Journal of Medical Diagnostic Methods

Published by OMICS Publishing Group
Online ISSN: 2168-9784
Publications
Objective: Ultrasound is used in many ways, not only as an initial diagnostic tool for confirmation of pathology determined from biopsies of the breast but also staging of breast cancer. Ultrasound is inexpensive and readily available almost all over the country. In a recent publication from the UK, the incidence of breast cancer in women younger than 35 years was 1.4% and in those younger than 30 years it was 0.43%. Breast Cancer is the most commonly diagnosed cancer amongst women worldwide. There were approximately 1.38 million new cases of breast cancer in the year 2008 and by 2020 this figure is anticipated to escalate to 1.7 million.Methodology: This research was a qualitative retrospective study which focused on charts from the Cancer Institute of Guyana that was acquired during the period of January 2010 to December 2016. Triple data entry was done to avoid errors. Data was entered into Microsoft excel 2007.Results: A total of 80 charts were reviewed, with a 95% confidence level and a confidence interval of 9.42. The average age at which women were being screened is 33 from 2010-2016. Ultrasound showed sensitivity was 97% and the specificity 98%.Discussion: Ultrasound was shown to be more sensitive than mammogram. Afro-Guyanese were the majority screened. Most persons had ultrasound done with both malignant and benign diseases being discovered with this modality. The malignant cases were more frequently diagnosed at stage II and the average of detection was 33.Conclusion: Ultrasound is effective and sensitive in the diagnosis of breast cancer. It is also effective in diagnosing benign breast diseases in younger women with dense breast tissue. Ultrasound is cheaper and safer than other imaging modalities for screening and diagnosis.
 
Axial T2W (a) Diffusion weighted trace (b) ADC map (c) Postcontrast T1W (d) Images show a mass in a 43-year-old woman with stage 2a squamous cell carcinoma. The mass is slightly hyperintense on axial T2W image (white star) (a) Remarkably hyperintens on diffusion weighted trace image (b=1000 sec/mm 2 ) (b) Prominently hypointense on ADC map (ADC value of carcinoma is 0.82 x 10-3 mm 2 /sec). The normal cervical stroma is seen as a hyperintense wall (c) This mass is seen as an irregular hypovascular area on the postcontrast T1W THRIVE image (d).
Objective: We aimed to evaluate the diagnostic accuracy of 3T MRI sequences for staging of uterine cervical carcinoma (CC).Methods: We examined 22 cases of CC by a 3T MRI with T2W single shot turbo spin echo, diffusion weighted imaging (DWI) and post-contrast dynamic T1W images. The quantitative evaluation of dynamic series was also performed.Results: For parametrial invasion, DWI and early phase post-contrast images yielded higher diagnostic accuracy. DWI showed 86% sensitivity, 41% specificity, 80% diagnostic accuracy, 100% PPV, and 70% NPV. Post-contrast early phase images yielded 80% sensitivity, 71% specificity, 77% diagnostic accuracy, 86% PPV, and 62% NPV. T2W sequences showed 73% sensitivity, 71% specificity, 73% diagnostic accuracy, 85% PPV, and 55% NPV. Late phase contrast-contrast images yielded 60% sensitivity, 71% specificity, 64% diagnostic accuracy, 82% PPV, and 45% NPV.Conclusion: 3T MRI has high diagnostic accuracy in the preoperative staging of CC especially with DWI.
 
Objective: To evaluate the value of 99mTc-EHIDA hepatobiliary scintigraphy with different Liver/Kidney ratio (LKR) in the distinguish of infant persistent jaundice.Methods: A total of 128 patients with infant persistent jaundice (45 females, with a mean age of 45.9 ± 23.4 d) underwent hepatobiliary scintigraphy were analyzed retrospectively. All patients were underwent to detecting their level of glutamyl transpeptidase (γ-GT) before hepatobiliary scintigraphy. We drawn the outline of same size region of interest in the near right of liver (L) edge and left kidney (K) at the ten minites of hepatobiliary scintigraphy and calculated the ROI of liver to kidney ratios. The receiver operating characteristic (ROC) curve was used to analyze the threshold and calculate the sensitivity and specificity of γ-GT.Results: The sensitivity, specificity and accuracy of hepatobiliary scintigraphy in the diagnosis of biliary atresia (BA) was 91.4% (32/35), 83.8% (78/93) and 85.9% (110/128), respectively. The LKR of (BA) group were slightly higher than infantile hepatitis syndrome (IHS) group (t2.23P<0.05). The LKR of between BAand BA and between IHS and HIShave no statistics significance (P>0.05, t1.17, 1.29, respectively). The AUC of serum γ-GT in diagnosis of BA is 0.87 according to the ROC curve, and the sensitivity and specificity of BA is 0.91 and 0.71, respectively. The accuracy of both methods was 91.5% when the LKR and γ-GT were combined to diagnosing the BA.Conclusions: The 99mTc-EHIDA dynamic hepatobiliary scintigraphy has unique advantages in the differential diagnosis of persistent jaundice in infants. The comprehensive analysis of LKR combined with serum γ-GT can obvious improve the diagnosis value for persistent jaundice in infants.
 
The present study reports a human case of paragonimiasis which coexisted with endometriosis, leiomyoma and salpingitis in Nigeria. A 28-year-old woman from the Igbo ethnic group presented with acute colicky abdominal symptoms at a hinterland Missionary Hospital. Therefore, emergency laparotomy was carried out. This revealed uterine fibroids and dense lesions between the pelvic organs. There were nodules attached to the mesenteric border of the ileum. Biopsy from several sites was performed. The individually labeled samples were received at a Reference Pathology Laboratory where paragonimiasis, endometriosis, leiomyomata and salpingitis were diagnosed. The patient’s immediate post-operative recovery status was uneventful until she was lost to follow up.
 
Objective: To assess the effectiveness of electrophysiological methods of research in diagnosis and prediction of early intra-abdominal complications after colon surgery.Background: The main reason of unsatisfactory results of early intra-abdominal complications treatment after colon surgery is delay in diagnosis of these complications and late repeated surgery.Methods: Electrophysiological method used in study includes complex installation of sensor system that registers simultaneously a number of physiological parameters.Results: With a favorable course in the early postoperative period there was a gradual decrease in the sensitivity threshold of the colonic wall according to current strength from 19 ± 4.2 to 9 ± 3.6 mA on the third day after the surgical intervention. If there were intra-abdominal complications in the early postoperative period, the threshold indices varied from 14 ± 2.9 to 24 ± 3.7 mA, and subsequently it happened that they ceased to be detected.This gives us the opportunity to start active methods of detoxification in the treatment group on 18-22 hours earlier than in the control group of patients. In addition, the periods of repeated lavage of the abdominal cavity decreased by (20.0 ± 0.3) hours in comparison with the control group. Mortality in the control group is 28.1%, in the treatment group-19%.Conclusions: Comparing the results of treatment of the main and control groups, it should be noted that the early intra-abdominal complications are diagnosed much earlier in the treatment group of patients, primarily due to the results of electrophysiological research methods.
 
Metastasis is uncommon in the toe. In the present case, the problem was differential diagnosis primarily as regards infection. However, radiology revealed a metastatic lesion. This merits publication on account of its reality.
 
Muscle volume measurement is important for ICUAW evaluation, which has been done using ultrasound and manual muscle testing. We compared the reliability of CT and other methods for muscle volume measurement. This observational study assessed 7 patients 40 years old or older who had been admitted to our ICU. Based on a prespecified CT protocol, muscle volume was evaluated on admission day and at 10-14 days after admission. Results show that the femoral muscle volume decreased significantly by up to 20%. The ICC between two raters was 0.97. Psoas muscle volume decline did not correlate with the femoral muscle decline. Femoral muscle volume evaluation was reliable and objective. This method is useful to quantify the ICUAW severity. Our pilot study based on CT femoral muscle volume evaluation will facilitate further studies to prevent ICUAW. Results show that CT using femoral muscle volume measurement is a reliable means of ICUAW evaluation.
 
India being a developing country, it concentrates its resources towards indigenizing various technologies making them economically feasible to the general population. Considering that roughly half of the country dwells in villages and small towns, even basic sanitation and primary health-care facilities are virtually non-existent in far-flung reaches of the Indian sub-continent. Coupling the problems of wide-spread poverty with increase in life-style related diseases warrants a greater budgetary allocation needed for providing primary health-care across the country. Among the various life threatening diseases cardio-vascular diseases form a sizable chunk. An attempt has been made towards indigenous development of a 12-channel ECG machine beginning from first principles. This paper presents a detailed technological overview on the development of an ECG machine with special emphasis on the design aspects of the analog front-end chip. Detailed computational simulations were employed in arriving at a viable electrical design of the front-end chip which could be fabricated cost-effectively. The front-end IC has been integrated with analog and digital modules to realize a one of a kind 12-channel ECG machine within the country.
 
Genito-pelvic actinomycosis is a rare condition that can be challenging to diagnose. It often occurs following long-term usage of Intra-Uterine Contraceptive Devices (IUCDs). The condition can be found at various anatomical levels but its presence in the psoas muscle is extremely rare. We report a case of a secondary psoas abscess which occurred in a 53 year old patient, three months after the removal of an IUCD that had been in situ for 8 years previously, and was associated with a severe infection. The initial management included drainage of the abscess and the upper urinary system followed by laparotomy. The time lapse between removal of the IUCD and onset of symptoms, lack of genitourinary infection and finally the delay of microbiological diagnosis contributed towards the difficulties in making this diagnosis.
 
Microwaves and infrareds have been employed as non invasive tools to image brain structures. Herein I present a case report that, with microwaves or infrareds, the US satellites have acquired the ability to trace the individual persons on the ground on their acoustic activities, and even plausibly their brain activities. Therefore, it is herein suggested that, to decrease down the pulse energy to the brain level while increase the size and sensitivity of antenna, it would also be possible for companies to make the microwave-induced thermoacoustic detector on brain activities.
 
We present two cases of granulocytic sarcoma of the breast in women who had a prior history of Acute Myeloid Leukemia (AML). Both patients presented with a palpable breast mass (one patient with a right breast mass and the other patient with bilateral breast masses) within one year following allogeneic peripheral blood stem cell transplantation for AML. Ultrasound-guided biopsy of the breast masses showed granulocytic sarcoma, a rare tumor without obvious primary bone marrow involvement. Reports of bilateral breast involvement with granulocytic sarcoma following allogeneic peripheral blood stem cell transplantation for AML are rare. Granulocytic sarcoma should be considered in the differential diagnosis of a new palpable breast mass in patients with a history of malignant hematologic tumor treated by allogeneic peripheral blood stem cell transplantation.
 
Objectives: The current preclinical study aimed at appraising the claim of anti diarrheal activity, acute and sub chronic oral toxicity of the polyherbal formulation Entoban to acknowledge its safety and efficacy. Methods: In order to investigate the antidiarrheal activity albino mice were treated with Entoban at doses of 2.5, 5,10 mg/kg. For evaluation of acute toxicity the animals were treated orally with doses (1 or 5 g/kg) of the Entoban capsule aqueous extract, maintained under standard laboratory conditions. Entoban was administered at doses of 50, 100 and 200 mg/kg body weight for 28 days for determining sub chronic oral toxicity. The data collected were summarized as mean ± SEM. Student’s t- test was used to determine significant differences. Results: Entoban showed significant inhibition of diarrhoea in dose dependent manner. Entoban did not cause any mortality in albino mice at the given doses of 1 or 5 g/kg. Other signs of toxicity like hair loss, weight reduction, mucus membrane (nasal), lacrimation, drowsiness, gait and tremors were also not observed. Conclusion: Results of the present study gave evidence of good tolerance of Entoban and the absence of detrimental effects on the functional state of the vital organs of the experimental animals in acute and sub chronic oral toxicity test. Future prospects include the clinical trials of the finished product as the clinical efficacy is proven in animal studies.
 
Background: Increased mean platelet volume (MPV) is a central process in the pathophysiology of coronary artery disease (CAD). Objectives: To investigate whether assessment of MPV, besides the traditional risk factors, enhances the assessment process for the risk of acute coronary syndrome (ACS). Materials and Methods: This study included 81 patients, divided into 2 groups; group I included 61 patients with acute coronary syndrome (ACS); further subdivided into group I a (37 Tn +ve patients) and group I b (24 Tn -ve patients) and group II included 20 completely healthy age matched as a control group; all patients were subjected to; history taking, clinical examination, ECG, assessment of MPV and lipid profile. Results: Tn +ve ACS patients had the highest MPV (13.3 ± 2.4fL), MPV correlated significantly with total cholesterol level, LDL level, and Tn level, P<0.001). By multivariate analysis, only MPV significantly increased the probability of Tn +ve ACS development (B ± SE=0.078 ± 0.028, t=2.8, 95% CI 0.022-0.133 with an odds ratio=0.358, P=0.007). MPV of ≥11.1 fL was the best cut-off value in predicting Tn +ve ACS with a sensitivity of 84% and a specificity of 65% (P=0.000). Conclusion: Our study determined that the MPV can facilitate the risk stratification for ACS occurrence. Which could be used as an alarming sign in follow up of patients with CAD to predict those at risk of Tn +ve ACS.
 
Introduction: Isolated injuries of the lunotriquetral (LTq) interosseous ligament and associated structures are less common and less well understood than other forms of dissociative carpal instability. For a VISI deformity to occur the LTq interosseous ligament must be disrupted but the progression of lunotriquetral dissociation requires further ligamentous injury, particularly the palmar LTq ligament, and for full dissociation between the lunate and triquetrum, the dorsal radiocarpal ligaments, which finally results in a static volar intercalated segmental instability (VISI) pattern. Case report: A 52-year old left-handed male patient of black origin was presented with a rare pattern of an acute static volar intercalated instability (VISI). Complete disruption of both the intrinsic lunotriquetral ligaments and the dorsal intercarpal ligaments were identified at surgery. Direct repair and dorsal capsulodesis plus temporary pinning of the lunotriquetral joint were carried out. The patient had a good clinical outcome at 2.5 years of follow up despite the persistent static VISI deformity in the last follow up radiographs. Conclusion: This case represents a clinical proof of both anatomical and biomechanical studies that in order for a static VISI deformity to occur (Stage III), not only must the lunotriquetral interosseous ligament and the palmar lunotriquetral ligaments be disrupted but there must also be disruption to the dorsal capsule.
 
Chest X-ray (PA view) showing parapneumonic effusion of the right lung (arrowed) with bibasal pleural effusion.
Background: High grade fever and atypical pneumonia in a susceptible Asian epidemic area could construe fatal consequences attributable to specific prevalence factitious organism: i.e Bukholderia pseudomallei. Case report: A 59 years old Indonesian man with predisposing factors of meliodosis initially presented with acuteshortness of breath and severe frontal headache associated in Emergency Department of Hospital Teluk Intan,Malaysia. He had history of prolonged low grade fever and non-productive cough for 5 days. Methods/Results: Culture and sensitivity test for blood and pleural fluid were negative for pathogenic organism.The specific tests for tuberculosis were non-reactive for Tuberculos bacilli. The specific oxidase-negative culture and sensitivity for psedomonas was positive after day 3 of hospitalisation and the IGM-ELISA titre antibody level for meliodosis was positive. The patient was well responded to immediate treatment and was discharged for a regular outpatient follow-up for eradication therapy. Conclusion: This case report documents the potential symptoms associated with atypical pneumonia in recognising Meliodosis in an epidemic Asian area. Early suspicion may avert untowards fatal consequences and improved the quality of life.
 
Background: Stroke volume variation (SVV) assessment using electric cardiometry could offer an alternative to invasive maneuvers for determining fluid response. Methods: Thirty patients with severe sepsis and hypotension (Mean arterial pressure i.e., MAP<65 mmHg), were enrolled in our study. Fluid resuscitation (30 ml/kg) was administered. Fluid response was defined as MAP ≥ 65 mmHg and lactate <4 mmol/L. Preload assessment was done through SVV, to assess fluid response. Results: The study included 13 males (43.3%) with age 47.8 ± 19.7. Paired comparison showed significant change in MAP readings (P value <0.001). ROC curve showed cutoff 12.5% for delta CO to predict fluid responsiveness with Area under Curve (AUC) 0.927, sensitivity 90.0%, and specificity 70.0%. ROC also showed delta CO cutoff 12.5% to predict survival with AUC 0.756, sensitivity 66.7% and specificity 66.7%. Conclusion: Stroke volume variation, measured by electric cardiometry could be used to predict fluid response and survival in acute circulatory failure in septic critically ill patients.
 
ASPECTS scheme (A: anterior, P: posterior). A. CT Axial slice at the level of thalamus and basal ganglion which includes 4 deep and 3 cortical territories: (M1-M3, insula (I), lentiform nucleus (LN), caudate (C), posterior limb of the internal capsule (IC)). B. CT Axial slice at the level adjacent to the most superior margin of the ganglionic structures which includes 3 cortical MCA territories: (M4-M6) (approximately 2 cm superior to M1, M2 and M3 respectively): C: lower image coronal view shows levels of image scoring.
54-years-old patient presented with Lt. sided weakness CT. (A) Shows hypoattenuation in Internal capsule (ASPECTS=9), initial DWI-MRI. (B) Shows hyperintensity in Caudate, Internal capsule, Lentiform nucleus, Insula, M1, M2 and M3 regions (DWIASPECTS=3), SWI in the initial MRI. (C) was normal, follow up MRI T2 *. (D) After 5 days demonstrated hypointensity in the Caudate and Lentiform nucleus picture goes with hemorrhagic transformation.
Radiological signs of ischemia in CT and DWI-MRI with sensitivity, specificity and accuracy of CT ASPECTS compared with DWI-MRI ASPECTS.
Background: Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a quantitative score to evaluate early ischemic changes in the middle cerebral arterial territory on Computed Tomography (CT) in addition to diffusion-weighted imaging (DWI).Aim: To study the value of ASPECTS using CT and DWI-MRI in patients with acute stroke related to middle cerebral artery (MCA) territories and their values in predicting hemorrhagic transformation (HT).Methods and Materials: A prospective study was done at Al-Imamain Al-Kadhmain Medical City in Baghdad, Iraq from January 2017 to January 2018 and conducted on 100 patients (62 male, 38 female) who had acute ischemic stroke related to MCA territories and imaged with CT and Magnetic Resonance Imaging (MRI) within 6 hours of symptoms onset.Results: Male: Female ratio 1.6:1, mean age 58.7 ± 11.78 years, the mean of time between onset of symptoms and CT scan was 165 minutes. The difference between CT and DWI ASPECTS was about one point. CT scan signs of early ischemic changes were found in 58% of the patients while DWI-MRI signs of early ischemic changes were recognized in 75% patients (significance level P=0.011). The overall sensitivity and specificity of CT ASPECTS compared to MRI-DWI was 82.86% and 83.37% respectively and the accuracy was 83.00%, 70 patients had follow up by another MRI to detect HT, patients with low ASPECTS had more tendency to exhibit HT.Conclusion: ASPECTS is a simple applicable tool for early accurate recognition and standardizing the reporting evaluation of acute ischemic stroke related to MCA territories. DWI-ASPECTS scored were roughly one point lower than CT-ASPECTS. Although CT-ASPECTS and DWI-ASPECTS were valuable in predicting symptomatic HT, DWIASPECTS are more sensitive.
 
Background: Albinism is an established risk factor for skin cancer in Black Africans, especially squamous carcinoma. Main observations: I present 17 albinos with histologic diagnosis of adenocystic carcinoma who were seen at the National Orthopaedic Hospital, Enugu, Nigeria, from 1979 to 2008. Two hundred and eight patients constituted the entire series. Out of them, the 17 adenocystic carcinomas were selected for special study. This showed an age range of 25 years to 63 years (mean, 41 years). Eleven were males and six females, i.e., M/F ratio of 2:1 approximately. The lesions measured from 3 cm to 11 cm, the average being roughly 5 cm. Of the sites affected, the head preponderated in two-thirds of the cases. Conclusion: Albinism of the adenocystic carcinoma type should be recognized alongside the more frequent squamous carcinomas. However, no albino should suffer skin cancer let alone one reaching up to 5 cm across. This is possible with implementation of preventive public education strategies, including maternal care, empowerment of women, and indoor employment of albinos, this being a statutory action of Government.
 
Objective: Implant infections in elective orthopedic surgery are still a clinically relevant problem with devastating consequences for the patient. Thereof results a great need for new strategies to prevent implant infections. Functionalization of implant surfaces to reduce the microbial adherence show great potential in vitro, but have to be tested in suitable models in vivo. Proper evaluation methods of the bacterial load on the implant surface are important for their evaluation. Up to now, the simultaneous assessment of the quantity and morphology of the bacterial infection in vivo was not performed. Methods: Cubic Ti90/Al6/V4-rods were inserted in the tibia of Lewis rats and infected with Staphylococcus aureus strain 36/07 in different concentrations. After 21 days, explanted implants were stained for living and dead cells. The bacterial surface colonization was analyzed by confocal microscopy and assessed semi quantitatively via two different approaches (spot method and volume method) using the software Imaris® × 64. Furthermore the bacterial morphology was evaluated. The results were compared to radiographic and histological changes. Results: The new semi quantitative CLSM evaluation to assess the bacterial biomass on implant surfaces was successfully implemented. Both methods gave equivalent results. The results of the morphologic assessment of the bacterial colonization were similar to those of the quantification. A tendency towards increasing bacterial biomass and biofilm formation on the implant surface was observed with decreasing infection concentrations. In contrast, histologic and radiographic assessment as well as the relative tibial bone weight revealed more severe changes for higher inoculation concentrations. Conclusion: In combination with the morphological assessment of the bacterial appearance this CLSM based evaluation is a suitable tool to assess the bacterial load on the implant surface. Combined with radiographical and histological evaluation of bone alterations, this model is appropriate for the evaluation of new implant surfaces.
 
A 52-year-old women presented to our emergency department with nausea, vomiting and acute, progressive abdominal pain in the entire abdomen radiating to the back. Her history reported a congenital cloaca, for which she underwent reconstructive surgery twice during childhood. On physical examination normal bowel sounds were heard and no signs of peritoneal irritation were present. A contrast-enhanced computed tomography showed dilated small intestinal loops in the left upper quadrant and a bowel obstruction due to a non-rotation of the midgut. Furthermore, interruption of the vena cava inferior with azyguous continuation, polysplenia, short pancreas, bicornuate uterus and a small diaphragmatic hernia were seen. In this case report, these congenital anomalies are presented in the context of an unusual case of polysplenia syndrome.
 
Objective: This study aimed to examine exercise hemodynamic parameters and exercise capacity in adults with repaired tetralogy of Fallot (rTOF) obtained during supine bicycle echocardiography. Background: In addition to volumetric MRI parameters, exercise capacity in adults with rTOF is often used to determine timing for pulmonic valve replacement (PVR). Supine bicycle echocardiography is useful in measuring right ventricular (RV) hemodynamic parameters and quantifying exercise capacity and myocardial workload.
 
The example of the images received through traditional (A, B, C) and advanced bright-field (D) light optical polarization microscopy. Arrows are indicated MVs. 
Micro vesicles (MVs) are secreted as a component of secretome of various cells including stem cells, progenitors/ precursors and mature cells with different origin. MV are found to be a biological markers reflecting pathophysiological stages of disease, i.e. cardiovascular (CV) and metabolic diseases, autoimmune diseases, malignancy, infections and eclampsia. The fundamental effect of MV affects cell-to-cell cooperation, regulation of immune interrelations and transferring of several molecules. Therefore, there is a large body of evidence that confirmed the fact of number and phenotypes of MVs may be as a target for personal medical care as well as cargo for drug to the target cells. In this context, laboratory methods regarding purification of MV samples, determination of MVs, identification of origin of them and measure their concentration are fairly promising. The short communication is devoted to the consideration of advantages of novel bright-field light optical polarization microscopy, which is posed as an alternative quantified free-labeled measurement of main characteristics of MVs.
 
The finding determines the dependence of body processes on STP and MCT, six processes which occur in the isolated rabbit ileum were used to prove the statement of the theory 1 of BUTT, mainly effects of extract and Autonomic drugs on isolated rabbit ileum together with novel mathematical principles were used to show that seven normal processes (motility, secretion, metabolism, circulation, immunoreactivity, absorption, digestion) of the isolated rabbit ileum are directly proportional to activated STP and MCT and inversely proportional to inactivated STP and MCT. Acknowledge that from the above relation, STP responses Rs was used base on the assumption that all body processes are responses of STP and MCT, in other words, body processes are manifestation of STP response, thus First and foremost, I posit that any number of response (Rsn) or magnitude of response (Rsm) is a function of orproportional to activated STP backbones (Ni) and inversely proportional to inactivated STP backbone (Ny). To estimate Nifor each receptor in the isolated rabbit ileum, I determined number of molecules (N) for each drug and extract and number of molecules (Nx) towards the receptor direction, also using a biomarker (isolated rabbit ileum) the magnitude of effect (contraction and relaxation) of extract/drugs on the ileum was determined by combination interactions, novel mathematical equations and quantum physics, which gave me insight about the autonomic nature of the extract. Again from the combination interaction of antagonists and agonists with the extract as well as novel mathematical equation and calculation, I deduced the receptor types which combined with the extract, the couple receptor types, and the linked cascades in un limited sense of their complexity, in spite that past finding have unraveled various receptor types, limitations of characterization and crystallography abounds and so warrant use of mathematic to gain useful insight, interestingly, observed height, STP components’ flux time and mathematically determined magnitude of response (Rsm), shows strong correlation, of course as found in other findings, we assumed that alternating responses seen was due to bimodal on or off switches peculiar to STPs and MCT, these act in turn to activate many targets and therefore more than two responses might have occurred as predicted from various novel equation and calculation. The seven processes investigated are; directly; motility, indirectly; secretion, epithelial protein synthesis and transluminal absorption, digestion, circulation, and immunoreactive processes respectively, as a matter of veracity, it important to state that only the result of isolated rabbit ileum motility was obtained from which other processes were inferred from perspective of STP and MCT vital cascade components using platform of mathematics, in so far as this remain the case, the principle of hypothesis was investigated and lead to the emergence of Boy’o Universal Theory of Therapy (BUTT) 1, Theory 1 of BUTT called dependence theory states that any process; pathologic, physiologic, biochemical, genetic, metabolic and congenital occurring in the body, including drug efficacy and drawback, is directly proportional to activated signal transduction pathways (STPs) and inversely proportional to inactivated ones provided that MCT remains constant. The result was subject to both statistical analysis and mathematical calculation, for the statistical result standard deviation was 1.05 and magnitude of response (Rsm) was 27.996 at number of active components (Nc1) of 0.7 to indicate inactivation of STPs, other values show activation, a fact that is of clinical, pharmacological, and biomedical importance.
 
Objective: The aim of this study is to estimate the false-positive rate of computer-aided detection (CAD) with fullfield digital mammography (FFDM) in the detection of breast cancer. Materials and Methods: This study was conducted in the period from February, 2013 until September, 2014. It included 659 patients who presented to the radiology department for mammography. Full-field digital mammography (FFDM), three-dimensional breast tomosynthesis and computer-aided detection (CAD) were done for all patients. The patients had breast ultrasound +/- MR Mammography, with special attention to the sites of CAD suspicious lesions. Follow up protocol was done for the selected patients. Results: From the 659 patients included in the study, 56 patients, with 70 lesions, had false positive findings of malignancy on CAD, giving a false positive rate of 8%. These cases had suspicious lesions on CAD not detected on further investigations. The results of the follow up of all patients showed no newly developed suspicious lesions. Conclusion: The false positive rate of a CAD system in detection of breast malignancy was introduced in this study. As per the available data, example the effect of breast density on false positive CAD scores helped the radiologists in our hospital to dismiss most of the false CAD marks with more confidence with no need for further investigation. However, if CAD marks were hard to dismiss, further investigation by ultrasound +/- MR mammography was advisable.
 
A 55 years-old patient was treated in 2007 with left mastectomy, chemotherapy and hormonal therapy for breast cancer, achieving complete response. Three years later, hepatic recurrence was detected and a planar 99Tc-MDP bone scintigraphy was performed to restage the disease and assess the presence of bone metastases.
 
An OPG show ectopic left maxillary third molar in the left maxillary region (arrows).  
Transaxial CT images show presence of ectopic tooth in left antral cavity (thick arrow) with fluid collection and sclerotic / bony areas (thin arrows) and slight expansion of cavity.  
Photograph of surgically removed ectopic tooth from left maxillary antrum.  
Histopathological section showing signs of ameloblastic tissue in dentigerous cyst.  
Dentigerous cysts are commonest type of developmental, epithelial-lined, odontogenic cysts arising in the jaw from the crowns of impacted, unerupted or embedded tooth, most often third molar. But dentigerous cysts arising from ectopic tooth in maxillary sinus is quite rare. Ameloblastoma changes in the dentigerous cysts are rare and to the best of our knowledge have not been reported to be arising from ectopic tooth in maxillary antrum. In this article, we present the radiological diagnosis, clinical features and management of this rare case of ameloblastic transformation in dentigerous cyst arising from ectopic tooth in maxillary antrum.
 
Schematic presentation of sampling procedures among health facility TB laboratories in three zones of Western Amhara, 2012.  
Abstract Introduction: Quality of TB laboratory services in both public and private health facilities is a mandatory component in detecting active pulmonary TB cases and treatment follow-up. Even though it is one of the key components of DOTs strategy, a very low TB detection rate (36%) in Ethiopia and 37.5 % in Amhara Region was observed. The quality of TB laboratory services was very low (6.8%) in Ethiopia. Methodology: Institutional based cross sectional study was conducted among 60 randomly selected public and private TB laboratories in Western Amhara, Ethiopia. Data were collected by interviewing 120 laboratory personnel and 384 TB suspected patients, reviewing 270 patient records and panel testing among 20 laboratories. Data entered in to computer via Epi Info version 3.5.4 for editing and analysed using SPSS version 19. Findings at 95% Confidence interval and p value<0.05 were considered as statistical significant. Results: The presence of quality laboratory services in the study areas was reported by 53.0% of the study participants. Supportive supervision and timely feedback, internal and external quality assurance practices, equity in training and resource distribution were issues given less attention in the study areas. Poor documentation from record reviewing and about 10% false negative discordant report on panel testing were observed. Shortage and unfair distribution of inputs can compromise service quality by 79% and 76% (OR=0.21, CI=0.08-0.57 and OR=0.24, CI=0.07-0.81) respectively. Patient’s age, sex, religion, residence & educational status were none significant on TB laboratory services satisfaction. Farmers were 2.25 [1.26-4.05] times satisfied on TB laboratory services than their counter parts. Conclusion: About 53.2% patients reported the presence of quality TB laboratory services. Documentation and microscopic diagnosis or reading problems were observed from record reviewing and panel testing. Equity in inputs, training access, standard operational procedures, supervision, quality control activities, informing patients and checking sputum quality were most important determinants to improve the quality of TB laboratory services.
 
The action and side effects of intravenous anesthetics are difficult to control in critical patients. The inhaled anaesthetic agents are, at the moment, an alternative to intravenous drugs for sedation in these patients. The Anesthetic Conserving Device (AnaConDa®) facilitates the use of volatile anesthetics in critical care units as part of prolonged sedation. This device (AnaConDa®) is a vaporizer that is integrated into the respiratory circuit, between the -piece and the patient. It consists of a heat-moisture exchanger filter. The volatile anaesthetic gas is applied continuously in liquid form using a syringe pump. During inspiration, the volatile substance is released via the evaporator and transported in such a way to the patient. During the expiration phase, the anaesthetic is exhaled by the patient and is stored in the carbon layer, followed by a rerelease into the gas mixture during the next inspiratory cycle. More than 90% of the anaesthetic gas is recirculated in such a way. 10% of the anaesthetic agent passes through the filter and is released outside through the fan expiratory outlet. The use of volatile anesthetics in critical patients could adopt a permanent position in various intensive care analog sedation concepts in future.
 
Background: Good laboratory practice requires that Clinical laboratories verifies the performance claims of a method before results generated by such an instrument can be used for decisions about patient care. Analytical evaluation of a new point of care methods should be done before its introduction into the routine use in order to confirm its declared analytical performance specifications. Objective: To evaluate the degree of analytical accuracy of the Hemochroma POC haemoglobin reader relative to the Coulter AcT hematology analyzer. Study design and setting: A comparative study, conducted at the University of Nairobi, Thematic unit of Clinical Chemistry Laboratory and the Department of Obstetrics and Gynecology. Materials and methods: The evaluation was performed according to the guidelines of the European Committee for Clinical Laboratory Standards (ECCLS) and the guidelines on the evaluation of point of care testing instruments by the Australian Association of Clinical Biochemists (AACB). The analytical ability of Hemochroma POC reader (Boditech Med Inc.) to determine the levels of hemoglobin (Hb) according to the manufacturers claimed accuracy levels was evaluated using the routine 'comparative' method, Coulter AcT (Beckman Coulter Inc, Fulerton, CA 92835). Results: Hemochroma POC hemoglobin reader yielded a correlation coefficient of 0.976 against the Coulter AcT hematology analyzer. The slope and the y-axis intercept as well as their 95% confidence intervals were 0.990 (95% CI 0.891 to 1.020) and 0.003 (95% CI -0.151 to 1.439), respectively.
 
Objective: Treatment options for moderate to severe skin psoriasis have considerably progressed over the past decades with the widespread use of targeted biologicals including Tumor Necrosis Factor antagonists (TNFa). Objective and reliable analytical assessments of the disease course and the treatment efficacy are eagerly awaited. Methods: To disclose initial therapeutic effects of the adalimumab TNFa in a group of 13 psoriatic patients. The analytical observations relied on two in vivo real-time non-invasive methods, namely Reflectance Confocal Microscopy (RCM) and skin capacitance mapping (SCM). The L* colorimetric assessment of pictures was used for analytical assessments.
 
Our aim is to determine whether the serum electrolytes (Sodium and Potassium) measured by two different methods on two different equipments are equivalent or not. This retrospective study was conducted over three month’s period (June 2017-August 2017). A total number of 300 patients from intensive care unit or in the different wards with a variety of diagnoses were enrolled in this study. Analysis of sodium and potassium levels in their serum was carried out using an electrolyte analyzer and an auto analyzer. Statistical measures were applied using students paired t-tests. The mean level (± standard deviation) of sodium measured by electrolyte analyzer was statistically significantly higher than the auto analyzer values (139.99 ± 7.48 mmol/l and 137.15 ± 7.66 mmol/l respectively; P˂0.0001). Regarding the potassium levels, the Mean level (± standard deviation) measured by electrolyte analyzer was statistically significantly greater than that of potassium measured by auto analyzer (4.290 ± 0.743 mmol/l and 4.147 ± 0.738 mmol/l respectively; p˂0.0001). Our results showed that serum electrolytes levels measured by electrolyte analyzer were higher than those measured by auto-analyzer. Differences obtained were statistically significant.
 
The paper presents a novel method of real time telepathology system which is a combination of ICT (information and communication technology) that aims to improve the delivery of health care facility by allowing the physician (pathologist) to view the specimen and make a diagnosis from a remote location without the dependency of the operator. The system possesses the capability of manipulating the microscope stage position through internet so as to adjust the sample slide that is to be viewed, assisting the expert to appreciate the histological images to be viewed in real time from far and distant location. This robotically controlled microscopic system make use of microcontroller along with multiple software which helps in altering the microscope stage positioning through commands received over internet as requested by the user. The use of internet to access the microscope make system possible to operate it from anywhere around the world where internet access is available and adequate bandwidth is present. The real time system of remote telemicroscopy possesses an accuracy of 1 mm along X-axis, 0.5 mm accuracy along Y-axis and 0.125 mm accuracy along Z-axis. Also, 5 MP webcam is used and for the purpose of sharing these images an internet connection having a minimum speed of 512 kbps is required.
 
Objectives: To evaluate the quality of three-dimensional (3D) CT angiography images of the liver using iterative model reconstruction (IMR). Materials and Methods: Twenty-four patients with suspected disease of the pancreatobiliary system who had undergone CT reconstruction with filtered back projection (FBP) (Protocol A), iDose (hybrid IR) (Protocol B), and IMR (Protocol C) were evaluated. Contrast-to-noise ratios (CNR) relative to the liver, aorta, and portal vein were measured and recorded. The quality of 3D images under the same CT-threshold was graded on a scale of 1 (poor) to 5 (excellent). Results: The CNR of the artery and portal vein was highest when using protocol C. Mean value (±standard deviation) of the artery-to-liver CNRs for each protocol was as follows: A (6.95 ± 1.53), B (12.05 ± 2.38), and C (33.12 ± 7.93). Mean value (±standard deviation) of the portal vein-to-liver CNRs for each protocol was as follows: A (2.81 ± 0.62), B (5.17 ± 1.40), and C (10.27 ± 3.99). The quality of 3D images significantly differed between the three methods, with that of Protocol C being the highest. Conclusions: Compared to FBP and hybrid IR, abdominal CT scans via IMR produced higher-quality 3D angiography images of the liver at the same radiation dose and with significant improvements in CNR.
 
Introduction: Phyllodes tumours are rare neoplasms, representing less than 1% of all primary tumours of the breast. Case report: We report the case of a woman who presented with a malignant phyllodes tumour of the breast, with an osteosarcomatous component. A year after surgery, a control thoracic CT scan revealed nodules in the lung. Shortly after, she also developed cardiac and dermo-hypodermic lesions, histologically characterized as angiosarcoma with an osteoclastic component. Discussion: Malignant breast phyllodes tumour often metastasizes to the lungs, bones, liver and brain. To the best of our knowledge, there is only one case in literature that reports a cutaneous metastasis of phyllodes tumour under the form of an angiosarcoma, whilst, to date, no such myocardial involvement has been reported.
 
Background: Ankle-brachial systolic pressure index, reflect arterial hemodynamics in lower extremity and therefore indicates the presence of peripheral arterial disease. On the other hand, an emerging method for assessing arterial stiffness is brachial-ankle pulse wave velocity. Automated devices, such as the “Vascular Profiler 1000” (VP1000) (Omron®, Kyoto, Japan), are currently available for measuring not only the brachial-ankle pulse wave velocity but also the ankle-brachial index, proving their utility in the diagnosis of peripheral arterial disease. Objective: This study assessed the agreement and reproducibility of non-invasive measurement of brachialankle pulse wave velocity (baPWV) and the ankle-brachial index (ABI) with the OMRON® VP1000 device, in a Mexican population of healthy individuals. Methods: The cross-sectional study was carried out in 36 healthy subjects (20 men and 16 women; average age was 20.6 ± 1.6 years, average BMI 23.5 ± 3.5 kg/m2, average waist circumference 82.5 ± 9.3 cm kg/m2) from Guadalajara, México. The baPWV and ABI were measured with the VP1000 device, and all values were expressed as the average ± SD. The correlation between the first and second measurements was analyzed using Pearson’s correlation coefficient and the Bland Altman method. All p-values were two-tailed, and p<0.05 was accepted as significant. Results: The right and left baPWV showed good correlation between the first and second measurements (r2Pearson=0.810, p<0.001 and r2 Pearson=0.831, p<0.001). The arterial ABI also showed good correlation between the first and second measurement (r2 Pearson=0.730, p<0.001 and r2 Pearson=0.599, p<0.001). The Bland-Altman plot of the first and second baPWV and ABI measurements demonstrated good agreement (mean difference -4.3 ± 39.43 cm/s and -0.0071 ± 0.43, respectively). Conclusion: The results obtained with the OMRON® VP1000 device, demonstrate high and significant correlation, as well as good agreement, between the first and second baPWV arterial stiffness and ABI values.
 
Background: Ankle-brachial systolic pressure index, reflect arterial hemodynamics in lower extremity and therefore indicates the presence of peripheral arterial disease. On the other hand, an emerging method for assessing arterial stiffness is brachial-ankle pulse wave velocity. Automated devices, such as the “Vascular Profiler 1000” (VP1000) (Omron®, Kyoto, Japan), are currently available for measuring not only the brachial-ankle pulse wave velocity but also the ankle-brachial index, proving their utility in the diagnosis of peripheral arterial disease. Objective: This study assessed the agreement and reproducibility of non-invasive measurement of brachialankle pulse wave velocity (baPWV) and the ankle-brachial index (ABI) with the OMRON® VP1000 device, in a Mexican population of healthy individuals. Methods: The cross-sectional study was carried out in 36 healthy subjects (20 men and 16 women; average age was 20.6 ± 1.6 years, average BMI 23.5 ± 3.5 kg/m2, average waist circumference 82.5 ± 9.3 cm kg/m2) from Guadalajara, México. The baPWV and ABI were measured with the VP1000 device, and all values were expressed as the average ± SD. The correlation between the first and second measurements was analyzed using Pearson’s correlation coefficient and the Bland Altman method. All p-values were two-tailed, and p<0.05 was accepted as significant. Results: The right and left baPWV showed good correlation between the first and second measurements (r2Pearson=0.810, p<0.001 and r2 Pearson=0.831, p<0.001). The arterial ABI also showed good correlation between the first and second measurement (r2 Pearson=0.730, p<0.001 and r2 Pearson=0.599, p<0.001). The Bland-Altman plot of the first and second baPWV and ABI measurements demonstrated good agreement (mean difference -4.3 ± 39.43 cm/s and -0.0071 ± 0.43, respectively). Conclusion: The results obtained with the OMRON® VP1000 device, demonstrate high and significant correlation, as well as good agreement, between the first and second baPWV arterial stiffness and ABI values.
 
Objective: The purpose of this study is to elucidate deformation of each compression and torsion exerted to the proximal left anterior descending (LAD) artery during the cardiac cycle. Background: We hypothesised that mechanical stress exerted on the proximal LAD artery by cardiac contractions is a determinant of the need for repeat revascularization after stenting, though the proximal LAD motion has not been thoroughly studied. Methods: We prospectively analysed the electrocardiogram-gated, 64-slice multi detector row computed tomography (CT) images obtained in 297 consecutive patients suspected of suffering from coronary artery disease for having major risk factors, an abnormal electrocardiogram, or angina pectoris. Results: Using multi-planar reconstruction and enhanced cross-sectional CT images, the compression and torsion of the proximal LAD artery between end-systole and end-diastole were 15.6 ± 26.4% and 0.5 ± 0.6°/mm, respectively. The compression ratio was significantly smaller in diabetic (12.3 ± 33.8%) than in non-diabetic (16.5 ± 24.1%) patients (P<0.05). The torsion was also smaller in patients with versus without 3-vessel coronary disease (0.3 ± 0.3°/mm versus 0.5 ± 0.6°/mm; P<0.05) and in patients with versus without histories of previous valve surgery (0.2 ± 0.1°/mm versus 0.5 ± 0.6°/mm; P<0.05). Conclusions: We measured the amount of compression and torsion to the proximal LAD artery associated with the cardiac contractions. These mechanical stimuli may promote plaque rupture and progression, and in-segment restenosis after stent implantations.
 
Antineutrophil cytoplasmic antibodies (ANCA) is usually considered to be associated with autoimmune neutropenia, but the association between ANCA and autoimmune pulmonary hemorrhage has been rarely reported. In this case, we reported a 49 year-old woman with paroxysmal cough and hemoptysis. The symptom didn’t improve from any anti-infection treatment. Further autoantibodies analysis reveals ANCA positive (MPO-ANCA 1472.3 AAU/ml, normal <180.0 AAU/ml), and negative anti-GBM antibodies. The patient was diagnosed with microscopic polyangiitis, and was treated with methylprednisolone and cyclophosphamide. After 10 days treatment, the patient’s hemoptysis and paroxysmal cough was eliminated. CT scan also revealed a miniaturized pulmonary lesion. Although rare, ANCA-associated pulmonary lesion should be kept aware when other factors such as infection and toxin cannot explain the severe symptom. Early detection and routine autoantibodies analysis are needed to prevent condition from deteriorating further and minimize mortality.
 
Three patients with gastric adenocarcinoma, endometrial cancer and pancreatic head cancer respectively were treated medications including herbal regimens. The clinical outcomes were followed. These regimens were effective. The patients were able to be engaged in mild physical labor or exercises. The patient with gastric cancer was cured after 10 months’ outpatient treatment without the evidence of recurrence for 116 months. The patient with endometrial cancer was cured gradually for a period of 44 months. The patient with pancreas head cancer showed decreased tumor size, increased body weight, and regained sex life for 31 months. Through these three successful cases treated with integrative medicine, we concluded that it is possible to reduce the side effects of conventional chemotherapies, improve patients’ life quality, and cure cancers or relieve cancer burdens by using regimens based on the principles in the practice of general medicine.
 
Top-cited authors
Rahul Kathariya
  • Dental Galaxy, Pune
Tomasz Zatoński
  • Wroclaw Medical University
Abdelaali Bahadi
  • La Faculté de Médecine et de Pharmacie de Rabat
Uday Gulati
Verna Dnk Vanderpuye
  • Korle Bu Teaching Hospital