Initial Screening Of Patients Research Articles

Diagnostic performance of lung ultrasound compared to CT scan in the diagnosis of pulmonary lesions of COVID-19 induced pneumonia: a preliminary study.

Chest CT scan is currently used to assess the extent of lung involvement in patients with the coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the diagnostic performance of lung ultrasound in the diagnosis of COVID-19 pulmonary manifestations in comparison to CT scan. Thirty-three symptomatic patients with suspected COVID-19 pneumonia were evaluated by lung ultrasound and then, at a short interval, chest CT scan. In the anterior chest, each hemithorax was divided into four areas. In the posterior chest, eight zones similar to the anterior part were examined. The axillary areas were also divided into upper and lower zones (20 zones were determined per patient). Mean age of the patients was 58.66 years. The sensitivity (95% CI) and specificity (95% CI) of lung ultrasound for the diagnosis of parenchymal lesions were 90.5% (69.6–98.8%) and 50% (21.1–78.9%), respectively. In the evaluation of pleural lesions, the sensitivity (95% CI) and specificity (95% CI) of lung ultrasound were 100% (71.5–100%) and 22.7% (7.8–45.4%), respectively. Owing to the high sensitivity of ultrasound in identifying lung lesions in patients with COVID-19 pneumonia, it can be recommended to use lung ultrasound as a tool for initial screening of patients with high clinical suspicion for SARS-CoV-2 infection during the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13337-021-00736-w.

Plastic Surgeons Nationwide Share Experience Regarding Telemedicine in Initial Patient Screening and Routine Postoperative Visits.

Summary:Physicians attempted to continue providing patient care through the SARS-CoV2 (COVID-19) pandemic. Surgeons embraced telemedicine as patient evaluation transitioned from physical encounters to virtual appointments. However, there is a paucity in the literature on the utility of telemedicine within plastic surgery or how it can meet patients’ needs. A survey study was created to assess surgeons’ involvement and experience with telemedicine. Subjective experience was assessed on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). This survey was distributed to the members of the American Society of Plastic Surgeons. Data were collected and analyzed via RedCap. Of the total 177 plastic surgeons who responded, 139 (78.5%) surgeons reported the implementation of telemedicine during the pandemic. Plastic surgeons felt that they were able to establish rapport (3.9 ± 0.9), meet the goals of the encounter (3.6 ± 1.0), and efficiently evaluate patients (3.5 ± 1.2). Plastic surgeons reported their overall experience was between helpful and neutral (3.2 ± 1.3). Most plastic surgeons have implemented telemedicine in their practice. The majority of telemedicine use was for breast, cosmetic, and reconstructive patient care. Telemedicine was most frequently used for initial patient screening and routine postoperative visits. Surgeons plan to continue using telemedicine when appropriate for patient screening and routine or unexpected postoperative visits in the future. Many have found utility of telemedicine in providing patient care and it is likely that telemedicine will be a part of routine practice moving forward.

English

BACKGROUND COVID 19 has been labelled as a global pandemic by the World Health Organization (WHO). The sudden rise in death toll and devastation associated with it has put the entire infrastructure, economy and health sector to test. The only way for the prevention and control of this infectious disease is rapid and accurate screening of masses. Public Health Authorities mainly use antibody testing in hot spots using a mix of RT-PCR and antibody testing nasopharyngeal and orpharyngeal swabs. Considering the potential risk factors, constraints of time, cost and manpower, mass screening for COVID is not possible through nasopharyngeal and oropharyngeal swabs alone. Hence, to search an alternate method to diagnose for the initial screening of patients is the need of the hour globally. Saliva can also be used as one of the diagnostic modalities for coronavirus, helping in the rapid testing of individuals at home or at hospital. The article intends to explain the evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients and demonstrates the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non - invasive diagnostic modality. KEY WORDS COVID 19, Throat Swab, Nasopharyngeal Swab, Saliva, Diagnostic Fluid

Machine Learning Based Emergency Patient Classification System

Public Health Office and the risk map created from the patient information. Many provincial hospitals currently have to admit a large number of patients to their emergency room. Each year, the number outgrow limited medical resources, causing tremendous operational delay, and thus undermining quality of medical services. In addition, existing ER flows remain lacking means of communicating with patients’ relatives and notifying them with treatment status of patients under their care. To addresses these concerns, registered nurses with experiences are required not only to make initial patient screening and prioritization, but also to serve as liaison between physicians and patients’ relatives. These double tasks impose great burden to already overloaded medical staffs. An emergency patient classification system, based on support vector machine was developed. It was implemented as a web application, written in PHP, and running on MySQL database. GIS technology was employed to analyze spatial data and producing relevant reports. The proposed system could classify emergency patient into different groups based on their severity, according to the government standard. The resultant recommendation, verified by a nurse on duty, as well as treatment status were presented to patients’ relatives on a digital screen. Moreover, the hospital was able to use the summarized reports, in both standard and spatial forms, for its managerial purposes. The develop system could help the hospital to make the most of their limit resources for treating emergency patients. The produced reports were useful for making relevant policies and executive planning.

DOES TRANS RECTAL ULTRASOUND (TRUS) HELPS IN DIFFERENTIAL DIAGNOSIS OF PROSTATE LESIONS? A STUDY AT TERTIARY CARE CENTER.

BACKGROUND: There are successions of investigations used in evaluation of prostatic pathology. Currently digital rectal examination & serum PSA levels are used for screening of prostatic cancer. Many conventional imaging techniques like plain radiography, computed tomography, radionuclide scintigraphy and transabdominal sonography were proved to be ineffective in detection of many prostatic conditions specially cancer at an early stage. Transrectal ultrasound (TRUS) has traditionally been considered as the pivotal imaging test for the prostate, providing clinically important information regarding benign and malignant conditions. OBJECTIVES: to evaluate the TRUS and colour Doppler ndings in various benign and malignant prostatic lesions with respect to its site, echo pattern, capsular status, local invasion, vascularity and to correlate with other investigations, like digital rectal examination and serum PSA etc. and also to study the accuracy of TRUS in differentiating benign from malignant lesions. METHODOLOGY: A prospective observational study carried out over a period of 1.5 years at a tertiary care hospital. All male patient referred to department of radio diagnosis with prostate related complains referred from surgery department. Study includes clinical symptoms, family and personal history, laboratory examination like PSA, radiological examination, digital rectal examination. . Various statistical characteristics of the test such as sensitivity, specicity, positive predictive value, negative predictive value were calculated whenever applicable. Out of total 64 patients' recruited OBSERVATIONS: commonest age group was 61 – 70 years (39.1%). Commonest prostatic pathology encountered was BPH (56.2%) followed by prostatic carcinoma (31.3%), prostatitis (4.7%), prostatic abscess & calculus (3.1%) prostatic cyst (1.6%). 75% patients of prostatic carcinoma and 13.9% of Benign Prostate Hypertrophy show PSA value greater than 10ng/ml. Echotexture pattern found on TRUS, in prostatic carcinoma patients was hypoechoic echotexture in 70% patients followed by mixed echotexture in 20% patients. Examination in Color Doppler found, 80 % patients of prostatic carcinoma show increased vascularity and 25 % of benign lesion also shows increased vascularity including all three cases of prostatitis and one out of two case of prostatic abscess. Any single test alone is not helpful in arriving at a diagnosis, but all the thr CONCLUSION: ee tests i.e. PSA level, digital rectal examination, and transrectal ultrasound, together give very conrmatory result, specically to differentiate benign from malignant condition of prostate. . Considering that the initial screening of patients will help in reducing the number of negative biopsies (unnecessary), without impairing the cancer detection capacity.

Ultrasonography as a Diagnostic Support Tool for Childhood Takayasu Arteritis Referred to as Fever of Unknown Origin: Case Series and Literature Review.

Introduction: Childhood Takayasu arteritis (c-TA) often shows nonspecific symptoms, such as fever of unknown origin (FUO). Delay of diagnosis may result in organ dysfunction by arterial occlusion; therefore, early diagnosis is very important. Although ultrasonography is the first-line screening tool for children with FUO, its diagnostic efficacy of evaluation of systemic arteries in c-TA that presents as FUO remains unclear. We evaluated the suitability of ultrasonography evaluation that included systemic vessels for the early diagnosis of c-TA initially presenting as FUO. Methods: We review five patients who received a diagnosis of c-TA in our institution and also performed a literature review regarding TA cases with FUO and diagnosed on the basis of initial ultrasonography. Results: As in our cases, the median period from onset to diagnosis was 25 days (interquartile range [IQR], 21-35). Comparing the initial ultrasonography findings with later contrast-enhanced computed tomography (CECT) findings in the abdominal aorta, celiac artery, superior mesenteric artery, bilateral renal arteries, and bilateral common carotid arteries, the concordance rate between ultrasonography and CECT was moderate (Kappa coefficient was 0.50). All the patients were successfully treated without severe vascular damage. The literature review revealed 12 articles; although 9 of the 13 patients did not show the characteristic features (such as blood pressure discrepancy, bruit, or pulse deficiency), the median time to diagnosis was still 5 months (IQR, 3-12). Conclusions: During initial screening for patients with FUO, ultrasonography including evaluation of systemic vessels could contribute to earlier diagnosis of c-TA.

TMD diagnosis: Sensitivity and specificity of the Fonseca Anamnestic Index

ABSTRACT Objective To verify whether the Fonseca Anamnestic Index (FAI) has adequate sensitivity and specificity to be used in the diagnosis of temporomandibular disorder (TMD). Methods Two hundred-sixty-five participants with symptoms of TMDs were assessed through the FAI and through the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then classified as sick or non-sick. The sensitivity, specificity, and predictive values of the FAI in relation to the RDC/TMD were calculated using the STATA 14.0 software. Results Most of the patients were female, white, without a steady job, and the average age was 37.57 years. The FAI showed high sensitivity (97.21%) but obtained a low specificity (26.00%). The positive and negative predictive values were 84.96% and 68.42%, respectively. Conclusion The FAI is very sensitive in identifying patients who actually have TMD but not very specific in identifying non-TMD patients, being indicated only for initial screening of patients.

Relationship between the inflammation/immune indexes and deep venous thrombosis (DVT) incidence rate following tibial plateau fractures

ObjectiveTo determine the relationship between inflammation/immune-based indexes and deep venous thrombosis (DVT) incidence rate following tibial plateau fracturesMethodsRetrospective analysis of a prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was performed. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on biomarkers (neutrophil, lymphocyte, monocyte, and platelet counts) at admission were collected, based on which neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte/lymphocyte (MLR), and systemic immune-inflammation index (SII, neutrophil* platelet/lymphocyte) were calculated. Receiver operating characteristic (ROC) was used to determine the optimal cutoff value for each variable. Multivariate logistic regression analysis was used to evaluate the independent relationship of each biomarker or index with DVT, after adjustment for demographics, co-morbidities, and injury-related variables.ResultsAmong 1179 patients included, 16.3% (192/1179) of them had a preoperative DVT. Four factors were identified to be significantly associated with DVT, including open fracture, increased D-dimer level. Among the biomarkers and indexes, only platelet and neutrophil were identified to be independently associated with DVT, and the significance remained after exclusion of open fracture. The other independent variables were elevated D-dimer level (> 0.55 mg/L), male gender, and hypertension in the sensitivity analysis with open fractures excluded.ConclusionThese identified factors are conducive to the initial screening for patients at risk of DVT, individualized risk assessment, risk stratification, and accordingly, development of targeted prevention programs.

Use of Machine Learning and Artificial Intelligence to predict SARS-CoV-2 infection from Full Blood Counts in a population

Since December 2019 the novel coronavirus SARS-CoV-2 has been identified as the cause of the pandemic COVID-19. Early symptoms overlap with other common conditions such as common cold and Influenza, making early screening and diagnosis are crucial goals for health practitioners. The aim of the study was to use machine learning (ML), an artificial neural network (ANN) and a simple statistical test to identify SARS-CoV-2 positive patients from full blood counts without knowledge of symptoms or history of the individuals. The dataset included in the analysis and training contains anonymized full blood counts results from patients seen at the Hospital Israelita Albert Einstein, at São Paulo, Brazil, and who had samples collected to perform the SARS-CoV-2 rt-PCR test during a visit to the hospital. Patient data was anonymised by the hospital, clinical data was standardized to have a mean of zero and a unit standard deviation. This data was made public with the aim to allow researchers to develop ways to enable the hospital to rapidly predict and potentially identify SARS-CoV-2 positive patients.We find that with full blood counts random forest, shallow learning and a flexible ANN model predict SARS-CoV-2 patients with high accuracy between populations on regular wards (AUC = 94–95%) and those not admitted to hospital or in the community (AUC = 80–86%). Here, AUC is the Area Under the receiver operating characteristics Curve and a measure for model performance. Moreover, a simple linear combination of 4 blood counts can be used to have an AUC of 85% for patients within the community. The normalised data of different blood parameters from SARS-CoV-2 positive patients exhibit a decrease in platelets, leukocytes, eosinophils, basophils and lymphocytes, and an increase in monocytes.SARS-CoV-2 positive patients exhibit a characteristic immune response profile pattern and changes in different parameters measured in the full blood count that are detected from simple and rapid blood tests. While symptoms at an early stage of infection are known to overlap with other common conditions, parameters of the full blood counts can be analysed to distinguish the viral type at an earlier stage than current rt-PCR tests for SARS-CoV-2 allow at present. This new methodology has potential to greatly improve initial screening for patients where PCR based diagnostic tools are limited.

Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

ObjectiveFNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures.MethodsA total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses.ResultsWhen DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas.ConclusionsThe sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.

Extra Pulmonary Manifestations of COVID-19

After being declared as a pandemic on March 11, 2020 by the World Health Organization, COVID-19 has affected 497 million people worldwide as of 9 April 2022. COVID-19 is a disease with a plethora of clinical manifestations, which extends to those beyond pulmonary signs and symptoms. Studies that report on the clinical presentation of COVID-19 rarely report specifically on cases with only extrapulmonary manifestations of COVID-19. Extrapulmonary clinical presentations of COVID-19 without pulmonary signs and symptoms is rare, and in such cases, COVID-19 is rarely suspected.We herewith describe four patients with extrapulmonary manifestations of COVID-19, with positive SARS-COV-2 PCR when the test was performed for initial patient screening. The first patient is a 44-year-old female who developed painful ulcer with burning sensation at the lateral side of the tongue along with low grade fever. This symptom appeared after the initial complaints of coughing and nasal congestion subsided. The second patient is a 37-year-old male, who complained of red eyes with itchiness and increased tear production for 3 days before seeing an ophthalmologist. The third patient is a 44-year-old female who developed burning sensation and soreness on her throat upon swallowing with fever and chills. These symptoms appear consecutively without any respiratory complaint. The fourth patient is a previously healthy, 30-year-old female, with a normal weight and BMI, and without any comorbidity, cardiovascular risk and neither personal nor family history of cardiovascular disease. In these 4 patients, COVID-19 stomatitis, conjunctivitis, pharyngitis and COVID-19-associated atrial fibrillation was subsequently diagnosed, respectively.In the pandemic stage of COVID-19, COVID-19 screening has often been routinely performed due to the high risk of transmission. However, the decrease in the number of COVID-19 cases may prompt physicians to perform SARS-COV-2 testing based on clinical suspicion. It is imperative to consider the likelihood of COVID-19 and perform SARS-COV-2 PCR in patients with extrapulmonary complaints that have persisting complaints despite treatment.

Evaluation of the positive predictive value of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard.

Objectives: For the past 20 years Fine Needle Aspiration Cytology (FNAC) has evolved as the most sensitive diagnostic tool for the initial screening of patients with thyroid nodules. Unfortunately FNAC is complicated by a recognized false negative rate of approximately 5%. The clinicians could face the difficulty in the management of patient when a cytological diagnosis is atypical only. The objective of study is to evaluate the positive predictive value (PPV) of atypical thyroid cytology cases according to the Bethesda system taking histopathology as gold standard. Study Design: Cross sectional study. Setting: Department of Pathology at Shaikh Zayed Hospital, Lahore. Period: Six months i.e. from 25.11.2014 to 25.5.2015. Materials and Methods: Patients presenting with solitary thyroid nodules in the outpatient department and fulfilling the inclusion criteria were included after evaluation by thyroid function tests and thyroid scan, FNAC was performed and reported according to Bethesda system of thyroid reporting. Later on, cases underwent lobectomy, total or hemi-thyroidectomy, the tissue was received in 10% formalin solution in our pathology department and then processed, stained and examined. FNAC results of atypical cases were then compared with the definitive histological diagnosis which were considered the gold standard. The slides were examined and any differences were sought by consensus of two pathologists. Eighty cases were observed with 95% confidence level, 11% margin of error, using non-probability purposive sampling technique for sample collection. Data was analyzed by SPSS version 15 (P value <0.05). Results: The mean age of patients was 38 years with SD ± 2.16. There were 22 (28%) males and 58 (72%) females in our study. In this study, positive predictive value for Atypia of undetermined significance/ Follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm (FN), suspicious for malignancy and positive for malignancy were 33.3%, 25%, 66.6% and 100% respectively. Overall PPV of atypical cytology was 35.71%. Overall accuracy of FNAC was 86.30%, 87.50% sensitivity and 86.15% specificity, PPV value 43.75% and negative predictive value was 98.25%. Conclusion: Results showed that Bethesda system of reporting is helpful for the management of patients who falls in to undetermined categories as it categorically divide atypical cytology cases in to three definite categories AUS, FN and suspicious for malignancy and these categories have different risks of malignancy. Thus can help to determine a better patient outcome due to proper clinical management of thyroid swellings.

Identifying risk factors for depression and anxiety symptoms in patients with chronic lymphocytic leukemia.

This study assessed whether empirically supported risk factors can identify future depression and anxiety symptoms in a specific cancer type, chronic lymphocytic leukemia (CLL). Patients enrolled in a CLL treatment clinical trial (N = 106) participated at baseline following informed consent and prior to treatment initiation. Risk factors with empirical support (personal or family psychiatric history, recurrent, advanced or progressive disease, low socioeconomic status, gender, medical comorbidities, and single marital status) and additional risk factors (cancer-specific stress, social contacts, negative life events, absolute lymphocyte counts, treatment group, and fatigue) were measured at baseline to predict depression and anxiety symptoms at 12months. Data show 14% (n = 15) and 12% (n = 13) of patients experienced moderate-severe depression and anxiety symptoms, respectively. Multiple linear regression analyses found medical comorbidities predicted 12-month anxiety symptoms (p < 0.05). Also, negative life events predicted depression and anxiety symptoms and fatigue predicted depression symptoms (p < 0.05). Empirically supported risk factors associated with depression and anxiety symptoms are limited in predicting future depression and anxiety symptoms beyond initial screening in patients with CLL. In addition to levels of depression and anxiety symptoms at baseline, negative life events, higher levels of fatigue, and greater medical comorbidities were associated with future depression or anxiety symptoms in patients with CLL.

An Early Disc Herniation Identification System for Advancement in the Standard Medical Screening Procedure Based on Bayes Theorem.

The aim of this research was to analyze objectively the process of disc herniation identification using Bayes Theorem. One of the symptoms of discus hernia is muscle weakness on the foot that is caused by displaced discs in the space of two vertebrae. This fact is used by experts in initial diagnosis of herniated discs and we used it to create non-invasive platform for the same purposes by measuring force values from four sensors placed on both feet (first, second, and fourth metatarsal head as well as the heel). Dataset consisted of several minute force recordings of 56 subjects with discus hernia and 15 healthy individuals during normal standing, standing on forefeet and heels. The subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Collected recordings were processed in several steps including filtering, extraction of forefeet and heel recordings, classification of average values for forefeet, and heel sensors to the groups with or without foot muscle weakness. Application of Bayes Theorem on the attributes of interest showed average 78.3% accuracy with 62.6% sensitivity and 80.9% specificity, while application of naive Bayes Network showed average 83.1% accuracy with 57.6% sensitivity and 88.2% specificity. Very weak or no correlation was observed between gender and disc hernia diagnosis (or obesity type and disc hernia diagnosis). Obtained results show that this method can be used in initial screening of patients and be a supportive tool to doctors to send the same patients for further examination.

The performance of the Alere HIV combo point-of-care test on stored serum samples; useful for detection of early HIV-1 infections?

IntroductionThe Alere HIV-1/2 Antigen/Antibody Combo point-of-care test is a commercially available 4th-generation rapid test for the diagnosis of HIV infection, including acute infection. We evaluated the sensitivity of this test...

Sacral Neuromodulation in Patients With a Cardiac Pacemaker.

The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE), in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG). Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter-Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.

Retrospective karyotype study in mentally retarded patients.

To describe the chromosomal alterations in patients with mental retardation (MR) using G-banding karyotype analysis. A retrospective study of the results G-banding karyotype analysis of 369 patients investigated for MR was performed. Based on the structural rearrangements found, the authors searched all chromosomal regions related with breakpoints, and these were compared with the literature on MR and databases. 338 (91.6%) normal cases, and 31 (8.4%) with some type of chromosomal abnormality were identified. Among the altered cases, 21 patients (67.8%) were identified with structural chromosomal alterations, nine (29%) with numerical alterations, and one (3.2%) with numerical and structural alterations. Structural chromosomal abnormalities were observed more frequently in this study. G-banding karyotyping contributes to the investigation of the causes of MR, showing that this technique can be useful for initial screening of patients. However, higher resolution techniques such as array based comparative genomic hybridization (aCGH) and multiplex ligation-dependent probe amplification (MPLA) can detect submicroscopic alterations commonly associated with MR.

Interphase Chromosome Profiling (ICP) Assay in Peripheral Blood As a Viable Alternative to Bone Marrow Aspirate in the Initial Genetic Screening of Myelodysplastic Syndrome

Myelodysplastic syndrome (MDS) is a common adult malignancy and cytogenetics plays an important role in the diagnosis and classification for management of the disease. Both peripheral blood (PB) and bone marrow (BM) samples are routinely used in the investigation of MDS cases. However, the failure rate for peripheral blood for classical chromosome studies is very high and a common practice in those scenarios is to reflex to FISH testing using a set of probes designed to detect the most common abnormalities involving chromosomes 5, 7, 8 and 20 (MDS-FISH). While FISH is very valuable when less than 20 or no metaphase cells are available for analysis, several studies in the literature clearly indicate that in MDS with normal karyotype results, adding MDS-FISH has no additional clinical value and does not detect any additional cytogenetic abnormalities. Therefore, classical cytogenetics remains the primary testing for MDS. While bone marrow samples have a higher success rate in producing informative karyotype results, one large prospective study suggests that use of PB samples in the initial screening of patients with various anemias and suspected MDS, utilizing FISH probes if necessary, when the karyotype studies are unsuccessful, is valid and justified (Am J Clin Pathol 2011;135:915-920). According to this study, such noninvasive approaches will be very useful in the initial screening and would avoid or at least postpone the bone marrow aspirate in a significant number of patients resulting in significant cost savings.Interphase chromosome Profiling (ICP) is a new novel molecular cytogenetic technology which is capable of producing a complete molecular karyotype from interphase nuclei of any tissue without the need for tissue culture. ICP has been demonstrated to be a failure proof technology with greater sensitivity to detection of large and/or cryptic cytogenetic aberrations than standard cytogenetics and FISH, and can also characterize marker chromosomes and chromosomal material of unknown origin in unbalanced rearrangements. (Cytogenet Genome Res 2014;142:226, Abstract #22). Besides the common deletions and monosomies involving the chromosomes 5, 7 and 20; and trisomy 8, several balanced translocations have been identified in MDS which cannot be detected by the current MDS-FISH panel. Additionally, other abnormalities present in both simple and complex karyotypes will be missed by MDS-FISH. ICP has been developed to detect most of these changes in both BM and PB samples.We have tested the utility of ICP on eight peripheral blood and two bone marrow samples from 10 MDS cases. Two of these had no karyotype results. Four had a normal karyotype and the other four had a normal MDS-FISH. Both BM samples had a normal karyotype. One had a history of AML with trisomy 8, but was not detected in the current relapsed sample. Two cases had additional clinical suspicion of CLL or Multiple Myeloma in addition to MDS.ICP was successful in all ten samples and the normal molecular karyotype is concordant with either the cytogenetics or FISH result. In the two failed cytogenetic cases and no FISH study, ICP showed a normal result. The guidelines for establishing the clonality when utilizing the ICP technology is in progress (manuscript in preparation). In the ICP validation studies referenced above, any abnormality present in four or more cells in a 20 cell analysis is considered positive and was always corroborated by either cytogenetics or FISH studies. However, in couple of patients, the clonal abnormality identified by FISH studies, was present in only two to three cells in the ICP study. At present, the clinical significance of these "minor" clones identified by ICP analyses is not clear. Large prospective studies are needed to answer this question. We have identified such minor clonal abnormalities in two of the ten cases in three to four cells. These abnormalities include marker chromosomes and potential balanced translocations involving chromosomes 1, 2, 12, and 14. As mentioned above, current MDS-FISH will not detect these minor clones but identified by the ICP technology and may be clinically significant.Our results clearly demonstrate that ICP is a very sensitive technology and may be considered and adopted as the preferred method of choice in the initial screening of MDS patients especially on peripheral blood samples. DisclosuresNo relevant conflicts of interest to declare.

Contrast Enhanced MRI in the Diagnosis of HCC.

Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide. Imaging plays a critical role in HCC screening and diagnosis. Initial screening of patients at risk for HCC is performed with ultrasound. Confirmation of HCC can then be obtained by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), due to the relatively high specificity of both techniques. This article will focus on reviewing MRI techniques for imaging HCC, felt by many to be the exam of choice for HCC diagnosis. MRI relies heavily upon the use of gadolinium-based contrast agents and while primarily extracellular gadolinium-based contrast agents are used, there is an emerging role of hepatobiliary contrast agents in HCC imaging. The use of other non-contrast enhanced MRI techniques for assessing HCC will also be discussed and these MRI strategies will be reviewed in the context of the pathophysiology of HCC to help understand the MR imaging appearance of HCC.

A New Trend in the Management of Esophageal Foreign Body: Transnasal Esophagoscopy.

(1) To analyze the outcomes of patients with esophageal foreign body managed by transnasal esophagoscopy. (2) To review the value of lateral neck X-ray. Case series with chart review. Tertiary referral center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Lateral neck X-ray was used for initial screening in patients suspected of having an esophageal foreign body between 2007 and 2013. Rigid esophagoscopy was used as standard for further investigations before July 2010 and transnasal esophagoscopy after July 2010. From January 2007 to June 2010, 43 patients who were suspected of having an esophageal foreign body under lateral neck X-ray received rigid esophagoscopy, 31 of whom were found to have an esophageal foreign body. From July 2010 to December 2013, 302 patients underwent transnasal esophagoscopy, and an esophageal foreign body was noted in only 52 of these patients. In the 302 patients who underwent transnasal esophagoscopy, the sensitivity and specificity of having an esophageal foreign body by lateral neck X-ray were 59% and 83%, respectively. The introduction of transnasal esophagoscopy has changed the diagnosis and management for an esophageal foreign body. Transnasal esophagoscopy is a quick and safe procedure that can be performed under local anesthesia. Transnasal esophagoscopy could replace lateral neck X-ray to become the initial screening procedure and a useful treatment for patients with an esophageal foreign body.