Differential Diagnostic Criteria Research Articles

The cellular-differential composition of the intestinal epithelium in various phases of inflammatory bowel diseases

BACKGROUND: The steady increase in the number of inflammatory bowel diseases and the absence of reliably significant diagnostic markers require the search for new morphological criteria for differential diagnosis. AIM: This study aimed to determine the cellular-differential composition of the intestinal epithelium in the phases of exacerbation and remission in Crohn’s disease and ulcerative colitis. MATERIALS AND METHODS: Tissue samples of 60 patients with inflammatory bowel diseases (Crohn’s disease, n=30; ulcerative colitis, n=30) and with irritable bowel syndrome (control group, n=15) were studied using histological, immunohistochemical, morphometric and statistical methods. RESULTS: Distinct features of the cellular-differential composition of the epithelium in the mucous membrane of the ileum, ascending colon, sigmoid colon, and rectum were identified across these conditions, with differences observed during exacerbation and remission in inflammatory bowel diseases. The proportion of goblet cells in the epithelial lining varied by intestinal region and disease type and phase. Goblet cell differentiation: 25.0% more goblet cells of the superficial epithelium between the crypts of the ileum in acute Crohn’s disease compared with remission (p=0.0002); 42.9% more goblet cells in the superficial epithelium of the ascending colon compared with irritable bowel syndrome (p=0.0001); 23.0% more goblet cells crypt in the sigmoid colon compared with ulcerative colitis in the acute stage (p=0.0024). There were no significant differences in the differentiation of Paneth cells. There was a threefold increase in endocrinocytes in the sigmoid colon in acute Crohn’s disease compared with irritable bowel syndrome (p=0.0238). Nonepithelial differon cells: fewer interepithelial lymphocytes in Crohn’s disease in remission compared with Crohn’s disease in the acute stage by 2.4 times in the sigmoid colon, 4.0 times in the rectum (p 0,0001); compared with irritable bowel syndrome by 4.8 times in the ileum, 2.7 times in the ascending intestine, 4.0 times in the sigmoid colon (p 0,05); 8.0 times in the rectum compared with ulcerative colitis in remission (p=0,0004). Additionally, the study found proliferative activity of crypt cells (mainly goblet-shaped) increased by 4.2 times in the sigmoid colon in acute Crohn’s disease compared with acute ulcerative colitis (p=0,0016). CONCLUSIONS: Morphometric parameters of the cellular-differential composition of the intestinal epithelium can serve as potential differential diagnostic criteria. Acute Crohn’s disease is characterized by a higher proliferation index in the sigmoid colon compared with acute ulcerative colitis, while Crohn’s disease in remission shows a lower number of interepithelial lymphocytes in the rectum compared with ulcerative colitis in remission.

Congenital hypertrophy of the retinal pigment epithelium (clinical cases)

Congenital hypertrophy of the retinal pigment epithelium is a benign pigmented formation on the globe fundus, which has a characteristic appearance during ophthalmoscopy and is not prone to significant growth as well as malignancy. Nevertheless, one of the forms of congenital hypertrophy of the retinal pigment epithelium is associated with familial adenomatous polyposis, therefore, for timely follow-up examination of patients, it is necessary to know the differential diagnostic criteria of various forms of this disease. The article presents three clinical cases and as well as summarizes information about various forms of congenital hypertrophy of the retinal pigment epithelium.

Anti-NMDA receptor encephalitis fatal case was mistaken as a debut of schizophrenia: the devil is in the psychopathological details

The article presents the clinical case of the patient Victor, 42 years old, who was admitted to a psychiatric hospital in an acute psychotic state with schizophreniform symptoms. His illness progressed rapidly, and at different stages, epileptic paroxysms and disorders of consciousness joined the symptoms typical of schizophrenia. It was then that the question arose of the need to revise the diagnosis of schizophrenia, to carry out a targeted neurological examination and to correct of the treatment regimen. Victor’s case, which ended in death, raises questions for psychiatrists about finding significant differential diagnostic criteria for distinguishing schizophrenia from schizophrenia-like psychoses. To avoid mistakes, it is proposed to rely on the so-called. “diagnostic clues” and “red flags” in identifying the psychopathology of anti-NMDA receptor encephalitis.

Differential Diagnosis of Tuberculosis and Sarcoidosis by Immunological Features Using Machine Learning.

Despite the achievements of modern medicine, tuberculosis remains one of the leading causes of mortality globally. The difficulties in differential diagnosis have particular relevance in the case of suspicion of tuberculosis with other granulomatous diseases. The most similar clinical and radiologic changes are sarcoidosis. The aim of this study is to apply mathematical modeling to determine diagnostically significant immunological parameters and an algorithm for the differential diagnosis of tuberculosis and sarcoidosis. Materials and methods: The serum samples of patients with sarcoidosis (SD) (n = 29), patients with pulmonary tuberculosis (TB) (n = 32) and the control group (n = 31) (healthy subjects) collected from 2017 to 2022 (the average age 43.4 ± 5.3 years) were examined. Circulating 'polarized' T-helper cell subsets were analyzed by multicolor flow cytometry. A symbolic regression method was used to find general mathematical relations between cell concentrations and diagnosis. The parameters of the selected model were finally fitted through multi-objective optimization applied to two conflicting indices: sensitivity to sarcoidosis and sensitivity to tuberculosis. Results: The difference in Bm2 and CD5-CD27- concentrations was found to be more significant for the differential diagnosis of sarcoidosis and tuberculosis than any individual concentrations: the combined feature Bm2 - [CD5-CD27-] differentiates sarcoidosis and tuberculosis with p < 0.00001 and AUC = 0.823. An algorithm for differential diagnosis was developed. It is based on the linear model with two variables: the first variable is the difference Bm2 - [CD5-CD27-] mentioned above, and the second is the naïve-Tregs concentration. The algorithm uses the model twice and returns "dubious" in 26.7% of cases for patients with sarcoidosis and in 16.1% of cases for patients with tuberculosis. For the remaining patients with one of these two diagnoses, its sensitivity to sarcoidosis is 90.5%, and its sensitivity to tuberculosis is 88.5%. Conclusions: A simple algorithm was developed that can distinguish, by certain immunological features, the cases in which sarcoidosis is likely to be present instead of tuberculosis. Such cases may be further investigated to rule out tuberculosis conclusively. The mathematical model underlying the algorithm is based on the analysis of "naive" T-regulatory cells and "naive" B-cells. This may be a promising approach for differential diagnosis between pulmonary sarcoidosis and pulmonary tuberculosis. The findings may be useful in the absence of clear differential diagnostic criteria between pulmonary tuberculosis and sarcoidosis.

Пухлина Бреннера у жінок репродуктивного віку з ожирінням: клініко-морфологічний аналіз випадків із практики

Background. Brenner tumors are rare epithelial ovarian tumors, the incidence of which among all ovarian tumors ranges from 0.6 to 2%. Considering the rarity of the pathology and absence of specific clinical symptoms, the authors present an analysis of own cases from the practice of Brenner tumor. Purpose – familiarization of the medical community with the clinical and morphological features of Brenner tumor in obese women of reproductive age based on an analysis of own practice cases. Materials and Methods. A clinical and morphological analysis of cases from practice of Brenner tumor of different histological variants in obese women of reproductive age is provided. Results. In the first case, in patient V., 42 years old, with obesity, a morphological study of the surgical material was diagnosed a benign variant of the Brenner tumor in the left ovary, which clinically manifested by pain and was not diagnosed by ultrasound. In the second case, in patient G., 36 years old, with obesity, it was morphologically diagnosed a benign variant of Brenner tumor in the right ovary, and borderline variant of Brenner tumor in the left ovary against the background of a benign variant. Brenner tumor in patient G. manifested by pain, infertility in anamnesis, and the presence of cysts on ultrasound examination. The menstrual cycle disorders in women in both cases may be caused by the presence of leiomyomas in the uterus or Brenner tumors or a combination of these tumor pathology. Conclusions. Brenner tumors are rare epithelial ovarian tumors, the only diagnostic method for which is a morphological examination of surgical material. Literature data about the role of obesity in the genesis of the development of these epithelial ovarian tumors, the presence in the described cases from practice of an increased body mass index in women with benign and borderline variants of Brenner tumors actualize the conduct of complex morphological studies in order to search, firstly, the etiopathogenetic features of the development of these ovarian tumors in obese women, and secondly, the morphological differential diagnostic criteria for these epithelial ovarian tumors in women with and without obesity.

Significance of relative and absolute content of blood lymphocyte subopopulations for differential diagnosis of viral and bacterial meningitis in children

The search for markers of early etiological verification of meningitis is an urgent task for clinical laboratory diagnostics.Objective of the study is to determine the significance of relative and absolute content of blood lymphocyte subpopulations for early differential diagnosis of viral and bacterial meningitis in children.Materials and methods. There was performed a clinical and laboratory examination of 61 children, 37 of them were diagnosed with viral meningitis, and 24 ones – with bacterial purulent meningitis. The control group included 15 healthy children. The relative and absolute content of the main subpopulations (T-lymphocytes: T-helpers (Th), cytotoxic T-lymphocytes (CTL), NK, B-cells) and small subpopulations (NKT, DNT- and DPT-lymphocytes, CD3+CD8br, CD3+CD8dim, CD3-CD8+NK) of lymphocytes was assessed by flow cytometry. Statistical analysis of the data was carried out.Results. The decrease of relative and absolute content of all studied subpopulations was identified during an acute period of bacterial purulent meningitis, in comparison with the control group, with the exception of B-lymphocytes, the number of them was increased. Absolute content of all subpopulations was reduced in case of viral meningitis compared with the control group, the relative content did not have any significant differences, with the exception of an increase in the relative content of B-lymphocytes. Calculation of diagnostic sensitivity and specificity revealed the effectiveness of identification of both relative and absolute content of lymphocyte subpopulations for differential diagnosis of viral or bacterial meningitis. Identification of B-lymphocytes, NKT, CD3+CD8dim in the blood had the highest diagnostic efficiency (area under the ROC curve (AUC) ranging from 0,9 to 1).Conclusion. Assessment of relative and absolute content of blood lymphocyte subpopulations is an effective tool for laboratory differential diagnosis of viral and bacterial meningitis and can be used as an early differential diagnostic criterion, especially in case of impossibility to analyze the composition of cerebrospinal fluid.

Tryptase in drug-induced anaphylaxis: the need for acute and baseline values.

The purpose of this narrative review was to summarize data and official recommendations purporting to paired tryptase determination in patients experiencing drug-induced anaphylaxis, published between January 1, 2023 and June 1, 2024. Three main lines of evidence obtained through paired acute and baseline tryptase determination were identified: diagnostic criterion for hypersensitivity reactions involving systemic mast cell activation; differential diagnostic criterion for hypersensitivity reactions involving other mechanisms of immediate reactions; and added value of acute and baseline tryptase levels for personalized management following drug-induced anaphylaxis: cause, risk of recurrence, underlying mast cell conditions including hereditary α-tryptasemia, familial clusters. The implementation of existing guidelines which consensually recommend paired tryptase measurement is a persistent unmet need hampering optimal diagnosis of drug-induced anaphylaxis and patient management. Another major unmet need is the lack of standardized recommendations for hereditary α-tryptasemia testing and counselling. Progress in this field is seen at a rapid pace, requiring significant efforts of continued medical education for practicing clinicians and laboratory specialists worldwide.

Characteristics of the colonic crypts in inflammatory bowel diseases

Purpose: to characterize changes in the colon crypts in colitis and to assess their significance in the morphological diagnosis of inflammatory bowel diseases (IBD). Materials and methods: colon biopsies were retrospectively reviewed in patients with IBD (30 patients with ulcerative colitis (UC) and 30 patients with Crohn's disease (CD)) and in 30 patients where the diagnosis of IBD was not confirmed (self-limiting colitis not related to IBD (non-IBD)). The age of the patients ranged from 19 to 53 years. In all cases, the diagnosis was established based on a combination of clinical, laboratory, and instrumental diagnostic methods. Multiple biopsies were obtained from all patients during colonoscopy. The processing of the material was carried out according to generally accepted methodology. All cases were scanned using the Aperio TC histological preparation scanner (Leica, Germany) and re-examined with an emphasis on crypt changes. Results: the crypt characteristics found during the study were divided into the following groups. The most frequently detected changes included inflammatory and destructive changes (98% of cases of IBD and 80% of cases of non-IBD). Atrophic changes in crypts were more often found in patients with non-IBD colitis compared with cases of IBD (30% in IBD and 53.3% in non-IBD; p=0.03). Significant differences in frequency were observed when dysregenerative changes in crypts were detected (76.7% of cases of colitis in IBD and 13.3% of cases in non-IBD; p&lt;0.001). Crypt budding was more pronounced in patients with UC compared with CD (92% in UC versus 70% in CD), and a special variant of crypt changes, which we termed "serpentine," was found exclusively in patients with CD. Conclusion: crypt changes found only in patients with IBD, such as budding crypts, can serve as an important differential diagnostic criterion for the diagnosis of IBD. In the IBD group, the discovered serpentine crypts can help in making a differential diagnosis between UC and CD. Inflammatory and destructive changes are found with equal frequency in both cases of IBD and non-IBD colitis and therefore cannot be considered specific diagnostic signs.

The role and place of arthroscopy in the early diagnosis of monoarthrosis (literature review)

Background. Knee osteoarthritis is a progressive incurable disease that in severe cases leads to total joint replacement, which requires significant economic costs and medical and social adaptation, has a number of postoperative complications and adverse outcomes. Therefore, special attention has recently been paid to the prevention and treatment of the early stages of the disease. The purpose of the study was to conduct a systematic analysis of scientific literature on the prospects and possibilities of using arthroscopy in the early diagnosis of monoarthrosis. Material and methods. A literature search was conducted in the PubMed and MEDLINE databases for 2010–2024 using the following medical subject headings and keywords: “deforming osteoarthritis of the knee joint”, “osteoarthritis of the knee joint”, “unilateral deforming osteoarthritis of the knee joint”, “unilateral osteoarthritis of the knee joint”, “gonarthrosis”, “monoarthrosis”, “arthroscopy”, “diagnosis”, “treatment”. If necessary, literature sources beyond the search period were used in some cases. A general search revealed 48 references on the use of arthroscopy as a diagnostic and therapeutic method in the early stages of monoarthrosis. The primary exclusion concerned the literature in which arthroscopy was used for the diagnosis and treatment of late-stage knee osteoarthritis (n = 38). The secondary exclusion included literature sources that contained only background information (summary, figures, references) (n = 12). As a result, only relevant full-text articles in professional journals remained (n = 15). Results. The lack of correlation between clinical symptoms and radiological signs of knee osteoarthritis causes low availability of orthopaedic care: more than 30 % of newly diagnosed patients have a severe stage of the disease, and in some cases the pathology is detected only in connection with the manifestation of complications; the diagnosis of osteoarthritis due to a large percentage of painless development of the disease (40 %) is often established at terminal stages. All of this suggests the need for further research into the various factors that influence the frequency, prevalence, economic and social burden of knee osteoarthritis. Arthroscopy is potentially the gold standard for validating non-invasive assessment methods such as magnetic resonance imaging, as it provides high magnification and direct view of articular cartilage with non-destructive interactive assessment of its structure and functional properties. Arthroscopy allows for a more detailed description of the depth and extent of lesions, as well as the detection of subtle changes such as cartilage softening, fibrillations, and tangential peeling. Clinical symptoms and structural changes in the knee joint elements visualised during arthroscopy in patients with monoarthrosis are covered in a few studies, some of which were published 10 years ago. The results of modern arthroscopic studies can be an important contribution to the development of diagnostic and differential diagnostic criteria for the early stages of monoarthrosis. Conclusions. Based on information and analytical studies of modern scientific literature, it has been found that knee osteoarthritis is accompanied by persistent pain, significant limitation of the lower limb function, and reduced ability to work, which often leads to joint replacement. Diagnosis of osteoarthritis in the early stages is difficult due to the absence of pathognomonic clinical, radiological and laboratory parameters, and in case of monoarthrosis with synovitis, it is complicated by differentiation with specific arthritis of the knee joint. Arthroscopy allows performing the necessary scope of diagnostic and therapeutic measures with verification of the pathological process and determination of gonarthrosis stage.

Infiltrative pulmonary tuberculosis and community-acquired pneumonia in primary care

Infiltrative pulmonary tuberculosis is a clinical form of tuberculosis, it is detected most often by the appeal of patients to the general medical network with complaints. This is the most common form of tuberculosis at the present stage, it is 60-85% in the structure. The timeliness of diagnosis and the effectiveness of treatment depend on the correct tactics of the doctor and the nursing staff at the first contact with the patient. Historical aspects, knowledge of the pathogenesis, the main clinical manifestations and differential diagnostic criteria will allow for the correct differential diagnosis of tuberculosis with community-acquired pneumonia in primary health care.

Diagnostic paradoxes of sepsis

Sepsis is currently one of the most important problems of medicine, and the treatment of this category of patients presents great difficulties and is characterized by high mortality. Acute Pneumonia (AP) has been the leading cause of septic conditions for many years, the proportion of which has recently begun to exceed half of all cases. The modern concept of AP considers the causative agent of the disease as the main cause of its occurrence and development, but for many years the search for reliable differential diagnostic criteria depending on the etiology has not been found. The peculiarities of the localization of AP, unlike other inflammatory diseases, force us to pay attention to the fundamental differences in the parameters of blood flow in the two circulatory circles. The inevitability of the onset of the inflammatory process with a vascular reaction forces us to understand the mechanisms of AP development on the basis of already studied, confirmed, and classical materials of medical science. New ideas about the pathogenesis of the disease make it possible to understand its leading importance in the observed pattern of AP and to recognize the obvious over diagnosis of sepsis in this category of patients. Understanding the need for such a step can significantly reduce the number of patients with sepsis, and a pathogenetic approach to medical care will really improve treatment outcomes.

Psychopathological analysis of the phenomenon of abstruseness (case of Sasha Shch.)

This article analyses the phenomenon of “abstruseness” from a psychological and psychiatric perspective. It presents differential diagnostic criteria and describes the features of the manifestation of abstruseness in the examined person, using the example of a clinical case of ten-year-old Sasha Shch.The conclusion is drawn that abstruseness can present itself both as a personal quality and as a psychopathological symptom attributed to the schizophrenic spectrum of mental disorders.

Emergency care for psychogenic paranoids in modern environment

The work presents data on the main modern variants of reactive paranoids. Clinical manifestations, differential diagnostic criteria, features of the dynamics, modern approaches to treatment of this pathology are described. The possibility of distinguishing modern variants of psychogenic paranoids is emphasized, taking into account the existing pathomorphosis of manifestations of this pathology. Currently, the most common forms are paranoids of attitude, persecution, litigious, somatogenic-reactive, induced, deprivation variants of psychogenic delusions. The patterns for the development of delusional psychogenic disorders are presented. The manifestations of attitude and persecution paranoid are described, with emphasis on the reflection of psychotraumatic experiences in patients’ statements and behavior. When considering litigious reactive psychosis, the importance of paranoid personality traits is emphasized, which contribute to the formation of a “struggle for justice” with a psychotic interpretation of real events. Information is given about the emergence of a relatively new variant of somatogenic-reactive paranoid in patients with combat injuries. Psychogenic deprivation hallucinosis with paranoid interpretation of experiences in premorbidly healthy individuals is described. Differential diagnosis of reactive paranoids and similar pathology is carried out. A special place is given to emergency care for psychomotor agitation of patients with the need to comply with the requirements of current legislation in psychiatry. Recommendations are given for further treatment of patients after relief of acute conditions, with the need to add psychocorrective measures to restore mental health.

Differential diagnostic criteria for chemical corneal burn in dogs and cats and methods of their treatment

The paper presents data on risk factors for the development of chemical burns of the cornea, and presents the most common causes that can cause burn injury to the cornea. The clinical picture of chemical burns of the cornea in dogs and cats is analyzed in detail, differential diagnostic criteria and their prognostic significance are described. A treatment regimen for chemical burns of the cornea is proposed depending on the location and size of the defect. The most common types of chemical reagents that cause corneal burns are household chemicals. The most severe type of burn is the one that affects the limbal zone, leading to the development of limbal cell insufficiency and, as a consequence, more severe complications. The proposed treatment regimen for chemical burns of the cornea, based on the size and location of the defect, has shown its effectiveness and consistency. With timely treatment, taking into account the clinical picture, and a prognosis based on it, it is possible to save not only the eyeball as an organ, but also to achieve complete restoration of the morphofunctional characteristics of the cornea.

Analysis of immune status assessment results of pregnant and breastfeeding women permanently residing in rural districts

The purpose of the study was to determine the immune status of healthy, pathologically observed pregnant and lactating women living in rural areas. It was found that the trend and intensity of IgA , IgG , IgM , IgE changes in blood serum of pregnant and lactating women were practically the same. 1.27 times according to IL-1b , 1.40 times according to IL-4, 1.25 times according to IL-6, 1.31 times according to IL-10 were reliably higher in women with observed pathology compared to healthy pregnant women. Differences in the trend and intensity of changes among lactating women were similar to the parameters of pregnant women. S3S, lactoferrin and procalcitonin indicators in the blood serum of pregnant women and lactating women were recommended as differential diagnostic criteria for evaluating immune status and prognostic criteria for evaluating the end of pregnancy.

Morphologic and Genetic Features of Unclassifiable Chronic Myeloid Neoplasms: Five-Year Experience of a Canadian Provincial Referral Center

Introduction: The challenge of diagnosing and definitively classifying myeloproliferative neoplasms (MPNs) and myelodysplastic/myeloproliferative neoplasms (MDS/MPNs) remains a conundrum in the field of hematology. While the World Health Organization has outlined diagnostic criteria for various categories, there remain cases that elude specific classification, falling under the umbrella of MPN, unclassifiable (MPN-U) and MDS/MPN, unclassifiable (MDS/MPN-U). In this study, we aimed to compare the morphological and genetic profiles of cases classified as MPN-U or MDS/MPN-U against more definitively classified cases (including chronic myelomonocytic leukemia (CMML), essential thrombocythemia (ET), MDS/MPN with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T), and primary myelofibrosis (PMF), including prefibrotic PMF (pre-PMF)). Methods: Morphologically unclassifiable myeloid neoplasm cases referred for pathologist review to our laboratory in the largest tertiary care center in British Columbia, Canada were identified through pathology database query over a five-year period. Bone marrow materials were reviewed and reanalyzed with standardized collection of qualitative and semiquantitative data by two hematopathologists. Morphological parameters studied included the myeloid to erythroid ratio, bone marrow cellularity, lineage dysplasia, megakaryocyte histotopography, bone marrow blast frequency, fibrotic changes, and bone marrow vascularity, among others. Clinical data, cytogenetic findings, and results of a targeted sequencing panel assessing a set of approximately 50 genes recurrently mutated in myeloid malignancies were collected by electronic medical record review. A cohort of contemporarily collected myeloid neoplasms with definitive pathologic diagnoses was reviewed for comparison. Statistical analyses were performed using python3. Results: The cohort comprised 29 cases classified as MPN-U, 12 cases of MDS/MPN-U, and 5 cases each of ET, PMF, pre-PMF, CMML, and MDS/MPN-RS-T. MPN-U cases were further subcategorized based on the apparent reason for difficulty in classification, including: overlapping features with another MPN; late stage/overt fibrosis; early stage without fully-developed morphologic features; and coexisting atypical morphologic findings. MPN-U with overlapping features had highly variable reticulin fibrosis, while, as expected, late stage entities had a high degree of reticulin fibrosis and early stage entities showed less overt fibrosis (Figure, Left, demonstrating select morphologic features of evaluated chronic myeloid neoplasms). MPN-U as a whole appeared to show less prominent fibrosis-associated findings than MDS/MPN-U and to, in general, show a greater degree of neovascularization, similar to changes observed in cases with PMF. Splicing factor and epigenetic modifier mutations appeared to be overrepresented in MDS/MPN-U relative to MPN-U, notably excluding MPN-U with atypical morphologic features (Figure, Right, demonstrating the distribution of pathogenic variants identified in evaluated myeloid neoplasms; results are indicated as presence (1) or absence (0) of a variant for each gene). Notably, no CALR mutations were identified in the MDS/MPN-U category or early stage / atypical morphology MPN-U, though they were enriched in overtly fibrotic MPN-U entities. Discussion/Conclusion: In this cohort we observed, as expected, significant overlap in cases classified as MPN-U and MDS/MPN-U with better delineated entities, though patterns of morphologic change and mutational spectra suggest potential directions for further investigation of additional criteria that may guide accurate classification of these neoplasms. These findings reflect the heterogeneity of MPNs described in the literature and the complexity of their genetic underpinnings, particularly in the context of concurrent dyshematopoiesis; suggest enhanced bone marrow vascularization may be an informative differential diagnostic criterion in evaluation of these neoplasms, though further study is required; and emphasize the need for broader genetic testing and perhaps further subtyping of MPN-U cases for a more nuanced analytical approaches for these disorders.

The importance of involving experts-by-experience with different psychiatric diagnoses when revising diagnostic criteria

Philosophers of science have recently called for experts-by-experience to be involved in revising psychiatric diagnoses. They argue that experts-by-experience can have relevant knowledge which is important for considering potential modifications to psychiatric diagnoses. I show how altering one diagnosis can impact individuals with a different diagnosis. For example, altering autism can impact individuals diagnosed with Attention Deficit Hyperactivity Disorder and Schizoid Personality Disorder through co-morbidity and differential diagnostic criteria. Altering autism can impact the population making up the diagnosis of Attention Deficit Hyperactivity Disorder and Schizoid Personality Disorder which can then influence which behaviour each diagnosis covers and which parts of the causal structure each diagnosis covers. Expanding one diagnosis can mean, if differential diagnostic criteria are present, that individuals who have a different diagnosis, or would one day have been diagnosed with that different diagnosis, are instead now diagnosed with the expanded diagnosis. Alternatively, if two diagnoses can be co-morbid then expanding one diagnosis can mean individuals who have a different diagnosis can now also receive the expanded diagnosis. Changing these can then impact the adequacy of symptoms formulated to cover behaviour and causal mechanisms formulated to cover the causal structure. This means experts-by-experience representing a range of diagnoses should be involved in decisions over modifying diagnoses they do not have. For example, Attention Deficit Hyperactivity Disorder individuals should be involved in decisions to modify autism. I discuss practical issues relating to how much say people with a range of diagnoses should have in relation to modifying a diagnosis which they do not have. We should employ a principle of equality whereby the level of say individuals with one diagnosis should have on another diagnosis should be equally reciprocated.

Magnetic resonance imaging in assessing the staging of intracerebral hemorrhages in children

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children.Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test.Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17).Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p &lt; 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

Allergic fungal rhinosinusitis and eosinophilic mucin chronic rhinosinusitis: Differential diagnostic criteria. A two-center comparative study following STROBE methodology

ObjectivesAllergic fungal rhinosinusitis (AFRS) and eosinophilic mucin chronic rhinosinusitis (EMRS) are two forms of chronic sinusitis distinguished by the presence (AFRS) or absence (EMRS) of fungal elements in sinus mucin. Detection of the fungal elements, however, is complex and it is difficult to say whether EMRS is in fact an entity distinct from AFRS. The aim of the present study, based on a retrospective series of AFRS and EMRS, was to identify the specific clinical and radiological elements distinguishing between the two. Materials and methodsA 2-center retrospective observational study following STROBE guidelines included patients managed for AFRS or EMRS between 2009 and 2022. Clinical, mycological, pathologic and radiological data were collected. Type of treatment and disease progression were also analyzed. Intergroup comparison used Student's test for mean values of quantitative variables, with calculation of P-values, and Pearson's Chi2 test or Fisher's exact test for categoric variables, with calculation of relative risk and 95% confidence intervals. ResultsThe AFRS group comprised 41 patients and the EMRS group 34. Demographic data were comparable between groups. EMRS showed a higher rate of asthma (79.4 vs. 31.4%; P<0.001), more severe nasal symptomatology (rhinorrhea, P=0.01; nasal obstruction, P=0.001), and more frequent bilateral involvement (85.3 vs. 58.5%; P=0.021). AFRS showed more frequent complications (19 vs. 0%; P=0.006). Radiologically, mucin accumulation was greater in AFRS, filling the sinus in 84.2% of cases, versus 26.3% (P<0.001), with more frequent sinus wall erosion (19 vs. 5.8%; P=0.073). The recurrence rate was higher in EMRS: 38.2 vs.21.9% (P=0.087). ConclusionThe present retrospective study found a difference in clinical and radiological presentation between AFRS and EMRS, with EMRS more resembling the presentation of severe nasal polyposis.

Early diagnosis and predicting of acute kidney injury in children with viral gastroenteritis of various agents (Literature review)

The most common viral infections causing gastroenteritis in children include rotavirus, norovirus, and the SARS-CoV-2. A typical clinical picture includes fever, vomiting, diarrhea, toxicosis and exicosis of varying severity. However, in 30—35% of cases, acute intestinal infections of viral etiology complicate of acute kidney injury (AKI), which significantly aggravates the course of the disease and affects the outcome of the disease. Currently used markers for the diagnosis of AKI are poor informative due to late detection of typical laboratory changes during the clinical picture's change. Currently, there are non-invasive biomarkers of AKI detected before changes in routine biochemical tests and can be used for early diagnosis of kidney damage. Using of these biomarkers in practice will develop of clinical and laboratory differential diagnostic criteria for early diagnosis, risk factors for the development of AKI in children with viral diarrhea of various agents, in order to start timely effective pathogenetic treatment and prevent serious complications.