New Algorithms For Diagnosis Research Articles

Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria.

To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA. This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA. Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8mm or (ii) at least one erosion at the SIJ. We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis. • Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

Структурний аналіз причин жіночого безпліддя у лікувальних закладах м. Харкова

Female infertility in the modern world remains an urgent problem that requires new algorithms for diagnosis and control of treatment. According to various authors, the first place among the causes of infertility in women is ovarian and menstrual disorders and chronic endometritis (CE). The purpose of the study is to analyze the causes of infertility in women according to the medical documentation of the “Prime-test” laboratory for the period 2014–2021, with confirmation of the diagnosis of CE by the immunohistochemistry (IHC) method. Materials and methods. Data from the medical records of patients who applied to the “Prime-test” laboratory after various gynecological interventions were studied. Female infertility was found in 521 cases. A complex histological and immunohistochemical study was conducted in 100 cases of CH. Invitrogen and eBioscience primary monoclonal antibodies were used. The results. The median age of patients with infertility was 35.7 years, with a median age of 30.45 years for patients diagnosed with CE. Ovarian-menstrual disorders (52.78%) are in the first place in the structure of the causes of infertility, in the second place (27.83%) are CE, and in the third place are infertility with an unknown cause (8.64%). The rest of the reasons accounted for a small number of cases. CE was confirmed histologically and by the IHC method in 100 cases, while the most informative marker in doubtful cases was CD138. Conclusions. Chronic endometritis is an understudied disease that requires optimization of the diagnostic and prognostic panel with the selection of the most informative markers and markers that will allow the most complete study of the state of the endometrium before and after treatment.

Skin Cancer Diagnosis by Using Fuzzy Logic and GLCM

Image processing is one of the most strong and popular computer science technologies increasingly used today especially with medical sciences. It’s commonly used to diagnose and detect many kinds of cancer diseases early such as skin cancer, and others. In this paper two techniques have been used to detect Skin Cancer. These two techniques are Fuzzy logic and GLCM (Gray Level Co-occurrence Matrix) where they can distinguish among cancerous skin and non-cancerous. The distinguish operation is based on extracted featured values from GLCM. The features GLCM include are Contrast, Correlation, Energy, Entropy, and Homogeneity. However, our contribution is a new algorithm for diagnosis two phase, the first is the normal situation and second is the skin cancer. After the design and implementation of the algorithm the result was good as we can see in the implementation section.

Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients

Despite effort to diagnose tuberculosis (TB) in the Human Immunodeficiency Virus (HIV) infected population, 45% of adults with HIV that had a previously unknown reason for death, demonstrated TB was the cause by autopsy examination. We aimed to assess the clinical outcomes of implementation a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness. This study is a prospective cohort conducted in three-referral hospitals in Kilimanjaro, recruited 97 PLHIV from February through June 2018. Patients provided urine and sputum samples for testing lateral flow - lipoarabinomannan (LF-LAM) and Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays, respectively. Anti-TB was prescribed to patients with positive LF-LAM or Xpert MTB/RIF or received broad-spectrum antibiotics but deteriorated. Of 97 patients, 84 (87%) provided urine and sputa, and 13 (13%) provided only urine. The mean age (95% confidence interval) was 40 (38-43) years and 52 (54%) were female. In 84 patients, LF-LAM increased TB detection from 26 (31%) by Xpert MTB/RIF to 41 (55%) by both tests. Of 97 patients, 69 (71%) prescribed anti-TB, 67% (46/69) and 33% (23/69) had definitive and probable TB respectively. Sixteen (16.5%) patients died, of which one died before treatment, 73% (11/15) died within 7 days of admission. The 30-day survival was similar in both treatment groups (log rank = 0.1574). Mortality was significantly higher among hospitalized patients compared to outpatients (P ≤ 0.027). Implementation of new algorithm increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay. Survival of PLHIV with confirmed or probable TB was comparable to those of PLHIV that were treated with broad-spectrum antibiotics alone. Further work should focus on the optimal timing and content of the immediate antimicrobial regimen for sepsis among PLHIV in TB-endemic settings.

Que retenir des dernières recommandations européennes sur l’insuffisance cardiaque chronique et aiguë ?

Heart failure is the main chronic disease in cardiology. Its prognosis remains poor despite improvements in its management that allow patients to live increasingly longer with this disease, alternating periods of stability and episodes of decompensation. Treatment guidelines are regularly updated to integrate new results of recent trials that are likely to influence routine care. These guidelines are proposed with different classes of recommendations and difference levels of evidence. It is of paramount importance to summarize the guidelines to make them accessible to the vast majority of cardiologists and easier to read to promote their application. Among the main novelties of the last set of European guidelines for the management of heart failure, we note the proposal for a new classification based on the level of left ventricular ejection fraction (LVEF) with a new class, called heart failure with mid-range ejection fraction (LVEF 40-50%), new algorithms for diagnosis and treatment, including the diagnosis of heart failure with preserved ejection fraction, a special focus on preventive strategies, the management of comorbidities including iron deficiency, simplification of the indications for cardiac resynchronization therapy, and finally a growing attention to patient pathways and to the management of hospital discharge. According to these guidelines, it is important that the physician choose the appropriate medications; but it is equally fundamental that the patient understands the disease and acquires self-care skills needed to become a real player in its management. This requires patient education, which is underdeveloped in France.

Using Molecular Phenotyping to Guide Improvements in the Histologic Diagnosis of T Cell-Mediated Rejection.

Recognition that some lesions typical of T cell-mediated rejection (TCMR) also occur in antibody-mediated rejection requires revision of the histologic TCMR definition. To guide this process, we assessed the relative importance of various lesions and the performance of new histology diagnostic algorithms, using molecular TCMR scores as histology-independent estimates of true TCMR. In 703 indication biopsies, random forest analysis and logistic regression indicated that interstitial infiltrate (i-lesions) and tubulitis (t-lesions) were the key histologic predictors of molecular TCMR, with arteritis (v-lesions) having less importance. Histology predicted molecular TCMR more accurately when diagnoses were assigned by strictly applying the Banff rules to the lesion scores and redefining isolated v-lesion TCMR. This improved prediction from area under the curve (AUC) 0.70 with existing rules to AUC 0.80. Further improvements were achieved by introducing more categories to reflect inflammation (AUC 0.84), by summing the lesion scores (AUC 0.85) and by logistic regression (AUC 0.90). We concluded that histologic assessment of TCMR can be improved by placing more emphasis on i- and t-lesions and incorporating new algorithms for diagnosis. Nevertheless, some discrepancies between histologic and molecular diagnoses persist, partially due to the inherent nonspecificity of i- and t-lesions, and molecular methods will be required to help resolve these cases.

New Diagnostic Candidate Molecular Biomarkers of Acute Respiratory Distress Syndrome

Editorial dedicated to the development of the algorithm of diagnosis and prognosis of acute respiratory distress syndrome (ARDS), based on the use of recent data (2012—2014) from the V. A. Negovsky Institute of General reanimatology. Modern approaches to the diagnosis and treatment of ARDS are discussed. Available modern data including results of own recent investigation have clearly demonstrated the potential of quantifying surfactant proteins SPA and SPD, which pro duced by cells of the respiratory epithelium, for the early diagnosis and prognosis of ARDS. A new algorithm for diagnosis and prognosis of ARDS based on a sequential quantification of SPA and SPD molecules in the plasma of patients in crit ical conditions is suggested. Circulating SPA and SPD are considered as valuable candidate biomarkers for developing multiparametric panel of biomarkers for diagnosis and prognosis of ARDS in patients with lifethreatening critical illness.

A new algorithm for diagnosis of anemia.

Studies of the cognitive processes of diagnosis have shown that use of heuristics (eg, shortcuts, rules of thumb) dominates clinical problem solving. Thus, an algorithmic approach to diagnosis can be particularly useful. Because the sensitivity and specificity of many tests are not known, however, this approach is not perfect. Therefore, algorithms should be taken as a general guide to diagnosis but should not be applied too rigidly. In the past, algorithms for anemia did not apply any principles of decision analysis. The algorithm presented in this article is based on test operating characteristics reported in the literature. Disease is excluded by highly sensitive tests (screening tests) and confirmed by highly specific tests (pathognomonic findings). This algorithm can reduce the need for expensive, complex procedures, including radioisotope studies (eg, chromium 51 red blood cell study, ferrokinetics). It provides a rational and semiquantitative estimation of diagnostic possibilities. Alternate pathways to diagnosis may arise in individual cases. Also, the algorithm is difficult to apply to multifactorial anemias.