Search

Background and Aim: Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy which is caused by nerve compression, in the wrist area (carpal tunnel). The use of ultrasound for the examination and diagnosis of musculoskeletal diseases has been increasing over the last few decades. The aim of this study was to compare the diagnostic values of clinical examination, sonography, and electrodiagnosis in the diagnosis of carpal tunnel syndrome. Materials and Methods: In this cross-sectional study (descriptive-analytic) we examined 70 wrists with symptoms consistent with CTS. Sonography and neural conduction studies were performed. Demographic data included age, height, gender, dominant hand, and underlying diseases associated with CTS. Clinical examination was performed and median nerve cross-section and thickness were measured by ultrasound. Then, the results of clinical examination, sonography, and neural conduction study were compared with one another. Results: We examined 70 wrists with symptoms consistent with CTS. Among 70 symptomatic wrists, 91.4% belonged to the women (mostly housewives) and the rest belonged to the men. The mean age of the patients was 49.56 ± 11.63 years. The results of NCV, clinical examination, distal flexor retinaculum sonography, and proximal sonography were positive in 82.9%,67.1%, 45.7%, and 32.9% of the patients respectively. The results of this study showed that sonography of the entrance of the carpal tunnel with a cut-off point of 8.5 mm2 had the highest diagnostic value with a sensitivity of 27% and a specificity of 42%. Conclusion: Measuring the median nerve surface area with ultrasound is useful for detecting and grading the severity of CTS, but it cannot replace neural conduction studies. The use of ultrasound as the first-line measure can be effective in decreasing the number of neurotransmission studies.

Groin hernia is one of the most common surgical conditions worldwide. Clinical examination can reveal the majority of inguinal hernias. Small inguinal and femoral hernias (in women) may be missed. Dynamic inguinal ultrasound (DIUS) can fill this diagnostic gap. A standardized technique of DIUS is, therefore, important and will be described. The results show high specificity (0.9980) and sensitivity (0.9758), demonstrating the value of the method (which is known to be highly examiner dependent).

Copyright of Acta Veterinaria Brasilica is the property of Acta Veterinaria Brasilica 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.)

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

Background: The diagnosis of polyneuropathy usually requires neurophysiological investigation, necessitating specialised testing and interpretation thereby increasing the time to final diagnosis. Aims: To investigate the predictive value of the clinical examination in patients with potential neuropathies. Methods: Patients were recruited based on their referral requesting neurophysiological testing. Two examiners tested ankle jerk reflexes and gradient to temperature sensation prior to the patient undergoing neurophysiology investigations, blinded to subsequent testing results. The neurophysiology investigations were either standard nerve conduction study (NCS) or thermal threshold testing (TTT) or both. These data were then analysed to determine the Kappa between examiners as well as sensitivity, specificity, and positive and negative likelihood ratios. Results: There was a modest level of agreement between examiners for ankle jerk testing (Kappa = 0.6) but poor agreement for gradient temperature testing (Kappa = 0.3). Bilateral absence of ankle jerk reflexes was moderately associated with abnormal NCS, with the following characteristics: sensitivity 72%, specificity 91%, positive likelihood ratio 7.6 and negative likelihood ratio 0.3. The presence of a temperature gradient was poorly diagnostic for abnormal TTT: sensitivity 87%, specificity 14%, with positive and negative likelihood ratios close to 1. Conclusion: The absence of ankle jerks performed moderately well in identifying patients likely to have large‐fibre neuropathy and could potentially be used to help decide who should be sent for NCS. Gradient temperature testing was much more subjective and did not change the likelihood of abnormal TTT. [ABSTRACT FROM AUTHOR]

Sexual history taking is an important part of caring for any clinical population. However, the topic is often wrapped in discomfort that makes it more challenging than it needs to be for both the provider and the individual providing the history. The act of taking an effective sexual history is more than simply asking all the right questions in the right ways; it requires an awareness of the impact of the clinical environment, the provider's own comfort with the content, and an awareness of any personal biases. In this study, we provide a framework for evaluating and addressing many of these factors as well as providing key points for consideration as a health care provider of any level. We offer several concrete strategies for including these strategies and processes in multiple clinical environments. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The development of abnormal foot will bring adverse effects on the growth and life of children. The early diagnosis of abnormal foot in children is conducive to the timely correction of children’s foot. Here, we review the classification methods of children’s foot types in order to provide valuable references for clinicians in the study of prevention and correction strategies of children’s abnormal foot types. METHODS: WanFang, VIP, CNKI, the Web of Science, and PubMed were searched for related literatures on the classification of children’s foot, and the methods for the classification of children’s foot types were summarized and systematically reviewed. RESULTS: (1)A total of 12 articles were finally included. The classification of children’s foot types can be divided into four methods: footprint index, radiological assessment, clinical examination, and anthropometric examination. (2)Each classification method has its own advantages and disadvantages. The footprint method is simple and quick, but the measurement results are one-sided. Radiological assessment method has potential radiation risk, high cost and complicated process. Although clinical examination method is quick and has low cost, it has strong subjectivity. Anthropometric tests are more accurate, but very time-consuming. (3)In the previous studies, the economical and fast foot printing method was selected as the classification method of children’s foot type, and a combination of multiple indicators was also used in some studies to improve the accuracy of children’s foot type classification. (4)The combination of multiple indicators is currently considered to be a accurate classification method. CONCLUSION: Most of foot type classification methods, which only display the structural characteristics of children’s feet in static state, lack gold standards. Future research needs to establish the relationship between static foot structure and dynamic foot function in order to achieve more accurate and scientific results in the classification of children’ foot types, thereby offering a good strategy for the healthy growth and development of children’s foot until the age of epiphyseal closure. [ABSTRACT FROM AUTHOR]

Objective Structured Clinical Examinations (OSCE) are used to assess clinical skills. We investigated how exit OSCEs changed in Australian medical schools in response to the COVID-19 pandemic. The lead ACCLAiM assessment academic from 12 eligible Australian medical school members of the Australian Collaboration for Clinical Assessment in Medicine (ACCLAiM) received a 45-item semi-structured online questionnaire. All schools (12/12) responded. Exit OSCEs were not used by one school in 2019, and 3/11 schools in 2020. Of eight remaining schools, four reduced station numbers and testing time. The minimum OSCE testing time decreased from 64 min in 2019 to 54 min in 2020. Other modifications included: a completely online 'e-OSCE' (n = 1); hybrid delivery (n = 4); stations using: videos of patient encounters (n = 3), telephone calls (n = 2), skill completion without face-to-face patient encounters (n = 3). The proportion of stations involving physical examination reduced from 33% to 17%. Fewer examiners were required, and university faculty staff formed a higher proportion of examiners. All schools changed their OSCEs in 2020 in response to COVID-19. Modifications varied from reducing station numbers and changing delivery methods to removing OSCE and complete assessment re-structuring. Several innovative methods of OSCE delivery were implemented to preserve OSCE validity and reliability whilst balancing feasibility. [ABSTRACT FROM AUTHOR]

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 good neurological outcome, defined as no, mild, or moderate disability (CPC 1–2 or mRS 0–3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool. Results: A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72–96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2–7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias. Conclusions: In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA). [ABSTRACT FROM AUTHOR]

Lateral epicondylitis (LE) is a painful condition that affects mainly older patients, but also athletes. Also known as tennis elbow, it belongs to most common causes of elbow pain in adults and is among the most frequent disorders caused by overuse. Typical symptoms include pain located in the lateral part of the elbow likely to radiate to the forearm. The process of lateral epicondylitis can be both acute and chronic. The aetiology of LE has not been exactly determined yet. Within clinical examination, it is possible to use several diagnostic tests such as Mill test, Cozen test, Maudsley test and Polk test. The treatment methods include various therapeutic modalities. The most common method of LE treatment is exercise. The basic types of exercise include isometric and concentric exercises; however, the most commonly used are eccentric exercises. Other therapeutic approaches consist of kinesio taping, manual therapy, and various types of physical therapy. [ABSTRACT FROM AUTHOR]

• The Society of Orthodontic Specialty Certifying Boards is a facilitating committee of the World Federation of Orthodontists that works closely with national orthodontic boards certifying agencies and organizations to promote board certification. • The establishment of guidelines for orthodontic specialty certification could be beneficial to standardize orthodontic specialty board certification worldwide. • The Society of Orthodontic Specialty Certifying Boards suggests the use of the scenario-based clinical examination as the certifying instrument for orthodontic specialty certification. • The ability to standardize the testing instrument, that is, scenario-based clinical examination, makes an argument for its use worldwide. The Society of Orthodontic Specialty Certifying Boards aims to encourage the formation of new certifying orthodontic boards worldwide and stimulate existing orthodontic certifying boards to review and revise their certification process. The main goal of Society of Orthodontic Specialty Certifying Boards is to motivate more orthodontists to become board certified by demonstrating their skills through time to protect the public and the specialty from unqualified practitioners. This article identifies the existing barriers in board certification and suggests a scenario-based clinical examination. [ABSTRACT FROM AUTHOR]

Abstract Assessing the responses of body tissue subjected to mechanical load is a fundamental component of the clinical examination, psychophysical assessments and bioengineering research. The forces applied during such assessments are usually generated manually, via the hands of the tester, and aimed at discreet tissue sites. It is therefore desirable to objectively quantify and optimise the control of manually applied force. However, current laboratory-grade manual devices and commercial software packages, in particular pressure algometer systems, are generally inflexible and expensive. This paper introduces and discusses several principles that should be implemented as design goals within a flexible, generic software application, given currently available force measurement hardware. We also discuss pitfalls that clinicians and researchers might face when using current pressure algometer systems and provide examples of these. Finally, we present our implementation of a pressure algometer system that achieves these goals in an efficient and affordable way for researchers and clinicians. As part of this effort, we will be sharing our configurable software application via a software repository.

Abstract Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1

Background: Examination methods change over time, and audits are useful for quality assurance and improvement. Objective: Comparison of traditional clinical test and objective structured clinical examination (OSCE) in a department of surgery. Methods: Examination records of results of the fifth year MBChB examinations for 2012–2013 (traditional) and 2014–2015 (OSCE) were analyzed. Using 50% as the pre-agreed pass mark, the pass rate for the clinical examinations in each year was calculated and these figures were subjected to t-test to determine any significant differences in each year and in type of clinical test. P value of

Among all oral diseases leading position holds dental caries and its complications. Despite the fact that modern dentistry has made great strides in the prevention and treatment of dental caries, the literature suggests maintaining a high prevalence of dental caries and its complications , reaching up to 98-100 % of the adult population. From our perspective, the ineffectiveness of measures for the prevention and treatment of dental caries and its complications can be connected with the individual characteristics of patients , such as their psychological state and behaviors. Based on the above, the aim of this work was to study the quality of life of patients with caries. The study involved 141 people aged 21 to 50 years, mean age was 37,2 ± 7,6 years. The study groups were identified with different levels of quality of life and made recommendations to improve the quality of life for patients with study pathology.

Objectives: This study aimed to investigate the prevalence and the possible association of the different types of temporomandibular disorders among young adult patients with anterior and/or posterior crossbites., Methods: This cross-sectional study included 584 individuals (259 male participants and 325 female participants) aged 18-29. The temporomandibular joint examination was conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I tests. In addition, dental and occlusal examinations were conducted to investigate the presence or absence of anterior and/or posterior crossbites. A chi-square test was used to evaluate any possible association between TMDs and gender and crossbite groups. A binary logistic regression analysis was performed to compute the odds ratios and assess the predictability of TMDs based on the presence or absence of crossbites., Results: Here, 47.1% of participants had a positive TMD. The presence of muscle disorder, disc displacement, and other joint disorders among participants was 16.4%, 26.7%, and 25.7%, respectively. The prevalence of TMDs in the female participants was significantly greater than in male participants (P= 0.046). There was a significant difference in the prevalence of disc displacements among crossbite groups (P= 0.026), and the anterior crossbite group had the highest prevalence (41%). There was no significant difference in the prevalence of muscle disorder and other joint disorders among crossbite groups (P= 0.149; P= 0.052, respectively). According to the binary logistic regression, only an anterior crossbite was significantly associated with higher predictability for disc displacement and other joint disorders (OR= 2.4; P= 0.008, OR= 2.34; P= 0.01, respectively). The presence of only a posterior crossbite was significantly associated with higher predictability for the occurrence of the disc displacement (OR= 1.58; P= 0.03)., Conclusion: The risk of development of disc displacement may be increased by the presence of an anterior or posterior crossbite. Also, the risk of developing other joint disorders may be increased by the presence of only an anterior crossbite., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Local Research Ethics Committee of the Faculty of Dentistry, University of Damascus issued approval UDDS-11723022023/SRC-299. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kamar Alden et al.)

Toxic epidermal necrolysis (TEN) is a serious dermatological condition often triggered by different drugs or medications or, less commonly, by infections, leading to extensive epidermal detachment and multisystemic complications, resembling the severity and systemic impact of burn injuries. This case report portrays a 26-year-old female patient with a history of psychiatric treatment and recreational drug use, presenting with typical prodromal symptoms and characteristic manifestations on the integument and mucosae. Clinical management involved an interdisciplinary team in a burn center, administering immunoglobulins, systemic steroids, and supportive therapies to prevent complications including infection and to support skin re-epithelization. Histopathological findings confirmed the diagnosis. Despite the extensive lesions, prompt treatment facilitated a positive outcome. The report emphasizes the necessity of referral to specialized centers and the complex, multidisciplinary management required for TEN patients to optimize survival and minimize long-term sequelae., Competing Interests: The authors declare that they have no conflict of interests.

Objective: Oral cancer is an increasingly growing health care burden in many parts of the world. Due to the relatively low prevalence of oral cancer, screening will lead to a low yield and a high proportion of false positive results. Clinical examination without histologic diagnosis can lead to misdiagnosis in over 40% of cases, especially when premalignant lesions are involved. However, clinical examination is effective especially in detecting the early stages of oral cancer, particularly in high-risk patients, such as smokers and alcoholics. The purpose of the current paper is to describe several cases of failure to diagnose lesions in the oral cavity during clinical and radiographic examinations, and to discuss how these diagnosis failures may be mitigated. Method and Materials: A series of three cases of oral tumors ranging from benign to malignant that were not recognized and referred in a timely manner, are presented. Conclusion: The difficulties faced by clinicians in diagnosing oral lesions are elucidated in this case series. The current case series, presenting instances in which pathologies were not detected and/or treated in spite of obvious signs, should serve as a warning for dental professionals. The general practitioner is the "first line of defense" for symptomatic and asymptomatic patients, and therefore the implementation of well-established screening protocols is of paramount importance. In light of the low sensitivity ratio of oral examinations, use of biopsies is mandatory when a lesion is suspected. [ABSTRACT FROM AUTHOR]

Background: In the context of the German contact restrictions due to the COVID-19 pandemic of March 2020, an online-based consultation system was established in our university orthopedic outpatient department to maintain patient care. As a basis for contact-minimizing communication, this was continued after the contact restrictions were lifted. The aim of this prospective pilot study was to assess the effectiveness, technical feasibility, and patient flow in this system under lockdown conditions and in the period afterwards.Methods: The evaluation took place from the beginning of the first lockdown on March 13, 2020, until May 31, 2021. For each patient encounter, the quality of the sound and video connections was documented. The outcomes of the consultations were recorded. Four categories were distinguished: 1) no follow-up necessary, 2) follow-up via online consultation, 3) referral for surgical therapy, and 4) follow-up in the outpatient clinic for physical examination. A comparison was made between an early cohort right after implementation of the online consultation and and a late cohort after establishment of the consultation.Results: There were 408 patient encounters via online consultation. A total of 360 (88%) consultations were uninterrupted. Initial presentations accounted for 124 (30%) consultations. In 75 (18%) patients, no further follow-up was necessary. Follow-up via online consultation was scheduled in 82 (20%) patients, direct referral for surgery was made in 86 (21%) patients, and a follow-up for physical examination was arranged in 165 (40%) patients. When comparing the early and late cohort, there was no difference in the duration of the conversation (p = 0.23). A significant difference was found in the type of further treatment. In the late cohort, conservative therapy was used more often (p < 0.01), resulting in a lower number of follow-up visits for clinical examination (p < 0.01).Conclusion: While a definite decision for further procedure was possible solely by online consultation in a large percentage of cases, 40% of patients still needed an additional in-person consultation for physical examination. A learning curve could be observed regarding the selection of patients suited for online consultation. Overall, online consultation is a useful measure to manage patient volume and to visibly support direct doctor-patient contact. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature 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.)

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Estimation of fetal weight during pregnancy plays an important role in prenatal and intrapartum care and is more important in pregnancies after 37 weeks to determine the type of delivery. The aim of this study was to compare and evaluate the accuracy and diagnostic value of two-dimensional ultrasound and clinical examination in estimating fetal weight and pregnancy outcomes. Materials and Methods: This cross-sectional study was conducted on 300 pregnant women without abnormal fetuses and pregnancies after 37 weeks; mothers who had a normal delivery or cesarean section were evaluated by the available method. The weight of the fetus was estimated before and after delivery, using ultrasound and clinical examination. Newborns were classified into five groups based on their fetal weight. Analysis of collected data was performed with SPSS software. Results: The mean age of the patients was 31 years and the mean weight of the neonates was 3450 g. At a weight of less than 3000 g, ultrasound and clinical evaluation were strongly correlated with the actual weight of the infant, but at weights of more than 3500 and 4000 g, weight estimation with ultrasound was highly accurate, and clinical examination had poor accuracy. In lower weights, square errors were fewer in both ultrasound and clinical examination, in comparison with higher weights. In higher weights, ultrasound is more reliable, and the diagnostic accuracy of clinical examination is reduced. Conclusion: Estimation of fetal weight with prenatal ultrasound is highly accurate. Clinical examination is more accurate in determining the weight of small fetuses and does not pay much attention to the diagnosis of macrosomic fetuses and even leads to overestimation, while ultrasound is much more accurate in diagnosing fetal macrosomia. [ABSTRACT FROM AUTHOR]

Undernutrition is a frequent problem in medicine. In practice, it concerns all practitioners, whether they work in the city, in hospitals, or in medico-social structures. In view of its deleterious physiopathological consequences for each individual, it deserves to be diagnosed and screened, particularly in certain high-risk situations (notably in the case of a lack of intake, increased needs and losses) and in principle in the elderly. In this context, the tools available to the practitioner are numerous, including: data from the clinical examination, anthropometric data (weight, BMI, skin folds), biological data (mainly albumin, transthyretin, BPR), and composite indices and nutritional scores (including the MNA, NRI, SGA, NRS- 2002 and MUST) [ABSTRACT FROM AUTHOR]

Background: The ability of clinical tools to identify early joint changes is limited. Synovitis is a fundamental finding in understanding haemophilia activity and the response to its therapies; thus, there is a need for sensitive methods to better diagnose subclinical synovitis early. Purpose: Our aim was to compare the frequency with which clinical assessment and ultrasound detected synovial hypertrophy in the most frequently affected joints in patients with haemophilia (elbows, knees and ankles). Methods: We analysed patients with haemophilia older than 16 years who came to the haemophilia centre for routine follow‐up. From the clinical assessment carried out in the consultation, the swelling, pain and history of haemarthrosis were evaluated and compared with the findings of synovial hypertrophy detected by ultrasound. This comparison was also analysed independently for elbows, knees and ankles. Results: A total of 203 joints of 66 patients with haemophilia (mean age 34 years), most of them on secondary, tertiary prophylaxis or on demand treatment, were included. In joints with swelling, pain and history of haemarthrosis, 78% of the joints showed synovial hypertrophy on ultrasound. However, in joints with no swelling, no pain and no history of haemarthrosis, 40% presented subclinical synovial hypertrophy on ultrasound. This percentage was higher in elbows than in knees and ankles. Conclusion: In adults with haemophilia, physical examination and point‐of‐care ultrasound study provide complementary data on their joint disease. However, without ultrasound, the ability to detect subclinical synovitis is considerably reduced, especially in the elbows. [ABSTRACT FROM AUTHOR]

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.

Background: Fractures of metacarpals and phalanges are the most common among upper limb bony injuries and contribute to about 10% of total fractures among them. It is well recognized that both soft tissue healing with fracture healing must be kept in mind during treatment of hand and metacarpal fractures because successful outcomes require the return of functional integrity to both the tissues. Objective: To evaluate the functional and radiological outcome of metacarpal fractures. Conclusion: High-resolution Radiological may be used to Evaluating the functional and radiological outcome of metacarpal fractures. [ABSTRACT FROM AUTHOR]

The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern health care system. The current pandemic has further threatened time spent with patients. This lack of time has led to a decline in clinical skills and a decrease in the number of faculty members who are confident in teaching at the bedside. We offer several strategies to get physicians and trainees back to the bedside to engage in clinical skills teaching and assessment. We recommend that providers pause before bedside encounters to be present with patients and learners and to develop clear goals for a bedside teaching session. We suggest that clinical teachers practice an evidence-based approach, which includes an hypothesis-driven physical examination. We encourage the use of point-of-care technology to assist in diagnosis and to allow learners to calibrate traditional physical examination skills with real-time visualization of disease. Tools like point-of-care ultrasound can be powerful levers to get learners excited about bedside teaching and to engage patients in their clinical care. We value telemedicine visits as unique opportunities to engage with patients in their home environment and to participate in patient-directed physical examination maneuvers. Finally, we recommend that educators provide feedback to learners on specific clinical examination skills, whether in the clinic, the wards, or during dedicated clinical skills assessments. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This is the second of two articles exploring assessment and clinical reasoning of conditions relating to the heart and cardiovascular system in the context of emergency care. In the last article, the structure and function of the heart was reviewed, and reference made to many of the conditions that may affect the heart. In addition, the common presenting complaints of cardiac conditions were highlighted, together with important aspects of the history for each symptom. The full cardiac examination was outlined. In this article, some of the common cardiac conditions will be discussed. These will be linked to common findings in the history, examination, and investigations. [ABSTRACT FROM AUTHOR]

Sheep production is being encouraged in Egypt as a mean of improving the daily dietary protein intake for humans. Nutritional disorders are considered one of the serious distresses that influence the animal production. The current study aimed to investigate mineral deficiency in sheep and its effect on health status at different New Valley governorate cities. Clinical examination of the sheep was performed. Blood, water and soil samples were collected from different localities. Hematological parameters, serum total protein, albumin, globulin concentrations, kidney function tests and the activity of liver enzymes were estimated. Moreover, the values of some elements in soil and water were determined. Clinical examination showed various symptoms as weight reduction, lameness and eye and skin lesions. The biochemical results exhibited significant reduction of hemoglobin (Hb), mean corpuscular Hb, red blood cell count, hematocrit, lymphocytes, neutrophils, median cells and mean corpuscular Hb concentration. On the same hand, serum calcium, phosphorus (P3+), magnesium (Mg2+), copper (Cu2+), iron (Fe2+) and zinc (Zn2+) levels were reduced. Albumin concentration and albumin/globulin ratio were also diminished. There was also significant reduction of serum liver enzymes activity in Paris village. Analyzing of soil reveled decline in concentration of Mg2+ in all studied areas and Cu2+ and Zn2+ in Paris only. However, high values of P3+ and Fe2+ in all localities. Water samples analysis showed low concentrations of Cu2+, Zn2+ and manganese level. The present study confirmed that mineral deficiencies have great negative impacts on the healthy status of sheep in New Valley governorate. [ABSTRACT FROM AUTHOR]

Congenital anomalies may affect a significant proportion of newly delivered babies and lead to a remarkable morbidity and mortality rate, so it is regarded as the leading cause of prenatal death and postnatal disability in many countries. Congenital anomalies, also known as congenital disabilities, affect the structure or function of many organs, which may result from a flaw or abnormality during the development phase. There is a variable prevalence of congenital anomalies in worldwide countries. In about 50% of congenital anomalies, the etiology is unknown, but in general, nearly (30-40%) of congenital malformation is genetic and environmental predisposition may account for about (5 to 10%). Prenatal and maternal history is essential to search for risk factors. When expecting congenital malformation, the accurate diagnosis has been done prenatally through either non-invasive techniques or invasive techniques. Because the rehabilitation and treatment of these babies with congenital malformations is complex and expensive, and the prevention of these conditions is only possible in 60% of cases, it is critical to determine causative and risk factors and avoid them early. To standardize records and include more detail about the prevalence of common and unusual abnormalities, epidemiological information obtained through the creation of populationbased registries is critical. As a result, knowing the pattern and prevalence of congenital anomalies can help determine baseline rates, monitor changes over time, recognize clues to the etiology of conditions, and prepare and assess antenatal screening for congenital anomalies, especially in the high communities. This research aims to determine what kinds of congenital abnormalities there are in live newborns and how common they are. The study was done in Karbala’s “neonatal intensive care unit” hospital for children in Karbala, Iraq. The study was conducted over a 24 month period from March 1, 2019, to February 30, 2021. Overt manifestation of deformities was evaluated systematically through history, clinical examination and other features of congenital anomalies were based on further necessary investigation such as radiography, ultrasonography and echocardiography, etc. Two hundred and ten newborns with congenital abnormalities were included in this study, males 128 (60.95%) and females 82 (39.05%). According to the International Classification of Disease (ICD) 10, the pattern of congenital anomalies was classified with systemic involvement [central nervous system (CNS), genitor- urinary system (GUS), cardiovascular system (CVS), gastro-intestinal (GIT), musculoskeletal (MS) and skin]. In the present study, the type of congenital anomalies which are more predominant is related to the cardiovascular system (CVS) 57 (27.14%). CVS anomalies included simple and cyanotic 44 (77.2%) and complex and cyanotic 13 (22.8%) congenital heart disease. The gastrointestinal system anomalies were 51 (24.28%), in which the duodenal atresia 13 (25.49%) and the cleft lip and palate 8 (15.68%). At the same time, the central nervous system anomalies are the third typical pattern of anomalies which account for about 32 (15.23%); meningomyelocele 15 (46.87%) and hydrocephalus 7 (21.87%). Male babies are affected by congenital anomalies more than females, and the full-term neonate has had a prevailing rate of affection. The cardiovascular system is mainly affected by congenital anomalies with predominant prevalence in males and full-term babies more than preterm. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a zoonotic disease which is caused by protozoan parasites of the genus Leishmania. Canids are the most important reservoir of the parasites; however, limited data are available on the species of Leishmania prevalent in these animals and their impact on human health. The objective of this study was to estimate the seroprevalence of leishmaniasis in dogs from an inter-Andean region of Colombia during July 2016–July 2017, and to describe the clinical and histopathological features of the disease.

Abstract Background In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. Methods This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. Results The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. Conclusion The agreement between lung ultrasound and auscultation is poor. Trial registration NCT02912624. Registered on September 23, 2016.

The anatomy of the cortico-bulbar tract that drives voluntary movements of mimic muscles is well described. Some cases of facial palsy with inverse automatic-voluntary dissociation (emotional facial palsy; EFP) are reported in the literature. These cases suggested a completely independent path of the fibers whose lesion results in EFP. We aimed to review the clinical reports of EFP available in the literature to characterize the anatomical aspect of the fibers whose lesion results in the isolated impairment of spontaneous smiling. Cortico-pontine fibers that control spontaneous smiling arise from the medial surface of the prefrontal cortex and descend through the anterior limb of the internal capsule, thalamus, and brain steam, independently from those that control voluntary movement. The mesial temporal lobe, particularly the amygdala, plays a crucial role in the network driving emotionally evoked facial expressions. We would highlight the relevance of an unusual and rarely explored neurological sign that could be added to clinical examination in ruling out focal brain pathology, such as stroke, tumors, or multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common type of cancer in women demanding accurate diagnosis to take remedial measures to treat.Objective: Comparing the diagnostic capability of the computer regulation thermography (CRT), as a novel and safe diagnostic procedure, with common methods including sonography, mammography and clinical examinations for diagnosing breast cancer in suspicious patients against pathology as the gold standard.Material and Methods: In this prospective clinical trial study, out of 97 referred patients, 44 meeting the inclusion criteria were selected. The selected patients were subjected to mammography, sonography, CRT and clinical examinations. Then, the patients showing suspicious symptoms of breast cancer underwent pathological examinations.Results: CRT indicated a higher specificity compared to mammography and sonography (78.9% vs. 71.4% and 47.0%, respectively). However, CRT sensitivity was lower than those of mammography, sonography and clinical examination (52% vs. 70.6%, 82.4% and 84.0%). Furthermore, CRT accuracy was lower than mammography, sonography and clinical examination (63.6% vs. 70.9%, 64.7% and 88.6%). While CRT positive prediction value (PPV) was higher than those of mammography and sonography, it was lower than that of clinical examination (76.5% vs. 75%, 60.9% and 95.5%). The negative prediction value (NPV) of CRT was less than all other modalities (55.5% vs. 66.7%, 72.7% and 81.8% for the clinical examination, mammography and sonography, respectively). Conclusion: Although CRT with a lower sensitivity and higher specificity, cannot be recommended to be used as a definitive diagnostic tool for breast cancer patients, it can be used as a complementary method with other methods to increase the diagnostic accuracy of suspicious patients.

Abstract 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 =

Abstract 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.

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.