جستجوی مقالات مرتبط با کلیدواژه « differential » در نشریات گروه « پزشکی »

Just as failure to diagnose an acute ischemic stroke (AIS) in a timely manner affects the patient’s out-come; an inaccurate and misplaced impression of the AIS diagnosis is not without its drawbacks. Here, we introduce atwo-stage clinical tool to aid in the screening of AIS cases in need of imaging in the emergency department (ED).Meth-ods:This was a multicenter cross-sectional study, in which suspected AIS patients who underwent a brain magneticresonance imaging (MRI) were included. The 18 variables from nine existing AIS screening tools were extracted anda two-stage screening tool was developed based on expert opinion (stage-one or rule in stage) and multivariate logis-tic regression analysis (stage-two or rule out stage). Then, the screening performance characteristics of the two-stagemode was evaluated.

Data from 803 patients with suspected AIS were analyzed. Among them, 57.4% were male,and their overall mean age was 66.9 ± 13.9 years. There were 561 (69.9%) cases with a final confirmed diagnosis of AIS.The total sensitivity and specificity of the two-stage screening model were 99.11% (95% CI: 98.33 to 99.89) and 35.95%(95% CI: 29.90 to 42.0), respectively. Also, the positive and negative predictive values of two-stage screening model were78.20% (95% CI: 75.17 to 81.24) and 94.57% (95% CI: 89.93 to 81.24), respectively. The area under the receiver operatingcharacteristic (ROC) curve of the two-stage screening model for AIS was 67.53% (95% CI: 64.48 to 70.58). Overall, usingthe two-stage screening model presented in this study, more than 11% of suspected AIS patients were not referred forMRI, and the error of this model is about 5%.

Here, we proposed a 2-step model for approaching suspectedAIS patients in ED for an attempt to safely exclude patients with the least probability of having an AIS as a diagnosis.However, further surveys are required to assess its accuracy and it may even need some modifications.

The aim of this study was to evaluate the radiographic and clinical features of malignant oral and maxillofacial lesions in patients referred to the Radiology Department of Mashhad Dental School from 2003 to 2017.

A total of 45 radiographs of patients who had been referred to the Radiology Department of Mashhad Dental School from 2003 to 2017 were selected from the radiology archive. The patients presenting with malignant lesions in jaws and a definite pathologic diagnosis were selected as the study population. The radiographic features of lesions were investigated using intraoral radiographies, panoramic, and cone-beam computed tomography (CBCT) or computed tomography (CT) views. Then, 18 patients whose information was available were evaluated. Fisher’s exact test was used to compare the characteristics of lesions.

The age of the patients ranged from 5 to 84 years, with a mean of 49.18 years. Of the 45 lesions identified, squamous cell carcinoma (SCC) was the most prevalent malignancy, followed by lymphoma and mucoepidermoid carcinoma. Most malignant lesions were seen in the posterior region of the jaws, and lesions were generally more prevalent in the mandible. Additionally, 77.8% of the observed malignancies had an ill-defined border, and 86.6% of them were radiolucent. In the clinical view, swelling was the most common symptom, and the duration of the disease in the majority of the lesions was less than 3 months.

Paying attention to the course of the lesion, its internal structure and borders in the radiographic view can lead to a more accurate differentiation of malignant lesions from benign ones and timely referral of the patient.

ntroduction:Differentiating actual epileptic seizures (ESs) from psychogenic non-epileptic seizures (PNES) isof great interest. This study compares the serum proteomics of patients diagnosed with ESs and PNES.Meth-ods:Eight patients with seizure (4 with PNES and 4 with TLE (temporal lope epilepsy)) were enrolled in thiscomparative study. Venous blood samples were drawn during the first hour following the seizure. Standard pro-tein purification technique was employed and proteins were subsequently separated via 2-D electrophoresis.After comparison of the serum proteomes from the two groups, protein expression was analyzed. The differen-tially expressed bands were determined using both matrix-assisted laser ionization time-of-flight (MALDI/TOF)and electrospray ionization quadruple mass spectrometry (MS).

This study identified 361 proteins, theexpression of 110 proteins increased, and 87 proteins decreased in the PNES group compared with TLE group.Four separate proteins were finally identified with MALDI/TOF MS analysis. Compared with PNES group, al-pha 1-acidglycoprotein 1, ceruloplasmin, and S100-βwere down-regulated and malate dehydrogenase 2 wasup-regulated in the serum of TLE patients.

Our results indicated that changes in serum levelsof S100-β, ceruloplasmin, alpha 1-acidglycoprotein 1, and malate dehydrogenase 2 after seizure could be intro-duced as potential markers to differentiate ES from PNES; however, more advanced studies are required to reacha better understanding of the underlying mechanisms.

Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department. Evidence acquisition: This article was conducted as a narrative review of 106 articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasonographic status was conducted in patients with acute abdominal pain referring to the emergency department.

In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain.

Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications.

Speech delay with an unknown cause is a problem among children. This diagnosis is the last differential diagnosis after observing normal findings in routine hearing tests. The present study was undertaken to determine whether auditory brainstem responses to click stimuli are different between normally developing children and children suffering from delayed speech with unknown causes. In this cross-sectional study, we compared click auditory brainstem responses between 261 children who were clinically diagnosed with delayed speech with unknown causes based on normal routine auditory test findings and neurological examinations and had >12 months of speech delay (case group) and 261 age- and sex-matched normally developing children (control group). Our results indicated that the case group exhibited significantly higher wave amplitude responses to click stimuli (waves I, III, and V) than did the control group (P=0.001). These amplitudes were significantly reduced after 1 year (P=0.001); however, they were still significantly higher than those of the control group (P=0.001). The significant differences were seen regardless of the age and the sex of the participants. There were no statistically significant differences between the 2 groups considering the latency of waves I, III, and V. In conclusion, the higher amplitudes of waves I, III, and V, which were observed in the auditory brainstem responses to click stimuli among the patients with speech delay with unknown causes, might be used as a diagnostic tool to track patients’ improvement after treatment.

To investigate the clinicopathology and magnetic resonance imaging (MRI) features of bladder paraganglioma, an extremely rare clinical entity.
Five patients with bladder paraganglioma (3 males and 2 females, 27-52 years old) were retrospectively reviewed. All cases underwent baseline MRI and contrast-enhanced scans, and three cases underwent diffusion weighted imaging (DWI) and cystoscopy. Cases were immunohistochemically examined with neuroendocrine markers (chromogranin and synaptophysin) and Ki-67, and histology was reviewed by a pathologist.
Three cases exhibited painless gross hematuria, including one case with hypertension, whereas two cases were asymptomatic. One of the three patients who underwent cystoscopy was negative. The tumors were round (n = 1) or oval (n = 4) and located in the anterior wall (n = 1), posterior wall (n = 1), lateral wall (n = 2) or trigone (n = 1). All tumors were located in the submucosal or lamina propria. Four cases presented with well-circumscribed margins, whereas one case was poorly circumscribed. All tumors exhibited slight hyperintensity on T1-weighted images (T1WI) and hyperintensity with “salt and pepper” appearance on T2-weighted images (T2WI). DWI indicated strong hyperintensity, and all cases exhibited conspicuous enhancement after intravenous gadobenate dimeglumine (Gd-DTPA) injection. Pathological evaluation confirmed paraganglioma.
MRI plays an important role in the preoperative diagnosis of bladder paraganglioma. This rare condition has a characteristic round or oval appearance, located in the submucosal area, with slight hyperintensity on T1WI and hyperintensity with “salt and pepper” appearance on T2WI. DWI indicated strong hyperintensity and conspicuous enhancement on contrast-enhanced scans.

To investigate associations between computer use data and sleep quality among university students. This descriptive, cross-sectional study was performed on 312 students of Tehran University of Medical Sciences, Iran. Data was collected using Epworth Sleepiness Scale (ESS), Insomnia Severity Index (TSI), Pittsburgh Sleep Quality Index (PSQI), and a background and computer use questionnaire. Descriptive statistics, independent samples test, Univariate analysis of variance and Chi Square test were used to analyze the data. The final sample was composed of 164 (52.6%) male and 148 (47.4%) female students aged 17-30 years. The mean of assessed sleep indices were not significantly different between the male and female groups (P =. 05). Among all the participants, 81.1% were poor sleepers (PSQI ≥ 5), 60.58% of them suffered from insomnia (ISI ≥ 8), and 49.36% of them reported sleepiness (ESS ≥ 10). There was a significant association between the computer work (hours/ day) and ISI and PSQI indices (P =. 05). Students who used computer between 24:00 to 2:00 had a meaningful higher ISI and PSQI indices compared to those whose computer use interval was 19:00 to 22:00. The prevalence of eye discomfort and the headache associated with computer use was significantly more common among female students. We found a significant association between the headache precededby computer use and ISI and PSQI indices (P =. 05). Poor sleep quality and insomnia were common among university students. The amount of prevalence was higher among nocturnal (24:00-2:00) computer users and those with prolonged durations of use. Also, the headache associated with computer use deteriorates the quantity and quality of sleeping.

Ileocolic intussusceptions and colonic pseudopolyps are well known entities in childhood. Intussusception appears within the first year of life, while pseudopolyps appear in preschool children. In contrast, colocolic intussusception is very rare in infants. A 5-month-old male infant was admitted to our hospital, with severe anemia and episodes of colicky abdominal pain. Abdominal ultrasound examination revealed an intussusception. As ultrasound guided hydrostatic reduction achieved partial reduction, emergency laparotomy was performed, showing a narrow-based polyp, as a lead point of a colocolic intussusception. In contrast to ileocolic intussusception, colocolic intussusceptions usually occur in adults or in late childhood. A solid colonic pseudopolyp, serving as a lead point for colocolic intussusception in an infant, has not been described so far.

Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical di­agnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultra­sonography for diagnosis of penile Mondor's disease. Seven patients with the clinical presentation of penile Mondor's disease were included in the study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients. Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic pur­poses, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according to us. Recovery from penile Mondor's disease is usually spontaneous and smooth. A simple physical examina­tion is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests should be avoided so that patients are not harmed.