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Anatomical Brain Images Alone Can Accurately Diagnose Chronic Neuropsychiatric Illnesses  [PDF]
Ravi Bansal, Lawrence H. Staib, Andrew F. Laine, Xuejun Hao, Dongrong Xu, Jun Liu, Myrna Weissman, Bradley S. Peterson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0050698
Abstract: Objective Diagnoses using imaging-based measures alone offer the hope of improving the accuracy of clinical diagnosis, thereby reducing the costs associated with incorrect treatments. Previous attempts to use brain imaging for diagnosis, however, have had only limited success in diagnosing patients who are independent of the samples used to derive the diagnostic algorithms. We aimed to develop a classification algorithm that can accurately diagnose chronic, well-characterized neuropsychiatric illness in single individuals, given the availability of sufficiently precise delineations of brain regions across several neural systems in anatomical MR images of the brain. Methods We have developed an automated method to diagnose individuals as having one of various neuropsychiatric illnesses using only anatomical MRI scans. The method employs a semi-supervised learning algorithm that discovers natural groupings of brains based on the spatial patterns of variation in the morphology of the cerebral cortex and other brain regions. We used split-half and leave-one-out cross-validation analyses in large MRI datasets to assess the reproducibility and diagnostic accuracy of those groupings. Results In MRI datasets from persons with Attention-Deficit/Hyperactivity Disorder, Schizophrenia, Tourette Syndrome, Bipolar Disorder, or persons at high or low familial risk for Major Depressive Disorder, our method discriminated with high specificity and nearly perfect sensitivity the brains of persons who had one specific neuropsychiatric disorder from the brains of healthy participants and the brains of persons who had a different neuropsychiatric disorder. Conclusions Although the classification algorithm presupposes the availability of precisely delineated brain regions, our findings suggest that patterns of morphological variation across brain surfaces, extracted from MRI scans alone, can successfully diagnose the presence of chronic neuropsychiatric disorders. Extensions of these methods are likely to provide biomarkers that will aid in identifying biological subtypes of those disorders, predicting disease course, and individualizing treatments for a wide range of neuropsychiatric illnesses.
Bronchial Washing to Diagnose Smear-Negative Pulmonary Tuberculosis  [PDF]
Jin Young Lee
Journal of Tuberculosis Research (JTR) , 2019, DOI: 10.4236/jtr.2019.73014
Abstract: Introduction: Bronchoscopy with bronchial washing is useful for the diagnosis of pulmonary tuberculosis (TB) when sputum smears are negative. However, its indication has not been standardized. Therefore, we conducted a retrospective study to assess the diagnostic value of bronchial washing in patients suspected with pulmonary TB. Methodology: A retrospective analysis was performed on patients diagnosed with pulmonary TB in Kosin university gospel hospital, a tertiary hospital with 969 beds in South Korea, from March 2017 to December 2018. We obtained three serial sputum samples for acid-fast bacilli (AFB) smear and culture, and all patients underwent bronchoscopy with bronchial washing for AFB smear and culture. Results: Fifty-six patients were enrolled in the study. Smear-negative pulmonary TB (SNPT) was diagnosed in 42/56 (75%) patients. Among the patients with smear-positive sputum, 14/14 (100%) showed culture-positive sputum, while smear- and culture-positive bronchial washing were seen in 7/14 (50%) and 12/14 (85.7%) patients, respectively. Among the patients with SNPT, 17/42 (40.47%) had culture-negative sputum and were diagnosed using the bronchoscopic washing. Conclusions: For patients with smear-negative sputum, it is necessary to perform bronchoscopic washing to increase the diagnostic rate of pulmonary TB. To control the transmission of pulmonary TB, it is necessary to use a fast and accurate examination method.
Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting  [PDF]
Helena Huerga, Francis Varaine, Eric Okwaro, Mathieu Bastard, Elisa Ardizzoni, Joseph Sitienei, Jeremiah Chakaya, Maryline Bonnet
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0051336
Abstract: Background The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya. Methods PTB smear-negative adult suspects were included in a prospective diagnostic study (2009–2011). In addition, program data (2008–2009) were retrospectively analysed. At the first consultation, clinical examination, chest X-ray, and sputum culture (Thin-Layer-Agar and Lowenstein-Jensen) were performed. Patients not started on TB treatment were clinically re-assessed after antibiotic course. The algorithm performance was calculated using culture as reference standard. Results 380 patients were included prospectively and 406 analyzed retrospectively. Culture was positive for MTB in 17.5% (61/348) and 21.8% (72/330) of cases. Sensitivity of the clinical-radiological algorithm was 55.0% and 31.9% in the prospective study and the program data analysis, respectively. Specificity, positive and negative predictive values were 72.9%, 29.7% and 88.6% in the prospective study and 79.8%, 30.7% and 80.8% in the program data analysis. Performing culture increased the number of confirmed TB patients started on treatment by 43.3% in the prospective study and by 44.4% in the program data analysis. Median time to treatment of confirmed TB patients was 6 days in the prospective study and 27 days in the retrospective study. Inter-reader agreement for X-ray interpretation between the study clinician and a radiologist was low (Kappa coefficient = 0.11, 95%CI: 0.09–0.12). In a multivariate logistic analysis, past TB history, number of symptoms and signs at the clinical exam were independently associated with risk of overtreatment. Conclusion The clinical-radiological algorithm is suboptimal to diagnose smear-negative PTB. Culture increases significantly the proportion of confirmed TB cases started on treatment. Better access to rapid MTB culture and development of new diagnostic tests is necessary.
The Professional Medical Journal , 2004,
Abstract: Objective: To detect and manage Pre-cancerouscervical change in order to prevent invasive cancer in a symptomatic sexually active women ofreproductive age group. Study design: An observational study. Place and duration of study: Study wasconducted in Gynae unit 11 of Bolan Medical College Complex Quetta from June 2002 to May2004.Patients and Methods: 370 women visiting either Gynae OPD or antenatal clinic were includedin study. Positive smears were followed by biopsy and histopathology. Results: 198(53.51%) smears werereported to be normal, 126(34%) inflammatory, 20(5.40%) borderline, mild dyskaryosis was seen in6(1.62%) moderate in 5(1.35%) and severe dyskaryosis in 3(0.81%). 14 smears were considered inadequatebecause of blood stained specimen or due to other artifacts. Patients with mild dyskaryosis were advisedto come for follow up and to repeat smear after three months.8(2.16%) patients with moderate to severedyskaryosis had punch biopsy. Histopathology revealed CIN-II in four cases of moderate dyskaryosisand CIN-III in one case of severe dyskaryosis. Two patients with moderate dyskaryosis were managedby local destructive procedure with electrocautry. While two patients with CIN-II and three patientswith severe dyskaryosis had total abdominal hysterectomy due to continuous pain lower abdominal andexcessive vaginal discharge. Conclusion: Cervical cancer screening by pap smear is a simple and effectivemethod of detecting pre malignant lesions. If it is done routinely in asymptomatic patients at regularintervals, it may help to decrease the incidence of the invasive cancer.
Smear layer in endodontics
?ivkovi? Slavoljub,Brkani? Tatjana,Da?i? Dragoslav,Opa?i? Vanja
Stomatolo?ki Glasnik Srbije , 2005, DOI: 10.2298/sgs0501007z
Abstract: Modern methods of root canal cleaning and filing are causing formation of the smear layer on treated surfaces. The aim of this paper was to review clinical aspect of smear layer in endodontics. Smear layer is the consequence of instrumentation of root canal walls and is consisted of organic and inorganic particles of cut dentine, necrotic and/or vital pulp fragments, microorganisms and their products. Existence of smear layer is affecting permeability of the radicular dentine, thus decreasing effects of canal medicaments and impairing adhesion of obturation materials in root canal. Removal of the smear layer from canal walls is possible with use of various chemical agents, ultrasonic or laser techniques. Regardless to contradictory attitudes and opinions, removing the smear layer is required for possible bacterial contamination, compromised effects of root canal medication and in order to obtain better obturation of canals 'system. .
Inpatients’ medical prescription errors
Aline Melo Santos Silva
Einstein (S?o Paulo) , 2009,
Abstract: Objective: To identify and quantify the most frequent prescription errors in inpatients’ medical prescriptions. Methods: A survey of prescription errors was performed in the inpatients’ medical prescriptions, from July 2008 to May 2009 for eight hours a day. Rresults: At total of 3,931 prescriptions was analyzed and 362 (9.2%) prescription errors were found, which involved the healthcare team as a whole. Among the 16 types of errors detected in prescription, the most frequent occurrences were lack of information, such as dose (66 cases, 18.2%) and administration route (26 cases, 7.2%); 45 cases (12.4%) of wrong transcriptions to the information system; 30 cases (8.3%) of duplicate drugs; doses higher than recommended (24 events, 6.6%) and 29 cases (8.0%) of prescriptions with indication but not specifying allergy. Cconclusion: Medication errors are a reality at hospitals. All healthcare professionals are responsible for the identification and prevention of these errors, each one in his/her own area. The pharmacist is an essential professional in the drug therapy process. All hospital organizations need a pharmacist team responsible for medical prescription analyses before preparation, dispensation and administration of drugs to inpatients. This study showed that the pharmacist improves the inpatient’s safety and success of prescribed therapy.
Intraoperative consultation and smear cytology in the diagnosis of brain tumours  [PDF]
JR Kini,V Jeyraj,CS Jayaprakash,S Indira,CNR Naik
Kathmandu University Medical Journal , 2008, DOI: 10.3126/kumj.v6i4.1734
Abstract: Background: Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. Objectives : 1) To assess the utility of intraoperative smear cytology and correlate with the final histopathological diagnosis. 2) To describe the cytomorphological features of common brain tumours in smear preparation. Materials and methods : The material for this study was obtained from 100 consecutive biopsies of central nervous system neoplasms sent for intraoperative consultation. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing. The smears were stained by the rapid Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with paraffin section findings. Results : Of the total 100 cases, 86 showed accuracy when compared with histopathological diagnosis. This was comparable with other studies. Of the remaining, two cases were frank errors, 12 cases showed partial correlation, with five cases showed incomplete typing of the cell type and seven, discrepancy in grading of tumours. The error percentage was 14%. Correlation with clinical details and radiological findings were helpful in improving the accuracy rate. Conclusions : Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible and cost effective tool to diagnose brain tumours. Smear cytology is of great value in intraoperative consultation of central nervous system pathology. Key words: Intraoperative consultation, smear cytology, central nervous system neoplasms ? doi: 10.3126/kumj.v6i4.1734 ? Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 453-457
Validation of a Clinical-Radiographic Score to Assess the Probability of Pulmonary Tuberculosis in Suspect Patients with Negative Sputum Smears  [PDF]
Alonso Soto,Lely Solari,Javier Díaz,Alberto Mantilla,Francine Matthys,Patrick van der Stuyft
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0018486
Abstract: Clinical suspects of pulmonary tuberculosis in which the sputum smears are negative for acid fast bacilli represent a diagnostic challenge in resource constrained settings. Our objective was to validate an existing clinical-radiographic score that assessed the probability of smear-negative pulmonary tuberculosis (SNPT) in high incidence settings in Peru.
New View on the Initial Development Site and Radiographic Classification System of Osteoarthritis of the Knee Based on Radiographic Analysis  [cached]
Ki-Ho Moon
International Journal of Biomedical Science , 2012,
Abstract: Introduction: Radiographic pathology of severe osteoarthritis of the knee (OAK) such as severe osteophyte at tibial spine (TS), compartment narrowing, marginal osteophyte, and subchondral sclerosis is well known. Kellgren-Lawrence grading system, which is widely used to diagnose OAK, describes narrowing-marginal osteophyte in 4-grades but uses osteophyte at TS only as evidence of OAK without detailed-grading. However, kinematically the knee employs medial TS as an axis while medial and lateral compartments carry the load, suggesting that early OAK would occur sooner at TS than at compartment. Then, Kellgren-Lawrence system may be inadequate to diagnose early-stage OAK manifested as a subtle osteophyte at TS without narrowing-marginal osteophyte. This undiagnosed-OAK will deteriorate becoming a contributing factor in an increasing incidence of OAK. Methods: This study developed a radiographic OAK-marker based on both osteophyte at TS and compartment narrowing-marginal osteophyte and graded as normal, mild, moderate, and severe. With this marker, both knee radiographs of 1,728 patients with knee pain were analyzed.Results: Among 611 early-stage mild OAK, 562 or 92% started at TS and 49 or 8% at compartment. It suggests the initial development site of OAK, helping develop new site-specific radiographic classification system of OAK accurately to diagnose all severity of OAK at early, intermediate, or late-stage. It showed that Kellgren-Lawrence system missed 92.0% of early-stage mild OAK from diagnosis. Conclusions: A subtle osteophyte at TS is the earliest radiographic sign of OAK. A new radiographic classification system of OAK was suggested for accurate diagnosis of all OAK in severity and at stage.
The Effect of Low CD4+ Lymphocyte Count on the Radiographic Patterns of HIV Patients with Pulmonary Tuberculosis among Nigerians  [PDF]
Christopher Affusim,Vivien Abah,Emeka B. Kesieme,Kester Anyanwu,Taofik A. T. Salami,Reuben Eifediyi
Tuberculosis Research and Treatment , 2013, DOI: 10.1155/2013/535769
Abstract: Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count <200?cells/mm3, 19 patients had CD4 count between 200–499?cells/mm3, while only 2 patients had CD4 count from 500?cells/mm3 upwards. The association between low CD4 count and radiographic finding was statistically significant, ( value ). Sixty (60) patients had negative sputum smear for Acid and Alcohol Fast Bacilli (AAFB), while the remaining 29 patients had positive smear. The association between low CD4 count and negative smear was statistically significant ( value ). Conclusion. The radiographic pattern and the result of the sputum smear for AAFB has a significant relationship and association with the immune status of patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis. 1. Introduction Human immunodeficiency virus (HIV) is a potent risk factor for tuberculosis (TB), both through an increase in the reactivation of the latent Mycobacterium tuberculosis infection and through an accelerated progression from infection to active disease, by undermining the cell-mediated immunity through depletion of CD4 lymphocytes [1–4]. TB has a great impact on morbidity and mortality in HIV-1 infected individuals than all other opportunistic infections [3]. TB and HIV infections have a synergistic influence on the host immunoregulation. TB can develop at any stage of immunosuppression regardless of the level of the circulating CD4+ T-lymphocytes [4]. CD4+ lymphocytes count is one of the surrogate markers for evaluating the degree of immunosuppression and HIV disease progression [4]. The levels of circulating CD4+ lymphocytes has a great impact on the radiographic pattern of TB. In HIV infections, TB can produce both typical and atypical radiographic patterns depending on the degree of immunosuppression [5–8]. Atypical radiographic presentations are lower frequency of cavitations, higher frequency of mediastinal lymphadenopathy, lower lung zone
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