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Beef cattle welfare and health status are influenced by housing and management systems. The present study aimed to assess the welfare and health status in the first 15 days after arrival of Limousine bulls imported from France and fattened in a commercial fattening unit in Italy. A total of 264 bulls were included in the study. Welfare, biosecurity, and major hazard and warning system were assessed on days 2 (T1) and 15 (T2) after arrival to the unit. At T1 and T2 an inspective clinical examination was performed on all bulls. At T1 and T2 blood samples were collected from 88 bulls for haematological analysis. Both at T1 and T2, the welfare, biosecurity, and major hazards and warning systems were classified with a general score of medium but with a decrease on animal-based measurements in T2. At T1 and T2 the clinical examination revealed a significant increase (p-value≤0.05) of skin lesions and lameness in T2. A high incidence of respiratory disease was noticed in both assessed times. Leucocytes and all differentials count, and platelets were significantly increased (p-value≤0.05) at T2, while the fibrinogen was significantly decreased. The haematological changes suggest that the bulls were under higher stress in T2 when compared with T1 linked with a difficult adaptation response to the fattening unit. A multi-factorial approach that integrates the indicators of the checklist and the clinical and haematological findings of animals can be a useful method to deepen the assessment of welfare in beef cattle.

Objectives The importance of the effects of stress on cats is well recognised, with visits to the veterinary clinic a common cause of stress. The aim of this study was to explore owners’ experiences of stress, both for themselves and their cat, during veterinary visits, and to gather data on owners’ perception of resources within the clinic to reduce stress in their cats. Methods A questionnaire aimed at cat owners with recent experience of an outpatient visit to the veterinary clinic was developed and distributed. Questions covered demographics; their most recent veterinary visit; their general experience of visits over the past 3 years; measures taken by the clinic to reduce stress; and awareness of the Cat Friendly Clinic programme. There were various question types, with owners often asked to rate stress from 1 (least stressful) to 10 (most stressful). Results A total of 277 respondents gave details about their experience of consultations over the past 3 years. Owners rated the stress of travelling to the clinic, other animals in the waiting room and the consultation itself (all median 6, interquartile range 4–8) as the most stressful elements. Most owners reported gentle methods of removing the cat from their carrier; however, almost a third (n = 81/263; 30.8%) had seen their cat scruffed during a consultation. Cat-only waiting rooms were viewed as the most effective measure to reduce stress in the clinic. Conclusions and relevance Veterinary clinics are already taking steps to address stress in cats, and owners have a good awareness of stress in their cats. Future work should focus on trialling specific interventions to determine their effectiveness in reducing stress in feline patients, and measures currently perceived by owners to be highly effective, such as cat-only waiting rooms, should be used where feasible.

Objectives: To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in intravitreal (IV) anti-vascular endothelial growth factor (anti-VEGF)-resistant neovascular age-related macular degeneration (nvAMD) cases. Materials and Methods: Eyes that were diagnosed as having active and treatment-naive nvAMD in the Ege University Ophthalmology Department, Retina Unit in 2011-2018, were non-responsive to IV anti-VEGF treatment, and for which indocyanine angiography (ICGA) could be obtained were included in the study. Active nvAMD was defined as the presence of fresh hemorrhage on clinical examination or findings of subretinal, intraretinal, or sub-retinal pigment epithelial fluid on spectral domain optical coherence tomography and accompanying fluorescein dye leakage in fluorescein angiography. Eyes that had activation findings despite at least 6 consecutive intravitreal anti-VEGF injections were defined as non-responders and underwent ICGA to assess for PCV. The diagnosis of PCV was based on the Everest II study criterion. Results: A total of 97 eyes of 88 patients were included in the study. Of 88 patients, 44 (50%) were female, 44 (50%) were male, and the mean age was 75.9±8.3 years (range: 59-93). The mean number of anti-VEGF injections until the time of ICGA was 7.3±2.2 (range: 6-15). PCV was detected in 62 eyes (63.9%) on ICGA. Conclusion: The prevalence of PCV is quite high among eyes with IV anti-VEGF treatment-resistant nvAMD in Turkey (63.9%). ICGA evaluation for PCV should be conducted for all nvAMD cases that are non-responsive to IV anti-VEGF treatment, both to shed light on the reason for resistance and to modify treatment as necessary. © 2022 by Turkish Ophthalmological Association Turkish Journal of Ophthalmology, published by Galenos Publishing House.

Infantile hypertrophic pyloric stenosis is the commonest cause of gastric outlet obstruction and vomiting in infancy resulting from gradual hypertrophy of the smooth muscle of the pylorus. Reports have suggested that the incidence of pyloric stenosis is increasing. This is a prospective study aimed to defining the various aspects of IHPS cases. A total no. of 39 patients presented to Alsader general teaching hospital during the period from January 2014 to the end of December 2018. The diagnosis was based on history, clinical examination with U/S study and we rarely need barium meal for the diagnosis. Results revealed that the male: female ratio was 12 to 1) male formed 92.3% while female is 7.6% of cases. The disease is more frequently in the first baby of the family (28 patients: 71.7%). Family history was positive in two cases (5.1%), associated anomalies are found in 2 cases which is about 5.1%. The mortality rate (0 %). In conclusion: The management start with the correction of the general state of patients then followed by operation (Ramstedts pyloromyotomy). Correction of fluid and electrolytes status of the patients preoperatively is very important to prevent operative and postoperative complications. Early feeding results in the retain of symptoms of vomiting so delay in the postoperative feeding up to the next postoperative day decrease the incidence of vomiting and risk of suffocation with overall reduction in the incidence of morbidity and mortality.

Objective. This study investigated the effects of flowable resin composites (FCR) on the restoration of noncarious cervical lesions (NCCL) and their impact on periodontal tissues. Materials and Methods. 30 periodontally healthy patients were assigned into three groups randomly; group VF: self-adhering FCR, group NF: fluoride-releasing FCR, and group SF: microhybrid FCR. Gingival crevicular fluid (GCF) volume levels of osteoprotegerin (OPG), immunoglobulins (IgA, IgM), and interleukins (IL-1, IL-1β, and IL-10) in GCF were analyzed with ELISA tests. Clinical success rates were evaluated using USPHS criteria during the 12-month follow-up. Results. The GCF volume was increased mostly in group SF ( 1.34 ± 0.09 μ l ). While the titer of interleukin was increased in all groups, higher increases were observed in IL-1 and IL-1β in group NF (170.78 pg/ml and 39.35 pg/ml). Increased IL-10 was observed in group VF ( 14.33 ± 0.85 pg / ml ). IgA levels varied partially among all groups ( p > 0.05 ), and even IgM levels were elevated immediately after the restoration process but returned to normal on the 28th day ( p < 0.05 ). Group NF failed in most of the USPHS criteria, while the material group VF and group SF presented acceptable results except in the marginal adaptation criterion ( p < 0.05 ). Conclusions. Clinical efficacy of self-adhering FCR was found the best for restoration of NCCL while fluoride-releasing FCR stimulated the periodontal response and had negative effects on GCF volume, cytokine, and immunoglobulin levels.

A anamnese é a primeira exploração do estado geral de um paciente e o primeiro contato do serviço médico-paciente, sendo fundamentada nas etapas: Identificação; Queixa principal; História da doença atual; Interrogatório sintomatológico; Antecedentes pessoais e familiares; e Hábitos de vida. Portando, se tornando o principal instrumento investigativo que, ao ser associado com as demais ferramentas tecnológicas, é perceptível a efetividade do cuidado. Contudo, a inadequação relacionada a aplicação de uma entrevista de anamnese está diretamente relacionada aos mais diversos erros, tanto diagnósticos como nas demais etapas do atendimento. Esse estudo tem abordagem descritiva qualitativa, dentro da estruturação de escrita em relatos de experiência sob a perspectiva práticas e teóricas, do módulo de Habilidades e Atitudes Médicas I. Por fim, o exame clínico é derivado de uma abordagem insubstituíveis que formam o chamado tripé da prática médica, que engloba tanto as hipóteses diagnósticas, como a interação/relação do profissional com o usuário, bem como a tomada de decisões diante dos achados clínicos.&nbsp

A systematic review and narrative synthesis looking at the adaptations of clinical examinations of medical students in response to the COVID-19 pandemic.

Hereditary GI polyposis in JRTs is a novel hereditary disease characterized by the development of solitary and multiple polypoid tumors, predominantly in the stomach and/or colorectum. Our recent study indicated that JRTs with GI neoplastic polyps harbor an identical germline variant in the APC gene, c.[462_463delinsTT], in a heterozygous state. Unlike sporadic cases, dogs afflicted with hereditary GI polyposis can be expected to have a prolonged survival time, as hereditary tumors are noninvasive. Since the discovery of this disease, the number of newly diagnosed cases in Japan has increased, allowing us to update the clinical and pathological features and provide a large number of diagnostic images. The present clinical case series study employing various diagnostic imaging techniques revealed that some of the cases harbored tumors in the small intestine in addition to the stomach and colorectum. Moreover, although rare, hereditary GI cancers can progress to the advanced stage and develop systemic metastasis, similar to sporadic GI tumors. These findings indicate that there is a wider range of variation in disease severity than was initially recognized. Our results can contribute to the accurate diagnosis of hereditary GI polyposis in clinical practice, pathological examinations, and future research.

Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3–5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013–April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2–5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169), SCOPUS: re.j, info:eu-repo/semantics/published

Background: The aim of this study was to assess the accuracy of clinical screening examination in newborns with dislocated hips compared with ultrasound scan (USS). Methods: Newborns, up to 3 months of age, with confirmed hip dislocations on USS were prospectively enrolled in a multinational observational study. Data from 2010 to 2016 were reviewed to determine pretreatment clinical examination findings of the treating orthopaedic surgeon as well as baseline ultrasound indices of developmental dysplasia of the hip (DDH). All infants had been referred to specialist centres with expertise in DDH, due to abnormal birth examination or risk factor. Results: The median age of the study population was 2.3 weeks and 84% of patients were female. Of the total 515 USS-confirmed dislocated hips included in the study, 71 (13.8%) were incorrectly felt to be reduced on clinical examination by the treating orthopaedist (P

Aims To evaluate the prevalence of clinical and ultrasonographic musculoskeletal involvement in Italian patients with inflammatory bowel disease (IBD). Methods In this cross-sectional multicenter study, 148 consecutive patients with IBD were evaluated by a gastroenterologist and a rheumatologist. All patients underwent a B-mode and power Doppler ultrasonographic examination of 6 pairs of entheses and of knee and ankle joints. Results A positive history for at least one musculoskeletal manifestation was reported by 40.5% of patients, more frequently in ulcerative colitis (UC) (p = 0.033). Inflammatory back pain was reported by 13.5% of patients, and a past history of peripheral arthritis by 14.9%, entheseal inflammation by 14.2% and dactylitis by 2.7%. At clinical examination, arthritis was observed in 19.6% of patients and enthesitis in 33%. Oligoarthritis and enthesitis at clinical examination were more frequently observed in UC than in Crohn disease (CD). 37.8% of total IBD patients fulfilled ASAS classification criteria for axial and/or peripheral spondyloarthritis, 8.1% ASAS classification criteria for axial spondyloarthritis, and 29.7% ASAS classification criteria for peripheral spondyloarthritis. With ultrasonographic examination, signs of entheseal involvement were observed in 87.8% of patients, while at power Doppler, ≥1 abnormality was observed in 27.1%. ASAS+ patients compared to those ASAS- had a significantly higher frequency at ultrasonography of acute entheseal abnormalities, power Doppler entheseal positivity and joint involvement. These abnormalities at ultrasonography were also observed in 34%, 13% and 12% of ASAS- patients. Conclusions Musculoskeletal manifestations occur frequently in patients with IBD. Ultrasonographic entheseal and joint involvement were also observed in asymptomatic patients.

Ziel dieser Studie war, medizinische Daten von freilebenden H. albicilla mit diagnostizierter Bleiintoxikation auszuwerten. Hierzu wurden klinische, bildgebende, blutchemische- und hämatologische Parameter sowie Blut- und Organbleikonzentrationen untersucht. Es wurde überprüft, ob das Vorhandensein verschiedener klinischer, bildgebender und labordiagnostischer Befunde Einfluss auf die Prognose einer Bleiintoxikation bei freilebenden H. albicilla hat. Über den Zeitraum von August 1998 bis Januar 2020 wurden Daten von 238 freilebenden, verletzt aufgefundenen H. albicilla, die in der Abteilung für Heim-, Zoo- und Wildtiere der Klinik für kleine Haustiere der Freien Universität Berlin vorgestellt wurden, ausgewertet. Als Einschlusskriterium für eine Bleiintoxikation wurde eine Blutbleikonzentration ab 0,4 ppm einhergehend mit typischen klinischen Symptomen gewählt. 31 % der Seeadler (73/238) wiesen eine Bleiintoxikation als alleinigen Befund auf und wurden in die Studie einbezogen. Die Seeadler stammten aus Brandenburg (44/73), Mecklenburg-Vorpommern (14/73), Sachsen (6/73), Schleswig-Holstein (4/73), Sachsen-Anhalt (3/73) und Berlin (2/73). Ein Großteil der Seeadler wurde in den Herbst- und Wintermonaten (Oktober bis März) aufgefunden (60/73, 82 %). Die häufigste Altersgruppe waren adulte Seeadler (50/73, 69 %), gefolgt von immaturen (17/73, 23 %) und juvenilen Vögeln (4/73, 5 %) sowie Nestlingen (2/73, 3 %). Weibliche Seeadler (40/73, 55 %) wurden häufiger vorgestellt als männliche (30/73, 41 %). Typische klinische Untersuchungsbefunde, die bei 72 der 73 Seeadler erhoben werden konnten, waren Apathie (72/72, 100 %), Dyspnoe (50/72, 68 %), ein schlechter Ernährungszustand (44/72, 60 %), Biliverdinurie (35/72, 48 %), Erbrechen (23/72, 32 %), Kropfstase (21/72, 29 %) und neurologische Ausfallserscheinungen (19/72, 26 %). Bei der röntgenologischen Untersuchung konnten bei 44 % der Vögel metalldichte Fragmente im Verdauungstrakt nachgewiesen werden (32/73). Die Bleifragmente befanden sich am häufigsten im Magen, gefolgt von Darm und Kropf. Eine Hämolyse der Erythrozyten wurde bei 62 % (45/73) der Seeadler nachgewiesen. Die mediane Blutbleikonzentration lag bei 3,0 ppm (Min=0,4 ppm; Max=21,7 ppm). Signifikant höhere Blutbleikonzentrationen konnten bei Seeadlern mit Biliverdinurie (rs=0,44; p=0,002), Dyspnoe (rs=0,38; p=0,001) und metalldichten Fragmenten im Verdauungstrakt (rs=0,3; p=0,009) festgestellt werden. Zudem wiesen adulte Seeadler signifikant häufiger höhere Blutbleikonzentrationen auf als andere Altersgruppen (rs=0,25; p=0,03). Die hämatologische Untersuchung ergab bei 26 % der Seeadler (18/73) eine Anämie (Hämatokrit unter 29 %). Bei den blutchemischen Parametern konnten die stärksten Abweichungen von den Referenzintervallen bei der Aspartat-Aminotransferase- und der Kreatinkinaseaktivität sowie der Glukosekonzentration beobachtet werden. Eine therapeutische Endoskopie erfolgte bei 59 % (16/27) der Seeadler mit metalldichten Fragmenten im Magen. In 69 % (11/16) der Fälle wurden die Fragmente zwar erfolgreich entfernt, aber trotz Endoskopie verstarben 13 von 16 Seeadlern. Die Blutbleikonzentration konnte mit Ca-Na2-EDTA 50 mg/kg KGW i.m. BID und 100 mg/kg KGW i.m. BID bzw. Ditripentat 50 mg/kg KGW i.m. SID intramuskulär kontinuierlich gesenkt werden. Insgesamt verstarben 79 % der Seeadler (31 weibliche, 25 männliche und zwei unbekannten Geschlechts) an den Folgen der Bleiintoxikation. Faktoren, die die Prognose signifikant beeinflussten, waren das Vorhandensein einer Dyspnoe (r=0,63; p=0,001), das Vorhandensein einer Biliverdinurie (r=0,43; p=0,005), die Höhe der Blutbleikonzentration (rs=0,36; p=0,002) sowie eine Hämolyse (r=0,31; p=0,01). Eine Überlebensbaumanalyse ergab, dass Dyspnoe und Anämie die einflussreichsten Faktoren für die Beurteilung der Prognose bei Seeadlern mit Bleiintoxikationen waren. Seeadler mit einer Dyspnoe wiesen eine Überlebenswahrscheinlichkeit von 6 % auf, Seeadler mit einer Anämie von 24 %. Die Leberbleikonzentrationen der Seeadler mit Bleiintoxikation waren höher als die Nierenbleikonzentrationen (rs=0,8; p=0,001). 74 % (34/46) der verstorbenen Tiere wiesen deutlich erhöhte Leberbleikonzentrationen und 24 % (11/46) deutlich erhöhte Nierenbleikonzentrationen auf (>8 ppm). Bei 86 % der Seeadler, die mit einer Blutbleikonzentrationen unter 1 ppm verstarben (6/9), konnten Leber- und Nierenbleikonzentrationen von über 1 ppm nachgewiesen werden. Dies ist die erste Studie, die den Verlauf einer Bleiintoxikation bei einer größeren Anzahl von Seeadlern auswertete. Die Ergebnisse dieser Arbeit können helfen, anhand klinischer, bildgebender und labordiagnostischer Befunde, die Prognose einer Bleiintoxikation bei Seeadlern besser zu beurteilen., The aim of this study was to evaluate medical data from German white-tailed eagles with diagnosed lead poisoning based on clinical signs, diagnostic imaging and laboratory diagnostic findings. From August 1998 to January 2020 238 free-living H. albicilla were presented at the Small Animal Clinic of the Freie Universität Berlin. Inclusion criterion was a blood lead concentration of 0.4 ppm, typical clinical symptoms associated with lead intoxication and absence of any other clinical findings. Based on these, data of 73 free-living white-tailed eagles were included in this study. The majority of eagles originated from Brandenburg (44/73), followed by Mecklenburg-Western Pomerania (14/73), Saxony (6/73), Schleswig-Holstein (4/73), Saxony-Anhalt (3/73) and Berlin (2/73). Most of the birds were found in autumn and winter months (October to March) (60/73, 82 %). The most common age group were adult white-tailed eagles (50/73, 69 %), followed by immature (17/73, 23 %) and juvenile birds (4/73, 5 %) as well as nestlings (2/73, 3 %). Female white-tailed eagles (40/73, 55 %) were presented more often than males (30/73, 41 %). Typical clinical findings could be evaluated in 72 out of 73 birds including apathy (72/72, 100 %), dyspnoea (50/72, 68 %), poor nutritional status (44/72, 60 %), biliverdinuria (35/72, 48 %), vomiting (23/72, 32 %), crop stasis (21/72, 29 %) and neurological signs (19/72, 26 %). Metal-dense fragments within the digestive tract were detected in 44 % of the birds during radiological examination (32/73). Those were most frequently located in the stomach, followed by intestines and crop. In 12 % of the white-tailed eagles, metal-dense fragments were furthermore found outside the digestive tract (4/34). Hemolysis was observed in the plasma of 62 % of all birds examined (45/73). The median blood lead concentration was 3.0 ppm (min=0.4 ppm; max=21.7 ppm). Significantly higher blood lead concentrations were found in white-tailed eagles presenting with biliverdinuria (rs=0.44; p=0.002), dyspnoea (rs=0.38; p=0.001), and metal-dense fragments located within the digestive tract (rs=0.3; p=0.009). Furthermore, higher blood lead concentrations were significantly more common in adult white-tailed eagles (rs=0.25; p=0.03) than in other age groups. Hematological examination of white-tailed eagles revealed anemia in 26 % of the birds (18/73). The greatest deviations from reference intervals in blood biochemistry parameters were observed in aspartate aminotransferase and creatine kinase activity as well as in glucose concentration. Therapeutic endoscopy was attempted in 59 % (16/27) of white-tailed eagles with metaldense fragments located in the stomach. Lead fragments were successfully retrieved in 69 % (11/16) of birds, but despite endoscopic treatment 13 of 16 white-tailed eagles died due to lead intoxication. Blood lead concentration could be continuously reduced with intramuscular administration of Ca-Na2-EDTA at 50 mg/kg BW BID, at 100 mg/kg BW BID or Ditripentate at 50 mg/kg BW SID. Overall, 79 % of the white-tailed eagles (31 females, 25 males and two unknown sex) presented died as a result of lead poisoning. Factors that significantly influenced the prognosis were the presence of dyspnoea (r=0.63; p=0.001), biliverdinuria (r=0.43; p=0.005), blood lead concentration (rs=0.36; p=0.002) as well as hemolysis (r=0.31; p=0.01). A survival tree analysis indicated that dyspnea was the most relevant factor for assessing the prognosis of white-tailed eagles with lead intoxication followed by the presence of anemia. White-tailed eagles with dypnoea had a 6 % survival rate, while the chance of survival of birds with anemia was 24 %. Postmortem liver lead concentrations of white-tailed eagles were higher than kidney lead concentrations (rs=0.8; p=0.001). 74 % (34/46) of the birds showed significantly increased liver lead concentrations while 24 % (11/46) had increased kidney lead concentrations (>8 ppm). In 86 % of the white-tailed eagles dying with blood lead concentrations of less than 1 ppm (6/9), liver lead concentrations higher than 1 ppm were detected. To the author’s knowledge this is the first study evaluating the course of lead intoxication in a larger number of white-tailed eagles. The results of this study should therefore help to better assess the prognosis of lead intoxication in this species and treat affected birds accordingly.

Asymmetric dimethylarginine (ADMA) is a well-established cardiac biomarker in humans. The purpose of this prospective study was to investigate if measuring serum ADMA concentration via ELISA allows detection of cardiac disease in horses. In this context, ADMA reference values in horses were established. Furthermore, a change in ADMA serum concentration before and after a 160 km endurance race was assessed and the differences in ADMA concentration between horses that completed the race and horses that did not was evaluated. For this propose 78 horses with no known medical history were compared to 23 horses with confirmed structural cardiac disease with or without arrhythmias. Horses with heart disease were staged based on the severity of cardiac disease from I to II. Furthermore, 52 healthy endurance horses competing in a 160 km race were assessed. The endurance horses were assigned to three groups: horses that successfully completed the race, horses that failed to qualify at the veterinary check for primarily metabolic reasons and horses that failed to qualify at the veterinary check for primarily gait related reasons. The latter two groups were combined to form a final group of “non-finishers” that were excluded for either “gait related” or “metabolic” disorders. Horses underwent physical examination, electrocardiography, echocardiography, and venous blood sampling. In the endurances horses venous blood samples were taken before and after the endurance race. Asymmetric dimethylarginine was measured via ELISA, with a subset cross-checked using liquid chromatograph triple quadrupole mass spectrometry. Reference intervals with 90th percent confidence intervals were established according to ASVCP-guidelines. Standard software was used to test for significant differences in ADMA, and the L-arginine/ADMA ratio between groups. The reference range for ADMA in healthy horses was 1.7 - 3.8 μmol/L. Serum ADMA was higher in horses with heart disease compared to healthy horses (p, Asymmetrisches Dimethylarginin (ADMA) ist ein etablierter und sensitiver kardialer Biomarker beim Menschen. In dieser prospektiven Studie sollte untersucht werden, ob die Messung der ADMA-Konzentration im Serum mittels ELISA den Nachweis einer Herzerkrankung bei Pferden ermöglicht. In diesem Zusammenhang wurden ADMA-Referenzwerte für Pferden ermittelt. Darüber hinaus sollte eine Veränderung der ADMA-Serumkonzentration vor und nach einem 160 km Distanzritt untersucht werden. In diesem Zusammenhang sollte geprüft werden, ob es Unterschiede in der ADMA-Konzentration zwischen Pferden gibt, die das Rennen beenden und die vom Rennen aufgrund einer gesundheitlichen Einschränkung ausgeschlossen werden müssen. Für den ersten Teil der Studie wurden 78 herzgesunde Pferde mit 23 Pferden mit einer bestätigten strukturellen Herzerkrankung mit oder ohne Arrhythmie verglichen. Für den zweiten Teil der Studie wurden 52 gesunde Distanzpferde, die an einem 160 km Distanzrennen teilnahmen, untersucht. Die Distanzpferde wurden in drei Gruppen eingeteilt: Pferde, die das Rennen erfolgreich abgeschlossen haben, Pferde, die aufgrund eines metabolischen Problems im Veterinärcheck disqualifiziert wurden und Pferde, die beim Veterinärcheck aufgrund eines veränderten Gangbildes disqualifiziert wurden. Es erfolgte eine Allgemeinuntersuchung, eine Elektrokardiographie und eine Echokardiographie der Pferde sowie eine venöse Blutentnahme. Bei den Distanzpferden wurde vor und nach dem 160 km Distanzritt venöse Blutproben entnommen. Aus den Blutproben wurde die ADMA-Konzentration mittels ELISA im Serum bestimmt. Basierend auf der Schwere der Herzerkrankung wurden die Pferde in Stadien von I bis II eingestuft. Bei einem Teil der Proben erfolgte eine Doppelmessung mittels Flüssigchromatographie-Triple-Quadrupol-Massenspektrometrie. Die Referenzintervalle für ADMA wurden entsprechend der ASVCP-Richtlinien eruiert. Die Standardsoftware SPSS wurde verwendet, um signifikante Unterschiede in der ADMA-Konzentration und der L-Arginin/ADMA-Ratio zwischen den Gruppen zu testen. Der in der vorliegenden Studie ermittelte Referenzbereich für ADMA liegt zwischen 1,7 - 3,8 μmol/L. Des Weiteren ergab die Studie, dass bei Pferden mit Herzerkrankungen die ADMA Konzentration im Serum im Vergleich zu herzgesunden Pferden signifikant höher (p

Введение. Одной из важнейших проблем, которая остро стоит перед системой здравоохранения РФ и здравоохранением всего мира, является проблема глобального старения населения. Важным инструментом диагностики хронических неинфекционных заболевания, факторов риска их возникновения является диспансеризация. Особенно важна диспансеризация, ежегодно проводимая администрацией предприятия. В результате данных мер профилактики, необходимо разработать корпоративную программу профилактики не только хронических неинфекционных заболеваний, но и преждевременного старения. Цель. Изучение клинико-экономических особенностей уровня здоровья работников предприятия и их приверженность к здоровому образу жизни в рамках разрабатываемой анти-эйджинговой программы. Материалы и методы. Для достижения цели исследования была разработана авторская анкета. Так же проводился анализ медицинской документации по результатам проводимой на предприятии Белгородской области диспансеризации сотрудников данного предприятия. В ходе исследования проанализированы данные 210 сотрудников предприятия Белгородской области, исследование проводилось на базе АО «Белгородский хладокомбинат». Результаты. Большинство сотрудников организаций АО «Белгородский хладокомбинат» оценивают состояние своего здоровья как среднее. Более половины сотрудников предприятия в течение года обращались за медицинской помощью по поводу ухудшения состояния, так же респонденты отметили, что посещают врачей только в рамках диспансеризации. По мнению опрошенных, залогом крепкого здоровья является: сон в течение 6-8 часов, правильное питание, занятие спортом, хорошая наследственность. Отсутствие вредных привычек отметило только треть сотрудников предприятия, это может быть связано с тем, что большинство сотрудников заявили, что не курят. Обсуждения. По результатам исследования можно сделать вывод о несоответствии между тем, как сотрудники предприятия оценивают свое здоровье и посещением ими рабочего места при плохом самочувствии. Получены так же данные о том, что многие работники в течение года выходили на работу, испытывая явное недомогание, что явно влияло на выполнение ими профессиональных обязанностей и, соответственно, на производительность труда. Получены данные, что некоторые сотрудники вообще не предпринимают никаких усилий по сохранению своего здоровья, остальные респонденты ответили, что регулярно делают зарядку, занимаются спортом, посещают бассейн. Также нами отмечено, что все сотрудники предприятия недостаточно осведомлены в вопросах геропрофилактики. Выводы (заключение). После изучения полученных результатов при разработке программ геропрофилактики на предприятии особое внимание следует уделить мерам, нацеленным на повышение эффективности диспансеризации, на повышение осведомленности сотрудников организаций о возможностях предупреждения заболеваний, формирование персональной и корпоративной ответственности за сохранностью здоровья сотрудников предприятия., Introduction. One of the most important problems facing the health care system of the Russian Federation and the health care of the whole world is the problem of global population aging. An important tool for diagnosing chronic non-communicable diseases and risk factors for their occurrence is clinical examination. The medical examination, annually conducted by the administration of the enterprise, is especially important. As a result of these preventive measures, it is necessary to develop a corporate program for the prevention of not only chronic non-communicable diseases, but also premature aging. The purpose of the study. The study of clinical and economic features of the level of health of employees of the enterprise and their commitment to a healthy lifestyle in the framework of the developed anti-aging program. Materials and methods. To achieve the goal of the study, an author's questionnaire was developed. The analysis of medical documentation was also carried out based on the results of the medical examination of employees of this enterprise carried out at the enterprise of the Belgorod region. The study analyzed the data of 210 employees of an enterprise in the Belgorod region, the study was conducted on the basis of JSC "Belgorodsk Khladokombinat". Results. Most of the employees of the organizations of Belgorod Khladokombinat JSC assess their health status as average. More than half of the company's employees applied for medical help during the year due to the deterioration of their condition, and the respondents also noted that they visit doctors only as part of medical examinations. According to the respondents, the key to good health is: sleep for 6-8 hours, proper nutrition, sports, good heredity. The absence of bad habits was noted only by a third of the employees of the enterprise, this may be due to the fact that the majority of employees said that they did not smoke. Discussions. According to the results of the study, it can be concluded that there is a discrepancy between the way employees of the enterprise assess their health and their visits to the workplace when they feel unwell. Data were also obtained that many workers went to work during the year, experiencing obvious malaise, which clearly affected their performance of professional duties and, accordingly, labor productivity. Data were also obtained that many workers went to work during the year, experiencing obvious malaise, which clearly affected their performance of professional duties and, accordingly, labor productivity. Data was received that some employees do not make any efforts to maintain their health at all, the rest of the respondents answered that they regularly do exercises, go in for sports, go to the pool. We also noted that all employees of the enterprise are not sufficiently aware of the issues of geroprophylaxis. Conclusions (conclusion). After studying the results obtained, when developing geroprophylaxis programs at the enterprise, special attention should be paid to measures aimed at improving the efficiency of medical examinations, raising awareness of employees of organizations about the possibilities of preventing diseases, and forming personal and corporate responsibility for the health of employees of the enterprise.

Clinical examination procedures (CEPs) are cornerstone clinical skills for veterinary practitioners, being taught in all veterinary faculties. CEPs include innocuous procedures that are well tolerated by animals as well as more distressful and less tolerated ones. In a classical approach, institutional animals are used to teach and practice CEPs. Two hundred and thirty-one undergraduate students from four consecutive years were assigned to two groups that used institutional animals only (AO) or a combination of students’ owned animals and simulation models (model–animal, MA) to teach and practice CEPs. This latter comprised stuffed teddy dogs, eye and ear models made of molding silicone, as well as skin models. The learning outcome of each system was compared through questionnaires (throughout classes and at the end of course), grades, and pass rates in objectively structured clinical examinations. Most veterinary students had their own animals, being easy to have a dog per group of two students in class. All the students’ owned animals adapted well to this environment. The interest in the practical activities with the simulation models was comparable to that exhibited in the classical AO system. Students reported to learn more with the MA system than with the AO, while the interest on the subjects and the relevance were appraised similarly in both systems. No differences existed in the final grades and pass rates. The MA system was effective for learning CEPs. Beyond animal welfare advantages, this system increased the out-of-school training and had financial saving benefits, being a valuable option for the teaching and training of CEPs.

Cats frequently suffer from anxiety related to travel and veterinary visits. One sequela is avoidance of veterinary visits and lack of adequate veterinary care. The objective of this study was to test clinical efficacy and safety of a novel formulation of a pregabalin 50 mg/mL oral solution for alleviation of anxiety and fear in cats during transport and veterinary visits. A total of 209 client-owned cats were given either a flavored pregabalin oral solution at the dosage of 5 mg/kg (n = 108) or an identical placebo (n = 101) approximately 90 min before placing them into the carrier and transporting them in a car for at least 20 min to a veterinary clinic. The treatment effect using a 5-point numerical rating scale was evaluated during transportation by the owner and during clinical examination by the veterinarian, both blinded to the treatment. In addition, to verify the owner assessment, an external expert blinded to the treatment and owner assessment evaluated the transportation video recordings using the same rating scale as the owner. Pregabalin 5 mg/kg statistically significantly decreased both travel- (p < 0.01) and veterinary-visit- (p < 0.01) related anxiety compared to the placebo. The external expert’s evaluation was in agreement with the owners’ assessment confirming the treatment effect during transportation (p < 0.01). Treatment was well tolerated with only a few cats showing transient slight incoordination and tiredness. The flavored oral solution formulation with a small dosing volume of 0.1 mL/kg was found by the owners to be user-friendly and was well-accepted by the cats. This study demonstrated that a single oral dosage of the novel pregabalin oral solution alleviates anxiety and fear related to transportation and veterinary visits in cats, thus providing practical aid for both owners and veterinarians to enable cat-friendly handling and improving the welfare of cats in situations they often perceive as very stressful.

Aims The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally. Methods A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis. Results There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging versus clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data. Conclusion There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.

Background: This study was conducted to compare the accuracy of MRI findings and clinical examination of ligamentous and meniscal injuries of the knee, taking arthroscopy as a standard diagnostic tool in knee injuries. Methods: All patients with knee injuries attending the outpatient department or emergency of our hospital underwent clinical examination. Out of them, 60 patients with knee injuries were subjected to clinical examination, MRI, and then arthroscopy. The findings of these diagnostic tools in respect to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and meniscus injuries were validated, compared, and analyzed using various statistical tools. The accuracy, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and specificity were calculated and an agreement between various tests was established using kappa statistics. Results: The accuracy of clinical examination in our study was 88% for ACL tears, 85% for meniscal tears, and 100% for PCL tears. The kappa measure of agreement between arthroscopy and clinical finding and MRI for ACL was 0.610 and 0.698, respectively, which was statistically significant. MRI (98.1) was found to be a more sensitive test for detecting ACL injury than clinical examination (90.4%) resulting in higher diagnostic accuracy (98.3%), while diagnostic accuracy of clinical examination and MRI was found to be 100% for PCL injuries. Hence, MRI is an excellent screening tool for ligamentous and meniscal injuries of the knee joint. We can avoid diagnostic arthroscopy in patients with knee injuries having equivocal clinical and MRI examinations and can proceed for therapeutic arthroscopy to deal with such injuries. Conclusions: For the assessment of ligamentous and meniscal injuries, MRI is an accurate and noninvasive modality. It can be used as a first-line investigation but arthroscopy remains the gold standard.

Objective To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA. Methods Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted. Results In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6–96.3%, PABAK 0.65–0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5–92.6% vs 51.0–87.4% (PABAK 0.47–0.85 vs PABAK 0.35–0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1. Conclusion Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.

Evidence acquisition, interpretation and preservation are essential parts of forensic case work that make a standardized documentation process fundamental. The most commonly used method for the documentation and interpretation of superficial wounds is a combination of two modalities: two-dimensional (2D) photography for evidence preservation and real-life examination for wound analysis. As technologies continue to develop, 2D photography is being enhanced with three-dimensional (3D) documentation technology. In our study, we compared the real-life examination of superficial wounds using four different technical documentation and visualization methods.To test the different methods, a mannequin was equipped with several injury stickers, and then the different methods were applied. A total of 42 artificial injury stickers were documented in regard to orientation, form, color, size, wound borders, wound corners and suspected mechanism of injury for the injury mechanism. As the gold standard, superficial wounds were visually examined by two board-certified forensic pathologists directly on the mannequin. These results were compared to an examination using standard 2D forensic photography; 2D photography using the multicamera system Botscan©, which included predefined viewing positions all around the body; and 3D photogrammetric reconstruction based on images visualized both on screen and in a virtual reality (VR) using a head-mounted display (HMD).The results of the gold standard examination showed that the two forensic pathologists had an inter-reader agreement ranging from 69% for the orientation and 11% for the size of the wounds. A substantial portion of the direct visual documentation showed only a partial overlap, especially for the items of size and color, thereby prohibiting the statistical comparison of these two items. A forest plot analysis of the remaining six items showed no significant difference between the methods. We found that among the forensic pathologists, there was high variability regarding the vocabulary used for the description of wound morphology, which complicated the exact comparison of the two documentations of the same wound.There were no significant differences for any of the four methods compared to the gold standard, thereby challenging the role of real-life examination and 2D photography as the most reliable documentation approaches. Further studies with real injuries are necessary to support our evaluation that technical examination methods involving multicamera systems and 3D visualization for whole-body examination might be a valid alternative in future forensic documentation.

Introduction: The aim of this study was to assess our use of OSCE from the perception of final year medical students. Materials and methods: This is a cross sectional survey of final year medical students undergoing the final examination in Surgery. All 102 medical students in the class were given the self-administered questionnaire to fill. The data were collated into excel spreadsheets and analysed using the SPSS version 21. Results: A total of 79 completed questionnaires were retrieved (return rate of 78%). All the students knew about and had participated previously in OSCE, 94.9% accorded the OSCE fair. 76(93.2%) wanted the examination as the main method of clinical assessment, 38(46.6%) had adequate preparation. In terms of the OSCE stations not mirroring real clinical scenarios, 38(48.1%) disagreed, and 26(20.5%) strongly disagreed. 34(43%) disagreeing that the logistics was poor. The students rating of the OSCE, on a scale of 1 - 10, gave a mean score of >8 for spread of the OSCE stations, detail of the questions and objectivity of the examination. The nearness to clinical reality was rated as 7.52 with artificiality of the stations rated as 4.12. Conclusion: The OSCE has gained acceptance amongst final year medical students. Keyword: Clinical examination; medical students assessment; measuring index.

Background: Precision regarding treatment of fever is reportedly low among the rural regions of India, leading to its irrational management. This study evaluates fever management practices followed by physicians at primary health centre and correlate this with standard fever management guidelines. Methods: One hundred and forty patients admitted to hospital with fever were enrolled in the study. Patient’s demographic profile and presenting symptoms were precisely studied along with their vital parameters. Patients were divided into two groups (A&B), with and without treated as per standard guidelines. Duration of illness, treatment with various drugs and clinical investigation of patients with fever were analysed statistically as outcome analysis. Results: Majority of patients (47.86 %) belonged to age of 18-30 years. Symptoms related to Upper respiratory tract infection (URTI), such as cough and rhinorrhoea, were the most common symptoms (104 patients, 74.28%). Most common clinical diagnosis was viral URTI in both the groups followed by enteric fever, acute gastroenteritis etc. No statistical significance observed in duration of illness in both groups. All the patients of group A were advised laboratory investigations to confirm the diagnosis as per the standard management protocol. Most frequently ordered investigations were complete blood count and peripheral smear for malarial parasite. Average number of drugs prescribed was 2.94 and 4.03 in group A and B (p value 0.001). 8.33% and 18.75% were belonged to category of more than 5 drugs per prescription (polypharmacy) in group A and B respectively. Amoxicillin and Azithromycin were the most preferentially prescribed antibiotics. 90% and 20% of antibiotics were prescribed appropriately (P=0.01) as per guidelines in group A and B respectively. Co-prescription of famotidine, pantoprazole etc was significantly high in group B (p

Cerebral palsy (CP), a heterogeneous disorder of movement and posture, is one of the most important causes of disability affecting children. With a wide variability in the clinical presentation and a paucity of reliable diagnostic tests, decision-making in CP is fraught with difficulties and challenges. The plethora of musculoskeletal manifestations includes poor muscle function, spasticity, rigidity, muscle weakness, poor selective motor control, soft-tissue and joint contractures, torsional malalignments, and lever arm dysfunctions. Children with CP are at a high risk of further worsening and progression of these musculoskeletal abnormalities with the natural course of the disease. A comprehensive assessment that includes a combination of detailed medical history, functional assessment, clinical examination, analysis of gait, and radiological assessment is required to provide a favorable treatment outcome in these children. A close surveillance is essential so as to identify risk factors for the development and progression of musculoskeletal problems so that early interventions can be carried out to circumvent them. This review article is to highlight the importance of clinical examination in the assessment of children with CP.

Objectives To examine three different methods for evaluating the effect of percutaneous sclerotherapy on limb venous malformations in a series of patients with a relatively long follow-up. Method The study was a retrospective study. Results Thirty-eight patients treated with percutaneous sclerotherapy underwent sclerotherapy, with a median number of sessions of 4 (range, 1–10). They were followed up for 1–60 months (average 12.5 months). The kappa between clinical manifestations and Doppler ultrasound was 0.684 ( P Conclusions Magnetic resonance imaging is the gold standard for VM imaging. Its consistency with clinical examination and Doppler ultrasound is poor, and Doppler ultrasound and clinical examination could be more appropriate for follow-up imaging after sclerotherapy.

Aims: Foreign bodies exerted in the palatal mucosa are extremely rare in clinical work. The aim of this case report was to describe a case of foreign body in the palate of an infant and to highlight that foreign bodies must be considered in the differential diagnosis of palatal lesions found in children. Presentation of Case: A healthy 12-month child was brought by his parents to the Department of Oral Medicine, School of Dental Medicine, University of Zagreb, since the mother accidentally noticed something in the child's mouth, a week before. The child's pediatrician and the doctor of dental medicine had examined the child and referred him for CT scan and examination at department of maxillofacial surgery. The lesion was hard on palpation and it bothered him while feeding. The child's medical history was non contributory and he was not taking any medication.Clinical examination revealed an oval white lesion in central hard palate, smooth and hard on palpation. Surrounding mucosa appeared normal. While mother was holding the child, we opened his mouth and examined the edges of the lesion with the instrumentHeidemann spatula. The lesion suddenly started to separate from palatal mucosa until it had completely falle be an artificial nail. Discussion and Conclusion: Besides local trauma, foreign bodies of oral mucosa are potentially lethal because of the risk of ingestion or obstruction of respiratory tract. Differential diagnosis of palatal lesions in children should include a possible foreign body. A thorough clinican prevent unecessary diagnostic procedures and misdiagnosis.

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children, with lower limb involvement highly prevalent. Recent evidence has highlighted the lack of specific lower limb physical examination (PE) tools for clinicians assisting the paediatric rheumatology team in identifying lower extremity disease in patients with JIA. Early clinical detection may lead to more prompt and targeted interventions to reduce lower limb problems in children with JIA. The aim of this pilot study is to provide preliminary data on the diagnostic accuracy of a lower limb PE tool in JIA. Methods: Children with JIA requiring magnetic resonance imaging (MRI) on their lower limb joints per their usual care were eligible. Lower limb joint counts were conducted clinically by a podiatrist and paediatric rheumatologist using the proposed twenty joint per side, PE tool. The PE were compared to MRI assessments completed by two independent paediatric radiologists. Data were analysed using agreement (observed, positive and negative) and Cohen’s kappa with 95% CIs. Results: Fifteen participants were recruited into the study in which 600 lower limb joints were clinically examined. Statistical analysis showed excellent inter-rater reliability between podiatrist and paediatric rheumatologist for both joint swelling and tenderness. Results of the intra-rater reliability of the podiatrist using the PE tool indicated excellent percentage agreements (98.5–100%) and substantial kappa coefficients (0.93–1). The inter-rater reliability between radiological assessments contrasted the PE results, showing low agreement and poor reliability. Comparisons between PE and MRI resulted in poor kappa coefficients and low agreement percentages. The most agreeable joint between MRI and PE was the ankle joint, while the worst performing joint was the sub-talar joint. Conclusion: Results indicate potential clinical reliability; however, the validity and diagnostic accuracy of the proposed PE tool remains unclear due to low kappa coefficients and inconsistent agreements between PE and MRI results. Further research will be required before the tool may be used in a clinical setting.

This article analyses the epidemiological situation concerned with sexually transmitted infections and dermatoses, as well as the dynamics of syphilis incidence, incidence of syphilis among migrants, incidence of dermatoses in the Russian Federation during the 2013-2017 period.

Supplemental Digital Content is available in the text, Purpose of review In the acute setting of circulatory shock, physicians largely depend on clinical examination and basic laboratory values. The daily use of clinical examination for diagnostic purposes contrasts sharp with the limited number of studies. We aim to provide an overview of the diagnostic accuracy of clinical examination in estimating circulatory shock reflected by an inadequate cardiac output (CO). Recent findings Recent studies showed poor correlations between CO and mottling, capillary refill time or central-to-peripheral temperature gradients in univariable analyses. The accuracy of physicians to perform an educated guess of CO based on clinical examination lies around 50% and the accuracy for recognizing a low CO is similar. Studies that used predefined clinical profiles composed of several clinical examination signs show more reliable estimations of CO with accuracies ranging from 81 up to 100%. Summary Single variables obtained by clinical examination should not be used when estimating CO. Physician's educated guesses of CO based on unstructured clinical examination are like the ‘flip of a coin’. Structured clinical examination based on combined clinical signs shows the best accuracy. Future studies should focus on using a combination of signs in an unselected population, eventually to educate physicians in estimating CO by using predefined clinical profiles.

Background Working farm dogs are invaluable on New Zealand sheep and beef farms. To date no study describing farm dog population and health has included information about incidence of illness and injury, or risk factors affecting health and career duration. This paper describes the methodology and initial results from TeamMate, a longitudinal study that was designed to address this gap. We describe the study population, husbandry practices, and prevalence of clinical abnormalities on enrolment. Methods Data about the farms, owners, husbandry practices and dogs were collected on farm at approximately 6-month intervals. All dogs over 18 months old and in full work were enrolled. Dogs were given physical examinations by veterinarians. On examination all abnormalities were noted, regardless of clinical significance. Results Six hundred forty-one working farm dogs and 126 owners were enrolled from the South Island of New Zealand. Forty-nine percent of dogs were Heading dogs (314 of 641) and 48% Huntaways (308 of 641). Median age of dogs was 4 years (range 1.5–14) and median body condition score (BCS) was four on a 9-point scale (interquartile range (IQR) 3–5). Fifty-four percent of dogs were male (345 of 641), and 6% (41 of 641) were neutered. Eighty-one percent of owners (102 of 126) fed dogs commercial biscuits and meat sourced on farm. Forty-four percent of dogs (279 of 641) had bedding in their kennel, 14% (55 of 393) had insulated kennels, 69% (442 of 641) had been vaccinated and 33% (213 of 641) were insured. Clinical abnormalities were found in 74% of dogs (475 of 641). Common abnormalities involved the musculoskeletal system (43%, 273 of 641), skin (including scars and callouses; 42%, 272 of 641), and oral cavity (including worn and broken teeth; 35%, 227 of 641). Conclusions Our results expand on those from previous surveys and indicate that musculoskeletal illness and injury, and skin trauma are the most commonly seen clinical abnormalities in working farm dogs. These results will provide a baseline for investigation of incidence and risk factors for illness, injury, retirement and death in New Zealand working farm dogs.

WOS: 000525972500001 PubMed: 32220120 … Scientific Research Projects Foundation of Pamukkale UniversityPamukkale University [2009TPF013] This study was financially supported by grant number 2009TPF013 from the Scientific Research Projects Foundation of Pamukkale University.

Хроническая обструктивная болезнь легких (ХОБЛ) - прогрессирующее заболевание, сопровождающееся быстрой потерей трудоспособности и высокой летальностью. ХОБЛ является всемирной проблемой и является третьей причиной всех смертей. По данным эпидемиологического исследования, проведенного при участии 12 исследовательских центров в РФ, распространенность ХОБЛ среди лиц с респираторными симптомами составила 21,8%, а среди лиц общей популяции - 15,3%. В данной статье рассмотрены вопросы оптимизации диагностики ХОБЛ при диспансеризации населения молодого и среднего возраста (от 18 до 60 лет) и последующего курирования. В статье представлен анализ анкет и оценочных шкал, утвержденных нормативными документами, для ранней диагностики заболевания с последующей постановкой диагноза, мониторинга лечения и качества жизни пациентов на протяжении всего времени.

The 2020 Covid19 pandemic has caused significant disruption to medical education across the world. At the University of Sheffield final year medical students undertook a virtual OSCE via technology in order to graduate however for our Physician Associate course this was more problematic as following completion of the assessments at the university students are also required to pass a national examination with a formal Objective Structured Clinical Examination (OSCE). Due to this it was felt that it was crucial to run an OSCE examination for our students on a face to face basis but within the context of managing the potential safety and risks inherent in doing so. This piece of work describes the process of running the examination including detail which we feel will be useful to others who may seek to undertake examinations for the same reason within the current health emergency or any future such events. It is important to note that some innovations we put in place with respect to technology enhancing safety will remain for future OSCE examinations in any circumstances.

Introduction The aim of this study was to assess the performance of VibraTip, a device used to test a person’s vibration perception during routine checks for peripheral neuropathy, against two thresholds of the Neuropathy Disability Score (NDS) for diagnosing distal symmetrical polyneuropathy (DSPN) in patients with type 2 diabetes mellitus (T2DM). Methods One hundred consecutive subjects with T2DM were enrolled in the study, of whom 54 were men. The mean age was 62.3 years, and the mean T2DM duration was 12.6 years. VibraTip was used at one foot site (on the pulp of the hallux; protocol A) and at three foot sites (pulp of the hallux and first and third metatarsal head; protocol B). NDS thresholds of ≥ 3 and ≥ 6 were used to establish the diagnosis of DSPN. Results Against the NDS ≥ 3 threshold, VibraTip showed a very high sensitivity (91.3%) and negative predictive value (NPV) (92%) and a high specificity (85.2%) with protocol A, and a very high sensitivity (95.6%) and NPV (96.1%) and a very high specificity (90.7%) with protocol B. Against the NDS ≥ 6 threshold, VibraTip showed a very high sensitivity (100%) and NPV (100%) and a very high specificity (95.2%) with protocol A, and very high sensitivity (100%) and NPV (100%) and very high specificity (96.8%) with protocol B. Conclusions The diagnostic performance of VibraTip is very high in patients with T2DM, rendering it a very useful device as a screening tool, particularly for the exclusion of DSPN. VibraTip performs very well at both NDS thresholds, but particularly well at the NDS ≥ 6 threshold. There appears to be no need to examine sites other than the hallux site with Vibratip.

Background: Video-sharing website “YouTube” is a growing source of healthcare information. But, the videos uploaded on this open platform are not peer reviewed, therefore, the information available needs to be sufficiently evaluated. No studies have been conducted to evaluate the authenticity and utility of obstetrics and gynecology (Obs/Gyne) physical examination YouTube videos. This study was performed to analyze the sources, contents, and quality of videos about the Obs/Gyne clinical examination available on YouTube. Methods: A systematic search was performed on YouTube website using the following key words: “OBSTETRIC,” “GYNECOLOGICAL,” “SPECULUM OBSTETRIC,” “OBSTETRIC CLINICAL,” “BIMANUAL PELVIC,” and “EXAMINATION” to analyze the sources, contents, and the quality of YouTube videos about the Obs/Gyne clinical examination during the period between November 2015 and March 2017. The videos were classified into educationally useful and useless based on the content, accuracy of the knowledge, and the demonstration. Results: Out of total 457 screened videos, 176 (38.51%) videos met the pre-set inclusion criteria. After review, out of 176 pertinent videos, 84 (47.7%) videos were found educationally useful, and out of these 84 useful videos, only 29 (34.5%) were highly educational in nature. Conclusion: YouTube videos showed variable educational value. Only, a small number of videos were identified as useful and can be used by the medical students for self-directed learning and by the clinical teachers for educational purposes or other academic activities.

It is well known that monitoring the effectiveness of primary prevention and the quality of dental care to the population is one of the most important components of any health care system. During the period from 1989 to 2005, the Republican “Program of comprehensive prevention of dental diseases in children” was actively introduced in the Republic of Kazakhstan. During this period in Almaty, the provision of dentists amounted to 4.5 positions per 10 thousand children, the staffing level of the posts was 100%. As a result, 54.5% of the children's population was covered by preventive examinations, and 92.4% of them were sanitized. In the years of the formation of the Republic of Kazakhstan, due to the lack of budgetary funds, the activity of preventive works decreased. The purpose of the work is to summarize the results of preventive work among children in Almaty using fluorine-containing preparations. The research results showed that currently, only 29 out of 182 large schools have stationary dental offices, where, starting from 2016, a new “Tariff of medical services” is being introduced. In particular, remineralization therapy, fluorine coating of intact teeth, fluoride-cement application of teeth, closure of fissures with sealants. Dynamic observation of children after 6 and 12 months revealed a tendency to stabilize the carious process. In the areas of the teeth, where the Cretaceous spots were determined, the enamel lustre appeared. The preservation of fillings was observed, their good marginal fit, the development of secondary caries and teeth affected by caries was not detected. Taking into account the needs, each school and preschool institutions should be provided with regular units of a dental hygienist who should provide all types of non-invasive prevention of dental diseases. It has been confirmed that a decrease in the incidence of dental morbidity is possible only with the introduction of an economically feasible program for the prevention of dental diseases and by providing highly qualified dental care with timely regular preventive measures.

Background The concept of e-Learning has been rapidly accepted as an important component of medical education and is especially adept at teaching clinical skills. However, their impact on learning, particularly in Otolaryngology Head and Neck Surgery (OHNS) medical school curriculum, has yet to be adequately explored. The aim of this pilot study is to develop interactive e-Learning resources and evaluate their impact in enhancing OHNS teaching in medical school. Methods This pilot study is a randomized controlled trial assessing the effectiveness of e-Learning resources in enhancing the current traditional lecture and tutorial-based teaching of OHNS in medical school. Nineteen final-year medical students from the University of Sydney were recruited for this study, who were randomly allocated into intervention group with additional e-Learning resources (Group A) and control group (Group B). Student knowledge was assessed through objective structured clinical examinations (OSCE) with use of standardized forms for objective scoring. Assessors were blinded to student randomization status. A post-study questionnaire was distributed to assess student feedback on the e-Learning resources. Results Eight students were allocated to Group A and 11 students to Group B. Group A performed significantly better than Group B in the overall examination scores (78.50 ± 13.88 v. 55.82 ± 8.23; P =

Background: Clinical studies of subarachnoid hemorrhage (SAH) and unruptured cerebral aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future unruptured intracranial aneurysm and SAH research. Methods: This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into “core,” “supplemental—highly recommended,” “supplemental” and “exploratory.” Results: We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as “Core.” The Glasgow Coma Scale was classified as “Supplemental—Highly Recommended.” All other Assessments and Clinical Examination variables were categorized as “Supplemental.” Conclusion: The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.

Background Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold’s manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI. Methods In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard. In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold’s manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience. The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold’s manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women. Results Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold’s manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold’s manoeuvres. Conclusions Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold’s manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold’s manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.

Background. The adolescent period is characterized by the features of growth and development of the organism when the risk of a number of diseases increases under the conditions of hormonal adjustment and under the influence of environmental factors. Objective. Our aim was to determine the reference values of the main values of peripheral blood and the prevalence of anemia in adolescents residing in the territory of the Tomsk region. Methods. We studied the results of medical examination of children aged from 13 to 16 years. To determine the main values of the general blood test (erythrocytes, hemoglobin, leukocytes, erythrocyte sedimentation rate), an automatic hematological analyzer was used. Evaluation of physical development was carried out by standard methods. The analysis of the results was carried out considering the sex, living conditions, weight, height, and body mass index. Results. We analyzed the values of peripheral blood of 7,120 adolescents. Rated values corresponded to the conventional age norms. The hemoglobin level and the number of erythrocytes are associated with the body weight, height, and body mass index of the respondents. Anemia of varying severity was recorded in 618/7,120 (8.7%) adolescents. More often anemia was verified in rural areas (OR 1.52; CI 95% 1.28–1.80) as well as in females (OR 2.62; CI 95% 2.18–3.15). Conclusion. Regional features of peripheral blood values and the prevalence of anemia in adolescents of the Tomsk region have been determined.

Background. Sexual development of adolescents is one of the important indicators of the population well-being, the study of which, in the context of the world trend towards a change in the period of puberty, can contribute to the identification of public health problems. Objective. Our aim was to study the basic indicators of sexual development of adolescents and to determine the regional characteristics of this population. Methods. The evaluation of secondary sexual characteristics was carried out by specialists according to Tanner criteria. Ultrasound examination of organs of the reproductive system was carried out using a portable scanner Mindray M7. The analysis of the results was carried out taking into account the gender, living conditions, physical development. Results. We examined 7,120 adolescents aged from 13 to 16 years. The degree of axillary hair distribution by Tanner criteria was 2.4±0.7 in young men, 2.9±0.4 — in girls, pubic hair — 2.0±0.9 and 2.6±0.8, respectively. The indicator of development of mammary glands by Tanner criteria in girls was 2.6±0.8, menstrual function by Tanner criteria — 2.4±0.8. Herewith, urban adolescents had later terms of appearance of the secondary sexual characteristics in comparison with the inhabitants of rural areas. Conclusion. We registered the delayed sexual development in 8.1% of girls and 13.6% of young men. Urban youths have experienced a delay in gonadal growth. Among the female population there was an outstripping growth and development of the uterus and ovaries in comparison with rural adolescents.

Made available in DSpace on 2021-06-25T10:22:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The work presented in this pilot study aimed to identify potential risk factors associated with bovine periodontitis development. Bovine periodontitis is a multifactorial polymicrobial infectious disease for which the aetiopathogenesis and risk factors are not fully understood. From cattle slaughtered in an abattoir in Scotland, 35 dental arcades with periodontal lesions and 40 periodontally healthy arcades were selected over seven visits for study. Multivariable logistic regression analysis was used to evaluate the association between periodontitis and the independent variables, gender, age and breed. For every increase in year of age, cattle were 1.5 times more likely to have periodontitis. A graphical analysis indicated that within the limits of this study, we could not detect any major influence of breed on the age-effect. Although logistic regression analysis demonstrated that periodontitis lesions are more prevalent with increasing age of cattle the underlying mechanisms remain unclear. It is likely that periodontitis is an important cause of oral pain in older cattle and can contribute to reduced productivity/performance. Further studies with a larger sample size are necessary to elucidate the associations between potential risk factors and periodontitis in cattle and to define its effects on animal welfare and productivity. School of Veterinary Medicine Universidade Federal de Goiás School of Veterinary Medicine College of Medical Veterinary and Life Sciences University of Glasgow, Bearsden Road Oral Sciences Research Group Dental School University of Glasgow, 378 Sauchiehall Street School of Veterinary Medicine Araçatuba Campus São Paulo State University (UNESP) School of Veterinary Medicine Araçatuba Campus São Paulo State University (UNESP) FAPESP: 2015/06917-9

This review aims at evaluating the role and the effectiveness of basic hemodynamic monitoring to guide and to titrate fluid administration during acute circulatory dysfunction. Fluid infusion is a cornerstone of the management of acute circulatory dysfunction. This is a time-related situation, which should be promptly faced to avoid multi organ dysfunction. For this purpose, the recognition of clinical signs of acute circulatory dysfunction is of pivotal importance. A prompt fluid resuscitation in the early phase of acute circulatory failure is a key and recommended intervention, on the other hand the hemodynamic targets and the safety limits indicating whether or not stopping this treatment in already resuscitated patients are still undefined. Bedside clinical examination has been demonstrated to be a reliable instrument to recognize the mismatch between cardiac function and peripheral oxygen demand. Mottling skin and capillary refill time have been recently proposed using a semi-quantitative approach as reliable tool to guide shock therapy; lactate level, central venous oxygen saturation and venous-to-arterial CO(2) tension difference are also useful to track the effect of the therapies overtime. Finally, the availability of echocardiography miniaturization of the machines has boosted this technique as part of the daily clinical assessment of patient, inside and outside the intensive care units (ICUs).

Background Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaLplus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaLplus is part of the Department of General Practice’s longitudinal curriculum for Family Medicine. Objectives This study aims to assess whether the AaLplus program has positive effects on students’ clinical skill development and subjective confidence in history taking, physical examination and venepuncture. Methods From 2015 to 2019, we asked all AaLplus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students’ performance in all taught skills using standardized checklists. Results From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient’s history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82–4.36, SDs range 0.74–0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaLplus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as “helpful” or “very helpful” (means for different stations 4.69–4.76, SDs 0.50–0.70). Conclusions AaLplus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program’s routine viability. Further studies are needed to analyze if programs like AaLplus could have an impact on the number of graduates choosing career in Family Medicine.

Background Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools. Methods Descriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann–Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis. Results In 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%). Conclusions Clinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients. Electronic supplementary material The online version of this article (10.1186/s12879-018-3613-8) contains supplementary material, which is available to authorized users.

В отличие от инфекционных заболеваний, которые быстро развиваются, такие хронические заболевания как сахарный диабет второго типа развиваются медленно и при обнаружении на очень ранних стадиях имеют благоприятный исход лечения. Однако, в связи с этим возникает проблема ранней диагностики заболевания, когда оно протекает практически бессимптомно. Данная проблема связана как с технической сложностью раннего выявления симптомов болезни, так и с отсутствием необходимого охвата потенциально подверженного данным заболеваниям населения. Решением данной проблемы может стать система выявления заболевания на ранней стадии по стандартным анализам, которые практически каждый человек сдает в процессе плановых диспансеризаций. Для того, чтобы организовать плановую оценку стандартных анализов на первые признаки сахарного диабета, требуется привлечение большого количества специалистов, которые обладают достаточными знаниями для того, чтобы сопоставить различные параметры, полученные в результате выполнения стандартных анализов, и оценить вероятность заболевания сахарным диабетом у конкретного пациента. В большинстве медицинских организаций достаточное количество квалифицированных кадров для выполнения этой работы отсутствует. В данном случае решением проблемы могла бы стать автоматизация процесса оценки результатов анализов.Unlike infectious diseases that develop rapidly, chronic diseases such as type II diabetes develop slowly and when detected at very early stages have a favorable outcome of treatment. However, in this regard, there is a problem of early diagnosis of the disease, when it is almost asymptomatic. This problem is related both to the technical complexity of early detection of symptoms of the disease, and to the lack of necessary coverage of the population potentially exposed to these diseases. The solution to this problem can be a system of detecting the disease at an early stage by standard tests, which almost everyone passes in the process of routine medical examinations. In order to organize a planned assessment of standard tests for the first signs of diabetes, it requires the involvement of a large number of specialists who have sufficient knowledge to compare the various parameters obtained because of standard tests, and to assess the likelihood of diabetes mellitus in a particular patient. In most medical organizations, there is no sufficient number of qualified personnel to perform this work. In this case, the solution would be to automate the process of evaluating the results of analyses.

OBJECTIVE. The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. SUBJECTS AND METHODS. The American College of Radiology Imaging Network 6657 Trial prospectively enrolled women with ≥ 3 cm invasive breast cancer receiving NACT. Preoperative measurements of residual disease included longest diameter by mammography, MRI, and clinical examination and functional volume on MRI. The accuracy of preoperative measurements for detecting pathologic CR and the association with final pathology size were assessed for all lesions, separately for single masses and nonmass enhancements (NMEs), multiple masses, and lesions without ductal carcinoma in situ (DCIS). RESULTS. In the 138 women with all four preoperative measures, longest diameter by MRI showed the highest accuracy for detecting pathologic CR for all lesions and NME (AUC = 0.76 and 0.84, respectively). There was little difference across preoperative measurements in the accuracy of detecting pathologic CR for single masses (AUC = 0.69–0.72). Longest diameter by MRI and longest diameter by clinical examination showed moderate ability for detecting pathologic CR for multiple masses (AUC = 0.78 and 0.74), and longest diameter by MRI and longest diameter by mammography showed moderate ability for detecting pathologic CR for tumors without DCIS (AUC = 0.74 and 0.71). In subjects with residual disease, longest diameter by MRI exhibited the strongest association with pathology size for all lesions and single masses (r = 0.33 and 0.47). Associations between preoperative measures and pathology results were not significantly influenced by tumor subtype or mammographic density. CONCLUSION. Our results indicate that measurement of longest diameter by MRI is more accurate than by mammography and clinical examination for preoperative assessment of tumor residua after NACT and may improve surgical planning.

Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. Triggers are represented by infections, sarcoidosis, rheumatologic diseases, inflammatory bowel disease, medications, autoimmune disorders, pregnancy and malignancy. Erythema nodosum typically manifests by the sudden onset of symmetrical, erythematous, warm nodules, usually located on the lower limbs. Often the lesions are bilaterally distributed. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Nonsteroidal antiinflammatory drugs and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered, an underlying infection should be ruled out.

Objective:This study is analyzing the role and significance of the three diagnostic methods (clinical diagnosis, magnetic resonance imaging (MRI) and arthroscopy), in establishing accurate diagnosis in knee injuries. The goal is to determine the diagnostic accuracy of each diagnostic method, using arthroscopy as gold standard. Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using patient’s history and positive clinical tests for meniscal lesions, ACL injury and articular cartilage lesions. All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for making the final diagnosis. Results: We analyzed the results of clinical tests for meniscal, ligamentous and articular cartilage injuries of the patients in both groups. Validity of the clinical tests was compared to the results got from MRI and arthroscopy. Accuracy of clinical diagnosis versus MRI diagnosis for medial(69.6% vs. 68.5%) and lateral (84% vs. 82.6%)meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of MRI diagnosis for ACL injuries was higher (91.3% vs. 81.4%). Accuracy (85.5% vs. 72.8%) of clinical diagnosis versus MRI diagnosis for articular cartilage lesions was better. Conclusion: Affirmation of clinical diagnosis in this study is a result of usage of standard clinical signs and tests which are fundamental in establishing clinical diagnosis of knee injuries. MRI is a diagnostic method which enriches the diagnostic process. Arthroscopy is defined as superior diagnostic method, also a gold standard for comparison of the other two diagnostic methods.

Aim: In India, dairy industries are important for the livelihood of small scale farmers and dairy owners. Tropical theileriosis, mostly affecting dairy cattle and buffaloes is a major threat to dairy and related industries. Tropical theileriosis is caused by Theileria annulata, a hemoprotozoan parasite transmitted by Ixodid ticks of Hyalomma spp. In the present study, we examined the clinical signs, hematological parameters and flow cytometric profile of whole blood in 30 theileriosis affected crossbred cattle. The aim of our study is to analyze, in comparison with clinical and hematological diagnosis, whether flow cytometry based profiling of leukocytes could be used as better, quick and alternative method for diagnosis and screening of bovine tropical theileriosis in crossbred cattle. Materials and Methods: In this study, we screened parasites in 30 peripheral blood samples from clinical cases of theileriosis by Giemsa’s staining technique in crossbred cattle. Hematological analysis was done to estimate hemoglobin (Hb) content, total red blood cell (RBC) count, total leukocyte count and differential leukocyte count. Further, flow cytometric analysis of whole blood was carried out to study leukocytes profile in affected cattle. Results: Microscopic examination of stained blood films revealed the presence of piroplasms in erythrocytes and schizonts in lymphocytes. Hematological examination revealed significant (p