Interpretation Of Clinical Signs Research Articles

Distinct Serum Glial Fibrillary Acidic Protein and Neurofilament Light Time-Courses After Rapid Head Rotations.

Traumatic brain injury (TBI) causes significant neurophysiological deficits and is typically associated with rapid head accelerations common in sports-related incidents and automobile accidents. There are over 1.5 million TBIs in the United States each year, with children aged 0-4 being particularly vulnerable. TBI diagnosis is currently achieved through interpretation of clinical signs and symptoms and neuroimaging; however, there is increasing interest in minimally invasive fluid biomarkers to detect TBI objectively across all ages. Pre-clinical porcine models offer controlled conditions to evaluate TBI with known biomechanical conditions and without comorbidities. The objective of the current study was to establish pediatric porcine healthy reference ranges (RRs) of common human serum TBI biomarkers and to report their acute time-course after nonimpact rotational head injury. A retrospective analysis was completed to quantify biomarker concentrations in porcine serum samples collected from 4-week-old female (n = 215) and uncastrated male (n = 6) Yorkshire piglets. Subjects were assigned to one of three experimental groups (sham, sagittal-single, sagittal-multiple) or to a baseline only group. A rapid nonimpact rotational head injury model was used to produce mild-to-moderate TBI in piglets following a single rotation and moderate-to-severe TBI following multiple rotations. The Quanterix Simoa Human Neurology 4-Plex A assay was used to quantify glial fibrillary acidic protein (GFAP), neurofilament light (Nf-L), tau, and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1). The 95% healthy RRs for females were calculated and validated for GFAP (6.3-69.4 pg/mL), Nf-L (9.5-67.2 pg/mL), and UCH-L1 (3.8-533.7 pg/mL). Rising early, GFAP increased significantly above the healthy RRs for sagittal-single (to 164 and 243 pg/mL) and increased significantly higher in sagittal-multiple (to 494 and 413 pg/mL) groups at 30 min and 1 h postinjury, respectively, returning to healthy RRs by 1-week postinjury. Rising later, Nf-L increased significantly above the healthy RRs by 1 day in sagittal-single (to 69 pg/mL) and sagittal-multiple groups (to 140 pg/mL) and rising further at 1 week (single = 231 pg/mL, multiple = 481 pg/mL). Sagittal-single and sagittal-multiple UCH-L1 serum samples did not differ from shams or the healthy RRs. Sex differences were observed but inconsistent. Serum GFAP and Nf-L levels had distinct time-courses following head rotations in piglets, and both corresponded to load exposure. We conclude that serum GFAP and Nf-L offer promise for early TBI diagnosis and intervention decisions for TBI and other neurological trauma.

Models of Cardiovascular Surgery Biobanking to Facilitate Translational Research and Precision Medicine

Biobanking in healthcare has evolved over the last few decades from simple biological sample repositories to complex and dynamic units with multi-organisational infrastructure networks and has become an essential tool for modern medical research. Cardiovascular tissue biobanking provides a unique opportunity to utilise cardiac and vascular samples for translational research into heart failure and other related pathologies. Current techniques for diagnosis, classification, and treatment monitoring of cardiac disease primarily rely on interpretation of clinical signs, imaging, and blood biomarkers. Further research at the disease source (i.e., myocardium and blood vessels) has been limited by a relative lack of access to quality human cardiac tissue and the inherent shortcomings of most animal models of heart disease.

Development and validation of a clinical respiratory disease scoring system for guiding treatment decisions in veal calves using a Bayesian framework.

Active infectious bovine respiratory disease (BRD) is an infection of the airways that needs to be diagnosed correctly so that appropriate treatment can be initiated. The simplest and most practical test to detect active BRD in dairy calves raised for veal is the detection and interpretation of clinical signs by producers or technicians. However, the clinical scoring system currently available for veal calves lacks sensitivity and specificity, contributing to economic losses and high use of antimicrobials. An accurate and reliable batch-level test to detect active BRD is essential to tailor antimicrobial use and reduce economic losses in veal calves. The objective of this study was therefore to develop and validate a new veal calf respiratory clinical scoring system (VcCRS), including reliable clinical signs (cough, ear droop or head tilt) and increased rectal temperature to detect active BRD in batches of veal calves housed individually, and to describe the accuracy of the scoring system for identifying batches of veal calves to treat. During 2017 to 2018, clinical examination, thoracic ultrasonography (TUS) and a haptoglobin concentration (Hap) were prospectively performed on 800 veal calves housed individually in Québec, Canada. Deep nasopharyngeal swabs were performed on 250 veal calves. A Bayesian latent class model accounting for imperfect accuracy of TUS and Hap was used to obtain weights for the clinical signs and develop the VcCRS. The VcCRS was then validated externally in 3 separate data sets. Finally, the applicability of the VcCRS at batch level was determined. We found that calves with 2 of the following findings-cough, unilateral or bilateral ear droop or head tilt, or increased rectal temperature ≥39.7°C-were considered positive and had a 31% chance of having active BRD. Without at least 2 of these 2 findings, a calf had a 100% chance of not having active BRD. At the batch level, we found that a batch with ≥3 positive calves among 10 calves sampled 2 wk after arrival at the fattening unit had a 94% chance of having an active BRD prevalence ≥10%. A batch with <3 positive calves had a 95% chance of not having an active BRD prevalence ≥10%. In this study, we developed a simple individual and batch-level score that is reliable across examiners and performs effectively in the detection of active BRD in veal calves. The implementation of this VcCRS in the veal calf industry would promote the elaboration of a protocol tailoring antimicrobial use.

Models of cardiovascular surgery biobanking to facilitate translational research and precision medicine.

Biobanking in health care has evolved over the last few decades from simple biological sample repositories to complex and dynamic units with multi‐organizational infrastructure networks and has become an essential tool for modern medical research. Cardiovascular tissue biobanking provides a unique opportunity to utilize cardiac and vascular samples for translational research into heart failure and other related pathologies. Current techniques for diagnosis, classification, and treatment monitoring of cardiac disease relies primarily on interpretation of clinical signs, imaging, and blood biomarkers. Further research at the disease source (i.e. myocardium and blood vessels) has been limited by a relative lack of access to quality human cardiac tissue and the inherent shortcomings of most animal models of heart disease. In this review, we describe a model for cardiovascular tissue biobanking and databasing, and its potential to facilitate basic and translational research. We share techniques to procure endocardial samples from patients with hypertrophic cardiomyopathy, heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction, in addition to aortic disease samples. We discuss some of the issues with respect to data collection, privacy, biobank consent, and the governance of tissue biobanking. The development of tissue biobanks as described here has significant scope to improve and facilitate translational research in multi‐omic fields such as genomics, transcriptomics, proteomics, and metabolomics. This research heralds an era of precision medicine, in which patients with cardiovascular pathology can be provided with optimized and personalized medical care for the treatment of their individual phenotype.

Can clinical signs or symptoms combined with basic hematology data be used to predict the presence of bacterial infections in febrile children under - 5\u2009years?

BackgroundInfectious diseases in children living in resource-limited settings are often presumptively managed on the basis of clinical signs and symptoms. Malaria is an exception. However, the interpretation of clinical signs and symptoms in relation to bacterial infections is often challenging, which may lead to an over prescription of antibiotics when a malaria infection is excluded. The present study aims to determine the association between clinical signs and symptoms and basic hematology data, with laboratory confirmed bacterial infections.MethodsA health survey was done by study nurses to collect clinical signs/symptoms in febrile (axillary temperature ≥ 37.5 °C) children under - 5 years of age. In addition, blood, stool and urine specimen were systematically collected from each child to perform bacterial culture and full blood cell counts. To determine the association between a bacterial infection with clinical signs/symptoms, and if possible supported by basic hematology data (hemoglobin and leucocyte rates), a univariate analysis was done. This was followed by a multivariate analysis only on those variables with a p-value p < 0.1 in the univariate analysis. Only a p-value of < 0.05 was considered as significant for multivariate analysis.ResultsIn total, 1099 febrile children were included. Bacteria were isolated from clinical specimens (blood-, stool- and urine- culture) of 127 (11.6%) febrile children. Multivariate logistical regression analysis revealed that a general bacterial infection (irrespective of the site of infection) was significantly associated with the following clinical signs/symptoms: diarrhea (p = 0.003), edema (p = 0.010) and convulsion (p = 0.021). Bacterial bloodstream infection was significantly associated with fever> 39.5 °C (p = 0.002), diarrhea (p = 0.019) and edema (p = 0.017). There was no association found between bacterial infections and basic haematological findings. If diarrhea and edema were absent, a good negative predictive value (100%) of a bacterial bloodstream infection was found, but the positive predictive value was low (33.3%) and the confidence interval was very large (2.5–100; 7.5–70.1).ConclusionOur study demonstrates that clinical signs and symptoms, combined with basic hematology data only, cannot predict bacterial infections in febrile children under - 5 years of age. The development of practical and easy deployable diagnostic tools to diagnose bacterial infections remains a priority.

Standardization of Clinical Assessment and Sample Collection Across All PERCH Study Sites.

Background. Variable adherence to standardized case definitions, clinical procedures, specimen collection techniques, and laboratory methods has complicated the interpretation of previous multicenter pneumonia etiology studies. To circumvent these problems, a program of clinical standardization was embedded in the Pneumonia Etiology Research for Child Health (PERCH) study.Methods.Between March 2011 and August 2013, standardized training on the PERCH case definition, clinical procedures, and collection of laboratory specimens was delivered to 331 clinical staff at 9 study sites in 7 countries (The Gambia, Kenya, Mali, South Africa, Zambia, Thailand, and Bangladesh), through 32 on-site courses and a training website. Staff competency was assessed throughout 24 months of enrollment with multiple-choice question (MCQ) examinations, a video quiz, and checklist evaluations of practical skills.Results.MCQ evaluation was confined to 158 clinical staff members who enrolled PERCH cases and controls, with scores obtained for >86% of eligible staff at each time-point. Median scores after baseline training were ≥80%, and improved by 10 percentage points with refresher training, with no significant intersite differences. Percentage agreement with the clinical trainer on the presence or absence of clinical signs on video clips was high (≥89%), with interobserver concordance being substantial to high (AC1 statistic, 0.62–0.82) for 5 of 6 signs assessed. Staff attained median scores of >90% in checklist evaluations of practical skills.Conclusions.Satisfactory clinical standardization was achieved within and across all PERCH sites, providing reassurance that any etiological or clinical differences observed across the study sites are true differences, and not attributable to differences in application of the clinical case definition, interpretation of clinical signs, or in techniques used for clinical measurements or specimen collection.

Correlative (99m)tc-labeled tropane derivative single photon emission computer tomography and clinical assessment in the staging of Parkinson disease.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by a selective loss of dopamine in the striatum. Problems remain in the accurate diagnosis of PD. The diagnosis of idiopathic PD is based on the interpretation of clinical signs and symptoms could be incorrect at the time of initial presentation. In vivo imaging of the dopaminergic system has the potential to improve the diagnosis of PD in its early stages. The imaging of dopamine transporter (DAT) with 99mTc-labeled tropane derivative (TRODAT-1) single photon emission computer tomography/computer tomography (SPECT/CT) has been proposed to be a valuable and feasible means of assessment of the integrity of dopamine neurons. The purpose of this study was to investigate the potential usefulness of 99mTc-TRODAT-1 imaging in the evaluation of patients with PD and classify into different stages of the disease. SPECT imaging with 99mTc-TRODAT-1 was conducted in 16 consecutive PD patients (9 men; 7 women) and in 6 age matched healthy volunteers (4 men; 2 women). The images were obtained 3 h after the intra-venous injection of the tracer. Specific uptake in the striatum and its sub-regions, including the putamen and caudate nucleus was calculated and the ratios of specific striatal binding to nonspecific occipital binding were calculated. ANOVA with Dunnett C post-hoc analysis was conducted using SPSS 20. A stepwise reduction in specific striatal uptake of 99mTc-TRODAT-1 with increasing disease severity between healthy control versus Stage I versus Stage II versus Stage III was found in PD patients (i.e., 3.77 vs. 2.56 vs. 1.57 vs. 0.63, P < 0.05). The changes were magnified by measurement of specific putaminal uptake (1.43 vs. 0.79 vs. 0.54 vs. 0.19, P < 0.05) and specific caudate uptake (1.90 vs. 1.47 vs. 0.73 vs. 0.27, P < 0.05). No remarkable adverse reactions were found in either healthy volunteers or PD patients during or after imaging. 99mTc-TRODAT-1 is accurate and widely available for the assessment of DAT activity, which might shed light on the integrity of the presynaptic nigrostriatal function. Our preliminary study results confirm the potential of using 99mTc-TRODAT-1 for DAT measurement, which is clinically important for the staging of PD.

Acute traumatic compartment syndrome: a systematic review of results of fasciotomy

Issues around diagnosis and treatment of acute compartment syndrome were investigated through a systematic review that examined results of 55 reports of fasciotomy published over four decades and reporting on 1920 fasciotomies. Most were reported since 2000. Injuries below the elbow and knee accounted for at least 75% of cases. The consensus was that diagnosis of compartment syndrome remains primarily based on a high index of suspicion and interpretation of clinical signs and symptoms over high technology methods of diagnosis. Compartment syndrome related amputation occurred in 5.5% of cases and death in 3.3% overall. Compared with fasciotomy before 6 h, delayed fasciotomy beyond 12 h was associated with a lower rate of acceptable outcome (15% for more than 12 h vs. 88% for &lt;6 h), a higher rate of amputation (14% vs. 3.2%) and death (4.3% vs. 2.0%).

Ist eine unterschiedliche Behandlung bei verschiedenen Schweregraden des Sulcus nervi ulnaris-Syndroms sinnvoll?

Cubital tunnel syndrome is the second most common chronic nerve entrapment of the upper extremity, yet both diagnosis and staging of the severity of the progression of the disease rely mostly on the keen observation and interpretation of clinical signs and symptoms. To be valid, a staging system must correlate well with the known pathophysiological mechanisms of chronic nerve compression, have objective parameters available to quantify differing degrees of sensory and motor dysfunction, and finally must allow different therapeutic consequences. In this study we have prospectively evaluated 44 patients who presented with the clinical diagnosis of cubital tunnel syndrome. Quantitative Sensory Testing was performed using a computer-assisted testing system (Sensory-Management Services L. L. C., Baltimore). Classic two-point discrimination, one point pressure threshold, pinch and grip strength were measured. Progression of disease was staged according to the gradual loss of sensory and motor function. After an average of 15 months postoperatively, ulnar nerve function was re-evaluated using the same parameters and outcome measured with the modified Bishop rating scale. The results of this study indicate that 100 % of patients in the moderate group had a good and excellent outcome, whereas only 74 % of the severe group were rated as good and excellent with 17 % moderate and 9 % poor outcome.

Causalité et pensée médicale : un cas en controverse

Questions of method in medicine are always posed in situations that are empirically difficult. The etiological model, undoubtedly still the dominant model in medicine, including in psychiatry, finds its justifications in the method, which proceeds from causality. The author recalls the history of the concept of causality, which, from the time of the Aristotelian and Arabic traditions (astrology and mathematics), was founded on the idea of a necessary order of the world, an order in which all events are linked. This conception was taken up by Renaissance philosophers and integrated into the epistemology of modern sciences since Copernicus, Kepler and Galileo, along with some notions of neoplatonic and medieval schools, that is, that of order and first cause. In the history of philosophy, it may be acknowledged that two traditions distinguish themselves on these questions: that of the rationalist and analytic tradition (according to the terms used by Descartes), and the empirical tradition. The rationalist principle becomes, with the Romantic movement, the inspiration for a priori and idealist doctrines; leading the way in medicine are Laplace and Claude Bernard. The empirical current of causality found its bases in the philosophy of Al Ghazali in the 11th century. However, it is to Hume that we owe a theory of causality that excludes an a priori deductibility of things and affirms the method of the proof of the link. Contemporary scientific epistemology is dominated by a neo-Humean conception of causality. The empirical method of causality significantly influenced the evolution of medicine and neurological and psychiatric conceptions of the brain. Suffice it to evoke, among others, pioneers such as Gall, and also Broca and Wernicke. The author articulates these historical considerations with neurological and psychological clinical data of a particular case. A controversial case, Parkinson's disease, illustrates the limits of the causality method in clinical practice. The author shows the value of considering the contradiction between the interpretation of clinical signs and technical investigations and the diagnostic certainly represented by an autopsy. The latter permits the establishment of a linear explanation of cause and effect, that is, a precise lesion corresponding to a known disease. The etiological model is thus confirmed thanks to the autopsy model; hence the need to reconsider clinical practice, its epistemology, and the validity of causal reasoning. We may observe that the debate between “topographical” and “functional” diagnoses arises, doubtless, from an old medical quarrel, which remains open despite the present finesse of tools at our disposal. We would be permitted to think that, without agreement between “topographical” and “functional” diagnoses, the interpretation of data should make these two fields interact in some other way. The author supports her argument by a phenomenological and psychoanalytical approach and identifies a clinical humanist episteme founded on indeterminism and which therefore takes into account that the observer and the observed define a field of experience that is limited and relative, always subject to double inference. The epistemological proposition, which follows, suggests leaving behind reasoning according to diagnostic categories and rather basing clinical practice on the understanding of the “course of the particular case through the disease”. The categorical method in medicine could give way to the more qualitative concept of the patient's experience and of his condition of being-in-the-world in its intersubjectivity. This would lead the clinician to leave behind etiology in favour of quantum, that is, probabilist, causality.

Monitoring Depth of Anaesthesia using Fuzzy Logic System

The depth of anaesthesia (DOA) achieved is a result of the concentration of the anaesthetic drugs in the brain. Until recent years, there has been no simple, accurate and objective method for assessing the DOA or alerting the anaesthetist to a state of awareness. The monitoring of DOA is complex, and dependent on many factors, which vary between patients and operating procedures. A method that can be adapted for handling complex and inexact knowledge (e.g. DOA) within a computer program is fuzzy set theory. This paradigm seems to be specially suitable for medical processes, since it depends upon expert experiences which are not precisely quantifiable, such as patients' subjective sensations, interpretation of clinical signs and effects of instrumental accuracy. In this paper, two significant extracted features from the processed auditory evoked response (AER) signal, describing the changes in amplitudes and latencies of MLAER waves, have been merged together using fuzzy logic to create a reliable index for DOA every 30 seconds.

The Diagnosis of Root Caries

The most commonly used clinical signs of root caries are visual (color, contour, surface cavitation) and tactile (surface texture) descriptions of a lesion. The traditional methods of visual-tactile diagnosis for root caries can produce a correct diagnosis but usually not until the lesion is at an advanced stage. Despite the subjectivity inherent in interpreting the clinical signs of root caries diagnosis, good to excellent inter-examiner reliability has been reported in clinical studies; however, the presence of filled surfaces dramatically enhances the agreement. When only untreated root caries is diagnosed, examiner reliability is reduced considerably. Clinicians look to diagnostic tests in the hope that they will perform better (that is, be more reliable) than clinical diagnosis and, therefore, can be used to replace clinical diagnosis. From the limited data available on diagnostic tests for root caries, tests determining the presence or absence of mutans streptococci and Lactobacilli are the most clinically helpful, producing calibrated efficiency scores exceeding 40 percent. The risk assessment approach to root caries diagnosis involves the determination of a patient's risk through the interpretation of clinical signs and the selection and application of an appropriate diagnostic test if the clinician is unsure of the diagnosis.

Algunas consideraciones prácticas para el manejo de los trastornos del movimiento en la infancia

Disorders of movement in children often cause semiological and diagnostic difficulties to the paediatricians concerned. Based on personal experience, the author analyzes aspects which are particularly useful in overcoming these problems. Epidemiology, rules for history taking, indications as to the interpretation of clinical signs and use of complementary studies are considered.

In Vivo Dehydration of Disposable (Acuvue) Contact Lenses

The in vivo dehydration of the Acuvue disposable contact lens was measured in six subjects using a contact lens refractometer. On average, the lenses dehydrated 6.2 +/- 1.9% after 20 min and 10.2 +/- 3.9% after 6 h of wear. The magnitude of dehydration is greater than has been reported for other hydrogel lens types of similar water content. This information may assist practitioners in the interpretation of clinical signs pertaining to lens behavior and associated patient symptoms.

Organophosphorus and Carbamate Insecticide Poisoning in Large Animals

Organophosphorus and carbamate insecticides are used commonly in agriculture to control pests of crops and animals. These compounds are toxic and livestock poisoning has occurred from mistaken addition of unused insecticide to feeds and animal access to improperly disposed of materials or "empty" containers. The morbidity rate approximates a third of animals exposed and about half of those affected die. Organophosphorus and carbamate insecticides generate their toxic effects by bonding to and inhibiting ChE enzymes (most importantly, AChE), which are responsible for breaking down the neurotransmitter ACh. The accumulation of ACh results in uninhibited impulse transmission at the cholinergic endings, including autonomic preganglionic junctions, certain neurons in the central nervous system, and motor nerves to the skeletal muscles. This eventually leads to fatigue of end organs; death usually is a result of respiratory failure. The "delayed neuropathy syndrome" is caused by some OP insecticides, but the pathophysiology of this syndrome does not involve the inhibition of ChE and accumulation of neurotransmitter. Over 100 anticholinesterase insecticides are in use. Variations in toxicity exist among these compounds, but larger diversities exist in the likelihood of poisoning because of differences in formulations, solvents, and conditions of use. Young animals usually are more sensitive than adults. Some of these agents are among the most toxic of manmade chemicals. These insecticides generally do not accumulate in tissues. The "chronic" effects depend on accrued physiological changes from frequent exposure to nonlethal doses. Clinical signs occur within minutes to a few hours and include the muscarinic signs of salivation, excessive lacrimation, frequent urination, and diarrhea. Concurrent nicotinic effects include muscular tremors followed by weakness and paralysis. Topical exposure results in similar poisoning but the onset of clinical signs may be delayed. Certain pour-on insecticides may cause a delayed (more than a week) syndrome in some breeds. Diagnosis of OP or carbamate insecticide poisoning is made by (1) interpretation of clinical signs and history that are consistent with this poisoning, (2) detection of the chemical compound in stomach or rumen contents and tissues, and (3) demonstration of the adverse biological effect, ChE inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)

The relationship between right atrial pressure and blood volume.

<h3>Introduction</h3> Present clinical criteria for detecting alterations in blood volume in postoperative patients are inadequate. Laboratory studies to support suspected findings also leave much to be desired. Blood volume studies using radioactive substances and dilution techniques approximate most accurately the existing state at a particular unit of time but they do not determine the rate of replacement, rate of withdrawal, or effectiveness of such therapy except as judged by repeat blood volume or reevaluation and interpretation of clinical signs. It is the purpose of this study to determine the efficacy of continuous monitoring of right atrial pressure in the detection of blood volume changes as previously reported in the experimental animal.^1,2 <h3>Methods</h3> Twenty-five consecutive thoracotomy patients were studied with regard to their cardiovascular status, including frequent preoperative and postoperative blood volumes, measurement of hourly urine output, blood pressure, respirations, pulse rate, and clinical evaluation of each patient during the

Valvotomy in the treatment of mitral stenosis.

The selection of patients who need surgical treatment for mitral stenosis is a problem which is no longer confined to special centres for cardiac surgery. If patients who are in greatest need of surgical treatment, and who are most likely to benefit from it, are to be given priority, selection must start with the practitioner and in the general medical clinic. The advent of valvotomy as a method of treatment has stimulated an intensive investigation of the patho logical physiology of mitral stenosis by means of cardiac catheterization and related technical procedures. This has led in turn to a renewed interest in the interpreta tion of clinical signs and symptoms. Many physical signs which have been a source of speculation since the early days of auscultation can now be more precisely interpreted in the light of surgical experience and of recent haemodynamic research. Many of the patients in the present series, and a great many others judged unsuitable for operation, have been investigated by cardiac catheterization, and, at the start, the information so obtained often fortified the decision for or against operation. But with increasing experience we are now seldom influenced by catheter findings in selecting favourable cases for surgery. Admittedly, in extending the scope of surgery to less favourable cases, full investi gation is still desirable. The low mortality and good results of mitral valvo tomy are already well known, and it is with the indica tions for operation that we are now mainly concerned. In this respect we were guided from the start by the pioneer work at Guy's Hospital (Baker, Brock, and Campbell, 1950) and in the United States (Harken et al., 1948; Bailey, 1949), but our present views have been moulded largely by personal experience.

The Silhouette Radiogram in the Interpretation of Clinical Signs

The Silhouette Radiogram in the Interpretation of Clinical Signs