Diagnostic Standards Research Articles

Point-of-care ultrasound for the diagnosis of distal forearm fractures in children and adolescents: a scoping review.

Distal forearm fractures are the most common pediatric fractures. Currently, the diagnostic reference standard is X-ray. However, there is growing evidence that point-of-care ultrasound can be used for the diagnosis of distal forearm fractures in children and adolescents with good accuracy. The objective of this scoping review was to explore the current evidence for the use of ultrasound for the diagnosis of pediatric distal forearm fractures and to identify the gaps in the literature for further research. We performed a scoping review searching on the following databases PubMed, MEDLINE, SCOPUS, EMBASE, and ClinicalTrials.gov. The main review question was "What is the evidence for using ultrasound to diagnose distal forearm fractures in patients < 18years old?" All types of studies, including randomized clinical trials and prospective and retrospective observational studies (case-control, cohort, and cross-sectional studies, case series) were included. Twenty-three articles were included in the scoping review; only two articles were from a single randomized controlled trial. Our scoping review found high sensitivity (91.5-99.5%) and specificity (85-99.5%) of POCUS for distal forearm fracture diagnosis. All studies used a linear ultrasound probe, with an upper range frequency ranging from 5 to 15MHz and typically used a six-view scanning protocol. The duration of the procedure was only a few minutes, and pain associated with ultrasound was usually mild. When compared with X-ray, an ultrasound first approach shortened the length of stay by an average of 15min per participant. Conclusions: The evidence suggests that ultrasound can be used for the diagnosis of clinically nondeformed distal forearm fractures in children and adolescents by a variety of practitioners. However, the current gaps in the literature include its translation into clinical practice and its cost-effectiveness.

Cytologic hallmarks and differential diagnosis of papillary thyroid carcinoma subtypes

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, characterized by a range of subtypes that differ in their cytologic features, clinical behavior, and prognosis. Accurate cytologic evaluation of PTC using fine-needle aspiration is essential but can be challenging due to the morphologic diversity among subtypes. This review focuses on the distinct cytologic characteristics of various PTC subtypes, including the classic type, follicular variant, tall cell, columnar cell, hobnail, diffuse sclerosing, Warthin-like, solid/trabecular, and oncocytic PTCs. Each subtype demonstrates unique nuclear features, architectural patterns, and background elements essential for diagnosis and differentiation from other thyroid lesions. Recognizing these distinct cytologic patterns is essential for identifying aggressive subtypes like tall cell, hobnail, and columnar cell PTCs, which have a higher risk of recurrence, metastasis, and poorer clinical outcomes. Additionally, rare subtypes such as diffuse sclerosing and Warthin-like PTCs present unique cytologic profiles that must be carefully interpreted to avoid diagnostic errors. The review also highlights the cytologic indicators of lymph node metastasis and high-grade features, such as differentiated high-grade thyroid carcinoma. The integration of molecular testing can further refine subtype diagnosis by identifying specific genetic mutations. A thorough understanding of these subtype-specific cytologic features and molecular profiles is vital for accurate diagnosis, risk stratification, and personalized management of PTC patients. Future improvements in diagnostic techniques and standardization are needed to enhance cytologic evaluation and clinical decision-making in thyroid cancer.

Rapid Dynamic Surface-Enhanced Raman Spectroscopy Detection of Amoxicillin-Mediated Morphological Changes in a Pathogen for Diagnosis of Clinical Urine Samples.

The swift and stable detection of pathogens in urine samples holds significant implications for the immediate clinical diagnosis and treatment of urinary tract infections (UTIs). In this study, we propose a detection strategy utilizing a hybrid substrate composed of graphene oxide (GO) and silver nanoparticles (Ag NPs) for the detection of pathogens subjected to amoxicillin-mediated (amo-mediated) treatment. This strategy employs dynamic surface-enhanced Raman spectroscopy (D-SERS) for stable and rapid detection, capturing signal variations induced by amo-mediated changes in pathogen morphology. During the 5 min D-SERS detection time window, stable SERS signals were detected for three types of pathogens and four types of pathogens were successfully distinguished using principal component analysis (PCA). In comparison to conventional nanosubstrates, the GO/Ag NP hybrid substrate exhibits outstanding stability and enhancement effects. This approach enables the dual detection of the pathogen cell structure and metabolites, facilitating specific identification of pathogens in the urinary tract, with a detection limit for Escherichia coli reaching 1 × 104 colony-forming units (CFU)/mL, meeting the clinical microbiology laboratory diagnostic standards for UTIs (105 CFU/mL). Testing of 188 clinically collected urine samples using this strategy yielded a sensitivity (SENS) of 86.4% and a specificity (SPC) of 89.7%. This introduces a novel method for diagnosing UTIs, offering broad applications in the field of clinical pathogen detection.

Abstract 4136784: Diagnostic significance and prognosis prediction of electrocardiogram plane QRS-T angle in patients with non-ST segment elevation acute coronary syndrome

Objective: For patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS), the diagnostic efficacy of traditional ECG is not sensitive and specific. Plane QRS-T angle (PQRS-Ta) can be used as a supplement to the current diagnostic criteria of ECG. Methods: The patients with recurrent chest pain in our hospital were analyzed retrospectively, and the plane QRS-T angle of the patients was calculated. The main results were as follows: (1) the clinical indexes of the two groups were analyzed according to the angle of QRS-T. (2) all patients were divided into three groups according to the final diagnosis. The diagnostic efficacy of QRS-T angle combined with standard ECG diagnostic criteria was analyzed, and the incremental diagnostic value of the new standard relative to the original standard was calculated. (3) the patients were scored by Gensini, and the differences of plane QRS-T angle among patients with different scores were compared. (4) the frequency of MACE was recorded, and the prognostic effect of QRS-T angle on the study population was analyzed. Results: After analyzing the data, there was a difference in the value of plane QRS-T angle between NSTE-ACS population and non-ACS population (p &lt; 0.001). It was found that every 1 °increase of plane QRS-T angle increased the risk of NSTE-ACS by 2.5% (χ 2, 27.59, P &lt; 0.001). The diagnostic accuracy of AUC quantified plane QRS-T angle combined with standard ECG in the diagnosis of NSTE-ACS was 0.68 (CI [0.64 ~ 0.70]). Through the analysis of NRI and IDI index, the relative NRI of the new model to the original model is 6.67%, 95% CI is 3.91%, and the CI is 9.42% (P &lt; 0.001). The IDI is 6.30%, the CI is 4.65%, and the CI is 7.95% (P &lt; 0.001). The new model improves the prediction effect by 6%. When the QRS-T angle increased by 1 °, the Gensini score increased by 0.199 points (95% CIRV 0.149) (Fidel60.975 (P &lt; 0.001). Comparing prognosis of the three groups, there was a statistical difference in the overall survival time among the three groups (χ 2 = 19.090 P &lt; 0.001). Conclusion: Compared with the original standard, the new diagnostic standard can improve the diagnostic efficiency of ECG. QRS-T angle can predict the prognosis of patients with NSTE-ACS. The higher the value of QRS-T angle, the greater the probability of major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome.

Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers

BACKGROUND: Magnetic foreign bodies in the gastrointestinal tract is a relatively rare problem in urgent pediatric surgery. Meanwhile, among cases with foreign bodies, they are the most difficult both in terms of timely diagnostics and timely treatment. There are no generally accepted therapeutic and diagnostic standards, and traditional algorithms of patient management are focused on the dynamic observation and are not correct. More so, algorithms described in the foreign literature contradict each other. The rate of surgical interventions and the risk of complications are high. Surgical tactics has many "white spots". All these issues remain open for discussion. AIM: To analyze the experience of four medical centers in the diagnostics and treatment of patients with magnetic foreign bodies in the gastrointestinal tract. METHODS: A retrospective analysis of diagnostic and treatment techniques applied in patients with magnetic foreign bodies in their gastrointestinal tract from four pediatric surgical hospitals in 2010–2023 was made. In the study there were patients with neodymium magnetic balls from the constructor (38 patients, 50%), neodymium magnets of other shapes and for other purposes (30 patients, 39.5%), ferrite magnets (6 patients, 7.9%), unknown types of magnets (2 patients, 2.6%). RESULTS: Patients’ average age was (4±3.65) years. The fact of foreign body swallowing was revealed in anamnesis of 46 (60.5%) patients. Mental illnesses were diagnosed in 4 children — 5.3%, which is higher than the average incidence in pediatric population. Clinical symptoms were registered in 4 (11.8%) children with a single magnet foreign body and in 33 (78.6%) children with multiple ones. The basic diagnostic technique was an overview radiography of the abdominal cavity (70 cases, 92%), which allowed to identify both a foreign body and complications (signs of intestinal obstruction, free gas in the abdominal cavity). Esophagogastroduodenoscopy was performed in 50 cases (65.8%), out of which one foreign body was detected in 34 (68%) cases, and in 28 patients, foreign bodies were removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among curative techniques, open surgeries prevailed — 32 cases (42%). Laparoscopy was used in few cases. CONCLUSION: The timely diagnostics of magnetic foreign bodies in gastrointestinal tract often depends on anamnesis findings, and if there is no such, diagnostics most often is delayed and is made only intraoperatively. Among the diagnostic techniques, it is difficult to identify a universal one that can be recommended as the "gold standard"; however, the most widely used and well-informative is abdominal X-ray and esophagogastroduodenoscopy. As to surgical tactics, the role of laparoscopic interventions is relatively low. Most often, endoscopy or "open" surgery are performed.

Advanced photodetector for hybrid PET-MRI systems

Background Currently, a wide variety of silicon photomultipliers (SiPMs) are available, each designed for specific applications in fields such as science, medicine, and industry. Advances in production technology have led to the development of more sensitive and efficient photodiodes, which are critical for applications requiring precision, such as medical imaging. Methods A research group has been working on designing a highly sensitive photodiode to enhance the capabilities of next-generation PET-MRI scanners. This involves integrating micropixel avalanche photodiodes (MAPDs) to improve image resolution. The chosen design features deep-immersion MAPDs with a pixel size of 12 microns and a density of 1000 pixels per square millimeter, allowing for high-detail photon detection. The 4x4 mm2 active area is optimized to balance sensitivity and size for high-resolution medical imaging. To produce these photodiodes, the group has outlined a production plan involving 20-inch silicon wafers grown using multiple techniques to enhance material properties. The Malaysian Institute of Microelectronic Systems (MIMOS), renowned for its expertise in optical microelectronics, was selected as the production center. With MIMOS' state-of-the-art facilities, the project aims to meet stringent medical diagnostics standards. Results The experimental results demonstrated that the MAPD-3NM photodiode achieved an amplification factor 1.8 times greater than the MAPD-3NK under optimal conditions. Its overvoltage range increased by 100%, reaching 4 V, enhancing photon detection and amplification. The MAPD-3NM also showed a significant reduction in dark current, about 3.5 times lower than the MAPD-3NK, improving performance in low-light environments. Additionally, the MAPD-3NM had a capacitance of 200 pF compared to 176 pF for the MAPD-3NK, contributing to its superior performance. These improvements make the MAPD-3NM more efficient and sensitive for scientific and medical applications. Conclusions This project represents a major advancement in photodetector technology for medical diagnostics, aiming to develop more accurate and efficient PET-MRI scanners that enhance patient outcomes with improved imaging capabilities.

High‐Resolution X‐Ray Imaging With 0D Organic–Metal Halide Scintillator Featuring Reversed Exciton Trapping

AbstractScintillators, essential for applications in nuclear medicine, radiation detection, and industrial inspection, convert high‐energy radiation into visible light. Manganese (Mn)‐based inorganic–organic hybrid materials are distinguished by their thermal stability, mechanical strength, and flexibility. However, the effects of temperature on Mn(II)‐based hybrid scintillators have not been clearly analyzed, making the elucidation of their temperature‐dependent luminescence mechanisms particularly important. A notable advancement is the synthesis of Mn‐1 nanocrystals (NCs) using methyltriphenylphosphonium chloride (mtppCl) and MnCl₂. These NCs exhibit distinctive temperature‐dependent photoluminescence luminescence: the intensity decreases from 77 to 150 K but paradoxically increases at higher temperatures due to anomalous thermal exciton behavior in the [MnCl₄]2⁻ tetrahedra. Besides, Mn‐1 NCs achieve a detection limit of 1.01 µGyair/s, surpassing medical diagnostic standards and outperforming commercial scintillators such as Bi₄Ge₃O₁₂ (BGO). Additionally, they show exceptional stability under continuous irradiation and can be incorporated into a flexible scintillating film with a resolution of 11.3 lp/mm at an MTF of 0.2. The current study has further refined the luminescence mechanism of Mn(II)‐based materials and optimizes their properties for a wider range of applications.

Strategies to Overcome Erroneous Outcomes in Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Testing: Insights From the COVID-19 Pandemic.

The reverse transcription-polymerase chain reaction (RT-PCR) test to detect SARS-CoV-2, the virus causing COVID-19, has been regarded as the diagnostic gold standard. However, the excessive sensitivity of RT-PCR may cause false-positive outcomes from contamination. Again, its technical complexity increases the chances of false-negatives due to pre-analytical and analytical errors. This narrative review explores the elements contributing to inaccurate results during the COVID-19 pandemic and offers strategies to minimize these errors. False-positive results may occur due to specimen contamination, non-specific primer binding, residual viral RNA, and false-negatives, which may arise from improper sampling, timing, labeling, storage, low viral loads, mutations, and faulty test kits. Proposed mitigation strategies to enhance the accuracy of RT-PCR testing include comprehensive staff training in specimen collection, optimizing the timing of tests, analyzing multiple gene targets, incorporating clinical findings, workflow automation, and implementing stringent contamination control measures. Identifying and rectifying sources of error in RT-PCR diagnosis through quality control and standardized protocols is imperative for ensuring quality patient care and effective epidemic control.

Validity of the TGI-SR+ in Francophone populations: Insights from Quebec and Belgium

The loss of a significant person can lead to a broad spectrum of responses. While most individuals gradually recover within a year, a minority develop Prolonged Grief Disorder (PGD). The Traumatic Grief Inventory Self-Report Plus (TGI-SR+) was recently developed to ensure that the original scale (TGI-SR) still accurately assesses PGD in line with the latest diagnostic standards of the DSM-5-TR and ICD-11. This study aimed to validate the TGI-SR+ within two French-speaking cohorts: 276 French-Canadian and 469 Belgian participants. Data were collected through an online survey in 2022. Confirmatory factor analysis resulted in a 4-factor model for the TGI-SR+ total scale, but high inter-item correlations favored a 1-factor solution. A 1-factor model was found for the DSM-5-TR and ICD-11 PGD scores. Convergent validity with mental health disorder, depression, and post-traumatic growth, and known-group validity were confirmed. The findings endorse the TGI-SR+ as a valid tool for detecting potential PGD.

Predictive modeling of bronchopulmonary dysplasia in premature infants: the impact of new diagnostic standards.

To provide a risk prediction for bronchopulmonary dysplasia (BPD) in premature infants under the new diagnostic criteria and establish a prediction model. In this study, we retrospectively collected case data on preterm infants admitted to the NICU from August 2015 to August 2018. A lasso analysis was performed to identify the risk factors associated with the development of BPD. A nomogram predictive model was constructed in accordance with the new diagnostic criteria for BPD. A total of 276 preterm infants were included in the study.The incidence of BPD under the 2018 diagnostic criteria was 11.2%. Mortality was significantly higher in the BPD group than the non-BPD group under the 2018 diagnostic criteria (P < 0.05). Fourteen possible variables were selected by the Lasso method, with a penalty coefficient λ=0.0154. The factors that eventually entered the logistic regression model included birth weight [BW, OR = 0.9945, 95% CI: 0.9904-0.9979], resuscitation way (OR = 4.8249, 95% CI: 1.3990-19.4752), intrauterine distress (OR = 8.0586, 95% CI: 1.7810-39.5696), score for SNAPPE-II (OR = 1.0880, 95% CI: 1.0210-1.1639), hematocrit (OR = 1.1554, 95% CI: 1.0469-1.2751) and apnea (OR = 7.6916, 95% CI: 1.4180-52.1236). The C-index after adjusting for fitting deviation was 0.894. This study made a preliminary exploration of the risk model for early prediction of BPD and indicated good discrimination and calibration in premature infants.

Clinical Relevance of Specific IgE in Penicillin Allergy Investigation

Introduction: Patients with immediate type allergic reactions to penicillins are at risk of anaphylaxis on reexposure. Diagnostic gold standard is drug provocation test (DPT) if allergy is not diagnosed by other means, such as skin testing or in vitro testing with measurement of specific IgE. Specific IgE testing carries low risk for the patient and blood sampling can be performed in primary care, but it is reported to have low sensitivity. The aim of this study was to evaluate if clinical characteristics of patients with suspected allergic reactions to penicillin and elevated specific IgE to penicillins, differed from patients without specific IgE, to identify predictors for elevated specific IgE to penicillins. Methods: Levels of specific IgE to five penicillins (penicillin G, penicillin V, amoxicillin, ampicillin, and penicillin minor determinants) were available for 9,100 patients. Using multiple logistic regression, clinical data from 430 patients in this group who had elevated specific IgE to one or more penicillins were compared to data from 4,094 patients without specific IgE to penicillins, who had undergone DPT with a penicillin. Results: In total 5.2% of patients had elevated specific IgE to one or more penicillins. Significantly more patients with elevated specific IgE had a history of immediate type reactions (<2 h) (OR = 4.34, p < 0.001); circulatory symptoms (OR = 1.63, p = 0.03) or angioedema (OR = 1.46, p = 0.005). Also, significantly more patients with elevated specific IgE had been treated with adrenaline (OR = 2.21, p = 0.005), steroids (OR = 1.76, p < 0.001), or antihistamines (OR = 1.83, p < 0.001). Conclusion: A history of an immediate type reaction requiring treatment, combined with elevated specific IgE to one or more penicillins is suggestive of an IgE mediated penicillin allergy and further allergy investigations may not be needed. Specific IgE to penicillins may be used early in allergy investigation of patients with severe immediate type reactions to penicillins.

Is There a Role for Bronchoscopy in Aspiration Pneumonia?

Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.

Diagnosis of acute lymphoblastic leukaemia: an overview of the current genomic classification, diagnostic approaches, and future directions.

B-acute lymphoblastic leukaemia (B-ALL) is a haematological disease resulting from haematopoietic system dysfunction, leading to the unchecked growth of immature B lymphoblasts. The disease's complexity is underscored by the spectrum of genetic aberrations that underlie B-ALL entities, necessitating advanced genetic analyses for precise classification and risk determination. Prior to the adoption of next-generation sequencing into standard diagnostic practices, up to 30% of B-ALL cases were not assigned to specific entities due to the limitations of traditional diagnostic methods. The advent of comprehensive genomic analysis, especially whole-genome transcriptome sequencing, has significantly enhanced our understanding of B-ALL's molecular heterogeneity, paving the way for the exploration of novel, tailored treatment strategies. Furthermore, recent technological innovations, such as optical genome mapping, methylation profiling, and single-cell sequencing, have propelled forward the fields of cancer research and B-ALL management. These innovations introduce novel diagnostic approaches and prognostic markers, facilitating a deeper, more nuanced understanding of individual patient disease profiles. This review focuses on the latest diagnostic standards and assays for B-ALL, the importance of new technologies and biomarkers in enhancing diagnostic accuracy, and the expected role of innovative advancements in the future diagnosis and treatment of B-ALL.

Comparative analysis of international and Malaysia approaches to the treatment of patients with chronic gastritis from the point of view of evidence-based medicine

Background: Chronic gastritis, often resulting from *Helicobacter pylori* infection, is a widespread gastrointestinal disorder. The condition requires evidence-based treatment approaches to ensure effective management and improved patient outcomes. This study conducts a comparative analysis of the treatment approaches for chronic gastritis in Malaysia and internationally, focusing on adherence to evidence-based medicine (EBM) practices. Understanding the similarities and differences in these approaches is critical for enhancing Malaysia's healthcare strategies. Methods and Materials: The study employed a systematic review of relevant literature sourced from global medical databases, including PubMed, Embase, and Cochrane Library. The review focused on therapeutic options, diagnostic standards, and evidence-based protocols for managing chronic gastritis, with emphasis on both international and Malaysian healthcare systems. Studies included in the review primarily focused on adult patients diagnosed with chronic gastritis and treated using evidence-based methodologies. Results: The analysis revealed significant parallels in the treatment protocols between Malaysia and international guidelines, particularly in the use of proton pump inhibitors (PPIs) and antibiotic regimens for *H. pylori* eradication. However, differences emerged in the implementation of advanced diagnostic tools, accessibility of healthcare services, and the influence of local antibiotic resistance patterns. While Malaysia follows global best practices, rural-urban healthcare disparities impact the consistency of treatment delivery and patient outcomes. Conclusion: Both international and Malaysian approaches to chronic gastritis prioritize evidence-based medicine. The findings suggest that Malaysia effectively adapts international guidelines to its local healthcare context, though improvements are needed in addressing healthcare accessibility and antibiotic resistance. Enhanced implementation of EBM practices, particularly in rural areas, and personalization of treatment based on resistance patterns, could further optimize patient outcomes in Malaysia.

NEW PERSPECTIVES ON URINALYSIS: RECOMMENDATIONS FROM THE EUROPEAN FEDERATION OF CLINICAL CHEMISTRY AND LABORATORY MEDICINE (EFLM)

This article highlights the significance of the updated recommendations from the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) – Urinalysis Guideline 2023. The guidelines emphasize the need for standardizing laboratory procedures to enhance research quality and reduce diagnostic errors. Based on current scientific data and international standards, these recommendations aim to ensure high reliability and accuracy of laboratory results. The implementation of urinalysis guideline has the potential to significantly improve diagnostic effectiveness, positively impacting the quality of patient care. Attention is also given to new technologies considered in the recommendations, which can greatly facilitate advancements in laboratory medicine. EFLM guidelines are essential for enhancing laboratory practices and maintaining high standards in medical diagnostics.

Evaluating the Confidence of Non-specialty Doctors Working in Trauma and Orthopedics in Performing Knee Arthrocentesis Through Simulation-Based Teaching.

Introduction Acute monoarthropathies that present in emergency settings include septic arthritis, where urgent joint arthrocentesis is the diagnostic gold standard. Literature indicates low confidence amongtrainee doctors in performing knee aspirations.Simulation-based teaching can be used to supplement procedural skills training and improve their confidence in performing such procedures. Methods This study aimed to assess the self-rated confidence of non-specialty doctors (N=8) in Trauma and Orthopedics in conducting knee aspirations using simulation-based teaching with an anatomically accurate knee model. Pre- and post-intervention questionnaires investigated self-reported confidence using a 10-point Likert-type scaleand participant experience using a 7-point Likert scale. Pre- and post-intervention surveys further qualitatively explored attitudes toward conducting the skill. Results Pre-intervention mean confidence was rated 3.9 (SD=2.70) out of 10, with a noted increase to 8.1 (SD=1.25) out of 10, providing a mean difference of 4.2 (SD=2.82) out of 10with p=0.007. All attendees agreed or strongly agreed on the usefulness and satisfaction of the activity. Qualitative analysis indicated themes of nervousness and lack of confidence pre-interventionand attitudes of increased confidence in the skill post-intervention. Conclusions Overall, increased statistically significant confidence was concluded amongnon-specialty doctors in conducting knee arthrocentesis following simulation-based teaching, with perceived usefulness and satisfaction of the activity. Nonetheless, we must consider potential limitations of clinical accuracy and realism through such procedural skills training.

Revising LH cut-off for the diagnosis of central precocious puberty via triptorelin stimulation assay.

Precocious puberty (PP) in girls is defined by thelarche before age 8. The diagnostic gold standard is an increased LH level following gonadotropin-releasing hormone (GnRH) stimulation. Alternatively, GnRH analogues like triptorelin can be used, though their interpretation varies. Since 2000, we have used a triptorelin-induced LH cut-off of 15 IU/L, 4 h post-stimulus. However, many girls showed LH values below this threshold despite evident pubertal progression. To establish a new LH threshold post-triptorelin stimulation for earlier diagnosis of central precocious puberty (CPP) in girls showing pubertal progression and to evaluate additional parameters for diagnostic accuracy. We enrolled 186 girls with thelarche onset between ages 1-8 and a GnRH analogue assay performed between 2015-2019 without signs of axis activation. Within this cohort, 62 patients repeated the triptorelin test due to rapid pubertal progression. The assay involved administering 100 mcg/m² of triptorelin and measuring LH, FSH, and estradiol levels before and four hours post-injection. Patients with axis activation at the second test had significantly higher post-stimulus LH levels at the first test compared to those below 15 IU/L. They also had higher basal LH levels, elevated LH/FSH ratio, and increased growth velocity. Statistical analysis identified a new post-stimulus LH threshold of 5 IU/L. We propose a LH value of 5 IU/L after triptorelin administration as a new threshold for early CPP diagnosis. While the LH/FSH ratio and growth velocity are associated with axis activation, they did not significantly enhance diagnostic accuracy when combined with the LH value.

Deep learning-driven ultrasound-assisted diagnosis: optimizing GallScopeNet for precise identification of biliary atresia.

Biliary atresia (BA) is a severe congenital biliary developmental abnormality threatening neonatal health. Traditional diagnostic methods rely heavily on experienced radiologists, making the process time-consuming and prone to variability. The application of deep learning for the automated diagnosis of BA remains underexplored. This study introduces GallScopeNet, a deep learning model designed to improve diagnostic efficiency and accuracy through innovative architecture and advanced feature extraction techniques. The model utilizes data from a carefully constructed dataset of gallbladder ultrasound images. A dataset comprising thousands of ultrasound images was employed, with the majority used for training and validation and a subset reserved for external testing. The model's performance was evaluated using five-fold cross-validation and external assessment, employing metrics such as accuracy and the area under the receiver operating characteristic curve (AUC), compared against clinical diagnostic standards. GallScopeNet demonstrated exceptional performance in distinguishing BA from non-BA cases. In the external test dataset, GallScopeNet achieved an accuracy of 81.21% and an AUC of 0.85, indicating strong diagnostic capabilities. The results highlighted the model's ability to maintain high classification performance, reducing misdiagnosis and missed diagnosis. GallScopeNet effectively differentiates between BA and non-BA images, demonstrating significant potential and reliability for early diagnosis. The system's high efficiency and accuracy suggest it could serve as a valuable diagnostic tool in clinical settings, providing substantial technical support for improving diagnostic workflows.

B-215 Evaluating RT-qPCR for Dengue Virus Detection: Outcomes of a Brazilian External Quality Assessment Program

Abstract Background Dengue virus (DENV), responsible for a prevalent arthropod-borne viral illness, poses a substantial public health challenge worldwide. Clinically, DENV's manifestation often resembles that of other arboviruses, resulting in frequent healthcare visits and complicating the early diagnosis, which is critical for patient management. While virus isolation is a viable method, RT-qPCR assays yield significantly quicker results. Rapid immunochromatographic tests are available; yet, RT-qPCR not only matches their sensitivity but also provides distinct advantages in clinical laboratory settings. These include higher throughput and integrated, traceable quality control within each routine, offering less subjective and more dependable results. Maintaining high diagnostic standards for DENV is imperative. External quality assessment programs (EQAP) play a key role in enhancing laboratory diagnostic capabilities by monitoring and assessing diagnostic methods. This study evaluates the diagnostic efficacy of RT-qPCR for DENV using data from an EQAP conducted by a Brazilian provider, accredited by ABNT NBR ISO/IEC 17043:2011. Methods The quality control samples comprised lyophilized suspensions containing viable DENV particles, grown on vero cells (BCRJ 0245/ATCC CCL-81) under BSL-3 conditions. From February 2017 to November 2022, twenty-four EQAP survey rounds were carried out, each encompassing three samples, culminating in 1,153 data points. The evaluation metrics included participant numbers, adequacy percentage, sensitivity, specificity, and the incidence of false positives and negatives. The Mann-Kendall test assessed trends in these metrics over the survey rounds. The RT-qPCR kits employed by participants were classified either as in-vitro diagnostic (IVD) or as laboratory-developed tests (LDT). Kits that demonstrated high performance in terms of adequacy, sensitivity, and specificity were identified and listed. Results The number of laboratories participating has increased. Starting with four in 2017, the program expanded to 28 by 2022. Laboratory accuracy was high during the evaluation period, with a median of 99% (97.8% in 2017 and 99.2% in 2022). The Mann-Kendall test indicated a significant trend of increased accuracy (p&amp;lt;0.001). Specificity remained stable at 98.8%, while sensitivity improved, with a median of 99.4%—rising from 93.3% in 2017 to 100% in 2022 (p&amp;lt;0.001). Only three false negatives were reported over three separate rounds, and six false positives were reported across four rounds. Both LDT and IVD RT-qPCR kits demonstrated high accuracy (99.4% and 98.4%, respectively). Biomanguinhos ZDC, Viasure ZDC, and ZDC Multiplex kits all showed 100% adequacy, sensitivity, and specificity. Conclusions This study highlights the increasing adoption of RT-qPCR for DENV detection, as evidenced by the growing number of laboratories in the EQAP program and the consistently high adequacy rates from 2017 to 2022. Nonetheless, the number of participating laboratories remains relatively small for a vast tropical country like Brazil. The high sensitivity and specificity, along with the infrequency of false results, underscore its effectiveness. The superior performance of certain kits suggests possible advancements in DENV diagnosis, contributing to global public health initiatives against this arboviral disease.

A Mass Media Campaign for Screening of Hyperglycemia in Pregnancy and Postpartum Follow-up: A Major Challenge in Resource-Constrained Settings, WDF-GDM Project, Pakistan

Abstract Background: Pakistan’s collaboration with the World Diabetes Foundation (WDF) introduced a pioneering and unparalleled initiative to enhance maternal and child healthcare. The mass media campaign for the detection of hyperglycemia in pregnancy (HIP) via screening, management, and prevention is a significant component of this collaboration to reduce the impact of hyperglycemia on maternal-fetal health and have insight on postpartum follow-up (PPFU) trends. Materials and Methods: WDF-GDM Project encompassed an extensive mass media campaign across 29 cities in 10 regions of Pakistan. The primary objective was to establish a national standard for screening and diagnostic standards of HIP, training healthcare providers in blood glucose (BG) screening, treatment, PPFU, as well as disseminating information about pre-conception counseling. The DIPSI method, which is a single-step, non-fasting oral glucose tolerance test with a diagnostic threshold of 140 mg/dL (7.8 mmol/L), was employed as a screening and diagnostic test. Results: A total of 17,392 pregnant women of diverse ethnic backgrounds attended antenatal visits; 77.2% (n = 13,417) underwent BG screening based on DIPSI criteria, irrespective of the period of gestation. The overall prevalence of HIP was 35.7% with gestationally impaired glucose tolerance at 25.7%, and gestational diabetes mellitus (GDM) at 9.97% postpartum, approximately 4767 women were eligible for PPFU. Among these, 7% experienced fetal loss. Of the 2376 women who completed PPFU, 81% were normoglycemic, 9% had impaired fasting glucose, 8% had impaired glucose tolerance, and 2% were diagnosed with diabetes. About 75% of women who had hyperglycemia during pregnancy reverted to normoglycemia postpartum, while a small percentage continued to have persistent diabetes. Conclusion: This study highlights a GDM prevalence of 9.97% in Pakistan and depicts the positive outcome where many women returned to normoglycemia after childbirth. Factors such as previous pregnancies, body mass index, and history of fetal loss were identified as contributors to the development of hyperglycemia during pregnancy. The WDF-GDM initiative’s approach and comprehensive methodology provide better insights for future maternal healthcare strategies in similar settings nationally and globally.