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Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis with much of this in primary care. Methods: A systematic review and meta-analysis of the primary literature was conducted to investigate the accuracy of symptoms, clinical history and first-line non-invasive tests to predict pelvic endometriosis (PROSPERO: CRD42020187543). We searched Medline, Embase, Web of Science and Scopus from conception (1966; 1972; 1997; 2004 respectively) to September 2022 for primary test accuracy studies assessing non-invasive tests against reference standard diagnosis for endometriosis. Two authors independently conducted data extraction and quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios for endometriosis were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); body mass index (BMI) ≥30kg/m 2 0.37 (0.19-0.68); trans-vaginal ultrasound scan (TVUSS) endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and cancer antigen-125 (CA-125) >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care.

Brucellosis is a widespread zoonotic illness with significant morbidity rates in Armenia. It causes a wide range of clinical consequences as it progresses, from mild ones that don't require changing the composition or length of an antibiotic prescription to fortunately uncommon, fatal situations involving the heart or central nervous system. According to the National Institutes of Health's Annual Statistical Records, the number of cases with Brucellosis that were initially diagnosed in Armenia was 309 in 2015, 362 in 2017, and 201 in 2018; simultaneously no data for 2016 has been provided. As Brucellosis is an endemic disease for Armenia, sometimes there can be co-infection of Brucellosis with other diseases. Management of such cases is difficult because of drug-drug interactions and hepatotoxicity of drags. The aim of the case report is to discuss the challenges of management of patient with Brucellosis and Viral Hepatitis C infection. A 59-year-old man was admitted to the hospital, Intensive Care Unit with gastrointestinal bleeding with a primary diagnosis of liver encephalopathy. Based on the clinical and laboratory findings, the patient was diagnosed with liver cirrhosis of mixed etiology (alcohol + Viral Hepatitis C), Child-Pugh C class (decompensated disease) Meld-Na22, splenomegaly, grade 3 ascites, stage 3 liver encephalopathy. 2 months after the first hospitalization the patient started to develop an increase in body temperature (up to 39C), pain in the spine, neuropathies and paresthesia. Patient was tested for Brucellosis, Wright-Hedelson (agglutination test) positive results (positive, 1:200 respectively), and positive serology results (high levels of IgG and IgM) confirmed diagnosis. Patient was treated based on international guidelines and drug-drug interaction information. [ABSTRACT FROM AUTHOR]

ABSTRACT A total of 120 one-day-old broiler chicks (Ross 308) were randomly assigned to 12 pens of 10 birds in a completely randomized design (CRD). In four experimental diets, soya bean meal was replaced with a maggot meal at the rate of 0, 40, 50 and 60% designated as group A, B, C and D respectively. Body weight was significantly higher (p