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Purpose: Traditional direct ophthalmoscopy (TDO) is the oldest method of fundus examination; however, it has fallen out of use due to its technical difficulty and limitations to clinical utility, amidst the advent of potentially better options. A spectrum of new technologies may help in addressing the shortcomings of TDO: simulation mannequins with non-tracked TDO, simulation models with tracked TDO, and smartphone ophthalmoscopy (SFO). Methodology: A systematic search of PubMed, Embase, and Cochrane databases for all studies evaluating usage of simulation mannequins/models and SFO in ophthalmology education was performed, from inception till April 2023 with no language restriction. We ensured that we included all possible relevant articles by performing backward reference searching of included articles and published review articles. Results: We reviewed studies on non-tracked TDO (n = 5), tracked TDO (n = 3) and SFO (n = 12). Non-tracked TDO and SFO were superior in training competency relative to control (TDO on real eyes). Intriguingly, tracked TDO was non superior to controls. SFO appears to enhance the learning effectiveness of ophthalmoscopy, due to real-time projection of the retina view, permitting instantaneous and targeted feedback. Learners reported improved ergonomics, including a wider field of view and more comfortable viewing distance. Retention of images and recordings permitted the audit of learning and paves the way for storage of such images in patients' electronic medical record and rapid dissemination for specialist referral. Conclusions: Smartphone ophthalmoscopy (SFO) permits integration of both the practice and learning of ophthalmoscopy, and the auditing of both. These advantages over traditional methods (with simulation or otherwise) may lead to a paradigm shift in undergraduate ophthalmology education. However, the nascency of SFO necessitates preservation of traditional techniques to tide through this period of transition. [ABSTRACT FROM AUTHOR] more...

Endometriosis is a complex gynecologic disorder characterized primarily by symptoms of pelvic pain, infertility, and altered quality of life. National and international guidelines highlight the diagnostic difficulties and lack of conclusive diagnostic tools for endometriosis. Furthermore, guidelines are becoming questionable at an increasingly rapid rate as new diagnostic techniques emerge. This work aims to provide a knowledge synthesis of the relevance of various diagnostic tools and to assess areas of improvement of conventional algorithms. MEDLINE and Cochrane Library databases were searched from January 2021 to December 2023 using relevant key words. Articles evaluating the diagnostic relevance and performance of various tools were included and independently reviewed by the authors for eligibility. Included studies were assessed using the GRADE and QUADAS‐2 tools. Of the 4204 retrieved articles, 26 were included. While anamnesis and clinical examination do contribute to diagnostic accuracy, their level of evidence and impact on the diagnostic process remains limited. Although imaging techniques are recommended to investigate endometriosis, ultrasonography remains highly operator dependent. Magnetic resonance imaging appears to exhibit higher sensitivities than ultrasound. However, concerns persist with regards to the terminology, anatomical definition of lesions, and accuracies of both ultrasound and magnetic resonance imaging. Recently, several biological markers have been studied and cumulative evidence supports the contribution of noncoding RNAs to the diagnosis of endometriosis. Marginal improvements have been suggested for anamnesis, clinical examination, and imaging examinations. Conversely, some biomarkers, including the saliva microRNA signature for endometriosis, have emerged as diagnostic tools which inspire reflection on the revision of conventional diagnostic algorithms. Synopsis: Endometriosis diagnosis remains complex. In addition to anamnesis, clinical examination, and imaging techniques, biomarkers offer encouraging perspectives supporting their inclusion in diagnostic algorithms for endometriosis. [ABSTRACT FROM AUTHOR] more...

Context: Orthopedic surgeons frequently encounter knee soft tissue injuries such as meniscal and ligament injuries. This study seeks to explore the diagnostic efficacy of clinical examination, magnetic resonance imaging (MRI), and arthroscopy in identifying knee injuries. Subjects and Methods: This prospective observational study enrolled 120 patients with knee injuries slated for arthroscopic surgery based on clinical and MRI assessments. The study assessed and compared the diagnostic accuracy of clinical and MRI findings. Statistical Analysis Used: Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, IL, USA) for the Windows program (21.0 version). The Spearman correlation analysis was done to assess the relationship between the various parameters. The level of agreement was assessed using Cohen’s kappa statistics. Interpretation of kappa statistics is as follows: 0 to 0.20-Slight agreement; 0.1 to 0.39-Fair; 0.40 to 0.59-Moderate; 0.60 to 0.79- Substantial and 0.80 to 0.90-Almost perfect agreement. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated and observed by using 2 × 2 contingency table. P < 0.05 was considered statistically significant. Results: When comparing MRI and arthroscopy findings, the anterior cruciate ligament (ACL) tear exhibited the highest sensitivity and specificity at 100.00% and 91.84%, respectively, while the medial meniscus tear had the lowest sensitivity and specificity at 80.23% and 61.76%. Regarding the comparison between clinical examination and arthroscopy, the Lachman test displayed the highest sensitivity at 95.92%, whereas McMurray’s test (Lateral Meniscus) had the lowest sensitivity at 54.55%, and the posterior Drawer’s test showed the lowest specificity at 60.00%. Lachman also demonstrated the highest diagnostic accuracy at 98.33%, while the posterior Drawer’s test had the lowest diagnostic accuracy at 70.00%. Conclusions: Despite a few limitations, clinical examination and MRI currently stand out as the most precise non-invasive methods for detecting abnormalities in the menisci and the ACL. These diagnostic approaches provide valuable insights into the structural integrity of these knee components, allowing for a comprehensive assessment without the need for invasive procedures. more...

The current preventive trends in clinical examination draw attention to the role of the external factors and stressful circumstances in psychodiagnostic research. Social frustration is an incapacity to fulfill relevant social needs because of a current situation. This term makes it possible to qualify criteria for the potential stress related to social functioning among family members, colleagues, and peers. The authors rationalized and tested a formalized questionnaire of Social Frustration Level developed at Bekhterev National Medical Research Centre for Psychiatry and Neurology in 2004 for patients with social adjustment disorders. The experiment justified the criterion validity of the Social Frustration Level Questionnaire. The article describes the structure of social frustration regarding the key spheres of activity attributed to internal and external frustration. The pilot study involved 45 patients with adjustment disorders, who showed significant frustration related to health problems and socio-economic status accompanied with relative satisfaction with interpersonal relations, i.e., family, friends, colleagues, and strangers. The research relied on the method of clinical psychological interview, as well as the Questionnaire of Social Frustration Level and the Integrative Anxiety Test. Personal anxiety and actual anxiety experiences proved to correlate with social frustration. The internal social frustration prevailed over the external one. The Questionnaire of Social Frustration Level proved to be an efficient practical tool to be used in systematic medical psychodiagnostics research, programs of disorder prevention, and psychotherapy. more...

Introduction and Hypothesis: Standardized digital rectal examination (DRE) correlates with anorectal manometry (ARM) measures. However, less is known about the relationship between DRE/ARM measures and patient-reported outcomes (PROs), especially among women with fecal incontinence (FI). Our aims were to evaluate associations between DRE and ARM measures and compare PROs with diagnostic evaluation measures for women with FI. Methods: We analyzed data from the parent clinical trial, Controlling Anal incontinence by Performing Anal exercises with Biofeedback or Loperamide (CAPABLe). We pooled data from randomized women who completed standardized ARM, DRE, and validated PROs at baseline and 12 and 24 weeks post-treatment initiation. PROs included FI severity, impact on quality of life, and bowel diary data. We analyzed ARM pressure and volume data and DRE using the Digital Rectal Examination Scoring System (DRESS) resting and squeeze mean scores. We used Spearman Rank Correlation to measure associations between the ARM measures and mean DRESS scores, and between PROs and ARM/DRESS scores. Results: Among 291 randomized women with ARM and DRE data, the correlation between DRESS and ARM resting measures was 0.196 (p<0.001) and between squeeze measures was 0.247 (p<0.001). At most timepoints, PROs more consistently correlated with squeeze ARM pressures and squeeze DRESS scores than resting measures. Conclusions: We found weak correlations between ARM and DRE measures and between those measures and PROs. Although DRE and ARM are commonly used diagnostic measures among women with FI, the weak correlations with patient-reported symptoms raises questions about their utility in clinical care. [ABSTRACT FROM AUTHOR] more...

Aim of the study: To compare clinical findings with MRI findings and evaluate the role of physical examination in the diagnosis, localization of the level, site, size, and type of lumbosacral disc herniation. Materials and methods: A prospective study of 104 patients with low back pain and/or sciatica was conducted et al.-Kindy Teaching Hospital between January to December 2022. All Participants were evaluated via history, clinical examination, and MRI. One hundred patients had a disc herniation in the lumbosacral region, which was confirmed by MRI assessment after clinical presentation and physical examination. The data were collected and analyzed by the chi-square test. Results: Most of the patients (84%) experienced pain in the lower back that radiated to the lower limb or limbs, and nearly half of the patients experienced paresthesia (48%). Sixty-six percent of the patients had a scoliotic list; limitation of lumbar spine movements was common in 96%, and a decrease in the straight leg raising test (SLR) was detected in 98%. Cross SLR "Well test" was positive in 64% of patients. The femoral nerve stretch test was positive in 40% of patients. Sixty-four percent were presented with neurological deficits, 42% with affected L5 nerve roots, 22% with affected S1 nerve roots, and no patients with L4 affected. Twenty-two percent showed a positive SLR test with an angle between 41 and 70°. Conclusion: Proper correlation between clinical and MRI will help determine the lesion's level, horizontal location, herniation type, and herniated disc size in the lumbosacral region and achieve a more accurate diagnosis. [ABSTRACT FROM AUTHOR] more...

Knee pain is a common reason for medical consultations. A thorough history and clinical examination often provide sufficient information to narrow down the diagnosis before advanced imaging is required. Incorporating classical orthopedic differential diagnoses is particularly useful in this process. Elderly individuals, especially women over 65, are disproportionately affected. Accurate identification of the condition, supported by targeted additional diagnostics, allows for stage-appropriate therapy, which should be categorized based on etiology and radiological findings. [ABSTRACT FROM AUTHOR] more...

Simple Summary: The aim of this prospective study was to determine whether competition-associated exercise and stress could have a negative effect on urinary biochemical parameters and urinary uromodulin and albumin separated using SDS-PAGE electrophoresis in adequately trained dogs. The results showed that urine pH was affected by exercise and proteinuria levels changed immediately after physical exercise with a return to baseline within 2 h after the physical activity; moreover, quali-quantitative evaluation of the urinary proteome showed a significant increase in urinary albumin and a decrease in uromodulin after exercise. Urinalysis and the evaluation of the urinary proteome by SDS-PAGE electrophoresis proved to be a non-invasive and economic technique for investigating the health status and pre- and post-exercise changes in athletic and working dogs. The aim of the present study was to investigate the effects of exercise during canicross competition on urinary biochemical parameters and urinary proteins. Our results showed that, among the parameters analysed in routine urinalysis, pH was affected by exercise and albuminuria also showed changes immediately after physical exercise with a return to baseline within 2 h after the physical activity. In particular, SDS-PAGE electrophoresis allowed the separation of the urinary proteins on the basis of their molecular mass allowing a qualitative evaluation of the urinary proteome and a quantitative analysis of urine albumin and uromodulin, with a significant increase in urinary albumin and a decrease in uromodulin after exercise. In this study, urine was collected by spontaneous voiding and the use of this non-invasive sampling method proved useful in obtaining information on the health of the animals in the immediate moments before and after the competition without increasing the stress of the animals involved in the competition by any visits or invasive manipulations by veterinarians. [ABSTRACT FROM AUTHOR] more...

Warmblood breeding is experiencing a situation with remarkable increase of expectations and demands with regard to conformation, movement, health, motivation and stamina of the horses. The breeding organizations are currently using the routine evaluations of young riding horses, broodmares and stallions to document the population level. Traits related to the breeding goals of modern riding horses are referred to in the monitoring, for which data are collected, for example, at events organized for studbook entry of mares, stallion selection for licensing or standardized performance tests. Foal shows are regularly organized by the studbooks as well. However, in the majority of cases data on the foals are currently not collected and used systematically. This implies an unused chance to get access to information providing early insight into the development of the population. The aim of this study was to collect and statistically analyze foal data on conformation, gaits, behavior and health, such that frequency and distribution statistics can serve as a basis to discuss options for future routines of studbooks. For our pilot study, we have assessed Hanoverian Warmblood foals born in 2015 and 2016 either at different public events or in their home stables. Conformation, gait and behavior data were collected by linear description using a standardized protocol. Additional information on incisor teeth, jaws and the umbilical region were made available through a short clinical examination. Findings from visual and palpatory assessment were gradually documented as were additional behavior data. Descriptive statistics on all parameters recorded were complemented by multiple analyses of variance which allowed inferences on the role of sex, age, season and type of event for the distribution of the foal data. The data pool for the statistical analyses comprised information on 1073 foals. Deviations from regular limb conformation had been found in up to 10% of the foals. Deviation of carpus position referred to as over at knee was seen more frequently than toed-in or toed-out stance of the limbs, weak or upright pastern and hooves with high heels. Results of the linear description of the foals indicated mostly minor if any irregularities in the limbs. The frequency of remarks on changes in the umbilical region was remarkably higher from the visual inspection (umbilical thickening; 38.0%) then from the palpatory examination (hernia opening; 10.7%). Statistical comparison of visual and palpatory findings on the navel revealed a Pearson correlation coefficient of 0.29. Deviations from normocclusion of incisor teeth had been documented from the clinical examination for about one third of the foals, with clearly higher quantity of overbite (31.6%) than underbite (1.0%). Analyses of variance showed significant influences of the age of the foals, the season and the type of the event on the distribution of overbite. The experiences and results of this pilot study imply that extension of the common foal assessments by several aspects of potential health relevance and by behavior traits should be feasible. Despite the additional efforts, an additional palpatory examination of the foals can be beneficial for strengthening the data basis supposed to be used as reference for management recommendations and possible breeding applications. Further investigation of the foal data with focus on the genetic background of observed conditions will show how the results from this pilot study may help to integrate new traits into the breeding program of the Hanoverian Warmblood. [ABSTRACT FROM AUTHOR] more...

Localisation in neurology is an important step in determining the location of a neurological lesion based on history taking and clinical examination before confirmation with imaging. Lesions can vary from the cortical to the subcortical, brainstem, and spinal cord levels, in which every presentation and finding from the patient can provide a rough idea of where the pathology is located. A differential diagnosis can later be made according to the duration of the symptoms and the cumulative signs and symptoms presented. This is considered the most important step in managing neurological patients to ensure that no stone is left unturned in making an accurate diagnosis. [ABSTRACT FROM AUTHOR] more...

Background: The heterogeneity of persons with temporomandibular disorders (TMD) and the lack of effective treatments have called for a biopsychosocial model and the development of a more personalised treatment approach. Emphasis on phenotypes might be a beneficial approach. Objective: Identifying phenotypes among persons with TMD using potential prognostic factors, including personal characteristics and responses to clinical tests. Additionally, examining the distribution of TMD diagnoses within the identified phenotypes. Methods: A cross‐sectional study including 208 persons (85% females) seeking physiotherapy for problems in the temporomandibular area. All participants were examined clinically and answered questionnaires electronically. The phenotypes were identified using latent class analysis based on seven potential prognostic factors selected within pain, function and psychological domains. Table analysis was used to explore the distribution of TMD diagnoses within the identified phenotypes. Results: Most participants fit into one of three identified phenotypes. Phenotype 1 (32%) was characterised by functional disability, low psychosocial scores and low risk for developing chronicity and future work disability; Phenotype 2 (29%) by parafunctional habits, low psychosocial score and seeking treatment to reduce pain; and Phenotype 3 (39%) by high levels of mental distress, fear avoidance and a large risk of future work disability. Intra‐articular disorders dominated Phenotype 1, myalgia and TMD‐related headache Phenotype 2, while Phenotype 3 included all the different TMD diagnoses. Conclusion: The knowledge about the three identified phenotypes might be useful for clinicians treating persons with TMD and for the development of preventive strategies and more personalised treatment. [ABSTRACT FROM AUTHOR] more...

Background and purpose: Prior studies highlighted the high diagnostic specificity (ranging from 92% to 100%) of clinical signs observed in functional neurological disorders (FNDs). However, these signs are rarely looked for by epileptologists when trying to distinguish between functional dissociative seizure (FDS) and epileptic seizure. The aim of this study was to determine the prevalence of inter‐ictal clinical signs of FND in a cohort of patients with probable FDS. The secondary objective was to compare the prevalence of inter‐ictal FND clinical signs in FDS patients with age‐ and gender‐matched epileptic patients without FDS. Methods: Patients diagnosed with FDS seen at two tertiary care centres and epileptic outpatients were included in the study. Each patient underwent a physical examination, searching for inter‐ictal clinical signs of FND. Results: In the FDS group, 79% of patients presented at least one sign of FND, compared to 16.6% of patients with epilepsy (p < 0.001). Moreover, 66.6% of FDS patients presented three or more FND signs, whereas only 4.1% of epileptic patients did (p < 0.001). The median number of FND clinical signs in the FDS group was four (SD 1.7; 5.5). Using the threshold of three signs or more, the specificity of detecting three or more FND signs was 83.3%, with a sensitivity of 79.2%. Conclusion: Inter‐ictal clinical signs of FND are present in patients with FDS and should be looked for during neurological examination. [ABSTRACT FROM AUTHOR] more...

Abstract Polymerase chain reaction (PCR) is an effective method for diagnosing infectious diseases and has been the primary method throughout the novel coronavirus disease (COVID-19) pandemic. PCR tests (from specimen collection to result acquisition) involve sample pretreatment, nucleic acid extraction, and PCR procedure. Automating the pretreatment process is crucial to mitigate the risk of infection for workers and to reduce the likelihood of sample contamination-triggered misdiagnosis, particularly when handling centrifuge tubes, cryopreservation tubes, and microtubes. Robotic systems have been engineered to automate cell culture and PCR-based diagnosis, predominantly designed for use with screw-capped containers. However, this leaves a notable gap in automation solutions for microtubes equipped with press-type caps. To address this gap, we developed a versatile microtube capper/decapper system. On the other hand, many tasks of manual operation using microtubes, which are routinely conducted in clinical tests and biological experiments, are performed. Compared to screw-type caps for centrifuge and cryopreservation tubes, press-type caps for microtubes present a considerably higher risk of the worker's fingers contacting the inside of the cap and/or generating airborne droplets. Despite the risks of contamination and infection derived from the manual handling of microtube caps, which can compromise diagnosis/experiment accuracy and worker safety, devices for manually opening and closing microtube caps without direct contact remain lacking. Therefore, leveraging the technology from the developed versatile microtube capper/decapper system for laboratory automation, we created a manually operated microtube equipped with an automatic capper/decapper system tailored for personnel in clinical and biological laboratories. In this study, we first examined the required specifications and prerequisites for a manual microtube capper/decapper and clarified the operating methods, operating procedures, operation environment, device size, accompanying functions, etc. Based on the required specifications and preconditions, we proceeded with the mechanical and control design of the conceptual model, manufactured a prototype, and confirmed its basic functions and performance. The compliant to the required specifications and preconditions and the usefulness of the proposed manual microtube capper/decapper were validated through various experiments and demonstrations. Using the proposed microtube capper/decapper, even small-scale operations, which are challenging to streamline, can be performed nearly as efficiently as full manual operations. Although operation time was not reduced, the ability to open and close microtubes without manual contact is crucial for improving diagnostic and experimental accuracy and for reducing the burden on and enhancing the safety of laboratory personnel. Because microtubes are used in various clinical tests and biological experiments, we believe that the proposed system can markedly reduce the workload for personnel across numerous clinical and biological laboratories. more...

A core tenet of total knee arthroplasty (TKA) is that achieving more natural kinematics will lead to superior patient outcomes. Yet this relationship has not been proven for large representative cohorts of TKA patients because accurately measuring 3-dimensional TKA kinematics is time-consuming and expensive. But advanced imaging systems and machine learning–enhanced analysis software will soon make it practical to measure knee kinematics preoperatively and postoperatively in the clinic using radiographic methods. The purpose of this study was to assess the reported relationships between TKA kinematics and outcomes and distill those findings into a proposal for a clinically practical protocol for a clinical kinematic exam. This study reviewed the recent literature relating TKA kinematics to patient outcomes. There were 10 studies that reported statistical associations between TKA kinematics and patient outcome scores utilizing a range of functional activities. We stratified these activities by the complexity of the radiographic examination to create a proposed examination protocol, and we generated a list of requirements and characteristics for a practical TKA clinical kinematic examination. Given considerations for a clinically practical kinematic exam, including equipment, time and other resources, we propose 3 exam levels. With basic radiographs, we suggest studying single-leg stance in extension, lunge or squat, and kneeling. For fluoroscopic systems with X-ray pulses up to 20 ms, we propose chair-rise or stair ascent to provide additional dynamic information. For fluoroscopic systems with X-ray pulses of less than 10 ms, we propose rapid open-chain knee flexion-extension to simulate the highly dynamic swing phase of gait. It is our hope that this proposed examination protocol spurs discussion and debate so that there can be a consensus approach to clinical examination of knee and TKA kinematics when the rapidly advancing hardware and software capabilities are in place to do so. [ABSTRACT FROM AUTHOR] more...

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis. [ABSTRACT FROM AUTHOR] more...

Introduction: Many researchers utilize self-reports to evaluate the prevalence of diseases. However, the accuracy of these self-reports remains uncertain in various studies. The objective of this particular study was to validate self-reported cases of diabetes among adults aged 35-70 years participating in the Shahedieh Cohort Study (SHCS). Methods: This cross-sectional study was conducted using data from the first phase of SHCS during 2015-2017. The study included 1000 Iranian adults aged 35-70 years. The Gold standard for diabetes was determined by measuring fasting blood sugar (FBS) and evaluating the history of treatment and use of diabetes medications. To assess self-report validity, various statistical indices such as sensitivity, specificity, positive and negative predictive values (NPVs), accuracy, positive likelihood ratio (LR +), negative likelihood ratio (LR-) and AUC were used. The agreement between self-reported diabetes and the gold standard was assessed using kappa statistics. All statistical analyses were performed using SPSS version 13 and R 4.3.1 software. Results: The study findings indicated that the prevalence of diabetes was 18% according to selfreport and 19.9% according to the gold standard measurement. The self-report accuracy was 95.67%. There was perfect agreement (kappa = 0.86) between the self-report and gold standard criteria. The AUC, sensitivity and specificity of self-reported diabetes were 0.937, 93.82% and 96.08%, respectively. Additionally, the results suggested that the self-report of diabetes was more valid in individuals with a normal body mass index (BMI) and without a family history of diabetes in first-degree relatives. Conclusion: The results showed that in the absence of diabetes control programs, self-report of diabetes is reliable and recommended. [ABSTRACT FROM AUTHOR] more...

Introduction: Lipoblastoma is a benign tumor derived from embryonic adipose tissue, accounting for 5 to 30 percent of soft tissue tumors in children. This study presents a case of a rapidly growing thigh mass in a 16-month-old child, for whom diagnosis based solely on serial clinical examinations proved challenging. Case Presentation: A 16-month-old girl presented with a lump at the posterior aspect of her left knee. Due to the rare nature of the tumor, diagnosis was delayed. Although serial clinical examinations showed no change in size, subsequent imaging revealed rapid growth, leading to a definitive diagnosis. Conclusion: In cases of fast-growing masses in children, particularly those with prominent adipose tissue imaging findings, it is crucial to consider lipoblastoma in the differential diagnosis. Advanced imaging methods should be recommended for monitoring, as serial examinations lack sufficient sensitivity in lipoblastoma follow-up. Our study underscores the limitations of serial examinations in lipoblastoma cases. Accurate diagnosis requires a combination of imaging studies and clinical evaluation. Once a definitive diagnosis is confirmed, prompt surgical removal of the tumor is advisable. [ABSTRACT FROM AUTHOR] more...

The triple test is an initial approach used for the evaluation of breast lumps. The clinical and physical examination are a critical component. Various studies indicate that there is difference in the clinical examination findings of benign vs. malignant breast lumps. The aim of the present study was to evaluate the significance of differences in the clinical examination of benign and malignant breast lumps from a cytological perspective. For this purpose, 301 consecutive breast lumps examined using fine needle aspiration cytology (FNAC) cases were included in the study. The patients were divided into category C-1 to C-5 based on the International Academy of Cytology classification system for the FNAC reporting of breast lesions. The clinical examination parameters studied included the age of the patients, duration, consistency, tenderness, mobility, location in the breast and the laterality of the lump. The cases were grouped into the benign group (C1, C2 and C3) and suspicious/malignant group (C4 and C5). The median duration of the benign lumps was 4 months compared with that of the malignant lumps, which was also 4 months. The malignant lesions were more likely to be in the upper quadrant, and were also non-mobile and hard (non-tender) upon a clinical examination. There were statistically significant differences in some of the clinical features, namely in the duration of presentation, site, mobility and consistency of the breast lump among various cytological category. On the whole, the present study re-emphasizes the importance of a thorough clinical examination for the better management of patients with breast lumps. [ABSTRACT FROM AUTHOR] more...

Objectives: This study aimed to evaluate the correlation between clinical examination and MRI findings with arthroscopy in diagnosing meniscal tears and cruciate ligament ruptures. Methods: The research involved a retrospective review of 165 patients, including 142 males and 23 females, who underwent arthroscopy for meniscal or cruciate ligament injuries between January 2018 and July 2020. The arthroscopic findings were compared with MRI reports and clinical examination results, including Lachman, anterior and posterior drawer tests for cruciate ligament injuries, and McMurray tests for medial and lateral meniscus injuries. Results: The study demonstrated that clinical examination showed strong sensitivity and specificity when compared to arthroscopy: Lachman test (84.76% sensitivity, 95% specificity), anterior drawer test (88.54%, 91.66%), and posterior drawer test (92.85%, 96.6%). McMurray tests for medial and lateral meniscus injuries yielded sensitivities of 81.51% and 68.42%, respectively, with corresponding specificities of 58.6% and 86.11%. MRI performance was also evaluated, with anterior cruciate ligament (ACL) tears showing 93.33% sensitivity and 90% specificity, while medial meniscus injuries had 84.87% sensitivity and 80.43% specificity. The lowest sensitivity was observed in diagnosing articular cartilage defects (29.16%), highlighting MRI's limitations in certain areas. Conclusion: In conclusion, despite arthroscopy’s superiority as the gold standard for knee injury diagnosis, it remains an invasive procedure. A well-conducted clinical examination, supplemented by MRI, remains invaluable in the diagnostic process, allowing for precise management of meniscal tears and ligamentous injuries. more...

Introduction: Computed tomography (CT) scan precisely shows soft and hard tissues in the same test hereby determines the lesion extension, involvement of regional node as well as of bone. Current study was aimed to evaluate the efficacy of clinical examination and CT to assess mandibular invasion in oral squamous cell carcinoma. Materials and methods: This cross-sectional study was conducted at Dhaka Dental College Hospital from July, 2016 to July, 2017 among conveniently selected 35 patients of histologically confirmed squamous cell carcinoma which was close to the mandible. The patients underwent proper clinical examination. CT scan was performed; preoperative staging and treatment plan was formulated according to the status of bone invasion. After mandibulectomy, the resected specimens were sent for histopathology. The findings from clinical examination and CT were then correlated with the gold standard, postoperative histopathology. Results: Clinical examination accurately detected 22 cases to have bone invasion and 8 cases with no bone invasion. It also gave 2 false positive and 3 false negative results. On the other hand CT accurately detected 24 cases to have bone invasion and 9 cases with no bone invasion. It provided one false positive and one false negative result. However, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of clinical examination were 88%, 80%, 91.67%, 72.73%, 85.71% respectively (p = 0.0002) and of CT were 96%, 90%, 96%, 90%, 94.28% respectively (p < 0.0001). Clinical examination and CT were found sensitive enough and have an acceptable range of specificity as primary investigative modalities. CT scan outperforms clinical examination in terms of sensitivity, specificity, NPV, and accuracy. Conclusion: CT scan imaging is the method of choice for planning treatment in advanced oral squamous cell carcinoma. This study reveals how a CT scan can provide additional diagnostic value to detect bone invasion. Update Dent. Coll. j: 2024; 14(2): 21-26 more...

Purpose: Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population. Methods: This IRB approved retrospective study was conducted at a tertiary children's hospital. Inclusion criteria included patients under 18 years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded. Results: Forty-seven patients (with 48 MRIs) met inclusion criteria over a ten year period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam. Conclusion: Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients. [ABSTRACT FROM AUTHOR] more...

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD. [ABSTRACT FROM AUTHOR] more...

The therapeutic management of cases with social anxiety in addition to young ages must have a well-developed protocol to achieve the subsequent acquisition of confidence and the possibility of continuity in a short period of time because it takes place over several sessions as well as adaptations during the checks as maintenance and reliability of the treatment plan. more...

Abstract Introduction Breast cancer disease is known as the most common cancer among women. Lack of knowledge and awareness is a leading cause of breast cancer, and since nearly all women are increasingly susceptible to this disease, training screening behaviors for early detection is proven essential in order to reduce breast cancer mortality. Therefore, the present study was designed to determine the effect of educational intervention based on the Health Action Model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan, Iran. Methods This quasi-experimental study was conducted on 162 women aged 30–69 years old among the clients of Comprehensive health service centers in Kashan, Iran and they were assigned to intervention and control groups. The research instrument included a questionnaire assessed within three phases: baseline, 3-months, and 6-months, containing Health Action Model (HAM) structures and also three screening behaviors. The intervention consisted of a model-based education package and was carried out over 2 months. To evaluate the effect of the intervention, the mean of model structures and proportion screening behaviors in the third and sixth months were compared with the baseline phase. All analyses were carried out using SPSS, version 22. Results The intervention and control groups were homogeneous regarding the structures of the HAM and the proportion of screening behaviors in the baseline phase (p > 0.05). In the 3-month (p more...

Introduction: This study aimed to ascertain the accuracy of clinical examination for the determination of pleural puncture sites as compared to the use of ultrasonography in patients with pleural effusion. Material and Methods: A single-centre, prospective, observational study was carried out amongst 115 patients with pleural effusion in a tertiary care hospital in western India. Patients were subjected to clinical assessment for determination of pleural puncture sites and the same were confirmed with ultrasonography. All physicians were blinded to the marking of the previous physician to prevent any influence on their assessment. Results: The study had 345 physician observations. The overall accuracy of the clinical examination was 94.8%. Multivariate logistic regression of the factors responsible for the accuracy of clinical examination demonstrated a significant role of higher body mass index (BMI) (OR-1.19) and lower zone pleural effusions (OR-4.99) when adjusted for age, gender, side of effusion, and experience of examining doctors. When the effusions were classified according to their location, lower zone pleural effusions and loculated pleural effusions had an error rate of 15.9% and 8.33%, respectively. Conclusion: An ultrasound is the standard of care to assess all pleural effusions and guide the best point for aspiration. more...

AbstractExercise-induced proteinuria has been widely investigated in humans, also in relation to intensity and duration of activity. Instead, there are only limited publications regarding urinary biochemical parameters and urinary proteins before and after physical activity in dogs. This paper aimed to investigate the effects of exercise on urinary biochemistry and proteins in military dogs. Twenty-four dogs were enrolled in this study. All the dogs were clinically sound, and they were examined before and after activity. Pulse rates (PR) and respiratory rate (RR) were monitored. Urine was sampled before and after a training session of search activity. Standard urinalysis was carried out, urine total proteins and creatinine were measured and the urinary protein:creatinine ratio was calculated; finally, the urinary proteins were separated using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Clinical examination before and after activity did not reveal any pathological finding. After activity, the PR was slightly increased, while the RR was notably increased (p more...

Social anxiety is one of the most common psychological disorders along with depression and generalized anxiety. Avoiding eye contact, persistent fear of being judged and negatively evaluated by others, and social isolation are just some of the specific features of this type of anxiety.As part of the complex oral rehabilitation treatment, we also faced such a case which involved a lot of attention and time, but to which was also added the joint and muscle pathology, superposing with the social the dental treatments anxiety , the patient needing a special complex treatment approach. more...

Breast cancer is the most common female cancer in the world. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of formal breast self-examination (BSE) as opposed to breast awareness has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. Design: The Commission of Senology (CS) of the Collège National de Gynécologie et Obstétrique Français (CNGOF) respected and followed the Grading of Recommendations Assessment, Development and Evaluation method to assess the quality of the evidence on which the recommendations were based. Methods: The CS studied 16 questions individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE versus abstention from this examination led to detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. Results: BSE should not be recommended for women in the general population, who otherwise benefit from clinical breast examination by practitioners from the age of 25, and from organized screening from 50 to 74 (strong recommendation). In the absence of data on the benefits of BSE in patients aged over 75, for those at high risk and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these categories wish to undergo BSE, information on the benefits and risks observed in the general population must be given, notably that BSE is associated with a higher number of referrals, biopsies, and a reduced quality of life. more...

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. more...

Introduction: Breast cancer disease is known as the most common cancer among women. Lack of knowledge and awareness is a leading cause of breast cancer, and since nearly all women are increasingly susceptible to this disease, training screening behaviors for early detection is proven essential in order to reduce breast cancer mortality. Therefore, the present study was designed to determine the effect of educational intervention based on the Health Action Model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan, Iran. Methods: This quasi-experimental study was conducted on 162 women aged 30–69 years old among the clients of Comprehensive health service centers in Kashan, Iran and they were assigned to intervention and control groups. The research instrument included a questionnaire assessed within three phases: baseline, 3-months, and 6-months, containing Health Action Model (HAM) structures and also three screening behaviors. The intervention consisted of a model-based education package and was carried out over 2 months. To evaluate the effect of the intervention, the mean of model structures and proportion screening behaviors in the third and sixth months were compared with the baseline phase. All analyses were carried out using SPSS, version 22. Results: The intervention and control groups were homogeneous regarding the structures of the HAM and the proportion of screening behaviors in the baseline phase (p > 0.05). In the 3-month (p < 0.05) and 6-month (p < 0.05) phases, the mean scores of the HAM constructs in the intervention group were found higher compared with the control group. Moreover, the proportion of clinical breast examinations in the intervention group was statistically higher than in the control group in the 3-month (p < 0.001) and 6-month (p < 0.001) phases. In addition, the proportion of mammography performed in the 3-month (p = 0.002) and 6-month (p < 0.001) phases were reported to be higher in the intervention group compared with the control group. Conclusion: Overall, these results provide important insight into the effectiveness of the interventions based on the Health Action Model in promoting breast cancer screening behaviors and the determinants of such behaviors. [ABSTRACT FROM AUTHOR] more...

Sensitivity, specificity, and agreement between clinical and magnetic resonance imaging (MRI) gradings of the medial collateral ligament (MCL) after acute knee injury were evaluated in 362 patients. Ninety-seven per cent were injured during sports/recreation. Sensitivity and specificity of MRI for grade II or III MCL injury was 68% (95% CI 58–77%) and 90% (95% CI 86–93%), respectively. Weighted Kappa analysis showed moderate agreement between clinical and MRI grading (0.56 [95% CI 0.48–0.65]). Findings were similar for patients with and without concomitant cruciate ligament rupture (0.57 [95% CI 0.48–0.66] and 0.55 [95% CI 0.35–0.75], respectively) and for specialists in orthopaedics and knee sub-specialists (0.55 [95% CI 0.39–0.70] and 0.57 [95% CI 0.47–0.67], respectively). Agreement between clinical and MRI grading of MCL injuries by orthopaedic specialists in a general hospital is at least moderate regardless of the presence of cruciate ligament injury. [ABSTRACT FROM AUTHOR] more...