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This article discusses two case reports of children with neurotransmitter disorders associated with dual pathology. The first patient presented with global developmental delay and was initially diagnosed with a chromosomal microdeletion. However, further evaluation revealed a deficiency in the GCH1 gene, which was treated with Sinemet (levodopa/carbidopa) and resulted in significant improvement. The second patient had symptoms attributed to prematurity and periventricular leukomalacia, but whole genome sequencing revealed a diagnosis of sepiapterin reductase deficiency (SRD). Treatment with Sinemet and 5-hydroxytryptophan led to an excellent response. The article emphasizes the importance of recognizing red flags for neurotransmitter disorders and avoiding premature diagnostic closure. [Extracted from the article]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Competitive bidding is a popular technique State Highway Agencies use for selecting contractors for public construction work. It intends to ensure that construction projects are awarded at the lowest price. However, public owners may award contracts at high prices due to collusive bid arrangements among bidders. The current practices and state-of-the-art methods of bid collusion detection are ineffective because they greatly rely on engineers' estimates, which can be inaccurate, and the similarity in the cost structure of the bids, which experienced collusive bidders can manipulate. This study contributes to the body of knowledge with a novel data-driven collusion red-flag detection framework (CRFD) that utilizes pattern mining techniques and statistical tests for detecting contractors with a red-flag pattern, which refers to a significant difference in the winning rates of a contractor with and without the co-occurrence of other particular contractors. A mechanism is also proposed to incorporate potential, influential factors into the CRFD to increase the detection power or examine possible collusion between different scenarios. The proposed method is expected to assist project owners in detecting early signs of bid collusion and eventually help them significantly enhance their award decision-making. [ABSTRACT FROM AUTHOR]

Nowadays, the most difficult task for a physical therapist is to carry out the screening for referral process, that is, to understand whether the patient is within his or her competence or whether he or she should be sent to a specialist. To succeed optimally in the screening process, in addition to theoretical knowledge and clinical experience, it is necessary to possess good clinical reasoning. The latter is not without errors, which must be known in order to be avoided. Succeeding in good screening helps the figure of the physical therapist establish himself or herself in the landscape of health professionals, increasing the esteem of physicians and patients. [ABSTRACT FROM AUTHOR]

Child physical abuse (CPA) may have subtle presenting signs and can be challenging to identify, especially at emergency centers that do not treat many children. The purpose of this study is to determine the performance of a simple CPA screening tool to identify children most at risk. A screening tool ("Red Flag Scorecard") was developed utilizing available evidence-based presenting findings and expert consensus. Retrospective chart review of children treated for injuries between 2014 and 2018 with suspected or confirmed CPA at a level I pediatric trauma center was then performed to validate the screening tool. Descriptive statistics and chi square tests were used to analyze the data. Of 408 cases, median age was 7 months and 60% were male. The majority (69%) were under 1 year of age. The most common history finding was delay in seeking care (58%, 236/408; p = <0.0001), the most common physical exam finding was bruising located away from bony prominences (45%, 182/408), and the most common imaging finding was unexplained brain injury (49%, 201/408). The majority, 84% (343/408), had at least 2 history findings. The combination score of at least 2 history findings and 1 physical/imaging finding was most sensitive (79%). The scorecard would have identified 94% of children who presented with no trauma history (198/211). The Red Flag Scorecard may serve as a quick and effective screening tool to raise suspicion for child physical abuse in emergency centers. Prospective study is planned to validate these results. IV • What is currently known about your topic? Child physical abuse can have subtle presentation and be easily missed or differentiated from non-inflicted injuries, especially outside of children's hospitals, such as primarily adult emergency rooms or trauma centers. Validated screening tools to raise suspicion for child physical abuse are lacking. • What new information is contained in this article? This article presents a new screening tool, the "Red Flag Scorecard" for use in emergency room settings to screen for possible child physical abuse in young children presenting with injury or altered mental status. A positive screen should prompt further evaluation by experts or transfer to a pediatric trauma center. [Display omitted] [ABSTRACT FROM AUTHOR]

The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization. The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students' adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach. A survey including three different flag case scenarios was sent to DPT students in 15 geographically diverse physical therapy programs. Previously published case scenarios measuring adherence to practice guidelines were used. Correlational analyses were performed to link student demographic details and guideline adherent management. The survey was completed by 64 students. Guideline adherent management was greater for red flags (85%) than yellow flag cases (25% and 42%). No significant relationship was noted between the student details and guideline adherent management. DPT students may need additional educational content related to yellow flag screening. Educators may consider utilizing published red and yellow flag cases to guide decision-making and highlight best screening practices. [ABSTRACT FROM AUTHOR]

Copyright of REUNIR: Revista de Administração, Contabilidade e Sustentabilidade is the property of REUNIR - Revista de Administracao, Contabilidade e Sustentabilidade and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Lumbar back pain in an adolescent is generally musculoskeletal, that is, due to a muscle strain or scoliosis. This case describes a young individual without any previous health issues who rapidly developed a life-threatening condition, though initially presenting with "only" back pain. Case presentation: A 16-year-old Caucasian male patient was admitted twice to the emergency department with debilitating lumbar pain without neurological or vascular symptoms. Imagery showed an extensive thrombosis of the inferior vena cava. No external cause, structural abnormality, or any systemic disease were found that predisposed the patient to this highly unusual vaso-occlusive incident. Conclusion: Thrombosis of the inferior vena cava is a rare but life-threatening entity. It is underrecognized and associated with serious short- and long-term morbidity and mortality. Increased awareness is essential because deep vein thrombosis in children seems to cause atypical symptoms, such as spinal pain or the absence of edema of the lower limbs, as in the present case. [ABSTRACT FROM AUTHOR]

We aimed to develop and validate a model for the criteria for admission of COVID-19 patients to the intensive care unit (ICU). A Delphi design study was conducted. The content validity index (CVI) was used to determine the degree of agreement among the experts to validate the content of the admission criteria tool. Eleven experts determined the validity. The evaluation was conducted using a 4-point rating scale. The accepted CVI value was 0.50 and more. The model was validated with 31 items in the 5 dimensions, with the item-CVI of 1, a face validity index of 1, and a scale-level content validity index (S-CVI) value of 1. We have developed and validated a red flag prediction model for ICU admission of COVID-19 patients. The accurate implementation of this model could improve the outcomes of those patients and possibly decrease mortality. [ABSTRACT FROM AUTHOR]

Purpose. Transthyretin is produced in the retina and approximately one quarter of patients with variant transthyretin amyloidosis (ATTRv) develop ocular involvement. Glaucoma is the most important ocular manifestation, leading to rapid loss of vision. The usefulness of glaucoma as a red flag for cardiac amyloidosis is unknown. Materials and Methods. On a national scale, we investigated the association between glaucoma and development of amyloidosis, compared to an age- and sex-matched population from the general population. Results. The study population included 365,496 subjects (1:1 ratio). Adjusted Cox-models showed no significant association between glaucoma and future diagnosis of amyloidosis (hazard ratio: 1.16 [0.80–1.70], p =.44). Conclusion. We conclude that while ocular involvement is a possible early manifestation of ATTRv, nationwide data suggest that glaucoma is probably not useful as a red flag for cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

The general medical physician will often encounter patients who develop acute complications of their cancer diagnosis or anti-cancer treatment. Here we provide an overview of emergency solid tumour oncology to guide the initial management of these patients. [ABSTRACT FROM AUTHOR]

Background: Research is increasingly identifying an overlap between psychosis and immunological dysregulation. Certain autoantibodies are being identified in a small but probably relevant subgroup of patients with psychosis. The term "autoimmune psychosis" (AIP) and its corresponding red-flag signs present the opportunity for a new field in psychiatry to promote diagnostic workup and immunomodulating therapy in individual cases. Objectives: The present protocol aims to determine the seroprevalence of autoantibodies in first-episode psychosis (FEPs) using AIP red flag signs, and to explore the frequency of autoantibody subtypes and potential mediating confounders. Methods/design: This is a hospital-based case-control study. All participants will be consecutively selected from the main tertiary psychiatric hospital in Shenzhen City, China. Individuals admitted to the psychiatric ward and diagnosed with FEPs will be enrolled. Based on recent consensus, participants with red flags of AIPs will be defined as cases, while the remainder will be matched as controls. Seropositive antibodies will be detected and verified in cerebrospinal fluid (CSF) samples based on the fixed cell-based assay (CBA) method. The propensity score-adjusted odds ratios will be determined to investigate the key mediating confounders regarding autoantibody subtypes and red flag subsets. Discussion: The results of this study will facilitate the early identification of AIPs in FEP patients using the red flag sign and help identify key mediators that improve the accuracy of diagnostic algorithms. It will have clinical significance to focus on serum antibodies that have been verified in CSF samples, due to its consistency with clinical practices in current psychiatry. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Red flags (RF) are typical cardiac and extracardiac manifestations that may precede the definitive diagnosis of cardiac amiloidosis (CA) by several years, playing a pivotal role in the early diagnosis of the disease. The principal aim of the research was to determine the chronology of onset of RF throughout the natural history of CA as well as its prognostic influence., Patients and Methods: Observational, retrospective inquiry of consecutive patients with a definitive diagnosis of CA in a terciary hospital centre in Ciudad Real (Spain) between February 2016 and December 2023. We defined 21 RF and 3 adverse clinical events, establishing the date of occurrence of each of them., Results: 102 patients (81.6±7.7 years; 84,3% males) with a diagnosis of CA (89.2% TTR; 10,8% AL) were included. The prevalence of RF was very high (8.4±2.3). In the natural history, the first to appear were integumentary, with the most specific cardiological ones being the closest to diagnosis. The 2-year mortality was 49%, with biomarker RFs and the presence of ≥10 RFs being associated with higher mortality., Conclusions: RFs proved highly prevalent among patients with CA and substantially preceded disease diagnosis. RF burden was associated with prognosis in the follow-up of ATTR patients., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Red Flags (RFs) are signs and symptoms related to the screening of serious underlying pathologies mimicking a musculoskeletal pain. The current literature wonders about the usefulness of RFs, due to high false-positive rates and low diagnostic accuracy. The aims of this systematic review are: (a) to identify and (b) to evaluate the most important RFs that could be found by a health care professional during the assessment of patients with low and upper back pain (named as thoracolumbar pain (TLP)) to screen serious pathologies. A systematic review of the literature was conducted. Searches were performed on seven databases (Pubmed, Web of Science, Cochrane Library, Pedro, Scielo, CINAHL, and Google Scholar) between March 2019 and June 2020, using a search string which included synonyms of low back pain (LBP), chest pain (CP), differential diagnosis, RF, and serious disease. Only observational studies enrolling patients with LBP or CP were included. Risk of bias was assessed with the Newcastle Ottawa Scale and inter-rater agreement between authors for full-text selection was evaluated with Cohen's Kappa. Where possible the diagnostic accuracy was recorded for sensitivity (Sn), specificity (Sp), and positive/negative likelihood ratio (LR+/LR–). Forty full-texts were included. Most of the included observational studies were judged as low risk of bias, and Cohen's Kappa was good (=0.78). The identified RFs were: advanced age; neurological signs; history of trauma; malignancy; female gender; corticosteroids use; night pain; unintentional weight loss; bladder or bowel dysfunction; loss of anal sphincter tone; saddle anaesthesia; constant pain; recent infection; family or personal history of heart or pulmonary diseases; dyspnoea; fever; postprandial CP; typical reflux symptoms; haemoptysis; sweating; pain radiated to upper limbs; hypotension; retrosternal pain; exertional pain; diaphoresis; and tachycardia. The diagnostic accuracy of RFs as self-contained screening tool was low, while the combination of multiple RFs showed to increase the probability to identify serious pathologies. Despite the use of single RF should not be recommended for the screening process in clinical practice, the combination of multiple RFs to enhance diagnostic accuracy is promising. Moreover, the identified RFs could be a baseline to develop a screening tool for patients with TLP. Differential diagnosis and screening for referral are mandatory skills for each healthcare professional in direct access clinical settings, and should be the primary step for an appropriate management of a patient with signs and symptoms mimicking serious pathologies in thoracolumbar region. Clinical reasoning and decision-making processes are essential throughout all phases of a patient's pathway of care. By which, the use of single Red Flag (RF) as a self-contained screening tool should not be recommended. The combination of multiple RFs promises to increase diagnostic accuracy and could grow into an excellent screening tool for thoracolumbar pain. [ABSTRACT FROM AUTHOR]

Introduction:  Most Hirschsprung's disease (HD) are diagnosed in young children with increased risk ("red flag"). Older children (>6 months) require open rectal biopsy (ORB) with its own impact on risk and resources. We investigated if "red flag", age, and sex used in combination could exclude HD.Materials and Methods:  "Red flags" are risk factors associated with HD, including neonatal bowel obstruction, genetic association, failure of passage of meconium in <48 hours, infantile constipation, distension with vomiting, or family history. All rectal biopsies (2015-2018) were reviewed for indications, methods, and histopathological findings. Logistic regression analysis was adopted to assess predictive value of "red flag," age, and sex (p < 0.05* was significant).Results:  A total of 187 children underwent 84 suction rectal biopsies and 113 ORBs (n = 197 in total). Final histopathological diagnoses were non-HD (n = 154) and HD (n = 43). Total 78% of rectal biopsies were non-HD, of which 63% by ORB. Non-HD was associated with absence of "red flag" (49 vs. 16%*), increased age at biopsy (22 months vs. 28 days*), >6 months old (62 vs. 30%*), and female gender (54 vs. 16%*), compared with HD. In the absence of "red flag," 7/82 (9%) had HD (negative predictive value = 91%). Logistic regression analysis found absent "red flag" predicted non-HD biopsy with odds ratio 4.77 (1.38, 16.47), corrected for age and sex.Conclusion:  Negative rectal biopsy rate for HD is very high. The majority required ORB. Although "red flag" and gender, but not age, have strong predictive values, it is inadequate for excluding HD. This study supports the need for alternative strategies in excluding HD. [ABSTRACT FROM AUTHOR]

Background and Objectives: Our study sought to evaluate and compare different prediction scores for massive transfusion in‐hospital packed red blood cell (PRBC) transfusions. Materials and Methods: Between January 2013 and December 2018, 1843 trauma patients were enrolled in the registry of a level‐1 trauma centre. All prehospital and in‐hospital variables needed to calculate the Shock Index and RED FLAG, Assessment of Blood Consumption (ABC) and Trauma Associated Severe Hemorrhage (TASH) scores were prospectively collected in the registry. The primary endpoint was the initiation of transfusion within the first hour of the patient's arrival at the hospital. Results: A total of 1767 patients were included for analysis with a mean age of 43 years (±19) and a mean Injury Severity Score of 15 (±14). The in‐hospital TASH score had the highest predictive performance overall (area under the curve [AUC] = 0.925, 95% confidence interval [CI] [0.904–0.946]), while the RED FLAG score (AUC = 0.881, 95% CI [0.854–0.908]) had the greatest prehospital predictive performance compared to the ABC score (AUC = 0.798, 95% CI [0.759–0.837]) and Shock Index (AUC = 0.795, 95% CI [0.752–0.837]). Using their standard thresholds, the RED FLAG score was the most efficient in predicting early transfusion (sensitivity: 87%, specificity: 76%, positive predictive value: 25%, negative predictive value: 99%, Youden index: 0.63). Conclusion: The RED FLAG score appears to outperform both the ABC score and the Shock Index in predicting early in‐hospital transfusion in trauma patients managed by pre‐hospital teams. If adopted, this score could be used to give advance warning to trauma centres or even to initiate early transfusion during pre‐hospital care. [ABSTRACT FROM AUTHOR]

The paper discusses the book that V. Camelliti has recently dedicated to «artists and art patronage in Pisa in the 13th-15th centuries». Camelliti shares the criticism expressed by A. Savorelli about the interpretation of Pisan typical «red banner» proposed by local chroniclers in the late 14th century. Although the origin of this Pisan «vexillum» can be effectively traced back to the concessions made to Pisa by emperor Frederick Barbarossa (1162), in the Trecento Pisan citizens believed that the red banner had been granted to the city by the popes of early 11th century, in order to promote the liberation of Sardinia from the Saracens. Not before the end of the 13th century the red banner was added with a white cross, which became the typical sign of the Pisan «Popolo». The pages written about this matter by Camelliti perhaps need a more precise anchorage to the political context of the city between 13th and 14th centuries. [ABSTRACT FROM AUTHOR]

Amyloidosis caused by systemic deposition of transthyretin (TTR) is called ATTR amyloidosis and mainly includes hereditary ATTR (ATTRv) amyloidosis and wild-type ATTR (ATTRwt) amyloidosis. Until recently, ATTRv amyloidosis had been considered a disease in the field of neurology because neuropathic symptoms predominated in patients described in early reports, whereas advances in diagnostic techniques and increased recognition of this disease revealed the presence of patients with cardiomyopathy as a predominant feature. In contrast, ATTRwt amyloidosis has been considered a disease in the field of cardiology. However, recent studies have suggested that some of the patients with ATTRwt amyloidosis present tenosynovial tissue complications, particularly carpal tunnel syndrome, as an initial manifestation of amyloidosis, necessitating an awareness of this disease among neurologists and orthopedists. Although histopathological confirmation of amyloid deposits has traditionally been considered mandatory for the diagnosis of ATTR amyloidosis, the development of noninvasive imaging techniques in the field of cardiology, such as echocardiography, magnetic resonance imaging, and nuclear imaging, enabled nonbiopsy diagnosis of this disease. The mechanisms underlying characteristic cardiac imaging findings have been deciphered by histopathological studies. Novel disease-modifying therapies for ATTR amyloidosis, such as TTR stabilizers, short interfering RNA, and antisense oligonucleotides, were initially approved for ATTRv amyloidosis patients with polyneuropathy. However, the indications for the use of these disease-modifying therapies gradually widened to include ATTRv and ATTRwt amyloidosis patients with cardiomyopathy. Since the coronavirus disease 2019 (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, occurred, the minimization of hospital visits and telemedicine have become increasingly important. As older age and cardiovascular disease are major factors associated with increased disease severity and mortality of COVID-19, many ATTR amyloidosis patients are at increased risk of disease aggravation when they are infected with SARS-CoV-2. From this viewpoint, close interspecialty communication to determine the optimal interval of evaluation is needed for the management of patients with ATTR amyloidosis. [ABSTRACT FROM AUTHOR]

We examine whether increased transparency in the comparison of financial measures and nonfinancial measures (NFMs) influences nonprofessional investors' reactions to the risk of fraudulent financial reporting. We consider a comparison of key financial measures and NFMs to be transparent when the relevant information is presented in close proximity and formatted to provide an easy comparison of the individual measures. We manipulate the presence of an NFM red flag and the transparency of the comparison of financial measures and NFMs. We find that when the NFM red flag is present (i.e., higher fraud risk) and transparent, investors choose lower investment levels. However, without increased transparency, as is typical in the current reporting environment, we observe that investors are more likely to increase their investment levels in firms with elevated fraud risk. Additionally, we observe that the effect of transparency on investment levels is driven by investors with greater investing experience. Data Availability: Contact the authors. JEL Classifications: M40; M41; M48. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this review, we summarize updates in the diagnostic approach of headaches with the aim of facilitating the distinction between primary and secondary etiology in headaches. Recent Findings: In the USA, headache is the fifth most common complaint in the emergency department, but only a minority will have a secondary etiology. Initial suspicion and diagnostic workup of secondary headache relies on a patient's medical history due to a scarcity of validated biomarkers. A special interest group under the International Headache Society recently synthesized information on red flags (information that indicates a secondary etiology) and green flags (information that indicates a primary etiology). A systematic diagnostic approach using red flags and green flags can help reduce unnecessary testing and shift attention to patient care. Summary: Going forward, further validation of these concepts is needed to properly introduce them for clinical use. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, there have been suggestions that there will be a reduction in cancer diagnoses, causing a detrimental effect on patients1. We therefore conducted an analysis to assess if there has been a reduction in new haematological malignancy diagnoses within the Belfast Health and Social Care Trust (BHSCT). Methods: We observed a significant decline in diagnostic tests used in the diagnosis of haematological malignancies. We therefore decided to analyse the impact of COVID-19 on the volume of tests performed to see if this impacted the number of new cases of haematological malignancies diagnosed. To ascertain the number of new diagnoses referred to Clinical Haematology we decided to analyse the number of new diagnoses discussed at the local Multidisciplinary Team Meetings (MDM) between March and June 2020 and compare this with the same period in 2019. In line with NICE guidelines2 there has been no change to the referral pathway for patients with new haematological malignancy. Results: Results show that there is no significant difference between the number of new malignant haematological diagnoses discussed during March to June 2020 and the same period in 2019. This confirms that the number of new diagnoses remains the same within the two time periods. Conclusion: This analysis highlights that despite a reduction in primary and secondary care diagnostic blood tests, there is no difference in the number of new cases of haematological malignancies discussed at Haematology MDM throughout the first surge of the COVID-19 pandemic locally. [ABSTRACT FROM AUTHOR]

We studied a subset of patients with autopsy-confirmed multiple system atrophy who presented a clinical picture that closely resembled either Parkinson's disease or progressive supranuclear palsy. These mimics are not captured by the current diagnostic criteria for multiple system atrophy. Among 218 autopsy-proven multiple system atrophy cases reviewed, 177 (81.2%) were clinically diagnosed and pathologically confirmed as multiple system atrophy (i.e. typical cases), while the remaining 41 (18.8%) had received an alternative clinical diagnosis, including Parkinson's disease (i.e. Parkinson's disease mimics; n = 16) and progressive supranuclear palsy (i.e. progressive supranuclear palsy mimics; n = 17). We also reviewed the clinical records of another 105 patients with pathologically confirmed Parkinson's disease or progressive supranuclear palsy, who had received a correct final clinical diagnosis (i.e. Parkinson's disease, n = 35; progressive supranuclear palsy-Richardson syndrome, n = 35; and progressive supranuclear palsy-parkinsonism, n = 35). We investigated 12 red flag features that would support a diagnosis of multiple system atrophy according to the current diagnostic criteria. Compared with typical multiple system atrophy, Parkinson's disease mimics more frequently had a good levodopa response and visual hallucinations. Vertical gaze palsy and apraxia of eyelid opening were more commonly observed in progressive supranuclear palsy mimics. Multiple logistic regression analysis revealed an increased likelihood of having multiple system atrophy [Parkinson's disease mimic versus typical Parkinson's disease, odds ratio (OR): 8.1; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 2.3] if a patient developed any one of seven selected red flag features in the first 10 years of disease. Severe autonomic dysfunction (orthostatic hypotension and/or urinary incontinence with the need for a urinary catheter) was more frequent in clinically atypical multiple system atrophy than other parkinsonian disorders (Parkinson's disease mimic versus typical Parkinson's disease, OR: 4.1; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 8.8). The atypical multiple system atrophy cases more frequently had autonomic dysfunction within 3 years of symptom onset than the pathologically confirmed patients with Parkinson's disease or progressive supranuclear palsy (Parkinson's disease mimic versus typical Parkinson's disease, OR: 4.7; progressive supranuclear palsy mimic versus typical progressive supranuclear palsy, OR: 2.7). Using all included clinical features and 21 early clinical features within 3 years of symptom onset, we developed decision tree algorithms with combinations of clinical pointers to differentiate clinically atypical cases of multiple system atrophy from Parkinson's disease or progressive supranuclear palsy. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis is becoming increasingly important among cardiologist and an early diagnosis is very important. Amyloidosis is a systemic disease and many cardiac and extracardiac elements (red flags) should raise the suspicion of the disease. Electrocardiographic and imaging techniques (such as echocardiography, cardiac magnetic resonance and scintigraphy) are useful tools to make a diagnosis together with the presence of orthopedic issues, peripheral neuropathy or plasma cell dyscrasia. Cardiac amyloidosis is also often associated with valvular disorder, heart failure or cardiomyopathy. Red flags are crucial to raise suspicion and reach an early diagnosis, in order to start a targeted treatment strategy that could change the patient's outcome. Indeed, in the last years four new drugs were approved to treat transthyretin amyloidosis., Competing Interests: The authors declare they have no conflict of interest., (© 2024 The Author(s).)

Over 80% of the adult population will experience an episode of low back pain (LBP). Low back pain is a pain in the lumbosacral region. When it progresses, which may be identified earlier with signs of a red flag, the manifestation might become radiculopathy. Radiculopathies are nerve root disease which may show signs of neurologic symptoms from the sensory, motoric, or autonomic origin. This study to help identify the clinical characteristics of a red flag in low back pain patients, which became lumbar radiculopathy for prognostic and diagnostic use. It is a descriptive quantitative cross-sectional study of medical records from patients hospitalized with complaints of low back pain with lumbar radiculopathy between January 2013–December 2015 in the Department of Neurology, Dr. Hasan Sadikin General Hospital, Bandung. It identifies a specific red flag and neurogenic symptoms. Patients most affected were housewives (26%), females (60%), and middle-aged adults (31%). The highest recorded symptom being sensory (76%), the highest progression was sensory to motoric (59%), affected by all three neurologic symptoms (39%), and trauma was the highest red flag recorded (48%). Low back pain patients who have signs of red flag show a high tendency to develop radiculopathy, which shows neurologic symptoms. If left untreated earlier, it may become a permanent disability. RADIKULOPATI LUMBAR: STUDI DESKRIPTIF GEJALA KLINIS RED FLAG DAN GEJALA NEUROLOGIS DI RSUP DR. HASAN SADIKIN BANDUNG Lebih dari 80% populasi penduduk dewasa akan mengalami episode low back pain (LBP). Low back pain merupakan nyeri pada bagian tulang belakang regio lumbo-sakral. Pada saat rasa sakitnya bertambah berat, gejala berbahaya dapat menjadi awal perkembangan LBP menjadi radikulopati. Radikulopati merupakan penyakit saraf pada daerah radiks neuron berupa gejala sensorik, motorik, dan otonomik. Penelitian ini bertujuan mengidentifikasi karakteristik gejala klinis tanda berbahaya (red flag) pada pasien LBP yang berlanjut menjadi radikulopati lumbar sebagai alat bantu diagnostik dan prognostik. Penelitian ini menggunakan metode penelitian cross-sectional kuantitatif deskriptif dari rekam medis pasien yang dirawat dengan diagnosis LBP dan radikulopati lumbar antara bulan Januari 2013–Desember 2015 di Departemen Ilmu Penyakit Saraf, RSUP Dr. Hasan Sadikin, Bandung. Penelitian ini mengidentifikasi gejala klinis red flag spesifik dan neurologis. Pasien yang terkena terutama ibu rumah tangga (26%), wanita (60%), usia dewasa pertengahan (31%). Gejala yang tercatat paling banyak adalah sensorik (76%), perkembangan progresif sensorik ke motorik (59%), mengalami gangguan ketiganya (39%), dan trauma menjadi penyebab red flag yang paling tinggi (48%). Pasien LBP yang memiliki gejala tanda berbahaya (red flag) memiliki kecenderungan tinggi berkembang menjadi radikulopati yang menunjukkan gejala neurologis. Jika tidak diobati lebih awal, ini dapat mengakibatkan kecacatan permanen.

Today, no one would doubt that the colour red and the red flag symbolise socialism, communism and revolution. However, that we all agree on these symbolic qualities is a rather recent historical phenomenon, since for thousands of years the colour red (and even more so: purple) had been reserved for the ruling elites or members of the clergy in different parts of the world. This article examines how the red flag emerged as a revolutionary symbol, with particular attention given to the transcultural transfer of knowledge and argues that this eventually became a fierce struggle for recognition. [ABSTRACT FROM AUTHOR]

Summary: Collaboration between gastroenterologists and rheumatologists is recommended for the correct management of patients with associated spondyloarthritis (SpA) and inflammatory bowel disease (IBD). We aimed to establish the appropriateness of several red flags for a prompt specialist referral. A systematic review of the literature was performed using the GRADE method to describe the prevalence of co‐existing IBD‐SpA and the diagnostic accuracy of red flags proposed by a steering committee. Then, a consensus among expert gastroenterologists and rheumatologists (10 in the steering committee and 13 in the expert panel) was obtained using the RAND method to confirm the appropriateness of each red flag as 'major' (one sufficient for patient referral) or 'minor' (at least three needed for patient referral) criteria for specialist referral. The review of the literature confirmed the high prevalence of co‐existing IBD‐SpA. Positive and negative predictive values of red flags were not calculated, given the lack of available data. A consensus among gastroenterology and rheumatology specialists was used to confirm the appropriateness of each red flag. Major criteria to refer patients with SpA to the gastroenterologist included: rectal bleeding, chronic abdominal pain, perianal fistula or abscess, chronic diarrhoea and nocturnal symptoms. Major criteria to refer patients with IBD to the rheumatologist included: chronic low back pain, dactylitis, enthesitis and pain/swelling of peripheral joints. Several major and minor red flags have been identified for the diagnosis of co‐existing IBD‐SpA. The use of red flags in routine clinical practice may avoid diagnostic delay and reduce clinic overload. 1. A systematic review of the literature was performed to investigate the prevalence of co‐existing IBD‐SpA and the diagnostic accuracy of red flags for specialist referral. 2. A consensus among gastroenterology and rheumatology specialists was used to confirm the appropriateness of each red flag for suspected diagnosis of co‐existing IBD‐SpA and specialist referral. 3. The use of specific red flags as major or minor criteria for specialist referral may avoid diagnostic delay in case of associated IBD‐SpA and reduce clinic overload. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim in the evaluation of patients presenting with acute or subacute low back pain (LBP) is to exclude a possible specific spinal pathology. Literature on the population-based incidences of these pathologies is scarce. The aim of our study was to investigate the population-based incidence of specific spinal pathologies as a cause of atraumatic acute or subacute LBP.Methods: From our institutional database, we identified all patients with a relevant LBP-related ICD-10 code during a visit to our emergency department (ED) in a level II/III teaching hospital between January 2012 and December 2014. Patients with a possible specific spinal pathology (cauda equina syndrome, spondylodiscitis, vertebral fracture, and cancer) were assessed in detail.Results: A total of 900 visits were due to atraumatic low back pain. Of these 284 (31.6%) were due to nonspecific LBP, and 583 (64.8%) due to radicular pain suggesting nerve root compression. In 33 (3.7%) cases, the LBP was caused by a specific spinal pathology. The annual incidences per 100,000 were 0.60 for CES, 2.1 for spondylodiscitis, 0.76 for cancer and 1.2 for compression fracture.Conclusions: The incidences of specific spinal pathologies were low. Given that LBP is a very common symptom, it is not surprising that the accuracy of red flag symptoms is poor. Each patient should be considered individually, and we advocate a low threshold for referral and advanced imaging in cases where a specific spinal pathology is suspected. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: Observational, prospective cohort. * BACKGROUND: Musculoskeletal pain is a common reason to seek health care, and earlier nonpharmacological treatment and enhancement of personalized care options are 2 high-priority areas. Validating concise assessment tools is an important step toward establishing better care pathways. * OBJECTIVES: To determine the predictive validity of Optimal Screening for Prediction of Referral and Outcome (OSPRO) tools for individuals with neck, low back, shoulder, or knee pain. * METHODS: A convenience sample (n = 440) was gathered by Orthopaedic Physical Therapy-Investigator Network clinics (n = 9). Participants completed demographic, clinical, and comorbidity questionnaires and the OSPRO tools, and were followed for 12-month outcomes in pain intensity, region-specific disability, quality of life, and comorbidity change. Analyses predicted these 12-month outcomes with models that included the OSPRO review-of-systems (OSPRO-ROS) and yellow flag (OSPRO-YF) tools and planned covariates (accounting for comorbidities and established demographic and clinical factors). * RESULTS: The 10-item OSPRO-YF tool (baseline and 4-week change score) consistently added to predictive models for 12-month pain intensity, region-specific disability, and quality of life. The 10-item OSPRO-ROS tool added to a predictive model for quality of life (mental summary score), and 13 additional items of the OSPRO-ROS+ tool added to prediction of 12-month comorbidity change. Other consistent predictors included age, race, income, previous episode of pain in same region, comorbidity number, and baseline measure for the outcome of interest. * CONCLUSION: The OSPRO-ROS and OSPRO-YF tools statistically improved prediction of multiple 12-month outcomes. The additional variance explained was small, and future research is necessary to determine whether these tools can be used as measurement adjuncts to improve management of musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Introduction: Headache is one of the most common presenting complaints in day to day medical practice however the secondary causes of headache are uncommon. Thus, appropriate selection of headache patient (Pt) is important to determine those that require neuroimaging due to likely secondary cause. Red flags and Clinical warning criterion (CWC) act as a screening tool to help in identifying those who may get benefit from neuroimaging. Aim: To evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache and to compare the findings between two groups of patients. Materials and Methods: This retrospective observational study was carried out in 500 selected patients, who underwent CT or MRI scan of head in Peoples College of Medical Sciences and Research centre, Bhopal, MP during the period of 2 year in between Jan 2013 to Dec 2014. Siemens Somatom sensation 40 slice MDCT and Siemens magnetom 1.5T MRI scanner were used for imaging. Five hundred patients of 10 to 70 year age were selected for the study based on our criterions of selection. Results: All 500 patients were divided in to two groups A and B based on presence or absence of red flag signs and CWC signs. Group A consists of 48 patients having one or more red flag or CWC signs and group B consists of 452 patients those don’t have any above signs. 29 cases (60.4%) out of total 48 cases of group A is suffering from chronic headache as compared to 97 cases (21.5%) out of total 452 patients of group B is having positive findings (p-value

Introduction: Headache is one of the most common presenting complaints in day to day medical practice however the secondary causes of headache are uncommon. Thus, appropriate selection of headache patient (Pt) is important to determine those that require neuroimaging due to likely secondary cause. Red flags and Clinical warning criterion (CWC) act as a screening tool to help in identifying those who may get benefit from neuroimaging. Aim: To evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache and to compare the findings between two groups of patients. Materials and Methods: This retrospective observational study was carried out in 500 selected patients, who underwent CT or MRI scan of head in Peoples College of Medical Sciences and Research centre, Bhopal, MP during the period of 2 year in between Jan 2013 to Dec 2014. Siemens Somatom sensation 40 slice MDCT and Siemens magnetom 1.5T MRI scanner were used for imaging. Five hundred patients of 10 to 70 year age were selected for the study based on our criterions of selection. results: All 500 patients were divided in to two groups A and B based on presence or absence of red flag signs and CWC signs. Group A consists of 48 patients having one or more red flag or CWC signs and group B consists of 452 patients those don't have any above signs. 29 cases (60.4%) out of total 48 cases of group A is suffering from chronic headache as compared to 97 cases (21.5%) out of total 452 patients of group B is having positive findings (p-value<0.05). Out of 500 patients, only 29 cases (5.8%) revealed some form of brain parenchymal pathology whereas other associated findings were seen in 97 cases e.g. sinusitis in 58 (11.6%), bone related pathology in 26 (5.2%) and chronic suppurative otitis media (CSOM) in 13 (2.6%) patients. conclusion: CT/MRI in patients without red flag or CWC sign yields very low percentage of clinically significant positive findings in neuroimaging. In the absence of these, the only reason for CT or MRI scan seems to reassure the patients and their loved ones. CT or MRI as a screening tool in these patients has limited value in term of cost effectiveness. [ABSTRACT FROM AUTHOR]

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STUDY DESIGN: Literature review and cross-sectional study. BACKGROUND: Direct access to physical therapy necessitates greater responsibility to determine appropriateness of care by recognizing the potential for concomitant disease or systemic involvement. Recent research has identified excessive variability in the reporting of red flag symptoms. An initial step to improve the identification of red flag symptoms is the development of a standardized screening tool. OBJECTIVE: To describe the development of a review-of-systems screening tool appropriate for use by orthopaedic physical therapists. METHODS: First, a red flag symptom item bank was compiled from a systematic literature review to allow for further psychometric testing and development of a screening tool. Second, physical therapists in 11 outpatient clinics recruited patients presenting with primary complaints of neck, shoulder, low back, or knee pain. Patients completed the red flag symptom item bank and standard questionnaires for comorbidities, negative mood, quality of life, pain, and function. The development of the screening tool involved identifying and combining different 3-item sets that characterized the highest number of patients reporting at least 1 positive symptom response (operationally defined as "red flag symptom responder"). RESULTS: The literature search yielded 103 studies that met the inclusion criteria, and the final item bank consisted of 97 items representing 8 body systems. Four hundred thirty-one patients with primary complaints of neck (n = 93), shoulder (n = 108), low back (n = 119), or knee (n = 111) disorders contributed to the cross-sectional study. The number of red flag symptom responders was 393 of 431 (91.2%). These patients were older, more likely to be female, had lower income, and were more likely to report neck or back pain (all, P<.05). A 10-item review-of-systems screening tool correctly identified 372 of 393 (94.7%) responders, and a 23-item version identified all 393 (100%) responders. The review-of-systems screening tools and the complete 97-item bank had similar correlations with concurrent clinical measures, except for depressive symptoms. CONCLUSION: Concise red flag symptom identification appears to be feasible in outpatient orthopaedic physical therapy settings. Future research will determine how this review-of-systems screening tool needs refinement for different patient populations and whether it predicts clinical outcomes or the need for referral to other providers. [ABSTRACT FROM AUTHOR]

Fraud has become a worldwide phenomenon and prime issue of concern. It dwells in all countries and affects all types of organisations irrespective of their size, profitability or industry. The primary objective of this paper is to provide an in-depth understanding of literature related to corporate fraud in order to understand 'why' fraud occurs and 'how' to combat it. Research studies published during the period commencing from the year 1984 to 2014 have been reviewed. The study aims to provide an in-depth discussion on significant red flags that may exist before fraud occurrence. It, also, provides a comprehensive view about fraud detection and prevention methods. Findings reveal that red flag is an important mechanism to prevent fraud. Application of single fraud detection technique will not curb the fraud effectively. Also, the top executives were found to be responsible for implementing anti-fraud policies and techniques within business organisation. Further, the present study tries to discern the research gap in existing literature and explore the area of future research. [ABSTRACT FROM AUTHOR]