Differential Diagnosis Research Articles

Sarcoidosis: oral manifestations (case report)

Relevance. Sarcoidosis is a multisystem granulomatous disease of unknown origin, commonly presenting with bilateral hilar lymphadenopathy, pulmonary infiltrates, and involvement of the eyes, skin, gums, and oral mucosa. This clinical case illustrates the oral manifestations of this rare systemic disease. Gingival hypertrophy and soft tissue lesions on the lip mucosa were the initial signs of the condition. Following an extended diagnostic process, the patient underwent treatment by both a dentist and a rheumatologist, leading to a stable remission of the disease.Case description. This article presents a clinical case of sarcoidosis manifesting in the mouth as gingival hypertrophy and a soft tissue lesion on the upper lip. In most cases, a diagnosis of sarcoidosis is made before any oral symptoms appear. Diagnosing a systemic disease based on primary oral symptoms poses a unique challenge, as dental professionals may not always be familiar with the oral manifestations of systemic conditions. In cases of suspected sarcoidosis, the oral mucosa should be thoroughly examined, and systemic sarcoidosis should be considered in the differential diagnosis of granulomatous lesions in the mouth.Conclusion. Early initiation of treatment can significantly improve the patient's quality of life and prognosis.

Central nervous system solitary fibrous tumors: Case series in accordance with the WHO 2021 reclassification. Framework for patient surveillance.

Solitary fibrous tumors (SFTs) are a rare type of mesenchymal tumors. The World Health Organization reclassified SFTs in 2021. Currently, guidelines concerning treatment and follow-up are lacking. We performed a retrospective case series with reclassification of SFTs, according to the most recent WHO classification, to explore tumor-behavior. The purpose is to build a framework for long-term patient surveillance. A retrospective case study was performed according to the PROCESS guidelines. Inclusion criteria were: patients operated on between 2013 and 2023 in two neurosurgical centers with the diagnosis of 'hemangiopericytoma' or SFT on histopathological stains. Patients were excluded if the original stains of the primary tumor were unavailable. The following demographic, radiologic and therapeutic parameters were included in the review: age, sex, original and reclassified anatomopathological diagnosis, location, extent of resection, use of postoperative radiotherapy, location of and time to recurrence, location of-and time to metastasis, and survival. Histological material was re-examined by experienced neuropathologists. Ten patients were identified with a solitary fibrous tumor of the central nervous system (CNS) (three females) between 2013 and 2023. Age at diagnosis ranged from 38 up to 81. Eight patients were treated by gross total resection (GTR) and postoperative radiotherapy (RT) was applied in five cases. Initial WHO grading consisted of three grade I, two grade II, and six grade III lesions. Reclassification according to the WHO 2021 classification of CNS tumors resulted in seven reclassifications, all towards a lower grade. Four patients showed local recurrence, six to eight years after diagnosis, and five patients developed systemic metastases, nine to 13 years after diagnosis. Although rare, SFT should be included in the differential diagnosis of intracranial tumors with extra-axial growth patterns. The current histological grade according to the WHO 2021 does not seem to account for local recurrence rate or systemic metastasis. When a solitary fibrous tumor is presumed, gross total resection is the recommended treatment. Lifelong patient follow-up is necessary due to the risk of delayed recurrence and distant metastasis, even after gross-total resection. We would advocate for the use of CT thorax-abdomen or full body PET in the detection of systemic metastases at diagnosis and during follow-up, however optimal intervals remain unclear.

Immune-Mediated Neuropathies: Top 10 Clinical Pearls.

Immune-mediated neuropathies encompass a range of neurological disorders, including chronic inflammatory demyelinating polyradiculoneuropathy, Guillain-Barré syndrome, multifocal motor neuropathy, autoimmune autonomic neuropathies, and paranodal nodopathies. Recognizing clinical patterns is key to narrowing the broad range of differential diagnoses in immune-mediated neuropathies. Electrodiagnostic testing is a useful tool to support the diagnosis of immune-mediated neuropathies. Our understanding of autoimmune demyelinating neuropathies is rapidly advancing, particularly with the discovery of nodal and paranodal antibodies. Recent advances in neuropathy treatment include the utilization of neonatal Fc receptors to reduce antibody recycling, and the development of complement inhibitors to reduce inflammatory damage, offering promising new therapeutic avenues. Timely identification of immune-mediated neuropathies is imperative as delay in diagnosis and treatment may lead to irreversible disability.

Hemophagocytic lymphohistiocytosis in a patient with Epstein-Barr virus-positive diffuse large B-cell lymphoma treated with chimeric antigen receptor T-cell therapy.

With the advent of chimeric antigen receptors T-cell therapy, understanding their role in the development of hemophagocytic lymphohistiocytosis has become increasingly complex. We describe a case of a young patient with Epstein-Barr virus-positive diffuse large B-cell lymphoma, who was treated with axicabtagene ciloleucel. The patient developed progressive cytopenia and, on Day 73 post-infusion, met criteria for hemophagocytic lymphohistiocytosis. Bone marrow evaluation revealed hemophagocytosis without evidence of clonal B cells. The patient was treated with tocilizumab, dexamethasone, etoposide and anakinra, which eventually led to improvement. Unfortunately, the patient succumbed to an infection. Disease progression was confirmed posthumously.This case report explores the differential diagnosis of hyperinflammatory syndromes following chimeric antigen receptor T-cell therapy and highlights the reduced efficacy of this treatment in patients with a T-cell/histiocyte-rich background.

An exploratory study on the potential of ChatGPT as an AI-assisted diagnostic tool for visceral leishmaniasis

Visceral leishmaniasis (VL) is a severe parasitic disease that poses significant diagnostic challenges due to its complex presentation and the necessity for comprehensive diagnostic methods. This exploratory study investigates the potential of Chat Generative Pre-trained Transformer (ChatGPT)/GPT-4, an artificial intelligence (AI) chatbot, in assisting the diagnostic process for VL. We evaluated the diagnostic accuracy of ChatGPT/GPT-4 in generating differential diagnosis lists for eight clinical vignette cases of VL, authored by a Brazilian infectious disease doctor. Our findings reveal that ChatGPT/GPT-4 included VL in the top five differential diagnoses in 75% of the cases (95% confidence interval [CI]: 40.1 – 93.7%) and identified VL as the top diagnosis in 50% of the cases (95% CI: 30.3 – 86.5%). These results underscore the high potential of ChatGPT/GPT-4 as an AI-assisted diagnostic tool, which is capable of providing accurate differential diagnoses and assisting healthcare professionals in resource-limited settings. The study highlights the broader applicability of AI chatbots in medical diagnostics, not only for common conditions but also for specialized and less prevalent diseases like VL. By integrating AI tools into the diagnostic workflow, healthcare providers can enhance their diagnostic accuracy and efficiency, ultimately improving patient outcomes. This research contributes to the growing body of evidence supporting the utility of AI in healthcare and underscores the need for further studies to validate these findings across larger and more diverse clinical scenarios.

Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case)

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immuno­histochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Im­munohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Chinese expert consensus on diagnosis, treatment and prevention of pulmonary infection in patients with solid tumors (2024 edition)

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia and the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, differential diagnosis from anti-tumor treatment associated pulmonary conditions, and consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physician, and general practice healthcare professionals involved in the management of solid tumors in adults.

Clinical data and MRI features-based nomogram for differentiation of central nervous system infection and central nervous system involvement in hematological malignancy.

Central nervous system leukemia (CNSL) and central nervous system infection (CNSI) are the most important complications in patients with acute leukemia (AL). However, the differential diagnosis could represent a major challenge since the two disorders are all heterogeneous entities with overlapping clinical characteristics and radiological appearances. In this paper, we conduct a retrospective study to develop a model based on clinical data and magnetic resonance imaging (MRI) to distinguish CNSL from CNSI. A total of 108 patients with AL who underwent cranial MRI between January 2020 and December 2023 in our hospital were included. Univariate and multivariate logistic regression analyses were used to determine the independent predictors. A nomogram was developed based on the predictors, and the performance of the nomogram was evaluated by the area under the receiver operating characteristic (ROC) curve. The validation cohort was used to test the predictive model. Hyperleukocytosis at initial diagnosis, marrow state, fever, conscious disturbance, coinfection in other sites and MRI (parenchyma type) were identified as independent factors. A nomogram was constructed and the discrimination was presented as AUC = 0.947 (95% CI 0.9105-0.984). Calibration of the nomogram showed that the predicted probability matched the actual probability well.

Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning.

Educators need tools for the assessment of clinical reasoning that reflect the ambiguity of real-world practice and measure learners' ability to determine diagnostic likelihood. In this study, the authors describe the use of the Brier score to assess and provide feedback on the quality of probabilistic diagnostic reasoning. The authors describe a novel format called Diagnostic Forecasting (DxF), in which participants read a brief clinical case and assign a probability to each item on a differential diagnosis, order tests and select a final diagnosis. DxF was piloted in a cohort of senior medical students. DxF evaluated students' answers with Brier scores, which compare probabilistic forecasts with case outcomes. The validity of Brier scores in DxF was assessed by comparison to subsequent decision-making in the game environment of DxF, as well as external criteria including medical knowledge tests and performance on clinical rotations. Brier scores were statistically significantly correlated with diagnostic accuracy (95 % CI-4.4 to-0.44) and with mean scores on the National Board of Medical Examiners (NBME) shelf exams (95 % CI-474.6 to-225.1). Brier scores did not correlate with clerkship grades or performance on a structured clinical skills exam. Reliability as measured by within-student correlation was low. Brier scoring showed evidence for validity as a measurement of medical knowledge and predictor of clinical decision-making. Further work must evaluated the ability of Brier scores to predict clinical and workplace-based outcomes, and develop reliable approaches to measuring probabilistic reasoning.

Congenital enteropathies in children: An algorithm for differential diagnosis and therapeutic management. Case report

Infant diarrhea may be caused by infectious, allergic, or surgical diseases. A distinct group comprises congenital enteropathies, a heterogeneous group of genetically determined diseases, including defects in the absorption and transport of nutrients and electrolytes, impaired differentiation of enterocytes and enteroendocrine cells, and defects in the modulation of the intestinal immune response. The final diagnosis of enteropathies is based on the results of molecular genetic tests; however, a detailed assessment of clinical and medical history data and the results of laboratory and instrumental studies enables quick diagnostic search direction and choice of the correct therapeutic tactics. The article considers the algorithm for the differential diagnosis of congenital diarrhea, presents a clinical case of congenital osmotic diarrhea due to disaccharidase insufficiency, and considers the difficulties of the diagnostic search and approaches to diet therapy. The prospective of using a fructose-based formula, Galactomin-19, in the diet therapy of glucose-galactose malabsorption, is presented.

Struma Ovarii- Association with Pseudo-Meigs Syndrome and Raised S. CA-125: A Case Report

The monodermal mature teratoma known as Struma Ovarii is a rare and uncommon form of ovarian tumours. It is primarily composed of thyroid tissue and is associated with hyperthyroidism, increased levels of S. CA-125 (Cancer Antigen-125), and pseudo-Meigs syndrome. Because the symptoms of this tumour are nonspecific, other extremely frequent ovarian lesions may be misdiagnosed and ignored. The majority of the time, incidental imaging and symptoms are used to make the first diagnosis of the cancer; histopathology is used to confirm the diagnosis. A good prognosis and successful curative treatment can result from surgically removing the tumour. The tumour's rarity makes misdiagnosis frequent. Nonetheless, a total abdominal hysterectomy combined with a bilateral salpingo-oophorectomy may be indicated in premenopausal patients in order to eradicate all symptoms. Ascites, hyperthyroidism, high S. CA-125 levels, and hydrothorax are all rare outcomes of struma ovarii. In this uncommon syndrome with negative cytology, individuals with ascites and pleural effusion should be examined for a differential diagnosis. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 50-55

Distinguishing genetic alterations versus (epi)mutations in Silver-Russell syndrome and focus on the IGF1R gene.

Silver-Russell Syndrome (SRS) is a growth retardation disorder characterized by pre- and post-natal growth failure, relative macrocephaly at birth, prominent forehead, body asymmetry, and feeding difficulties. The main molecular mechanisms are imprinting alterations at multiple loci, though a small number of pathogenic variants have been reported in the SRS genes IGF2-PLAG1-HMGA2 and CDKN1C. However, around 40% of clinically suspected SRS cases do not achieve a molecular diagnosis, highlighting the necessity to uncover the underlying mechanism in unsolved cases. evaluate the frequency of genetic variants in undiagnosed SRS patients (NH-CSS≥4), and investigate whether (epi)genetic patients may be distinguished from genetic patients. 132 clinically SRS patients without (epi)genetic deregulations were investigated by Whole Exome (n=15) and Targeted (n=117) Sequencing. Clinical data from our cohort and from an extensive revision of literature were compared. pathogenic variants were identified in 9.1% of this cohort: 3% in IGF2, PLAG1, and HMGA2 genes, while 3% in the IGF1R gene, associated with IGF-1 resistance (IGF1RES), an SRS differential diagnosis. Overall, IGF2-PLAG1-HMGA2 and IGF1R account for 3.6% of SRS with NH-CSS score ≥ 4. A clinical cross-comparison of (epi)genetic versus genetic SRS underlined (epi)genotype-phenotype correlation, highlighted the prevalence of body asymmetry and relative macrocephaly in mosaic (epi)genetic SRS and recurrence of genetic familial cases. Furthermore, overlapping features were evidenced in (epi)genetic SRS and IGF1RES patients. Our study explores the frequency of genetic SRS, underscores body asymmetry as distinctive phenotype in (epi)genetic SRS and suggests IGF1R sequencing in SRS diagnostic flow-chart.

Atypical PC-BPPV – Cupulolithiasis and Short-Arm Canalithiasis: A Retrospective Observational Study

Background and Purpose: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis. Methods: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP). Results: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, “floating” sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm. Discussion and Conclusion: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487).

Solid pancreatic masses: What’s hidden beneath? Insights into rare pancreatic lesions

The diagnostic approach to solid pancreatic masses has significantly evolved from the era when a focal pancreatic mass was almost synonymous to pancreatic ductal adenocarcinoma, to a wide spectrum of pancreatic lesions, some of which have good prognosis. With the advent of advanced diagnostic tools, particularly refined imaging and tissue acquisition techniques, a broader spectrum of differential diagnoses has been recognized, encompassing conditions ranging from neuroendocrine tumors or inflammatory masses, to rare entities like metastatic clear cell sarcoma or solitary fibrous tumors. We herein discuss case reports of some rare pancreatic lesions, which were diagnosed by combining clinical and imaging features and endoscopic ultrasound-guided tissue sampling and confirmed on surgical specimens. Further reports on these rare pancreatic tumors will contribute to a better understanding of their pathogenesis and effective management.

A Case of Abdominal Discomfort for Long Duration

In our regular medical practice, we encounter a lot of patients with abdominal discomfort. Commonly every physician suspects this kind of symptoms as gaseous distension of gastro-intestinal tract or acidity. The most valuable thing is the proper physical examination to rule out any underlying pathology. Most common causes of epigastric pain are associated with gastritis, or hepatobiliary system and pancreas related disorders. Here we will describe a 47-year-old male patient who presented with abdominal discomfort for last 6 months. For last 2 months he developed an epigastric lump which was increasing in size and was associated with weight loss. After proper clinical evaluation and necessary relevant investigations, he was diagnosed having Non-Hodgkin’s Lymphoma (NHL). Non-Hodgkins Lymphoma represents monoclonal proliferation of lymphoid cells. The incidence of these tumors increases with age. Clinically the proliferation rate indicates whether it is a high- or low-grade tumor. The patient underwent some investigations like CT guided FNAC from the enlarged abdominal lymph node which confirmed high grade Non-Hodgkins Lymphoma and started with chemotherapy and responded well. As abdominal discomfort is one of the common complaints, we face during our regular medical practice so routine physical examination including abdominal examination is very crucial and informative for clinical diagnosis and Lymphoma is an important differential diagnosis in case of any abdominal lump. Bangladesh Crit Care J September 2024; 12 (2): 175-178

Primary signet ring cell carcinoma of the appendix presenting as gangrenous appendicitis with peritonitis: A case report

Introduction and clinical importance: Primary signet ring cell carcinoma (SRCC) of the appendix is an exceedingly rare malignancy with a non-specific clinical manifestations, and it often masquerades as acute appendicitis. Case presentation A 76-year-old man presented with acute abdominal pain and peritonitis. Abdominal computed tomography revealed relative acute appendicitis with peritonitis, and emergency laparoscopic partial cecectomy with appendectomy revealed gangrenous appendicitis with perforation. A histopathological examination revealed a primary appendiceal signet ring cell carcinoma (PASRCC). Clinical discussion: This case highlights the importance of considering appendiceal malignancies in the differential diagnosis of acute appendicitis. SRCC is a histological variant commonly associated with multiple malignancies of the gastrointestinal tract, particularly gastric and colorectal cancers. Conclusion: PASRCC is a rare malignancy presenting with symptoms indistinguishable from those of acute appendicitis. Clinicians should maintain a high index of suspicion for appendiceal malignancy, particularly in older patients with atypical clinical presentations. Early recognition, accurate diagnosis by histopathological and immunohistochemical examinations, and appropriate management are essential for optimizing the outcomes in these patients.

Unprecedented presentation of pelvic synovial sarcoma: A compelling case report

Synovial sarcoma (SS) is a rare tumor that typically arises in various body regions, with its manifestation in the abdominal-pelvic area being exceptionally uncommon. However, despite its rarity in this location, it often metastasizes to the thorax. Despite its slow growth, it can be misdiagnosed as benign in less than 10% of cases. Diagnosis necessitates identification of the SYT-SSX fusion transcript, alongside immunohistochemical and cytogenetic assessments. Treatment involves surgical resection followed by radiotherapy for localized tumors, while chemotherapy is necessary for metastatic cases. Despite treatment, synovial sarcomas have a high recurrence rate, with about half recurring within two years. We report the case of a 73-year-old patient from sub-Saharan Africa who presented to the emergency room with obstructive symptoms, revealing a mass near the anus compressing the rectum upon imaging, causing an obstructive syndrome. Despite initial tumor resection, histological analysis identified a neurofibromatous origin. Twenty months later, recurrence prompted a hospital visit, revealing thoracic metastases necessitating surgery and chemotherapy. Subsequent analysis confirmed perianal synovial sarcoma. This case underscores the rarity of pelvic-anal synovial sarcoma and emphasizes the importance of early detection and proper management. Synovial sarcoma should figure prominently on the list of differential diagnoses of high-grade pelvic masses due to the importance of adjuvant chemotherapy.

Objectively measured levels of moderate to vigorous intensity physical activity are associated with cognitive impairment in diabetic hemodialysis patients: a cross-sectional study.

The purpose of this study was to observe the relationship between objectively measured levels of physical activity and cognitive impairment (CI) in the presence or absence of diabetes in middle-aged and elderly hemodialysis patients. In this multicenter cross-sectional study, 339 clinically stable hemodialysis patients (210 males; mean age: 67.38 ± 8.07 years) aged ≥55 years were included from 7 dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) was used to assess the CI. The duration of physical activity at different intensities, including moderate to vigorous physical activity (MVPA) as well as light physical activity (LPA), was measured using a triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, USA). Logistic regression and multiple linear regression were used for analyses. The prevalence of CI was higher in hemodialysis patients with comorbid diabetes (24.3%). In diabetic patients, MVPA (increase per 10 min/day) was negatively associated with CI after adjusting for covariates [(OR = 0.89, 95%CI = 0.79-0.99), p = 0.042]. However, no significant association between physical activity and CI was found in non-diabetic hemodialysis patients. Further analyses revealed that MVPA was positively associated with temporal orientation, attention and calculation and recall in diabetic hemodialysis patients. Physical activity was associated with CI in diabetic hemodialysis patients rather than the non-diabetes group. This study is important for early differential diagnosis of CI and improvement of cognitive status in hemodialysis patients.

Prospects for the use of radiomics in brain tumors

Radiomics is a new branch in diagnostics that can ensure more efficient use of medical equipment, reduce the time that a physician spends on a patient, and also increase the accuracy of differential diagnosis in various fields of medicine. The review provides general information about radiomics and radiogenomics in oncology with the results of research in this area obtained in recent years, with special attention to the role of these methods in neuro-oncology, as well as solving the problems of brain tumors diagnosing. The above research results on radiomics and radiogenomics in neuro-oncology indicate the undoubted promise of these techniques, however, as in other fields of medicine and biology, errors cannot be completely excluded, and the task of the team of specialists involved in it is to minimize this probability.

Foveal hyper-reflective vertical lines detected by optical coherence tomography: Imaging features, literature review and differential diagnoses.

To describe foveal hyper-reflective vertical lines (FVL) as a specific morphological finding on structural spectral-domain optical coherence tomography (SD-OCT) and discuss its differential diagnosis. Observational case series. Ten patients (10 eyes) with FVL were meticulously examined at the Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. Detailed analysis of SD-OCT findings, clinical records, and retinal imaging was conducted to establish correlations between FVL and various underlying conditions. We established the following list of settings, supported by the clinical context and ancillary investigations, in which SD-OCT displayed FVL: inflammation (1 eye), mechanical (1 eye), resorption of fluids of various origins (4 eyes), macular telangiectasia (1 eye), age-related macular degeneration (1 eye), diabetic retinopathy (1 eye) and scar (1 eye). FVL can be observed in various underlying conditions. Recognition of this pattern and formulation of an appropriate differential diagnosis is of interest for correctly diagnosing and treating patients whose structural OCT harbors this yet overlooked finding.