowlesi qPCR detected DNA from a P. knowlesi culture. Of eight cases of mixed Plasmodium species infection, five were identified with our qPCR assays with better sensitivity as compared to BS and ICT. Eight out of 323 patients with negative BS were hospitalized for symptoms suggestive malaria after malaria-endemic area travel or known with history of malaria had a low positive duplex qPCR. Between day of diagnosis and post-treatment follow-up at D2-D4 of malaria, a 3.1-log P. falciparum load decrease was observed by qPCR. These new Plasmodium qPCRs allowing detection of human plasmodial species have excellent species specificity and allow rapid detection of P. falciparum cases, malaria with low parasitaemia, and mixed Plasmodium species infection.IMPORTANCEMalaria is a disease transmitted by a Plasmodium parasite genus. Most cases are caused by Plasmodium falciparum. Despite a significant drop of incidence and mortality since 2000, 249million cases and 608,000 deaths have been estimated in 2022, mainly in Africa. Due to the increasing number of travels to endemic areas, incidence of imported malaria is rising in Europe. Various techniques are used in European laboratories, such as microscopic examination of thin and thick smears and rapid diagnostic tests. However, these techniques require skilled operators to differentiate plasmodial species and have limited sensitivity. Actually, molecular diagnosis is carried out using point-of-care test for rapid results with excellent sensitivity but is unabled to determine involved species and assess parasitaemia. In this study, we developed a combined molecular tool based on both detection of all human plasmodial species (Plasmodium spp.) and P. falciparum. We have also developed specific qPCRs for each human plasmodial species.

MATERNITY NURSING CARE FOR MRS. H G1P1A0 H 1ST POSTPARTUM SECTIO CAESAREA INDICATIONS OF PREMATURE RUPTURE OF MEMBRANES FOCUS PAIN RELIEVING INTERVENTION WITH THERAPY FINGER HOLDINGAND WARM COMPRESSAT PERMATA BUNDA HOSPITAL

Background: Sectio Caesarea delivery is an artificial delivery by removing the fetus or baby through the abdominal wall by making an incision in the uterine wall provided that the uterus is intact and the fetus weighs more than 500 grams. Causes of cesarean section delivery There are problems on the part of the mother and baby (Sari &amp; Absari, 2020). The Maternal Mortality Rate (MMR) is one of the targets that has not been completely addressed and is a priority in the Sustainable Development Goals (SDG). The goal is to reduce maternal mortality to below 70 per 100,000 live births by 2030. Based on data from the 2021 Indonesia Health Profile Book, the number of deaths from year to year is increasing. It can be seen from the number of maternal deaths in Indonesia in 2021, which is 7,389 compared to 2020, which is 4,627 deaths (Angka Kematian Ibu, 2022, p. Kementrian Kesehatan Republik Indonesia). Relaxation technique is a technique related to human behavior and is effective in overcoming acute pain, especially pain due to diagnostic and surgical procedures. One of the techniques used is the finger holding technique and warm compress.Methodology: This design uses a case study research design. This type of research used in quantitative research is to analyze the process of conclusion and dynamics of existing situational relationships and relationship processes that occur from a phenomenon. The subject in this study is Mrs. H, 32 years old, post-sectio caesarea, with premature rupture of membranes at Permata Bunda Hospital.Results: The researchers identified that after finger holding therapy and warm compresses for 3 consecutive days, it can reduce the degree of discomfort and reduce pain. Conclusion: There is a very significant influence, it can be concluded that giving finger holding therapy and warm compresses can reduce the degree of discomfort and reduce pain.

What You Need to Know About: The Management of Malignant Pleural Effusion

Malignant pleural effusion (MPE) is a common complication of malignancy and is regularly seen on the general medicine take. Diagnosis of MPE is indicative of advanced or metastatic disease and carries a poor prognosis, with median survival ranging from 3 to 12 months. Despite recent advancements in systemic anti-cancer treatment, the goal of management in MPE remains the palliation of symptoms. This article reviews the current guidelines and evidence on the assessment and management of MPE. Assessment involves imaging techniques such chest X-ray and computed tomography (CT) scans, whilst thoracic ultrasound has a crucial role in guiding diagnostic procedures. Diagnostic pleural aspiration remains a cornerstone for establishing a tissue diagnosis, although its yield is variable depending on tumour type. Emergence of targeted immunotherapy has necessitated the need for large tissue samples for molecular testing, driving the need for pleural biopsies in relevant cases. Management encompasses therapeutic aspiration, chemical pleurodesis and indwelling pleural catheter insertion, each offering distinct benefits and considerations. Recent developments in equipment and combined approaches have enhanced patient outcomes and quality of life. The complexity of MPE requires a patient-centred approach to assessment and management and where possible patients should be managed with specialists in pleural disease on an outpatient basis.

Clinical presentation and management of vasculitis in an adolescent with Systemic Lupus Erythematosus: a case report

Systemic Lupus Erythematosus is a multifaceted autoimmune disease with diverse clinical manifestations, predominantly affecting females. This case report presents the clinical presentation and management of vasculitis in a 16-year-old male with SLE, an atypical demographic for the disease. The study examines the challenges of diagnosing and treating SLE in adolescents. The patient exhibited polyserositis, cutaneous vasculitis, malar rash, and oral ulcers. Diagnostic procedures included clinical evaluation, laboratory tests (ANA, anti-dsDNA, complement levels), and a skin biopsy histopathological examination. Treatment consisted of hydroxychloroquine, corticosteroids, and immunosuppressive agents. Laboratory findings revealed positive ANA, elevated anti-dsDNA titers, and low complement levels, confirming SLE with associated vasculitis. Histopathology verified skin-limited vasculitis. The patient responded well to the treatment regimen, achieving remission and reducing disease flares. Regular monitoring and a multidisciplinary approach were pivotal in managing the condition. This case underscores the importance of considering SLE in atypical demographics, such as adolescent males. Early diagnosis and comprehensive management are vital for improving outcomes and quality of life. Further research is warranted to address the unique challenges and optimal treatment strategies for pediatric and male SLE patients, emphasizing the need for awareness and tailored therapeutic approaches in managing chronic autoimmune diseases in diverse populations.

Diagnostic yield and complications of ultrasoundguided trans-thoracic biopsies by pulmonologists: a single-centre retrospective study of lesions with pleural contact.

Introduction Ultrasound-guided trans-thoracic needle biopsy (US-TTNB) is a method of choice for the diagnostic management of peripheral lung lesions and pleural masses for pulmonologists. If complication risk factors and diagnostic yield have been well reported for CT-guided biopsies, publications for US-TTNB in this field are very scarce. Methods The primary objective of this study was to describe the diagnostic yield of US-TTNB carried out by pulmonologists defined by a definitive histopathological diagnosis Secondary objectives were to identify factors that may influence diagnostic yield and to describe complications of this procedure. Between September 2015 and December 2022, charts of consecutive patients presenting peripheral lesion with pleural contact and having undergone US-TTNB were retrospectively analyses. ROC curves were performed to assess the probability of having a contributing biopsy (definitive histology) depending on scannographic measurements and the number of punctures. Univariate and then multivariate analysis were performed to look for variables associated with complications. Results One hundred and fifty nine patients were enrolled in this study. Among them, diagnosis was obtained for 140 patients (88% success rate). The histology was in favor of a neoplastic process in 96% of cases (135/140). Analysis of the ROC curves showed that the depth of the lesion (AUC 75%; CI95% 65-85; cut-off 3.0cm), the width of the lesion (AUC 73%; CI95% 63-86; cut-off 3.9cm), the pleural contact (AUC 68%; CI95% 57-80; cut-off 3.8cm) and the number of biopsies (AUC 70%; CI95% 59-81; cut-off 3 biopsies) were the variables associated with diagnostic yield. Complications occurred for 27 patients (17%) mainly pneumothorax (6%), hemoptysis (6%), and sepsis (6%) Univariate analysis showed a significant association between pneumothorax and lesion depth (OR 0.68; 95% CI 0.65-0.92; p = 0.03) with a predicted probability > 5% for a depth < 4cm according to general linear model analysis. Univariate and multivariate analysis revealed a significant association between the number of biopsies and the risk of sepsis (OR 1.90; 95% CI 1.19-3.26; p = 0.01) with a predicted probability > 5% for more than 4 biopsies. Conclusion US-TTNB is a reliable diagnostic procedure that can be performed by pulmonologists. The depth, width, pleural contact of the lesion and the number of biopsies are key variables associated with diagnostic yield. The depth of the lesion is associated with the risk of pneumothorax, and the number of biopsies with the risk of pulmonary sepsis.

Prescriptive Appropriateness in an Outpatient Primary and Secondary Cardiovascular Prevention Service.

In the absence of appropriateness specific guidelines, one important cause of health resources waste could be overuse of diagnostic procedures. Since arterial hypertension is a very frequent disease there could be such a risk in its management. To evaluate the prescriptive appropriateness of non-invasive diagnostic tests (echocardiography, carotid ultrasound, ECG exercise test, 24h Ambulatory Blood Pressure Monitoring-ABPM) in a primary and secondary prevention outpatient's service. 559 outpatients visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. 449 prescriptions were made (198 echocardiography, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing). General appropriate prescriptions prevalence was 40.3%, 24h ABPM being the most appropriate one (49.4%) followed by echocardiography (43.9%), ECG exercise test, (38.9%) and carotid ultrasound (30.4%). Appropriateness was significantly higher for secondary prevention patients (61.6 vs. 35.3%, p < 0.001) particularly for heart and carotid ultrasound. Significant univariate correlations were identified between age, cardiovascular risk category, degree of prevention (primary vs. secondary), duration of hypertension and the presence of valvular heart disease and prescription appropriateness. However, at multivariate analysis these findings were not confirmed. Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams particularly in the primary prevention setting.

Clues in dermatopathological diagnostics

Numerous diagnostic clues are used in routine dermatopathological diagnostics. Ideally, adiagnostic clue can lead directly to aspecific diagnosis and save further time-consuming additional diagnostic procedures. This article discusses the concept of "clues to diagnosis" starting from its historical beginnings with areview of relevant studies and including current literature. Selected clues to dermatophytosis, psoriasis, and mycosis fungoides are analyzed. In addition, some newer and still little-known dermatopathological clues to inflammatory and infectious skin disease are presented. The aim is to specify the use of clues on the basis of current findings and to draw attention to scientifically sound clues.