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Purpose: To compare different concepts of direct composite restorations in class-II cavities using bulk-fill composites and a conventional composite with different layer thicknesses in a clinical study over a period of 2 years. Materials and Methods: A low-viscosity (SDR), a high-viscosity bulk-fill (Tetric EvoCeram Bulk Fill) and a conventional nanohybrid composite (Tetric EvoCeram) were randomly assigned and placed in different layer thicknesses up to 4 mm in 160 class-II cavities in 94 patients. Restorations were clinically examined at baseline (n = 160), after 12 (n = 150) and 24 months (n = 148) and evaluated according to eight selected FDI criteria. In case of complete loss of the restoration or irreversible pulpitic symptoms, the restoration was rated as failure; repair was considered as relative failure. Results: The materials investigated showed no significant differences regarding the FDI scores and failure rate during the entire follow-up. After 12 months, 7 failures and after 24 months a total of 8 failures were observed. After 2 years, Tetric EvoCeram Bulk Fill with a 4-mm layer thickness and SDR in combination with Tetric EvoCeram Bulk Fill with a 2-mm layer thickness exhibited a non-significant tendency towards increased hypersensitivity (FDI score 5) as compared to the reference material Tetric EvoCeram with a 2-mm layer thickness (p = 0.051; Kruskal-Wallis test). Conclusion: The clinical stability of bulk-fill materials in layers up to 4 mm is comparable to nanohybrid composites after 2 years. [ABSTRACT FROM AUTHOR]

Urinary retention due to the impossibility of evacuation of bladder contents and the secondary pathophysiologic processes, which it entails, as well as by inducing mental discomfort or a perpetual state of restlessness, represents a medical emergency in pets. The etiology of urinary retention is represented by: mechanical urinary retention, retention caused by obstruction or occlusion, urethral but also extraurethral; paralytic urinary retention, which occurs secondary to spinal cord lesions, or in geriatric patients due to proliferative processes or degeneration of the spinal column. Retention of spastic origin is characterized by the occurrence of sphincter spasm which is frequently produced by sympathetic irritation resulting in increased tonicity of the bladder sphincter, consequence of pelvic plexus irritation or the presence of diseases such as colic or peritonitis. A good therapeutic management influences both the evolution and the well-being of the patient, therefore an early identification of the specific clinical signs of urinary retention is essential in all types of urinary retention. [ABSTRACT FROM AUTHOR]

Introduction: Salivary gland tumours are relatively uncommon, but they have a multifaceted clinical presentation and varied morphological configuration. The investigations required for these tumours remain debatable. We conducted a study to determine the accuracy of various modalities used in salivary gland tumours. Methods: We enrolled 72 subjects, consisting of 44 females and 28 males, with a mean age of 40.93 ± 16.51 years (range: 15 to 79 years), suffering from various salivary gland tumours. The tumour distribution included 42 parotid gland tumours (58.33%), followed by 21 submandibular gland tumours (29.16%), three sublingual gland tumours (4.16%), and six minor salivary gland tumours (8.33%). These individuals were subjected to clinical examination, sonography, and fine needle aspiration cytology as per indications. The results of each modality were compared to surgical pathology to find sensitivity and accuracy. Results: The clinical examination was found to be least sensitive (83.8%) as compared to FNAC (97.6%), and ultrasound (100%). Ultrasound had the highest diagnostic accuracy (86.2%) as compared to clinical examination (80.6%) and FNAC (82.6%). Conclusion: Although sonography was found to have the highest sensitivity and accuracy as compared to fine needle aspiration cytology and clinical examination, the difference was subtle, as both sonography and fine needle aspiration cytology had a statistically significant correlation with histopathology. [ABSTRACT FROM AUTHOR]

Background: Intravenous contrast media (IVCM) in radiology are extremely important for accurate diagnosis and are used daily all over the globe. These contract media are very safe if administered correctly. However, adverse events have also been reported. This study was undertaken to determine the understanding of the patients towards the usage of IVCM in radiology. Methods: This is a cross-sectional study conducted on patients recommended for IVCM-mediated radiological examinations. The data were collected by face-to-face interactions using the self-administered questionnaire before IVCM administration. The questionnaire was all about patient’s information for IVCM usage, their associated benefits and risks. Results: Out of 225 patients who participated, a majority (72%) had insufficient knowledge of IVCM-associated risks and benefits. Both male and female patients showed a similar understanding of IVCM (p>0.05). Educated patients showed better understanding than uneducated patients (p<0.001). Similarly, employed patients demonstrated a higher level of understanding of IVCMs compared to unemployed patients (p<0.05). Moreover, 63.5%, 45.3% and 62.2% of patients believed that IVCM caused cancer, cardiovascular disorders, and adverse allergic reactions, respectively. Moreover, 52.4%, 33.3% and 49.3% of patients believed that IVCM caused shortness in breath, loss of consciousness and increase of heart rate, respectively. In addition, 29.3%, 62.2% and 20.0% of patients also advised diarrhea, itching and convulsion, respectively. Conclusion: Overall, patients’ knowledge was unsatisfactory for understanding contrast media in radiology. This study recommends that the Ministry of Health, Saudi Arabia, should arrange frequent awareness programs on contrast media in Qassim. [ABSTRACT FROM AUTHOR]

Background The current study aimed at observing the cyto morphological patterns in patients presenting with enlarged cervical lymph nodes, Delineate distribution of clinical diagnosis and to correlate them with fine needle aspiration cytology (FNAC), their distribution with age and gender specific distribution of various cytomorphological patterns of cervical lymphadenopathy. Materials and Methods Totally 60 consecutive patients presenting with cervical lymphadenopathy from September 2021 to August 2022, in the Department of ENT, Government Vellore Medical College, Vellore, Tamil Nadu, India, were enrolled into the current study. All patients >12 years of either sex who presented with cervical lymph node enlargement, following the exclusion of all cases where, <12 years of age, FNAC smears were inadequate or suboptimal for diagnostic interpretation. Based on clinical findings they are divided into 3 groups: Non specific, tubercular, neoplastic lymphadenitis. The clinical diagnosis was then correlated with FNAC diagnosis. Results Maximum number of cases (75%) presented with neck swelling of less than 3 months duration. The majority of the cases (98%) Presented with unilateral neck swelling. The majority of our patients (27%) Presented with level II neck nodes. In the majority of our patients the size of lymph nodes was less than 3 cms. Consistency of lymph nodes varied from soft to firm in about 46 patients . 10 Patients had hard neck nodes. In 45(80%) patients in our study had clinically mobile lymph nodes and there was fixity of lymph nodes in 11(20%) patients. In our study out of 45 patients who presented with mobile lymph nodes, 38 were discrete while 7 patients presented with matted lymph nodes. We made a clinical diagnosis of nonspecific cervical lymphadenopathy in 23 patients (41%), Tubercular lymphadenitis in 22 patients (39%),Neoplastic nodes in 11 patients (20%) Conclusion Cervical lymphadenopathy is a common occurrence and should be duly noted and a systemic approach should be followed to diagnose the cause which further helps in determining the proper treatment course for the patient. Mostly history and physical examination reveal the etiology for the same and hence should be taken into consideration while examining. When the cause of lymphadenopathy remains unexplained,a three to four weeks of observation period is appropriate when the clinical setting indicates high probability of benign disease. Thus a case of cervical lymphadenopathy has to be evaluated carefully to prevent any misdiagnosis. [ABSTRACT FROM AUTHOR]

The global lockdown caused by the COVID-19 pandemic in 2020 necessitated several modifications for objective structured clinical examination (OSCE) to be conducted virtually. Since the reopening of higher institutions post COVID-19 in the year 2022, the teaching and learning methods at Universiti Putra Malaysia (UPM) have reverted to either face-to-face or hybrid modes. Nevertheless, there were circumstances where an adaptation of the virtual OSCE method for a hybrid session had to be arranged, specifically for students who could not physically attend the examination. Therefore, in this commentary, we aim to share the experience of conducting a hybrid OSCE session for preclinical medical students at UPM. It also summarises the advantages and challenges faced by the students, examiners and examination committee, as well as future recommendations, should a similar situation arises in the future. [ABSTRACT FROM AUTHOR]

Purpose: This literature review was performed to assess whether implant failures are associated with titanium allergy. Materials and Methods: An electronic search of the MEDLINE/PubMed, Cochrane Library, and Scopus databases up to April 2021 was conducted, and the obtained articles were independently assessed by two reviewers. Articles describing cases of implant failure in which the cause of implant failure was only identified as allergy were included. Results: Twelve studies were included. Eight studies identified Ti allergy by clinical examinations, of which four used patch tests, three used the lymphocyte transformation test (LTT)/memory lymphocyte immunostimulation assay (MELISA), and one used both tests. Nine studies reported cases of titanium hypersensitivity in combination with other systemic allergy-related disorders, with eight cases also showing positive results for Ni, Hg, Cr, and Co hypersensitivity. Ten papers reported the improvement of symptoms after the removal of the Ti implants and their replacement with zirconia implants, and two of these papers showed good results. Conclusion: Cases of probable titanium allergy included those with true titanium allergies and those with a potentially different cause. However, the differentiation of these cases is difficult. Since no definitive method has been established for diagnosing titanium allergy, a comprehensive diagnosis based on the clinical course and clinical examination using a patch test/LTT/MELISA is necessary. Implant treatment should be performed with caution in patients with any preoperative allergies. [ABSTRACT FROM AUTHOR]

On the 23rd of September 2022, a small intensive aquaculture unit populated with rainbow trout (Oncorhynchus mykiss) reported increased mortality in adults and juvenile fish. The unit comprised 12 enclosed concrete basins with a capacity of ten cubic meters of water, populated with 150 kg of fish each. Fish were subjected to a clinical examination on the site, after which whole fish were harvested for a bacteriological and histopathological examination. Water quality parameters were examined using classic biochemical methods and Fourier Transform Infrared Spectroscopy in order to find out whether the environment in which the fish live is also a predisposing factor that could facilitate different pathogens and induce a state of disease in the fish. Real-time PCR was performed on strains of Aeromonas spp. sampled from the fish to accurately identify the pathogen species. The goal was to accurately identify the problems and predisposing factors that lead to disease outbreaks. [ABSTRACT FROM AUTHOR]

Elderly patients have a high incidence of falls that result in facial injuries. Many cases present with dental crown fractures and soft-tissue lacerations. The initial diagnosis is especially important in this type of dental trauma, since an initial error can result in the failure to establish the correct treatment from the very beginning, worsening the prognosis, which, in the worst case, can compromise the teeth affected by the trauma. Case report: We present the case of a patient, a 79-year-old woman, who suffered an accidental fall. The patient was examined by a dentist in the emergency room. She was diagnosed with a simple crown fracture of the right upper central incisor and right upper lateral incisor without any pulpal involvement and with laceration of the lower lip. Months later, she had an episode of inflammation in the lower lip, and she developed edema and pain. An X-ray of the lower lip revealed a radiopaque mass compatible with a fragment of dental tissue due to the inclusion of remnants of the dental tissue resulting from the previous accident fall. Conclusions: The population of geriatric patients is steadily increasing in our society, and a higher frequency of falls has been observed in this age group, affecting the maxillofacial region, with consequent dental trauma on many occasions. Therefore, as professionals, we must pay special attention to the prevention and treatment of this problem, insisting on the importance of routine investigation in the emergency visit for dental trauma, which includes a meticulous examination of the soft tissues accompanied by a radiographic examination, when the inclusion of foreign bodies is suspected. [ABSTRACT FROM AUTHOR]

Trauma of the shoulder encompasses a wide range of potential injuries. The shoulder forms the articulation between the upper limb and trunk, with a close anatomical relationship to the neck and brachial plexus. Acute injuries can have large overlaps of presenting symptoms and many of the special tests we use are imperfect, and must be applied and interpreted in the context of the injury. It is important that a holistic approach is taken to the assessment of acutely injured shoulders in order to ensure injuries are adequately recognized and to guide appropriate further investigations and management. The purpose of this article is to provide a systematic approach to assessment of acute shoulder injuries and summarize the evidence base for special clinical tests that aid in diagnosis. [ABSTRACT FROM AUTHOR]

The article titled "Interdisciplinarity Approaches in Context of Complex Intraoral Rehabilitation Treatment at Young Patients with Social Anxiety - Clinical Examination - Part 1" discusses the impact of social anxiety on oral rehabilitation treatment. It emphasizes the importance of an interdisciplinary approach to address the complex needs of patients with social anxiety. The article provides a detailed description of a clinical examination conducted on a patient, including various aspects such as extraoral examination, examination of muscle groups, inspection of the temporomandibular joint (TMJ), and examination of the oral orifice. The examination also includes assessments of occlusion and mandibulocranial relations, with the use of radiography for further analysis and diagnosis. The text does not provide information on the context or purpose of the examination. [Extracted from the article]

Abstract Background To assess the diagnostic performance of clinical examination and ultrasound (US) assessment of knee effusion in primary knee osteoarthritis (KOA) patients. Furthermore, the success rate for effusion aspiration and the factors related to it were investigated. Methods This cross-sectional study included patients diagnosed with primary KOA-induced knee effusion clinically or sonographically. The affected knee of each patient was subjected to clinical examination and US assessment using the ZAGAZIG effusion and synovitis ultrasonographic score. Patients with confirmed effusion and consented to aspiration were prepared for direct US-guided aspiration under complete aseptic techniques. Results One hundred and nine knees were examined. During visual inspection, swelling was detected in 80.7% of knees and effusion was confirmed by US in 67.8% of knees. Visual inspection was the most sensitive at 90.54% while bulge sign was the most specific at 65.71%. Only 48 patients (61 knees) consented to aspiration procedure; 47.5% had grade III effusion, and 45.9% had grade III synovitis. Successful aspiration was achieved in 77% of knees. Two needle types were used; a 22 gauge / 3.5-inch spinal needle in 44 knees and an 18 gauge/ 1.5-inch needle in 17 knees, with a success rate of 90.9% and 41.2%, respectively. Aspirated amount of synovial fluid correlated positively with effusion grade (rs=0.455, p

Background and Aim: Hematology and serum biochemical analyses are integral parts of the clinical evaluation of sick animals. This is especially true regarding the clinical care of wildlife species, where clinical signs and historical data relating to the particular illness are often not available. Therefore, this study was designed to report various hematology and serum biochemistry parameters in Arabian oryx (Oryx leucoryx). Materials and Methods: Various hematology and serum biochemistry parameters were determined in 49 Arabian oryx of various ages and sexes. Hematology parameters included total red blood cells (RBC), packed cell volume (PCV), hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH concentration, and total leukocyte count (white blood cell) using an automated hematology analyzer. Serum biochemistry variables included glucose (Trinder method), total protein (biuret method), albumin using the Bromcresol Green (BCG) method, and blood urea nitrogen (colorimetric method). In addition, serum electrolyte concentrations of calcium, magnesium, and phosphorus were determined using colorimetric methods. Results: There was a significant difference in RBC count, PCV, and serum glucose concentration between adult and young Arabian oryx. The RBC count was significantly higher in males than in females, whereas the serum glucose concentration was significantly higher in females. Conclusion: Results of this study showed significant differences in RBC, PCV, and serum glucose concentration between apparently normal young and Adult Arabian oryx. Similar differences were also detected between normal males and females. Knowledge of these data could prove vital in the clinical evaluation of the health status of this wildlife species.

Abstract Background Timely and accurate identification of life- and limb-threatening injuries (LLTIs) is a fundamental objective of trauma care that directly informs triage and treatment decisions. However, the diagnostic accuracy of clinical examination to detect LLTIs is largely unknown, due to the risk of contamination from in-hospital diagnostics in existing studies. Our aim was to assess the diagnostic accuracy of initial clinical examination for detecting life- and limb-threatening injuries (LLTIs). Secondary aims were to identify factors associated with missed injury and overdiagnosis, and determine the impact of clinician uncertainty on diagnostic accuracy. Methods Retrospective diagnostic accuracy study of consecutive adult (≥ 16 years) patients examined at the scene of injury by experienced trauma clinicians, and admitted to a Major Trauma Center between 01/01/2019 and 31/12/2020. Diagnoses of LLTIs made on contemporaneous clinical records were compared to hospital coded diagnoses. Diagnostic performance measures were calculated overall, and based on clinician uncertainty. Multivariate logistic regression analyses identified factors affecting missed injury and overdiagnosis. Results Among 947 trauma patients, 821 were male (86.7%), median age was 31 years (range 16–89), 569 suffered blunt mechanisms (60.1%), and 522 (55.1%) sustained LLTIs. Overall, clinical examination had a moderate ability to detect LLTIs, which varied by body region: head (sensitivity 69.7%, positive predictive value (PPV) 59.1%), chest (sensitivity 58.7%, PPV 53.3%), abdomen (sensitivity 51.9%, PPV 30.7%), pelvis (sensitivity 23.5%, PPV 50.0%), and long bone fracture (sensitivity 69.9%, PPV 74.3%). Clinical examination poorly detected life-threatening thoracic (sensitivity 48.1%, PPV 13.0%) and abdominal (sensitivity 43.6%, PPV 20.0%) bleeding. Missed injury was more common in patients with polytrauma (OR 1.83, 95% CI 1.62–2.07) or shock (systolic blood pressure OR 0.993, 95% CI 0.988–0.998). Overdiagnosis was more common in shock (OR 0.991, 95% CI 0.986–0.995) or when clinicians were uncertain (OR 6.42, 95% CI 4.63–8.99). Uncertainty improved sensitivity but reduced PPV, impeding diagnostic precision. Conclusions Clinical examination performed by experienced trauma clinicians has only a moderate ability to detect LLTIs. Clinicians must appreciate the limitations of clinical examination, and the impact of uncertainty, when making clinical decisions in trauma. This study provides impetus for diagnostic adjuncts and decision support systems in trauma.

Leishmaniasis is a transmissible infection brought about by an obligatory intracellular protozoan from the genus Leishmania. It occurs worldwide in tropical and subtropical regions and can be burdensome in resource-constrained countries. The infection ranges in severity from mild cutaneous lesions to more severe and sometimes life-threatening visceral and distorting mucocutaneous sicknesses. Importantly, cutaneous leishmaniasis (CL) is prevalent in the Middle East with a pooled prevalence of 12%. It imposes a significant health and socioeconomic burden

Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical–Etiology–Anatomy–Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds. [ABSTRACT FROM AUTHOR]

Newborn foals are very susceptible to potentially fatal diseases. Therefore, it is of great importance to identify variables that allow to predict the survival of these patients, and promptly start the appropriate treatment for each case. A retrospective study was carried out at the Equine Foal Care Perinatology Center, located in the municipality of Cajicá, Cundinamarca. The medical records of 106 foals admitted to hospitalization between September of 2019 and December of 2020 were reviewed, the necessary data was collect, and analyzed, in order to evaluate the predictive value of the clinical examination against the survival of hospitalized neonatal foals, and to identify which of these variables function as early markers of survival. Different statistical tests were used, such as the Kolmogorov Smirnov test, the Mann-Whitney test, the binary logistic regression, the chi-square tests, the ROC curves and the odds ratio (OR). The variables most significantly related to survival were heart rate (p = 0.019), rectal temperature (p = 0.002), lukewarm ears and limbs (p = 0.013) and concordant full strong pulse (p = 0.002). Risk factors associated with foal nonsurvival were temperature < 38 °C, heart rate < 100 bpm, cold ears and extremities, and weak pulse. [ABSTRACT FROM AUTHOR]

We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-arrest patients who underwent prognostic tests, including the gray–white-matter ratio (GWR-BG), the Glasgow Coma Scale motor (GCS-M) score before sedative administration, and the neuron-specific enolase (NSE) level measured at 24 h after the ROSC. We investigated the prognostic performances of the tests as single predictors and in various combination strategies. Classification and regression-tree analysis were used to provide a reliable model for the risk stratification. Out of all the patients, 55 (44.0%) had good outcomes. The NSE level showed the highest prognostic performance as a single prognostic test and provided improved specificities (>70%) and sensitivities (>98%) when used in combination strategies. Low NSE levels (≤32.1 ng/mL) and high GCS-M (≥4) scores identified good outcomes without misclassification. The overall accuracy for good outcomes was 81.8%. In comatose patients with low NSE levels or high GCS-M scores, the premature withdrawal of life-sustaining therapy should be avoided, thereby complying with the formal prognostication-strategy algorithm after at least 72 h from the ROSC. [ABSTRACT FROM AUTHOR]

Purpose: This cross‐sectional study aimed to assess the graduating dental residents' perspectives on the online clinical examination format. Methods: The questionnaire used to assess the perspectives was developed via a focus group discussion and was validated for face and content validity, readability testing, and pilot testing for the online version. This self‐administered, online questionnaire integrated 15 Likert‐scale‐based multiple choice questions and one open‐ended question. It was distributed to the residents across 16 dental schools after the clinical examination was completed. The perspectives regarding examination preparation, the ability to transition to online mode, and the performance in the examination were assessed. Descriptive statistical analysis (counts and percentages) was performed. Results: A total of 256 subjects participated in the study by returning the online survey. In the preparation phase, 70.7% (n = 181) residents reported anxiety and 56.1% (n = 144) reported stress. During the examinations, only 13.6% (n = 35) of the participants reported difficulty with internet speed. The majority, 64.6% (n = 165) of the participants reported that the absence of an external examiner face‐to‐face reduced anxiety. The compiled answers to the open‐ended question revealed that residents expressed inconvenience in digitizing the academic logbooks and clinical work. The poor quality of sound and images affected the display of skills. Conclusions: The study revealed a moderate level of acceptance for the novel online practical examination method. The residents reported stress before and during the examination due to the sudden transition to an online examination. The online practical examination with modifications might be a viable alternative to the in‐person clinical examination. [ABSTRACT FROM AUTHOR]

Background: Omission of pelvic examination (PE) has been associated with diagnostic delay in women diagnosed with gynaecological cancer. However, PEs are often not carried out by GPs. Aim: To determine the perceptions of GPs about the role of PEs, the barriers to and facilitators of PEs, and GPs' experience of PEs in practice. Design and setting: Qualitative semi-structured interview study conducted in one health board in Scotland (mixed urban and rural) with an approximate population of 500 000. Method: Interviews were conducted face-to-face or by telephone between March and June 2019. Framework analysis used the COM-B behaviour change model concepts of capability, opportunity, and motivation. Results: Data was compatible with all three domains of the COM-B framework. Capability related to training in and maintenance of skills. These went beyond carrying out the examination to interpreting it reliably. Opportunity related to the clinical environment and the provision of chaperones for intimate examination. Interviewees described a range of motivations towards or against PEs that were unrelated to either capability or opportunity. These all related to providing high-quality care, but this was defined in different ways: 'doing what is best for the individual', 'doctors examine', and 'GPs as pragmatists'. Conclusion: GPs' reasons for carrying out, or not carrying out, PEs in women with symptoms potentially indicating cancer are complex. The COM-B framework provides a way of understanding this complexity. Interventions to increase the use of PEs, and critics of its non-use, need to consider these multiple factors. [ABSTRACT FROM AUTHOR]

Dental caries pose a significant public health concern, affecting a vast population globally. Traditional clinical examination methods, although reliable, can be subject to human error and time-consuming. Artificial intelligence (AI) technologies have emerged as promising tools to enhance diagnostic accuracy and efficiency. This study explores the potential of AI in revolutionizing dental caries detection. Materials and Methods: A cohort of 50 patients with varying degrees of dental caries participated in this comparative analysis. Clinical examination by dental professionals served as the gold standard for caries detection. AI algorithms were trained using dental images, and their performance was evaluated against the clinical examination results. Results: The AI-based detection system demonstrated a sensitivity of 92% and a specificity of 85% in identifying dental caries, with an overall accuracy of 88%. The clinical examination yielded a sensitivity of 86% and a specificity of 90%, resulting in an overall accuracy of 88%. Statistical analysis indicated no significant difference between AI-based detection and clinical examination (P > 0.05). Conclusion: AI technology exhibits promise as an adjunctive tool for dental practitioners, potentially reducing diagnostic errors and improving efficiency. Integrating AI into routine dental practice may aid in early caries detection and promote better oral health outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Standard setting for clinical examinations typically uses the borderline regression method to set the pass mark. An assumption made in using this method is that there are equal intervals between global ratings (GR) (e.g. Fail, Borderline Pass, Clear Pass, Good and Excellent). However, this assumption has never been tested in the medical literature to the best of our knowledge. We examine if the assumption of equal intervals between GR is met, and the potential implications for student outcomes. Methods Clinical finals examiners were recruited across two institutions to place the typical ‘Borderline Pass’, ‘Clear Pass’ and ‘Good’ candidate on a continuous slider scale between a typical ‘Fail’ candidate at point 0 and a typical ‘Excellent’ candidate at point 1. Results were analysed using one-sample t-testing of each interval to an equal interval size of 0.25. Secondary data analysis was performed on summative assessment scores for 94 clinical stations and 1191 medical student examination outcomes in the final 2 years of study at a single centre. Results On a scale from 0.00 (Fail) to 1.00 (Excellent), mean examiner GRs for ‘Borderline Pass’, ‘Clear Pass’ and ‘Good’ were 0.33, 0.55 and 0.77 respectively. All of the four intervals between GRs (Fail-Borderline Pass, Borderline Pass-Clear Pass, Clear Pass-Good, Good-Excellent) were statistically significantly different to the expected value of 0.25 (all p-values

In humans, the lacrimal gland is located in the socket of the frontal bone above the outer orbital area. As an essential part of the eye surface, the gland is fixed to the orbital periosteum by connective tissue. The lacrimal gland passes through the outer tendon membrane, which divides the gland into larger orbital and minor eyelid glands. The lacrimal glands are the main contributors to tear film. They secrete electrolytes, proteins, and water to help nourish and protect the eye’s surface. Furthermore, clinically, lacrimal glands are associated with a variety of inflammatory reactions and immune factors and are also vulnerable sites for tumors. Changes in tear gland morphology or secretory function affect tear film stability and tear secretion quality. Various technological devices have been developed and applied to lacrimal glands. This article systematically reviewed the clinical examination of the lacrimal gland to help inform personalized strategies for the diagnosis of lacrimal gland-related diseases.

Aim. To identify problems in the management of preventive examinations in remote areas, using the example of the Khvoininsky district of the Novgorod Oblast and ways to improve it. The article reveals the problems of managing preventive measures in the regions of the Russian Federation, remote from the regional center.Material and methods. Observations and experience of preventive measures carried out by the staff of St. Petersburg State Pediatric Medical University within the "University — Region" project, data from electronic medical records of 178 patients were used.Results. A high proportion of loss to follow-up was noted — 99 out of 278 (36%). The bulk was patients over 40 years old, who were assigned to health group IIIa. The difficulty of conducting medical examinations in a sparsely populated area is associated with insufficient awareness of the population, combined with low interest, a shortage of specialists, untimely necessary studies, a significant bureaucratic work, unstable Internet connection, and insufficient cancer awareness among medical workers.Conclusion. Expanding the promotion and information component of preventive measures, increasing patient focus, combining the first and second stages of clinical examination into one with subsequent convenient routing of patients, introducing telemedicine technologies and portable diagnostic complexes, improving the professional knowledge and competencies of primary care physicians — all these activities are aimed at improving coverage of population, increasing the adherence of patients with effective medical follow-up.

Background: To assess the diagnostic performance of clinical examination and ultrasound (US) assessment of knee effusion in primary knee osteoarthritis (KOA) patients. Furthermore, the success rate for effusion aspiration and the factors related to it were investigated. Methods: This cross-sectional study included patients diagnosed with primary KOA-induced knee effusion clinically or sonographically. The affected knee of each patient was subjected to clinical examination and US assessment using the ZAGAZIG effusion and synovitis ultrasonographic score. Patients with confirmed effusion and consented to aspiration were prepared for direct US-guided aspiration under complete aseptic techniques. Results: One hundred and nine knees were examined. During visual inspection, swelling was detected in 80.7% of knees and effusion was confirmed by US in 67.8% of knees. Visual inspection was the most sensitive at 90.54% while bulge sign was the most specific at 65.71%. Only 48 patients (61 knees) consented to aspiration procedure; 47.5% had grade III effusion, and 45.9% had grade III synovitis. Successful aspiration was achieved in 77% of knees. Two needle types were used; a 22 gauge / 3.5-inch spinal needle in 44 knees and an 18 gauge/ 1.5-inch needle in 17 knees, with a success rate of 90.9% and 41.2%, respectively. Aspirated amount of synovial fluid correlated positively with effusion grade (rs=0.455, p < 0.001) and negatively with synovitis grade on US (rs = − 0.329, p = 0.01). Conclusions: The superiority of the US over clinical examination in detecting knee effusion suggests that US should be used routinely to confirm the presence of effusion. Long needles (spinal needle) may have a higher success rate of aspiration than shorter needles. [ABSTRACT FROM AUTHOR]

COVID-19's infection control policies have hindered the Deliberate Practice of clinical examinations. Guided Mental Rehearsal (GMR) may overcome this obstacle by facilitating independent, repetitive practice. Underpinned by the 'Motor Simulation Theory,' GMR reinforces similar neuro-circuit activations during physical practice and was proven effective in surgical training. This prospective, randomized controlled study evaluated the efficacy of GMR versus 'peer-learning' of Confrontational Visual Field Examination (CVFE). Third-year medical-students without clinical Ophthalmology experience were recruited. Controls (n = 40) watched an e-learning instructional video (8-min CVFE tutorial) followed by 6-min of 'peer-learning.' GMR-students (n = 40) had 'peer-learning' replaced by a 6-min GMR audio-recording (CVFE running commentary). Pre-test and post-test MCQs were administered to determine baseline knowledge and knowledge acquisition, respectively. 28 controls and 26 GMR-students performed CVFE on simulated patients with right homonymous hemianopia. Four Ophthalmologists graded their performances using a checklist-based marking scheme. Both groups did not exhibit a significant difference in pre-test scores (8.550 vs. 7.947, p = 0.266); outcome of sub-group analysis of CVFE-performing candidates was similar (8.214 vs. 7.833, p = 0.561). Post-test scores were significantly higher than pre-test in both groups (all p <.001), without inter-group difference (14.000 vs. 15.000, p = 0.715). GMR-group had significantly higher scores on CVFE performance than controls (85.354 vs. 73.679%, p =.001). GMR improved psychomotor but not cognitive aspect of learning CVFE. This may be attributable to GMR's theoretical resemblance with physical practice, with additional expert guidance. By enabling independent learning, GMR may also reduce the demand for teaching manpower and thus education cost in the future. [ABSTRACT FROM AUTHOR]

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Background: Since some of the clinical examinations are not suitable for patients with severe spinal cord injury (SCI), blood biomarkers have been reported to reflect the severity of SCI. The objective of this study was to screen out the potential biomarkers associated with the diagnosis of SCI by bioinformatics analysis. Methods: The microarray expression profiles of SCI were obtained from the Gene Expression Omnibus (GEO) database. Core genes correlated to pyroptosis were obtained by crossing the differential genes, and module genes were obtained by WGCNA analysis and lasso regression. The immune infiltration analysis and GSEA analysis revealed the essential effect of immune cells in the progression of SCI. In addition, the accuracy of the biomarkers in diagnosing SCI was subsequently evaluated and verified using the receiver operating characteristic curve (ROC) and qRT-PCR. Results: A total of 423 DEGs were identified, among which 319 genes were upregulated and 104 genes were downregulated. Based on the WGCNA analysis, six potential biomarkers were screened out, including LIN7A, FCGR1A, FGD4, GPR27, BLOC1S1, and GALNT4. The results of ROC curves demonstrated the accurate value of biomarkers related to SCI. The immune infiltration analysis and GSEA analysis revealed the essential effect of immune cells in the progression of SCI, including macrophages, natural killer cells, and neutrophils. The qRT-PCR results verified that FGD4, FCAR1A, LIN7A, BLOC1S1, and GPR27 were significantly upregulated in SCI patients. Conclusion: In this study, we identified and verified five immune pyroptosis-related hub genes by WGCNA and biological experiments. It is expected that the five identified potential biomarkers in peripheral white blood cells may provide a novel strategy for early diagnosis. [ABSTRACT FROM AUTHOR]

Background: Timely and accurate identification of life- and limb-threatening injuries (LLTIs) is a fundamental objective of trauma care that directly informs triage and treatment decisions. However, the diagnostic accuracy of clinical examination to detect LLTIs is largely unknown, due to the risk of contamination from in-hospital diagnostics in existing studies. Our aim was to assess the diagnostic accuracy of initial clinical examination for detecting life- and limb-threatening injuries (LLTIs). Secondary aims were to identify factors associated with missed injury and overdiagnosis, and determine the impact of clinician uncertainty on diagnostic accuracy. Methods: Retrospective diagnostic accuracy study of consecutive adult (≥ 16 years) patients examined at the scene of injury by experienced trauma clinicians, and admitted to a Major Trauma Center between 01/01/2019 and 31/12/2020. Diagnoses of LLTIs made on contemporaneous clinical records were compared to hospital coded diagnoses. Diagnostic performance measures were calculated overall, and based on clinician uncertainty. Multivariate logistic regression analyses identified factors affecting missed injury and overdiagnosis. Results: Among 947 trauma patients, 821 were male (86.7%), median age was 31 years (range 16–89), 569 suffered blunt mechanisms (60.1%), and 522 (55.1%) sustained LLTIs. Overall, clinical examination had a moderate ability to detect LLTIs, which varied by body region: head (sensitivity 69.7%, positive predictive value (PPV) 59.1%), chest (sensitivity 58.7%, PPV 53.3%), abdomen (sensitivity 51.9%, PPV 30.7%), pelvis (sensitivity 23.5%, PPV 50.0%), and long bone fracture (sensitivity 69.9%, PPV 74.3%). Clinical examination poorly detected life-threatening thoracic (sensitivity 48.1%, PPV 13.0%) and abdominal (sensitivity 43.6%, PPV 20.0%) bleeding. Missed injury was more common in patients with polytrauma (OR 1.83, 95% CI 1.62–2.07) or shock (systolic blood pressure OR 0.993, 95% CI 0.988–0.998). Overdiagnosis was more common in shock (OR 0.991, 95% CI 0.986–0.995) or when clinicians were uncertain (OR 6.42, 95% CI 4.63–8.99). Uncertainty improved sensitivity but reduced PPV, impeding diagnostic precision. Conclusions: Clinical examination performed by experienced trauma clinicians has only a moderate ability to detect LLTIs. Clinicians must appreciate the limitations of clinical examination, and the impact of uncertainty, when making clinical decisions in trauma. This study provides impetus for diagnostic adjuncts and decision support systems in trauma. [ABSTRACT FROM AUTHOR]

To assess the ability of physical examination (PE), transvaginal ultrasonography (TVUS), and magnetic resonance imaging (MRI) alone and combined to diagnose deep infiltrating endometriosis (DIE). We retrospectively queried our pelvic MRI database to identify women who underwent PE, TVUS, and pelvic MRI for DIE up to 12 months before surgery between January 1, 2016 and August 31, 2020. The presence of uterosacral ligaments (USL), vaginal, rectosigmoid (RS), parametrial, or sacrorectogenital septum (lateral) DIE shown by PE, TVUS, and MRI were correlated with surgical and histological findings. Academic hospital. We included 178 patients. Clinical and imaging evaluation of women who were diagnosed at surgery with deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of each technique separately and combined were assessed for each location. When the 3 techniques were combined, 2 models were tested as follows: all 3 techniques positive and concordant; and ≥2 techniques positive and concordant. The prevalence of USL, vaginal, RS, and lateral DIE were 94.4%, 20.2%, 34.3%, and 32.6%, respectively. In addition, MRI was more sensitive than PE, TVUS or any combination to detect DIE. Moreover, MRI and model B were the most accurate for detecting USL and RS locations with an accuracy of 90.4% and 82.6%, a sensitivity of 91.1% and 50%, and a specificity of 77.8% and 90.9%, respectively. Model B was the most accurate for the vaginal location with an accuracy, sensitivity, and specificity of 82.6%, 50%, and 90.9%, respectively. Finally, MRI was more accurate than any combination for identifying a lateral location with an accuracy, sensitivity, and specificity of 75.1%, 36%, and 93.8%, respectively. A combination of PE, TVUS, and MRI was more accurate than each technique separately to diagnose DIE because of the equally high sensitivity of each, as well as the high specificity of PE and TVUS. [ABSTRACT FROM AUTHOR]

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

Congenital cardiac diseases (CHDs) may sometimes lead to acute cardiac and respiratory failure, requiring emergency measures. Both cyanotic and non-cyanotic CHDs carry a significant risk of unfavorable prognosis, depending on their hemodynamic impact. Taking into account the fact that not all health facilities benefit from the presence of a pediatric cardiologist, a minimum knowledge of the evidence of deterioration due to cardiac causes is important for general pediatricians. The initial measures include oxygen therapy and ensuring an adequate blood flow to maintain acceptable levels of oxygen and tissue perfusion. From the multitude of congenital cardiac anomalies, obstructive lesions of the left heart, those that associate left to -right shunts, as well as severe cyanogenic anomalies are those with the highest degree of emergency addressability and in which surgical intervention cannot be delayed.

Abstract Introduction Clinical examinations (assessments) are integral to ensuring that medical students can treat patients safely and effectively. The COVID-19 pandemic disrupted traditional formats of clinical examinations. This prompted Medical Schools to adapt their approaches to conducting these examinations to make them suitable for delivery in the pandemic. This systematic review aims to identify the approaches that Medical Schools, internationally, adopted in adapting their clinical examinations of medical students in response to the COVID-19 pandemic. Methods Three databases and four key medical education journals were systematically searched up to 22 October 2021; a grey literature search was also undertaken. Two reviewers independently screened at title, abstract stage and full text stage against predefined eligibility criteria. Discrepancies were resolved by discussion and involvement of senior authors. Risk of bias assessment was performed using an adapted version of a pre-existing risk of bias assessment tool for medical education developments. Results were summarised in a narrative synthesis. Results A total of 36 studies were included, which documented the approaches of 48 Medical Schools in 17 countries. Approaches were categorised into in-person clinical examinations (22 studies) or online clinical examinations (14 studies). Authors of studies reporting in-person clinical examinations described deploying enhanced infection control measures along with modified patient participation. Authors of studies reporting online clinical examinations described using online software to create online examination circuits. All authors reported that adapted examinations were feasible, scores were comparable to previous years’ student cohorts, and participant feedback was positive. Risk of bias assessment highlighted heterogeneity in reporting of the clinical examinations. Conclusions This review identified two broad approaches to adapting clinical examinations in the pandemic: in-person and online. Authors reported it was feasible to conduct clinical examinations in the pandemic where medical educators are given sufficient time and resources to carefully plan and introduce suitable adaptations. However, the risk of bias assessment identified few studies with high reporting quality, which highlights the need for a common framework for reporting of medical education developments to enhance reproducibility across wider contexts. Our review provides medical educators with the opportunity to reflect on past practises and facilitate the design and planning of future examinations.

ObjectiveThe 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 methodsThe 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).ResultsIn 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.ConclusionOur 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.

Cholesterol oxidases (COXases) have a diverse array of applications including analysis of blood cholesterol levels, synthesis of steroids, and utilization as an insecticidal protein. The COXase gene from Janthinobacterium agaricidamnosum was cloned and expressed in Escherichia coli. The purified COXase showed an optimal temperature of 60 °C and maintained about 96 and 72% of its initial activity after 30 min at 60 and 70 °C, respectively. In addition, the purified COXase exhibited a pH optimum at 7.0 and high pH stability over the broad pH range of 3.0–12.0. The pH stability of the COXase at pH 12.0 was higher than that of highly stable COXase from Chromobacterium sp. DS-1. The COXase oxidized cholesterol and β-cholestanol at higher rates than other 3β-hydroxysteroids. The Km, Vmax, and kcat values for cholesterol were 156 μM, 13.7 μmol/min/mg protein, and 14.4 s−1, respectively. These results showed that this enzyme could be very useful in the clinical determination of cholesterol in serum and the production of steroidal compounds. This is the first report to characterize a COXase from the genus Janthinobacterium. [ABSTRACT FROM AUTHOR]

Background: Skinfold callipers are often used in clinical practice to estimate subcutaneous adipose tissue thickness. Recently, LipoTool emerged as a potential digital system to measure skinfolds, however comparisons with competing equipment are lacking. Aim: The aim of this study was to test the agreement between two competing skinfold callipers (digital and mechanical). Methods: The sample included 22 healthy male adult participants. A certified observer measured eight skinfolds twice using different skinfold callipers (digital and mechanical). Differences between equipment were tested using Wilcoxon signed rank test The distribution of error was examined using the normality test Results: Differences between skinfold callipers were significantly in five skinfolds: triceps (Z = -3.546; P < 0.001), subscapular (Z = -3.984; P < 0.001), suprailiac (Z = 3.024; P = 0.002), supraspinale (Z = 3.885; P < 0.001), abdominal (Z z = −2.937; P = 0.003), thigh (Z = -2.224; P = 0.026) and calf (Z = -2.052; P = 0.040). Differences between callipers were constant. Conclusions: Mechanical and digital callipers tended to record different values of skinfold thickness. Clinical examination should consider equipment-related variation in fat mass estimation. [ABSTRACT FROM AUTHOR]

Simple Summary: Clinical examination procedures (CEPs) are cornerstone skills for veterinarians that are taught in all veterinary faculties. CEPs include procedures that are well tolerated by animals and others that are not. In a classical teaching approach, institutional animals which are kept in kennels at the university are used to teach and practice CEPs. Undergraduate students (n = 231) 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. The latter comprised stuffed dogs and handmade molding silicone models. The learning outcome of each system was compared through questionnaires, grades, and pass rates in objectively structured clinical examinations. Most veterinary students had their own animals, and it was 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 AO system, and students reported to learn more with the MA method. No differences existed in the final grades and pass rates. The MA system was effective for learning CEPs. Beyond animal welfare advantages, the MA system increased out-of-school training and had financial saving benefits. 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. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) could be associated with a reduced lumbar mobility. For the evaluation of lumbar flexibility, parameters such as finger-floor distance (FFD) are historically established. However, the extent of the correlation of FFD to lumbar flexibility or other involved joint kinematics such as pelvic motion, as well as the influence of LBP, is not yet known. We conducted a prospective cross-sectional observation study with 523 participants included (167 with LBP > 12 weeks, 356 asymptomatic). LBP-participants were matched for sex, age, height, and body-mass-index with an asymptomatic control cohort, resulting in two cohorts with 120 participants each. The FFD in maximal trunk flexion was measured. The Epionics-SPINE measurement-system was used to evaluate the pelvic and lumbar Range-of-Flexion (RoF), and the correlation of FFD to pelvic- and lumbar-RoF was evaluated. In an asymptomatic sub-cohort of 12 participants, we examined the individual correlation of FFD to pelvic- and lumbar-RoF under gradual trunk flexion. Participants with LBP showed a significantly reduced pelvic-RoF (p < 0.001) and lumbar-RoF (p < 0.001) as well as an increased FFD (p < 0.001) compared to the asymptomatic control cohort. Asymptomatic participants exhibited a weak correlation of FFD to pelvic-RoF and lumbar-RoF (r < 0.500). LBP patients revealed a moderate correlation of FFD to pelvic-RoF (male: p < 0.001, r = −0.653, female: p < 0.001, r = −0.649) and sex-dependent to lumbar-RoF (male: p < 0.001, r = −0.604, female: p = 0.012, r = −0.256). In the sub-cohort of 12 participants, gradual trunk flexion showed a strong correlation of FFD to pelvic-RoF (p < 0.001, r = −0.895) but a moderate correlation to lumbar-RoF (p < 0.001, r = −0.602). The differences in FFD in an individual patient, assuming consistent hip function, may be attributed partially to the differences in lumbar flexibility. However, the absolute values of FFD do not qualify as a measure for lumbar mobility. Rather, using validated non-invasive measurement devices should be considered. [ABSTRACT FROM AUTHOR]

Simple Summary: Cats are often anxious during travel and veterinary visits which can lead to a lack of veterinary care. In this study, a novel pregabalin 50 mg/mL oral solution was tested in 209 cats suffering from anxiety. The cats were given either flavored pregabalin solution or an identical placebo solution without pregabalin 90 min before transporting them in a car for at least 20 min to a veterinary clinic. The effect of the treatment during transportation was evaluated by the cat owner and during clinical examination by the veterinarian. Neither the cat owner nor the veterinarian knew which treatment the cat had received. Both travel- and veterinary-visit-related anxiety were significantly decreased in cats that had received pregabalin. Treatment was well tolerated. Only few cats showed slight incoordination and tiredness for a short time. The owners found a small volume o flavored oral solution user-friendly. It was also well accepted by the cats. This study showed that a single oral dosage of the novel pregabalin solution alleviates anxiety and fear related to transportation and veterinary visits in cats, thus aiding both owners and veterinarians by enabling cat-friendly handling and improving the welfare of cats in stressful situations. 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. [ABSTRACT FROM AUTHOR]

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Introduction: This study aimed to assess the satisfaction of physiotherapy students with the general structure of objective structured clinical examination (OSCE). Materials and Methods: A researcher-made questionnaire consisting of eight items was distributed to 43 graduate and undergraduate physiotherapy students to evaluate the general structure of OSCE. Data analysis was done through SPSS software v. 20, considering a significance level of P<0.05. Results: Among 43 participants with a mean age of 23.7±2.4 years old, the percentage of desirable attitude toward attractiveness of the OSCE was 46.6%, being fair was 21%, identifying strengths and weaknesses was 53.5%, the ability to assess knowledge and information was 11.7%, good assessment of practical skills was 30.3%, good assessment of clinical diagnosis skills was 34.9%, and appropriateness was 34.9%. In total, 88.4% of the participants believed that OSCE increases students' stress. The total satisfaction of all the participants with the OSCE was 2.7±0.8, with last year's students significantly less than graduate ones (2.6±0.9 vs 2.9±0.3). Conclusion: The findings showed that the satisfaction of physiotherapy students regarding the general structure of the OSCE was not desirable, and OSCE was considered stressful. Therefore, due to the importance of OSCE in assessing clinical skills, it is better to improve the quality of holding the OSCE by fixing existent shortcomings, including shortness of time at each OSCE station and establishing training sessions. [ABSTRACT FROM AUTHOR]