Diagnostic Guidelines Research Articles

Expert consensus on classification and diagnosis of congenital orofacial cleft.

Congenital orofacial cleft, the most common birth defect in the maxillofacial region, exhibits a wide range of prognosis depending on the severity of deformity and underlying etiology. Non-syndromic congenital orofacial clefts typically present with milder deformities and more favorable treatment outcomes, whereas syndromic congenital orofacial clefts often manifest with concomitant organ abnormalities, which pose greater challenges for treatment and result in poorer prognosis. This consensus provides an elaborate classification system for varying degrees of orofacial clefts along with corresponding diagnostic and therapeutic guidelines. Results serve as a crucial resource for families to navigate prenatal screening results or make informed decisions regarding treatment options while also contributing significantly to preventing serious birth defects within the development of population.

Historical Perspective on Antinuclear Antibody Testing.

Serum factors binding to cell nuclei were first described in the 1940s and the antibodies responsible for the binding to self (autoantibodies) discovered in the late 1950s. Routine standardized testing using a cell line (HEp-2) started in the 1980s and continues to evolve. In addition to the classic immunofluorescence assay (IFA), various immunochemical techniques have been developed for the measurement of antinuclear antibodies (ANAs). The complexity of ANA IFA pattern reading and the varying sensitivities, specificities, and overall clinical performance of the alternative methods often generated controversies and sometimes even confusion among healthcare providers and laboratorians. A better understanding of the historical roots of ANA testing can aid in understanding these controversies and assist with selecting the best performing methods. In this review, we present historic and contemporary ANA testing methods, highlighting the pros and cons of each. We also overview the current practice of ANA testing based on several recent large laboratory surveys. Optimal patient care critically requires that clinicians and laboratorians using ANA testing understand the performance and limitations of the methods used by their institutions, as well as the meaning of the test results. Recently published surveys and standardization efforts initiated by several stakeholder scientific organizations will likely lead to new ANA diagnostic guidelines, to be followed by an improvement in testing practices, management, and outcomes for patients with autoimmune disorders.

Self-perceived knowledge, influencing factors and proposed educational interventions for diagnostic stewardship in the microbiology laboratory: The experience of Irish paediatric doctors.

Lab users should display an understanding of microbiology tests and avoid inappropriate requests which may yield negative clinical consequences. Our research addressed diagnostic stewardship education and the perspectives of paediatric hospital doctors on their (1) self-perceived knowledge, (2) motivators for test ordering, (3) proposed educational interventions and (4) preferred teaching modalities. An anonymous, mixed-methods, 34-item online questionnaire was distributed to paediatric doctors across three Irish hospital sites from March to May 2023. Descriptive statistics summarised Likert-scale responses and inductive thematic analysis was used to analyse open-ended items. Subgroup analyses examined differences between consultants and non-consultant hospital doctors (NCHDs). The analysis included 100 respondents (n = 45 consultants, n = 55 NCHDs, 24% response rate). Consultants scored higher than NCHDs in self-perceived knowledge (p < 0.001). Patient comorbidity, clinical status, local guidelines and accuracy of microbiological tests were the strongest motivators for test-ordering. Consultants were more likely to be influenced by accuracy (p = 0.03), costs (p = 0.01) and laboratory workload (p = 0.01). Only 27% reported formal teaching on diagnostic stewardship. NCHDs demonstrated increased willingness to engage in educational interventions (p = 0.024), and a comparatively higher interest in in-person teaching (p = 0.002) and gamification (p = 0.02). Respondents indicated a preference for formal guidelines on microbiology testing, in-person teaching, cost familiarisation and e-learning modules. Novel methods (peer-to-peer programmes, simulation and gamification) were less favoured. Dominant themes included; collaborative learning, increased microbiology presence, accessibility to education, barriers and administrative issues. Formal diagnostic stewardship educational programmes should be integrated into post-graduate curriculums for both NCHDs and consultants. Focuses for educational interventions include; development of local diagnostic stewardship guidelines, teaching on the cost and accuracy of microbiology tests, senior supervision and role-modelling.

Canadian Association of Radiologists Central Nervous System Diagnostic Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Central Nervous System Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurosurgery, and neurology, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 24 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 55 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 51 recommendation statements across the 24 scenarios. This guideline presents the methods of development and the referral recommendations for congenital disorders of the brain, cerebrovascular disease, multiple sclerosis and demyelinating disease, headache, concussion, pituitary and juxtasellar lesions, cranial neuropathy, brain stem symptoms, altered intracranial pressure (hypertension, hypotension, hydrocephalus suspected shunt malfunction, normal pressure hydrocephalus), vestibular and cochlear symptoms (hearing loss, vertigo), mental status change (acute, dementia/memory loss), visual loss, epilepsy and seizure, CNS infection, intracranial space-occupying lesions, suspected cerebral venous sinus thrombosis, vasculitis, movement disorders/Parkinsonism, metabolic and toxic encephalopathies, and aneurysm screening.

Diagnostic parameters knowledge, guideline use and dietary approaches in type 2 diabetes and prediabetes care among healthcare providers in Ainamoi sub-County, Kenya

Type 2 diabetes and prediabetes are metabolic diseases which are currently of great public health concern worldwide and which are associated with significant morbidity, mortality and even disability. Correct diagnosis, use of guidelines and optimum dietary care in diabetes care by the healthcare providers (HCPs) are attributed to better outcomes among the patients. This study utilized a cross-sectional design carried out at purposively sampled level 2 to level 5 health facilities of Ainamoi Subcounty, Kericho Kenya. One hundred and fifty participants were recruited by convenience sampling. Structured questionnaire was administered using Open Data Kit (ODK) app and collected by trained enumerators. The questionnaire elucidated data on knowledge of diagnostic parameters for diabetes, access and use of guidelines and dietary approaches prescribed by healthcare providers. Research was approved by University of Eastern Africa Baraton Institutional Ethics Committee and National Commission for Science, Technology Institute, License Number. NACOSTI/P/23/23262. Data was analyzed using statistical package for social sciences (SPSS) version 20 software. Descriptive analyses were conducted for all the variables. Categorical data was summarized as frequencies and percentages. The Chi-square test was used to compare various categorical variables in the study. The statistical significance level was set at p &lt; 0.05. Less than a quarter (21%) of the respondents did not use diabetes guidelines suggestions. Up to 88.3% of HCPs prescribed low carbohydrate and only 8.3% prescribed a Mediterranean diet. Additionally, 82.7% of respondents could correctly identify Fasting Plasma Glucose parameter for Type 2 diabetes diagnosis while about two thirds could identify this parameter in Prediabetes diagnosis. Correct identification of glycated hemoglobin A1C (HBA1C) parameter for prediabetes (p=0.001) and for T2DM (p&lt;0.001) and Fasting Plasma Glucose for Type 2 diabetes diagnoses (0.003) were significantly associated with years of experience. Similarly, statistical significance was noted between access and use of diabetes guideline with level of practice (p &lt;0.001) and with years of experience (p= 0.002). The findings of this study showed limited usage of guidelines in clinical practice which may be linked to the observed limited awareness of diagnostic criteria used in diabetes care. Low carbohydrate diet was majorly prescribed with low emphasis on Mediterranean diet. Improved access to and utilization of standardized guidelines in dietary diabetes care and aggressive advocacy for the same at all levels of healthcare provisions is recommended to ensure timely and optimum care for better outcomes. Key words: Diabetes guidelines, Diagnostic criteria, Dietary Approaches, Health Care Provider

P-1809. Strategies to Optimize Antibiotic Stewardship for Patients with COVID-19 Using a Systems Engineering Framework

Abstract Background The COVID-19 pandemic stressed antimicrobial stewardship (AMS) programs with increased workloads and lack of guidance on the treatment of COVID-19. Throughout the pandemic, COVID-19 patients have received antibiotics for this viral illness despite reported low rates of confirmed bacterial co-infections. The purpose of this study was to identify challenges to and strategies for successful antibiotic stewardship for COVID-19 inpatients. Part 1 of Table 1 Methods We utilized the Premier Healthcare Database to identify hospitals with appropriate antibiotic prescribing before and maintained during the pandemic while facing significant COVID-19 patient burden. We conducted semi-structured interviews with pharmacists, physicians, and quality leaders involved in AMS during the pandemic. Interview guides were developed according to participants’ roles using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively using directed content analysis guided by the SEIPS model. Part 2 of Table 1 Results We conducted 30 interviews from 19 different high-performing health care systems across the country. We interviewed 17 pharmacists, 12 physicians and 1 nurse. The main challenges participants identified included lack of knowledge and formal guidance on how to treat COVID-19, feelings of helplessness, and diagnostic uncertainty. Strong, clear leadership from hospital leaders or infectious disease groups, organizational and national guidelines and clinical experience caring for COVID-19 helped providers overcome lack of knowledge, and guidelines on how to treat COVID-19 assuaged feelings of helplessness. Diagnostic tools including host response biomarkers (e.g. procalcitonin) and chest imaging were utilized and incorporated into workflows to help overcome diagnostic uncertainty and guide antibiotic prescribing. Part 3 of Table 1 Conclusion Successful strategies for COVID-19 antibiotic stewardship included overcoming knowledge gaps with clear leadership from infectious disease teams and implementation of structured COVID-19 diagnostic and treatment guidelines. Disclosures All Authors: No reported disclosures

P-243. Catheter-Associated Urinary Tract Infections: What’s the secret?

Abstract Background In the United States, more than 1 million CAUTIs are diagnosed each year, ranking among the top 5 most common healthcare-associated infections; however, our observations suggest that these numbers are inflated due to the lack of clear diagnostic guidelines. Most laboratories process urine cultures (UC) in reflex when a urinalysis (UA) sample shows 10 or more cells/µL. By adding specific criteria to decrease the number of UC, we decreased unnecessary use of antibiotics and overall cost from CAUTI misdiagnosis. Methods In this study, we enforced conditions that increase standards for reflex UC processing. These conditions included patient symptoms, presence of indwelling catheter, and levels of red blood and epithelial cells. We prospectively evaluated outcomes for patients whose UA samples did not meet our criteria. We suppressed UA samples that did not meet our criteria and did not report the culture results. Results Analysis of UC requests from 2020 to 2023 revealed several notable findings: 37% of the urine samples were approved for culture, 44% of those yielded positive results, and 56% showed either mixed flora or no bacterial growth. All UC samples that met criteria had white blood cell counts between 25 and 50 /HPF, with 91% displaying over 50 /HPF. Notably, none of the excluded samples resulted in patients developing urinary complications. Amongst the suppressed UC, 9% yielded positive culture results consistent with asymptomatic bacteriuria. We noticed CAUTI reductions from 31/year in 2018 to 8/year in 2023. Our intervention helped avoid unnecessary antibiotics use, decreasing the number of hospitals acquired Clostrioides difficile infections from 31 cases in 2018 to 9 cases in 2023. Conclusion The high rejection rate of UC samples suggests opportunities for optimizing appropriateness criteria to improve diagnostic yield and resource utilization. Further analysis of rejection reasons may help identify areas for clinician education regarding appropriate UC ordering. Disclosures All Authors: No reported disclosures

Meta-synthesis of patient experiences with chronic fatigue syndrome

ABSTRACT Objective: This paper systematically reviews and analyzes qualitative studies on the illness experiences of patients with Chronic Fatigue Syndrome (CFS) to provide a basis for healthcare professionals in developing support programs. Methods A systematic search of multiple databases, including PubMed, Web of Science, and Embase, was conducted, covering relevant literature from database creation to August 2023. The study employed an aggregative synthesis approach, systematically integrating qualitative data to identify common themes and patterns across studies. Results A total of 1,885 articles related to CFS were identified through the initial search, with 10 additional articles obtained through reference searching, bringing the total to 1,895. After duplicate checking and initial screening based on titles and abstracts, 123 articles were selected. Following a full-text review, re-screening, and quality assessment, 24 articles were ultimately included, involving 389 CFS patients. These studies identified 84 categories and 4 themes.1. Difficulty in Diagnosing CFS; 2. The Multidimensional and Complex Manifestations of CFS; 3. CFS and Social Challenges;4. CFS Diagnosis and Management Strategies. Conclusion The study recommends enhancing healthcare professionals' understanding of CFS through specialized training, the development of diagnostic and treatment guidelines, and the promotion of early identification. Raising public and medical awareness is crucial for reducing stigma. Energy management and psychological interventions can alleviate symptoms and improve quality of life, while support groups can provide emotional support and reduce feelings of isolation. Financial support and gender-sensitive approaches are essential to meet the diverse needs of CFS patients.

Synovial biomarkers in the diagnosis of post-traumatic osteoarthritis following anterior cruciate ligament and meniscus injuries: protocol for a systematic review

IntroductionThis review aims to synthesise research evidence regarding biomarkers in the synovial fluid that may predict the risk of post-traumatic osteoarthritis (PTOA) in young adults. Considering the high prevalence of...

A case of massive hematoma: reflections on hypermobile Ehlers-Danlos syndrome

Ehlers-Danlos Syndrome (EDS) refers to a group of connective tissue disorders characterized by significant clinical and genetic variability, affecting multiple systems in the body. Classified as a rare disease, EDS includes 14 subtypes, all marked by joint hypermobility, skin extensibility, and tissue fragility. These subtypes present with a wide range of clinical manifestations and severities, including frequent joint dislocations, scoliosis, arterial dissections, and organ ruptures. Hypermobile EDS (hEDS) is the most common subtype, with newly established clinical diagnostic guidelines. In this case, a patient presented with minor hemoptysis over 8 h, and a chest CT scan revealed a massive hematoma in the left lower lung. Due to the complexity and varied presentations of EDS, misdiagnosis is common. This report shares our experience with diagnosis and treatment in this case, highlighting the importance of increasing awareness for improved survival outcomes.

Torsion and ruptured ovarian cystadenocarcinoma with internal bleeding complicated with retroperitoneal hematoma after tumor transection: A case report.

Ovarian tumor torsion is a critical gynecological emergency, predominantly affecting women of reproductive age, with benign teratomas being the most common culprits. In contrast, malignant ovarian tumors, such as mucinous cystadenocarcinoma, infrequently present with torsion due to their invasive and angiogenic characteristics. The occurrence of torsion in malignant tumors complicates diagnosis and management, particularly when associated with complications like congestion, infarction, and internal bleeding. This report details a rare case of primary ovarian mucinous cystadenocarcinoma presenting with acute torsion and significant internal bleeding. Our study highlights the diagnostic challenges and the urgent need for clear treatment guidelines, addressing an important gap in the existing literature regarding the management of torsion malignant ovarian tumors. By documenting this case, we aim to contribute to the understanding of this rare condition and provide insights that may help clinicians in similar scenarios. A 51-year-old postmenopausal woman presented with acute abnormal pain. Transvaginal ultrasound examination showed an 8-cm heterogeneous right ovary mass without ovarian blood flow on color Doppler. Laparoscopy revealed torsion and rupture of the right ovarian tumor with 900 mL hemoperitoneum. The patient underwent right salpingo-oophorectomy complicated by continuous oozing and hematoma formation in the infundibular ligament. Unexpectedly, histopathology revealed a mucinous cystadenocarcinoma of the right ovary, pT1c2. The patient underwent staging surgery and prophylactic hyperthermic intraperitoneal chemotherapy. After 4 years of follow-up, no tumor recurrence or metastasis was found. Currently, there are no effective preoperative diagnostic and treatment guidelines for ruptured malignant ovarian tumors with torsion. The possibility of malignancy should be considered, and frozen section biopsy should be considered during surgery. Full detorsion before tumor resection to avoid incomplete pedicle coagulation and bleeding. Specimen removal by in-bag morcellation in minimally invasive surgery to prevent complications related to residual fragments of the specimen or dissemination of an occult malignancy.

Impact of an institutional antifungal stewardship program on antifungal usage and outcomes in patients with invasive fungal infections.

Therapeutic and prophylactic use of antifungals is rising continuously. However, lack of awareness of diagnostic and treatment guidelines and limited laboratory modalities are leading to inappropriate use. This study assessed the impact of an institutional antifungal stewardship program on antifungal use practices and patient outcome. In the pre-intervention phase, data was collected regarding antifungal therapy among patients with invasive fungal infections. Appropriateness of antifungal prescription was assessed. In the intervention phase, simple algorithms for diagnosis and management of fungal infections were prepared from international guidelines; and incorporated into a booklet for distribution. Monthly training sessions were conducted. New serological and molecular tests and therapeutic drug monitoring were introduced. In the post-intervention phase, an antifungal stewardship team was constituted which was available for clinical advisory on demand and participated in ongoing training. Data regarding antifungal therapy was collected and compared with pre-intervention data. Proportion of untreated patients decreased from 25% to 18.9% post-intervention (P=0.28). Among patients with single fungal infection, appropriate antifungal use increased from 72.6% to 77.9% (P=0.4). Among those with dual fungal infections, appropriate antifungal use for at least one infection increased from 57.1% to 88.5% (P=0.04). 49 incidents of inappropriate use in various categories was seen among 75 patients who received antifungals pre-intervention, which decreased to 42 incidents among 94 patients post-intervention (P=0.06); particularly evident among patients with dual infections (P=0.002). Mortality increased from 51% to 75.86% post-intervention (P=0.0001). Overall, the small improvement noticed in antifungal usage pattern can still be considered significant, given the limited study period.

Retrospective analysis in children with vaccination granuloma

Vaccine granulomas are acommon (0.3-1%) adverse event (AE) of (accidentally) subcutaneously administered vaccines and specific immunotherapies containing aluminum conjugates. The clinical symptoms with persistent itching subcutaneous nodules, predominantly affect infants and young children on the lateral thigh. To sensitize dermatologists to recognize this common and harmless vaccination AE, in order to prevent invasive diagnostics and confusion among parents and physicians. Retrospective analysis of 13children consulting pediatric dermatology between 2019 and 2023. Identification of diagnostic criteria and guidelines for action, based on the literature. In all, 13children (9boys, 4girls) with subcutaneous indolent but itching nodules at the vaccination sites (11 on the thighs, 2on the upper arms) with alatency of weeks to months were retrospectively evaluated. The children were vaccinated according to German STIKO ("Ständige Impfkommission") recommendations. Only inactivated vaccines contain aluminum. The documented occurrence of the first vaccination granulomas was between the 12thand 36thmonth of life. Regarding the STIKO vaccination calendar, the third immunization with the hexavalent inactivated vaccine coincides with the first administration of the live measles, mumps and rubella (MMR) vaccine (varicella(V)). This may incorrectly lead to the assumption that the live vaccine was the cause of granuloma development. Aluminum conjugation appears to be acentral trigger of the granulomas; further susceptibility factors are largely unknown. Diagnosis of sensitization to aluminum through epicutaneous testing has no practical impact and is, therefore, not routinely recommended. After weeks to years, granulomas spontaneously regress.

P0477 Perianal Crohn’s fistula in the absence of luminal disease -natural history, time to progression to luminal disease and management in contemporary clinical practice: An ECCO-CONFER case series

Abstract Background Isolated perianal fistulae (IPAF) without concurrent luminal disease is an uncommon presentation of Crohn’s disease (CD), posing unique diagnostic and management challenges. IPAF in CD often show complex features, such as secondary tracts and abscesses, and respond poorly to standard treatments for crypto-glandular fistulae1. Data on the natural history, progression to luminal disease, and effective management of IPAF in CD remain limited. This study examines contemporary diagnostic evaluation, clinical course, and outcomes for patients with IPAF lacking luminal CD at diagnosis. Methods We collected retrospective data on adult patients diagnosed with IPAF with the absence of luminal CD confirmed on at least one imaging-based diagnostic investigation within twelve months of diagnosis. Data collected included demographics, imaging and endoscopic findings, fistula classification2, surgical and medical treatments, treatment response3,4, and follow-up details. Results Data collection is ongoing. An interim analysis of complete data available at the time of this abstract included 40 patients (22 males, 55%). (Table 1). The mean age was 33.9 years (±13.8). Complex PAF was present in 33 patients (83%). Baseline evaluation included a median of 2 fistula investigations and 2 luminal investigations per patient (from ileocolonoscopy, MRI, video capsule endoscopy, computed tomography enterography, intestinal ultrasound (IUS), and faecal calprotectin). Combined surgical and medical therapy was used in 32 patients (80%), including Seton placement (n=27, 68%) and fistulotomy (n=17, 43%). Medical treatments included antibiotics (mean: 2.7 courses), immunomodulators (n=20, 50%), and biologics (n=29, 73%, primarily anti-TNF: n=26, 65%). (Table 2) The median follow-up was 90 months (IQR: 36.75–115.5 months). Clinical remission was achieved in 19 patients (48%), while 12 (30%) reported clinical response with residual changes on imaging. Subsequent luminal disease developed in 20 (50%) with a median time to detection of luminal disease of 3.9 years. Conclusion In contemporary practice, diagnosis of IPAF remains rare and typically involves at least 2 diagnostic evaluations for luminal disease, including ileocolonscopy. Use of anti-TNF therapy in this cohort is common, with reported outcomes broadly in line with results seen in PAF in context of luminal disease. Future research should prioritize clinical outcomes, optimal diagnostic and monitoring guidelines, and the potential of new biologics or combination therapies to enhance response in this unique population.

Alcohol dependence syndrome managed with homoeopathic medicine Bufo Rana – An evidence-based case report

Alcohol dependence syndrome (ADS) is a cluster of physiological, behavioural and cognitive phenomena wherein alcohol use takes on a much higher priority for a given individual than other behaviours that once had great value. A definite diagnosis of ADS should be made with the diagnostic guidelines of the International Classification of Diseases (ICD)-10 classification of mental diseases. The harm caused by ADS constitutes a major public health problem, as it causes numerous mental and physical disorders and imposes a massive economic burden. Excessive spending on alcohol leads to debts and heavy treatment expenses, amongst other financial consequences. The conventional treatment utilises several medications for detoxification, craving reduction and withdrawal management. However, homoeopathy can provide a valid and effective treatment to help patients to break the cycle of alcohol dependence, reduce the craving and relieve the withdrawal symptoms without adverse effects. A 35-year-old male patient presented with an irresistible desire to take alcohol and withdrawal symptoms of tremors in abstinence at the outpatient department (OPD) of National Homoeopathy Research Institute in Mental Health, Kottayam. The condition was diagnosed as ADS as it fulfilled the diagnosis guidelines provided in the ICD-10. Initially, the patient was treated in the OPD without significant improvement. Later, the patient was admitted into the inpatient department, and after careful case-taking, the homoeopathic medicine Bufo Rana 200 was prescribed. After the remedy was administered, the alcohol craving and dependence were markedly reduced, and the symptoms of withdrawal were relieved. The alcohol dependence was assessed using the severity of the alcohol dependence questionnaire, and the score changed from 46 to 2. The causal attribution for the outcome changes was assessed using the Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory. The score was +9, close to the maximum (13), showing the positive relationship between the intervention and the outcome. Therefore, this case report strongly suggests that the homoeopathic medicine Bufo Rana has a positive role in treating ADS.

Performance evaluation of the LIOFeron®TB/LTBI IGRA for screening of paediatric LTBI and tuberculosis

Purpose: High-accuracy diagnostic screening tests for Mycobacterium tuberculosis (MTB) infection are required, primarily to detect patients with latent infections (LTBIs) in order to avoid their progression to active tuberculosis disease. The performance of the novel IGRA LIOFeron®TB/LTBI was evaluated in children. The originality of this test is the new MTB antigen contained (l-alanine dehydrogenase), identified as a tool to differentiate active TB from LTBI infection. Methods: From March 2022 to November 2023, a population of 90 children was enrolled and grouped into healthy, active TB or LTBI individuals, based on diagnostic guidelines. The blood of all these participants was tested with LIOFeron®TB/LTBI assay in comparison to diagnosis, as gold standard, and to the current used IGRA QuantiFERON®-TB Gold Plus. Results: The two assays demonstrated an excellent concordance of their results with patients’ diagnosis of MTB infection. The performance of LIOFeron®TB/LTBI assay in terms of accuracy of MTB infection diagnosis was high at ROC analysis (AUC = 0.997), and the test showed 100% sensitivity in LTBI detection. The QuantiFERON®-TB Gold Plus sensitivity for LTBI detection was 85.7%. Conclusions: Based on the obtained results, the LIOFeron®TB/LTBI assay appears to be a promising test for TB and LTBI screening among paediatric patients.What is known:• The detection of LTBI in children, exposed to MTB infections, followed by appropriate treatment, has a pivotal role in reducing tuberculosis burden.• IGRA tests are easy-to-use methods for helping large TB screening in paediatrics.What is new:• The LIOFeron®TB/LTBI performance evaluation showed 100% of sensitivity in the detection of LTBI patients.• The LIOFeron®TB/LTBI assay might be useful for the detection of LTBI and active tuberculosis paediatric patients.

Caries de la primera infancia. Visión de conjunto actualizada. Revisión narrativa de la literatura

Objective: The purpose of this literature review is to gather updated information on diagnostic and therapeutic guidelines for early childhood caries. Material and methods: PubMed, Embase, Ovid, Cochrane Central and Google Scholar were searched for appropriate articles up to 5 years old (up to January 2018 inclusive). 229 studies were identified, including 13 clinical trials that discussed different treatment modalities for teeth affected by this disease. Conclusion: Early childhood caries is an increasingly common disease and is a condition that presents a unique set of clinical challenges for dental health professionals. This updated information recommends starting treatment as early as possible to eliminate the risk of increased cavitations because of early childhood dental caries and its consequences in these patients.

Neuromuscular Ultrasound Training in Neuromuscular Fellowship Programs in Canada: Minding the Gap.

Neuromuscular ultrasound (NMUS) is gaining prominence as a valuable tool for diagnosing neuromuscular disorders at the point of care. Neuromuscular disorder diagnostic criteria guidelines have begun incorporating NMUS findings. As interest grows, fellowship programs must consider incorporating training into their curricula. This study evaluated the current state of NMUS training, potential barriers, and interest in training across Canadian neuromuscular fellowship programs. A 23-question online survey was developed and distributed via email to all 10 neuromuscular fellowship program directors across Canada. Seven (70%) programs responded to the survey. There was general agreement among programs on the value of NMUS, however, only one (14.3%) program reported they would consider recent graduates to be competent in NMUS. Critical barriers to incorporation of NMUS training included lack of a formalized curriculum, faculty expertise and time, and equipment. Two (28.6%) programs reported that accessibility of equipment and one (14.3%) that faculty expertise was not a barrier to NMUS training. Two (28.6%) programs have local NMUS training options available to fellows (in only one program is NMUS training mandatory). All programs expressed interest in additional training opportunities, and three (43%) programs reported taking steps toward incorporating NMUS training into their curricula. NMUS training is in its infancy in Canada, with several common barriers identified across programs. There is universal interest in further NMUS training opportunities for fellows, highlighting the importance of a common approach to addressing the educational gap to support development of formalized NMUS training mechanisms in Canada.

Clinical Competency in Managing Malnutrition-Sarcopenia Syndrome Among Physical Therapists: A Cross-Sectional Survey.

Malnutrition and sarcopenia are interrelated health concerns among the elderly. Each condition is associated with increased mortality, morbidity, rehospitalization rates, longer hospital stays, higher healthcare costs, and reduced quality of life. Their combination leads to the development of "Malnutrition-Sarcopenia Syndrome" (MSS), characterized by reductions in body weight, muscle mass, strength, and physical function. Despite being preventable and reversible through nutritional and physical interventions, the clinical competence of physical therapists (PTs) in managing MSS remains underexplored. This study aims to assess the clinical competency of PTs in MSS management. An anonymous cross-sectional survey was conducted from January to August 2024 among 337 certified PTs in Israel, using the "Qualtrics" platform. The survey assessed prior familiarity with MSS concepts, MSS knowledge levels, screening and treatment skills, attitudes and beliefs toward MSS management, and interprofessional collaboration practices. While 52% of PTs were familiar with MSS, familiarity with diagnostic guidelines was low (EWGSOP2: 3.6%; GLIM: 0.6%). The MSS knowledge score was moderate, but screening and treatment skills were low. Attitudes toward MSS management were moderately positive, but self-belief in diagnosing and treating MSS was low. Interprofessional collaboration was limited, particularly in malnutrition care. PTs familiar with MSS had higher knowledge, better skills, more positive attitudes and beliefs, and greater interprofessional collaboration. Significant gaps exist in the clinical competency of Israeli PTs in MSS management. Integrating MSS content into physical therapy curricula and providing continuing professional development are necessary to enhance competencies. Equipping PTs with essential tools, clarifying roles, and promoting interprofessional collaboration can optimize MSS management and improve patient outcomes.

Optimizing Diagnosis of Eustachian Tube Dysfunction: A Comparative Analysis of Clinical and Instrumental Methods

Eustachian Tube Dysfunction (ETD) is a common condition affecting millions of people worldwide, yet its diagnosis remains challenging due to the lack of a universally accepted gold-standard test. The ETDQ-7, a self-reported questionnaire, has been widely used to assess ETD symptoms and quality of life. This comparative study aimed to evaluate the diagnostic accuracy of the ETDQ-7 in ETD and assess its suitability for adoption in resource-constrained settings. A comprehensive analysis of existing studies was conducted to compare the diagnostic accuracy of the ETDQ-7 with tympanometry, a widely used gold-standard test for ETD diagnosis. The results of this study show that the ETDQ-7 has a moderate diagnostic accuracy, with sensitivity and specificity values ranging from 0.75 to 0.95. The study highlights the importance of considering the specific context and characteristics of each study when interpreting the results. The findings of this study have implications for the development of diagnostic guidelines and the improvement of middle ear health in underserved populations. The ETDQ-7 was found to be a reliable and valid tool for diagnosing ETD in resource-constrained settings, but its diagnostic accuracy should be considered in the context of the specific study population and methodology used.