Diagnostic Tool For Early Identification Research Articles

Role of Personalized Medicine in Myocardial Infarction With Nonobstructive Coronary Artery Disease (MINOCA): An Updated Review

Cardiovascular diseases, notably myocardial infarction (MI), contribute significantly to global mortality. While traditional MIs are often associated with notable coronary artery blockages, a subgroup experiences MI without such blockages, termed myocardial infarction with nonobstructive coronary arteries (MINOCA). Current diagnostic methods, like invasive coronary angiograms, are inadequate in diagnosing MINOCA due to the absence of visible vessel blockages. Personalized medicine endeavors to introduce novel diagnostic tools for early identification and tailored management of MINOCA. Unlike percutaneous coronary intervention, which lacks efficacy in MINOCA, personalized medical management aligned with the specific underlying pathophysiological cause is essential. Treatments may include statins, agents modulating the renin-angiotensin system, and antiplatelet therapies if linked to plaque disruption. At the same time, calcium channel blockers may be pivotal if coronary artery spasm is the primary cause. Research is ongoing to refine tailored therapies and discover new biomarkers, highlighting the crucial need for individualized approaches in managing MINOCA.

Relationship between gingival and peri-implant sulcular fluid active matrix metalloproteinase-8 concentration and clinical indices in healthy and diseased conditions

Aim: The study was to evaluate the active matrix metalloproteinase-8 (aMMP-8) concentration in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) in healthy and diseased conditions, before and after non-surgical treatment, and to compare it with the various clinical parameters used to estimate the gingival and peri-implant inflammation. Methods: Plaque index/modified PI (PI/mPI), gingival index/simplified GI (GI/sGI), probing depth (PD), bleeding on probing index/modified BOPI (BOPI/mBOPI), radiographic bone loss/radiographic marginal bone loss (rBL/rMBL), and GCF/PISF samples were evaluated, before and 3 months after non-surgical treatment, GCF/PISF samples were analyzed by a chair-side mouth-rinse test (ImplantSafe®) in combination with a digital reader (ORALyzer®). Results: In all groups, aMMP-8 median levels were statistically higher in the PISF than in GCF and they did not change after treatment. Moreover, it was statistically higher in Group 3 (periodontitis/peri-implantitis) compared to the other groups. A positive correlation of the GCF/PISF and aMMP-8 median concentration was seen with increasing PD and BOPI/mBOPI values. A higher covariation of aMMP-8 mean levels in GCF with PD was found when compared to PISF levels. aMMP-8 mean levels in PISF expressed a higher covariation with increasing grades of sGI, rMBL, and BOPI while aMMP-8 GCF concentration established a better covariation with PD and PI. Conclusions: PISF of sites with peri-implant mucositis and peri-implantitis showed higher levels of aMMP-8 compared to sites with gingivitis and periodontitis. Compared to clinical indices, aMMP-8 concentration in GCF/PISF can be a beneficial adjunctive diagnostic tool for early identification and screening of the risk of peri-implant diseases. After non-surgical therapy, PISF aMMP-8 concentration remained mostly unchanged, while the GCF concentration of aMMP-8 significantly decreased.

Radio-iodination and biological evaluation of pentoxifylline as a novel probe for diagnosis of intermittent claudication

The diagnosis of intermittent claudication (IC) is challenging. Imaging with radiopharmaceuticals provides a new method for detecting acute IC. Pentoxifylline improves blood flow to ischemic tissues via increasing erythrocyte elasticity and inhibiting platelet aggregation. Pentoxifylline was radio-iodinated with radioiodine-131 (131I) through a direct electrophilic substitution reaction. Furthermore, various factors that might influence the radiolabeling strategy were investigated. The radiochemical yield of [131I]iodopentoxiphyline was evaluated by using paper chromatography and HPLC methods. The biodistribution pattern of [131I]iodopentoxiphyline was studied, where Swiss albino mice was used as a model of acute limb ischemia-reperfusion. The maximum radiochemical yield of pentoxifylline was found to be 94.11 ± 2.35%. The biodistribution findings revealed that [131I]iodopentoxiphyline was significantly deposited at the ischemic site (left hind limbs), with encouraging target/non-target (T/NT) ratios. At 0.25 and 1 h post injection, the uptake of [131I]iodo-pentoxifylline was 5.30 ± 0.30 and 9.98 ± 1.12%, respectively. Also, the maximum T/NT ratio for [131I]iodo-pentoxifylline (9.45 ± 0.26) was obtained at 0.25 h post injection. Due to safety and selectivity, [131I]iodo-pentoxifylline may be a good prospective diagnostic tool for early identification of IC. Moreover, the outcome of this study can be expected to apply to I-123 as well.

Correlation Between Computed Tomography Severity Score and Mortality in Patients with COVID-19 Chest Infection

Introduction: Computed Tomography (CT) is one of the most essential diagnostic tools for early identification and treatment of COVID -19 pneumonia. The objective of this study was to identify the relationship between CT severity score and mortality in COVID-19 patients. Method: A total of 62 patients with confirmed COVID-19 were included in this study. All these patients underwent High resolution computed tomography (HRCT) chest using a standard protocol. The CT severity score in all of these patients was calculated and the results were analyzed by SPSS version 21. Results: A higher CT severity score was associated with higher chances of mortality in the patients of COVID-19. There was no significant association of mortality with the age, sex, and number of lobes involvement Conclusion: HRCT chest can help in the early identification of the patients who need to be admitted to the Intensive care unit. Early admission and intervention to patients with high CT severity scores can help to reduce mortality.

Early Metabolic and Inflammatory Intraperitoneal Changes After Rectum Perforation.

Purpose Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an AL.Methods Twelve pigs were randomized into 2 groups. In the experimental group, an iatrogenic rectal perforation was performed, with the control group having a sham operation. The 2 groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines interleukin (IL) 1, IL6, and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol, and pyruvate were performed and the lactate/pyruvate ratio was calculated.Results Glucose levels were lower in the experimental group after 4 hours. After 7 hours, lactate and lactate/pyruvate ratio was higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group. Blood samples showed higher IL6 after 7 hours in the experimental group. Conclusion In this study, several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an AL.

Diagnostic value of urinary interleukin-6 in urinary tract infection in children.

Introduction Urinary tract infection (UTI) is the second most common bacterial infection in children. Aim of the study To estimate the value of urinary Interleukin-6 (IL-6) in diagnosis of UTI in children and also if it can differentiate between upper and lower UTI. Patients and Methods This study included 80 children, divided into 40 patients suffering from UTI and 40 healthy children served as a control group. Patients were classified into acute pyelonephritis (n=22) and lower UTI (n=18). Urine IL-6 was measured by enzyme-linked immune- sorbent assay (ELISA) technique. Results Urinary IL-6 was significantly higher in patients with UTI than control group (p value <0.001) and also it was significantly higher in upper than lower UTI cases (p value <0.001). Conclusion Urinary IL-6 level is a reliable diagnostic tool for early identification of UTI in febrile children. The study confirms usefulness of Urinary IL-6 level is a reliable diagnostic tool for early identification of urinary IL-6 to differentiate between upper and lower UTIs.

Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances

Objective: In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. Approach: HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and patterns (PATTERN) and common representatives for each category were extracted. This procedure was done with respect to the diagnostic value in the evaluation of the maturation age throughout the second and complete third trimester of pregnancy as well as to potential differences associated with maternal life-style factors (physical exercise, smoking), nutrient intervention (docosahexaenoic acid (DHA) supplementation), and complications of pregnancy (gestational diabetes mellitus (GDM), intra-uterine growth restriction (IUGR)). Main results: We found a comprehensive minimal set that includes [lAMP: short term variation (STV), initially introduced in cardiotocography, sAMP: heart rate increase across one interbeat interval of phase rectified averaged signal - acceleration capacity (ACst1), lCOMP: scale 4 multi-scale entropy (MSE4), PATTERN: skewness] for the maturation age prediction, and partly overlapping [lAMP: STV, sAMP: ACst1, sCOMP: Lempel Ziv complexity (LZC)] for the discrimination of the deviations. Significance: The minimal set of category-based HRV representatives allows for a screening of fetal development and well-being. These results are an important step towards a universal and comparable diagnostic tool for the early identification of developmental disturbances.Novelty & SignificanceFetal development and its disturbances have been reported to be associated with a multiplicity of HRV indices. Furthermore, these HRV indices change with maturation. We propose the abstraction of HRV categories defined by short- and long-term fluctuation amplitude, complexity, and pattern indices that cover all relevant aspects of maturational age, behavioral influences and a series of pathological disturbances. The study data are provided by multiple centers. Our approach is an important step towards the goal of a standardized diagnostic tool for early identification of fetal developmental disturbances with respect to the reduction of serious complications in the later life.

Diagnostic Value of Serum YKL-40 Level for Coronary Artery Disease: A Meta-Analysis.

This meta-analysis aimed to identify the value of serum YKL-40 level for the diagnosis of coronary artery disease (CAD). Through searching the following electronic databases: the Cochrane Library Database (Issue 12, 2013), Web of Science (1945 ∼ 2013), PubMed (1966 ∼ 2013), CINAHL (1982 ∼ 2013), EMBASE (1980 ∼ 2013), and the Chinese Biomedical Database (CBM; 1982 ∼ 2013), related articles were determined without any language restrictions. STATA statistical software (Version 12.0, Stata Corporation, College Station, TX) was chosen to deal with statistical data. Standard mean difference (SMD) and its corresponding 95% confidence interval (95% CI) were calculated. Eleven clinical case-control studies that recruited 1,175 CAD patients and 1,261 healthy controls were selected for statistical analysis. The main findings of our meta-analysis showed that serum YKL-40 level in CAD patients was significantly higher than that in control subjects (SMD = 2.79, 95% CI = 1.73 ∼ 3.85, P < 0.001). Ethnicity-stratified analysis indicated a higher serum YKL-40 level in CAD patients than control subjects among China, Korea, and Denmark populations (China: SMD = 2.97, 95% CI = 1.21 ∼ 4.74, P = 0.001; Korea: SMD = 0.66, 95% CI = 0.17 ∼ 1.15, P = 0.008; Denmark: SMD = 1.85, 95% CI = 1.42 ∼ 2.29, P < 0.001; respectively), but not in Turkey (SMD = 4.52, 95% CI = -2.87 ∼ 11.91, P = 0.231). The present meta-analysis suggests that an elevated serum YKL-40 level may be used as a promising diagnostic tool for early identification of CAD.

Diagnostic significance of serum osteopontin level for pancreatic cancer: a meta-analysis.

This meta-analysis aimed to identify the significance of serum osteopontin (OPN) level for the diagnosis of pancreatic cancer (PC). Through searching the following electronic databases-the Cochrane Library Database (Issue 12, 2013), Web of Science (1945-2013), PubMed (1966-2013), CINAHL (1982-2013), EMBASE (1980-2013), and the Chinese Biomedical Database (CBM) (1982-2013)-related articles were determined without any language restrictions. The STATA statistical software (version 12.0; Stata Corporation, College Station, TX) was chosen to deal with statistical data. Standard mean difference (SMD) and its corresponding 95% confidence interval (95% CI) was calculated. Eleven clinical case-control studies, which recruited 491 PC patients and 481 healthy controls, were selected for statistical analysis. Combined SMD of OPN suggested that the serum OPN level in PC patients was significantly higher than that in healthy controls (SMD=3.58, 95% CI=2.42-4.74, p<0.001). Ethnicity stratified analysis indicated a higher serum OPN level in PC patients compared with control subjects among both Caucasians and Asians (Caucasians: SMD=2.62, 95% CI=1.33-3.91, p<0.001; Asians: SMD=4.54, 95% CI=2.80-6.27, p<0.001; respectively). The main finding of our meta-analysis revealed that an elevated serum OPN level may be used as a promising diagnostic tool for early identification of PC.

Comparison of broad range 16S rDNA PCR to conventional blood culture for diagnosis of sepsis in the newborn

Neonatal sepsis is a significant cause of morbidity and mortality in neonates. The gold standard for detecting bacterial sepsis is blood culture. However, it has low sensitivity and a reporting delay of approximately 48–72h. Molecular assays for the detection of bacterial DNA represent possible new diagnostic tools for early identification of a bacterial cause. This study aimed at comparing a broad range 16S rDNA PCR to conventional blood culture for detecting bacterial DNA in blood samples from neonates with suspected sepsis. Fifty neonates with suspected sepsis, admitted at Neonatal Intensive Care Unit of Ain Shams University Hospitals, were included in this study. From each neonate, a minimum of 2–3ml blood was collected by standard sterile procedures, 1ml for conventional blood culture and 1–2ml EDTA blood for PCR. The isolated microorganisms were identified by conventional microbiological methods. Thirty neonates (60%) gave positive blood culture results. The most frequently isolated microorganisms were Staphylococcus aureus (n=17, 56.7%), followed by Coagulase negative Staphylococci (n=7, 23.3%), Escherichia coli (n=4, 13.3%), and Candida spp. (n=2, 6.7%). Twenty-eight (56%) neonates gave positive bacterial blood culture while 35 (70%) neonates gave positive PCR results. Considering the blood culture as the gold standard in diagnosis of bacterial neonatal sepsis, the sensitivity, specificity, positive predictive value and negative predictive value of PCR in detecting bacteremia relative to blood cultures were 20/28 (71.42%), 7/22 (31.81%), 20/35 (57.14%) & 7/15 (46.66%), respectively.In conclusion, PCR approach appears to be a relatively easy, reliable and valuable complementary method for diagnosis of neonatal sepsis for samples obtained during antimicrobial treatment especially when routine cultures remain negative. Staphylococci spp. has played an important role in causing neonatal sepsis. So, implementation of simple infection control measures such as hand washing, barrier nursing and promotion of clean deliveries should be considered to reduce neonatal sepsis.

Role of Biomarkers in Chemotherapy-Induced Cardiotoxicity

Chemotherapy-induced cardiotoxicity remains an unresolved problem strongly impacting the quality of life and the overall survival of cancer patients. The main strategy for minimizing cardiotoxicity is early detection of high-risk patients and prompt prophylactic treatment. The current standard for monitoring cardiac function detects cardiotoxicity only when a functional impairment has already occurred, not allowing for any early preventive strategies. Measurement of cardiospecific biomarkers can be a valid diagnostic tool for early identification, assessment, and monitoring of cardiotoxicity. In particular, the role of troponin in identifying patients at risk of cardiotoxicity and of angiotensin-converting enzyme inhibitors in preventing cardiac dysfunction and cardiac events is clearly emerging as a new effective approach. Therefore, we propose troponin as a criterion standard marker for the assessment of cardiac risk of both old and new antineoplastic treatments, and its evaluation should be included among the criteria utilized to define cardiotoxicity.

Comparison of broad range 16S rDNA PCR and conventional blood culture for diagnosis of sepsis in the newborn: a case control study

BackgroundEarly onset bacterial sepsis is a feared complication of the newborn. A large proportion of infants admitted to the Neonatal Intensive Care Unit (NICU) for suspected sepsis receive treatment with potent systemic antibiotics while a diagnostic workup is in progress. The gold standard for detecting bacterial sepsis is blood culture. However, as pathogens in blood cultures are only detected in approximately 25% of patients, the sensitivity of blood culture is suspected to be low. Therefore, the diagnosis of sepsis is often based on the development of clinical signs, in combination with laboratory tests such as a rise in C – reactive protein (CRP). Molecular assays for the detection of bacterial DNA in the blood represent possible new diagnostic tools for early identification of a bacterial cause.MethodsA broad range 16S rDNA polymerase chain reaction (PCR) without preincubation was compared to conventional diagnostic work up for clinical sepsis, including BACTEC blood culture, for early determination of bacterial sepsis in the newborn. In addition, the relationship between known risk factors, clinical signs, and laboratory parameters considered in clinical sepsis in the newborn were explored.ResultsForty-eight infants with suspected sepsis were included in this study. Thirty-one patients were diagnosed with sepsis, only 6 of these had a positive blood culture. 16S rDNA PCR analysis of blinded blood samples from the 48 infants revealed 10 samples positive for the presence of bacterial DNA. PCR failed to be positive in 2 samples from blood culture positive infants, and was positive in 1 sample where a diagnosis of a non-septic condition was established. Compared to blood culture the diagnosis of bacterial proven sepsis by PCR revealed a 66.7% sensitivity, 87.5% specificity, 95.4% positive and 75% negative predictive value. PCR combined with blood culture revealed bacteria in 35.1% of the patients diagnosed with sepsis. Irritability and feeding difficulties were the clinical signs most often observed in sepsis. CRP increased in the presence of bacterial infection.ConclusionThere is a need for PCR as a method to quickly point out the infants with sepsis. However, uncertainty about a bacterial cause of sepsis was not reduced by the PCR result, reflecting that methodological improvements are required in order for DNA detection to replace or supplement traditional blood culture in diagnosis of bacterial sepsis.

Micro method for determination of nonesterified fatty acid in whole blood obtained by fingertip puncture

Diagnostic tools for early identification of subjects at high risk for type 2 diabetes and other obesity-related disorders are important in prevention of these diseases. Nonesterified fatty acids (NEFAs) have been suggested to serve as a prediagnostic marker of diabetes and obesity-related disorders. In the current study, we developed a sensitive and reproducible micro method for quantification of NEFA in less than 10 μl whole blood. The method involves only two steps: (i) conversion of NEFA to fatty acid acyl-coenzyme A (acyl-CoA) esters using an acyl-CoA synthetase and (ii) quantification of the formed acyl-CoA esters with a fluorescent biosensor based on bovine acyl-CoA binding protein (ACBP). Lys50 of ACBP was mutagenized to a cysteine residue that was covalently modified with 6-bromoacetyl-2-dimethylaminonaphthalene to make a fluorescent acyl-CoA indicator (FACI-50). FACI-50 exhibits high fluorescence emission yield with maximum at 490 nm in the presence of CoA when excited at 387 nm. The addition of palmitoyl-CoA to a CoA-saturated FACI-50 lowered fluorescence emission by eightfold. Ethanol extract from 1 μl whole blood was incubated with ATP, CoA, and FACI-50. Following background fluorescence reading, NEFAs were converted to acyl-CoA by the acyl-CoA synthetase and the NEFA content was calculated from fluorescence emission changes using palmitic acid as external standard. The FACI-50 NEFA method was compared with two commercially available methods for quantification of NEFA.

Symptomatic skeletal muscle metastasis and elephantiastic lymphedema in a patient with recurrent ovarian carcinoma

Background Distant tumor metastases in ovarian cancer patients in striated muscles are extremely rare. So far, only one case of metastatic but asymptomatic spread to striated muscle has been described. Case A patient with recurrent ovarian carcinoma presented with a gluteal mass 1 week following optimal debulking surgery. CT and MRI initially suggested muscle necrosis or intramuscular bleeding. Increasing pain and massive lymphedema led to immobilization and clinical deterioration. Repeated ultrasound and CT-guided biopsy confirmed the diagnosis of skeletal muscle metastases. Conclusion This is the first case description of distant skeletal muscle metastasis as the leading clinical symptom of late stage ovarian carcinoma. It reveals possible limitations of CT and MRI as diagnostic tools for early identification of striated muscle metastases.