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PubMed2004

Reasoning process characteristics in the diagnostic skills of beginner, competent, and expert dentists.

The purpose of this study was to evaluate qualitative differences in the diagnostic reasoning process at different developmental stages of expertise. A qualitative design was used to study cognitive processes that characterize the diagnosis of oral disease at the stages of beginner (five junior students who had passed the NBDE I), competent (five GPR first-year residents), and expert dentists (five general dentists with ten or more years of experience). Individually, each participant was asked to determine the diagnosis of an oral condition based on a written clinical case, using the think aloud technique and retrospective reports. A subsequent interview was conducted to obtain the participants' diagnostic process model and pathophysiology of the case. The analysis of the verbal protocols indicated that experts referred to the patient's sociomedical context more frequently, demonstrated better organization of ideas, could determine key clinical findings, and had an ability to plan for the search of pertinent information. Fewer diagnostic hypotheses were formulated by participants who used forward reasoning, independent of the stage of development. Beginners requested additional diagnostic aids (radiographs, laboratory tests) more frequently than the competent/expert dentists. Experts recalled typical experiences with patients, while competent/beginner dentists recalled information from didactic courses. Experts evidenced cognitive diagnostic schemas that integrate pathophysiology of disease, while competent and beginner participants had not achieved this integration. We conclude that expert performance is a combination of a knowledge base, reasoning skills, and an accumulation of experiences with patients that is qualitatively different from that of competent and beginner dentists. It is important for dental education to emphasize the teaching of cognitive processes and to incorporate a wide variety of clinical experiences in addition to the teaching of disciplinary content.

Clinical Competence↗
PubMed2004

Testing the association between thyroid dysfunction and psychiatric diagnostic group in an iodine-deficient area.

OBJECTIVE: To test the association between thyroid dysfunction and psychiatric diagnostic group in a large sample of consecutive patients, while controlling for the effects of age, sex, medication and concomitant medical conditions. METHODS: We compared the distribution of psychiatric diagnostic groups according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), and of selected psychopathological symptoms in 100 newly admitted psychiatric patients who had genuine thyroid disease and 92 psychiatric patients who had nonspecific alterations of thyroid function with the corresponding items for the whole group of admitted patients (n = 1134) during the observation period. This analysis was then repeated using an age-matched and sex-matched comparison group selected from all admitted patients in a random order. RESULTS: When all admitted patients were considered, the presence of a genuine thyroid disorder was associated with the diagnosis of a mood disorder (ICD-10 category F3). This effect was no longer detectable when the age-matched and sex-matched comparison group was used, indicating a simple effect of these 2 variables. Nonspecific alterations of thyroid-stimulating hormone (TSH) were associated with the ICD-10 diagnostic group F4 (neurotic, stress-related and somatoform disorders), with demographic variables being similar in this subgroup to those of all admitted patients. These patients also tended to display more symptoms of a mild depressive syndrome. When only patients with nonspecifically decreased TSH concentrations were tested, these findings could not be reproduced. Nonspecifically decreased concentrations of thyroxine and free thyroxine index were found significantly more often in the diagnosis group F1 (mental disorder due to substance use), reflecting results for alcohol-dependent patients. This result could not be replicated using an age-matched and sex-matched control group. CONCLUSION: In newly admitted psychiatric patients with genuine thyroid disease, there was no notable association of thyroid disease and major psychiatric diagnostic groups according to ICD-10, especially depression. This argues against the hypothesis of thyroid disorders being a major risk factor for psychiatric illnesses. Nonspecific alterations of TSH were more frequently seen in patients of diagnostic group F4 and with mild depressive syndromes, possibly representing an altered influence of stress-regulating systems on thyroid function.

Adolescent↗
PubMed2005

Diagnostic work-up of rectal bleeding in general practice.

BACKGROUND: GPs have many patients with gastrointestinal discomfort. Among bowel-related complaints, the sign of rectal bleeding is of particular importance in patients aged 50 years and above, as it can be an early sign for serious bowel diseases such as colon carcinoma. Despite many guidelines offered to GPs for screening and early detection of colorectal carcinomas, there is very little information about the actual diagnostic approach to the sign of rectal bleeding. AIM: The aim of the study was to collect data concerning treatment strategies used by GPs who treat patients presenting with rectal bleeding. DESIGN OF STUDY: Prospective data collection. SETTING: General practices in Germany. METHOD: Over the course of a year, GPs recorded their treatment strategies in patients presenting with rectal bleeding and associated symptoms. Using a digital practice patient file, physicians participating in the study were able to continuously transmit data electronically to the researchers of the study about diagnostics, referrals, hospital admissions, and final diagnoses. RESULTS: During the course of 1 year, 94 participating physicians collected data on 1584 patients. Information about treating rectal bleeding was recorded for 422 patients; 60% of the patients were referred to specialists in internal medicine or gastroenterologists for further diagnostics. A colonoscopy was the most frequently performed diagnostic procedure (46.2%). Twenty-two per cent (n = 93) of the patients--54 of them aged 50 years and above--were exclusively treated by their GP without conducting a colonoscopy or cooperating with specialists. For these patients, GPs diagnosed less severe diseases like haemorrhoids or other proctologic diseases. CONCLUSION: By using a study that allows GPs to transmit electronically their findings and data, it is possible to draw a picture of treatment strategies of GPs in patients presenting with rectal bleeding. The high percentage of patients who received medical treatment in consultation with specialists underscores the significance of the sign of rectal bleeding in general practice. The need for further diagnostic measures in patients who have been treated exclusively by GPs has to be discussed.

Abdominal Pain↗
PubMedDate not supplied

Long-term rhinoflowmetry: a new method for functional rhinologic diagnostics.

BACKGROUND: With current functional diagnostic tools in rhinology (rhinomanometry, rhinoresistometry, and acoustic rhinometry) long-term assessment of nasal function is difficult to acquire. Usually, only the situation at the time of examination is evaluated. Therefore, temporary nasal complaints of the nasal cycle are difficult to assess. It was the aim of this work to create a diagnostic tool to measure nasal flow over a long time period under physiological and everyday life conditions. We term the method long-term rhinoflowmetry (LRFM). METHODS: A portable device recording nasal airflow over a time period up to 72 hours was developed. Kinetic pressure fluctuations during respiration as a measure for the flow were registered over time and relative airflow was calculated. A summary of diagnostic results is given in six exemplary patients. RESULTS: Classic nasal cycles could be recorded in detail with durations ranging from 90 minutes to 10 hours. The manifestation of nighttime nasal obstruction as well as a case of paradoxical nasal obstruction were objectified. LRFM enables the assessment of time, duration, and extent of temporary nasal obstruction. CONCLUSION: LRFM enables an assessment of temporary nasal obstruction as well as physiological and pathological fluctuations in the nasal cycle. Especially in cases in which traditional rhinological diagnostic tools are unsatisfying, the enhanced diagnostic quality of LRFM appears to be a promising supplement to the currently available rhinological monitoring methods.

Circadian Rhythm↗
PubMed2005

Diagnostic value of ultrasonography in the evaluation of blunt abdominal trauma.

PURPOSE: To evaluate the diagnostic value of ultrasonography (US) in detecting intraabdominal injuries in patients with blunt abdominal trauma. MATERIALS AND METHODS: Blunt trauma patients admitted to the emergency department from January 2002 to August 2003 were retrospectively evaluated. A total of 454 patients with blunt abdominal trauma who underwent US examination were included. Ultrasonography results were compared with findings of CT, diagnostic peritoneal lavage, laparotomy and clinical course. Sensitivity, specificity, positive and negative predictive values of US in detecting free fluid, intraabdominal parenchymal organ injury or both were calculated. RESULTS: Computed tomography, diagnostic peritoneal lavage and laparotomy results showed that intraabdominal organ injury was present in 37 of 454 patients. Ultrasonography examinations were positive in 51 patients. True-positive findings were seen in 32 of these patients. In these 32 patients, US examination showed free fluid in 19, fluid and abdominal organ injury in 11 and only abdominal organ injury in 2. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US in detecting intraabdominal injury were 86.5%, 95.4%, 62.7%, 98.7% and 94.7%, respectively. CONCLUSION: Ultrasonography has high diagnostic performance in the screening of patients with blunt abdominal trauma. Abdominal US is a useful and valuable diagnostic tool after clinical evaluation in patients with blunt abdominal trauma. Because of its high negative predictive value, we recommend that clinical follow up is adequate for patients whose US results are negative for intraabdomial organ injury.

Abdominal Injuries↗
PubMedDate not supplied

Diagnostic work-up for faecal incontinence in daily clinical practice in the Netherlands.

BACKGROUND: To study variation in Dutch hospitals in applying diagnostic and treatment options for faecal incontinence. METHODS: Surgeons, gastroenterologists, internists and gynaecologists were contacted by phone or mail and requested to complete a questionnaire. The questionnaire asked for general information about patients with faecal incontinence, the use and availability of diagnostic techniques, the use of incontinence scores and therapeutic options. RESULTS: In total 306 specialists were contacted and data were collected from 203 specialists from 86 hospitals (response rate 66%). The most frequently applied diagnostics were sigmoidoscopy (64%), endoanal sonography (58%), evacuation proctography (56%) and/or anorectal manometry (51%). The choice seemed to be related to the availability of the techniques. Sigmoidoscopies were performed significantly more often in local hospitals (p < 0.001), while in medical academic centres significantly more endoanal MRI examinations were conducted (p < 0.05). The most stated treatment option was physiotherapy (90%), followed by dietary measures (83%), medicating (71%) and surgery (68%). However, in general, combinations of treatment options were used. CONCLUSIONS: A substantial variety exists in the diagnostic work-up of faecal incontinence. In general, at least one anorectal functional test and an imaging technique are the diagnostic techniques of choice. Pelvic floor physiotherapy is the first choice in conservative treatment.

Endosonography↗
PubMed2005

Diagnostic tools for animal diseases.

While traditional testing methods are still widely used in veterinary diagnostic laboratories exciting new technologies, such as biosensors and microarray techniques, are being developed. Nucleic acid diagnostic techniques such as polymerase chain reaction (PCR) have become routine diagnostic tools in veterinary laboratories not only to make specific typing determinations but also to rapidly screen large numbers of samples during disease outbreaks. In addition, nanotechnologies, although not yet implemented in veterinary laboratories, hold the promise of screening for numerous pathogens in a single assay. Other biotechnologies are likely to be widely used in the future as they can improve diagnostic capabilities while reducing the time and perhaps, the costs, associated with conventional technologies. This paper describes some of these new technologies and concludes that although a lot of developmental work is still required, biotechnology and its applications hold great promise for improving the speed and accuracy of diagnostics for veterinary pathogens.

Animal Diseases↗
PubMed2005

Lung CT Analysis and Retrieval as a Diagnostic Aid.

Image retrieval is currently a very active research field due to the large amount of visual data being produced in most modern hospitals. Most often, the goal is to aid the diagnostic process. Unfortunately, only very few medical image retrieval systems are currently used in clinical routine. One of the application domains for image retrieval is the analysis and retrieval of lung CTs. A first user study in the United States shows that these systems allow improving the diagnostic quality.This article describes the approach to an aid for lung CT diagnostics. The analysis incorporates several steps and the goal is to automate the process as much as possible for easy integration into diagnostics. Thus, several automatic steps are proposed from a selection of the most characteristic slices, to an automatic segmentation of the lung tissue and a classification on the segmented area into diagnostic classes. Feedback to the MD will be given in the form of marked regions in the images that appear to be different from the norm of healthy tissue. We are currently working on a small set of training images with marked and annotated regions but a larger set of images for the evaluation of our algorithm is in work. For this reason, the article does currently not contain much quantitative evaluation.For several tasks we use existing open source software such as Weka and itk. This allows an easy reproduction of the search results.

Algorithms↗
PubMed2005

[DNA-based diagnostics of long QT syndrome].

BACKGROUND: Long QT syndrome is characterised by inherited long QT interval on the ECG and increased risk for syncope and sudden death caused by arrhythmias. For Romano-Ward syndrome and Jervell and Lange-Nielsen syndrome DNA based diagnostics are available. MATERIALS AND METHODS: This paper is a summary of our experience with DNA-based diagnostics of LQTS since the autumn of 2003. The diagnostic analyses are performed by sequencing the exons of five genes, KCNQ1, HERG, SCN5A, minK and MiRP1. RESULTS AND INTERPRETATIONS: As of mid-January 2005, 56 probands with long QT syndrome have been referred for genetic testing. We have identified an underlying mutation in 64% of the patients. Mutations in the KCNQ1 gene are most frequent in Norwegian long QT syndrome patients, as 61% of the patients have their mutation in this gene. The detection of a mutation in the probands has led to genetic testing of 215 relatives; 99 out of these are heterozygous for the mutation present in the family. Heterozygous patients have been referred to a cardiologist. Of the 43 that have been referred to follow up at the department of cardiology at Rikshospitalet, 35 have started treatment with beta blockers to reduce the risk of arrhythmias. Thus, DNA-based diagnostics has clinical significance leading to prophylactic treatment of long QT syndrome patients. Compared to evaluation of ECG, which is negative in 30% of mutation carriers, the sensitivity of DNA-based diagnostics of relatives of probands with a known mutation, is close to 1.

Adult↗
PubMed2005

[The diagnostic value of serum carcinoma markers, fecal K-ras and p53 gene mutation in pancreatic cancers].

OBJECTIVE: To evaluate the diagnostic value of serum carcinoma markers CA19-9, CA242, CA50 and carcinoembryonic antigens (CEA), fecal K-ras and p53 gene mutation in pancreatic cancer. METHODS: We collected 136 new cases of pancreatic cancer and 240 patients with benign digestive diseases including 49 patients with benign pancreatic diseases diagnosed in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Tumor Hospital and Shenyang PLA General Hospital from February 2002 to March 2004. Blood samples were collected and serum carcinoma markers CA19-9, CA242, CA50 and CEA were measured. Fecal K-ras and p53 gene mutation were also measured. We decided the optimal cut-off points with receiver operating characteristic curves and calculated the areas under the curve (AUC). RESULTS: The AUC of serum CA19-9 and CA242 were 0.855 +/- 0.031 (95% CI 0.794 - 0.916) and 0.859 +/- 0.031 (95% CI 0.799 - 0.920) respectively. The optimal cut-off point for serum CA19-9 was 68 U/ml, with the sensitivity of 84.4% (98/116) and the specificity of 84.3% (145/172) for the diagnosis of pancreatic cancer. The optimal cut-off point for serum CA242 was 25 U/ml, with the sensitivity of 88.4% (84/95) and the specificity of 79.1% (144/182). The sensitivity of fecal K-ras mutation was 77.8%, and the specificity was 82.2%. The sensitivity and specificity of fecal p53 gene mutation were 27.8% and 95.2% respectively. The diagnostic scale of pancreatic cancer was calculated by four variables: serum CA19-9, CA242, fecal K-ras and p53, of which each variable deserved one point if measured positive. The optimal cut-off point for the scale was 2, and the AUC of the diagnostic scale was 0.946 +/- 0.017 (95% CI 0.912 - 0.980). CONCLUSIONS: Serum CA19-9 and CA242 are valuable diagnostic tools for pancreatic cancer. The diagnostic value will be further improved when they are combined with the measurement of fecal K-ras and p53 gene mutation.

Adolescent↗
PubMedDate not supplied

[Development of a synthetic positive control which also detects plasmid contamination in diagnostic polymerase chain reaction].

This paper describes a technique for the development of a positive control for use in a nested PCR to show that the PCR has worked correctly with both outer and inner primers designed for diagnostic amplification of 618 bp and 317 bp products respectively. This positive control produces a larger product than the diagnostic sample that can be discriminated on an agarose gel. This technique is advantageous over traditional cloning of the diagnostic PCR product itself by: 1) making it visually easy to detect plasmid contamination and thus, prevent false positives from the plasmid; 2) develop a positive control when the target organism is at a very low prevalence so initial detection is not relied on for cloning positive controls. This will ensure the PCR is working correctly prior to diagnostic sampling, reducing false negatives; or 3) for developing a PCR and determining the sensitivity prior to the use of diagnostic samples. The methods used to produce this nested positive control demonstrates how to use large oligonucleotide primers in PCR without non-specific binding occurring.

DNA Primers↗
PubMed2005

Inferior petrosal sinus sampling in the diagnostic evaluation of Cushing's syndrome: K.E.M. experience.

INTRODUCTION: An overlap in the clinical and biochemical features of the more common pituitary Cushing's disease and the rare ectopic ACTH secreting tumors often leads to a diagnostic dilemma. High quality computed imaging modalities have a poor sensitivity and do not always help in localising the tumor. Inferior petrosal sinus sampling (IPSS) with measurement of ACTH levels localizes the source of excess ACTH secretion and aids in the differential diagnosis of ACTH dependant Cushing's syndrome. AIMS AND OBJECTIVES: To analyze the efficacy of inferior petrosal sinus sampling in the basal state and its role in the diagnostic evaluation in patients of Cushing's syndrome. MATERIAL AND METHODS: Forty four patients of proven Cushing's syndrome underwent HDDS and pituitary imaging followed by IPSS (unstimulated). The data was analysed in 39 patients with definite histopathological diagnosis which included 34 patients with Cushing's disease, four with ectopic Cushing's syndrome and one with adrenal carcinoma. A centre:periphery ratio of plasma ACTH levels of > or =2 was considered diagnostic of Cushing's disease. RESULTS: Cannulation rate was 100%. No neurological complications were encountered. IPSS could correctly localize the lesion in 23 of 34 patients of Cushing's disease (sensitivity: 67.6%). All patients of ectopic Cushing's syndrome and adrenal carcinoma had a ratio of <2 (specificity: 100%). IPSS helped in localization of the lesion and improved the diagnostic yield from 26.7% to 73.5%. CONCLUSIONS: IPSS helps in localization in patients of Cushing's syndrome with a diagnostic dilemma and should be carried out only in centers with suitable expertise.

Adolescent↗
PubMed2005

Diagnostic 123I and 131I activities and radioiodine therapy. Effects on urinary iodine excretion in patients with differentiated thyroid carcinoma.

AIM: Urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated effects of the application of different radioiodine isotopes on UIE in patients with differentiated thyroid carcinoma (DTC). PATIENTS, METHODS: In 91 consecutive patients with DTC UIE, measured as iodine/creatinine ratio, was determined before and after application of 123I and 131I for diagnostic or therapeutic purposes. Additionally, remnant volume (V) was determined prior to therapy. Group A consisted of 33 patients with supposed successful ablation of DTC. These patients received 370 MBq 131I for diagnostic use and served as controls. 58 patients (group B) with remnants, relapses and metastases received 370 MBq 123I for diagnostics prior to therapy with 1.5-22.2 GBq 131I. Factors influencing individual changes in urinary iodine excretion (deltaUIE) were investigated by using non-parametric tests. RESULTS: In group A UIE did not change significantly after application of 131I. As well, UIE remained unchanged after diagnostic application of 123I in group B. In contrast, UIE increased significantly already 24 h after therapeutic application of 131I in this group. In patients with small remnants (V < 2.5 ml) a significant but only moderate increase of UIE could be observed (average increase: 47 microg I/g crea). In patients with larger remnants, with relapses or metastases increase of UIE values was significant and more pronounced. CONCLUSIONS: It was confirmed that UIE increased significantly during radioiodine therapy in patients with DTC and radioiodine-accumulating tissue. The increase of UIE after therapeutic administration of radioiodine can be explained by the disintegrated thyroid follicles in thyroid remnants. The radioiodine-induced iodine release may be one reason for thyroid "stunning" even after application of diagnostic amounts of 131I.

Creatinine↗
PubMed2006

[Stepwise diagnostic workup in general practice as a consequence of the Bayesian reasoning].

The dependency of the predictive values of tests on the prevalence of diseases is an escrow issue of clinical diagnostics. The relation between pre-test probability and post-test probability is well explained by Bayes' theorem, and the relation between prevalence and false diagnoses can be described well by modifying this theorem. In cases of low prevalence the positive predictive value (PPV) is lower and the false-positive predictive value (FPPV) higher. These aspects mainly depend on the test specificity. But basically, in cases of low prevalence there is a higher negative predictive value (NPV) and a lower false negative predictive value (FNVP). Depending on the sensitivity and specificity, NPV and FNPV vary only slightly in low prevalence ranges. These statistical relations are able to explain the typical mode of operation of general practitioners with their unselected patients. In order to increase PPV and decrease FPPV in the diagnostic workup, the GP must use his clinical experience, time and stepwise diagnostic procedures. More diagnostic studies are necessary to improve the diagnostic workup in patient care.

Bayes Theorem↗
PubMed2006

The effect of sedation on diagnostic validity of facet joint nerve blocks: an evaluation to assess similarities in population with involvement in cervical and lumbar regions (ISRCTNo: 76376497).

BACKGROUND: Zygapophysial or facet joint pain in patients suffering with chronic spinal pain without disc herniation or radiculopathy may be diagnosed with certainty by the use of controlled diagnostic blocks. But, in patients suffering with either lumbar or cervical facet joint pain, even this diagnostic approach may be confounded by false-positives when using a single diagnostic block. It may also be confounded by the administration of anxiolytics and narcotics prior to, or during, the controlled diagnostic facet joint blocks. The effect of sedation on the validity and potential differential results in patients suffering with combined cervical and lumbar facet joint pain has not been evaluated. OBJECTIVE: To assess the effects of midazolam and fentanyl on the diagnostic validity of facet joint blocks in patients suffering with both cervical and lumbar facet joint pain. STUDY DESIGN: Randomized, double-blind, placebo-controlled study. METHODS: The design consisted of a placebo group receiving a sodium chloride solution and two experimental groups receiving either midazolam or fentanyl. Patients included in the study had been diagnosed with facet joint pain using controlled comparative local anesthetic blocks of the medial branches and L5 dorsal rami. They had been treated with lumbar and cervical facet joint nerve blocks and experienced good pain relief; and were presenting for repeat treatment after a period of symptom relief. The study was performed in an interventional pain management practice in the United States; a total of 60 patients participated with 20 patients randomly allocated into each group. Outcome measures included numeric pain scores, proportion of pain relief, and ability to perform prior painful movements. OUTCOME MEASURES: Outcomes were assessed at baseline and after the administration of 1 of the 3 solutions (Group I, sodium chloride solution; Group II, midazolam; or Group III, fentanyl). RESULTS: Overall, 50% of the patients were relaxed or sedated in the placebo group, while 100% of the patients in the midazolam and fentanyl groups were relaxed or sedated. As many as 10% of the patients reported significant relief (>= 80%) with the ability to perform prior painful movements. CONCLUSIONS: Perioperative administration of sodium chloride, midazolam, or fentanyl can confound results in the diagnosis of combined cervical and lumbar facet joint pain. False-positive results with placebo or sedation may be seen in a small proportion of patients.

Adult↗
PubMed2006

[Possibilities of colposcopy in the diagnostics of cervical Chlamydia-mycoplasmatic infections (population prospective study)].

Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.

Adolescent↗
PubMed2005

[Diagnostics of viral respiratory infections in hospitalized patients and ambulatory patients from SENTINEL program during 2004/05 season in Poland].

The aim of the study was to evaluate an impact of respiratory infections on the study population, type/subtype of influenza viruses circulating during 2004/05 season within the groups of hospitalised (n=35) and ambulatory patients (n=420) and to determine antigenic affinity of isolated viral strains. Laboratory diagnostics of influenza A and B type, RSV, adenovirus and parainfluenzavirus (type 1, 2 and 3) was performed using direct immunofluorescence test (DIFA), virus isolation on MDCK cell line and RT-PCR assay. Respiratory viruses were detected in about half of hospitalised patients and one fifth of ambulatory patients. Within these groups more than 80% hospitalised patients and 70% ambulatory patients were infected with influenza virus. Two influenza A subtypes (H3N2) and (H1N1) and B type were detected. Influenza ranged from 68,8% (26-45 age group) to 89,5% (15-25 age group) of all laboratory confirmed respiratory infections, only among the youngest children (0-3 years old) one fourth of infections was caused by influenza virus and in 50% samples RSV was detected. Influenza virus was also present in over 80% positive samples from hospitalised patients over 65 years old. Sensitivity of RT-PCR compared to other influenza diagnostic methods was 95% and specificity was > or = 99%. Fast and accurate influenza diagnostics using molecular biology methods enables implementing therapy with the new generation antivirals (neuraminidase inhibitors), that are effective only when administered up to 36-48 h from onset of the illness. In diagnostics of other. respiratory viruses it is necessary to apply more sensitive diagnostic methods e.g. multiplex RT-PCR. Influenza isolates were A/Wyoming/3/2003-like, B/Hong Kong/330/2001-like, A/New Caledonia/20/99-like and B/Jiangsu/10/2003-like strains that were components of influenza vaccines for 2003/04 and/or 2004/05 seasons. Annual vaccination remains the best way to prevent infection in high risk populations. Costs of influenza vaccine and oseltamivir prophylaxis in our country are on average respectively fifty and five times lower than each day of patients' stay at an intensiv care unit. Every year within the confines of global surveillance programs (e.g. SENTINEL), there are monitored circulating influenza viruses, in order to define vaccine composition for the next season and identify new and potentially pandemic strains.

Adolescent↗
PubMed2006

[Diagnostic laparoscopy in gunshot wounds of the abdomen in children].

Diagnostic laparoscopy in gunshot wounds of the abdomen was performed in 14 children. The diagnostic value of laparoscopic and other methods of diagnostics was evaluated. An analysis of the results has shown that laparoscopy for gunshot wounds of the abdomen in children is of great diagnostic value. The indications and contraindications for diagnostic laparoscopy in such cases have been formulated. The surgical strategy used reduced 3 times the number of unnecessary laparoscopies for gunshot wounds of the abdomen in children.

Abdomen↗