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According to World Health Organization estimates released in 2021, there were 241 million cases of malaria and 627,000 deaths worldwide in 2020. Sub – Saharan Africa and India carried almost 85% of the global burden. Nigeria is among the six countries which accounted for more than half of all malaria cases worldwide, mostly consisting of pregnant women and children under 5years. Nearly 110million clinical cases of malaria are diagnosed each year, and malaria contributes up to 60% of out – patients’ visits and 30% of hospital admissions. This study sought to establish the accuracy with which malaria is presumptively diagnosed and treated based on clinical presentations only and the cost estimates on the patient in the study facilities. A prospective study was carried out between October, 2018 to June 2019 using 356 participants who came to the health facilities to access treatment with suspected cases of malaria and were presumptively diagnosed and treated for malaria. Demographics and blood samples were collected from eligible and consented patients and screened for plasmodium parasite by microscopy. The results obtained showed 88% of the patients tested negative for plasmodium parasite while 12% tested positive. The cost of anti-malarial ranged from 500 – 1000 naira (using the median score). Authors concluded that only 12% of those treated for malaria actually needed such treatments. This underscores the need to test for malaria before treatment.

Resumen Trichophyton benhamiae es un dermatofito zoofílico. Puede causar tinea corporis, tinea faciei y tinea capitis. Se caracteriza por producir lesiones inflamatorias, sobre todo en niños. El objetivo de esta publicación es describir 7 casos clínicos de pacientes pediátricos atendidos entre julio del 2019 y enero del 2020 en nuestra institución. A los pacientes se les solicitó estudio micológico convencional, con posterior confirmación con MALDI-TOF MS y secuencia-ción del ADN ribosomal. Se aisló e identificó T. benhamiae como agente etiológico; el nexo epidemiológico fue el contacto con cobayos. Estas son las primeras descripciones de infecciones causadas por T. benhamiae en Argentina. Al realizar estudios micológicos convencionales, este agente puede confundirse con otros dermatofitos, por lo tanto, se requieren herramientas como MALDI-TOF MS o la secuenciación para llegar a un diagnóstico definitivo. Es importante contar con datos epidemiológicos, como el contacto con mascotas no tradicionales, para una presunción diagnóstica adecuada.

To determine the proportion of children referred to academic medical centers with concerns about autism spectrum disorders (ASDs) who received a probable ASD diagnosis, identify factors predicting ASD diagnosis, and describe the children with ASD concerns who were not found to have autism.A total of 55 developmental-behavioral pediatricians (DBP) at 12 academic sites in the DBPNet research network recorded data on ≤15 consecutive new patients. They coded presumed diagnoses after their first visit with the child.Of 784 new visits, 324 (41%) had concern for ASD; of these, 221 (68%) were presumptively ASD+; 103 (32%) were ASD-. In a mixed model accounting for clustering within site and covariates significant in bivariate analysis, significant predictors of receiving a presumptive ASD diagnoses were socialization concerns, languages other than English spoken in the home, and coming for second opinion. Also concern for "other behavior problems" (not mood, oppositionality, anxiety, attention, or repetitive behaviors) predicted not receiving ASD diagnoses. This model was not clinically useful because it misclassified 26.9% of children. ASD- children4 years old had more language delay and less cognitive impairment and socialization concern than their ASD+ age peers. ASD- children ≥4 years old were more likely to have attention-deficit /hyperactivity disorder (ADHD) and learning disability with normal cognition than their ASD+ age peers.Two thirds of children referred to academic centers with concern for ASD received a presumptive diagnosis of ASD. While those with ASD were not easily distinguished from those without ASD at referral, virtually all children with ASD concerns had multiple DBP diagnoses made and required DBP follow-up care.

A 14-year-old, 5.8 kg (12.7 lb) male castrated Jack Russell Terrier was referred for investigation of syncope and an arrhythmia. Electrocardiogram showed pronounced variation in the sinus rate including long periods of sinus arrest and an inconsistent escape rhythm. Sick sinus syndrome was the presumptive diagnosis. A single lead permanent transvenous pacemaker was implanted and was programmed to perform ventricular-demand pacing. Postoperative pacemaker interrogation revealed undersensing and asynchronous pacing during episodes of supraventricular tachycardia (SVT). This intermittent pacemaker malfunction was attributed to a specific pacemaker programming feature called quiet timer blanking. Adjustment of pacemaker parameters did not restore normal function. Treatment with sotalol (5 mg per os q 12 h) was used to medically treat the SVT, and asynchronous pacing was not observed during follow-up visits. To the authors’ knowledge, this is the first documented case of quiet timer blanking causing paroxysmal undersensing and asynchronous pacing in a dog with a permanent pacemaker.

Pedro Santos-Moreno,1 Nelson J Alvis-Zakzuk,2 Edwin Castillo,1 Laura Villarreal,1 Carlos Pineda,3 Hugo Sandoval,4 Omaira Valencia1,5 1Center of Rheumatoid Arthritis, BIOMAB, Bogota, Colombia; 2Universidad de la Costa-CUC, Departamento de Ciencias Económicas, Barranquilla, Colombia; 3Sociomedical Research Unit, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico; 4Sociomedical Research Unit, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México; 5Fundación Santa Fé de Bogotá, Bogotá, ColombiaCorrespondence: Omaira ValenciaFundación Santa Fé de Bogotá, Carrera 7B # 123-90, Bogotá, ColombiaEmail o.valencia10@uniandes.edu.coBackground: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA from everyday clinical practice.Methods: We performed a retrospective analysis for patients with presumptive SRA who tested negative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies, through an ADP imaging-based, that is a standard clinical practice in our center. After we confirmed the diagnosis of SRA or reclassified patients in terms of another proper diagnosis, we estimate direct costs in two scenarios: a conventional and ADP. We compared the cost of RA treatment during the first year against the cost of the most misdiagnosed treatment (osteoarthritis) found after applying the ADP to determine potential cost-savings.Results: We included 440 patients with a presumptive diagnosis of SRA. According to the imaging-based ADP, SRA was confirmed in 106/440 (24.1%), unspecified RA in 9/440 (2.0%), and osteoarthritis in 325/440 (73.9%) of those patients. Although the costs of conventional diagnosis per patient is lower than those of ADP ($59,20 USD vs $269,57 USD), we found a potential drug cost-savings of $1,570,775.20 US Dollars after 1 year of correct treatment.Conclusion: An alternative diagnosis process, including X-rays, US and MRI imaging, and clinical and blood-test assessment, not only increased diagnostic certainty in patients referred for evaluation of presumptive SRA but also suggested a potential cost-savings in pharmacological treatments avoided in misdiagnosed patients.Keywords: cost-savings, seronegative rheumatoid arthritis, diagnosis, imaging

We report a case of a newborn with unilateral retinal detachment that could not be repaired. At examination under anesthesia, the retina was markedly abnormal and a presumptive diagnosis of retinal dysplasia was made. Several years later, the eye was enucleated because it was blind and painful. Final pathology was consistent with familial exudative vitreoretinopathy (FEVR). The literature describing unilateral retinal dysplasia is sparse. This case adds to the clinical spectrum of pathologic findings in FEVR.

Objective Ultrasonographic differential diagnosis of ovarian tumors is important for appropriate management. We conducted study to compare the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with a subjective assessment (SA) in differentiating between benign and malignant adnexal masses in Korean women. Methods A total of 353 patients who underwent adnexal surgery with abnormal pelvic ultrasonographic findings from August 2016 to August 2017 were included in study. The presumptive diagnosis of adnexal malignancy was determined by both SA and the ADNEX model to be >10% calculated risk of malignancy. The area under the curve (AUC) comparison between the SA and ADNEX models was performed using DeLong’s method. Results 340 patients with benign tumors and 13 with malignant adnexal tumors among 292 (82.72%) premenopausal and 61 (17.28%) postmenopausal women were included. The AUCs of SA and the ADNEX model for discrimination between benign and malignant tumors were 0.79 and 0.92, respectively (P=0.10). The sensitivity and specificity of SA and the ADNEX model were 83.5% and 97.0%, and 90.0% and 82.0%, respectively. Comparison of the ADNEX model regarding menopausal status revealed that the predictability was not different. The AUCs of SA and the ADNEX model in premenopausal women were 0.74 and 0.89, respectively (P=0.12). The AUCs of SA and the ADNEX model in postmenopausal women were 0.86 and 0.94, respectively (P=0.60). Conclusion The ADNEX model offers excellent discrimination between benign and malignant ovarian tumors with similar sensitivity and specificity to SA in both premenopausal and postmenopausal Korean women.

Oral hygiene is an important step in the control of the biofilm, a factor related to diseases such as gingivitis and tooth decay. The systematization of oral hygiene in children is a set of measures that seeks to achieve sequential learning, thus guaranteeing a better elimination of the biofilm. Objetive: To show a sequence of systematized steps in oral hygiene in a pediatric patient with a definitely positive behavior. Case Report: Six year old female patient, without relevant medical history. On clinical intraoral examination presented biofilm accumulation and swollen gums. The presumptive diagnosis was marginal gingivitis associated with biofilm, the treatment included a preventive phase with motivation and education. The control of the disease evolution was carried out with a card of Systematization Technique of Oral Hygiene, the methodology included the recording of the educational sessions using videos and photographs. Results: the adequate use of the amount of toothpaste was achieved, the integrity was improved to 100%, the brushing time increased from 24 to 120 seconds and it was possible to add tongue brushing and not rinsing after brushing within the oral hygiene routine. Conclusion: The patient was able to clean all dental surfaces, using homogeneous times for each surface, following an orderly sequence in toothbrushing, as well as to acquire knowledge regarding the amount of toothpaste to use, tongue brushing and not rinsing after toothbrushing. The systematization of oral hygiene allowed us to achieve these achievements in six sessions.

This study evaluated the presence of radiolucid lesions in digital panoramic radiographs from the archives of the State University of Paraiba (UEPB) Diagnostic Imaging Clinic, performed in 2017. After surveying the radiographs performed by the service in that year, those with radiolucent lesions were selected, being excluded those with poor quality and with patient positioning errors. By means of a structured form, the characteristics observed in the radiographs were recorded by a single trained and calibrated observer. The analysis took place through descriptive statistics and all ethical aspects were respected. There was a low prevalence (14.2%) of radiographs with radiolucent lesions, which mainly affected young female patients. These lesions were small in size, located predominantly in the posterior periapical region of the mandible, with a unilocular aspect, being associated with a posterior tooth, mainly premolar. Inflammatory lesions were the most prevalent, with a presumptive diagnosis highlighting the predominance of abscesses followed by cysts/granulomas. The dentigerous cyst was the third most prevalent odontogenic lesion, occurring in its entirety in females. Odontogenic keratocysts and Stafne's bone cavity were also detected.

Background: Inflammatory brain diseases are relatively common causes of CNS disease in dogs and cats but its overall incidence in the veterinary species is currently unknown. They can be associated with infectious agents (such as bacteria, virus, protozoa and fungi) or autoimmune causes. Achieving a definitive diagnosis can be challenging in most cases, as this would require obtaining samples from the CNS for histological examination and that would pose high risks to the patient and is associated with significant financial cost. In practice, clinicians use a combination of clinical, imaging and laboratory test findings to achieve a presumptive diagnosis, so an in-depth understanding of the most common conditions is essential in order to plan appropriate diagnostic investigations. Aim of the article: This article reviews the latest knowledge on inflammatory brain diseases in companion animals, including current thoughts on aetiology, treatment options and prognostic factors.

Hb Winnipeg [α75(EF4)Asp→Tyr (α2); HBA2: c.226G>T (or HBA1)] is a stable α-globin chain variant described in a few articles. The majority of reported cases in older articles were clustered in Canada. It can occur on both α1- and α2-globin genes and in different populations. In this study, eight cases of Hb Winnipeg were characterized by DNA sequencing during a wide-spectrum study of suspected α-globin gene variants collected in the United Kingdom. All cases detected peaked in the S window between 4.4 and 4.54 min. on high performance liquid chromatography (HPLC). The isoelectric focusing (IEF) averaged at 6.21 below Hb A. All the mutations were detected on the α1-globin gene except in one case. The ethnic origin of the majority of the patients was Canadian. Only one case was associated with the common polymorphism HBA2: c.-24C>G (or HBA1) [Cap +14 (C>G)] on both α-globin genes without any apparent effect on the variant expression. All cases were detected in a heterozygous state. Hb Winnipeg expression was consistently lower than the theoretical value for α chain variants, ranging between 11.8 and 15.8% of total hemoglobin (Hb). This study gave more details about Hb Winnipeg that may help in presumptive diagnosis, especially in routine laboratories.

espanolAntecedentes Los anticuerpos anticitoplasma del neutrofilo (ANCA) se asocian con vasculitis. Existen diferentes metodos para determinar su presencia. Se ha descrito la interferencia de anticuerpos antinucleares (ANA) en la diferenciacion de los patrones P-ANCA y C-ANCA. Objetivo Determinar la frecuencia de ANCA en una poblacion con manifestaciones de enfermedad autoinmune; y evaluar la interferencia de los ANA en su interpretacion. Materiales y metodos Estudio de corte transversal retrospectivo, descriptivo no experimental incluyendo 3.330 datos con diagnostico presuntivo de enfermedad autoinmune y solicitud de ANCA. Las determinaciones de ANCA y de ANA se realizaron mediante inmunofluorescencia indirecta, L-ANCA® y CytoBead® ANCA. Antiproteinasa 3 y antimieloperoxidasa fueron determinados mediante ELISA y CytoBead® ANCA. Resultados Se encontraron ANCA positivos en el 10,21% y el 12,64% con ANCA positivos presentaban ANA positivos. La concordancia kappa para antiproteinasa 3 entre CytoBead® ANCA y ELISA fue del 100% (K = 1; p Conclusiones Los resultados indican una solicitud sobreestimada de este marcador como ayuda diagnostica en consulta de atencion primaria no direccionada. Para una adecuada evaluacion de ANCA se debe implementar la tecnica de inmunofluorescencia indirecta para tamizaje y confirmar con la determinacion de antigenos especificos para antiproteinasa 3 y antimieloperoxidasa por cualquiera de los ensayos confirmatorios. La alta concordancia mostrada por CytoBeads® ANCA hace que planteemos el empleo de dicha alternativa para la determinacion de ANCA y su confirmacion. Dada la interferencia de los ANA, se recomienda solicitar la prueba ANA por inmunofluorescencia indirecta ante la presencia de resultados P-ANCA positivos, con el fin de minimizar «falsos positivos». EnglishBackground Antibodies against neutrophil cytoplasm (ANCA) are associated with vasculitis. There are different methods to determine their presence. The interference of antinuclear antibodies (ANA) in the differentiation between P-ANCA and C-ANCA patterns has been described. Objective To determine the frequency of ANCA in a population with manifestations of autoimmune disease, and evaluate the interference of ANA in its interpretation. Materials and methods Retrospective, descriptive nonexperimental cross-sectional study, including 3,330 data. The presumptive diagnosis was autoimmune disease and a test for ANCA was requested. The ANCA and ANA determinations were made by indirect immunofluorescence, L-ANCA® and CytoBead® ANCA. Anti-proteinase 3 and anti-myeloperoxidase were detected by ELISA and CytoBead® ANCA. Results ANCAs were positive in 10.21% and 12.64% of those positive for ANCA were positive for ANA. The inter-rater agreement statistic (Kappa) for anti-PR3 between CytoBead ANCA and ELISA was 100% (K = 1.00; P Conclusions The results suggest an overestimated request for ANCAs as a diagnostic aid in primary care which was not addressed. For an adequate evaluation of ANCAs, the indirect immunofluorescence technique should be implemented for the control and confirmation with the determination of specific antigens for anti- proteinase 3 and anti- myeloperoxidase in any of the confirmatory assays. The high concordance shown by ANCA CytoBeads makes us consider the use of this alternative for the determination of ANCAs and the confirmation. Given the interference of ANAs, the ANA test by IFI in the presence of positive P-ANCA results is recommended in order to minimize “false positives”.

Introducción: la feohifomicosis es una infección micótica que ocurre especialmente en pacientes inmunosupri­midos y que provoca lesiones cutáneas y, ocasionalmente, en otros órganos. La histopatología, el cultivo y la bio­logía molecular son parte del estudio diagnóstico. El tratamiento incluye la combinación de terapia antimicótica sistémica e intervenciones quirúrgicas. Presentación del caso: hombre de 61 años, diabético y trasplantado renal, con historia de 1 año de lesión ulce­rada en rodilla derecha, no dolorosa y secretante. Histopatológicamente se observaron hifas dematiáceas, con diagnóstico presuntivo de feohifomicosis. Ante la mala evolución clínica a pesar del uso de itraconazol, requirió inicio de anfotericina B y manejo quirúrgico, de donde se aisló en cultivo Cladophialophora spp., confirmando así el diagnóstico. Actualmente está recibiendo voriconazol, con mejoría satisfactoria. Conclusiones: se presenta un caso de feohifomicosis tumoral en un paciente inmunosuprimido, con poca me­joría al uso de terapia sistémica, que requirió combinación con manejo quirúrgico para obtener mejores resul­tados.

Lipofibromatosis is a recently recognized slow growing rare pediatric tumor. Paucity of its cytological description in the literature leads to its pre operative misdiagnosis and further incomplete management. A twelve-month-old female presented with a rapidly progressive mass in the right thigh and buttock region. On examination, the mass was huge and involved the medial, posterior and lateral aspects of the thigh. The cytological smears showed mature adipocytes with few spindled out cells. FNA was reported as a lipoma, corroborating with the radiological presumptive diagnosis. However, histopathological and immunohistochemical features favoured a diagnosis of Lipofibromatosis. The cytological smears were reviewed and a cyto-histo correlation was established. The diagnosis of Lipofibromatosis rests upon classical cytological features in a clinically and radiologically suggestive picture. An early and accurate diagnosis if established can help the surgeon plan excision with wider margins as incomplete excision is associated with a high rate of recurrence.

Antecedentes: La dermatología se ha considerado clásicamente una especialidad limitada al ámbito ambulatorio. Sin embargo, los pacientes ingresados presentan con frecuencia afecciones cutáneas asociadas o no a enfermedades sistémicas. Objetivo: Analizar las características de las interconsultas realizadas al Servicio de Dermatología del Hospital Central de Mendoza. Diseño: Estudio observacional analítico de corte longitudinal. Materiales y métodos: Se incluyeron 425 interconsultas de pacientes hospitalizados y ambulatorios que requirieron una evaluación dermatológica urgente, desde el 1 de febrero hasta el 31 agosto de 2019. Resultados: Se analizaron 266 (62,59%) interconsultas de pacientes ambulatorios con requerimiento de evaluación dermatológica urgente, de ellas 228 (85,71%) fueron derivados del Servicio de Guardia. Ciento cincuenta y nueve (37,41%) fueron interconsultas de pacientes hospitalizados, de las cuales 74 (46,54%) fueron solicitadas por Clínica Médica. Las dermatopatías infecciosas fueron las más frecuentes (38,82%), seguidas de las inflamatorias (37,65%). Las lesiones cutáneas asociadas a enfermedad sistémica fueron más frecuentes en los internados (p = 0,003). Del total de las interconsultas, 230 (54,11%) contaban con un diagnóstico presuntivo y, de ellos, 127 (55,21%) coincidieron con el diagnóstico definitivo realizado por el dermatólogo. Se comparó la coincidencia entre el diagnóstico presuntivo y el definitivo entre grupos de médicos con orientación clínica frente a quirúrgica y se halló coincidencia en el 30,95% y el 23,40% de los casos, en ese orden, sin observarse diferencias estadísticamente significativas (p = 0,28). Conclusión: La evaluación dermatológica facilita el diagnóstico y el manejo del paciente en el contexto hospitalario.

Aplasia cutis congenita (ACC) is a rare disease that is characterized by complete or partial absence of skin at birth, either in a localized or widespread region. Melanocytic nevi refers to tumor-like malformations of the skin or mucous membrane caused by benign proliferation of melanocytes. It is classified as a giant congenital melanocytic nevus (GCMN) when the diameter of the largest nevus exceeds 20 cm. The co-occurrence of ACC and GCMN is extremely rare, to the best of our knowledge. We report a case of coexistence of ACC and GCMN of infancy in a 2-month-old male infant. The lesions consisted of a large hyperpigmented plaque occupying most of the trunk and pelvic region, and smaller hyperpigmented plaques on the trunk, head, and extremities. Additionally, there were large, sharply marginated, triangular, depressed atrophic plaques covered by thin, translucent, glistening epithelial membranes in the center of the GCMN on the back. The presumptive diagnosis was coexistence of GCMN and ACC. This could be a manifestation of SCALP syndrome, a rare neuro-cutaneous condition characterized by the presence of Sebaceous nevus, Central nervous system (CNS) malformations, Aplasia cutis congenita, Limbal dermoid and Pigmented (giant melanocytic) nevus.

Amaç: Bu çalışmada, rutin laboratuvarlarda brusellozun tanısında kullanılan Brucella immuncapture test (BCAP), Rose Bengal (RB), Standart Tüp Aglütinasyon (STA) ve ELISA testleri ile yeni bir serolojik test olan Brucella Coombs Gel Test (BCGT)’in etkinliğinin karşılaştırılması amaçlanmıştır.Hastalar ve Yöntem: Dâhiliye, enfeksiyon hastalıkları ve pediatri kliniklerinden bruselloz ön tanısı ile laboratuvarımıza gönderilen 107 hastaya ait serum örneklerinde BCAP, RB, STA, ELISA IgG/IgM ve BCGT testleri uygulanmıştır. Cohen’s Kappa testi ile tanı testleri arasındaki uyum istatistiksel olarak analiz edilmiştir. Ayrıca, BCGT testinin duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri saptanmıştır.Bulgular: Elde edilen verilere göre; 107 hastanın 102’si (95.3%) BCAP testi ile 96’sı (%89.7) RB testi ile 80’i (%74.8) STA testi ile 100’ü (%93.5) BCGT ile 104’ü (%97.2) ELISA IgG testi ile ve 101’i (94.3%) ELISA IgM testi ile pozitif olarak tespit edilmiştir. Yapılan istatistiksel analizler sonucunda (Cohen’s Kappa Test), BCAP ile BCGT (?=0.824) arasında güçlü uyum saptanmıştır. Ayrıca BCGT testinin duyarlılık ve özgüllüğü sırasıyla %98.08 ve %71.43 olarak saptanmıştır.Sonuç: BCGT insan brusellozunun tanısında kullanılabilecek umut vadeden bir teknik gibi görünen, hızlı, az maliyetli ve yüksek duyarlılığa sahip bir testtir. Ancak, bu testin rutin laboratuvarlarında kullanılabilirliğini destekleyecek daha fazla bilimsel çalışmaya ihtiyaç vardır. Aim: The aim of this study was to compare the efficiency of the Brucella Coombs Gel Test (BCGT), a new serological diagnosis test, with the methods used in routine laboratory such as Brucella immuncapture test (BCAP), Standard Tube Agglutination (STA), Rose Bengal (RB) and ELISA for the diagnosis of brucellosis.Patients and Method: The serum samples of 107 patients with a presumptive diagnosis of brucellosis sent from three different clinics (internal medicine, infectious disease and pediatric clinics) were subjected to four different diagnostic methods (BCAP, RB, STA, and ELISA). The correlations between these diagnostic tests were analyzed using the Cohen’s Kappa test. Additionally, sensitivity, specificity, positive and negative predictive values, and accuracy of BCGT were measured.Results: According to the obtained data, the positivity of different Brucella tests (BCAP, RB, STA, BCGT, ELISA IgG and IgM) were 102 (95.3%), 96 (89.7%), 80 (74.8%), 100 (93.5%), 104 (97.2%) and 101 (94.3%), respectively. According to the Kappa test results, there was strong agreement between BCAP and BCGT (?=0.824). Furthermore, the sensitivity and specificity values of BCGT in our study were 98.08% and 71.43%, respectively.Conclusion: BCGT is a rapid, cost-effective and highly sensitive test, which appears to be a promising technique for the diagnosis of human brucellosis; however, further scientific studies are needed to support the applicability of this test in routine laboratories.

This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (≤15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse. RESUMO: O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (≤15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.

Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.

Background Visual characteristics seen during digital single-operator cholangioscopy (DSOC) have not been validated. The aim of this 2-phase study was to define terminology by consensus for the visual diagnosis of biliary lesions to develop a model for optimization of the diagnostic performance of DSOC. Materials and methods In phase 1 (criteria identification), video-cholangioscopy clips were reviewed by 12 expert biliary endoscopists, who were blinded to the final diagnosis. Visual criteria were consolidated into the following categories: (1) stricture, (2) lesion, (3) mucosal features, (4) papillary projections, (5) ulceration, (6) abnormal vessels, (7) scarring, (8) pronounced pit pattern.During the second phase (validation), 14 expert endoscopists reviewed DSOC (SpyGlass DS, Boston Scientific) clips using the 8 criteria to assess interobserver agreement (IOA) rate. Results In phase 1, consensus for visual findings were categorized into 8 criteria titled the "Monaco Classification." The frequency of criteria were: (1) presence of stricture-75%, (2) presence of lesion type-55%, (3) mucosal features-55%, (4) papillary projections-45%, (5) ulceration-42.5%, (6) abnormal vessels-10%, (7) scarring-40%, and (8) pronounced pit pattern-10%. The accuracy on final diagnosis based on visual impression alone was 70%.In phase 2, the IOA rate using Monaco Classification criteria ranged from slight to fair. The presumptive diagnosis IOA was fair (κ=0.31, SE=0.02), and overall diagnostic accuracy was 70%. Conclusions The Monaco classification identifies 8 visual criteria for biliary lesions on single-operator digital cholangioscopy. Using the criteria, the IOA and diagnostic accuracy rate of DSOC is improved compared with prior studies.

Background: Underestimation of leptospirosis cases is happening in many countries. The most common factor of underreporting is misdiagnosis. Considering the limitations of direct detection of pathogen and serological diagnosis for leptospirosis, clinical features and blood tests though non-specific are usually referred in making presumptive diagnosis to decide disease management. Methods: In this single-centre retrospective study, comparative analysis on clinical presentations and laboratory findings was performed between confirmed leptospirosis versus non-leptospirosis cases. Results: In multivariate logistic regression evidenced by a Hosmer-Lemeshow significance value of 0.979 and Nagelkerke R square of 0.426, the predictors of a leptospirosis case are hypocalcemia (calcium

La tuberculosis abdominal comprende alrededor del 5% de todos los casos de tuberculosis, esta patología es considerada una enfermedad de inicio insidioso y presentación crónica, misma que rara vez es catalogada como una urgencia; sus complicaciones, sin un adecuado enfoque clínico, pueden desorientar al médico, en muchos casos de tuberculosis en niños, la confirmación de laboratorio nunca se establece, como sucede con este caso en particular y es allí donde se determina que un diagnóstico presuntivo de tuberculosis abdominal basado en la respuesta clínica o imagenológica que presente el paciente al tratamiento empírico, especialmente para situaciones en las que existe un alto índice de sospecha de esta patología. Palabras clave: tuberculosis abdominal, tuberculosis en niños, tratamiento.

Background Rapid diagnostic tests (RDT) can effectively manage malaria cases and reduce excess costs brought by misdiagnosis. However, few studies have evaluated the economic value of this technology. The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis. Main text A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT. Electronic databases including MEDLINE, EMBASE, Biosis Previews, Web of Science and Cochrane Library were searched from Jan 2007 to July 2018. Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to evaluate the quality of the studies. Then cost and effectiveness data were extracted and summarized in a narrative way. Fifteen economic evaluations of RDT compared to other diagnostic methods were identified. The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality. Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons, but the results could be influenced by the alternatives, study perspectives, malaria prevalence, and the types of RDT. Conclusions Based on available evidence, RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis. Further research is also required to draw a more robust conclusion.

Under conditions of egg and poultry farming noninfectious diseases are widespread and cause significant economic damage. These diseases can be caused by a variety of etiological factors: the deficiency of the necessary chemical elements, substances or their combination, excessive amount of certain classes of organic substances in feed. Diseases of complex etiology are also recorded, which arise from a combination of unfavorable factors and anatomical and physiological properties of individual bird crosses. Under the influence of unfavorable factors in various organ systems, pathological processes of various nature (dystrophic, necrotic, inflammatory) arise. In this case, the symptoms and pathological changes can be either similar or poorly visible macroscopically. In this regard, the results of histological examination of organs and tissues play an important role in making a presumptive diagnosis. The article introduces the original results of researches on pathomorphological diagnosis of the most widespread diseases in industrial poultry farming of noninfectious etiology: chronic feed borne toxicoses (including mycotoxicoses), hypovitaminosis A, hyposelenosis, amyloidosis, necrosis of the femoral head. The results of examination of spontaneous material stuff. The findings are formulated in the form of histological diagnoses. The attention is focused on the main (pathognomonical) signs of a great value for differential diagnostics of this group of diseases. Various variants of pathomorphological course of the diseases running both in a classical way, and in the form of a pathomorphosis (the variated pathoanatomical and histological lesions against application of vaccines and antibiotics) are considered.

Introduction The study of behaviour is a fundamental part of comprehensive patient care, since the patient should be considered as a biopsychosocial entity. In the case of Alzheimer's disease (AD), the major limitation in the diagnosis of the patient is that it can only be made after death. Therefore, identification of behaviours consistent with behavioural dysfunction, psychosis and neuropsychiatric symptoms represents a very useful tool for establishing a presumptive diagnosis in vivo of AD. Further taking into account that diabetes mellitus (DM) is a disease with a growing worldwide incidence that is considered a risk factor for the development of AD, the presence of depressive behaviours and mild cognitive impairment stand out as important elements identified in the DM/AD link. Results This study presents the results of a review of evidence obtained from secondary sources and describes characteristic behaviours identified in AD. Conclusions We conclude that the depressive behaviour identified in both AD and MD and the analysis of depressive behaviours along with mild cognitive impairment are part of the link between DM and AD.

Leukemoid reaction is defined by a leukocyte level above 50 x 103/µL with a predominance of mature neutrophils and the presence of immature granulocytic forms in the peripheral blood (left shift). We report a case of a 36-year-old woman with severe coronavirus disease 2019 (COVID-19) infection admitted to the ICU with a leukocytosis of 70.9 x 103/µL white blood cells (WBC) throughout her hospitalization. A left shift with bandemia along with toxic granulations was also noticed and further investigation excluded more commonly known causes. A presumptive diagnosis of leukemoid reaction was made secondary to COVID-19 infection; however, it could not be confirmed since workup for lymphoproliferative disorders could not be performed as the patient passed away. The leukemoid reaction could be associated with severe COVID-19 infection; however, more data are needed to evaluate this association.

An atypical teratoid rhabdoid tumor (ATRT) is a pediatric embryonic tumor of the central nervous system and is uncommon in adults. We report a case of a 33-year-old female who presented with multiple dural lesions that were diagnosed as ATRT. She had a past history of endoscopic transnasal transsphenoidal and subsequent transcranial decompression of suprasellar lesion 6 months prior, with a presumptive diagnosis of atypical pituitary adenoma, which on retrospective evaluation was confirmed as sellar ATRT. Adult sellar ATRT, though rare, has now been proposed as a distinct clinicopathological and genetic variant that is predominantly seen in middle-aged women. We discuss the uniqueness of this rare aggressive tumor with reference to the age, location, and the challenges faced in the clinical and pathological diagnosis.

Amlodipine is a calcium channel blocker shown to be effective in lowering blood pressure with minimal adverse effects in mammals. To provide a retrospective evaluation of amlodipine use in psittacine birds, medical records were reviewed for all avian patients prescribed amlodipine for treatment for the presumptive diagnosis of hypertension, based on clinical signs and indirect blood pressure measurements. Five birds were treated with amlodipine between 2010 and 2018. The median age was 33 years (range, 22–37 years) and 3/5 birds presented for ataxia or seizures. The median indirect systolic blood pressure at diagnosis was 243 mm Hg (range, 200–275 mm Hg). In 3/5 birds, amlodipine was the only drug prescribed, whereas, in 2/5 birds, enalapril was also prescribed in addition to amlodipine. In addition to the prescription of enalapril, blood pressure measurements were obtained indirectly, which are variables to be considered in this report. The initial median dose of amlodipine prescribed was 0.4 mg/kg (range, 0.1–0.4 mg/kg) PO q24h. In 3/5 birds, amlodipine administration was increased either in dose or frequency. Median follow-up time was 25 months (range, 2–55 months) after the initiation of amlodipine treatment. Owners in all 5 cases reported improvement of clinical signs by a median time of 2 months (range, 1–15 months). Three of 5 birds (60%) demonstrated a decreasing trend in blood pressure during the first 6 months after treatment with amlodipine was started (average, ≥20% decrease). Prospective, controlled studies are needed to investigate the efficacy of amlodipine in psittacine birds.

Down syndrome (DS) is typically recognizable in those who present with multiple dysmorphism, especially in regard to facial phenotypes. However, as the presentation of DS in neonates is less obvious, a phenotype-based presumptive diagnosis is more challenging. Recently, an artificial intelligence (AI) application, Face2Gene, was developed to help physicians recognize specific genetic syndromes by using two-dimensional facial photos. As of yet, there has not been any study comparing accuracy among physicians or applications. Our objective was to compare the facial recognition accuracy of DS in Thai neonates, using facial photographs, among physicians and the Face2Gene. Sixty-four Thai neonates at Thammasat University Hospital, with genetic testing and signed parental consent, were divided into a DS group (25) and non-DS group (39). Non-DS was further divided into unaffected (19) and those affected with other syndromes (20). Our results revealed physician accuracy (89%) was higher than the Face2Gene (81%); however, the application was higher in sensitivity (100%) than physicians (86%). While this application can serve as a helpful assistant in facilitating any genetic syndrome such as DS, to aid clinicians in recognizing DS facial features in neonates, it is not a replacement for well-trained doctors.

Diffuse large B-cell lymphoma (DLBCL) can arise in both lymph nodes and extranodal sites. DLBCLs rarely present in the soft tissue of the upper extremity. We report a case of a 64-year-old woman who presented with a large left upper arm mass and underwent surgical resection under the presumptive diagnosis of sarcoma but the final pathology showed DLBCL. Sarcomas are common malignant tumors of the soft tissue of the extremities, but lymphomas also occasionally present as a soft tissue mass. It is important to keep lymphomas in mind in order to avoid unnecessary surgical excisions.