Screening Test In Patients Research Articles

Nocturnal Hypoxemia, a Key Parameter in Overlap Syndrome

The overlap syndrome (OS) is defined as a synergic relation between obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD). Patients with overlap syndrome present the clinical features of each disorder to a greater or a lesser extend depending on the predominant disease. We assessed the main differences between patients with OS and patients with OSA and we highlight the importance of nocturnal hypoxemia on clinical status and management of the patients with overlap syndrome, in order to simplify OSA screening tests in patients with COPD. The study population included 62 selected patients divided in two groups: the first group � subjects diagnosed with OS and the second group - subjects with OSA, without the diagnostic of COPD. The majority of the patients were male, with a mean age of 55�9.84 years in the OSA group and 65.5�10.32 years in the OS group. The nocturnal hypoxemia was more important in the OS grup, with 276.83 minutes spent at a SpO2 below 90% versus 132.98 minutes in the OSA group. The mean AHI was 57.7�29.244 events/hour of sleep in the OS group and 50.7�26.01 events/hour of sleep in the OSA group. At the diagnosis, the mean daytime SpO2 was 90.9�3.59% in the OS group and 95.9�1.57 % in the OSA group. There were statistically significant differences between the two groups concerning age, AHI, Epworth Slepiness Scale, nocturnal desaturation, medium and minimum SpO2 during sleep, daytime SpO2 at the diagnosis and at 1-year follow-up, the presence of cardiovascular comorbidities such as pulmonary hypertension and heart failure. Our study showed that patients with COPD have OSA predictors that differ from those usually recognise in the general population. In OS patients, the most important parameter is the nocturnal hypoxemia. So, it is very useful that the clinicians be trained to include in the management of selected obese COPD patients, comprehensive sleep history, sleep hygiene and OSA screening because, in clinical practice, OSA is quite often underdiagnosed in these patients.

The role of a sequencing-based clinical intestinal screening test in patients at high-risk for Clostridium difficile and other pathogens: a case report

BackgroundHospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated symptoms, including mild, moderate, or severe diarrhea. Clostridium difficile infection is challenging to treat, often recurrent, and leads to almost 30,000 annual deaths in the USA alone. Here we present a case where SmartGut™, an at-home, self-administered sequencing-based clinical intestinal screening test, was used to identify the presence of Clostridium difficile in a patient with worsening diarrhea. Identification of this pathogen and subsequent treatment led to a significant improvement in symptoms.Case presentationThe patient is a 29-year-old white woman with a history of severe irritable bowel syndrome with diarrhea, hemorrhoidectomy, and anal sphincterotomy complicated by a perianal fistula and perirectal abscesses that required extended courses of broad-spectrum antibiotics. In June 2016, she developed intermittent Clostridium difficile infections, which required continued antibiotic use. Months later she used an at-home, self-administered, intestinal microbial test, the first of which was negative for the presence of Clostridium difficile, but it detected the relative abundance of microbes associated with irritable bowel syndrome outside the healthy reference ranges. In the subsequent 2 months after the negative Clostridium difficile result, her gastrointestinal symptoms worsened dramatically. A second microbiome test resulted in a positive Clostridium difficile finding and continued abnormal microbial parameters, which led the treating physician to refer her to a gastroenterologist. Additional testing confirmed the presence of Clostridium difficile with a toxin-positive strain. She received treatment immediately and her gastrointestinal symptoms improved significantly over the next week.ConclusionsThis case report suggests that more frequent DNA testing for Clostridium difficile infections may be indicated in patients that are at high-risk for Clostridium difficile infection, especially for patients with irritable bowel syndrome, and those who undergo gastrointestinal surgery and/or an extended antibiotic treatment. This report also shows that such testing could be effectively performed using at-home, self-administered sequencing-based clinical intestinal microbial screening tests. Further research is needed to investigate whether the observations reported here extrapolate to a larger cohort of patients.

Montreal Cognitive Assessment scale in patients with Parkinson Disease with normal scores in the Mini-Mental State Examination.

ABSTRACT.Several screening tests have been used for cognitive evaluation in Parkinson’s disease (PD).Objective:To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson’s disease and no cognitive impairment complaints.Methods:A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered.Results:80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups.Conclusion:The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.

What is the Utility of Routine Complete Blood Count, Liver Function Tests, and Chest X-ray in the Evaluation of Patients with Clinically Node-Negative Breast Cancer?

National Comprehensive Cancer Network guidelines suggest a selective workup of early-stage breast cancer with complete blood count (CBC) and liver function tests (LFTs) and no longer recommend chest X-ray (CXR) to screen for occult metastasis. We evaluated the utility of routine preoperative screening tests in patients with clinically node-negative (cN0) breast cancer. We identified 1611 patients with cN0 breast cancer treated at our institution between October 1998 and December 2015; 94.4 per cent of the patients underwent at least one preoperative screening test: 90.8 per cent CBC, 89.4 per cent LFTs, and 63.6 per cent CXR. Thirty-six per cent of CBCs, 13.1 per cent of LFTs, and 6.7 per cent of CXRs were abnormal. Abnormalities led to 17 CT scans, and one found an occult metastasis. Eleven patients (0.7%) were diagnosed with metastatic disease postoperatively, but only half had abnormal preoperative screening tests. Positive predictive values of preoperative CBC, LFTs, and CXR for occult metastasis are 1.3 per cent, 1.1 per cent, and 1.5 per cent, respectively. Preoperative screening in cN0 breast cancer is of low yield. Even when abnormalities are found, metastasis is present in less than 1 per cent of patients, and a normal study does not rule out metastasis. Routine preoperative determination is not warranted, and staging studies should be limited to patients with signs or symptoms.

Yield of Echocardiography in the Evaluation of Cerebral Ischemic Events: A Single Center Cohort Study

Background: Echocardiography (ECO) is frequently used as a screening test in patients with acute ischemic brain disease. We aimed to evaluate the additional information and therapeutic impact resulting from ECO in these patients. Methods: We conducted a prospective study performing ECO on consecutive patients with ischemic stroke or transient ischemic attacks, admitted to our centre between February 2013 and May 2017. Results: A total of 696 patients were included (female, 57.3%; mean age, 70 ± 15.3 years). Seven hundred thirty two echocardiographic examinations were performed (696 transthoracic and 36 transesophageal). Echocardiography yielded findings judged of clinical importance in 142 patients (20.4%, 95% CI 17.5-23.5). The most frequent of these were left atrial volume enlargement or a normal evaluation. Echocardiography findings resulted in changes in the management of 76 patients (10.7% 95% CI 8.8-13.4); initiation of anticoagulation therapy, administration of IV antibiotic therapy, cardiac surgeries, or other pharmacological therapies occurring in 42 cases (6%). The presence of coronary heart disease (OR: 2.64 95% CI 1.34-5.25), atrial fibrillation (OR: 0.24; 95% CI, 0.2-0.69), and admission NIHSS (OR: 1.04; 95% CI, 1.01-1.09), were the variables associated with changes in management. Conclusions: In unselected patients with acute ischemic stroke ECO had a low yield of additional information, and it changed management in a small percentage of patients.

Prevalence of and Risk Factors for Peripheral Neuropathy in Chinese Patients With Diabetes: A Multicenter Cross-Sectional Study.

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, and its progression significantly worsens the patient's quality of life. This study investigated the prevalence and risk factors associated with DPN in a large sample of Beijing individuals with type 1 and 2 diabetes, as well as compared the diagnostic methods for DPN. A total of 2,048 diabetic patients from 13 centers in Beijing were assessed for DPN through questionnaires and examination. Patients were divided into DPN group and suspected DPN/non-DPN group. The demographic, clinical and biological characteristics between the two groups were compared. Binary logistic regression analysis was performed to identify potential variables associated with DPN in diabetic patients. The diagnostic methods for DPN were also compared. Among the 2,048 diabetic patients, 73 cases of type 1 diabetes mellitus, 1,975 cases of type 2 diabetes were included in this study. Among them, 714 (34.86%) were identified with DPN, 537 (26.22%) were suspected of having DPN, and 797 (38.92%) were identified without DPN. Patient's age, duration of diabetes, and diabetic retinopathy were the significant independent risk factor for DPN among patients with type 2 diabetes. The odds ratio (OR) was 1.439 (95% confidence interval (CI): 1.282–1.616, P < 0.001), 1.297 (95% CI: 1.151–1.462, P < 0.001), and 0.637 (95% CI: 0.506–0.802, P < 0.001), respectively. Ankle reflex, temperature sensation plus vibration sensation are the best screening test for patients with type 1 and 2 diabetes. The Youden indexes were 62.2 and 69.8%, respectively. The prevalence rates of DPN in the Chinese patients with type 1 and type 2 diabetes in Beijing were 21.92 and 35.34%, respectively. Patient's age, duration of diabetes, and diabetic retinopathy are the independent risk factors for DPN.

Evaluation of cytomegalovirus DNA in periymphatic fluid in patients with sensorineural hearing loss using PCR technique

Purpose:Congenital cytomegalovirus (CMV) infection is the most common congenital infection in developing countries with sensorineural hearing loss (SNHL) being the most important of its long-term sequelae. The aim of this research was to evaluate the amount of CMV DNA in perilymph of patients with SNHL undergoing cochlear implant (CI) procedure by Polymerase chain reaction (PCR) technique.Materials and Methods:This cross-sectional and prospective study was conducted in a group of patients with ages ranging from 1 to 7 years. The perilymph was extracted preoperatively using a Yale spinal needle after opening of the round window. 25 microliters of perilymph was extracted and stored at -80 degrees centigrade. PCR technique was employed to detect CMV DNA. The data was collected and statistically analyzed.Results:A sample size of 41 patients with bilateral profound SNHL was selected. After cochlear implantation, CMV DNA evaluation was performed which was found positive in 18 patients (43.9%) and negative in 23 patients (56.09%) with a statistically significant relationship. No statistical relationship was found with gender, age and other comorbid disorders. 3-6 months’ follow-up was individually performed to compare Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) tests in CMV DNA positive and negative patients, yielding different results which were statistically insignificant.Conclusion:The early detection of CMV infection with real time PCR technique enables us to perform viral screening tests in patients with SNHL.

Fetal Fibronectin Test Performance in Patients at Low Risk for Preterm Delivery

Objectives: Spontaneous preterm birth is a leading cause of neonatal death. Fetal fibronectin (fFN) testing in cervical secretions between 22-34.6 weeks of gestation is used to predict non-delivery within the next 7 days in patients with symptoms of preterm labor. The objective of this study is to analyze fFN test performance in a group of patients with low risk for preterm delivery that presented with preterm labor symptoms, and to evaluate how the results of fFN testing influenced management decisions. Materials and Methods: Patients after preterm delivery (gestational age 24.0-36.6 weeks) and patients who underwent fFN testing in Metropolitan Hospital, NYC Health+Hospitals, New York, NY, from January 1, 2015 to December 31, 2015 were identified and reviewed. Patients with positive fFN test results (fFN+; &gt;50 ng/dL) were compared to patients with negative fFN test results (fFN-). Results: Among 77 patients identified, 66 (86%) were fFN- and 11 (14%) fFN+; 15 patients (78%) who delivered preterm were not tested with fFN. Preterm birth rate during the study period was 1.9%. There was no difference in maternal or neonatal characteristics between the two groups. Among fFN-, 4 patients (6%) delivered preterm, while among fFN+, none delivered preterm. In both groups, none delivered within 7 days of testing. Compared to fFN-, fFN+ had higher rates of admissions (36% vs 0%; P&lt;0.001) and steroid administration (82% vs 0%; P&lt;0.001). Conclusions: In this retrospective analysis, use of fFN testing as an initial screening test for patients with symptoms of preterm labor in this low risk population did not result in improved clinical outcomes and was associated with a higher rates of hospital admissions and steroid administration.

Low-Dose and Standard Overnight and Low Dose-Two Day Dexamethasone Suppression Tests in Patients with Mild and/or Episodic Hypercortisolism.

We previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing's syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing's syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing's syndrome. Thirty patients determined to have Cushing's syndrome by biochemical testing and 14 patients determined not to have the condition had the 0.25 mg and standard 1 mg overnight DEX suppression test and the two-day low-dose DEX suppression tests. Our results show that morning serum cortisol and cortisol/DEX ratios following an overnight dexamethasone suppression test were similar in patients with Cushing's syndrome and those not having Cushing's syndrome. However, a morning cortisol value above 7.6 μg/dl following a dose of DEX of 0.25 mg was found in 12 patients with Cushing's syndrome and none in those not having Cushing's syndrome, suggesting that a high cortisol value after this low dose of dexamethasone can indicate that further testing for Cushing's syndrome is warranted. Our data suggest that the traditional 1 mg overnight or the 2 mg/2 day DEX suppression testing should no longer be used as a screening test in patients who could have mild and/or periodic Cushing's syndrome, while the 0.25 mg dose of DEX may pick up some patients with mild Cushing's syndrome.

Evaluation of the DOAC-Stop® Procedure to Overcome the Effect of DOACs on Several Thrombophilia Screening Tests.

The impact of direct oral anticoagulants (DOACs) on laboratory assays used for thrombophilia testing (e.g., antithrombin, protein S, protein C, lupus anticoagulant and activated protein-C resistance) is a well-known issue and may cause false-positive and -negative results. Therefore, the correct interpretation of tests that are performed in patients taking DOACs is mandatory to prevent misclassification and the subsequent clinical consequences. We aimed at evaluating the efficiency of a new and simple procedure (DOAC-Stop®; Haematex Research, Hornsby, Australia) to overcome the effect of all DOACs in real-life settings and to assess the percentage of erroneous results due to the presence of DOACs on thrombophilia screening tests. For this purpose, 135 DOAC-treated patients (38 apixaban, 40 dabigatran, 15 edoxaban, and 42 rivaroxaban) and 20 control patients were enrolled. A significant drop in apixaban, dabigatran, edoxaban, and rivaroxaban plasma concentrations following the DOAC-Stop® treatment was observed (74.8–8.2 ng/mL [ p < 0.0001], 95.9–4.7 ng/mL [ p < 0.0001], 102.1–8.8 ng/mL [ p = 0.001], and 111.3–7.0 ng/mL [ p < 0.0001], respectively). The DOAC-Stop® treatment was mostly effective to overcome the effect of DOACs on PTT-LA, dilute Russell's viper venom time (dRVVT) screen, and dRVVT confirm tests. Using our procedures, false-positive results due to DOACs were observed only with lupus anticoagulant tests (up to 75%) and fell to zero after the DOAC-Stop® procedure, regardless of the DOAC considered. In conclusion, the DOAC-Stop® adsorbent procedure appeared to be an effective and simple way to overcome the interference of DOAC on coagulation tests and should facilitate the interpretation of thrombophilia screening tests in patients taking DOACs.

Low conversion rate of QuantiFERON-TB Gold screening tests in patients treated with tumor necrosis factor inhibitors: A retrospective cohort study identifying an important practice gap

Low conversion rate of QuantiFERON-TB Gold screening tests in patients treated with tumor necrosis factor inhibitors: A retrospective cohort study identifying an important practice gap

ACTIVATED PARTIAL TH ROMBOPLASTIN TIME AS INDICATOR OF DABIGAT RAN EFFICIENCY IN PA TIENTS WITH NON - VALVULAR ATRIAL FIBR ILATION

Dabigatran, a new generation anticoagulant, is a direct thrombin inhibitor, which has a rapid onset of action and relatively wide therapeutic scope, with no need for monitoring of efficacy, as is the case with vitamin K antagonists. However, there are certain emergency situations that require immediate assessment of the effectiveness of dabigatran. The aim of this study was to determine whether the aPTT as a screening coagulation test, can be reliably used to assess the anticoagulant effect of dabigatran. The study included 32 patients with non-valvular atrial fibrillation who received dabigatran (Pradaxa, Boehringer Inhelheim) in a single dose of 110 mg or 150 mg twice a day. In all patients screening coagulation (PT, aPTT, INR) was done before the treatment. aPTT was performed 4 hours, 8 hours and 12 hours after taking the drug. There was a statistically significant prolongation of aPTT after 4 hours and 8 hours of taking the drug in patients who were treated with 150 mg of dabigatran compared to 110 mg, while after 12 hours there was no statistically significant difference in aPTT between these two groups. There was a strong correlation between the control values of aPTT and the total increase in aPTT after dabigatran administration (r = 0.96 for a dose of 150 mg IR = 0.83 for a dose of 110 mg). aPTT is a useful test for assessing the effect of dabigatran and can be used as a screening test in patients who urgently need to determine the efficacy of the drug.

Emergence of micronuclei and apoptosis as potential biomarker of oral carcinogenesis: An updated review

More than 95% cancers of oral cavity are squamous cell carcinoma. They contribute major health problems in developing countries like India. The critical etiological factor for oral squamous cell carcinoma (OSCC) is the consumption of tobacco in various forms. OSCC results from alterations in genes that control the cell cycle or that are involved in deoxyribonucleic acid repair and are characterized by the loss of ability of cells to evolve to death when genetic damage occurs. The occurrence of chromosomal damage can be evaluated by counting micronuclei (MNs) and degenerative alterations, indicative of apoptosis such as karyorrhexis, pyknosis, and condensed chromatin. Apoptosis has been associated with the elimination of potentially malignant cells, hyperplasia, and tumor progression. Hence, reduced apoptosis or its resistance plays a vital role in carcinogenesis. MNs are one of such biomarkers that are cytoplasmic chromatin masses with the appearance of small nuclei that arise from lagging chromosomes at anaphase or from acentric chromosome fragments. They are induced in the cells by numerous genotoxic agents that damage the chromosome. Bigger MNs result from exclusion of whole chromosome following damage to the spindle apparatus of the cell (aneugenic effect), whereas smaller MNs result from structural aberrations causing chromosomal fragments (clastogenic effect). Thus, MN count and apoptosis can be a useful biomarker, and it can be used as a screening test for patients with habit of tobacco consumption and patients with manifestations of oral lesion including premalignant and malignant conditions.

Longitudinal Changes in Performance on Cognitive Screening Tests in Patients with Mild Cognitive Impairment and Alzheimer Disease

Background: Neuropsychological tests that can track changes in cognitive functions after diagnosis of Alzheimer disease (AD) and mild cognitive impairment (MCI), including episodic memory, should be further developed. Methods: The participants of our study consisted of 22 mild AD patients and 11 MCI patients. They were followed up for 2 years. Brief cognitive screening tests were administered to the participants. Longitudinal changes in test performance were evaluated and analyzed. Results: In this longitudinal study, the Scenery Picture Memory Test (SPMT) showed significant changes over 2 years in both MCI and AD participants. The Mini-Mental State Examination (MMSE) and Word Fluency Test-vegetable showed significant changes only in AD participants. Other tests all showed little or no decline in results. Conclusions: The SPMT can be a useful tool for effectively observing changes during follow-up of MCI and AD patients.

The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA1c in Patients With Coronary Artery Disease: A Report From EUROASPIRE IV: A Survey From the European Society of Cardiology.

OBJECTIVEThree tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD).RESEARCH DESIGN AND METHODSFPG, 2h-PG, and HbA1c were used to screen 4,004 CAD patients without a history of diabetes (age 18–80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes.RESULTSComplete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA1c predicted the primary outcome, whereas the 2h-PG, dichotomized as <7.8 vs. ≥7.8 mmol/L, was a significant predictor (hazard ratio 1.38, 95% CI 1.07–1.78; P = 0.01). During follow-up, diabetes developed in 78 of the 2,609 patients (3.0%) without diabetes at baseline. An FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, whereas HbA1c 5.7–6.5% and 2h-PG 7.8–11.0 mmol/L were both significant independent predictors.CONCLUSIONSThe 2h-PG, in contrast to FPG and HbA1c, provides significant prognostic information regarding cardiovascular events in patients with CAD. Furthermore, elevated 2h-PG and HbA1c are significant prognostic indicators of an increased risk of incident diabetes.

Utilidad de los estudios serológicos en los centros de Atención Primaria para el diagnóstico precoz de la enfermedad de Lyme

ObjectiveThe main aim of this study was to determine the usefulness of an early diagnosis of Lyme disease (LD) in Primary Health Care Centres (PHCC) using the ELISA test as serological screening technique. MethodsA retrospective study (2006-2013) was performed in order to determine the anti-Borrelia seropositivity in 2,842 people at risk of having LD. The possible relationship between the environment and the area of residence with anti-Borrelia seropositivity was also studied according to the origin of the specimens (PHCC/Hospital). ResultsOverall, 15.2% of samples were positive to Borrelia spp. Seropositivity was significantly higher in samples sent by PHCC doctors than those sent by Hospital doctors. Seropositivity was significantly higher in rural than in urban populations and in those who live in mountainous or flat areas. The percentage of seropositivity has increased over the years. ConclusionsThe role of the PHCC doctor is essential for achieving an early diagnosis of Lyme disease, as a higher percentage of seropositives was detected in samples submitted from PHCC. Furthermore, most early localised LD patients were diagnosed in PHCC, avoiding the appearance of sequelae. Therefore, detection of Borrelia specific antibodies using an ELISA assay is a useful screening test for patients at risk of LD.

First-line screening tests for Cushing's syndrome in patients with adrenal incidentaloma: the role of urinary free cortisol measured by LC-MS/MS.

Patients with adrenal incidentaloma present a wide range of cortisol secretion, which is not always properly defined by first-line screening tests recommended to rule out Cushing's syndrome (CS), such as 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), or 24-h urinary free cortisol (UFC). Therefore, we examined the diagnostic performance of each screening test in patients with adrenal incidentaloma. In a series of 164 consecutive patients with adrenal incidentaloma, we measured serum cortisol after 1-mg DST, LNSC, and UFC (with LC-MS/MS). Medical history was investigated for cardiovascular events (CVE) in a subgroup of 93 patients with at least 2 years of follow-up. Serum cortisol <50nmol/L after 1-mg DST presented the highest sensitivity (100%) to rule out CS, despite a low specificity (62%). UFC > 170nmol/24h achieved the highest diagnostic accuracy (sensitivity 98%, specificity 91%, and negative/positive likelihood ratios of 0.02/10.83, respectively). The prevalence of CVE was higher in patients with non-suppressed cortisol after 1-mg DST and high UFC levels (p = 0.018). Traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia, BMI > 30kg/m2, smoke or high gender-based waist circumference) were not associated with CVE. The 1-mg DST at its lowest threshold presented high sensitivity in identifying CS, but its low specificity encourages us to consider UFC levels, measured with LC-MS/MS, to reduce false-positive test results. High UFC levels could also be considered as markers to stratify cardiovascular risk in patients with adrenal incidentaloma.

Calprotectin (S100 A8/A9) and TNF-alpha in differential diagnosis of chronic abdominal pain in children

&lt;i&gt;Introduction:&lt;/i&gt; Chronic abdominal pain in children is a very frequent and sometimes challenging diagnostic issue. Differential diagnosis in that cases is difficult and often connected with numerous, time-consuming, expensive, and frequently stressful diagnostic studies. The aim of the study was to establish whether fecal calprotectin concentration (FCC) and TNF-alpha may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included patients (median age 13 years), who were assigned to functional gastrointestinal disorders group (n=33); inflammatory gastrointestinal disorders other than IBD (n=71), children with IBD (n=37) and 22 healthy children served as a control group. The concertation of FCC and TNF-alpha in stool samples was measured using ELISA. &lt;i&gt;Results:&lt;/i&gt; In healthy children and in children with functional disorders FCCs were below 100 μg/g. In patients with IBD FCCs and TNF-alpha were markedly elevated as compare to children with functional gastrointestinal disorders, however using ROC discrimination of IBD patients was significantly better using FCC than TNF-alpha. &lt;i&gt;Conclusion:&lt;/i&gt; FCC is better test for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders as compare to TNF-alpha concentration in stool. FCC as screening test in patients with chronic abdominal pain should allow to diminish unnecessary diagnostic in cases of functional gastrointestinal disorders.

What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review.

Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.

Some Aspects of the Evaluation of Brush Border Enzymuria Originating from Proximal Renal Tubules as Screening Test in Patients with Psoriatic Arthritis

Some Aspects of the Evaluation of Brush Border Enzymuria Originating from Proximal Renal Tubules as Screening Test in Patients with Psoriatic Arthritis