Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 – August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.

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Cryoprobe biopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin

Journal of the Intensive Care Society ◽

10.1177/1751143719847323 ◽

2019 ◽

Vol 21 (2) ◽

pp. 119-123

Author(s):

Marcos J Las Heras ◽

Jose Dianti ◽

Manuel Tisminetzky ◽

Graciela Svetliza ◽

Sergio E Giannasi ◽

...

Keyword(s):

Respiratory Failure ◽

Diagnostic Yield ◽

Specific Treatment ◽

Case Series ◽

Safe Procedure ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Select Group ◽

Lung Sample ◽

Appropriate Treatment

Rationale Acute hypoxemic respiratory failure is a condition that comprises a wide array of entities. Obtaining a histological lung sample might help reach a diagnosis and direct an appropriate treatment in a select group of patients. Objective To describe our experience in the use of cryobiopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin. Methods Retrospective analysis of case series of patients with acute hypoxemic respiratory failure who underwent lung cryobiopsy at the Intensive Care Unit of the Hospital Italiano de Buenos Aires, Argentina. Results Cryobiopsy yielded a histological diagnosis in all patients ( n = 10, 100%). This led to either a change in therapy or continuation of a specific treatment in eight of these patients. Cryobiopsy was found to be contributive in all the patients who did not meet Berlin criteria for acute respiratory distress syndrome. No major complications were associated with the procedure. Conclusions Cryobiopsy is a safe procedure with a high diagnostic yield in a selected group of patients.

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Facial Esthetics Classification and Gingival Pigmentation Index of Treatment Needs

RGUHS Journal of Dental Sciences ◽

10.26715/rjds.11_1_2 ◽

2019 ◽

Vol 11 (1) ◽

pp. 77-88

Author(s):

Puzhankara Lakshmi ◽

Menon Sai Megha ◽

Suresh Reshma

Keyword(s):

Indian Population ◽

Treatment Plan ◽

Specific Treatment ◽

Treatment Modalities ◽

Treatment Needs ◽

Complete Coverage ◽

Facial Esthetics ◽

Comprehensive Classification ◽

Precise Assessment ◽

Classification And Treatment

Background : The Indian population shows an extensive range of gingival pigmentation. A detailed description of the gingival pigmentation pattern would provide data for the formulation of an efficient plan for depigmentation. This article gives a novel comprehensive classification to aid in the precise assessment of the pattern and distribution of gingival pigmentation and decision regarding the methods for depigmentation. Methods : Previously existing, established indices and classifications for degree of pigmentation, facial complexion, smile line, lip colour and their modifications were used to differentiate various categories of Esthetics: Esthetic, Unaesthetic-mild, Unaesthetic-severe. Treatment needs were formulated based on the category of Esthetics. Results : The various categories of esthetics include E (Esthetic), M (Unaesthetic-Mild), N (UnaestheticSevere) and specific treatment modalities have been assigned based on the treatment needs. Discussion : The treatment for gingival pigmentation should be based on overall facial esthetics. The classification given in this article takes into consideration the components of facial esthetics: Facial Pigmentation, Degree and distribution of gingival pigmentation, smile line and lip colour. The treatment plan proposed considers the need for the treatment and the possible treatment for each category of esthetics. Conclusion : The classification proposed in this article attempts a complete coverage of combinations of facial esthetic components and the Treatment Index encompasses all the possible treatment modalities for each combination. Although a learning curve might exist, once mastered, the classification and treatment index would serve as a baseline for determining treatment needs in patients with gingival pigmentation.

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Diagnostic accuracy of magnetic resonance imaging in the evaluation of pulmonary infections in immunocompromised patients

Polish Journal of Radiology ◽

10.5114/pjr.2020.93258 ◽

2020 ◽

Vol 85 (1) ◽

pp. 53-61 ◽

Cited By ~ 1

Author(s):

Rashmi Singh ◽

Mandeep Garg ◽

Kushaljit Sodhi ◽

Nidhi Prabhakar ◽

Paramjeet Singh ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Immunocompromised Patients ◽

Pulmonary Infections ◽

Resonance Imaging

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Prevalence of Pulmonary Infections Caused by Atypical Pathogens in non-HIV Immunocompromised Patients

Advances in Experimental Medicine and Biology - Pulmonary Infection and Inflammation ◽

10.1007/5584_2016_28 ◽

2016 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

E. M. Grabczak ◽

R. Krenke ◽

M. Przybylski ◽

A. Kolkowska-Lesniak ◽

R. Chazan ◽

...

Keyword(s):

Immunocompromised Patients ◽

Pulmonary Infections ◽

Atypical Pathogens

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Diagnostic Yield of MRI for Sensorineural Hearing Loss – An Audit

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.87 ◽

2020 ◽

Vol 47 (5) ◽

pp. 656-660

Author(s):

Helen Wong ◽

Yaw Amoako-Tuffour ◽

Khunsa Faiz ◽

Jai Jai Shiva Shankar

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Diagnostic Yield ◽

Internal Auditory Canal ◽

Auditory Brainstem ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Clinical Indication ◽

Presenting Symptoms ◽

Brainstem Response

ABSTRACT:Purpose:Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.Materials and methods:The charts of 500 consecutive patients who underwent CEMRI of internal auditory canal for SNHL were categorized as cases with relevant positive findings on CEMRI and those without relevant findings. Demographics, presenting symptoms, interventions and responses, ordering physicians, and investigations performed prior to CEMRI testing were recorded. Chi-squared test and t-test were used to compare proportions and means, respectively.Results:CEMRI studies revealed relevant findings in 20 (6.2%) of 324 subjects meeting the inclusion criteria. Pre-CEMRI testing beyond audiometry was conducted in 35% of those with relevant positive findings compared to 7.3% of those without (p < 0.001). Auditory brainstem response/vestibular-evoked myogenic potentials were abnormal in 35% of those with relevant CEMRI findings compared to 6.3% of those without (p < 0.001).Conclusion:CEMRI is a valuable tool for assessing potential causes of SNHL, but small diagnostic yield at present needs justification for contrast injection for this indication. Our findings suggest preferred referral from otolaryngologists exclusively, and implementation of a non-contrast MRI for SNHL may be a better diagnostic tool.

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Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-1119-6543 ◽

2020 ◽

Vol 08 (05) ◽

pp. E656-E667 ◽

Cited By ~ 3

Author(s):

Donevan R. Westerveld ◽

Sandeep A. Ponniah ◽

Peter V. Draganov ◽

Dennis Yang

Keyword(s):

Systematic Review ◽

Sensitivity And Specificity ◽

Diagnostic Yield ◽

Meta Analysis ◽

Concordance Rate ◽

Surgical Pathology ◽

Adverse Event Rate ◽

Secondary Outcome ◽

Pancreatic Cysts ◽

Cyst Type

Abstract Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-the-needle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs. Methods Comprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB. Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7–15.4]; I2 = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0–7.4], I2 = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5–52.3]; I2 = 48), for a MC (OR: 8.9; 95 % [CI: 1.9–40.8]; I2 = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9–36.9]; I2 = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4–97.6]; I2 = 36.5 %) and 94 % (95 % CI: [81.5–99.7]; I2 = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3–14.1]; I2 = 82.9). Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in risk-stratifying MCs and providing a specific cyst diagnosis.

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Electronic Health Record–Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency

American Journal of Medical Quality ◽

10.1177/1062860619861947 ◽

2019 ◽

Vol 35 (3) ◽

pp. 252-257 ◽

Cited By ~ 1

Author(s):

Ryan F. Coughlin ◽

David Peaper ◽

Craig Rothenberg ◽

Marjorie Golden ◽

Marie-Louise Landry ◽

...

Keyword(s):

Emergency Department ◽

Decision Support ◽

Electronic Health Record ◽

Urine Culture ◽

Diagnostic Yield ◽

Secondary Outcome ◽

Health Record ◽

Diagnostic Efficiency ◽

Ed Visits ◽

Electronic Health

The authors evaluated the effectiveness of an electronic health record (EHR)-based reflex urine culture testing algorithm on urine test utilization and diagnostic yield in the emergency department (ED). The study implemented a reflex urine culture order with EHR decision support. The primary outcome was the number of urine culture orders per 100 ED visits. The secondary outcome was the diagnostic yield of urine cultures. After the intervention, the mean number of urine cultures ordered was 5.95 fewer per 100 ED visits (9.3 vs 15.2), and there was a decrease in normal, or negative, cultures by 2.42 per 100 ED visits. There also was a statistically significant decrease in urine culture utilization and an increase in the positive proportion of cultures. Simple EHR clinical decision-support tools along with reflex urine culture testing can significantly reduce the number of urine cultures performed while improving diagnostic yield in the ED.

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Endodontic Treatment and Esthetic Management of a Geminated Central Incisor Bearing a Talon Cusp

Case Reports in Dentistry ◽

10.1155/2014/123681 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Elif Tarım Ertaş ◽

Meral Yırcalı Atıcı ◽

Hakan Arslan ◽

Bilal Yaşa ◽

Hüseyin Ertaş

Keyword(s):

Case Report ◽

Multidisciplinary Approach ◽

Treatment Plan ◽

Specific Treatment ◽

Central Incisor ◽

Dental Anomalies ◽

Treatment Needs ◽

Radiologic Diagnosis ◽

Radiographic Findings ◽

Clinical Problems

Gemination with talon cusps is an uncommon morphologic dental anomaly, characterized by the formation of clinically wide tooth that can cause significant aesthetic and clinical problems including esthetic impairment, pain, caries susceptibility, and tooth crowding. These morphological dental anomalies have specific treatment needs due to the abnormal morphology and need virtuous radiologic diagnosis. Multidisciplinary approach can supply success of the treatment plan that can provide esthetic and occlusal requirements. In this case report, the multidisciplinary approach for the treatment of geminated tooth with talon cusp is presented with the clinical and radiographic findings.

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Understanding Sexual Addiction and Hypersexuality (DRAFT)

10.1093/med/9780190225889.003.0015 ◽

2018 ◽

Cited By ~ 1

Author(s):

Monica Meyer

Keyword(s):

Affect Regulation ◽

Treatment Plan ◽

Multidisciplinary Treatment ◽

Specific Treatment ◽

Sexual Addiction ◽

Three Dimensions ◽

Negative Consequences ◽

Interpersonal Neurobiology ◽

Theoretical Perspectives ◽

Pornography Addiction

Various terms such as sexual addiction and hypersexuality have been used to describe a problematic and destructive pattern of excessive sexual behavior that persists despite negative consequences. Proposed diagnostic criteria are presented and several typologies are described in terms of their clinical presentation and associated consequences. Pornography addiction is discussed in terms of its typical course and observed impact on sexual arousal, sexual functioning, and the romantic partnership. Interpersonal neurobiology is used to conceptualize sex addiction from the three interacting theoretical perspectives of dysfunctional neural reward circuitry, maladaptive affect regulation, and disordered intimacy (or insecure attachment). A set of standard multimodal, multidisciplinary treatment recommendations are presented in the context of the three dimensions of interpersonal neurobiology that draw upon interventions that can be integrated into a unique, client-specific treatment plan. Complimentary, alternative, and integrative methodologies are explored to form a more comprehensive approach to treatment.

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