Diagnostics最新文献

Background: The aim of this study was to evaluate and compare the maxillofacial structures of individuals with unilateral cleft lip and palate (UCLP) and healthy controls using cone beam computed tomography (CBCT).

Methods: The study included a total of 90 subjects, comprising 45 randomly selected individuals with UCLP (30 males and 15 females, mean age 14.69 ± 3.95 years) in the study group and 45 healthy individuals (30 males and 15 females, mean age 14.46 ± 3.65 years) in the control group. Maxillofacial measurements were taken in three different planes and categorized into five groups, namely vertical, facial, cranial, maxillary, and mandibular. In the statistical comparison between groups, the significance level was determined as p < 0.05.

Results: There were no significant differences in the age and gender distributions between the groups (p > 0.05). Upper anterior face height and posterior face height in the UCLP group were found to be significantly shorter than the control group (p < 0.05). Midface width and depth were inadequate in the UCLP group (p < 0.05). Anterior and posterior cranial base lengths were significantly shorter in individuals with UCLP (p < 0.05). Nasal width and interorbital width were significantly greater in the UCLP group (p < 0.05). In addition, maxillary width, maxillary length, and mandibular width were significantly shorter in the UCLP group than in the control group (p < 0.05).

Conclusions: While the control group exhibited generally longer measurements in all three dimensions compared to the study group, the skeletal structures adjacent to the cleft demonstrated the most notable developmental deficiency.

Background. Alterations induced by direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) to thromboelastometry and thrombin generation are not well defined. We performed a simultaneous investigation of thromboelastometry and thrombin generation for patients who were chronically anticoagulated with DOACs or VKAs. Methods. A total of 131 patients on DOACs [apixaban (n = 37), rivaroxaban (n = 34), dabigatran (n = 30), edoxaban (n = 30)] and 33 on VKAs were analyzed. Whole blood was analyzed for thromboelastometry and plasma was analyzed for thrombin generation. Results. While the thromboelastometry clotting time (CT) was responsive to the hypocoagulability induced by DOACs or VKAs, clot formation time and maximal clot formation were not. Cumulatively, the parameters denoting the velocity of thrombin generation (lag time, time-to-peak) were relatively less responsive to the hypocoagulability induced by VKAs than DOACs. Conversely, the parameters denoting the quantity of thrombin generation [peak-thrombin and the endogenous thrombin potential (ETP)] were more responsive to the hypocoagulability induced by VKAs than DOACs. Apixaban showed relatively small differences (peak vs. trough) in the plasma concentration and a relatively small (peak vs. trough) difference of hypocoagulability when assessed by the CT or the ETP. The CT and the ETP were strongly correlated with DOAC concentrations or with the VKA-INR. Conclusions. DOACs and VKAs altered thromboelastometry and thrombin generation to an extent that probably reflects the mode of action of these drugs and may also have practical implications for patients' management. Apixaban showed a small difference of hypocoagulability (peak vs. trough), suggesting a more stable anticoagulation over the daily course of treatment. Based on the correlations of the CT or the ETP vs. the DOAC concentrations, we estimated that critical values of the CT or the ETP would correspond to DOAC concentrations of 400 or 20 ng/mL. Whenever dedicated tests for DOAC concentrations are not available, the CT or the ETP can be used as surrogates to evaluate the level of anticoagulation induced by DOACs.

The midface is a key area in facial aesthetics, highly susceptible to age-related changes such as fat pad absorption, bone resorption, and loss of skin elasticity. These changes lead to the formation of prominent folds, such as the nasolabial fold. In addition, critical vascular structures and non-vascular components, such as the facial artery, angular artery, and parotid gland, make this region prone to complications during filler injections. High-frequency ultrasound (HFUS) offers real-time, radiation-free visualization of facial anatomy, enabling injectors to accurately target the desired treatment planes and avoid critical structures. This article is the second in a series of articles on ultrasound-guided facial injections and focuses on the midface. It provides a detailed overview of the sonographic anatomy of key areas, including the nose, tear trough, nasolabial fold, zygomatic, and preauricular regions. Step-by-step techniques for ultrasound-guided filler injections are described, emphasizing the importance of scanning both before and during injections to ensure safe filler placement. By using ultrasound in this area, injectors can possibly minimize risks such as vascular occlusion and other complications, such as the Tyndall effect and intra-parotid injection. With ongoing advancements, ultrasound-guided injections are expected to become more refined, enhancing both aesthetic outcomes and patient safety.

Objective. Our objective was to assess the proportion of false-positive CHD cases at the first-trimester evaluation of the fetal heart, performed by experienced operators. Methods. This multicenter retrospective study included of pregnant women with suspicion of CHDs during first-trimester screening for aneuploidies. In all cases, the fetal heart assessments were performed by obstetricians with extensive experience in first-trimester scanning, following an extended protocol proposed by SIEOG national guidelines, which included an axial view of the fetal abdomen and chest to assess visceral situs and evaluation of the four-chamber view (4CV) and three-vessel trachea view (3VTV) with color Doppler. In all suspected cases, fetal echocardiography was offered within 16 and/or at 19-22 weeks' gestation. Results. From a population of 4300 fetuses, 46 CHDs were suspected. Twenty-four cases were excluded from this analysis because the parents opted for early termination of the pregnancies due to associated structural and/or genetic anomalies. For the remaining 22, echocardiography was performed by 16 weeks in 14 cases (64%) and after 16 weeks in 8 cases. In 19 cases (86.4%), a fetal cardiologist confirmed the presence of a CHD. In three cases (13%), the cardiac anatomy was found to be normal at the fetal echocardiography and postnatally. Conclusions. This study shows that the proportion of false-positive cases at the first-trimester ultrasound examination of the fetal heart, performed by experienced operators, may carry a higher risk of false-positive diagnosis than expected. Therefore, this issue must be discussed in instances where a CHD is suspected at the first-trimester screening.

Uterine arteriovenous malformations (UAVMs) that occur after birth are a rare cause of late postpartum hemorrhage. Acquired UAVMs usually occur in conjunction with pathology of the placenta. In the spectrum of placenta accreta (PAS), subinvolution of the placental bed plays an important role in its pathophysiology. We present a case of UAVM in a pregnant woman with PAS who presented with marked metrorrhagia after delivery, which was treated with classical management. Then, 35 days later, she presented to the emergency room with severe metrorrhagia. As it was suspected that she had placental remnants, an instrumental uterine control was performed, but the bleeding persisted, requiring further uterine packing and blood administration. Later, uterine artery embolization was performed with good results. Color Doppler ultrasound, magnetic resonance imaging, and angiography were the methods with the greatest diagnostic value. The differential diagnosis was as complex as the treatment. We hypothesize that UAVM may develop from minimal residual PAS in this late postpartum period. Moreover, they may recover rapidly after local surgical ablation. Considering the clinical condition, hemodynamic status, and desire to preserve fertility, we were able to avoid a hysterectomy, which is often chosen in such cases of severe, life-threatening bleeding complications.

Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5-10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250-500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5-10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46-29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79-45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period.

Introduction: Antenatal diagnosis of cardiac abnormalities and counselling parents about postnatal care require a multidisciplinary team, which includes a paediatric cardiologist, a neonatologist, and a fetal medicine physician. Some of these kinds of expertise are not available in all centres with fetal medicine expertise. However, with modern technology, this could be provided remotely. Our objective was to assess the feasibility and outcomes of prenatal multidisciplinary tele-echocardiography diagnostic and counselling services. Materials and Methods: Two centres based in separate countries provided a joint diagnostic and counselling service over a period of 14 months. The primary centre performed the fetal echocardiography with a Voluson E10 machine, and images were transmitted live using Zoom OPS system with video-consultation and counselling. The fetal echo was performed using the ISUOG Guidelines check list. Results: There was an initial feasibility period of 2 months during which 10 women whose fetuses had normal hearts were scanned to test the workability of the system. Over a period of 12 months, 513 high-risk fetuses were then scanned, and out of these, 27 had congenital malformations. The most common were hypoplastic left heart syndrome (HHLS) and atrio-ventricular septal defect. Tele-echocardiography and counselling were successful in all the cases. Satisfaction with the service was 3.8/4, with the main limitation being the need for further referral to a tertiary centre for delivery. Conclusions: Tele-echocardiography is reliable, and when combined with live counselling and support from a paediatric cardiologist, it is an option acceptable to patients. The greatest benefit was from being counselled by a team of experts at a single consultation rather than having to travel to another centre for consultation. With rapidly evolving technology, making video transmission easier and less expensive, we feel that consideration should be given not only to the development of tele-echocardiography but also to extending it to other aspects of fetal medicine.

Background: Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis.

Methods: Patients admitted to a specialized cardiovascular hospital emergency department with suspected infective endocarditis between January 2011 and January 2020 were included. The primary outcome was left-sided infective endocarditis according to the Duke criteria. Logistic regression was used to derive the scoring system, with internal validation performed through bootstrapping. Candidate variables were obtained from the admission medical history, physical examination, and laboratory parameters.

Results: Of the 805 individuals with suspected infective endocarditis (median age 56 years (40-73); 58.6% men), 530 confirmed the diagnosis based on the Duke criteria. The EndoPredict-Dx assigned points for male sex, previous endocarditis, petechiae, heart murmur, suspected embolism, symptoms lasting 14 or more days at the time of admission, hemoglobin level ≤ 12 g/dL, leukocyte level ≥ 10 × 10⁹/L, C-reactive protein level ≥ 20 mg/L, and urine red blood cells ≥ 20,000 cells/mL. Patients were divided into three risk groups. The AUROC was 0.78 (95% CI 0.75-0.81) for the derivation cohort and 0.77 for the internal validation.

Conclusions: The EndoPredict-Dx score accurately predicted the likelihood of infective endocarditis using clinical and laboratory data collected at admission.

Hyperglycemia and tuberculosis are dual global pandemics. Each has a propulsive and amplifying effect on the other, and, because of this, we must consider hyperglycemia and tuberculosis together. Hyperglycemia is immunosuppressive and increases the risk of tuberculosis by threefold. It also leads to a more advanced presentation of pulmonary tuberculosis, thus increasing the likelihood of being smear positive and having cavitating lesions, and it impacts the duration and outcomes of treatment, with an increased one year mortality seen in patients with tuberculosis and diabetes. Additionally, any degree of hyperglycemia can have an impact on susceptibility to tuberculosis, and this effect is not limited to poorly controlled diabetes. Conversely, tuberculosis itself is associated with hyperglycemia and worsens hyperglycemia in those with diabetes mellitus. The impact of this relationship varies based on the base rates of each disease in different regions of the world. In order to successfully achieve the World Health Organization's goals of tuberculosis eradication and adequate glycemic control, we must improve our understanding, co-management, and screening of hyperglycemia and tuberculosis. This review aims to explore the current research investigating the relationship between tuberculosis and diabetes, including the changes in disease susceptibility, presentation, geographic distribution, and effects on treatment.

Background/Objectives. Otomastoiditis, an inflammatory condition affecting the middle ear and mastoid cells, poses significant risks for hearing impairment. This study aimed to analyze the clinical presentations, anatomical variations, and audiometric outcomes associated with acute and chronic otomastoiditis over a five-year period at the ENT Clinic of the Clinical County Emergency Hospital of Craiova. Methods. A retrospective clinical-statistical analysis was conducted on 145 patients aged 2 to 78 years, who were treated for otomastoiditis. The study involved a comprehensive review of clinical and audiometric data, with a focus on the type of hearing loss (conductive or mixed), audiometric thresholds, and the relationship between the anatomical form of the disease and the severity of hearing loss. Results. The majority of cases (93.83%) were chronic otomastoiditis, with 66.89% of patients presenting with mixed hearing loss and 33.10% with conductive hearing loss. Audiometric assessments revealed significant air conduction deficits, particularly at low and mid-range frequencies, with losses averaging 50-55 dB in cases of conductive hearing loss. Chronic cases demonstrated notable bone conduction impairments, indicating progressive cochlear damage. Statistical analysis identified a moderate correlation between the anatomical form of the disease and the severity of hearing loss, particularly in patients with cholesteatomatous-suppurative forms. Conclusions. This study underlines the critical need for the early and precise diagnosis of otomastoiditis, supported by audiometric evaluations. Our findings emphasize the substantial risk of progressive cochlear damage in chronic cases, underscoring the necessity for timely intervention to mitigate long-term hearing loss. These results offer valuable insights for clinicians, potentially guiding improved therapeutic approaches and contributing to enhanced patient outcomes in managing chronic otomastoiditis.