Gastrointestinal tuberculosis:Diagnostic approaches for this uncommon pathology

A case report entitled“Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction”recently published in the World Journal of Clinical Cases presented a rare cause of gastric outlet obstruction and highlighted the atypical manner in which gastrointestinal tuberculosis(TB)can present.The literature with regards to this rare pathology is limited to case reports and case series with the largest being published using data from between 2003 and 2013.However,since then the diagnostic tools available have significantly changed with more modern and increasingly accurate tests now available.This editorial reviews the current state of the art with regards to diagnosis in gastrointestinal TB.

Carcinosarcoma of the breast:Facing the challenge of a rare nosologic entity

Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast cancer.It is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone.Although cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation.Despite recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative approach.Since CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented.Nevertheless,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone metastases.Thus,surgical removal of breast CS does not necessarily ensure patient’s long-term recovery.Moreover,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is limited.Nevertheless,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone.The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread.Clinical features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

Overview of genetic causes of recurrent miscarriage and the diagnostic approach

Recurring miscarriage(RM)is a frustrating reproductive complication with variable etiology.Numerous genetic defects have been known to play a crucial role in the etiology of RM.Chromosomal abnormalities are frequently detected,while other genetic defects cannot be diagnosed through routine research,such as cryptic chromosomal anomalies,single nucleotide polymorphism,single-gene defect,and gene copy number variation.Diagnostic laboratories have recently used variable advanced techniques to detect potential genetic abnormalities in couples with RM and/or in products of conception.Here we aim to summarize the known genetic causes of RM,with a focus on the new diagnostic techniques.Knowledge of the genetic profile of miscarriages is important for prognosis and potential counseling planning,as well as the prenatal diagnostic strategy in subsequent pregnancies.

Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

Combined hepatocellular-cholangiocarcinoma:An update on epidemiology,classification,diagnosis and management

Background:Combined hepatocellular-cholangiocarcinoma(CHC)is a rare subtype of primary hepatic malignancies,with variably reported incidence between 0.4%–14.2%of primary liver cancer cases.This study aimed to systematically review the epidemiological,clinicopathological,diagnostic and therapeutic data for this rare entity.Data sources:We reviewed the literature of diagnostic approach of CHC with special reference to its clinical,molecular and histopathological characteristics.Additional analysis of the recent literature in order to evaluate the results of surgical and systemic treatment of this entity has been accomplished.Results:The median age at CHC’s diagnosis appears to be between 50 and 75 years.Evaluation of tumor markers[alpha fetoprotein(AFP),carbohydrate antigen 19–9(CA19–9)and carcinoembryonic antigen(CEA)]along with imaging patterns provides better opportunities for CHC’s preoperative diagnosis.Reported clinicopathologic prognostic parameters possibly correlated with increased tumor recurrence and grimmer survival odds include advanced age,tumor size,nodal and distal metastases,vascular and regional organ invasion,multifocality,decreased capsule formation,stem-cell features verification and increased GGT as well as CA19–9 and CEA levels.In case of inoperable or recurrent disease,combinations of cholangiocarcinoma-directed systemic agents display superior results over sorafenib.Liver-directed methods,such as transarterial chemoembolization(TACE),percutaneous ethanol injection(PEI),hepatic arterial infusion chemotherapy(HAIC),radioembolization and ablative therapies,demonstrate inferior efficacy than in cases of hepatocellular carcinoma(HCC)due to CHC’s common hypovascularity.Conclusions:CHC demonstrates an overlapping clinical and biological pattern between its malignant ingredients.Natural history of the disease seems to be determined by the predominant tumor element.Gold standard for diagnosis is histology of surgical specimens.Regarding therapeutic interventions,major hepatectomy is acknowledged as the cornerstone of treatment whereas minor hepatectomy and liver transplantation may be applied in patients with advanced cirrhosis.Despite all therapeutic attempts,prognosis of CHC remains dismal.

Decision Level Fusion Using Hybrid Classifier for Mental Disease Classification

Mental health signifies the emotional,social,and psychological well-being of a person.It also affects the way of thinking,feeling,and situation handling of a person.Stable mental health helps in working with full potential in all stages of life from childhood to adulthood therefore it is of significant importance to find out the onset of the mental disease in order to maintain balance in life.Mental health problems are rising globally and constituting a burden on healthcare systems.Early diagnosis can help the professionals in the treatment that may lead to complications if they remain untreated.The machine learning models are highly prevalent for medical data analysis,disease diagnosis,and psychiatric nosology.This research addresses the challenge of detecting six major psychological disorders,namely,Anxiety,Bipolar Disorder,Conversion Disorder,Depression,Mental Retardation and Schizophrenia.These challenges are mined by applying decision level fusion of supervised machine learning algorithms.A dataset was collected from a clinical psychologist consisting of 1771 observations that we used for training and testing the models.Furthermore,to reduce the impact of a conflicting decision,a voting scheme Shrewd Probing Prediction Model(SPPM)is introduced to get output from ensemble model of Random Forest and Gradient Boosting Machine(RF+GBM).This research provides an intuitive solution for mental disorder analysis among different target class labels or groups.A framework is proposed for determining the mental health problem of patients using observations of medical experts.The framework consists of an ensemble model based on RF and GBM with a novel SPPM technique.This proposed decision level fusion approach by combining RF+GBM with SPPM-MIN significantly improves the performance in terms of Accuracy,Precision,Recall,and F1-score with 71\%,73\%,71\%and 71\%respectively.This framework seems suitable in the case of huge and more diverse multiclass datasets.Furthermore,three vector spaces based on TF-IDF(unigram,bi-gram,and tri-gram)are also tested on the machine learning models and the proposed model.

A Novel Convolutional Neural Network Model for Malaria Cell Images Classification

Infectious diseases are an imminent danger that faces human beings around the world.Malaria is considered a highly contagious disease.The diagnosis of various diseases,including malaria,was performed manually,but it required a lot of time and had some human errors.Therefore,there is a need to investigate an efficient and fast automatic diagnosis system.Deploying deep learning algorithms can provide a solution in which they can learn complex image patterns and have a rapid improvement in medical image analysis.This study proposed a Convolutional Neural Network(CNN)model to detect malaria automatically.A Malaria Convolutional Neural Network(MCNN)model is proposed in this work to classify the infected cases.MCNN focuses on detecting infected cells,which aids in the computation of parasitemia,or infection measures.The proposed model achieved 0.9929,0.9848,0.9859,0.9924,0.0152,0.0141,0.0071,0.9890,0.9894,and 0.9780 in terms of specificity,sensitivity,precision,accuracy,F1-score,and Matthews Correlation Coefficient,respectively.A comparison was carried out between the proposed model and some recent works in the literature.This comparison demonstrates that the proposed model outperforms the compared works in terms of evaluation metrics.

Hypertension in Adolescent

Hypertension in adolescents is, as in other patients, one of the important cardiovascular risk factors, associated with hypertension in adults and with appearance of cardiovascular complications later in life. In recent years it is in increase, in parallel with occurrence of overweight in this age group. There is mostly essential or obesity-related hypertension. It is often asymptomatic, therefore it holds true also for adolescents, that it has to be actively searched, especially in risk groups such as overweight adolescents, adolescents with positive family history or some of the other classical cardiovascular risk factors. If we have normal-weight adolescent with important hypertension or symptomatic adolescent without positive family history, the possibility of secondary hypertension has to be thinking of and extended, on possible cause focused and stepwise diagnostics performed. In this case, the treatment is etiological. Otherwise, the first-line treatment in adolescents comprises nonpharmacological treatment measures. Sometimes, because of poor nonpharmacological treatment compliance and presence of hypertensive-target organ damage, antihypertensive medications have to be introduced. However, preventive actions represent the most important task, in the form of primary and primordial prevention. In this article, diagnostic approach, prevention and treatment strategies in adolescents are shortly presented.

Peritoneal Tuberculosis in a Patient with HIV： Case Study in the Excellent Center in HIV/AIDS Care in Lubumbashi＇s University, Lubumbashi City

Tuberculosis is a disease of poverty. It is also a disease that prevents escaping poverty. There is a case report of disseminated tuberculosis with peritoneal involvement and peritoneal responsible for the clinical manifestations that may delay diagnosis. This location deserves mention as a share of expansion of tuberculosis in the presence of abdominal pain and bread signs of lung disease at a lower cost balance.

Diagnostic Techniques for COVID-19:A Mini-review of Early Diagnostic Methods

The outbreak of severe pneumonia at the end of 2019 was proved to be caused by the SARS-CoV-2 virus spreading out the world.And COVID-19 spread rapidly through a terrible transmission way by human-to-human,which led to many suspected cases waiting to be diagnosed and huge daily samples needed to be tested by an eff ective and rapid detection method.With an increasing number of COVID-19 infections,medical pressure is severe.Therefore,more e fficient and accurate diagnosis methods were keen urgently established.In this review,we summarized several methods that can rapidly and sensitively identify COVID-19;some of them are widely used as the diagnostic techniques for SARS-CoV-2 in various countries,some diagnostic technologies refer to SARS(Severe Acute Respiratory Syndrome)or/and MERS(Middle East Respiratory Syndrome)detection,which may provide potential diagnosis ideas.

Small bowel bleeding:a comprehensive review

The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitalizations.Angiodysplasia is the commonest cause of obscure GI bleeding,particularly in the elderly.Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients.Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds.Deep enteroscopy has also an added advantage of therapeutic potential.Computed tomography is helpful in identifying extra-intestinal lesions.In cases of difficult diagnosis,surgery and intra-operative enteroscopy can help with diagnosis and management.The treatment is dependent upon the aetiology of the bleed.An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy.Small bowel bleeding can be managed by conservative,radiological,pharmacological,endoscopic and surgical methods,depending upon indications,expertise and availability.Some patients,especially those with multiple vascular lesions,can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.