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Diagnostic reasoning

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https://www.readbyqxmd.com/read/29244189/molecular-diagnosis-of-human-microsporidian-infections
#1
Martin F Heyworth
With the transformation of HIV infection from an acutely life-threatening disease into a chronic condition (as a consequence of the development of effective antiretroviral medication), the perceived clinical importance of diagnosing and treating microsporidian infections diminished, at least in industrialized countries. In locales where effective antiretroviral therapy is not available, as well as in patients with immunodeficiency for reasons other than HIV infection (e.g., following organ transplantation), and in individuals with suspected ocular microsporidiosis, diagnosing microsporidian infections remains a clinical priority...
December 13, 2017: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29243500/designing-medical-technology-for-resilience-integrating-health-economics-and-human-factors-approaches
#2
Simone Borsci, Ijeoma Uchegbu, Peter Buckle, Zhifang Ni, Simon Walne, George B Hanna
The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered. Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology...
December 15, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/29243060/synovial-aspiration-and-serological-testing-in-two-stage-revision-arthroplasty-for-prosthetic-joint-infection-evaluation-before-reconstruction-with-a-mean-follow-up-of-twenty%C3%A2-seven%C3%A2-months
#3
Heinrich M L Mühlhofer, C Knebel, Florian Pohlig, Susanne Feihl, Norbert Harrasser, Johannes Schauwecker, Rüdiger von Eisenhart-Rothe
INTRODUCTION: The two-stage revision protocol is the gold standard for controlling and treating low-grade prosthetic joint infections of total hip and total knee arthroplasty. The antibiotic pause for diagnostic reasons before reconstruction (stage two) is discussed in relation to the persistence of the infection and the development of resistant bacterial strains. Serological markers and a synovial analysis are commonly used to exclude the persistence of infection. Therefore, we asked (1) is the serological testing of C-reactive protein and leucocytes a valuable tool to predict a persistence of infection? and (2) what is the role of synovial aspiration of Plymethylmethacrylat (PMMA) spacers in hip and knee joints? MATERIALS AND METHODS: One hundred twelve patients who were MSIS criteria-positive for a prosthetic joint infection were studied, including 45 total hip arthroplasties (THA) and 67 total knee artrhoplasties (TKA) patients...
December 14, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/29240509/mild-bleeding-disorders-what-every-clinician-should-know
#4
H K Hussein, Plr Nicolson, K Fordwor, G C Lowe
Patients with mild bleeding disorders are under-recognized and frequently present to general physicians. The underlying reasons for bleeding are multifactorial. There is little evidence to guide diagnostic and management decision making in patients with mild bleeding disorders. This article outlines different types of mild bleeding disorders, with a particular focus on bleeding associated with low levels of von Willebrand factor and mild platelet defects. It gives practical, evidence-based advice on the investigation and management of patients with a suspected or known mild bleeding disorder, considering the scenarios of an acute bleed, stable outpatient, peri-surgical management and thrombosis...
December 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29240454/a-comparison-of-the-expectations-and-experiences-of-medical-students-from-high-middle-and-low-income-countries-participating-in-global-health-clinical-electives
#5
Michael J Peluso, Adam Rodman, Douglas A Mata, Anne T Kellett, Susan van Schalkwyk, Robert M Rohrbaugh
Phenomenon: Global health education (GHE) is expanding to include socioculturally and resource-different settings, with the goal of developing a workforce with members who can promote health equity locally and globally. GHE is also no longer limited to students from high-income countries (HICs). However, it is unknown whether the motivations and experiences of medical students from HICs and from low- and middle-income countries (LMICs) participating in GHE clinical electives through institutional partnerships are similar or different...
December 14, 2017: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/29237784/low-yield-of-filmarray-gi-panel-in-hospitalized-patients-with-diarrhea-an-opportunity-for-diagnostic-stewardship-intervention
#6
Matthew M Hitchcock, Carlos A Gomez, Niaz Banaei
FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, UT) is a multiplex, on-demand, sample-to-answer, real-time PCR assay for the syndromic diagnosis of infectious gastroenteritis that has become widely adopted and, in some instances, replaced conventional stool culture and parasite exams. Conventional testing has historically been restricted among hospitalized patients due to low diagnostic yield, but it is not known whether use of the FilmArray GI Panel should be circumscribed. Cary-Blair stool samples submitted for FilmArray GI Panel in adult patients admitted to an academic hospital from August 2015 to January 2017 were included in this study...
December 13, 2017: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/29236052/micrornas-in-parkinson-s-disease-from-pathogenesis-to-novel-diagnostic-and-therapeutic-approaches
#7
REVIEW
Loredana Leggio, Silvia Vivarelli, Francesca L'Episcopo, Cataldo Tirolo, Salvo Caniglia, Nunzio Testa, Bianca Marchetti, Nunzio Iraci
Parkinson's disease (PD) is the most prevalent central nervous system (CNS) movement disorder and the second most common neurodegenerative disease overall. PD is characterized by the progressive loss of dopaminergic (DAergic) neurons in the substantia nigra pars compacta (SNpc) within the midbrain, accumulation of alpha-synuclein (α-SYN) in Lewy bodies and neurites and excessive neuroinflammation. The neurodegenerative processes typically begin decades before the appearance of clinical symptoms. Therefore, the diagnosis is achievable only when the majority of the relevant DAergic neurons have already died and for that reason available treatments are only palliative at best...
December 13, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29233139/demand-related-factors-influencing-caregivers-awareness-of-malaria-tests-and-health-workers-testing-practices-in-makarfi-nigeria
#8
Olufemi Ajumobi, Kabir Sabitu, IkeOluwapo Ajayi, Patrick Nguku, Joy Ufere, Peter Wasswa, Chinwoke Isiguzo, Jennifer Anyanti, Jenny Liu
BACKGROUND: Despite the World Health Organization's recommendation of malaria test-treat strategy, which is the treatment of parasitological confirmed malaria cases with anti-malarials, presumptive diagnosis of malaria remains fairly common in Nigeria. The reasons for this have not been established in Makarfi, Nigeria, despite the high burden of malaria in the area. A study was conducted among caregivers of febrile children less than 5 years presenting for treatment to understand their awareness of malaria diagnostic testing and being offered testing by clinicians, the determinants of these outcomes, and caregivers' perspectives of health workers' testing practices...
December 12, 2017: Malaria Journal
https://www.readbyqxmd.com/read/29231993/etiology-and-long-term-rebleeding-of-endoscopic-ulcerative-lesions-in-the-small-bowel-in-patients-with-obscure-gastrointestinal-bleeding-a-multicenter-cohort-study
#9
Tomonori Aoki, Atsuo Yamada, Yoshihiro Hirata, Hirohumi Suzuki, Ayako Nakada, Ryota Niikura, Motoko Seto, Makoto Okamoto, Kazuhiko Koike
BACKGROUND: Among patients with obscure gastrointestinal bleeding (OGIB), endoscopic ulcerative lesions in the small bowel have diverse etiologies and often cause rebleeding. Certain characteristics of patients or ulcerations may be reasonable indications for diagnostic balloon-assisted endoscopy (BAE) to assess etiology and may be risks of rebleeding; however, these characteristics are unclear. We aimed to elucidate appropriate indications for diagnostic BAE and predictors of long-term rebleeding in patients with small-bowel ulcerative lesions...
December 12, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29230923/primary-antifungal-prophylaxis-decrease-of-invasive-fungal-disease-incidence-and-reduction-of-risk-factors-in-hematological-patients-in-a-5-year-retrospective-study
#10
Yan Li, Mingjuan Liu, Bing Zhai, Xiaoli Zhao, Lijun Wang, Honghua Li, Shuhong Wang, Haiyan Zhu, Quanshun Wang, Chunji Gao, Wenrong Huang, Li Yu
BACKGROUND: Invasive fungal disease (IFD) is a major cause of morbidity and mortality in patients with hematological malignancies. AIM: To evaluate the efficacy and rationality of primary antifungal prophylaxis (PAP) in a 5-year real life setting and choose an appropriate PAP strategy. METHODS: Clinical data of patients were retrospectively reviewed and IFD was diagnosed using the revised diagnostic criteria. The efficacy of PAP and the risk factors for IFD, especially the rationality of PAP, were evaluated...
December 12, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29227141/cervical-porcupine-quill-foreign-body-involving-the-spinal-cord-of-a-dog-a-description-of-various-imaging-modality-findings
#11
Christelle Le Roux, Frans J Venter, Robert M Kirberger
Although porcupine quill injuries are common in dogs, the detailed appearance of the quill on diagnostic ultrasound, computed tomography, and magnetic resonance imaging has not been sufficiently described. A 4-year-old, intact, female Jack Russel terrier presented with severe neck pain and ataxia after an altercation with a porcupine 2 weeks earlier. Radiology, diagnostic ultrasound, computed tomography and magnetic resonance imaging were all utilised to identify a quill imbedded in the cervical vertebral canal and cervical musculature and were compared to each other...
December 8, 2017: Journal of the South African Veterinary Association
https://www.readbyqxmd.com/read/29226649/comparison-of-the-diagnostic-power-of-serum-il-6-il-8-and-tnf-%C3%AE-for-the-idiopathic-anterior-uveitis-in-children
#12
Beata Zelazowska-Rutkowska, Malgorzata Mrugacz, Bogdan Cylwik
BACKGROUND: Uveitis is the inflammation of the uvea that often occurs in children. There are many causes of disease, but some of them do not have any reasons and are then called idiopathic uveitis. Cytokines play an important role in the regulation of the immune response. Determination of cytokine profiles could contribute to the explanation of the etiology of uveitis and could serve to evaluate the inflammation intensity as well as be helpful in the early diagnosis this disease. The purpose of this study was to determine the serum level of selected inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor α (TNF-α) and to compare their diagnostic power as a markers of idiopathic anterior uveitis in children...
November 1, 2017: Clinical Laboratory
https://www.readbyqxmd.com/read/29226234/implementation-of-a-clinical-reasoning-course-in-the-internal-medicine-trimester-of-the-final-year-of-undergraduate-medical-training-and-its-effect-on-students-case-presentation-and-differential-diagnostic-skills
#13
Sigrid Harendza, Ingo Krenz, Andreas Klinge, Ulrike Wendt, Matthias Janneck
Background: Clinical reasoning, comprising the processes of clinical thinking, which form the basis of medical decisions, constitutes a central competence in the clinical routine on which diagnostic and therapeutic steps are based. In medical curricula in Germany, clinical reasoning is currently taught explicitly only to a small extend. Therefore, the aim of this project was to develop and implement a clinical reasoning course in the final year of undergraduate medical training. Project description: A clinical reasoning course with six learning units and 18 learning objectives was developed, which was taught by two to four instructors on the basis of 32 paper cases from the clinical practice of the instructors...
2017: GMS Journal for Medical Education
https://www.readbyqxmd.com/read/29224826/evaluation-of-the-diagnostic-efficacy-and-spectrum-of-autofluorescence-of-benign-dysplastic-and-malignant-lesions-of-the-oral-cavity-using-velscope
#14
Ravikant S Ganga, Dipali Gundre, Shivani Bansal, Pankaj M Shirsat, Pooja Prasad, Rajiv S Desai
OBJECTIVES: Conventional oral examination and biopsy are the only reliable methods for the early detection of oral cancer at present. Autofluorescence examination of oral tissues using the VELscope has been suggested as an adjunctive tool for cancer detection and diagnosis. The aim of our study was to evaluate the efficacy of the VELscope in recognizing dysplastic and/or neoplastic changes in oral mucosal lesions that were identified on conventional oral examination. MATERIALS AND METHODS: Two hundred patients with oral mucosal lesions were subjected to conventional oral examination followed by VELscope examination and their autofluorescence characteristics were compared with the histopathological diagnosis...
December 2017: Oral Oncology
https://www.readbyqxmd.com/read/29224581/executive-function-and-other-cognitive-deficits-are-distal-risk-factors-of-generalized-anxiety-disorder-9-years-later
#15
Nur Hani Zainal, Michelle G Newman
OBJECTIVE: The cognitive model (Hirsch & Mathews, 2012) and attentional control theory (Eysenck & Derakshan, 2011) postulate that compromised executive function (EF) and other cognitive constructs are negatively linked to increased excessive and uncontrollable worry, the core symptom of generalized anxiety disorder (GAD). However, the prospective link between neuropsychological constructs and GAD are not well understood. METHODS: A nationally representative sample of 2605 community-dwelling adults whose average age was 55...
December 11, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/29223413/predictors-of-pressure-ulcer-risk-in-adult-intensive-care-patients-a-retrospective-case-control-study
#16
Ana Beatriz de Almeida Medeiros, Maria Isabel da Conceição Dias Fernandes, Jéssica Dantas de Sá Tinôco, Marcelly Santos Cossi, Marcos Venicios de Oliveira Lopes, Ana Luisa Brandão de Carvalho Lira
OBJECTIVES: To evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients. METHOD: A retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n=90) and a control group without pressure ulcers (n=90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model. RESULTS: The risk factors that predicted pressure ulcers were friction (OR=5...
December 6, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29223310/cystinuria-one-possible-reason-for-kidney-and-salivary-gland-lithiasis-relationship
#17
Marc-Kevin Le Roux, Nicolas Graillon, Jean-Marc Foletti, Cyrille Chossegros
Salivary gland lithiasis affects 1 to 2% of adults. The submandibular glands are concerned in 87% of cases. An association between kidney and salivary lithiases, although often mentioned, has rarely been observed. We relate an exceptional case of parotid and submandibular cystine sialolithiasis with kidney cystine lithiasis in a patient with cystinuria. Cystine lithiasis occurs in 1% of kidney lithiasis cases. The purpose of this article is to discuss the arguments, diagnosis, and therapeutic attitude in front of salivary cystine lithiasis...
November 22, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29222249/thrombocytopenia-in-pregnancy
#18
REVIEW
Douglas B Cines, Lisa D Levine
Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances made over the past 5 to 10 years in understanding and managing the more common causes of thrombocytopenia in pregnancy...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222181/fifteen-minute-consultation-an-approach-to-a-child-presenting-to-the-emergency-department-with-acute-psychotic-symptoms
#19
Anil Vasudev Israni, Sumant Kumar, Nahin Hussain
Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons. First, primary psychotic conditions are uncommon in pre-pubertal children. Second, differentiating between delirium and psychosis can be difficult in children, more so in infants, toddlers and young children. Third, intervening and managing a secondary cause of psychosis can significantly optimise outcome...
December 8, 2017: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/29219113/diagnostic-role-of-microrna-expression-profile-in-the-prenatal-amniotic-fluid-samples-of-pregnant-women-with-down-syndrome
#20
Emin Karaca, Ayça Aykut, Biray Ertürk, Burak Durmaz, Ahmet Güler, Barış Büke, Ahmet Özgür Yeniel, Ahmet Mete Ergenoğlu, Ferda Özkınay, Mehmet Özeren, Mert Kazandı, Fuat Akercan, Sermet Sağol, Cumhur Gündüz, Özgür Çoğulu
BACKGROUND: Down syndrome is the most common chromosomal anomaly in humans. Down syndrome is the most common chromosomal anomaly in humans affecting people from every race and age. Most of the cases are can be diagnosed by prenatal diagnostic methods in pregnancy. Due to the longtime of culture method applied for prenatal diagnosis, genetic analysis has been developed and developing for rapid diagnosis. For this reason, the effective use of miRNAs was investigated in the rapid analysis of prenatal samples with Down syndrome...
December 8, 2017: Balkan Medical Journal
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