Results Of Clinical Examination Research Articles

Predictive value of monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) for poor prognosis after intravenous thrombolytic therapy for acute ischaemic stroke

IntroductionThe purpose of this study was to examine the relationship between monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and poor short-term 3-month and long-term 6-month prognosis after intravenous thrombolysis in patients with acute ischaemic stroke.Material and methodsBy retrospective analysis, 763 eligible patients with acute ischaemic stroke with intravenous thrombolysis were included in the study, and the general data and clinical laboratory examination results of the patients were collected. The relationship between MHR and poor prognosis at 3 and 6 months in patients with intravenous thrombolysis was derived by stepwise regression using the R language, followed by 1:1 propensity score matching to determine the MHR threshold and to investigate the relationship between high and low MHR values and poor prognosis.ResultsMHR level was found to predict the prognosis of intravenous thrombolysis patients with acute ischaemic stroke, and it was an effective predictor of poor prognosis at 3 and 6 months after intravenous thrombolysis. MHR has a threshold of 0.584. High MHR levels were strongly associated with a poor 3-month prognosis of intravenous thrombolysis in patients with acute ischaemic stroke (OR = 5.657; 95% CI: 4.124–7.762; p < 0.001). High MHR level was closely associated with poor prognosis of acute ischaemic stroke patients with intravenous thrombolysis at 6 months (OR = 4.923; 95% CI: 3.603–6.726; p < 0.001).ConclusionsMHR level is a valid predictor for poor prognosis at 3-6 months after intravenous thrombolysis in patients in acute ischaemic stroke.

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records.

Tuberculosis (TB) causes over 1million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil. We obtained data on individuals treated for TB between 2015 and 2018 from Brazil's National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment. Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62-3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25-1.32], vs. female sex), Black race (aOR 1.23 [1.19-1.28], vs. White race), no education (aOR 2.03 [1.91-2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63-2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88-2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41-1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16-1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95-3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11-1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14-2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29-2.41], vs. receiving DOT). The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.

#1763 Risk factors and clinical prediction models for osteoporosis in predialysis chronic kidney disease patients

Abstract Background and Aims The research concerning osteoporosis among individuals with predialysis chronic kidney disease (CKD) has been relatively neglected in existing literature. Furthermore, the risk factors for osteoporosis in this demographic have not been adequately investigated. The objective of this study was to explore the risk factors associated with osteoporosis in predialysis CKD patients and to construct a predictive model capable of estimating the likelihood of osteoporosis in these individuals. Method A retrospective study was conducted on 326 predialysis CKD patients. Relevant clinical examination results and measurements of bone mineral density (BMD) using dual-energy X-ray absorptiometry were collected. Binary logistic regression was utilized to explore the risk factors associated with osteoporosis and to develop predictive models. Results In male predialysis CKD patients, age represents a risk factor, while 25-(OH)-Vitamin D acts as a protective factor against osteoporosis. Among female patients, age, underweight status, NBAP, and advanced CKD (G5) are significant risk factors for osteoporosis, whereas PTH serves as a protective factor. In pre-dialysis CKD patients in stages CKD1-4, age, underweight status, and NBAP are identified as risk factors for osteoporosis. For G5 predialysis patients, advanced age and NBAP pose a high risk of osteoporosis, while 25-(OH)-Vitamin D and PTH exhibit protective effects. Additionally, nomogram models illustrating the risk of osteoporosis in pre-dialysis patients of different genders and renal function stages were created. Conclusion Age, underweight, severity of renal dysfunction, NBAP, PTH, and 25-(OH)-vitamin D are strongly associated with osteoporosis in predialysis CKD patients.

Prediction of cervicalgia regression after surgery for cervical osteochondrosis

In the medical rehabilitation of patients with cervical osteochondrosis, a surgery is one of the stages in the treatment of this spinal pathology. However, the use of modern high-tech diagnostic and treatment methods does not always make it possible to achieve such a result of surgical intervention that would satisfy both the patient and the attending physicians. Due to this, we are obliged to constantly study and develop new diagnostic and therapeutic measures that could help improve the quality of treatment of clinical manifestations of cervical osteochondrosis. The multifactorial analysis of data about patients with cervical osteochondrosis allowed creating a database of various diagnostic and prognostic factors, on the basis of which the «Method for predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis» was developed depending on the severity of the identified diagnostic and prognostic factors and the volume of the upcoming surgical intervention. The proposed method of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis can serve as an integral part of a comprehensive preoperative examination of patients with this spinal pathology. As a result of applying the proposed diagnostic method, additional opportunities arise to guide the surgeon to an individual set of surgical measures with the most promising outcome. Moreover, comfortable psychological conditions are created for the patient as fear and uncertainty in the result of the upcoming treatment are eliminated, which gives him / her confidence in the outcome of the upcoming operation and helps to improve treatment results and reduce the disability of patients. The work is based on the analysis of the results of a comprehensive clinical examination, treatment, and follow-up of 457 patients who underwent surgical treatment for cervical osteochondrosis. The reliability of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis is 96.9 %.

Traumatic and iatrogenic sciatic nerve injury in 38 dogs and 10 cats: Clinical and electrodiagnostic findings.

Reports describing sciatic nerve injuries (SNI) and their outcome are scarce in veterinary medicine. Describe the causes of traumatic and iatrogenic SNI and evaluate which clinical and electrodiagnostic findings predict outcome. Thirty-eight dogs and 10 cats with confirmed SNI referred for neurologic and electrodiagnostic evaluation. Clinical and electrodiagnostic examination results, including electromyography (EMG), motor nerve conduction studies, muscle-evoked potential (MEP), F-waves, sensory nerve conduction studies, and cord dorsum potential (CDP), were retrospectively evaluated. Quality of life (QoL) was assessed based on owner interviews. Surgery (42%) and trauma (33%) were the most common causes of SNI; in dogs, 24% were caused by bites from wild boars. Ability to flex and extend the tarsus was significantly associated with positive outcome in dogs. Mean time from onset of clinical signs until electrodiagnostic evaluation was 67 ± 65 (range, 7-300) days and 65 ± 108 (range, 7-365) days for dogs and cats, respectively. A cut-off amplitude of 1.45 mV for compound motor action potentials (CMAP) was predictive of positive outcome in dogs (P = .01), with sensitivity of 58% and specificity of 100%. Clinical motor function predicts recovery better than sensory function. Electrodiagnostic findings also may play a role in predicting the outcome of SNI. Application of the proposed CMAP cut-off amplitude may assist clinicians in shortening the time to reassessment or for earlier suggestion of salvage procedures. Owners perceived a good quality of life (QoL), even in cases of hindlimb amputation.

Angioedema induced by ofloxacin

A 42-year-old woman was prescribed the second-generation 4-fluoroquinolone antibiotic ofloxacin to cure loose movements. However, after taking the medication, she developed lip edema. Antibiotics called fluoroquinolones are frequently administered for a variety of medical disorders. The patient was successfully treated with corticosteroids after the diagnosis of ofloxacin-induced hypersensitive reaction was made based on the patient's history, clinical examination, and normal test results. Because ofloxacin, this type of reaction is extremely uncommon. Anti-allergic medicines and drug cessation were used to treat the disease.

THE USE OF LABORATORY CRITERIA IN THE RISK ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AFTER TRANSPEDICULAR FIXATION OF THE LUMBAR SPINE

Objective. To investigate the peculiarities of the development of postoperative complications after surgical treatment of degenerative diseases of the lumbar spine with transpedicular fixation of the vertebrae and their relationship with changes in preoperative laboratory parameters. Methods. A retrospective analysis of the biochemical examination data of 35 patients with degenerative diseases of the lumbar spine who underwent discectomy with transpedicular fixation was performed. In four groups of patients with postoperative complications: 10 patients — inflammation of the what fabrics around metal structures and 5 patients — instability of the metal structure. The results of the examination of 20 people without specified complications served as a comparison group. Comparison was made with a control group (20 practically healthy people). Results. Patients have a significant increase in serum ALT activity by 42.29 and AST by 63.55 %, by 38.37 % of the level of CS content, by 37.21 % of total glycoproteins compared to those in the control group. In patients with soft tissue inflammation around the serum instrument zone, the content of LDLP was recorded by 29.27 %, by 23.53 % of the UA, by 12.34 % of TP results higher by 32.01 % ALT activity and 83 %, 49 % AST, 54.96 % AlP activity, 31.40 % — AlP/AcP, 60.47 % — concentration of CS, 95.57 % — total glycoproteins than in persons in the control group. In the serum of patients with the development of instability of metal structures, 28.55 % was observed by activity of the ALT, AlP — by 38.47 %, AcP — by 48.84 %, less by 58.35 % of AlP/AcP, the CHOL content of 13 88 %, higher by 25.43 % of the LDLP content than such persons in the control group. Content of the P was lower by 31.51 % and the Ca/P ratio was higher by 38.95 %, the content of CS by 83.72 %, total glycoproteins — by 48.83 %. Conclusions. Comparative analysis of the results of preoperative clinical and laboratory examination of patients with degenerative spinal diseases with transpedicular fixation which is reflected in the deviations of their preoperative laboratory parameters from such persons with uncomplicated course of the postoperative period after similar surgery.

Radiometry in a comprehensive assessment of the effectiveness of extracorporeal shock wave therapy of calcifying tendinobursopathy of the shoulder

Introduction. Uncomfortable working conditions and excessive professional loads on the shoulder joints cause a high prevalence of degenerative-dystrophic changes in the periarticular tissues. Calcifying tendinitis and bursitis occupy a special place, characterized by multifocal accumulation of calcium phosphate crystals in tendons, mucous bags and muscles. The study is devoted to solving the problem of optimizing the X-ray diagnostics of the evolution of calcifying tendinobursopathy of the shoulder (CTS) in the dynamic assessment of the effectiveness of extracorporeal shock wave therapy.
 The aims of the study to optimize the X–ray diagnosis of calcifying tendinobursopathy of the shoulder in people working under the influence of adverse production factors.
 Materials and methods. The authors conducted a comparative retrospective analysis of the results of a comprehensive dynamic clinical and X-ray examination of 155 able-bodied men aged 35-57 years with an average work experience of 14.5±2.7 years (miners, loaders, bricklayers) examined for pain syndrome and dysfunction in the shoulder joint. The main group (65 people) are patients with CTS clinic, the presence of calcifications in the periaricular tissues of the rotator cuff and in the biceps muscle of the shoulder, evaluated in dynamics after shock wave therapy (SWT) of the shoulder in the phases of rest, resorption and recovery. The comparison group (90 people) consisted of patients with the absence of instrumentally detectable signs of multifocal accumulation of calcium phosphate crystals in the periarticular tissues of the shoulder. The study included patients whose routine conservative treatment proved ineffective. The following criteria for the effectiveness of therapy were identified: pain at rest, measured using a visual analog scale (VAS); dimensions (calcification area (in mm2)); optical density and calcification density gradient. Specialists evaluated the data at the initial stage of the study before the use of therapy, immediately after treatment and 12 months after the final SWT session.
 Results. In patients of the main group with the presence of CTS, the main manifestations of shoulder-scapular periarthritis (SSP) both in the main group and in the comparison group were moderately pronounced, however, the frequency of detection of the main SSP syndromes, primarily rotator cuff lesion, as well as background pathology (arthrosis of the shoulder joint) and acromioclavicular joint) were significantly higher in the main group. The effectiveness of SWT was demonstrated by regression of pain syndrome and positive dynamics of density characteristics of periarticular tissues of shoulder joints in areas of interest (in anatomotopographic projections of localization of tendons, mucous bags and muscles). In all patients of the main group, the decalcification process was characterized by both a visually perceptible pattern of disintegration and a decrease in its area, and a decrease in optical density immediately after the end of treatment. In 36.9% of patients, 12 months after the start of SWT, the X-ray and X-ray densitometric picture confirmed the prolongation of the decalcification process up to complete lysis of foci and calcification sites.
 Conclusions. In a comprehensive assessment of the effectiveness of CTS therapy, along with traditional X-ray diagnostics, special methodological techniques of radiometry (X-ray diffraction and X-ray densitometry in areas of interest) can be used, allowing for more accurate and more objective reflection of the direction of the dynamics of changes.
 The use of X-ray calcifications in the arsenal of methodological techniques, such as area, optical density and optical density gradient, can significantly improve the quality of diagnosis and avoid the use of computed tomography and an increase in radiation exposure to the patient.
 High-energy extracorporeal shockwave therapy is largely able to solve the problem of treating resistant forms of calcifying tendinobursopathy of the shoulder.

Ketepatan Pengkodean Diagnosis Demam Berdarah Dengue Berdasarkan Hasil Pemeriksaan Klinis di Rumah Sakit Singaparna Medika Citrautama

One of the supporting units in the hospital, namely medical records, is a manual / electronic record carried out by health care providers such as diagnosis. One of the medical record activities is to code the disease. Coding is the provision of alphanumeric symbols carried out by the coder. The diagnosis coding provided must be correct in accordance with the codes listed in ICD-10, the correct coding will affect hospital health financing. The research was conducted at Medika Citra Utama Hospital. This study aims to describe the coding procedures and accuracy of disease diagnosis using a cross sectional design. The population of cases in this study were medical records of dengue haemorrhagic fever patients from January to December 2022. The number of samples was 98 medical records. The sampling technique used was simple random sampling. The results of the study of diagnosis coding procedures carried out by the coder have not been in accordance with the steps that have been determined by ICD-10 volume 2 due to the busyness of officers in carrying out other activities and there are 78.6% of medical records that are appropriate and in accordance with the results of clinical examinations, 21.4% of medical records that are not appropriate and do not match the results of clinical examinations resulting in pending claims at the hospital. The conclusion of this study is that coder officers are expected to do coding referring to ICD-Volume 2 and pay attention to clinical examination in order to get accurate coding so that hospital claims are claimed on time.

The relationship between atherosclerosis and dementia.

The main objective is to confirm a hypothesis that atherosclerosis, through various mechanisms, considerably influences cognitive impairment and significantly increases the risk for developing dementia. Complete sample should be 920 individuals. The present study aimed to analyse epidemiological data from a questionnaire survey. The work was carried out in the form of an epidemiological case control study. Subjects are enrolled in the study based on results of the following examinations carried out in neurology departments and outpatient centres during the project NU20-09-00119 from 2020 to 2023. Respondents were divided into four research groups according to the results of clinical examination for the presence of atherosclerosis and dementia. The survey was mainly concerned with risk factors for both atherosclerosis and dementia. It contained questions on lifestyle factors, cardiovascular risk factors, leisure activities, and hobbies. Analysis of the as yet incomplete sample of 877 subjects has yielded the following selected results: on average, 16% of subjects without dementia had primary education while the proportion was 45.2% in the group with both dementia and atherosclerosis. Subjects with dementia did mainly physical work. Low physical activity was more frequently noted in dementia groups (Group 2 - 54.4% and Group 3 - 47.2%) than in subjects without dementia (Group 1 - 19.6% and Group 4 - 25.8%). Coronary heart disease was more frequently reported by dementia patients (33.95%) than those without dementia (16.05%). Cognitively impaired individuals, in particular those with vascular cognitive impairment, have poorer quality of life and shorter survival. Risk factors contributing to such impairment are similar to those for ischaemic or haemorrhagic stroke. It may be concluded that most of the analysed risk factors play a role in the development of both atherosclerosis and dementia.

DETERMINATION OF IL-1β mRNA GENE EXPRESSION AND HMGB-1 mRNA GENE EXPRESSION IN WOMEN WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY AT THE STAGE OF PREPARATION FOR ASSISTED REPRODUCTIVE TECHNOLOGIES

Despite the large number of studies on the identification and search for noninvasive early diagnostic markers of genital endometriosis, this problem remains relevant today. It is important to introduce early diagnosis of genital endometriosis for the purpose of timely prevention and treatment.Objective: to study the expression levels of IL-1β and HMGB-1 mRNA genes in women with genital endometriosis associated with infertility, and to evaluate the effect of our proposed preparation for assisted reproductive technologies on the level of IL-1β and HMGB-1 mRNA gene expression.Material and methods. To analyze gene expression IL-1β and HMGB-1 and determine relative normalized mRNA expression IL-1β and HMGB-1, the polymerase chain reaction method was used with real-time reverse transcription(RT-PCR. The object of molecular genetic studies using the RT-PCR method was the fraction of mononuclear cells isolated from the whole blood of patients with endometriosis. In this study, we performed a retrospective analysis of the medical records of 30 women with infertility undergoing an assisted reproductive technology program. The main group consisted of 20 women diagnosed with external genital endometriosis who underwent assisted reproductive technologies. Women in the main group, in addition to standard training for assisted reproductive technologies, received a probiotic containing Lactobacilli 1010 manufactured by Unic Biotech Ltd, India. They took one pill twice a day for one month as part of a general treatment before undergoing assisted reproductive technologies. We determined the expression level of IL-1β and HMGB-1 before and after this preparation stage. The control group consisted of 10 women who had tubal infertility due to a previous inflammatory disease, but according to the results of a comprehensive clinical and laboratory examination, they were compared to healthy women. These women, aged 21 to 42 years, with a mean age of 29,75 years, did not receive our proposed preparation with the inclusion of a probiotic. This study was conducted at the Bukovyna State Medical University and the clinic "Yuzko medical center".Results. In the main group, the IL-1β mRNA gene expression level before training was (26,7877±0,01), which was significantly higher than the level after training (0,1610±0,01*). Consequently, the use of the probiotic led to a dramatic reduction in elevated mesothelin levels, underscoring its efficacy and potential application in assisted reproductive technology training programs. Also, a high level of expression of mRNA genes can be noted HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies (table 2). Expression level of mRNA genes HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies was (11,9198±0,01). After our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic, the mRNA gene expression level HMGB-1in the whole blood of women of the main group was (0,2821±0,01*). Therefore, our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic is quite effective, since the expression levels of IL-1β mRNA genes and HMGB-1sharply decreased.Conclusions. Extremely high expression of mRNA genes IL-1β and HMGB-1 indicates a close connection between the pathogenesis of endometriosis and inflammation. The inclusion of probiotics in the complex scheme of preparation for assisted reproductive technologies leads to a noticeable improvement in the well-being of the patient and a significant decrease in the expression of IL-1β and HMGB-1 mRNA genes. Therefore, we recommend our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic.

Modern management of leukemoid reactions

ABSTRACT. Leukemoid reaction (LR) is a transient hematological syndrome of reactive nature characterized by persistent leukocytosis of more than 50,000 cells/µL. LR can be caused by a variety of factors, including infections, intoxications, malignant neoplasms, severe hemorrhages, or acute hemolysis.
 The most common form of LR is neutrophilic myeloid reaction, which occurs in 80-90 % of cases. The diagnosis of LR is based on clinical examination and laboratory test results, including complete blood count with differential leukocyte formula, determination of leukocyte alkaline phosphatase level, aspiration and biopsy of bone marrow.
 Differential diagnosis of LR from other forms of leukemia is a challenging task. For this, it is necessary to conduct a thorough examination, including cytogenetic and molecular analysis of peripheral blood and bone marrow granulocytes. Despite certain advances in the differential diagnosis of LR, the mortality rate of patients in the world remains high, which requires the attention of doctors of various profiles.
 Treatment of LR depends on the underlying cause that caused it. The article proposes a diagnostic and treatment algorithm for LR in the case of its toxico-infectious origin.

Oral acute toxicity study of ethanol extract of Mobe leaves (Artocarpus lacucha Buch-Ham) in Wistar rats

Many medicinal plants are now being chosen because the treatment is safer and cheaper. Artocarpus lacucha Buch-Ham is a plant with many pharmacological activities and is efficacious; its safety has not been studied. Acute oral toxicity evaluation followed Organization for Economic Co-operation and Development guidelines using the fixed dose method. The evaluation began with a preliminary test, then a primary test with three groups: a 2000 mg/Kg BW dose test group, a 5000 mg/Kg BW dose test group, and a control group. The results of visual observations, haematological and clinical examinations, and histological examination of organs (liver, spleen, kidneys, lungs and heart) showed no toxicity in the animals, and they did not die during testing. The findings of this study support the safety of Artocarpus lacucha Buch-Ham leaf ethanol extract, which did not produce harmful results in acute toxicity tests.

A case of a combined course of typhoid fever and leptospirosis

Coinfections are becoming increasingly relevant and urgently require research. The development of international tourism has caused the rapid spread of infectious diseases from countries with unfavorable sanitary and hygienic conditions. This article analyzes the clinical case of a patient who recently returned from India and developed a combined course of typhoid fever and leptospirosis due to astrovirus infection and blastocystosis. The disease was characterized by symptoms of enteritis, low-grade fever, and mild intoxication. The patient repeatedly sought medical help. Diagnoses of “acute respiratory viral infection” and “intestinal infection of unknown etiology” were established. Symptomatic therapy was performed without a positive effect; fever and severe asthenic syndrome persisted. The patient was hospitalized on the 18th day of illness with moderate severity. Taking into account clinical, anamnestic, and epidemiological data and laboratory examination results, typhoid fever was diagnosed. A polymerase chain reaction (PCR) test identified astrovirus RNA in the stool, and Blastocystis hominis was detected during stool examination. Despite the ongoing pathogenetic and antibacterial therapy, considering the determination of the pathogen’s sensitivity to antibiotics, the patient’s condition worsened. On day 23 of the illness, jaundice, hemorrhagic syndrome, and signs of acute renal failure were noted. Through in-depth analysis of changes in the clinical and laboratory findings, considering epidemiological history data (stay in a region endemic for leptospirosis), leptospirosis was diagnosed and treated with antibacterial therapy. Complex intensive therapy using extracorporeal treatment methods helped prevent the development of unfavorable outcomes of combined pathology. This clinical case emphasizes that doctors must be wary of imported infections and conduct additional comprehensive investigations of suspected cases.

Predictors of reduced quality of life in patients with systemic sclerosis

Predictors of reduced quality of life in patients with systemic sclerosis

Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial

BackgroundAbdominal pain is common in patients visiting the emergency department (ED). The aim of this study was to assess the diagnostic contribution of point-of-care ultrasound (POCUS) in patients presenting to the ED with acute abdominal pain.MethodsWe designed an interventional randomized, controlled, open label, parallel-group, trial in two French EDs. We included adult patients presenting to the ED with acute abdominal pain. Exclusion criteria were a documented end-of-life, an immediate need of life-support therapy and pregnant or breast-feeding women. Patients were randomized in the experimental group (i.e., workup including POCUS) or control group (usual care). The primary objective of the study was to assess the added value of POCUS on diagnostic pathway in the ED, according to the diagnostic established a posteriori by an adjudication committee. The primary endpoint was the proportion of exact preliminary diagnosis between the 2 groups. The preliminary diagnosis made after clinical examination and biological results with POCUS (intervention arm) or without POCUS (usual care) was considered exact if it was similar to the adjudication committee diagnosis.ResultsBetween June 2021 11th and June 2022 23th, 256 patients were randomized, but five were not included in the primary analysis, leaving 125 patients in the POCUS group and 126 patients in the usual care group (130 women and 121 men, median [Q1-Q3] age: 42 [30;57]). There was no difference for exact diagnosis between the two groups (POCUS 70/125, 56% versus control 78/126 (62%), RD 1.23 [95% CI 0.74–2.04]). There was no difference in the accuracy for the diagnosis of non-specific abdominal pain nor number of biological or radiological exams. Diagnostic delays and length of stay in the ED were also similar.ConclusionsIn this trial, systematic POCUS did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED with acute abdominal pain. However, as it was a safe procedure, further research should focus on patients with suspected etiologies where POCUS is particularly useful.Trial registration: This trial was registered on ClinicalTrials.gov on 2022/07/20 (https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1) (NCT04912206).

Autosomal recessive cerebellar ataxias: a diagnostic classification approach according to ocular features.

Autosomal recessive cerebellar ataxias (ARCAs) are a heterogeneous group of neurodegenerative disorders affecting primarily the cerebellum and/or its afferent tracts, often accompanied by damage of other neurological or extra-neurological systems. Due to the overlap of clinical presentation among ARCAs and the variety of hereditary, acquired, and reversible etiologies that can determine cerebellar dysfunction, the differential diagnosis is challenging, but also urgent considering the ongoing development of promising target therapies. The examination of afferent and efferent visual system may provide neurophysiological and structural information related to cerebellar dysfunction and neurodegeneration thus allowing a possible diagnostic classification approach according to ocular features. While optic coherence tomography (OCT) is applied for the parametrization of the optic nerve and macular area, the eye movements analysis relies on a wide range of eye-tracker devices and the application of machine-learning techniques. We discuss the results of clinical and eye-tracking oculomotor examination, the OCT findings and some advancing of computer science in ARCAs thus providing evidence sustaining the identification of robust eye parameters as possible markers of ARCAs.

Al-Based Detection of Dental Caries: Comparative Analysis with Clinical Examination

ABSTRACT Dental caries pose a significant public health concern, affecting a vast population globally. Traditional clinical examination methods, although reliable, can be subject to human error and time-consuming. Artificial intelligence (AI) technologies have emerged as promising tools to enhance diagnostic accuracy and efficiency. This study explores the potential of AI in revolutionizing dental caries detection. Materials and Methods: A cohort of 50 patients with varying degrees of dental caries participated in this comparative analysis. Clinical examination by dental professionals served as the gold standard for caries detection. AI algorithms were trained using dental images, and their performance was evaluated against the clinical examination results. Results: The AI-based detection system demonstrated a sensitivity of 92% and a specificity of 85% in identifying dental caries, with an overall accuracy of 88%. The clinical examination yielded a sensitivity of 86% and a specificity of 90%, resulting in an overall accuracy of 88%. Statistical analysis indicated no significant difference between AI-based detection and clinical examination (P > 0.05). Conclusion: AI technology exhibits promise as an adjunctive tool for dental practitioners, potentially reducing diagnostic errors and improving efficiency. Integrating AI into routine dental practice may aid in early caries detection and promote better oral health outcomes.

EHRLICHIOSIS AND DEMODICOSIS IN BALI LOCAL DOG

Ehrlichiosis is a zoonotic disease caused by infection with intracellular bacteria Ehrlichia sp. which can be transmitted by ticks. Demodicosis is a parasitic disease caused by the mite Demodex sp. which has a predilection for the dermis, hair follicles, and sebaceous glands. A male local breed dog aged approximately 2 years with a body weight of 8 kg came with complaints of hair loss and high intensity itching with a scale of 8/10. The results of clinical examination showed alopecia, scale, and erythema almost all over the body accompanied by tick infestations found on the back, anemic mucosa, left prescapularis lymph nodes and left popliteus experienced swelling. Hematological examination showed macrocytic hypochromic anemia, leukocytosis, lymphocytosis, granulocytosis, and thrombocytopenia. Blood smear and serology examination showed Ehrlichia sp.. infection while deep skin scrapping examination showed Demodex sp. infection. Based on the anamnesis, physical examination and laboratory examination, the case of the dog suffering from ehrlichiosis accompanied by demodecosis. The therapy given was in the form of doxycycline, ivermectin, diphenydramine, vitamin B complex, and bath therapy with sulfur soap. Observation of therapy on the 14th day provided clinical improvement in terms of reducing itching intensity, Demodex sp. infection intensity, and hematological parameters. On the 28th day of the last treatment, the dog's body condition was getting better, new hair started to grow and the body condition score increased. Dogs should be given food rich in nutrients such as liver, meat and egg yolks, as well as providing nutritional supplements to speed up the dog's recovery.

Alterations in Rumination, Eating, Drinking and Locomotion Behavior in Dairy Cows Affected by Subclinical Ketosis and Subclinical Acidosis

This study delves into the effects of subclinical ketosis (SCK) and subclinical acidosis (SCA) on various parameters related to dairy cow rumination, eating, drinking and locomotion behavior. The research hypothesized that these subclinical metabolic disorders could affect behaviors such as rumination, feeding, and locomotion. A total of 320 dairy cows, with a focus on those in their second or subsequent lactation, producing an average of 12,000 kg/year milk in their previous lactation, were examined. These cows were classified into three groups: those with SCK, those with SCA, and healthy cows. The health status of the cows was determined based on the milk fat–protein ratio, blood beta-hydroxybutyrate, and the results of clinical examinations performed by a veterinarian. The data collected during the study included parameters from the RumiWatch sensors. The results revealed significant differences between the cows affected by SCK and the healthy cows, with reductions observed in the rumination time (17.47%) and various eating and chewing behaviors. These changes indicated that SCK had a substantial impact on the cows’ behavior. In the context of SCA, the study found significant reductions in Eating Time 2 (ET2) of 36.84% when compared to the healthy cows. Additionally, Eating Chews 2 (EC2) exhibited a significant reduction in the SCA group, with an average of 312.06 units (±17.93), compared to the healthy group’s average of 504.20 units (±18.87). These findings emphasize that SCA influences feeding behaviors and chewing activity, which can have implications for nutrient intake and overall cow health. The study also highlights the considerable impact of SCK on locomotion parameters, as the cows with SCK exhibited a 27.36% reduction in the walking time levels. These cows also displayed reductions in the Walking Time (WT), Other Activity Time (OAT), and Activity Change (AC). In conclusion, this research underscores the critical need for advanced strategies to prevent and manage subclinical metabolic disorders within the dairy farming industry. The study findings have far-reaching implications for enhancing the well-being and performance of dairy cattle. Effective management practices and detection methods are essential to mitigate the impact of SCK and SCA on dairy cow health and productivity, ultimately benefiting the dairy farming sector.