Diagnostic Possibilities Research Articles

ANALYSIS OF MODERN METHODS AND TOOLS FOR DIAGNOSTICS OF FLEXIBLE PAVEMENT

Solving the problem of increasing the durability of pavement requires establishing a level of permissible defectiveness that takes into account insecure hidden damage, such as hidden cracks. A detailed study of hidden cracks became possible with the development of means and methods for non-destructive testing of pavement, but their diversity greatly complicates the procedure for choosing the optimal methods and technical means for solving problems of pavement diagnostics. Therefore, the article analyzes the potential and scope of instrumental methods for diagnosing non-rigid pavement for solving problems of assessing the state of non-rigid pavement with cracks in layers of monolithic materials, and substantiates the most promising methods and tools for positioning and identifying cracks in pavement layers. The conducted studies allow: to substantiate the requirements for equipment for solving the problems of flaw detection of flat-layered media, in particular, non-rigid pavement; develop a procedure for diagnosing non-rigid pavement; to develop methods for interpreting diagnostic results to solve the problems of finding, positioning and identifying cracks in layers of non-rigid pavement. The conducted studies have proved that GPRs have the greatest potential for solving the problem of non-rigid pavement flaw detection. The advantages of GPR sounding for solving this class of problems are ensured by the continuity of data collection, the best resolution relative to other geophysical methods, high shooting speed, and the possibility of using it in a wide range of road construction materials. It can also be stated that there is considerable experience in the use of GPR for searching, positioning and identifying through cracks in layers of non-rigid pavement, while research on finding, positioning and identifying hidden cracks is very limited. Therefore, further research should be aimed at solving the following problems: improving methods for restoring the dielectric constant in multilayer structures, which will improve the reliability of GPR data interpretation results and the efficiency of diagnostics; development of methods for recording and analyzing the polarization state of the signal reflected from cracks, which creates a theoretical foundation for flaw detection of pavements and expands the possibilities of GPR diagnostics; substantiation of the type of antenna units, which will improve the accuracy of measurements. The solution of these problems will allow assessing the state of non-rigid pavement with cracks, based on information about the geometric and structural heterogeneity of the layers of the structure, obtained from the results of GPR sounding.

Methods improvement for diagnostics and treatment of inflammatory diseases in the temporomandibular joint

PurposeThe article subject relevance is conditioned by poor knowledge of the aetiology and pathogenesis of inflammatory diseases in this area. The purpose of this study was to identify the most rational approach to solving the issues of improving methods for treating arthritis and arthrosis. MethodsThe leading approach was the combination of the analysis results concerning the clinical examination of dental patients of various age groups with the logical construction of conclusions drawn from the research results. The paper presented the clinical examination data of patients with TMJ pathologies of various age groups and described the methods of their treatment. ResultsThe results include the main effective methods identification for the diagnostics and treatment of inflammatory diseases in the temporomandibular joint and the main prospects for improving these methods in the future, with the aim of a general expansion of ideas regarding the possibilities of diagnostics and treatment of such diseases. ConclusionThe study value lies in the possibility of using its results in practical dentistry to bring practical improvements to the currently available methods for diagnostics and treatment of inflammatory TMJ diseases.

Correlation between CK-MB, TSH, LDL, HDL, Troponin T, Troponin I and myocardial infarction

Introduction: The assessment of patients with acute chest pain of possible cardiac cause continues to be a challenge and positive diagnosis has psychological, social and legal implications. The presence of ST segment elevation in the ECG is highly specific (but only about 50% sensitive) for acute myocardial infarction (MI). However, many patients presenting to coronary care units has chest pain without ST elevation in the ECG. The diagnostic possibilities in these cases include: acute coronary syndrome in evolution, or ‘non-ischaemic’ chest pain. The World Health Organization defines for diagnosing AMI, the presence of two of the three enlisted features namely, symptoms of myocardial ischemia, elevated levels of cardiac marker (protein or enzyme) concentrations in the blood, and a typical electrocardiographic pattern involving the development of Q waves or persistent T wave changes. Methods: In this Prospective study, the data of the registry maintained in the Department of biochemistry, Tertiary care Teaching Hospital were analysed. The WHO case definition was used to assign a diagnosis in 430 patients presenting to the emergency department with symptoms of cardiac ischemia.

Detection of abnormal lymphocytes in the peripheral blood of COVID-19 cancer patients: diagnostic and prognostic possibility

ABSTRACT Background Peripheral morphological abnormalities play important roles in the early diagnosis and prognosis of the COVID-19 infection. The aim of the present study was to assess the morphological alterations in the peripheral blood (PB) cells in patients with COVID-19 infection, with special attention to a different group of atypical lymphocytes that had been observed in the PB of COVID-19 cancer and non-cancer patients. Methods The PB cells were examined in 84 COVID-19 positive cancer patients, and 20 COVID-19 positive non-cancer patients, compared to 30 healthy normal controls. The data were correlated to the disease severity, patients’ clinicopathological features, and outcomes. Results There was an increased incidence of giant platelets, neutrophils shifting left, and abnormal monocytes in the COVID-19 positive cancer and non-cancer patients compared to the control group (P < .001, P < .001 and P = .014; respectively). Neutrophils with abnormal toxic granulations, Pseudo Pelger-Heut abnormality, and reactive lymphocytes were significantly increased in COVID-19 cancer patients compared to COVID-19 non-cancer patients and the control group (P = .001, P < .001, and P < .001; respectively). An abnormal form of lymphocytes’ morphological changes (Covicytes) was significantly detected in COVID-19 cancer patients [60.7% (51/84)], and in COVID-19 non-cancer patients [55% (11/20)], while it was absent in the normal controls [0.0% (0/30), P < 0.001]. The presence of the Covicytes is associated significantly with a better prognosis in cancer and non-cancer COVID-19 patients. Conclusion Covicytes could be a useful marker supporting the diagnosis of SARS-COV-2 infection, and it is associated with a favorable prognosis.

Principles of the perioperative management of direct oral anticoagulants

Within the approved indications direct oral anticoagulants (DOAC) are increasingly gaining acceptance instead of vitaminK antagonists (VKA). In the last 12months 5guidelines relevant to the perioperative management of DOACs have been updated. This article summarizes the current recommendations for the perioperative management of treatment with DOACs. The available substances and their pharmacological properties as well as the possibilities for specific laboratory diagnostics of the effect of DOAC are explained. Special focus is placed on anesthesiologically important aspects of substance-specific preoperative and postoperative intermission intervals, the procedure for neuraxial regional anesthesia and antagonization with specific antidotes in cases of life-threatening bleeding.

In Vitro Comparison of Three Intraoral Scanners for Implant-Supported Dental Prostheses.

With continuing technological developments, there have been advances in the field of fixed prosthetics, particularly in impression-taking techniques. These technological advances mean that a wide variety of diagnostic and/or rehabilitation possibilities can be explored without the need for physical models. The aim of this study was to evaluate the accuracy of three intraoral scanners used in oral implant rehabilitation using an extraoral scanner as a reference and varying the scanning area. Three models representing different clinical scenarios were scanned 15 times by each intraoral scanner and three times by the extraoral scanner. The readings were analyzed and overlaid using engineering software (Geomagic® Control X software (Artec Europe, Luxembourg)). Statistically significant differences in accuracy were found between the three intraoral scanners, iTero® (Align Technology Inc., San Jose, CA, USA), Medit® (Medit®: Seoul, Korea), and Planmeca® (Planmeca®: Helsinki, Finland). In all clinical scenarios, the iTero® scanner had the best trueness (24.4 μm), followed by the Medit® (26.4 μm) and Planmeca® (42.1 μm). The Medit® showed the best precision (18.00 μm) followed by the iTero® (19.20 μm) and Planmeca® (34.30 μm). We concluded that the iTero® scanner had the highest reproducibility and accuracy in the clinical setting.

Diagnosis of Ischemic Stroke: As Simple as Possible.

The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.

A case of prenatal diagnosis of diastrophic dysplasia in the 1st trimester of pregnancy

A case of early prenatal diagnosis of diastrophic dysplasia at 13 weeks 2 days of gestation is described. During ultrasound screening of the first trimester, fetal changes characteristic of this form of systemic skeletal dysplasia were revealed – micrognathia, micromelia, flexion contracture in the elbow and knee joints, pathognomonic abduction of the thumb of the hands and feet for diastrophic dysplasia (hitchhiker thumb), varus deviation and postaxial polydactyly of the feet, in combination with by a significant increase in the nuchal translucency. Pregnancy was interrupted for medical reasons. The possibilities of ultrasound diagnostics of diastrophic dysplasia by two- and three-dimensional ultrasound using are shown.

Improvement of Diagnostic Yield by an Additional Amplicon Module to Hybridization-Based Next-Generation Sequencing Panels

Many approaches aimed at improving next-generation sequencing output for clinical purposes exist. However, sequencing gaps or misalignments for regions that are difficult to cover because of their low complexity or high homology still exist. Our aim was to improve the yield of sequencing data. A hybridization-based next-generation sequencing library was pooled with custom add-on amplicon-based libraries processed by the same commercial test and run in parallel and sequenced simultaneously. Formulas and steps for proper amplicon pooling (250 to 7000 bp) and final library merging are presented. The novel strategy was tested on selected archetypal situations: diagnostics of a gene with many pseudogenes, a genomic region surrounded by Alu repeats, simple one-time addition of an extra gene, and mosaicism detection. The sequence of all supplemented genomic regions was traced with reasonable coverage at the background of a hybridization captured library. The flexible add-on module expands the possibilities of routine diagnostics. The technical solution makes it possible to mix amplicons that differ significantly in size and process them in one tube simultaneously with samples of the hybridization-based panel. The proposed approach reduces turnaround time and increases diagnostic yield.

The Present Status of Diagnostic Imaging of Postoperative Complications after Orthognatic Interventions (Literature Review)

This article presents a review of foreign literature on the methods of diagnostics imaging of postoperative complications in orthognathic surgery. After the analysis, it can be argued that high-tech methods, such as computed tomography, cone beam computed tomography have improved the possibilities of imaging diagnostics in obtaining clinically significant information about postoperative complications of the maxillofacial region. Nevertheless, it should be noted that foreign sources not cover such issues as: tomographic semiotics of postoperative complications in orthognatic surgery, the role and place of radiation technologies in the examination of patients with postoperative complications; don`t specified indications and contraindications for use of each methods.

The Relationship of Self-Compassion and Features of the Emotional Sphere of the Personality

Self-compassion is as an important personal formation that reveals complex emotional and reflexive processes. The authors of the concept K. Neff and P. Gilbert showed that self-sympathy is an important diagnostic criterion for the ability of a person to adapt to difficult life situations. The study highlighted two parameters of the emotional sphere of the personality — emotional schemes and cognitive regulation of emotions and showed the possibilities of modern diagnostics in the study of these parameters. On a sample of students of the Far Eastern State University, an empirical study was conducted using methods adapted to the Russian sample: the scale «Self-sympathy» (K. Neff), the questionnaire «Cognitive regulation of emotions (N. Garnefsky), and the scale «Emotional schemes» (R. Lehi). It has been shown that more than 50 % of students had negative components of self-compassion (self-criticism, self-isolation, and excessive identification) and ineffective strategies for regulating emotions. The study revealed significant correlations between scales of self-compassion, emotional schemes and parameters of cognitive regulation of emotions.

Effect of global warming on dermatology practice: The increase in cases of cutaneous larva migrans in the eastern Black Sea region of Turkey.

Cutaneous larva migrans (CLM) is a parasitic disease seen in people in contact with soil in tropical countries. Almost all cases reported in regions without a tropical climate have a history of travel to a tropical region. In our study, we aimed to investigate the effect of climate change on CLM cases and the demographic characteristics of these cases. For this purpose, the climate information of the period in which we determined the case series and the characteristics of the patients were investigated. The study was designed retrospectively. Patient files and pre- and post-treatment photographic archives were reviewed retrospectively. In addition, the region's weather history over the last 50 years was examined. The records of patients diagnosed with CLM in 2018 were reviewed retrospectively. In total, 22 cases were detected. The common feature of all cases was that they worked as tea pickers. After examining the weather conditions of the period when the cases were commonly reported, it was determined that there was a sharp temperature increase compared with previous years. Due to climate change, an increase in the number of CLM cases is observed in non-tropical regions. Since it is considered a disease-specific to tropical regions, the diagnosis may be overlooked in cases outside these regions. However, CLM should be kept in mind as a diagnostic possibility by clinicians practicing in non-tropical regions as well, especially when treating patients who work with soil, such as tea harvesters.

Hereditary neuropathy with liability to pressure palsies (HNPP): Intrafamilial phenotypic variability and early childhood refusal to walk as the presenting symptom

BackgroundLimping and/or refusal to walk is a common complaint in the setting of the pediatric department, with a widely diverse differential diagnosis. An unusual etiology, is that of a hereditary neuropathy.Hereditary neuropathy with liability to pressure palsies (HNPP) is a recurrent, episodic demyelinating neuropathy, most commonly caused by a 17p11.2 chromosomal deletion encompassing the PMP22 gene.MethodsWe pursued chromosomal microarray analysis (CMA) in multiple affected individuals of a single extended family, manifesting a range of phenotypic features consistent with HNPP.ResultsA 4.5 years-old boy presented for in-patient evaluation due to refusal to walk. Initial investigations including spine MRI and bone scan failed to yield a conclusive diagnosis. Following family history, which implied an autosomal dominant mode of inheritance, CMA was pursued and confirmed a 17p11.2 deletion in the proband consistent with HNPP. Importantly, following this diagnosis, four additional affected family members were demonstrated to harbor the deletion. Their variable phenotypic features, ranging from a prenatal diagnosis of a 6 months-old sibling, to recurrent paresthesias manifesting in the fourth decade of life, are discussed.ConclusionsOur experience with the family reported herein demonstrates how a thorough anamnesis can lead to a rare genetic etiology with a favorable prognosis and prevent unnecessary investigations, and underscores HNPP as an uncommon diagnostic possibility in the limping child.

Angsterkrankungen in der Rehabilitation

Anxiety disorders are among the most common and socio-medically relevant mental illnesses. Correct diagnosis and initiation of appropriate therapy are of the utmost importance for patients' prognosis and for ensuring their social and occupational participation. This article therefore aims to provide an overview of new developments in the field of anxiety disorders relevant to rehabilitation.Within the framework of the changes in ICD-11, anxiety disorders now receive an independent chapter with a focus appropriate to their frequency and relevance. Further innovations concern the revised S3 guideline (2020) with the increasing consideration of digital therapy options, such as virtual reality exposure therapy (VER) as well as Internet-supported therapy methods as part of the therapy recommendations. Systemic therapy is also considered for the first time. However, the evidence for both procedures is significantly lower than for behavioral therapy, psychodynamic therapy, or pharmacotherapy. Online interventions are therefore not recommended as the sole therapy.Important for the practice in rehabilitation is the knowledge of the core symptoms of each of the above mentioned diagnoses as well as the diagnostic possibilities taking into account especially the correlations and interactions with physical diseases.Both psychotherapy and psychopharmacotherapy are available for treatment. In the field of psychotherapy, cognitive behavioral therapy (CBT) is the therapy of first choice due to the broadest base of evidence. In consideration of comorbid somatic diseases, attention must be paid to possible contraindications for antidepressants. Psychosomatic rehabilitation is an important resource in the overall treatment spectrum, especially if chronification or a threat to participation is foreseeable, in order to give the affected person confidence and motivation for further successful treatment of the anxiety disorder in an intensified treatment setting, in addition to teaching anxiety management strategies and socio-medical clarification. An important task of somatic rehabilitation is to recognize comorbid anxiety disorders and to provide the affected persons with an appropriate explanatory model of their complaints and to be able to initiate targeted treatment.

P.046 Extensive leukoencephalopathy as a differential diagnosis of motor neuron disease: case report and literature review

Background: Weakness is frequently a reason to attend neurology consultation which entails a challenge due to its wide range of diagnostic possibilities. We present the case of an elderly woman with long-standing right upper limb weakness. Methods: Patient data was obtained from medical records and an extensive neuropathological evaluation was performed. Results: Weakness started off in her right hand, which progressed insidiously to her right hemibody. with hyperreflexia, atrophy, fasciculations and foot drop. Subsequently, bulbar and left hemibody deterioration began. She died due to ventilatory failure four years after the first symptom appeared. A tigroid pattern in the neuroimaging studies suggest white matter involvement, while the neuropathological studies showed loss of motor neurons in the spinal cord. Conclusions: The available evidence does not allow us to dismiss the hypothesis of a motor neuron disease or a leukodystrophy. Cases like this one establish a diagnostic challenge due to their complexity and unusual etiology.

Barriers and facilitators of appropriate antibiotic use in primary care institutions after an antibiotic quality improvement program – a nested qualitative study

BackgroundAntibiotic prescribing by physicians in primary care institutions is common and affected by several factors. Diagnosis and treatment of infections in a nursing home (NH) resident is challenging, with the risk of both under- and overtreatment. Identifying barriers and facilitators of appropriate antibiotic prescribing in NHs and municipal acute care units (MACUs) is essential to ensure the most adequate antibiotic treatment possible and develop future antibiotic stewardship programs.MethodsAfter implementing a one-year antibiotic quality improvement program, we conducted six semi-structured focus group interviews with physicians (n = 11) and nurses (n = 14) in 10 NHs and 3 MACUs located in the county of Østfold, Norway. We used a semi-structured interview guide covering multiple areas influencing antibiotic use to identify persistent barriers and facilitators of appropriate antibiotic prescribing after the intervention. The interviews were audio-recorded and transcribed verbatim. The content analysis was performed following the six phases of thematic analysis developed by Braun and Clarke.ResultsWe identified thirteen themes containing barriers and facilitators of the appropriateness of antibiotic use in primary care institutions. The themes were grouped into four main levels: Barriers and facilitators 1) at the clinical level, 2) at the resident level, 3) at the next of kin level, and 4) at the organisational level. Unclear clinical presentation of symptoms and lack of diagnostic possibilities were described as essential barriers to appropriate antibiotic use. At the same time, increased availability of the permanent nursing home physician and early and frequent dialogue with the residents’ next of kin were emphasized as facilitators of appropriate antibiotic use. The influence of nurses in the decision-making process regarding infection diagnostics and treatment was by both professions described as profound.ConclusionsOur qualitative study identified four main levels containing several barriers and facilitators of appropriate antibiotic prescribing in Norwegian NHs and MACUs. Diagnostic uncertainty, frequent dialogue with next of kin and organisational factors should be targeted in future antibiotic stewardship programs in primary care institutions. In addition, for such programs to be as effective as possible, nurses should be included on equal terms with physicians.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

Current tendencies in diagnostics and treatment of peripheral benign lung tumors

The OBJECTIVE was to estimate clinical characteristics, diagnostic possibilities of computed tomography, minimally invasive methods of treatment of peripheral benign lung tumors.MATERIALS AND METHODS. Benign tumors were diagnosed in 311 (8.2 %) patients among 3789 people with bronchopulmonary neoplasms. A comparative assessment of the results of diagnostics and treatment of two groups of patients was carried out. The first group included 103 patients treated from 2003 to 2009, the second one – 128 patients treated from 2013–2020. 219 (94.8 %) patients were operated on. RESULTS. Benign lung tumors were more often detected at the age of 40-60 years – in 143 (61.9%) patients. The majority (184 patients, 79.6%) had no complaints. In 208 (90 %) patients, tumors were diagnosed during fluorography studies. In the second group, multispiral computed tomography revealed tumors less than 10 mm in size in 38 % of cases. The histological type of tumors was determined during intraoperative express histological test. In the second group, the number of thoracoscopies increased from 2.2 to 43 %, and – thoracotomies decreased from 94.5 to 52.3 %, the number of stapler resections of the lungs doubled, and the number of tumor enucleation decreased by half (p&lt;0.01). Thoracotomy was performed in case of deep tumor localization or large size of the tumor, it was impossible to find it endoscopically. Ten patients underwent lobectomy.CONCLUSION. Most peripheral benign lung tumors are asymptomatic. Computed tomography revealed tumors less than 1cm in size in 38 % of cases. To rule out malignancy, it is necessary to perform urgent surgery with an intraoperative express histological test. Thoracoscopy allows to remove surface peripheral tumors using the method of stapler resection.

Full Digital rehabilitation in TMD patient

The purpose of the current work is to verify the feasibility of a digital articulator assembly for the diagnosis and therapy of patients with TMD. They were used for optical impression (Carestream intraoral scanner), Condylography (Cadiax 4 Diagnostic Gamma), facial scanning (Carestream CS 9600), mounting in an articulator (Reference SL), for CAD processing /CAM (Exocad), for recording functional movements (MODJAW). the digital recordings are reliable and stackable on the analog recordings, for the construction of prosthetic and therapeutic artifacts in accordance with the occlusal concepts of the Vienna school it was necessary to find skills and customizations in the management of the CAD/CAM software. Digital technology helps and amplifies the diagnostic possibilities in both general and dysfunctional patients allowing the reproducibility of the acquired data and their optimization. There is still no standard protocol that can be brought into daily practice.

Benign and malignant neoplasms of the adrenal glands from the perspective of pathology

In the case of neoplasms of the adrenal glands that are radiologically and clinically unclear, the indications for surgical resection as well as the subsequent clarification of the entity and dignity on the surgical specimen are difficult. The diagnostics of adrenal neoplasms, in particular the clear distinction between an adenoma and a carcinoma are often tricky from the point of view of apathologist. In the following, not only the problems of classification and the possibilities of diagnostics in pathology but also an overview of the most important differential diagnoses of other benign and malignant tumors of the adrenal cortex and medulla are presented.