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Drug-Induced Vanishing Bile Duct Syndrome: From Pathogenesis to Diagnosis and Therapeutics.

Semin Liver Dis 2021 Jun 15. Epub 2021 Jun 15.

Instituto de Fisiología Experimental (CONICET-UNR), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.

The most concerned issue in the context of drug/herb-induced chronic cholestasis is vanishing bile duct syndrome. The progressive destruction of intrahepatic bile ducts leading to ductopenia is usually not dose dependent, and has a delayed onset that should be suspected when abnormal serum cholestasis enzyme levels persist despite drug withdrawal. Immune-mediated cholangiocyte injury, direct cholangiocyte damage by drugs or their metabolites once in bile, and sustained exposure to toxic bile salts when biliary epithelium protective defenses are impaired are the main mechanisms of cholangiolar damage. Read More

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Association of Acute Kidney Injury with Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair.

Cardiology 2021 Jun 15:1-7. Epub 2021 Jun 15.

Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, prior single-center studies have demonstrated a high incidence of acute kidney injury (AKI) following TMVr. The main objective of this study was to examine risk factors for AKI, and its association with outcomes in patients undergoing TMVr.

Methods: We queried the National Readmission Database to identify TMVr procedures performed between January 2014 and December 2017. Read More

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Significance of detecting postmortem serum IgE in frozen corpses for the diagnosis of anaphylaxis in forensic.

Leg Med (Tokyo) 2021 Jun 9;53:101930. Epub 2021 Jun 9.

Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China. Electronic address:

The aim of this study was to detect the postmortem serum total IgE levels in frozen corpses and identify whether the death incident caused by an anaphylaxis in forensic medicine. Autopsy cases with pathological death (total, n = 106; 4-214 h postmortem) include cardiac disease (n = 15), pulmonary infection (n = 12), central nervous system disorder (n = 6), pulmonary emboliszn (n = 7), hapetic disease (n = 5), kidney disease (n = 6), enteric disease (n = 10), necrotizing pancreatitis (n = 7), diffuse peritonitis (n = 6), MODS (n = 6), toxicosis (n = 5:), anaphylactic shock (n = 7), bronchial asthma (n = 8) and other disease (n = 6) were examined. Results showed that there was no significant difference between serum IgE levels and ages, postmortem intervals (PMIs), gender as well as survival time. Read More

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United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and Bell-Ringers/Dings: Perceived Differences and Similarities.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

Associate Professor, Twitter:

Context: After a potential concussion mechanism, a cadet is unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition.

Objective: The primary purpose of an overall study was to explore determinants that contributed to United States Air Force Academy (USAFA) cadets to disclose a concussion. Read More

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Segmentation and recognition of breast ultrasound images based on an expanded U-Net.

PLoS One 2021 15;16(6):e0253202. Epub 2021 Jun 15.

UItrasonic Diagnosis Department, Chengcheng County Hospital, Weinan, Shanxi province, China.

This paper establishes a fully automatic real-time image segmentation and recognition system for breast ultrasound intervention robots. It adopts the basic architecture of a U-shaped convolutional network (U-Net), analyses the actual application scenarios of semantic segmentation of breast ultrasound images, and adds dropout layers to the U-Net architecture to reduce the redundancy in texture details and prevent overfitting. The main innovation of this paper is proposing an expanded training approach to obtain an expanded of U-Net. Read More

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The World Brain Death Project: The More You Say It Does Not Make It True.

J Clin Ethics 2021 ;32(2):97-108

Pediatric Intensive Care Unit, Royal Children's Hospital, 50 Flemington Rd., Parkville, Melbourne, 3052 Australia.

The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic and metaphysical assertions that were either false, ad hoc, or confused. Read More

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Nickel Hypersensitivity to Atrial Septal Occluders: Smoke Without Fire?

Clin Rev Allergy Immunol 2021 Jun 15. Epub 2021 Jun 15.

First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.

Nickel is one of the most common contact allergens worldwide; it is used as the main component of the devices used for atrial septal defects (ASDs) and patent foramen ovale (PFO) closure. Developing nickel hypersensitivity after PFO/ASD occlusion is significantly rarer described in medical literature than typical nickel contact sensitization. The exact pathophysiological mechanism of this "device syndrome" remains unknown, and many question the real incidence or even the existence of this clinical entity. Read More

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Diagnosis and management of osteoporosis in chronic kidney disease stages 4 to 5D: a call for a shift from nihilism to pragmatism.

Osteoporos Int 2021 Jun 15. Epub 2021 Jun 15.

Bone and Mineral Research Unit (ISPA) (REDinREN), Hospital Universitario Central Asturias, Oviedo University, Asturias, Spain.

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4-5D (eGFR < 30 ml/min 1.73 m). The present article reports and summarizes the main recommendations included in this 2021 document. Read More

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Hyperglycemia and Hypo-HDL-cholesterolemia Are Primary Risk Factors for Age-related Cataract, and a Korean-style Balanced Diet has a Negative Association, based on the Korean Genome and Epidemiology Study.

J Korean Med Sci 2021 Jun 14;36(23):e155. Epub 2021 Jun 14.

Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan, Korea.

Background: The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004-2013. Read More

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Factors affecting delay in diagnosis of colorectal cancer; a cross sectional study; from tertiary care hospital of Karachi Pakistan.

Int J Clin Pract 2021 Jun 15:e14529. Epub 2021 Jun 15.

Surgical unit 3, Dr. Ruth K.M Pfau Civil Hospital, Dow University of Health Sciences Karachi, Pakistan.

Background: Colorectal cancer incidence is increasing in our region. There is no specific CRC control program or national cancer registry in Pakistan. Previously no data has been published on presentation delay and diagnosis delay of CRC in our region. Read More

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MXene and black phosphorus based 2D nanomaterials in bioimaging and biosensing: progress and perspectives.

J Mater Chem B 2021 Jun 15. Epub 2021 Jun 15.

Center for Biomedical Photonics & College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China.

Bioimaging and biosensing have garnered interest in early cancer diagnosis due to the ability of gaining in-depth insights into cellular functions and providing a wide range of diagnostic parameters. Emerging 2D materials of multielement MXenes and monoelement black phosphorous nanosheets (BPNSs) with unique intrinsic physicochemical properties such as a tunable bandgap and layer-dependent fluorescence, high carrier mobility and transport anisotropy, efficient fluorescence quenching capability, desirable light absorption and thermoelastic properties, and excellent biocompatibility and biosafety properties provide promising nano-platforms for bioimaging and biosensing applications. In view of the growing attention on the rising stars of the post-graphene age in the progress of bioimaging and biosensing, and their common feature characteristics as well as complementarity for constructing complexes, the main objective of this review is to reveal the recent advances in the design of MXene or BPNS based nanoplatforms in the field of bioimaging and biosensing. Read More

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Deep Learning in Classification of Covid-19 Coronavirus, Pneumonia and Healthy Lungs on CXR and CT Images.

J Med Biol Eng 2021 Jun 10:1-9. Epub 2021 Jun 10.

Division of Graduate Studies, Tijuana Institute of Technology, Baja CA 22414 Tijuana, Mexico.

Purpose: In this paper, the transfer learning method has been implemented to chest X-ray (CXR) and computed tomography (CT) bio-images of diverse kinds of lungs maladies, including CORONAVIRUS 2019 (COVID-19). COVID-19 identification is a difficult assignment that constantly demands a careful analysis of a patient's clinical images, as COVID-19 is found to be very alike to pneumonic viral lung infection. In this paper, a transfer learning model to accelerate prediction processes and to assist medical professionals is proposed. Read More

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Twelve-year Incidence of Open-angle Glaucoma: The Thessaloniki Eye Study.

J Glaucoma 2021 Jun 15. Epub 2021 Jun 15.

Glaucoma Unit, Moorfields Eye Hospital NHS Foundation Trust, London, UK Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA Wayne State University, Detroit, Michigan, USA Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objective: To determine the 12-year incidence of open-angle glaucoma (OAG), with further classification into primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG), in an elderly Caucasian population.

Design: Longitudinal, population-based study in urban Northern Greece.

Participants: Surviving cohort of the 2554 Thessaloniki Eye Study subjects ≥60 years old who had the baseline examination. Read More

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Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.

BMJ Qual Saf 2021 Jun 14. Epub 2021 Jun 14.

NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK

Background: Diagnostic error is a global patient safety priority.

Objectives: To estimate the incidence, origins and avoidable harm of diagnostic errors in English general practice. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available (missed diagnostic opportunities, MDOs). Read More

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Newborn screening for cystic fibrosis: Role of primary care providers in caring for infants with positive screening results.

Can Fam Physician 2021 Jun;67(6):e144-e152

Clinician scientist in the Division of Pediatric Medicine at the Hospital for Sick Children, Chief Science Officer and Senior Scientist at ICES, and Professor of Pediatrics with a cross appointment at the Institute of Health Policy, Management and Evaluation and the Epidemiology Division of the Dalla Lana School of Public Health at the University of Toronto.

Objective: To explore primary care providers' (PCPs') preferred roles and confidence in caring for infants receiving a positive cystic fibrosis (CF) newborn screening (NBS) result, as well as management of CF family planning issues, given that expanded NBS has resulted in an increase in positive results.

Design: Mailed questionnaire.

Setting: Ontario. Read More

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Evaluation of test characteristics of 2 ELISA tests applied to bulk tank milk and claw-trimming records for herd-level diagnosis of bovine digital dermatitis using latent class analysis.

J Dairy Sci 2021 Jun 11. Epub 2021 Jun 11.

Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 369 Sentrum, N-0102 Oslo, Norway.

Bovine digital dermatitis (DD) is an infectious claw disease with a negative effect on animal welfare and production. Treponema spp. is the main causative agent, and infected animals produce specific antibodies. Read More

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The Dilemma, Conversion Disorder or Stiff Person Syndrome, a Case Report.

Sultana Jahan

CNS Spectr 2021 Apr;26(2):145-146

University of Missouri, Department of Psychiatry, Columbia, MO, USA.

Study Objectives: The main objectives of this case study are 1. Clinicians facing symptoms that are difficult to interpret should exercise caution in diagnosing conversion disorder. 2. Read More

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Diagnostic tools for neurosyphilis: a systematic review.

BMC Infect Dis 2021 Jun 14;21(1):568. Epub 2021 Jun 14.

Infection Control Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.

Purpose: Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods.

Methods: We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Read More

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Deforestation drivers in the Brazilian Amazon: assessing new spatial predictors.

J Environ Manage 2021 Jun 11;294:113020. Epub 2021 Jun 11.

Department of History and Geography, State University of Maranhão, Cidade Universitária Paulo VI, São Luís, 65055-000, Brazil. Electronic address:

Researches on the deforestation of the Amazon have gained prominence in the last recent years, mainly with the change in the policy regarding the facing of this phenomenon by the Brazilian government. Therefore, an understanding about the causes that pressure the occurrence of deforestation remains relevant and has a leading role in the world. Therefore, the aim of this study is to perform the analysis of the spatial variability of the reasons for the deforestation in the Amazon Biome, in Brazil, (2010-2019). Read More

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Gut microbiome composition and serum metabolome profile among individuals with spinal cord injury and normal glucose tolerance or prediabetes/type 2 diabetes.

Arch Phys Med Rehabil 2021 Jun 11. Epub 2021 Jun 11.

Departments of Physical Medicine and Rehabilitation, the University of Alabama at Birmingham, Birmingham, Alabama. Electronic address:

Objective: To compare the gut microbiome composition and serum metabolome profile among individuals with spinal cord injury (SCI) and normal glucose tolerance (NGT) or prediabetes/type 2 diabetes (P/DM).

Design: Cross-sectional design.

Setting: Research university. Read More

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Improvement in left ventricular ejection fraction after pharmacological up-titration in new-onset heart failure with reduced ejection fraction.

Neth Heart J 2021 Jun 14. Epub 2021 Jun 14.

Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

Objective: Recent studies have reported suboptimal up-titration of heart failure (HF) therapies in patients with heart failure and a reduced ejection fraction (HFrEF). Here, we report on the achieved doses after nurse-led up-titration, reasons for not achieving the target dose, subsequent changes in left ventricular ejection fraction (LVEF), and mortality.

Methods: From 2012 to 2018, 378 HFrEF patients with a recent (< 3 months) diagnosis of HF were referred to a specialised HF-nurse led clinic for protocolised up-titration of guideline-directed medical therapy (GDMT). Read More

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Machine learning reveals the most important psychological and social variables predicting the differential diagnosis of rheumatic and musculoskeletal diseases.

Rheumatol Int 2021 Jun 14. Epub 2021 Jun 14.

QualiPsy, EE 1901, University of Tours, 37000, Tours, France.

There is an ongoing debate about the importance and the extent to which psychological and psychopathological factors, adverse childhood experiences, and socio-demographic characteristics are associated with the development of certain types of rheumatic disease. With the aim of contributing to knowledge on the subject, the present study uses machine learning modeling to determine the importance of 20 psychological and social variables in predicting two classes of rheumatic disease: inflammatory rheumatic and musculoskeletal diseases (RMD) (rheumatoid arthritis = RA, spondyloarthritis = SA, and Sjögren's syndrome = SS) versus non-inflammatory RMD, namely fibromyalgia = FM). A total of 165 French women with FM, RA, SA, and SS completed an inventory of personality traits, a psychopathology diagnosis questionnaire, and a fatigue/pain questionnaire. Read More

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Cardiac Biomarkers in Pediatrics: An Undervalued Resource.

Clin Chem 2021 Jun 14. Epub 2021 Jun 14.

CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.

Background: The clinical use of common cardiac biomarkers, such as brain natriuretic peptides and troponins, has traditionally been limited to adult populations in the assessment of heart failure and acute coronary syndrome, respectively. While many have discounted the value of these markers in pediatric populations, emerging evidence suggests they may be useful in the diagnosis and prognostication of many cardiac and noncardiac pathologies in neonates, children, and adolescents, and an increasing number of pediatric hospitals are routinely measuring cardiac markers in their clinical practice.

Content: This review summarizes and critically evaluates the current literature regarding the application of cardiac biomarkers for clinical decision-making in the pediatric population. Read More

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Basophil Activation Test for Allergy Diagnosis.

J Vis Exp 2021 May 31(171). Epub 2021 May 31.

Allergy Unit, Hospital Regional Universitario de Málaga; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA; Departamento de Medicina, Universidad de Málaga; Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND.

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and specific IgE (sIgE) determination in the evaluation of IgE-mediated allergic reactions to food, insect venom, drugs, as well as some forms of chronic urticaria. However, the role of this technique in the diagnostic algorithms is highly variable and not well determined. BAT is based on the determination of basophil response to allergen/drug cross-linking IgE activation through the measurement of activation markers (such as CD63, CD203c) by flow cytometry. Read More

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Trend of recognizing depression symptoms and antidepressants use in newly diagnosed Parkinson's disease: Population-based study.

Brain Behav 2021 Jun 14. Epub 2021 Jun 14.

Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia.

Objectives: Although depression symptoms are common among patients with Parkinson's disease (PD), the medical literature still reports underrecognition of depression in patients with PD. Our main objective is to examine the trend of depression recognition during the first year of PD diagnosis using large population data.

Methods: We conducted a population-based study of residents in Wales, using the Secure Anonymized Information Linkage (SAIL) Databank. Read More

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Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries.

Cochrane Database Syst Rev 2021 Jun 14;6:CD014546. Epub 2021 Jun 14.

Dundee Dental School, University of Dundee, Dundee, UK.

Background: The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. Read More

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Help-seeking behaviour and subsequent patient and system delays in stroke.

Acta Neurol Scand 2021 Jun 14. Epub 2021 Jun 14.

Research Unit for General Practice, Aarhus C, Denmark.

Objectives: Prehospital delay is the main reason why only a limited number of stroke patients receive reperfusion therapy. We aimed to investigate help-seeking behaviour in patients and bystanders after onset of stroke and subsequent patient and system delay.

Materials & Methods: We conducted a cross-sectional study of 332 patients with stroke. Read More

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Equine "Idiopathic" and Infundibular Caries-Related Cheek Teeth Fractures: A Long-Term Study of 486 Fractured Teeth in 300 Horses.

Front Vet Sci 2021 28;8:646870. Epub 2021 May 28.

The Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, United Kingdom.

Limited objective information is available on the prevalence of non-traumatic equine cheek teeth fractures, the signalment of affected horses, and the clinical features and treatment of these fractures. This study aims to document patterns of idiopathic and infundibular caries-related cheek teeth fractures in a referral population and evaluate associations between fracture patterns and horse age, Triadan position of affected teeth, clinical signs, and deemed necessity for treatment. A retrospective case review. Read More

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Histopathological Account of Obstetrical and Gynecological Specimens: Retrospective Study at a Tertiary Care Center of Peshawar.

Cureus 2021 May 11;13(5):e14950. Epub 2021 May 11.

Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK.

Introduction Histopathologic specimen examination of surgically isolated organs and tissues yields valuable information regarding a disease process and plays a vital role in the future management of a patient. Our aim was to account for the common diagnosis yielded from histopathological specimens of the obstetrics and gynecology department and to determine if all the obstetric and gynecological specimens should be routinely sent for histopathology. Methods A retrospective, cross-sectional study was conducted at the histopathology unit of a tertiary care hospital in Peshawar. Read More

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Review on Pneumococcal Infection in Children.

Cureus 2021 May 9;13(5):e14913. Epub 2021 May 9.

Paediatrics, Base Hospital, Mahaoya, LKA.

Childhood pneumococcal infection is a growing concern among paediatricians especially, in countries where there is no routine vaccination program against . The disease is associated with significant morbidity and mortality in young children particularly those who are under the age of two years. Its main virulent factors include polysaccharide capsule, autolysin, pneumolysin, choline-binding Protein A, the higher chance for genetic transformation, and the presence of pilli that facilitate enhanced binding of bacteria to host cellular surfaces. Read More

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