Diagnostic Conclusions Research Articles

Automated and reliable detection of multi-diseases on chest X-ray images using optimized ensemble transfer learning

Chest radiography is a comparatively low-cost, most probably applied in a medical process that brings crucial information to discover diagnostic conclusions. Chest X-rays (CXR) are used in the prognosis of chest diseases that includes asthma, lung cancer, pneumonia, and COVID-19. Artificial intelligence detects the multi-disease automatically to enhance its proficiency and performance by solving image detection complications with various machine learning and deep learning approaches. Convolutional Neural Network (CNN) has been designed for the advancement of computerized recognition systems. For the classification of medical images, texture, shape, size, and tissue constitution are essential features for detecting diseases. Hence, huge input features are merged with deep CNN validated to increase the effectiveness of CXR analysis. In addition, multi-scale features are visualized in CNN for the detection of variable sizes of thoracic diseases. This paper has implemented a novel multi-disease diagnosis model using chest X-ray images through deep learning approaches, and thus, it helps to minimize the computational cost. The standard CXR images are gathered from the standard datasets. After, the pre-processing is performed for cleaning and contrast the images. Further, the image segmentation is carried out using Optimized DeepLabv3 (ODeepLabv3), where the optimization of parameters in DeepLabv3 is done by a new Mutation Rate-based Lion Algorithm (MR-LA). Then, multi-disease classification is carried out through Optimized Ensemble Transfer Learning (OETL), where the OETL is carried out through VGG16, ResNet, ImageNet, MobileNet, GoogleNet, Inception, and Xception. Here, the parameter optimization of all models is done by the same MR-LA. The proposed model improved the effectiveness and performance in expressions of sensitivity, precision, and specificity factors and get higher classification and detection accuracy. The outcome of the recommended method over other models is identified by the relative analysis conducted.

Meningoencefalomielite por Cryptococcus spp. em felino

Cryptococcosis is a systemic mycosis caused by encapsulated yeasts from the gender Cryptococcus. It mainly affects the nasal cavity, adjacent tissue and lungs, and can spread to the central nervous system, eyes and skin, causing meningoencephalomyelitis. It can be noninfectious or infectious via yeasts and bacteria, and felines are the most prevalent when infected by the Feline Leukemia Virus (FeLV) or Feline Infectious Peritonits (FIP). The neurological signs of infection by criptococcus could be convulsion, depression, disorientation, ataxia, paralysis of the pelvic limbs, mydriasis and blindness. For diagnosis, the neurological exam is indispensable, and must be combined with the general full body physical exam, with the intention to find the injury. The aim of this study is to report the case of a cat, 10 months old, with meningoencephalomyelitis by Cryptococcus spp. The animal presented the clinical signs of abrupt change in behavior, excessive fear, lack of appetite and progressive weight loss. Methadone was administrated for the pain, used gabapentin that changed for pregabalin. Cerebrospinal fluid (CSF) analysis and MRI were performed to assist in the diagnosis. However, false negatives can occur, which may consequently hinder adequate treatment. In this report, diagnostic conclusion occurred post-mortem. Thus, the patient lacked the adequate treatment to stabilize in life.

Intelligent Diagnostic System Development based on Artificial Intelligence Technology

Intelligent diagnosis is an important scenario in smart healthcare, with conversational diagnostic scenarios being the most common. The process of collecting symptom information through conversations with users and inferring diseases based on symptoms. Through a dialogue based diagnostic system, it can meet some of the medical consultation needs of residents, thereby freeing doctors from some basic consultations and greatly alleviating the shortage of medical resources. In the actual diagnosis process, the symptoms reported by patients are often insufficient to support accurate diagnosis. It is necessary to ask the user if they have any other symptoms through dialogue to form a diagnostic conclusion. Existing research mainly adopts reinforcement learning methods, which gradually learn the dialogue process between traditional Chinese medicine students and patients in real medical scenarios, and obtain strategies for symptom inquiry and disease diagnosis. Despite the advantages of reinforcement learning in dealing with temporal decision problems, the diagnostic accuracy is still low and data dependency is strong. In this article, a medical dialogue robot architecture based on medical dialogue diagnosis technology, medical knowledge graph technology, and "inference machine" technology is proposed to build an intelligent diagnosis architecture. Secondly, in terms of algorithm, this article proposes a disease diagnosis algorithm based on Naive Bayes Classification and a symptom screening algorithm based on symptom set differences for symptom query process, This algorithm increases the interpretability of diagnostic results by simulating the questioning and diagnostic process of doctors, and combines it with the medical dialogue robot architecture to achieve intelligent diagnosis throughout the entire process.

4 Norm Selection and Application in Socially Responsible Neuropsychological Practice

Objective:In the wake of the national controversy over demographically corrected normative comparisons used in neuropsychological assessment, the field finds itself in need of adopting better practices and providing stronger instruction in norm selection and application when assessing underrepresented populations. Neuropsychologists must employ critical thinking within their clinical decision-making that takes into account patient demographics, analysis of the measures themselves, normative samples, and statistical adjustments employed in normative studies. Not doing so may result in erroneous diagnostic conclusions, exposing underserved patient populations to poor or harmful clinical care and even misdiagnosis. The following case series presents several demographic considerations illustrating how selection and application of different (at times, ill-fitting) normative reference groups can affect treatment outcomes in the Latinx community. We examined the performance of various published norms when applied to monolingual and bilingual Spanish speakers.Participants and Methods:This study samples three demographically diverse (i.e., education, age, and sex) clinical cases and applies regression-based and stratified norms to raw scores to demonstrate the possible differential outcomes when using different reference groups. One example is Ms. Congeniality, a 69-year-old, Spanish and English bilingual woman with 12 years of education who presented for a third revaluation at our clinic due to progressive memory loss. Her prior Spanish language profiles demonstrated impaired confrontation naming and steadily decreasing letter fluency over the past 10 years.Results:Her performance on semantic fluency (i.e., animal naming) showed relative stability based on her raw scores (10 in 2012, 11 in 2016, and 12 in 2022). Using the Neuropsi A&M norms, which stratify performance across nine age ranges between ages 6-85 and three education ranges between 0-10+ years, her performance over the past 10 years ranged between the less than 1st percentile to the 9th percentile (1%, 1%, and 9%, respectively). However, using the NP-NUMBRS norms, which use regression-based continuous age (19-60) and education (0-20) predictors of test performance, her scores corresponded to steadily improved performance (8%, 28%, and 86%). Thus, this qualitative comparison demonstrates a likely overcorrection for individuals of advanced age when using norms based on samples that are a poor fit because they lack representation of older adults, as in NP-NUMBRS, and a possible undercorrection when using norms with overly broad education stratifications (e.g., 10-22 years, as in Neuropsi).Conclusions:Application of ill-fitting normative standards can have far-reaching implications for interpretation of neuropsychological test results. Moreover, this case series exemplifies the need for higher-order instruction in norm selection, specifically for underserved communities who run the risk of being misdiagnosed. Through case examples, this study underscores the importance of understanding the unique effects of different demographic corrections in the context of limited available normative reference groups. This abstract is the first illustration in a series of papers aimed at facilitating the decision-making process within the framework of socially responsible neuropsychological practice.

Examining accurate diagnosis of complex PTSD in ICD-11

BackgroundComplex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. MethodsParticipants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. ResultsClinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LimitationsThe use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. ConclusionsFindings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.

H - 69 Making Diagnostic Decisions Using Linguistically Congruent Neuropsychological Assessment in a Monolingual Low Education Latino: a Single Case.

As life expectancy and Latino populations increase in the United States, it is important to provide linguistically congruent neuropsychological assessments to assist in the treatment and diagnosis of neurodegenerative processes. This case used a linguistically congruent evaluation and appropriate norms in a 72-year-old Latin male with low education, to inform treatment recommendations. A 72-year-old Latin male with five years of education was referred by his neurologist in the context of cognitive, behavioral, and functional decline over the past several years. He was educated outside of the United States, in a Spanish-speaking country, and speaks limited English. Therefore, testing was administered in Spanish. All test data were compared to other Spanish-speaking clinical patients with low education levels from his country of origin when available (11 articles). Overall given the evidence, he was diagnosed with Mild Neurocognitive Disorder due to Multiple Etiologies, with behavioral disturbance. His profile revealed weaknesses in verbal learning and memory, attention, and psychomotor processing speed. However, when compared to non-corrected norms, he performed significantly different (at least 1 SD) across several measures. Using a linguistically congruent evaluation, in addition to a compilation of age and education-corrected norms, we came to a diagnostic conclusion of a Mild Neurocognitive Disorder. If the normative data not been corrected for age and education, his impairments in visuospatial abilities and attention would have been inflated. As the Latino population continues to age, it becomes increasingly important to develop ways to assess this population appropriately.

The concept of a second opinion in psychiatry

The article analyses the second opinion strategy, which involves providing patients with the opportunity to obtain a second (different) opinion from a qualified specialist in cases where patients are not sure of the correctness of their diagnosis or want to consider other treatment options. The use of second opinion in general medicine and in psychiatry is compared. It is pointed out that it is rare to get a second opinion in psychiatry, and there is very little scientific research on this issue in both general and forensic psychiatry. It is concluded that the lack of demand for the concept of second opinion on the part of psychiatrists is associated with many factors, in particular with the prevalence of diagnostic and therapeutic relativism. It is argued that psychiatrists should reconsider their attitude to the concept of second opinion, gain communication skills with patients on the topics of substantiating the correctness of their own diagnostic conclusion and create criteria for an objective assessment of the qualifications of doctors.

Danish Prostate Registry (DanProst) – an Updated Version of the Danish Prostate Cancer Registry, Methodology, and Early Results

In 2016, we introduced the Danish Prostate Cancer Registry (DaPCaR) which was built on the National Pathology Register from 1995 to 2011. DaPCaR was laborious to use as most data had to be manually imputed with no regular updates. In here we present a new comprehensive centralized prostate registry called the Danish Prostate Registry (DanProst), which includes all men having undergone any histological evaluation of prostate tissue merged with laboratory-, treatment-, prescription data as well as vital status. Here the data included and the methodology of DanProst are described. DanProst is built upon all men with a histological assessment of the prostate from the Danish National Registry for Pathology. The primary histology and potential prostate cancer histological diagnosis for each unique individual is extracted and translated by newly made algorithms for topography, procedure, diagnostic conclusion, and pathological staging. Further information is added from DaPCaR, the CPR Registry, the Danish Cause of Death Registry, the Danish Cancer Registry, the National Patient Registry, the Danish Register of Laboratory Results for Research, and the Danish National Prescription Registry. The translation algorithms were validated based on the comparison with DaPCaR in the period 2010–2016. DanProst includes 190,422 men. A total of 95,152 (50%) men are diagnosed with prostate cancer until 2021. Median diagnostic PSA was 11 ng/ml, most men are diagnosed by ultrasound-guided biopsy (N = 63,751; 67%), and most frequently defined primary treatment was radical prostatectomy (N = 14,778; 19%). DanProst to DaPCaR coherency was > 99%, 95%, and 94% for the primary histological procedure, primary histological conclusion, and diagnostic histological conclusion, respectively. DanProst is a continuously updated, centrally kept, validated registry with automatic integration of data from other national registries, allowing for contemporary nationwide analysis in men with histological assessment of the prostate.

Biochemical and molecular characteristics among infants with abnormal newborn screen for very-long-chain acyl-CoA dehydrogenase deficiency: A single center experience

ObjectiveTo define the biochemical and molecular characteristics and diagnostic outcomes of a large US cohort of VLCAD deficiency positive cases as detected by newborn screening (NBS) with MS:MS. This relatively common disorder of fatty acid oxidation is screened for in every state in America and often results in extensive testing of multiple samples to arrive at a diagnostic conclusion. Materials and methodsWe compared NBS dried blood spot (DBS) acylcarnitine profile (ACP) C14, C14:1, C14:2, C14:1/C12:1 ratio and plasma C14, C14:1, C14:2, C14:1/C12:1, C14:1/C16 and C14:1/C2 ratios among true positive and false positive cases. Results of VLCAD enzyme analysis, molecular testing and fibroblast fatty acid oxidation probe assay were analyzed. ResultsThe presence of compound heterozygous or homozygous pathogenic variants, along with elevations of C14, C14:1 and C14:1/C12:1 ratio, identified 19 VLCAD deficiency cases. All were asymptomatic at most recent follow-up visits. The C14:1/C12:1 ratio in NBS-DBS ACP and plasma acylcarnitine profiles at follow-up (follow-up plasma ACP), is the most useful marker to differentiate between true and false positive cases. Among all cases with molecular analysis data available, approximately 56.7% had a single pathogenic mutation. Lymphocyte enzyme analysis (n = 61) was uninformative in 23% of cases studied. ConclusionVLCAD deficiency NBS by MS:MS is highly effective at identifying asymptomatic affected infants. Our cohort showed that elevation of C14:1/C12:1, in both NBS DBS and plasma ACP, was informative in discriminating affected from unaffected individuals and contributes to improve the accuracy of confirmatory testing of infants with presumptive positive for VLCAD deficiency.

THE USE OF "SOFT COMPUTING" FOR THE DIFFERENTIAL DIAGNOSIS OF THE FUNCTIONAL STATE OF THE CARDIOVASCULAR SYSTEM

The application of soft computing technology for diagnosing the functional state of the cardiovascular system is considered. Soft computing technology uses fuzzy sets, fuzzy logic, fuzzy neural networks, genetic algorithms and evolutionary modeling as tools. Various methods of soft computing technology in solving various problems often complement each other when used in various combinations. This technology is focused on solving control problems with semi-structured control objects. The main informative indicators (indicator variables) characterizing the functional state of the cardiovascular system and obtained on the basis of statistical information are identified. These informative indicators include the tension index, the vegetative rhythm index, the indicator of the adequacy of regulatory processes, the tension index of regulatory systems, and also special indicators that are derivatives of classical statistical indicators: respiratory modulation index, functional arrhythmia index, cardiorespiratory synchrony index, parasympathetic control destabilization index. The quality of the classification of possible diseases is determined by indicators such as sensitivity, specificity, predictive value and diagnostic efficiency. Keywords: Neural networks, fuzzy inferences, diagnostic conclusion, confidence coefficient.

A practical approach to the sampling, fixation, softening, and sectioning of whole honey bees for histologic evaluation.

The Western honey bee (Apis mellifera) is economically important as the primary managed pollinator of many agricultural crops and for the production of various hive-related commodities. Honey bees are not classically or thoroughly covered in veterinary pathology training programs. Given their unique anatomic and biological differences from the other species more traditionally evaluated by veterinary pathologists, establishing routine and consistent methods for processing samples for histology ensures accurate diagnostic and research conclusions. We developed and tested several field protocols for the sampling of honey bees. We compared the tissue-quality outcomes for worker bees fixed, collected, and/or softened under the following protocols: 1) routine formalin fixation; 2) softening chitin via exposure to Nair for 2 d or 3) 5 d; 4) shortened times between formalin submersion and trimming of body segments to enhance penetration of formalin into internal tissues; 5) ethanol submersion of specimen prior to formalin fixation; 6) indirect dry ice exposure; and 7) prolonged -80°C storage. Routine formalin fixation, exposure to Nair for 2 d, indirect dry ice exposure, and trimming body segments within 2 h of formalin submersion resulted in the highest quality histologic tissue sections. The poorest quality sections resulted from softening of chitin by exposure to Nair for 5 d, submersion in ethanol for 3 d before formalin fixation, and prolonged storage at -80°C. Our results indicate that routine formalin fixation is adequate, and that immobilizing bees with indirect dry ice exposure aids in sample collection without negatively impacting the quality of histologic sections.

Two cases of urinary schistosomiasis with unusual egg presentations: Dra 1 repeat sequence not detected

Introduction: Schistosoma haematobium is the primary cause of urinary schistosomiasis in man. It is rare to find other human schistosome species in urine because they are located in the intestines, or those of animal origin. Mixed infections of human and animal species of schistosomes may occur in cattle breeding areas like Nigeria. Case Report: During a prevalence study on urinary schistosomiasis, two teenage boys from different local government areas (LGAs) of Kaduna State, Nigeria had mixed urinary Schistosoma infections. Their urine samples were centrifuged at 3000 rpm (revolutions per minute) for 5 minutes. Microscopic examination of the urine sediments revealed highly polymorphic eggs (or morphotypes). After subjecting the genomic DNA for detection of S. haematobium Dra 1 tandem repeat sequence by polymerase chain reaction (PCR), it was not amplified. However, there was amplification in a classical urinary schistosomiasis caused by S. haematobium (which served as positive control). Conclusion: Unusual egg presentations in urinary schistosomiasis may present a dilemma in making diagnostic conclusion. Hence, these two cases suggest the possibility of human–animal Schistosoma hybrids circulating in the area, especially S. haematobium–S. bovis hybrids.

Fuzzy Intelligence Learning Based on Bounded Rationality in IoMT Systems: A Case Study in Parkinson’s Disease

As a cause of interfering with routine activities, freezing of gait (FOG) is a severe syndrome of Parkinson’s disease (PD) and usually performs as an abrupt and momentary inability to effective stepping forward. Advanced wearable acceleration sensors based on socially implemented Internet of medical things (IoMT) devices can remotely provide a platform for recognizing FOG. However, due to the diverse data acquisition modes that appear in classic IoMT devices, the obtained data may contain imprecise, hesitant, and incomplete ones. Meanwhile, the bounded rationality owned by neurologists usually has a big impact on using wearable acceleration sensors to predict illnesses. Therefore, the objective of this article lies in exploring a fuzzy intelligence learning approach based on bounded rationality in IoMT systems and providing a valid scheme for biomedical data analysis. Specifically, a brand-new three-way group decision-making approach by means of TODIM (an acronym in Portuguese for interactive multicriteria decision-making) with incomplete dual hesitant fuzzy (DHF) information and its applications in detecting FOG in PD using IoMT devices are systematically explored. First, taking advantage of DHF sets (DHFSs) when depicting realistic group decision information, the concept of multigranulation (MG) incomplete DHF information systems is built. Second, adjustable MG DHF probabilistic rough sets (PRSs) are further put forward via DHF similarity relations. Third, a three-way group decision-making approach is constructed by virtue of adjustable MG DHF PRSs and TODIM. Finally, the validity, effectiveness, and practicality of the constructed three-way group decision-making approach are investigated by a University of California, Irvine (UCI) dataset with several experimental analyses in the background of FOG detection in PD using IoMT devices. The experimental result indicates that the developed fuzzy intelligence learning approach achieves reasonable diagnostic conclusions for FOG detection in PD from the perspective of uncertain information processing abilities, decision risks, and bounded rationality.

Detection of Leishmania spp. in Cats: Analysis of Nasal, Oral and Conjunctival Swabs by PCR and HRM.

Feline leishmaniasis (FeL) is caused by several species of parasites of the genus Leishmania. The disease can occur with the presence or absence of clinical signs, similar to those observed in other common infectious diseases. In endemic regions for FeL, the infection has been associated with dermatological lesions. Therefore, considering the search for less invasive and more effective diagnostic techniques, we aimed to investigate the presence of Leishmania spp. in domestic cats through Polymerase Chain Reaction (PCR) and high-resolution melting (HRM) analyses of conjunctival, oral, and nasal epithelial cells, and we detected the presence of anti-Leishmania IgG antibodies from serological techniques of the Immunofluorescent Antibody Test (IFAT) and ELISA. The PCR and HRM for detection of Leishmania spp. were performed on 36 samples of epithelial cells from the conjunctiva of male and female cats, collected using sterile swabs. The serological tests IFAT and ELISA were also performed. The prevalence of Leishmania donovani infection was 11.1% (4/36) by PCR assay, and those results were confirmed for Leishmania species using the HRM technique. Twenty-four cats (24/36 = 66.7%) were reactive to the IFAT and twenty-two cats were reactive by the ELISA technique (22/36 = 61.1%). The use of conjunctival swabs was shown to be a non-invasive, practical, and easy-to-perform technique, and in addition to the genetic sequencing and HRM, it was able to identify the parasitic DNA of L. donovani in cats. This technique can be used for screening diagnosis in future epidemiological surveys of FeL and can be used as a complement to clinical and/or serological tests, as well as associating the clinical history of the animal, for the diagnostic conclusion.

Infrared thermography as a method of diagnosing reproductive pathologies in animals

The development and practical implementation of unique instrumental methods for diagnosing obstetric, gynecological, and andrological pathologies remain relevant. In this regard, thermography shows promise as a non-contact remote diagnostic express method that allows detecting differences in the distribution and intensity of infrared radiation depending on the physiological or pathological state of the animal organism. In this regard, the purpose of the work was to present the possibility of using the infrared thermography method for diagnosing reproductive pathologies in animals. Assessing the functional state and conducting preventive diagnosis of pathological processes in the genitals using thermal imagers can be crucial in animal reproduction. In addition, exceptional safety, autonomy, and non-contact qualities make thermal imagers indispensable in veterinary medicine. Therefore, thermography provides identification and differentiation of the phases of the sexual cycle and preventive diagnosis of obstetric-gynecological and andrological pathologies at a pre- or subclinical stage of development, dystrophic or inflammatory. Practical utilization of thermal imagers enables, in some cases, to make a final diagnostic conclusion; in others, to receive only preventive information followed by thorough, further comprehensive and specific research.

Hypnosuggestive Therapy of Hypoactive Sexual Desire Combined with Weakened Lubrication. Case Report

A female patient Ch., 30 years old, married. She has two daughters (age – 7 years and 2 years). Husband is 29 years old. Living conditions are normal. Her relationship with her husband is good, they love each other. She says that she has no spontaneous sexual desire and arousal. They only appears during cunnilingus. At the same time, her erotic libido is completely intact. Have sex with her husband five to six times a week and only at his suggestion. Initially, the spouse was the initiator of the visit to the doctor, as she had “grown cold” to him. She was not bothered by the current state of affairs, but since her husband was not happy about it, she sought medical help on her own. Before the first birth she was very passionate, there was no sexual dysfunction of any kind. Interest in sex disappeared at 5–6 months of the first pregnancy. One and a half months after the first birth, she started to live a sexual life. Since then, in addition to the absence of spontaneous desire for sexual intercourse, insufficient lubrication of the vagina was also revealed. She has no bad habits, is gynecologically healthy, and has no chronic diseases. We attributed the occurrence of sexual problems to the first pregnancy. However there were no changes in her sexual sphere after the childbirth. Due to the absence of obvious somatic reasons of sexual disorders, as well as to the efficiency of hypno-suggestive therapy (we made the final diagnostic conclusion considering the results of treatment) we concluded that her sexual disorders were the result of existing inertial shifts in the body which had conserved the sexual dysfunctions originally caused by factors related to pregnancy. A program (stereotype) of sexual response was formed, the existence of which persisted for a long time, although the influence of factors associated with the first pregnancy was absent. Five sessions of hypnosuggestive therapy (programming, modeling) were conducted. The results obtained indicated complete elimination of sexual problems. If before the treatment the patient’s sexual libido did not arise even during foreplay, that as a result of it, it began to appear even before caressing and kissing, and she became a frequent initiator of sexual contacts. This happened immediately after the first hypnosis session. Before the beginning of the treatment, lubrication had not appeared in the patient during the preliminary period, but appeared only during cunnilingus. At the 3rd session of hypnosis the patients felt the sensation of moistness in the vagina, and when she came home she found that there was a lot of lubrication in the vagina. After this session there was enough lubricant when fondling and kissing to perform intercourse, but less than before the development of the disorder. After the 4th session of hypnotherapy during caressing and kissing an abundant amount of lubricant began to be secreted. Moreover, lubrication in the presence of sexual desire began to occur even before caressing and kissing.

Ambulatory video EEG extended to 10 days: A retrospective review of a large database of ictal events

ObjectiveThis work aims to determine the ambulatory video electroencephalography monitoring (AVEM) duration and number of captured seizures required to resolve different clinical questions, using a retrospective review of ictal recordings. MethodsPatients who underwent home-based AVEM had event data analyzed retrospectively. Studies were grouped by clinical indication: differential diagnosis, seizure type classification, or treatment assessment. The proportion of studies where the conclusion was changed after the first seizure was determined, as was the AVEM duration needed for at least 99% of studies to reach a diagnostic conclusion. ResultsThe referring clinical question was not answered entirely by the first event in 29.6% (n = 227) of studies. Diagnostic and classification indications required a minimum of 7 days for at least 99% of studies to be answered, whilst treatment-assessment required at least 6 days. ConclusionsAt least 7 days of monitoring, and potentially multiple events, are required to adequately answer these clinical questions in at least 99% of patients. The widely applied 72 h or single event recording cut-offs may be inadequate to adequately answer these three indications in a substantial proportion of patients. SignificanceExtended duration of monitoring and capturing multiple events should be considered when attempting to capture seizures on video-EEG.

Pathology of carotid triangle of the neck as one of the extra-respiratory causes of chronic cough (clinical case)

One of the extra-respiratory causes of chronic hacking cough is a tumorous pathological process in the carotid triangle of the neck. A 41-year-old patient sought medical assistance for a hacking cough that worsened in the evening and had lasted for more than 8 weeks. After treatment prescribed by the primary care physician, the patient noticed a short­term improvement. However, shortly after discontinuing the therapy, the cough resumed and intensified. The patient was referred for a consultation with an otolaryngologist. During the examination, an elastic, condensed formation with somewhat limited mobility and a smooth surface measuring 2.5 × 3.0 cm was found in the area of the carotid triangle of the neck. Ultrasound examination of the soft tissues of the neck and ultrasound Dopplerography of the neck vessels were performed. An entity was detected that, based on all ultrasound characteristics, appears to be a carotid paraganglioma on both sides. The diagnostic conclusion was confirmed by the result of neck magnetic resonance imaging, which described carotid paragangliomas. After establishing the diagnosis of carotid chemodectoma in the neck, the patient was consulted by an oncologist and referred to a specialized department, where they underwent successful surgical treatment. Following the surgical intervention, the patient remained under the dispensary observation of an otolaryngologist and a vascular surgeon for the next 12 months. During this period, there were no complaints of cough recurrence. The cessation of the triggering factor in the afferent pathway of the neuroreflex arc of the cough reflex, achieved by removing the carotid paraganglioma, contributed to the disappearance of the cough — a symptom that had negatively impacted the patient's quality of life.The clinician should be highly vigilant if an initiated cough persists for several weeks or months and the patient demonstrates an excessively sensitive cough reflex. It is important to remember that chronic idiopathic cough can be a distinct clinical entity with an unidentified underlying pathology, and it can also contribute to the identification of a clinical pattern different from cough-associated diseases. In cases of persistent idiopathic cough that is unresponsive to treatment, the concept of distinct afferent pathways and an «anatomical diagnostic protocol» should be employed to determine the pathology and guide patient management.

THE ROLE OF NASAL ENDOSCOPY IN PATIENTS OF MUCORMYCOSIS

Objective: The Rhino-orbital- cerebral infection is the most typical presentation of mucormycosis where there is an invasion of the fungal infection from paranasal sinuses to orbit and brain (6,11).Extension of the disease leads to vascular thrombosis, including the cavernous sinus and other cerebral vessels due to fibrin reaction and Mucor thrombus formation. Nasal Endoscopy aids in the early detection and management of the disease (8). This study aims to study the signs and symptoms of patients with mucormycosis and the role of nasal endoscopy in early diagnosis. Subjects And Methods: A Prospective study was conducted on 150 patients of age 20-90 years attending ENT OPD and admitted under the Department of otorhinolaryngology at a tertiary care center in Central India. Subjects with or without Covid 19 infection, comorbidities like diabetes and hypertension and patients on steroids were selected for nasal endoscopy. Patients with benign or malignant lesions of nasal cavity and post operative cases of FESS for mucor were excluded. Results: In out study, majority patients were from the 5th decade followed by the 6th. In the classification system designed on the basis of endoscopy findings, majority were in Group B(42%) followed by Group C (28.7%). Maxillary sinus was found to be the most common sinuses involved as seen in the MRI of 110 patients. Out of 150 patients, debridement was done in 74 patients. In our study, we have concluded that diagnostic nasal endosco Conclusion: py aids in early diagnosis and management of mucormycosis. The grading system makes the management of the large number of patients easier. Appropriate time, treatment and resources can be given to the required patients. All patients after this management protocol stood well and were successfully discharged with only 8% mortality rate.

Should artificial intelligence have lower acceptable error rates than humans?

The first patient was misclassified in the diagnostic conclusion according to a local clinical expert opinion in a new clinical implementation of a knee osteoarthritis artificial intelligence (AI) algorithm at Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark. In preparation for the evaluation of the AI algorithm, the implementation team collaborated with internal and external partners to plan workflows, and the algorithm was externally validated. After the misclassification, the team was left wondering: what is an acceptable error rate for a low-risk AI diagnostic algorithm? A survey among employees at the Department of Radiology showed significantly lower acceptable error rates for AI (6.8 %) than humans (11.3 %). A general mistrust of AI could cause the discrepancy in acceptable errors. AI may have the disadvantage of limited social capital and likeability compared to human co-workers, and therefore, less potential for forgiveness. Future AI development and implementation require further investigation of the fear of AI's unknown errors to enhance the trustworthiness of perceiving AI as a co-worker. Benchmark tools, transparency, and explainability are also needed to evaluate AI algorithms in clinical implementations to ensure acceptable performance.