Positive Diagnosis Research Articles

Burden of community acquired pneumonia in medically admitted patients with positive past admission history

Aims: The study examined the correlation between Community-Acquired Pneumonia (CAP) burden in hospitalized geriatric patients and their history of admission frequency, revealing a correlation between previous admissions and CAP burden in newly admitted patients. Methods: This study analyzed geriatric patients aged 65 and above admitted to King Hussein Medical Centre in Amman, Jordan. The patients were divided into two age groups and assessed for prognostic factors such as frequency of prior admissions, CURB-65 assessment score, comorbidity burden, and composite outcomes of interest (cOI). The study found that positive cOI was associated with adverse outcomes such as high admission rates, transfers to critical care units, oxygen desaturation, and mortality. Patients were divided into two groups based on Community-Acquired Pneumonia (CAP) diagnosis, with improved cOI indicating the absence of adverse outcomes. The study conducted multiple linear regression analysis to investigate the relationship between past admission frequencies and CAP severity. The results showed significant correlations between factors such as age, gender, and comorbidity burden. Results: This retrospective observational study evaluated 641 geriatric patients who were medically admitted for community-acquired pneumonia (CAP). The results showed that approximately 52.73% (338 patients) experienced a negative diagnosis of CAP, while 47.27% (303 patients) experienced a positive diagnosis. The study found a statistically significant difference in the tested gender between the dichotomised outcome groups (Groups I-II). The odds ratio for a positive CAP in elderly geriatric patients admitted for medical reasons was found to be 3.441. The CAP positivity group had a distribution rate for poorer outcomes of approximately 74.9% (227 patients) compared to 29.0% (98 patients) in the CAP negativity group. The study also found a statistically significant association between comorbidity burden and frailty among geriatric patients. The highest distribution rates were observed in geriatric patients with a CURB-65 score of 3, followed by those with a score of 4, with frequencies of 171 (56.4%) and 124 (40.9%), respectively. The study performed a multiple linear regression analysis, focusing on the assessment of CURB-65 scores in geriatric patients diagnosed with community-acquired pneumonia who were medically admitted. The constructed regression model accounted for approximately 86.4% of the variability in the target variable, as explained by the four independent variables tested. Conclusion: The study found a significant correlation between geriatric patients' prior admission history and the diagnosis of community-acquired pneumonia, indicating an increased severity of CAP with a higher frequency of past admission days.

Prevalence of Post-Traumatic Stress Disorder among COVID-19 Survivors: A 6-Month Follow-up Study in a Few Referral Hospitals of Tehran, Iran

Background: COVID-19 has significantly impacted individuals globally, leading to heightened levels of stress and psychological distress. COVID-19 hospitalized patients experience social exclusion, physical pain, and survival anxiety. This study aims to screen recovered COVID-19 patients for Post-Traumatic Stress Disorder (PTSD) and assess its correlation with psychosocial factors for six months. Methods: In this descriptive-analytical cohort study, 401 patients aged 18-80 years were hospitalized in hospitals related to Tehran University of Medical Sciences due to COVID-19 from March 1 to May 31, 2021, and were followed for six months. Recovered patients completed electronic PCL-5 and demographic questionnaires to be screened for PTSD and other psychiatric comorbidities. The data were analyzed utilizing multivariate logistic regression models. Results: Based on the PCL-5, PTSD was diagnosed in 6.4% of the samples. 10.2% of the samples received a subthreshold PTSD diagnosis. 46.2% of the samples with a PTSD diagnosis had a positive past psychiatric history. Results demonstrated that a previous positive psychiatric diagnosis has a statistically significant relationship with PTSD (p<0.05). This research did not reveal any significant association between PTSD symptoms and demographic features. Conclusion: PTSD and subthreshold PTSD rates in COVID-19 patients after hospital discharge are significant. A positive past psychiatric history was recognized as a contributing factor contributing to the onset of PTSD. COVID-19 survivors should be screened for PTSD during follow-up examinations.

Positive signs from the history as an aid for early diagnosis in functional movement disorders: The prospective TASMAN study.

There has been a concerted move in recent times to shift from an exclusionary to a positive diagnosis of functional movement disorders (FMDs). To date, most of the focus has been on defining positive physical signs. Here the focus was on the diagnostic specificity of specific symptoms and patient characteristics. For this prospective cohort study, newly referred patients in the Netherlands and Australia were recruited before their first neurology appointment. Participants completed questionnaires within 2 months prior to their visit at one of the six different clinics. Directly following the first consultation, physicians received a questionnaire about their diagnostic process. Patients were excluded if the diagnosis was not a movement disorder. Univariate and multivariate regression analyses were conducted to identify predictors of FMDs. Subsequently, a predictive model was constructed and assessed using the area under the receiver operating curve. Between 1 March 2021 and 1 March 2023, 465 patients were eligible for inclusion, of whom 171 (37%) had an FMD and 294 (63%) a non-FMD. Distinguishing factors amongst these groups included age at onset, gender, history or family history of a functional and psychiatric disorder, sudden onset, specific triggers, fluctuation patterns throughout the day and over an extended period, pain, fatigue, depression, anxiety and dissociation. Using these, a predictive model was developed, yielding a discriminative accuracy of 88%. Specific symptoms and patient characteristics have high diagnostic discriminative value between FMDs and non-FMDs, providing an additional tool in positive diagnosis.

Perceptions and Practices of Primary Care Providers in Europe and the US in the Diagnosis and Treatment of Irritable Bowel Syndrome: A Multinational Survey.

The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition. We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists. Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition. Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.

Pediatric MASLD: current understanding and practical approach.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent chronic liver disease in children in industrialized countries mainly due to the rise in obesity and overweight. Besides risk of progressive liver damage, MASLD also carries an increased risk of extra-hepatic morbidity, most importantly type 2 diabetes mellitus and cardiovascular disease. Important challenges remain in the prevention, detection, and treatment of this prevalent disorder. This review outlines the epidemiology and risk factors of MASLD and provides an approach to screening, diagnosis, and treatment based on current best available evidence and expert opinion. What is known: • NAFLD/MASLD is a common disorder in children strongly related to obesity/overweight and insulin resistance. • This silent disorder is underdiagnosed due to lack of awareness and lack of simple diagnostic criteria. What is new: • New diagnostic criteria have transformed NAFLD/MASLD from a diagnosis of exclusion to a positive diagnosis with simple criteria. • Effective treatments are emerging for adults and will likely become available for children. • Identifying children with NAFLD/MASLD has become even more important due to this new treatment perspective.

Abstract A026: A novel ddPCR detects hypermethylated RASSF1A in plasma of patients with pediatric Wilms tumor

Abstract Background: Wilms tumor is the most common pediatric renal cancer. Within the SIOP-Renal Tumor Study Group (SIOP-RTSG), diagnosis is based on imaging and patients receive neo- adjuvant treatment. Final diagnosis is established via histopathological analysis at the timepoint of surgery, which also determines the intensity of adjuvant treatment. Overall, patients with Wilms tumor have a 90% survival rate, but one in five patients will suffer from a relapse, which requires intensive treatment and induces long-term toxicity. It is challenging to identify patients at risk of suffering from relapse at initial diagnosis. Hence the need for additional biomarkers that will optimize risk stratification and minimal residual disease monitoring. RASSF1A is a tumor suppressor gene that is silenced via hypermethylation of its promotor region in multiple adult and pediatric tumors and is reported to represent an aggressive phenotype. We have previously reported on thirteen patients with Wilms tumor where increased hypermethylation of RASSF1A (RASSF1A-M) was observed in plasma cell-free DNA (cfDNA). The aim of this study was to further investigate the levels of RASSF1A-M in a larger cohort. Methods: The presence of RASSF1A-M in plasma cfDNA of patients with Wilms tumor was quantified using a multiplexed droplet digital PCR comprising methylation-specific restriction enzymes. Diagnosis and pre- surgery samples were included to evaluate RASSF1A-M levels during treatment. Results: A total of 49 patients were evaluated. At diagnosis, 37/46 (80.4%) samples were positive for RASSF1A-M. Negative samples were from patients with localized disease (N=6), regressive type regionally advanced Wilms (N=1) or mixed type metastatic Wilms (N=2). RASSF1A-M levels were significantly elevated in regionally advanced and metastatic disease compared to localized disease. Of the 37 positive diagnosis samples, 23 pre-surgical follow-up samples were available. In 7/23, RASSF1A-M was still detectable. These belong to patients with stromal-, regressive- or diffuse anaplastic predominant tumors. Interestingly, an increasing methylation level was seen in one patient with a regressive tumor. Conclusion: RASSF1A-M is a potential biomarker for patients with Wilms tumor, since it was detected in the majority of patients. Furthermore, significantly increased levels were observed in regionally advanced and metastatic disease. In the small number of patients with persisting levels of RASSF1A-M, we did not observe an association with risk groups. In collaboration with SIOP-RTSG, additional follow-up samples will be analyzed to explore the potential of RASSF1A-M as biomarker for relapse detection. Citation Format: Julia Sprokkerieft, Nathalie S.M. Lak, Zeinab van Gestel-Fadaie, Marry M. van den Heuvel-Eibrink, Godelieve A.M. Tytgat. A novel ddPCR detects hypermethylated RASSF1A in plasma of patients with pediatric Wilms tumor [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A026.

Identifying Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System.

This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system. A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific "indicators" (maternal positive antibody test and abnormal antibody titer, maternal/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed. Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal/infant HDFN diagnosis, and infant jaundice/phototherapy. We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding. · A case ascertainment method was developed to identify HDFN from structured and unstructured data.. · The method used in this study may be used in future pharmacoepidemiologic studies.. · The study highlighted an unmet need for improved practices in HDFN coding..

Abstract 4135466: Feasibility of Using Existing Infection Surveillance Methods for Percutaneous Coronary Intervention-related Infections

Background: Percutaneous coronary intervention (PCI) is a treatment that requires attention in terms of infection control, as it necessitates aseptic procedures similar to surgical operations. However, surveillance practices for PCI-related infections are uncommon, and no standardized surveillance program has been established. Purpose: To assess the feasibility of using existing surveillance methods to detect PCI-related infectious diseases. Method: To identify PCI-related bloodstream infections of local access sites, four existing case definitions, namely, laboratory-confirmed bloodstream infections (LCBI), clinical sepsis (CSEP), local access site infection (LASI), and exit site infection (ESI), were retrospectively applied to 1,037 patients who underwent PCI between April 2018 and March 2021. Of these, 167 experienced fever, underwent blood culture testing, and/or received antibiotics within 6 days of PCI. To confirm consistent evaluation, two independent infection control experts evaluated each case record according to the four case definitions. Results: Twenty-three patients (2.2%) were diagnosed with PCI-related infections, including two patients according to LCBI, 21 according to CSEP, and none according to LASI and ESI. Thirteen patients (LCBI: 1, CSEP: 12) received circulatory assist devices such as intra-aortic balloon pumping. Of the remaining 11 patients, 10 underwent emergency PCI, and one underwent elective PCI ( P =0.0001). The average length of hospital stay was 16.1 days for patients with PCI-related infections and 4.7 days for non-infected patients ( P <0.05). Conclusion: The positive diagnosis of PCI-related infections was predominantly based on CSEP. Many of these positive patients underwent emergency PCI and/or received circulatory assist devices. The results of the present study warrant further investigations with larger patient cohorts.

EPID-13. PREDICTORS OF HISTOPATHOLOGIC RESULTS OF BRAIN BIOPSY IN PATIENTS SUSPECTED OF SECONDARY CNS LYMPHOMA

Abstract Patients suspected of secondary CNS lymphoma (SCNSL) often undergo brain biopsies. Recent studies doubt biopsy utility due to high SCNSL diagnosis rates. We sought to enumerate histopathologic biopsy results in suspected SCNSL patients to evaluate utility of biopsy. We furthermore assess clinical and radiographic factors based on ability to distinguishing SCNSL from non-SCNSL. 109 patients with non-CNS lymphoma who subsequently presented with brain lesions that underwent biopsy at MD Anderson Cancer Center were included. Histopathologic diagnoses were obtained. Pre-operative imaging was assessed for contemporary radiologic diagnoses by obtaining the leading differential reported at the time of the study. Subsequently, a staff neuroradiologist, blinded to biopsy outcomes and clinical considerations, provided a retrospective diagnosis. 61 patients had SCNSL whereas 48 did not. Non-SCNSL biopsy results included infection (n=16, 33%), glioma (n=12, 25%), nonspecific (n=12, 25%), and other metastases (n=3, 6%). Patients with non-indolent lymphoma (DLBCL, mantle cell, Burkitt’s, and lymphoblastic lymphoma) were more likely to have SCNSL on biopsy (p<0.001, OR 12.55). Patients with SCNSL had shorter time interval since initial diagnosis (median 18.1mo vs. 63.2mo, p=0.008). Systemic progression of disease at biopsy was not associated with SCNSL (p=0.35). There was no difference in age, stage, LDH, Albumin, ECOG, IPI, anatomic location, or B-symptoms at times of diagnosis or neurosurgery. No patient had positive CSF cytology prior to biopsy. Neither retrospective nor contemporary radiographic diagnoses had sufficient accuracy to replace biopsy. A positive retrospective diagnosis trended towards association with SCNSL pathology (sensitivity=0.94, specificity=0.23, PPV=0.65, NPV=0.70, p=0.08). A positive contemporary diagnosis was associated with SCNSL pathology (sensitivity=0.67, specificity=0.73, PPV=0.76, NPV=0.64, p<0.001). Similar biopsy proportions yielded SCNSL and non-SCNSL. Although some factors are associated with SCNSL, none can reliably distinguish patients. Given the divergent treatments for the reported pathologies, our study reiterates the necessity of biopsy in suspected SCNSL.

BIOM-70. CSF TUMOR CELL (CSF-TC) DETECTION, QUANTIFICATION AND BIOMARKER ASSESSMENT HELPS IN CLINICAL MANAGEMENT OF BREAST CANCER AND NON-SMALL CELL LUNG CANCER PATIENTS HAVING LEPTOMENINGEAL DISEASE (FORESEE STUDY, NCT05414123)

Abstract Leptomeningeal metastases (LM) or the presence of cancer cells in the cerebrospinal fluid (CSF)/pia remains a challenging disease to diagnosis and treat. Current standard of care methods to diagnose or assess treatment response of LM (Clinical Evaluation, MRI and Cytology) have limited sensitivity and specificity and are poorly quantifiable. This creates challenges for physicians to manage LM or determine the best course of treatment. The FORESEE Study was a multi-center, prospective clinical trial evaluating a novel diagnostic platform, CNSide, that aimed to overcome these challenges. The FORESEE study enrolled patients with breast or non-Small Cell Lung Cancer (NSCLC) with suspicion of or confirmed LM. CNSide can detect and quantify tumor cells in the CSF from patients with breast cancer or NSCLC having a suspicious or confirmed LM. This platform also is able to identify actionable mutations in the CSF via Fluorescent In Situ Hybridization (FISH) and next-generation sequencing. The primary end point of the FORESEE study was clinical utility and the impact of CNSide on physician treatment decisions. Secondary endpoints included evaluating the clinical performance of CNSide vs. cytology in tumor cell detection (sensitivity, specificity, PPV and NPV). The study enrolled 40 patients (22 breast cancer and 18 NSCLC). Each patient underwent standard of care diagnostic evaluations at baseline and at three follow up timepoints through their treatment. CNSide aided clinical decision making in 93% (50/54) of the clinical decisions. At baseline 39 patients were assessed and confirmed a positive LM diagnosis in 15% (6/39), a negative LM diagnosis in 8% (3/39), progression in 15% (6/39), resolution in 15% (6/39) and no progression, or resolution in 36% (14/39) of the patients. CNSide informed the specific drug selected for treatment in 26% (10/39) patients at baseline and demonstrated clinical high utility. The FORESEE data is undergoing ongoing analysis; updated analysis will be presented at the meeting.

Novel Gene Variants in a Nationwide Cohort of Patients with Pheochromocytoma and Paraganglioma.

Pheochromocytomas (PCCs) and paragangliomas (PGLs), denoted PPGLs, are rare neuroendocrine tumours and are highly heterogeneous. The phenotype-genotype correlation is poor; therefore, additional studies are needed to understand their pathogenesis. We describe the clinical characteristics of 63 patients with PPGLs and perform a genetic study. Genetic screening was performed via a targeted gene panel, and clinical variables were compared among patients with a positive molecular diagnosis and negative ones in both PCC and PGL cohorts. The mean age of patients with PCC was 50.0, and the mean age of those with PGL was 54.0. Disease-causing germline variants were identified in 16 individuals (25.4%), twelve and five patients with PCC and PGL, respectively. Genetically positive patients were younger at diagnosis in both cohorts. Variants in genes associated with either isolated PPGLs or syndromic forms of the disease were detected in a cohort of PPGLs. We have identified novel variants in known genes and set the importance of genetic screening to every patient with PPGLs, with a special focus on the young. A longer follow up of patients with variants in genes associated with syndromic forms is of clinical value.

Economic impact case study of a wearable medical device for the diagnosis of obstructive sleep apnoea

BackgroundAcuPebble SA100 (‘AcuPebble’) is a novel wearable medical device to diagnose obstructive sleep apnoea (OSA). This paper investigates the potential economic impact of the technology in the UK through cost savings analysis, and the redirection of savings into further diagnoses.MethodsA cost comparison study was conducted, comparing AcuPebble to the standard diagnostic approach of home respiratory polygraphy (HRP) and in-clinic polysomnography (PSG), estimating the net benefit value (NBV) and return on investment (ROI). Cohort size was varied to model the effects of volume discounted pricing and staff training costs. To demonstrate the potential for cost savings, data on the healthcare costs of undiagnosed OSA patients were used to quantify the benefit of increased OSA diagnosis rates, as facilitated by AcuPebble.ResultsFor 500 uses of AcuPebble, the NBV in the diagnostic pathway over one year would be in excess of £101,169, increasing to £341,665 for 1,500 uses, £1,263,993 for 5,000 uses, and to £2,628,198 for 10,000 uses, with ROIs of 2.02, 3.03, 5.05, and 6.56, respectively. Given an initial cohort of 1,500 patients, 4,555 extra AcuPebble studies could be completed by redirecting resources from HRP/PSG. Direct cost savings to the NHS from resultant lower undiagnosed rates could be between £24,147 and £4,707,810, based on the cost per use and the percentage of tests that result in a positive diagnosis (varied from 25 to 75% positives).ConclusionsAcuPebble presents an opportunity for substantial healthcare savings, enabling an increase in the number of people tested, diagnosed and treated for OSA.

Diagnosis and evaluation of anterior and posterior urethral stenosis in men: Clinical and radiological aspects.

The diagnosis of urethral strictures logically includes a precise assessment of urinary symptoms, but must also take into account the impact on sexuality. What role will new imaging play in 2024? A literature review from December 2020 to December 2023 was carried out, combined with a synthesis of the recommendations of the American, Canadian, European and French urology associations. References from these recommendations were also used. The evaluation of urethral stenosis comprises several phases. First phase: questioning will focus on making an etiological diagnosis and establishing the impact on urinary and sexual quality of life, with the help of questionnaires. Second phase: the clinical examination should not be overlooked, as it will have a major impact on treatment proposals. Third phase: additional examinations are needed to make a positive diagnosis of the stenosis, and to assess its extent, severity and consequences. These include flowmetry/post-voiding residual (PVR), retrograde uretrography (RUG) and voiding cystourethrography (VCUG) together with fibroscopy. Today, there is a growing consensus in favor of MRI for the evaluation of posterior urethral stenosis, in particular to search for associated lesions. The evaluation of urethral strictures should focus on making a positive and etiological diagnosis. It is essential to assess the impact on voiding and sexual activity, as well as any associated lesions, which may affect management and the information given to patients.

Diagnostic Accuracy of Dual-Energy CT for Bone Stress Injury of the Lower Limb.

Background Because of its ability to help assess the presence of subtle morphologic changes in bone and bone marrow edema, dual-energy CT (DECT) could be an alternative to MRI in the diagnosis of bone stress injury that includes a stress fracture (SF) and stress reaction (SR). Purpose To determine the diagnostic accuracy of DECT in identifying bone stress injury of the lower limb using MRI as the reference standard. Materials and Methods This prospective study, conducted between June 2021 and January 2024, included consecutive patients clinically suspected of having stress injury (SF or SR) of the lower limb (leg, ankle, or foot). Imaging diagnosis was based on the absence or presence of cortical or periosteal changes, bone marrow edema, or a fracture line. The diagnostic performance of four blinded independent readers was determined for the entire cohort and for the subset of participants without fracture lines. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Interobserver agreement was evaluated with Kendall coefficient of concordance (W). Results A total of 184 patients (mean age, 58 years ± 17 [SD]; 97 male) were enrolled. At MRI, 107 of 184 participants (58%) had positive diagnoses, including 70 with SF and 37 with SR. The mean overall sensitivity and specificity were 91% (390 of 428; 95% CI: 0.85, 0.95) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.94 (95% CI: 0.91, 0.97). Among patients without fracture lines (n = 114), the mean overall sensitivity and specificity of DECT were 79% (117 of 148; 95% CI: 0.65, 0.88) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.87 (95% CI: 0.81, 0.94). The interobserver agreement was very good for diagnosis of SF and SR combined (Kendall W = 0.90) and SR alone (Kendall W = 0.84). Conclusion DECT helped to accurately diagnose bone stress injury of the lower limb by identifying fracture lines and osseous stress reactions. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Breighner in this issue.

Impact of High Troponin Level on the Outcome in COVID-19 Positive Patients.

COVID-19 is a new disease caused by the recently discovered SARS-CoV-2 virus. The COVID-19 disease manifests in several ways and it may affect various systems, including the gastrointestinal, musculoskeletal, neurological, cardiovascular, and pulmonary systems. Individuals who have ad-additional health conditions, such as cardiovascular disorders, are particularly more likely to experience illness and death. This study aimed to assess the clinical effect of COVID-19 on myocardial injury, as measured by troponin elevation, and to determine if this effect has an impact on the outcome. This retrospective study was conducted at King Saud Medical City. The electronic medical records used to identify all admitted patients between March 23 and June 15, 2020, with a laboratory-confirmed positive COVID-19 diagnosis who had troponin I measured. During the study period, 768 COVID-19-positive patients were hospitalized. Of those, 187 patients were excluded because the troponin level was not measured. The remaining 581 (75.7%) had troponin I measured. Overall, 89 of 581 (15.3%) patients died. Of those, 67.8% were in the markedly elevated cTnI group, 8.5% were in the mildly elevated cTnI group, whereas no deaths were reported in the group with normal cTnI levels. Myocardial injury was observed in COVID-19-admitted patients at a significant level that warrants attention to this consequence. In older individuals with pre-existing cardiovascular comorbidities, the diagnosis of myocardial injury was linked to a higher likelihood of being admitted to the intensive care unit, experiencing a worse prognosis, and ultimately, death.

Rasmussen's Aneurysm: A Rare Cause of Massive Hemoptysis in Pulmonary Tuberculosis

Rasmussen's aneurysm is a rare cause of hemoptysis in patients with tuberculosis. It is an under-recognised vascular complication of active pulmonary tuberculosis, with a mortality rate of over 50%. It is secondary to an aneurysmal dilatation of the pulmonary artery adjacent to tuberculous cavity. Thoracic CT angiography is the gold standard for making a positive diagnosis and precising the hemorrhagic site, with a mapping of the pulmonary artery damage. Rupture of the artery can cause massive hemoptysis, which can sometimes be devastating. It is important to remember that hemoptysis persists despite successful bronchial artery embolisation in all patients with tuberculosis.

An evaluation of the first ten years of Newborn Screening for cystic fibrosis in Ireland

Abstract Ireland has the world’s highest incidence of cystic fibrosis (CF). Newborn screening for CF (NBSCF) improves outcomes but identifies carriers and may yield false positive/inconclusive results. This study aimed to evaluate the performance of the first 10 years of the Irish NBSCF programme. Data collected by the programme between 01st July 2011 and 30th June 2021 were analysed, including cases of CF, CF carriers and Cystic Fibrosis Screen Positive Inconclusive Diagnosis (CFSPID). Microsoft Excel was used to calculate sensitivity, specificity and positive predictive value (PPV). Results were compared to European Cystic Fibrosis Society (ECFS) standards. Overall 650,809 neonates were screened, with 290 cases of CF, 533 CF carriers and 21 CFSPIDs reported. NBSCF identified 284 (98%) of the children with CF, sensitivity was 97.93% (95% CI 96.29-99.57), specificity was 99.91% (95% CI 99.91-99.92%), PPV was 0.34 (95% CI 0.31-0.37). The observed incidence of CF was 1 in 2,203, still Europe’s highest. Of the six undetected cases, most were of Asian ethnicity, suggesting panel limitations for diverse ethnicities.The Irish NBSCF programme exceeded ECFS standards. Most false negatives were caused by CFTR mutations undetected by the genetic panel. Increasing the size of the genetic panel increases detection of CFSPID and carriers and is not currently recommended. Ongoing validity monitoring is vital as the Irish population diversifies. Key messages • The Irish Newborn Screening Programme for Cystic Fibrosis is effective. • Ongoing validity monitoring is vital as the Irish population diversifies.

Diagnostic potential of relative changes in high-sensitivity troponin levels during intracoronary acetylcholine provocation testing

Abstract Background Intracoronary acetylcholine (ACh) provocation testing is useful for the diagnosis of vasospastic angina (VSA). However, the positive or negative diagnosis of ACh testing is often challenging when lacking typical anginal symptoms and electrocardiographic changes during provocation tests. We hypothesized that relative changes in cardiac troponin levels during ACh provocation testing may be suggestive of myocardial ischemia and would be helpful for the VSA diagnosis. Purpose To evaluate the diagnostic potential of relative changes in high sensitivity troponin I (hs-TnI) levels during intracoronary ACh provocation test. Methods This preliminary study included a total of 29 patients undergoing invasive coronary angiography with or without ACh provocation tests. Patients were divided into three groups; no ACh provocation tests (i.e. angiography alone), negative ACh tests, and positive ACh tests. Blood samples were obtained twice, before and after angiography, through the arterial sheath to evaluate hs-TnI. The primary measure was relative changes in hs-TnI (i.e. Δhs-TnI). Positive ACh provocation test was defined as total or subtotal coronary occlusion accompanied by chest pain and/or ischemic electrocardiographic changes. Results Of the 29 patients, 10 (34.5%) underwent coronary angiography alone, while ACh provocation testing was performed in 19 (65.5%) patients, of whom 7 (36.8%) and 12 (63.2%) had negative and positive ACh test results. Overall, the mean time interval between the blood sample collections was 76 minutes. Levels of hs-TnI before angiography did not differ significantly in the no, negative, and positive ACh test groups (5.3 [2.8, 8.6] vs. 2.9 [1.3, 8.8] vs. 3.3 [1.6, 8.5] pg/ml, p=0.76), while Δhs-TnI was highest in the positive ACh test group, followed by the negative and no ACh test groups (4.2 [0.5, 8.1] vs. 0.8 [0.4, 4.6] vs. −0.3 [−0.6, 0.3], p=0.002) (Figure). Conclusions In patients undergoing intracoronary ACh testing for the VSA diagnosis, a relative increase in Δhs-TnI during angiography was observed than in those who did not undergo the provocation tests, particularly when the ACh test diagnosis was positive. Our findings suggest that Δhs-TnI has the potential to aid in the positive or negative diagnosis of ACh provocation testing.

Health literacy in pregnant women facing prenatal screening: a short report from “SaperePer” project

Abstract Advancements in health promotion and prenatal medicine have made noninvasive prenatal testing (NIPT) a common practice during pregnancy, but understanding prenatal health information becomes crucial not only for the well-being of the mother but also for that of the unborn child. Analyze health-related information during pregnancy is fundamental, and this work fits perfectly with this topic, reporting preliminary results from the pilot study “SaperePer”. A health-related questionnaire was administered to 358 women in the first trimester of pregnancy, aiming to study different outcomes: 1.level of knowledge of NIPT; 2.number of screening tests undergone; 3.willingness to undergo a diagnostic test with a high outcome risk of screening test; 4.willingness to end the pregnancy following a diagnosis of pathology. The questionnaire was divided into 3 sections: personal characteristics and lifestyle habits, prenatal health behavior scale (PHBS), and knowledge of NIPT. Preliminary results showed that the level of knowledge of NIPT was higher in older, atheist, working, wealthy highly educated, and preliminary informed women, as well as the higher number of screening tests undergone and the propensity to undergo an invasive diagnostic test after a high-risk screening result (KS and MW tests p < 0.05). On the contrary, women with lower education, faithful and, even more, not preliminary and appropriately informed during prenatal counseling showed lower knowledge of NIPT, lower number of tests undergone, and meager chances to undergo an invasive diagnostic test or to end the pregnancy after a positive diagnosis of pathology (KS and MW tests p < 0.05). In conclusion, this study evaluated health-related information during the first but crucial stages of pregnancy, opening a new understanding of how health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women, particularly in those women with lower cultural tools. Key messages • Health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women. • Understanding prenatal health information becomes crucial both for maternal and prenatal well-being.

Memory impairment after one year of the acute episode of Covid-19 infection

Abstract Introduction Memory impairment is one of the most frequently reported sequelae of COVID-19 infection. The aim of our study was to estimate the risk of memory disorders one year after the acute episode of COVID-19 infection in the Tunisian population of Monastir. Methods This is a cohort study conducted in Monastir University Hospital. The study included two groups: Exposed subjects were randomly selected among those with a positive diagnosis of COVID-19 between September 2021 and January 2022. The non exposed group was selectd among subjects with a negative COVID-19 diagnosis during the same period and who had no COVID infection during the following year. The Mac Nair scale was used to assess memory impairment after one year of follow up. Results Our study included 140 subjects diagnosed with Covid-19 and 139 subjects who had never been in contact with this virus. The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9% (IC95% [11.5 - 24.2%]), whereas in the non exposed group it was 9.4% (IC95% [4.45% -14.5%]). Multivariate analysis revealed that the group exposed to Covid-19 had a significantly higher Mac-Nair Total score after one year of the acute episode of infection compared with the non exposed group (exp β = 1.25, IC95% [1.10; 1.42]). The other main predictors of memory impairment in the study population were age (exp β = 1.006, IC95% [1.001; 1.01]), diabetes (exp β = 1.67, IC95% [1.44; 1.95]), history of anxiety and depression ((exp β = 1.71, IC95% [1.35; 2.17]) and obesity (exp β = 1.25, IC95% [1.10; 1.42]), whereas vaccination with two or more doses prior to COVID-19 infection (exp β = 0.84, IC95% [0.74; 0.96]) and male gender (exp β = 0.65, IC95% [ 0.57; 0.73]) were found to be protective against these disorders. Conclusions Our study allowed us to estimate the risk of long-term memory disorders following Covid-19 infection. This could help better guide preventive measures to reduce the incidence of these disorders. Key messages • The incidence rate of memory impairment at one year post-Covid-19 infection was 17.9%. • The main other predictors of memory impairment were age, female gender, diabetes, history of anxiety and depression and obesity whereas vaccination prior to COVID-19 infection was a protective factor.