135,009 results match your criteria diagnostic challenge

Adrenal adenoma as a cause of atypical psychosis: Presentation, diagnosis, surgical technique and outcome (case report with a brief literature review).

Int J Surg Case Rep 2021 Jul 8;85:106187. Epub 2021 Jul 8.

Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco.

Introduction And Importance: Psychiatric symptoms may be a mode of the revelation of several endocrinopathies, but rarely in primary hyperaldosteronism, which can increase psychiatric comorbidity, as well as cardiovascular risk.

Case Presentation: We report a case of a 26-year-old engineer, who suffered from atypical psychosis before being hospitalized for a state of agitation, he presented with high blood pressure and severe hypokalemia. An etiological assessment revealed a right adrenal adenoma, which was afterward resected, with a very good evolution. Read More

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Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection.

PLoS Negl Trop Dis 2021 Jul 27;15(7):e0009453. Epub 2021 Jul 27.

Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock-like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)-multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Read More

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ACA Medicaid expansion association with racial disparity reductions in timely cancer treatment.

Am J Manag Care 2021 Jul;27(7):274-281

Flatiron Health, Inc, 233 Spring St, Fifth Fl, New York, NY 10025. Email:

Objectives: Racial disparities in cancer care and outcomes remain a societal challenge. Medicaid expansion through the Affordable Care Act was intended to improve health care access and equity. This study aimed to assess whether state Medicaid expansions were associated with a reduction in racial disparities in timely treatment among patients diagnosed with advanced cancer. Read More

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Rapid antigen detection alone may not be sufficient for early diagnosis and/or mass screening of COVID-19.

J Med Virol 2021 Jul 27. Epub 2021 Jul 27.

Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.

Currently, COVID-19 pandemic is still severe, and the major challenge in the fight against this pandemic is how to early find pre-symptomatic and asymptomatic individuals and to eliminate silent transmission. Rapid antigen detection alone may not be sufficient for early diagnosis and/or mass screening of COVID-19, and direct probe-based RT-LAMP assay or other nucleic acid amplification (NAA)-based POCT strategies should be recommended to use alone or together with rapid antigen test in mass screening or community-based testing of SARS-CoV-2 This article is protected by copyright. All rights reserved. Read More

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The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial.

JMIR Res Protoc 2021 Jul 27;10(7):e28624. Epub 2021 Jul 27.

David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.

Background: Indoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon. Read More

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Essentials for Interpreting Intracranial Vessel Wall MRI Results: State of the Art.

Radiology 2021 Jul 27:204096. Epub 2021 Jul 27.

From the Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.

Intracranial vessel wall (VW) MRI has become widely available in clinical practice, providing multiple uses for evaluation of neurovascular diseases. The Vessel Wall Imaging Study Group of the American Society of Neuroradiology has recently reported expert consensus recommendations for the clinical implementation of this technique. However, the complexity of the neurovascular system and caveats to the technique may challenge its application in clinical practice. Read More

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Osteochondrolipoma of the Hand.

J Hand Surg Am 2021 Jul 23. Epub 2021 Jul 23.

Sanford Orthopedics and Sports Medicine, Sioux Falls, SD; Department of Orthopaedics, University of Kansas Medical Center, Wichita, KS.

Lipoma is the most common type of benign soft tissue tumor and is composed of mature adipose tissue. A neoplasm of adipose tissue with admixed mature bone and cartilage, or osteochondrolipoma, is an extremely rare histologic variant. Most documented osteochondrolipomas have occurred in the soft tissues of the head and neck related to the oral cavity, and the tumor is seen involving the extremities. Read More

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Exomphalos with intestinal fistulation: Case series and systematic review for clinical characterization, management and embryopathogenesis.

J Pediatr Surg 2021 Jul 14. Epub 2021 Jul 14.

Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Chelsea Children's Hospital, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK. Electronic address:

Introduction: Exomphalos with intestinal fistulation (EIF) is a rare variant of exomphalos with intestine opening to the surface of an intact sac, and may result in a diagnostic challenge. We report 3 new cases and conducted a systematic review of the literature, to characterize its association with the type of exomphalos and vitellointestinal duct (VI) as well as to evaluate its management and outcomes.

Methods: A literature search from PubMed using keywords pertaining to exomphalos and fistulation was used to identify all unique cases reported between 1950 and 2020, in addition to the case series reported here, to establish the clinical presentation, histological findings, management and outcomes. Read More

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Comparative assessment of faecal diagnostics for detection and predictive modelling of endemic Fasciola hepatica infection in sheep and cattle on Australian farms.

Vet Parasitol 2019 27;276S:100001. Epub 2018 Dec 27.

Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, New South Wales, Australia.

The diagnosis, monitoring and flukicide efficacy testing of fasciolosis on-farm is reliant on non-terminal methods. The coproantigen ELISA (cELISA) has been recommended for diagnosis of fasciolosis and associated flukicide efficacy testing as an alternative to fluke egg counts for monitoring parasitism. Recently experimental multi-age infections have suggested that the reliability of efficacy results can be improved by a second cELISA testing at 6 weeks post-treatment (wpt) in addition to the generally accepted 1 wpt. Read More

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December 2018

In-home assessment of flea control and dermatologic lesions in dogs provided by lotilaner (Credelio®) and spinosad (Comfortis®) in west central Florida.

Vet Parasitol 2019 4;276S:100009. Epub 2019 Apr 4.

Department of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, KS 66506, USA. Electronic address:

Post-launch field investigations of recently-approved flea control products establish an efficacy baseline and in subsequent years can detect any efficacy decline suggestive of emerging resistance. As part of a continuing program of yearly assessment of flea control products in west central Florida, this study, using client-owned dogs, investigated the efficacy of lotilaner and spinosad in controlling fleas and in alleviating dermatologic signs likely associated with flea infestations. Forty-four qualifying households were randomized to either a lotilaner (Credelio®) (minimum dose rate 20 mg/kg) or a spinosad (Comfortis®) (30 mg/kg) group, with 33 and 36 dogs in each group, respectively. Read More

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Full-length G Glycoprotein directly extracted from Rabies Virus with Detergent and then Stabilized by Amphipols in Liquid and Freeze-dried Forms.

Biotechnol Bioeng 2021 Jul 23. Epub 2021 Jul 23.

Bioprocess R&D Department, Sanofi Pasteur, Marcy l'Etoile, France.

Pathogen surface antigens are at the forefront of the viral strategy when invading host organisms. These antigens, including membrane proteins (MPs), are broadly targeted by the host immune response. Obtaining these MPs in a soluble and stable form constitutes a real challenge, regardless of the application purposes (e. Read More

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Mesenchymal tumours of the gastrointestinal tract.

Pathologica 2021 Jun;113(3):230-251

Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy.

Mesenchymal tumours represent a heterogenous group of neoplasms encopassing benign, intermediate malignancy, and malignant entities. Sarcomas account for approximately 1% of human malignancies. In consideration of their rarity as well as of intrinsic complexity, diagnostic accuracy represents a major challenge. Read More

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Pathology of non-alcoholic fatty liver disease.

Pathologica 2021 Jun;113(3):194-202

Department of Pathology, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of different conditions which are characterized by hepatic steatosis in the absence of secondary causes. It is currently the most common chronic liver disease worldwide, and its estimated prevalence is about 1.5-6. Read More

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Pathology of autoimmune hepatitis.

Pathologica 2021 Jun;113(3):185-193

Pathology Department Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.

Autoimmune hepatitis (AIH) is a relatively rare non-resolving chronic liver disease, which mainly affects women. It is characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis on liver histology and a favourable response to immunosuppression. The putative mechanism for the development of autoimmune hepatitis is thought to be the interaction between genetic predisposition, environmental triggers and failure of the native immune system. Read More

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The Efficient Dizziness History and Exam.

Otolaryngol Clin North Am 2021 Jul 20. Epub 2021 Jul 20.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA. Electronic address:

Dizziness is a common complaint in otolaryngology clinics and can present a diagnostic challenge. A thorough history including onset, duration, and exacerbating and alleviating factors, along with physician persistence, can help differentiate between otologic and nonotologic forms of dizziness. An otologic and neurotologic physical examination, including vestibulo-ocular reflex and cranial nerve function evaluation and postural examination, can shed further light on symptom etiology. Read More

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Acute Vestibular Syndrome and ER Presentations of Dizziness.

Otolaryngol Clin North Am 2021 Jul 20. Epub 2021 Jul 20.

Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA. Electronic address:

Acute vestibular syndrome (AVS) describes sudden onset, severe, continuous dizziness that persists for more than 24 hours. Its wide differential presents a diagnostic challenge. Vestibular neuritis is the most common cause, but stroke, trauma, medication effects, infectious, and inflammatory causes all present similarly. Read More

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A systematic review of the applications of Expert Systems (ES) and machine learning (ML) in clinical urology.

BMC Med Inform Decis Mak 2021 Jul 22;21(1):223. Epub 2021 Jul 22.

NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, NG72UH, UK.

Background: Testing a hypothesis for 'factors-outcome effect' is a common quest, but standard statistical regression analysis tools are rendered ineffective by data contaminated with too many noisy variables. Expert Systems (ES) can provide an alternative methodology in analysing data to identify variables with the highest correlation to the outcome. By applying their effective machine learning (ML) abilities, significant research time and costs can be saved. Read More

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A questionnaire-based study to comprehensively assess the status quo of rare disease patients and care-givers in China.

Orphanet J Rare Dis 2021 Jul 22;16(1):327. Epub 2021 Jul 22.

Gene Therapy Center, Department of Pediatrics, University of Minnesota, 5-174 MCB, 420 Washington Ave SE, Minneapolis, MN, 55455, USA.

Background: There are over 16.8 million rare disease patients in China, representing a large community that should not be neglected. While the public lack the awareness of their existence and difficult status quo, for one reason that they exist as a rare and special group in our society, for another reason that all sectors of the community haven't introduced and propagandized them suitably. Read More

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Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study.

BMC Public Health 2021 Jul 22;21(1):1445. Epub 2021 Jul 22.

Institute for Global Health, University College London, London, UK.

Background: Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered.

Methods: Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Read More

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A Real Saline Challenge: Diagnosing Primary Aldosteronism in the Setting of Chronic Kidney Disease.

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211034337

University of Texas Southwestern Medical Center, Dallas, TX, USA.

Primary aldosteronism (PA) is the most common cause of secondary hypertension but remains largely undiagnosed. Chronic kidney disease (CKD) complicates the diagnosis of PA by affecting the biochemical screening evaluation and confirmatory testing, and by increasing the complication rate of adrenal venous sampling (AVS). To raise clinician awareness of the challenges of PA diagnosis in CKD, we present an illustrative case with subsequent review of the literature and discuss some recent developments in PA diagnostic strategies particularly applicable to the CKD population. Read More

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Deriving Health Utility Indices From a Food Allergy Quality-of-Life Questionnaire.

Pediatr Allergy Immunol 2021 Jul 26. Epub 2021 Jul 26.

Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Background: The Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) is widely used to assess food allergy-specific health-related quality of life (FAQL), but cannot be used directly in cost-utility analyses, which require health state utility (HSU) scores. Currently, limited evidence is available regarding the HSU of food allergic children/adolescents. This study aimed to develop mapping algorithms from the FAQLQ-PF onto HSU scores generated by generic, preference-based, health-related quality-of-life (HRQL) instruments. Read More

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[Approach to the diagnosis and management of patients with cardiac amyloidosis. A consensus document by the Tuscan section of the Italian Association of Hospital Cardiologists (ANMCO) and the Tusco-Umbrian section of the Italian Society of Cardiology (SIC)].

G Ital Cardiol (Rome) 2021 Aug;22(8):621-634

U.O.C. Cardiologia, Ospedale della Versilia, Lido di Camaiore (LU).

The diagnosis of cardiac amyloidosis (CA) is challenging because of its phenotypic heterogeneity, multi-organ involvement often requiring the interaction among experts in different specialties and subspecialties, the lack of a single non-invasive diagnostic tool, and limited awareness in the medical community. Recent studies have challenged the dogma of CA as a rare, incurable disease, and have redefined the epidemiology and therapeutic options for this condition. Missing or delaying the diagnosis may have a profound impact on patient outcome, as potentially life-saving treatments may be omitted or delayed, particularly chemotherapy in the case of amyloid light-chain amyloidosis. Read More

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Multi-Band Brain Network Analysis for Functional Neuroimaging Biomarker Identification.

IEEE Trans Med Imaging 2021 Jul 26;PP. Epub 2021 Jul 26.

The functional connectomic profile is one of the non-invasive imaging biomarkers in the computer-assisted diagnostic system for many neuro-diseases. However, the diagnostic power of functional connectivity is challenged by mixed frequency-specific neuronal oscillations in the brain, which makes the single Functional Connectivity Network (FCN) often underpowered to capture the disease-related functional patterns. To address this challenge, we propose a novel functional connectivity analysis framework to conduct joint feature learning and personalized disease diagnosis, in a semi-supervised manner, aiming at focusing on putative multi-band functional connectivity biomarkers from functional neuroimaging data. Read More

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Miliarial type perifollicular B cell pseudolymphoma: an easily overlooked rare subtype of pseudolymphoma cutis manifesting as a centrofacial acneiform eruption.

J Eur Acad Dermatol Venereol 2021 Jul 26. Epub 2021 Jul 26.

Department of Dermatology, Medical University of Vienna, Vienna, Austria.

Miliarial type perifollicular B cell pseudolymphoma (MTPBCP) is an uncommon subtype of pseudolymphoma cutis clinically defined by multiple asymptomatic, translucent, firm pinhead sized skin-colored or brownish-red papules with symmetric distribution. Predilection sites are the centrofacial area and the neck. This exceedingly rare type of pseudolymphoma may pose a diagnostic challenge both clinically and histologically. Read More

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[Recommendations for the management of acute lower respiratory infections in children under 2 years of age. Update 2021].


Arch Argent Pediatr 2021 Aug;119(4):S171-S197

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them. In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications. Read More

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[Hyper IgE syndrome: atopic dermatitis as first manifestation. Case report].

Arch Argent Pediatr 2021 Aug;119(4):e370-e374

Unidad de Inmunología, Hospital de Niños Sor María Ludovica, La Plata, Argentina.

Atopic dermatitis is the most common form of eczema often developed before the first year of life. Nevertheless, when the presentation is atypical or related to infections the diagnostic represents a challenge for the pediatricians. It is important to maintain a high index of suspicion for the detection of primary immunodeficiency associated to severe eczema. Read More

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The Challenge of Acute Kidney Injury Diagnostic Precision: From Early Prediction to Long-Term Follow-up.

Kidney Int Rep 2021 Jul 19;6(7):1755-1757. Epub 2021 May 19.

Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.

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Multi-omics analysis of respiratory specimen characterizes baseline molecular determinants associated with SARS-CoV-2 outcome.

iScience 2021 Aug 9;24(8):102823. Epub 2021 Jul 9.

Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi 110070, India.

Rapid diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection still remains a major challenge. A multi-omic approach was adopted to analyze the respiratory specimens of 20 SARS-CoV-2-positive, 20 negative and 15 H1N1 pdm 2009 positive cases. Increased basal level of MX1 (MX dynamin-like GTPase 1) and WARS (tryptophan-tRNA ligase) correlated with SARS-CoV-2 infection and its outcome. Read More

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