Search

Summary This Good Practice Paper provides recommendations for the diagnosis and initial management of transplant‐eligible high‐risk myeloma patients. It describes recent updates to the genetic diagnostics of high‐risk myeloma and provides recommendations for treatment on the basis of recent prospective clinical trial evidence. [ABSTRACT FROM AUTHOR]

The recognition of constipation as a possible non‐Immunoglobulin E (IgE)‐mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE‐mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non‐IgE‐Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review. [ABSTRACT FROM AUTHOR]

This article provides information on the diagnosis and management of smouldering myeloma, a precursor condition to multiple myeloma. It discusses various diagnostic tests and imaging techniques used to identify smouldering myeloma and emphasizes the importance of restaging if there is evidence of progression. The article also provides recommendations for screening and initial investigations for suspected myeloma. Additionally, it discusses risk stratification models and treatment options for smouldering myeloma, including the use of lenalidomide. The article concludes by highlighting ongoing clinical trials and the need for further research in the treatment of smouldering myeloma. [Extracted from the article]

This article summarizes several studies on various topics. The first study examines the relationship between internalizing symptoms and problematic pornography use in college students, finding that higher levels of internalizing symptoms are associated with higher levels of problematic pornography use. The second study focuses on sleep-wake disorders among veterans with opioid use disorder, revealing that 24.4% of veterans with opioid use disorder have a sleep disorder, with obstructive sleep apnea being the most common type. The third study explores the association between cannabis use and lifetime suicidal ideation and attempts, finding that cannabis use is associated with an increased risk of suicidal ideation and attempts. Another study examines the impact of mandatory buprenorphine training and the removal of the X-waiver on prescribing patterns for physicians, showing that while there was an increase in knowledge and a decrease in concern about legal consequences after training, there were no significant differences in buprenorphine prescribing patterns. The fifth study focuses on emergency department patients with illicit fentanyl use and co-occurring psychiatric disorders, highlighting the prevalence of illicit fentanyl use and the need for routine assessments and treatment for mental health and substance misuse in this population. Lastly, a study examines the burden of emergency admissions and hospitalizations for nonfatal acute iatrogenic events in people with sickle cell disease and opioid dependence or tolerance, emphasizing the need for improved interventions and better access to care for this population. The first article also highlights the need for further research to improve opioid treatment strategies and [Extracted from the article]

This ENETS guidance paper, developed by a multidisciplinary working group, provides up‐to‐date and practical advice on the diagnosis and management of digestive neuroendocrine carcinoma, based on recent developments and study results. These recommendations aim to pave the road for more standardized care for our patients resulting in improved outcomes. Prognosis is generally poor for digestive NEC, most are advanced at diagnosis and median survival in metastatic disease is 11–12 months. Surgery can be of benefit for localized disease after extensive preoperative imaging. Carboplatin in combination with etoposide is recommended as first‐line treatment for metastatic disease. Irinotecan with fluoropyrimidines has the best evidence as second‐line treatment. Immunotherapy plays a minor role in biomarker‐unselected patients. Molecular profiling if available is encouraged to identify new targets. More prospective clinical trials are highly needed to fulfil the unmet needs in this field, especially on new predictive and prognostic biomarkers and to improve survival of patients with advanced disease. [ABSTRACT FROM AUTHOR]

Gastro‐oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA‐associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA‐associated GORD and medical and dietary management. The task force (TF) on non‐IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web‐based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA‐associated GORD. [ABSTRACT FROM AUTHOR]

Aims: The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self‐administered paper towel test (PTT‐ISA; invention disclosure #2021‐347) to objectively demonstrate UI. Aims were to determine: (1) PTT‐ISA compliance and (2) relationship to questionnaire results. Methods: 276 community women were invited to complete both SWAN questionnaire and PTT‐ISA. For PTT‐ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT‐ISA plus questionnaire results was formed. Results: Of 276 women, noncompliance with PTT‐ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire‐only and PTT‐ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT‐ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. Conclusion: PTT‐ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self‐administered by community women outside of a clinic environment. Further research comparing PTT‐ISA with clinician‐observed cough test is warranted. As independently self‐administered, PTT‐ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey‐dependent research. [ABSTRACT FROM AUTHOR]

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well‐being across the lifespan. This EAACI Task Force was therefore established, to develop an up‐to‐date, research‐informed position paper, detailing the optimal approach to the diagnosis and management of common exercise‐related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision‐making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs. [ABSTRACT FROM AUTHOR]

Background and Purpose: Multiple sclerosis (MS) is an unpredictable disease characterised by a highly variable disease onset and clinical course. Three main clinical phenotypes have been described. However, distinguishing between the two progressive forms of MS can be challenging for clinicians. This article examines how the diagnostic definitions of progressive MS impact clinical research, the design of clinical trials and, ultimately, treatment decisions. Methods: We carried out an extensive review of the literature highlighting differences in the definition of progressive forms of MS, and the importance of assessing the extent of the ongoing inflammatory component in MS when making treatment decisions. Results: Inconsistent results in phase III clinical studies of treatments for progressive MS, may be attributable to differences in patient characteristics (e.g., age, clinical and radiological activity at baseline) and endpoint definitions. In both primary and secondary progressive MS, patients who are younger and have more active disease will derive the greatest benefit from the available treatments. Conclusions: We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype. Because the definition of progressive MS differs across clinical studies, careful selection of eligibility criteria and study endpoints is needed for future studies in patients with progressive MS. [ABSTRACT FROM AUTHOR]

When it affects the daily life of the patient or causes complications, it is known as gastroesophageal reflux disease (GORD). GRAPH Rosan Meyer Gastroesophageal reflux (GOR) is a common condition, especially in the first year of life. Editorial comments on: "Diagnosis and management of food allergy associated gastroesophageal reflux disease in young children - EAACI position paper". [Extracted from the article]

Monitoring of human serum albumin (HSA) in a point‐of‐care fashion is urgently needed in particular for elderly or chronically ill patients. Herein, a dual‐state emissive chalcone probe having the feature of aggregation‐induced emission was designed and synthesized. The concentration of HSA can be evaluated by the ratios of emission from probes in aggregated and monomeric state, which gives a visually discernible red‐to‐green color change. A simple, portable paper‐based analytical device have been fabricated by integration of the recognition probe in the detection pad and employed for HSA test using the whole blood samples. This paper‐based assay shows the analytical capability comparable to the standard testing methods but is in a point‐of‐care fashion, providing a promising tool for at‐home HSA detection and HSA‐related disease diagnosis. [ABSTRACT FROM AUTHOR]

Mobility can be defined as the ability to move or be moved freely and easily. In older adults, mobility impairments are common and associated with risk for additional loss of function. Mobility loss is particularly common in these individuals during acute illness and hospitalization, and it is associated with poor outcomes, including loss of muscle mass and strength, long hospital stays, falls, declines in activities of daily living, decline in community mobility and social participation, and nursing home placement. Thus, mobility loss can have a large effect on an older adult's health, independence, and quality of life. Nevertheless, despite its importance, loss of mobility is not a widely recognized outcome of hospital care, and few hospitals routinely assess mobility and intervene to improve mobility during hospital stays. The Quality and Performance Measurement Committee of the American Geriatrics Society has developed a white paper supporting greater focus on mobility as an outcome for hospitalized older adults. The executive summary presented here focuses on assessing and preventing mobility loss in older adults in the hospital and summarizes the recommendations from that white paper. The full version of the white paper is available as Text S1. J Am Geriatr Soc 67:11–16, 2019. [ABSTRACT FROM AUTHOR]

Objectives The immune trypanolysis test ( TL) is an accurate sero-diagnostic tool increasingly implemented for sleeping sickness medical surveillance, but it is restricted to the reference laboratories. To facilitate storage and transport of the test specimen, we developed a protocol for the examination of blood spotted on filter paper ( TL-fp) that can be stored and shipped at ambient temperature. We compared its performance with the classical TL on plasma ( TL-pl) that needs to be kept frozen until use. Methods The study was conducted in active foci of the Republic of Guinea. In total, 438 specimens from treated and untreated sleeping sickness patients and serological suspects were tested with both methods. Result TL-fp gave significantly less positive results than TL-pl, but all the confirmed sleeping sickness cases were positive with the TL-fp protocol. Conclusion TL-fp appears to offer a good compromise between feasibility and sensitivity to detect currently infected subjects who play a role in the transmission of Trypanosoma brucei gambiense and is useful for contributing to the elimination of gambiense sleeping sickness. [ABSTRACT FROM AUTHOR]

A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta‐lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost‐effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross‐reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1‐6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low‐risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus. [ABSTRACT FROM AUTHOR]

Introduction: Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point‐of‐care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. Methods: This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub‐Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. Results: Of the 266 abstracts reviewed, 52 full‐text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0–12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow‐up). Maternal‐related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. Discussion: We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. Conclusions: This paper identifies barriers and proposes strategies for timely ART initiation in infants. [ABSTRACT FROM AUTHOR]

Aims/Introduction: The prevalence of diabetes mellitus is increasing rapidly in Japan, and diabetic neuropathy is a major factor decreasing diabetic patients' quality of life, as well as a risk factor for sudden death. The present study aimed to determine the prevalence of diabetic neuropathy and raise awareness about it among patients and their physicians. Materials and Methods: Diabetic outpatients ( N = 5077) at 249 medical institutions within Kanagawa Prefecture, Japan, were surveyed by questionnaire and underwent foot examinations. The questionnaire included 10 questions about sensory abnormalities of both feet, muscle cramps and autonomic symptoms. Foot examinations included testing for vibratory perception of the medial malleolus, Achilles tendon reflexes and touch sensation of the bottom of the great toe using tissue paper. Results: Of the 5077 patients surveyed, 70.4% reported symptoms. Overall, 75.4% of the patients underwent vibratory perception testing, of whom 44.9% had abnormal thresholds (≤10 s). On the tissue paper touch test, performed in 94.6% of patients, 11.9% had no touch sensation. Of the 2803 type 2 diabetic patients with known background factors who underwent foot examinations, 49.4% had diabetic neuropathy. There was a high prevalence of diabetic neuropathy (36.1%) in patients with <5-year history. Of the patients with no touch sensation on the tissue paper test, 81.3% had diabetic neuropathy. Conclusions: The present study identified the prevalence of diabetic neuropathy in Kanagawa Prefecture. The tissue paper test is a simple and excellent method of evaluating decreased superficial sensation that can help evaluate the severity of diabetic neuropathy. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00174.x, 2011) [ABSTRACT FROM AUTHOR]

The advent of electronic medical records brought image filing systems to many hospitals, as well as electronic endoscopic medical records. However, data integration among multiple different vendors has not yet been accomplished. We start the Japan Endoscopic Database ( JED) Project endorsed by Japan Gastroenterological Endoscopy Society ( JGES) from January 2015. The purposes of this project are as follows: (i) developing the world's largest endoscopic database generated from daily use of the reporting system; (ii) capturing the actual performance of endoscopic practice in Japan; and (iii) standardizing the terminology and fundamental items for registry of clinical studies. Moreover, the JED project has the potential to automatically collect data about adverse events, competency and evaluation of residents, and actual numbers of procedures on a nationwide scale, certification for the specialty board system, and so on. We believe that this design paper will be helpful not only for future nationwide research but also for international research ( UMIN000016093). [ABSTRACT FROM AUTHOR]

This report was written by the Japanese Society of Dysphagia Rehabilitation, the Japanese Association of Rehabilitation Nutrition, the Japanese Association on Sarcopenia and Frailty, and the Society of Swallowing and Dysphagia of Japan to consolidate the currently available evidence on the topics of sarcopenia and dysphagia. Histologically, the swallowing muscles are of different embryological origin from somatic muscles, and receive constant input stimulation from the respiratory center. Although the swallowing muscles are striated, their characteristics are different from those of skeletal muscles. The swallowing muscles are inevitably affected by malnutrition and disuse; accumulating evidence is available regarding the influence of malnutrition on the swallowing muscles. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles. When sarcopenia does not exist in the entire body, the term "sarcopenic dysphagia" should not be used. Additionally, sarcopenia due to neuromuscular diseases should be excluded; however, aging and secondary sarcopenia after inactivity, malnutrition and disease (wasting disorder and cachexia) are included in sarcopenic dysphagia. The treatment of dysphagia due to sarcopenia requires both dysphagia rehabilitation, such as resistance training of the swallowing muscles and nutritional intervention. However, the fundamental issue of how dysphagia caused by sarcopenia of the swallowing muscles should be diagnosed remains unresolved. Furthermore, whether dysphagia can be caused by primary sarcopenia should be clarified. Additionally, more discussion is required on issues such as the relationship between dysphagia and secondary sarcopenia, as well as the diagnostic criteria and means for diagnosing dysphagia caused by sarcopenia. Geriatr Gerontol Int 2019; 19: 91–97. [ABSTRACT FROM AUTHOR]

Abstract: Background: In the earliest clinical stages of Alzheimer’s disease (AD) when symptoms are mild, clinical diagnosis can be difficult. AD pathology most likely precedes symptoms. Biomarkers can serve as early diagnostic indicators or as markers of preclinical pathologic change. Candidate biomarkers derived from structural and functional neuroimaging and those measured in cerebrospinal fluid (CSF) and plasma show the greatest promise. Unbiased exploratory approaches, eg, proteomics or cortical thickness analysis, could yield novel biomarkers. The objective of this article was to review recent progress in selected imaging and neurochemical biomarkers for early diagnosis, classification, progression, and prediction of AD. Methods: We performed a survey of recent research, focusing on core biomarker candidates in AD. Results: A number of in vivo neurochemistry and neuroimaging techniques, which can reliably assess aspects of physiology, pathology, chemistry, and neuroanatomy, hold promise as biomarkers. These neurobiologic measures appear to relate closely to pathophysiologic, neuropathologic, and clinical data, such as hyperphosphorylation of tau, amyloid beta (Aβ) metabolism, lipid peroxidation, pattern and rate of atrophy, loss of neuronal integrity, functional and cognitive decline, as well as risk of future decline. Current advances in the neuroimaging of mediotemporal, neocortical, and subcortical areas of the brain of mild cognitive impairment (MCI) and AD subjects are presented. CSF levels of Aβ42, tau, and hyperphosphorylated tau protein (p-tau) can distinguish subjects with MCI who are likely to progress to AD. They also show preclinical alterations that predict later development of early AD symptoms. Studies on plasma Aβ are not entirely consistent, but recent findings suggest that decreased plasma Aβ42 relative to Aβ40 might increase the risk of AD. Increased production of Aβ in aging is suggested by elevation of BACE1 protein and enzyme activity in the brain and CSF of subjects with MCI. CSF tau and p-tau are increased in MCI as well and show predictive value. Other biomarkers might indicate components of a cascade initiated by Aβ, such as oxidative stress or inflammation. These merit further study in MCI and earlier. Conclusions: A number of neuroimaging candidate markers are promising, such as hippocampus and entorhinal cortex volumes, basal forebrain nuclei, cortical thickness, deformation-based and voxel-based morphometry, structural and effective connectivity by using diffusion tensor imaging, tractography, and functional magnetic resonance imaging. CSF Aβ42, BACE1, total tau, and p-tau are substantially altered in MCI and clinical AD. Other interesting novel marker candidates derived from blood are being currently proposed (phase I). Biomarker discovery through proteomic approaches requires further research. Large-scale international controlled multicenter trials (such as the U.S., European, Australian, and Japanese Alzheimer’s Disease Neuroimaging Initiative and the German Dementia Network) are engaged in phase III development of the core feasible imaging and CSF biomarker candidates in AD. Biomarkers are in the process of implementation as primary outcome variables into regulatory guideline documents regarding study design and approval for compounds claiming disease modification. [Copyright &y& Elsevier]

The article discusses the diagnosis and investigation of patients with mantle cell lymphoma (MCL. Topics covered include the latest information on molecular pathology, the use of positron emission tomography/computed tomography (PET/CT) scanning in staging and response assessment, and biological prognostic factors of MCL.

Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed. [ABSTRACT FROM AUTHOR]

In this paper, we present a review of critical concepts, and produce recommendations on management issues in cutaneous T‐cell lymphomas (CTCLs) of adults. A panel of nine experts was selected for their expertise in research and clinical practice of CTCLs. During an initial meeting, the areas of major concern in the management of CTCLs were selected by generating and rank‐ordering clinical key questions using the criterion of clinical relevance, through group discussion. Recommendations were achieved by multiple‐step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. The panel produced recommendations on how to facilitate the clinical suspicion of CTCL; indication of cutaneous biopsy; optimal histological diagnosis, immunohistochemistry and genetic markers; and staging pathway and up‐to‐date therapeutics (with particular focus on new treatments). The critical concept of integration of the different medical expertise in the management of the patients with CTCL was thoroughly examined. These recommendations are intended for use not only by expert centers but above all by "not experienced" dermatologists and hematologists as well as general practitioners. [ABSTRACT FROM AUTHOR]

The incidence of arbovirus infections has increased dramatically in recent decades, affecting hundreds of millions of people each year. The Togaviridae family includes the chikungunya virus (CHIKV), which is typically transmitted by Aedes mosquitoes and causes a wide range of symptoms from flu‐like fever to severe arthralgia. Although conventional diagnostic tests can provide early diagnosis of CHIKV infections, access to these tests is often limited in developing countries. Consequently, there is an urgent need to develop efficient, affordable, simple, rapid, and robust diagnostic tools that can be used in point‐of‐care settings. Early diagnosis is crucial to improve patient management and to reduce the risk of complications. A glass‐fiber laser‐cut microfluidic device (paper‐based analytical device [PAD]) was designed and evaluated in a proof of principle context, for the analysis of 30 µL of patient serum. Biological raw materials used for the functionalization of the PAD were first screened by MAC‐ELISA (IgM capture enzyme‐linked immunosorbent assay) for CHIKV Immunoglobulin M (IgM) capture and then evaluated on the PAD using various human samples. Compared with viral lysate traditionally used for chikungunya (CHIK) serology, CHIKV pseudo‐particles (PPs) have proven to be powerful antigens for specific IgM capture. The PAD was able to detect CHIKV IgM in human sera in less than 10 minutes. Results obtained in patient sera showed a sensitivity of 70.6% and a specificity of around 98%. The PAD showed few cross‐reactions with other tropical viral diseases. The PAD could help health workers in the early diagnosis of tropical diseases such as CHIK, which require specific management protocols in at‐risk populations. [ABSTRACT FROM AUTHOR]

Drug hypersensitivity reactions ( DHRs) are a matter of great concern, both for outpatient and in hospital care. The evaluation of these patients is complex, because in vivo tests have a suboptimal sensitivity and can be time-consuming, expensive and potentially risky, especially drug provocation tests. There are several currently available in vitro methods that can be classified into two main groups: those that help to characterize the active phase of the reaction and those that help to identify the culprit drug. The utility of these in vitro methods depends on the mechanisms involved, meaning that they cannot be used for the evaluation of all types of DHRs. Moreover, their effectiveness has not been defined by a consensus agreement between experts in the field. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology has organized a task force to provide data and recommendations regarding the available in vitro methods for DHR diagnosis. We have found that although there are many in vitro tests, few of them can be given a recommendation of grade B or above mainly because there is a lack of well-controlled studies, most information comes from small studies with few subjects and results are not always confirmed in later studies. Therefore, it is necessary to validate the currently available in vitro tests in a large series of well-characterized patients with DHR and to develop new tests for diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis ( OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent. [ABSTRACT FROM AUTHOR]

Correct management and classification of anaphylaxis is mandatory. Records of emergency department (ED) visits to any of the three pediatric hospitals in Stockholm, because of reactions to foods during 2007, were identified. A retrospective analysis of clinical ED records of 371 children with 381 unique occasions of reactions to foods was performed. Symptoms/signs of reactions to foods recorded for classification of anaphylaxis were related to those presented in the EAACI Taskforce position paper on Anaphylaxis in Children (Allergy 2007; 62: 857). Forty-six different symptoms/signs of reactions to foods were retrieved. Several severe signs or symptoms from the respiratory tract and signs indicating reduced brain perfusion were not described in detail in the EAACI paper, hampering correct classification of anaphylaxis including grading of severity in our material. After modification of the EAACI classification including such signs and symptoms, we were able to classify 128 (35%) children with anaphylaxis. Seventy children (19%) did not fulfill our modified EAACI's criteria for anaphylaxis. They had been given adrenaline before or at arrival to hospital, possibly preventing anaphylaxis. Another 173 (47%) children/ adolescents had neither been given adrenalin, nor fulfilled the criteria for anaphylaxis. Classification of food-induced anaphylaxis and severity grading should be built on signs and symptoms to facilitate diagnosis. The existing EAACI tool is helpful, but for Swedish children it is not quite applicable, in particular because of the lack of description of some respiratory, neurological or possible cardiovascular signs and symptoms. [ABSTRACT FROM AUTHOR]

Flavivirus infections are a serious healthcare concern in tropical and subtropical countries. Although well-established laboratory tests can provide early diagnosis of acute dengue or Zika infections, access to these tests is limited in developing countries, presenting an urgent need to develop simple, rapid, and robust diagnostic tools. Microfluidic Paper-based Analytical Devices (μPAD), are typically rapid, cost-effective, user-friendly, and they can be used as diagnostic tools for the diagnosis of these infections at Point of Care settings. Early and prompt diagnosis is crucial to improve patient management and reduce the risk of complications. In the present study, we developed and evaluated a wax-printed paper-based device for the detection of the dengue and Zika non-structural NS1 viral protein in blood and plasma. Experiments have been carried out to increase specificity, while maintaining the required sensitivity. As a consequence, the quality of the raw materials and the washing steps were proved to be crucial. The μPAD was able to detect specifically in 6-8 min 10 ng/mL of protein in various sample types. A prototype for the differential detection of dengue and/or Zika NS1 protein was developed. The reading of the results was simplified by using a dedicated application on a smartphone. [ABSTRACT FROM AUTHOR]

The aims of this study were to investigate the effectiveness of a computer database (CD) developed for this study, a plain paper unstructured history (USH) and structured histories (SH) for the recording of important prognostic factors for simulated dento-alveolar trauma. Twelve vocational trainees, seven postgraduates in paediatric dentistry and 24 general dental practioners were randomly assigned to using USH, SH or CD. Each dentist visited a series of simulated trauma cases (with models, photos, radiographs and actors) and was asked to record important prognostic factors for each injury and make a diagnosis. There were a total of 243 dentist contacts with the trauma stations. The average percentage of important prognostic factors recorded per station was: USH 53%, SH 75.3% and CD 58.6%. SH was significantly better than the other two methods ( P < 0.001,anova). Interestingly, those general dental practitioners (GDPs) who qualified prior to 1990 were significantly poorer at recording important prognostic information using CD. This effect was not obvious when using USH and SH. It was also seen that USH and SH were significantly better at helping clinicians reach a correct diagnosis as compared with CD ( P < 0.001, chi-squared). A paper-based SH was the most effective method for collecting essential prognostic information for simulated trauma cases used in this study. At present, the introduction of our CD for recording of trauma is not justified without significant modification. [ABSTRACT FROM AUTHOR]

In bilingual and multilingual settings one is constantly challenged by the difficulty of teasing apart phenomena associated with normal second language (L2) reading acquisition from authentic warning signs of reading failure. The bulk of this paper focuses on a critical discussion of a cluster of beliefs that pertain to the issues concerning the diagnosis of reading disability in multilingual and bilingual settings among school children. Findings from available research on reading acquisition among bilingual children and research focusing specifically on the assessment of English-as-a-second language (ESL) children who might be at risk for reading disability are used to evaluate the validity of these beliefs. While some beliefs are supported by research, others are not. In particular, the research suggests that reliable diagnosis of dyslexia among ESL children can be achieved by examining within-language differences on various indices of basic reading skills such as phonological processing, and by noting a significant gap between oral and reading comprehension. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with heart failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and the Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and the United States. [ABSTRACT FROM AUTHOR]

The article presents a commentary on the role of phosphatidylethanol in assessing postmortem ethanol intake in autopsies. The author highlights the use of the ethanol compound as a biomarker in determining alcohol consumption in an autopsied person's brain and serum blood level. The author also offers the detailed information on the research conducted on the effectiveness of phosphatidylethanol in autopsies.

The term irritant-induced (occupational) asthma ( IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA. [ABSTRACT FROM AUTHOR]

Most Human African Trypanosomiasis (HAT) control programmes in areas endemic for Trypanosoma brucei gambiense rely on a strategy of active mass screening with the Card Agglutination Test for Trypanosomiasis (CATT)/T. b. gambiense. We evaluated the performance, stability and reproducibility of the CATT/T. b. gambiense on blood-impregnated filter papers (CATT-FP) in Kajo-Keji County, South-Sudan, where some areas are inaccessible to mobile teams. The CATT-FP was performed with a group of 100 people with a positive CATT on whole blood including 17 confirmed HAT patients and the results were compared with the CATT on plasma (CATT-P). The CATT-FP was repeated on impregnated filter papers stored at ambient and refrigerated temperature for 1, 3, 7 and 14 days. Another 82 patients with HAT, including 78 with a positive parasitology, were tested with the CATT-FP and duplicate filter paper samples were sent to a reference laboratory to assess reproducibility. The CATT-FP was positive in 90 of 99 patients with HAT (sensitivity: 91%). It was less sensitive than the CATT-P (mean dilution difference: -2.5). There was no significant loss of sensitivity after storage for up to 14 days both at ambient and cool temperature. Reproducibility of the CATT-FP was found to be excellent (kappa: 0.84). The CATT-FP can therefore be recommended as a screening test for HAT in areas where the use of CATT-P is not possible. Further studies on larger population samples in different endemic foci are still needed before the CATT-FP can be recommended for universal use. [ABSTRACT FROM AUTHOR]

Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology ( EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity. [ABSTRACT FROM AUTHOR]

Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA ( Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists. [ABSTRACT FROM AUTHOR]

The article features the recipients of the British Journal of Urology International (BJUI) such as E. David Crawford, Tarek Bismar and Guillaume Ploussard. It says that Crawford, recipient of the Bob Krane Prize, focuses on prostate specific antigen (PSA) research. Bismar, recipient of the Coffey Priza, states that his inspiration for his research was his patients. Meanwhile, the John Blandy Price winner Ploussard focused his research on the developments in prostate cancer diagnosis.

The article presents research papers on clinical observations and follow-up patients at the Bethlem Royal Hospital in London, England. There are eight chapters that presents background, aims, method and clinical characteristics of patients. In the first chapter, Felix Post summarizes present knowledge of late paraphrenia, drawing on the clinical descriptions of earlier workers and emphasizing the relative rarity of descriptions of schizophrenia occurring after the age of 50 or 60 and the difficulty early nosologists had in making the differentiation from senile psychosis.

Objective Muscle dysmorphia is a relatively recently identified psychological condition that, since its inception, has been variously conceptualized as an eating disorder and subsequently as a type of body dysmorphic disorder within the somatoform disorders. This review aims to inform and encourage ongoing debate surrounding the diagnostic placement of this disorder. Method We present a review and synthesis of the extant literature with a view to informing future decisions regarding the conceptualization of muscle dysmorphia. Results The validity of muscle dysmorphia as a clinical entity has been empirically demonstrated. While the condition bears little semblance to somatization as currently conceptualized, the research suggests a strong conceptual similarity with anorexia nervosa. However, future research needs to utilize more appropriate measures of male eating disorder pathology. Muscle dysmorphia is also inclusive of obsessive compulsive features that are typical to those seen in eating disorder presentations. Discussion We suggest that muscle dysmorphia be reanalyzed through the lens of an eating disorder spectrum. Recognition of muscle dysmorphia as an eating disorder may offer more clinical utility in recognizing the male experience of eating disorder pathology and also help reduce the number of current male cases falling into the EDNOS category. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:483-491 [ABSTRACT FROM AUTHOR]

The use of statistics in medical diagnoses and biomedical research may affect whether an individual may live or die, whether their health is protected or jeopardized. Because society depends on sound statistical practice, all practitioners of statistics, whatever their training or occupation, have social obligations to perform their work in a professional, competent, and ethical manner. [ABSTRACT FROM AUTHOR]

The roles of physicists in medical imaging have expanded over the years, from the study of imaging systems (sources and detectors) and dose to the assessment of image quality and perception, the development of image processing techniques, and the development of image analysis methods to assist in detection and diagnosis. The latter is a natural extension of medical physicists’ goals in developing imaging techniques to help physicians acquire diagnostic information and improve clinical decisions. Studies indicate that radiologists do not detect all abnormalities on images that are visible on retrospective review, and they do not always correctly characterize abnormalities that are found. Since the 1950s, the potential use of computers had been considered for analysis of radiographic abnormalities. In the mid-1980s, however, medical physicists and radiologists began major research efforts for computer-aided detection or computer-aided diagnosis (CAD), that is, using the computer output as an aid to radiologists—as opposed to a completely automatic computer interpretation—focusing initially on methods for the detection of lesions on chest radiographs and mammograms. Since then, extensive investigations of computerized image analysis for detection or diagnosis of abnormalities in a variety of 2D and 3D medical images have been conducted. The growth of CAD over the past 20 years has been tremendous—from the early days of time-consuming film digitization and CPU-intensive computations on a limited number of cases to its current status in which developed CAD approaches are evaluated rigorously on large clinically relevant databases. CAD research by medical physicists includes many aspects—collecting relevant normal and pathological cases; developing computer algorithms appropriate for the medical interpretation task including those for segmentation, feature extraction, and classifier design; developing methodology for assessing CAD performance; validating the algorithms using appropriate cases to measure performance and robustness; conducting observer studies with which to evaluate radiologists in the diagnostic task without and with the use of the computer aid; and ultimately assessing performance with a clinical trial. Medical physicists also have an important role in quantitative imaging, by validating the quantitative integrity of scanners and developing imaging techniques, and image analysis tools that extract quantitative data in a more accurate and automated fashion. As imaging systems become more complex and the need for better quantitative information from images grows, the future includes the combined research efforts from physicists working in CAD with those working on quantitative imaging systems to readily yield information on morphology, function, molecular structure, and more—from animal imaging research to clinical patient care. A historical review of CAD and a discussion of challenges for the future are presented here, along with the extension to quantitative image analysis. [ABSTRACT FROM AUTHOR]

I This study by Claire i [1] I in the UK investigated the prevalence of uveitis within a population of donkeys in the UK i . Clinical signs included miosis (n = 1), corpora nigra atrophy (n = 6), anterior lens capsule pigment (n = 2), cataract (n = 8), posterior synechiae (n = 3), lens subluxation (n = 1), vitreal changes (n = 2), peripapillary scarring (n = 3), and phthisis bulbi (n = 1). Improved knowledge of the prevalence, types and risk of development of post extraction complications may help reduce these complications. [Extracted from the article]

Haemophilia and inherited bleeding disorders in newborns and their carrier mothers pose unique challenges. The pattern of bleeding and the causes and risk factors for bleeding are decidedly different than an older child or an adult with haemophilia/inherited bleeding disorder. This document outlines the needs for further research and education, summarizes the state of the art background information and provides guidance regarding research, education and access to care issues in this population. [ABSTRACT FROM AUTHOR]

There is paucity of comprehensive data on the blood usage with regard to diagnostic categories of Asian recipients. The purpose of this study is to analyse data for blood usage in a korean university hospital in order to obtain additional information on transfusion practices in relation to diagnoses. Data of information on patients discharged during the period from March 1996 to February 2002, who have received packed red blood cells (RBC), fresh frozen plasmas (FFP), and platelet components (PLT) were extracted from the computerized registers. We used only the principal four-digit diagnostic categories of the Tenth Revision of International Classification of Diseases. A total of 397 489 units of blood components (RBC 171 916 units; FFP 69 301 units; and PLT 156 272 units) were transfused for 17·2% of all discharged patients. Acute myeloid leukaemia, liver cell carcinoma, advanced gastric cancer, alcoholic or other unspecified cirrhosis of liver were the top 5 diagnoses related with the highest usage of blood component. The results showed a different blood usage pattern compared to those of previous studies. These provide a baseline transfusion practice at our institution, and the data would help in predicting future blood needs in a variety of diagnostic categories. [ABSTRACT FROM AUTHOR]

Endometriosis is a common and painful gynaecological condition that takes an average of 6.4years to diagnose. While laparoscopic surgery is the recommend gold standard in diagnosis of endometriosis, transvaginal ultrasound (TVS) is able to assist surgeons in the planning and management of patients, especially when there is limited visualisation in the posterior compartment. Uterosacral ligaments (USL) are located in the posterior compartment and are one of the first and most common places that endometriosis deposits, The International Deep Endometriosis Analysis (IDEA) group consensus, which are the current guidelines for DE imaging, recommends a thorough ultrasound assessment to identify endometriotic disease. This includes an assessment of anatomic structures in the posterior compartment including the USLs. However, IDEA does not explicitly articulate specifics of USL imaging and measurements on ultrasound. The primary aim of this review is to determine is to identify ultrasound techniques and characteristics of USLs in the diagnosis of deep infiltrative endometriosis (DE). The secondary aim is to describe and summarise these findings into normal and pathological findings. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A population, interventions, comparator, and outcome framework was used to define a search strategy. Articles were screened using Covidence review management system, and data was extracted by two authors using a standardised and piolet‐tested form. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP). Medline, Embase and Scopus and Google Scholar were searched yielding 250 articles, with 22 being included in the review. Analysis of the data demonstrated inconsistent reporting of ultrasound techniques and characteristics of USLs. Most (20/22) papers described abnormal criteria of USLs, only 5/22 papers determined what the normal USL appearance is or what techniques (11/22) were applied. Even though reporting was heterogeneous, there was a high level of tertiary centre participation with gynaecological experienced operators, therefore was a high level of agreement. Through review of the current literature, this study has investigated ultrasound techniques and characteristics of USLs for the diagnosis of DE. All papers included in this review reported presence of pathological sonographic findings of the USLs when DE was presented therefore it is recommended that USL examination become a part of TVS exams when DE is clinically suspected. This study also demonstrated that there was lack of data and no agreement when it comes to measuring USLs with DE. Even so, the current evidence demonstrates that scanning the USLs, and locating, identifying, and describing USL thickening and endometriotic nodules in the various locations using the described techniques and characteristics in this review has clinical value in early diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia. [ABSTRACT FROM AUTHOR]

Standardization of allergen provocation tests of the airways requires standardization of each of the steps involved, including standardization of the extracts used. The value of international standards is emphasized and so is the determination of a clinically relevant potency. The allergen extracts used for bronchial provocation tests must be compared with qualitatively and quantitatively clinically relevant standards using complementary immunochemical and biological methods. Ideally the same extracts should be used for diagnosis (skin test, specific IgE determinations, provocations) and treatment (immuno- therapy). The importance of the biological compared with the non-biological methods is that the biological methods are established in allergenic patients in order to select a clinically relevant potency of the allergen in question, and this potency ought to be confirmed in clinical trials. Once established the biological potency of an in-house preparation can be reproduced by supplementary in vitro methods. Very few commercial allergen preparations are available which fulfil the above-mentioned criteria. [ABSTRACT FROM AUTHOR]

Discusses the development and use of the Mini-Mental State (MMS) Examination in diagnosing cognitive disorders. Method used in assessing the validity of MMS results; Background on different versions of MMS tests; Applications of MMS.

Background: The outcome of microbiological diagnostics may depend on the sampling technique. It was the aim of the present study to compare two widely used sampling techniques for subgingival bacteria using quantitative real-time polymerase chain reaction. Methods: Twenty patients with chronic periodontitis were randomized into two groups. [n group A, samples were taken first with a paper point and then with a curet at the same site (single-rooted teeth with probing depth >5 mm) before scaling and root planing and after 10 weeks. The sampling sequence was reversed in group B. The analysis enabled the quantification of Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivaIis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis and total bacteria! counts (TBCs). Statistical analysis included t test, kappa, and Spearman correlation. Results: Higher TBC was harvested with curets than by paper points (P = 0.008). The plaque composition with regard to total target pathogens was similar for both sampling techniques. A strong positive correlation was found between curet and paper point samples for TBC and single target bacteria. Conclusions: Overall, there was a relatively good agreement for the results of paper point and curet sampling. Thus. both techniques seem to be suitable for microbiological diagnostics. [ABSTRACT FROM AUTHOR]

The article presents a discussion on the paper "Diagnosis in Endodontics." Professor T.C. Rowbotham opened the discussion by thanking professor I. Curson for the paper and complimented him on skirting around the question on the interpretation of pulp testing. He wondered if Curson would elaborate a little further about his particular likes and dislikes with regard to the various pulp vitality testing methods and what reliance he placed on electrical methods and on thermal tests. Curson replied that he used them all each time if he wanted to find out whether the pulp was vital or not.

Usefulness of11C-Methionine PET in the Diagnosis of Benign Tumors Presenting with Temporal Lobe Epilepsy.Purpose:We assessed the diagnostic value of11C-methionine (MET)-PET in the differential diagnosis of benign tumors presenting with temporal lobe epilepsy.Methods:This series consisted of seven patients who had a type of complex partial seizure (CPS) associated with temporal lobe epilepsy, and were found to have benign tumors in the temporal lobe. They included three males and four females, ranging in age from 13 to 48 years. The age at seizure onset ranged from 6 to 26 years old, and the time to operation ranged from 2 to 28 years. High-resolution magnetic resonance imaging (MRI) with a 1.5 T magnet revealed organic lesions in the temporal lobes. MET-PET was performed in all seven patients, and 18F-fluoro-2-deoxy-glucose (FDG)-PET was performed in four patients. After presurgical examinations including repeated EEGs, video-EEG monitoring, and neuropsychological testing, three patients underwent invasive monitoring for focus detection and functional mapping. All seven patients underwent tumor resection together with focus excision under intraoperative ECoG guidance. Using the image analysis software Dr. View (Asahi Kasei Joho, Tokyo, Japan) on a personal computer, the region of interests (ROIs) were placed on the tumor and contralateral brain over the MRI, and then transferred to the PET images co-registered with MRI. The uptake of tracers was evaluated by the lesion-to-contralateral ratio (L/C ratio) and the standardized uptake value (SUV), a value calculated by dividing the brain activity of tracer per volume of brain by the injected activity of tracer per body weight. Surgical specimens were examined to investigate the tumor histology and Ki-67 labeling index. Microdygenesis of the resected foci was also examined. Statistical significance of differences in MET uptake between patients with dysembryoplastic neuroepithelial tumor (DNT) and those with ganglioglioma and gliomas was analyzed using the SUV and L/C ratio by the Student'sttest.Results:After surgery, six patients remained seizure-free and one achieved a rare-seizure outcome for at least 6 months. The tumor was identified as high MET uptake lesion in three cases and was not depicted on MET-PET in four patients. Among the four patients who underwent FDG-PET, two patients showed high MET uptake in the tumor. However, all four patients showed low glucose uptake in the tumor and surrounding cerebral cortex. Pathological examination demonstrated DNTs in four cases, ganglioglioma in one case, low grade astrocytoma in one case, and pleomorphic xanthoastrocytoma (PXA) in one case. One patient with DNT showed a number of ectopic neurons in the white matter, a finding compatible with microdysgenesis. Ki-67 labeling index was 4% in one patient with DNT and 5% in one patient with PXA. The labeling index of the remaining five patients was 1% or lower. While four patients with DNT did not show visually high MET uptake, ganglioglioma and gliomas of the remaining three patients were identified as high-MET-uptake-lesions. MET uptake was significantly higher in patients with gliomas than in patients with DNT (SUV: P= 0.045, L/C ratio: P= 0.0079). The Ki-67 labeling index was not related to MET uptake expressed in SVU (P= 0.91) and L/C ratio (P= 0.38).Conclusion:In the seven patients with temporal lobe epilepsy and benign tumors in this study, we observed a high MET uptake in brain gliomas but not in DNTs. This high MET uptake was not related to the proliferation capacity measured by Ki-67 labeling index. MET-PET was useful for the differential diagnosis of DNT. Evaluation of Magnetic Spontaneous Brain Activity with Magnetoencephalography Frequency Topography.Purpose:To evaluate frequency changes of magnetic background brain activities obtained from epilepsy patients.Methods: A whole head–type magnetometer with 102 orthogonal pairs of planar gradiometers, Neuromag System (Neuromag Ltd., Helsinki, Finland), and an electroencephalograph, BIOTOP (NEC, Tokyo, Japan) were used. We recorded simultaneous magnetoencephalography (MEG), electroencephalography, electrocardiography, and electrooculography in six patients with epilepsy. Sampling frequency was 600–615 Hz, and analog filter was 0.1–200 Hz. MEG recordings around epileptic discharges were selected and processed through fast Fourier transformation to obtain frequency power spectra by using the equipped signal-processing software, Graph. The power spectra of orthogonal pairs of MEG channels were summed by each MEG sensor; for instance, the power spectra of MEG sensor MEG011 was the sum of the power spectra of MEG channels, MEG0112 and MEG0113. The averaged values between target frequency bands were projected on two-dimensional planes or the patient's individual brain surface images, sensor by sensor. Intersensor area was filled with interpolated values, whereas data of any noisy sensor were excluded. The magnitude of the calculated values was coded on a color bar in the topography images. Conventional electrically equivalent current dipole (ECD) estimation was done at the peak of the epileptic spikes by using the ECD estimation software, Source Modelling, and the locations of the estimated ECDs and the areas with increased power spectra in the MEG frequency topography were compared.Results:We generated consecutive images of MEG frequency topography accompanied by the estimated ECDs if the time span of the MEG frequency topography included the epileptic spikes. All six cases showed high 4- to 7-Hz activities preceding epileptic spikes near the ECDs. The high 8- to 13- and 14- to 25-Hz activities were observed at the time of the epileptic spike near these ECDs.Conclusions:Although ECD estimation by MEG is widely used to locate epileptic foci, the ECD data do not provide information on the extent or the propagation of the epileptic discharges. Whereas the search for fine abnormal waves before epileptic spikes is the gold standard to decide the origin of the epileptic discharge in electrocorticographic study, this method is not appropriate for ECD estimation because the statistical reliability of ECDs estimated before obvious epileptic spikes is thought to be poor. Therefore, we developed the MEG frequency topography to improve these problems of ECD estimation. Contrary to other types of pick-up coils, the planar gradiometer shows the maximal signal if the electric source exists just below the gradiometer. Fortunately, this property of the planar gradiometer mimics the bipolar electrode leads in electroencephalogram, and we can use the MEG frequency topography as if it were conventional EEG frequency topography. MEG frequency topography provides information on the extent and the propagation of brain activities by frequency bands. Suppose that the extent and propagation of high activities in MEG frequency topography are equivalent to those of the epileptic discharges; evaluation of the MEG recordings by using MEG frequency topography is useful to study the characteristics of each patient's epilepsy pattern. We did not perform strict statistical analysis between conventional ECD estimation and MEG frequency topography because our MEG frequency topography was the first trial, and this new tool must be refined further. However, MEG frequency topography has the potential to disclose new significant information about the mechanism of the epilepsy different from the information obtained through conventional ECD estimation. Hippocampalα-[11C] Methyl-l-Tryptophan Uptake Negatively Correlates with Glucose Metabolism in Patients with Intractable Temporal Lobe Epilepsy.Background:The most common pathologic finding in pharmacologically intractable temporal lobe epilepsy (TLE) is hippocampal sclerosis. However, positron emission tomography (PET) studies with 2-[18F]-fluorodeoxyglucose (FDG) show that the interictal hypometabolic abnormal zone is wider and involves not only the hippocampus but also the temporal, frontal, and parietal lobes, the thalamus, and the basal ganglia. The basis for this interictal hypometabolism in TLE is unclear. Therefore, PET studies with other radiopharmaceuticals assessing other neuronal metabolic pathways may be helpful in further understanding the pathophysiology of the interictal functional anomalies in TLE. Some evidence indicates that serotonergic systems modulate epileptogenesis. The implied increased rate of serotonin synthesis might represent a compensatory mechanism to decrease the level of cortical excitability.α-[11C] Methyl-l-tryptophan (α-MTrp) was developed as a tracer for PET measurement of serotonin synthesis in vivo. Reports suggest thatα-MTrp PET might be a useful tool in the localization of the epileptogenic area in cortical malformations.Objective:To determine whether metabolism in the brain serotonergic system, including the kynurenine pathway, is involved in TLE.Methods:We studied 14 patients with intractable TLE by PET by usingα-MTrp and FDG and compared the results with those of 21 normal control subjects who hadα-MTrp PET studies. Seven patients had unilateral hippocampal atrophy (HA), whereas seven had normal hippocampal volumes (NVs). We defined regions of interest (ROIs) on seven different structures with high serotonergic innervation including the hippocampus, amygdala, lateral temporal lobe, frontal lobe, thalamus, lenticular nucleus, and cingulate cortex. Those magnetic resonance imaging (MRI)-defined ROIs were then transferred to the corresponding, coregistered PET studies. The netα-MTrp uptake constant K* was calculated for each ROI from the time–activity curve, and the input function was estimated from the venous sinus radioactivity and blood samples. Z-scores for regional K* values ipsilateral and contralateral to the seizure focus in patients were compared with those in normal controls. The correlation between glucose utilization value and the normalized K* values from ROIs on the same side was examined to assess the relation between hypometabolism and the change in the uptake ofα-MTrp.Results:When all patients were combined, no significant difference in the z-scores of normalized regional K* values were found for any of the homologous pairs. A significant increase ofα-MTrp uptake was observed in the hippocampus ipsilateral to the seizure focus in seven TLE patients with NV compared with that in seven patients with HA as well as with normal controls. In TLE patients, glucose utilization in the lateral temporal lobe ipsilateral to the seizure focus was correlated negatively with K* forα-MTrp in the ipsilateral hippocampus and positively with K* in the ipsilateral lenticular nucleus and cingulate cortex. Glucose utilization in the frontal lobe ipsilateral to the seizure focus was also negatively correlated with K* forα-MTrp in the ipsilateral lateral temporal lobe. Conversely, normalized regional glucose utilization in the hippocampus or amygdala was not correlated with the mean z-scores of any of the normalized regional K* values.Conclusions:We found an increased hippocampalα-MTrp uptake in TLE patients with NV. Negative correlation also was seen between temporal lobe glucose metabolism andα-MTrp uptake in the hippocampus on the side of the seizure focus. Although the possibility that a hyperactive kynurenine pathway might be responsible for the anomalies ofα-MTrp uptake noted here cannot be dismissed, a dysfunctional serotonergic system is also a plausible explanation for our findings.α-MTrp PET studies may be useful for lateralizing the epileptic focus in TLE patients with normal hippocampal volumes. Cost-Effectiveness of Computed Tomography in the Evaluation of Patients with Epilepsy.Purpose:To determine the cost-effectiveness of cranial computed tomography (CT) scans in epilepsy patients.Methods:Newly diagnosed epilepsy patients from 1995 to 2000 were prospectively investigated by cranial CT scan in our clinic for epilepsy. The cost of finding a case of significant pathology was estimated to determine the cost-effectiveness of cranial CT scan in the diagnosis of these patients.Results:The 572 cases of generalized and 172 cases of partial epilepsy patients were studied. Overall abnormalities were found by CT scan in 32% of the patients, but specified abnormalities were found only in 10% of the patients. No clinically important abnormalities were detected by CT in all the 480 generalized patients without focal abnormalities in neurologic or EEG examinations or both, and the cost of finding a case with significant pathology was estimated to be≥64,214 yuan. Conversely, specified abnormalities were found by CT in 50% of the patients with partial seizures having focal abnormalities in neurologic or EEG examinations, and the cost of finding a case of significant pathology was estimated to be 800 yuan (cost for a CT scan,∼400 yuan in our hospital).Conclusions:At a time of shrinking health care budgets, especially in developing countries, CT-scan evaluation of neurologically normal patients with generalized seizures is expensive and clinically unrewarding in this series. [ABSTRACT FROM AUTHOR]