Academic literature on the topic 'One-day diagnosis'

Abstract The differential diagnosis of female virilization and infertility can be significantly narrowed using routine laboratory testing. The case presented herein is an example of a 28 year old Caucasian female patient with amenorrhea, hirsutism, and infertility in the context of markedly elevated serum testosterone levels. This case highlights the use of bilateral ovarian vein sampling for testosterone as a means to localize the ectopic testosterone production and to guide future surgical procedures. Adrenal vein sampling procedures are relatively more common than other methods. Ovarian vein sampling is less common, yet in this case, it proved diagnostic. This case demonstrates the needed cooperation of the clinical laboratory and the patient care team performing the catheterization, for this type of testing to be useful. In this unique case, we discovered bilateral production of androgens.

In this prospective observational study, we tested the feasibility and efficacy of a novel one-day PCa diagnosis path based on biparametric magnetic resonance (bpMRI) and digital pathology by fluorescence confocal microscopy (FCM). Patients aged 55–70 years scheduled for PBx due to increased PSA levels (3–10 ng/mL) and/or abnormal digitorectal examination were enrolled. All patients underwent bpMRI and PBx with immediate FCM evaluation of biopsy cores. Patients were asked to fill out a dedicated Patient Satisfaction Questionnaire. Patients’ satisfaction rates and concordance between digital pathology and standard HE evaluation were the outcomes of interest. Twelve patients completed our one-day PCa diagnosis path. BpMRI showed suspicious lesions in 7 patients. Digital pathology by FCM identified PCa in 5 (41.7%) of the 12 patients. Standard pathology confirmed the diagnosis made through digital pathology in all the cases. At a per patient level, high concordance between the methods was achieved in Gleason Grading (4 out of 5 patients). The level of agreement in the number of positive cores was lower but did not affect the choice of treatment in any of the 5 PCa cases. At a per core level, the agreement was very high for the diagnosis of anyPCa (96.2%) and csPCa (97.3%), with a k coefficient of 0.90 and 0.92, respectively (near perfect agreement). In conclusion, one-day PCa diagnosis by FCM represents a feasible, reliable, and fast diagnostic method that provides significant advantages in optimizing time and resources, leading to patients having a higher quality standard of care perception.

Folliculotropic mycosis fungoides (FMF) is one of the three recognized variants of mycosis fungoides. FMF predominates in men over 50 years old. Often it takes a long time for the definitive diagnosis after the onset of skin lesions. Dermoscopy today represents almost an extension of the clinical dermatological examination, with its application being expanded day after day in medical literature. The authors demonstrate the dermoscopic findings recently described in the context of FMF (follicular accentuation / white halo around the follicles), in a case of typical clinical presentation, with a diagnosis confirmed by the clinical-dermatological correlation.

Background: People who have a diagnosis of Borderline Personality Disorder (BPD) experience a great deal of psychological distress. Their relationships with others can mediate their distress yet they find it difficult to maintain relationships. Method: This study examines the feasibility of a one day workshop teaching Dialectical Behaviour Therapy (DBT) skills to the friends, relatives and partners of people who have a diagnosis of BPD. A single group, repeated measures design was used to test the primary outcome hypothesis; that one month after the workshop, attendees’ emotion regulation and mindfulness skills will be improved. A single cohort pre-post design was used to test the secondary outcome hypothesis; that a month after the workshop, people with BPD will rate the environment between themselves and their friend or relative as more validating. The feasibility of the workshop was addressed, in part, through thematic analysis of semi-structured interviews with the participants at one month follow up. Results: Recruitment to the workshop was poorer than expected; 22 people, invited by 17 clients with BPD, participated. There was no change in mindfulness or emotion regulation skills as a result of the workshop but there was a significant difference between the perceived invalidating environment before (Mdn=1.93, IQR=1.29) and one month after (Mdn=1.64, IQR=0.82) the workshop (p=.023). Qualitative findings suggest that friends and family developed self-efficacy, coping skills, felt less isolated and gained compassion for the person with BPD. Conclusions: A larger scale study is feasible but protocol modifications are necessary. A three armed randomised controlled trial comparing the one day DBT skills workshop, with a wait list control group and a teaching and social support group is recommended.

Bien prendre en charge le bon patient au bon moment au bon endroit selon les dernières recommandations des sociétés savantes est aujourd’hui la préoccupation de chaque professionnel de santé dans le but d’améliorer l’état de santé des populations. A travers la mise en place du parcours de soins innovant accéléré «Diagnostic en un jour» pour les pathologies hépato-biliopancréatiques aux Hôpitaux Universitaires de Strasbourg et la réalisation d’une étude comparative au parcours classique avec respectivement 330 vs 152 patients, l’efficacité́ et la soutenabilité́ financière de celui-ci sont prouvées. Nous montrons la possible diffusion de ce modèle à plus grande échelle pour d’autres pathologies et régions. Par ailleurs, la démarche VBHC appliquée à travers les questionnaires standardisés établis pour les cancers du foie et du pancréas permettra le recueil des résultats qui impotent aux patients PROMs et cliniques CROMs ayant pour objectif de tendre vers la pertinence et l’excellence des soins
Nowadays, taking good care of the right patient at the right time in the right place according to the latest guidelines established by professional societies is the main concern of each health care provider, aiming to improve populations’ state of health. From the example of the innovative and accelerated care pathway “Oneday diagnosis” for hepatobiliary and pancreatic diseases taking place in Strasbourg university hospital and the comparative study to ordinary pathway with respectively 330 vs 152 patients, we demonstrated its efficiency and sustainability. We confirmed the possible replication elsewhere and for other pathologies. Furthermore, the application of the VBHC concept through standardized questionnaires for liver and pancreatic cancers would allow to collect outcomes that matter to patients PROMs and clinical outcomes CROMs with the objective of reaching relevant and excellent care

Emphasizing diagnosis, causality, and holistic treatment, this is the only book offering a full discussion of Avoidant Personality Disorder for therapists and sufferers. Avoidant Personality Disorder (AvPD) is an extremely widespread, devastating disorder that generally goes unrecognized or misrepresented by what little scientific literature there is on the topic. Therapists are left mystified about how to diagnose and treat it, and patients and other sufferers are at a loss as to what is wrong and how to go about correcting it. The Essential Guide to Overcoming Avoidant Personality Disorder is the only book available to guide both patients and those trying to help them. This thorough and much-needed volume explores the development of AvPD and presents a holistic view of its causes from the psychoanalytic, cognitive-behavioral, and interpersonal perspectives. It offers an extensive section on diagnostic criteria that will be useful to sufferers and therapists, and it discusses the various therapies for AvPD. Finally, and perhaps most critically, the book provides a section intended as a guide for psychiatrists—and a self-help guide for sufferers—including a day-by-day, one-step-at-a-time, monthly guide on how to overcome AvPD.

Skin cancer is Australia’s ‘national cancer’. At least two in three Australians are diagnosed with skin cancer by the age of 70 and over 1000 Australians are treated for skin cancer every day. The good news is that skin cancer is one of the most preventable forms of cancer. This book brings together leading experts in the prevention, diagnosis and treatment of skin cancer, providing practical information about the sun and health. The book begins with an explanation of what skin cancer is and how it forms, then discusses ultraviolet radiation and how to protect yourself, the effects of tanning, myths and truths about sunscreen, getting enough Vitamin D, the impact of the sun on your eyes, early detection and treatment of skin cancer, and life after skin cancer. It is a must-read for anyone living under the Australian and New Zealand sun.

The diagnosis of schizophrenia cannot be made based on the results of an ob­jective diagnostic test or laboratory measure, though we and others are working towards this. Instead, clinicians diagnose schizophrenia based on behaviour and psychopathology (including the symptoms described in the previous chapter). These require the subjective interpretation of clinicians, but they can be as­sessed reliably. The definitions of major mental illnesses used by clinicians are presented in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (in the United States) and the World Health Organization’s International Classification of Diseases (ICD) in other countries. These def­initions are updated from time to time to reflect gains in knowledge, or to reflect modern thinking on the similarities and differences between certain disorders. From one edition to the next, some diagnoses are revised, some are added, and some vanish altogether, only to be replaced or absorbed under other diagnoses. The diagnostic criteria for schizophrenia as defined by the most recent version of the DSM (DSM- 5) include the presence of two or more of the following symptoms: delusions, hallucinations, disorganized speech, disorganized or cata­tonic behaviour, and negative symptoms. At least one of the two must be delu­sions, hallucinations, or disorganized speech, while the second symptom type required for diagnosis could be any of the remaining four criteria. The require­ment of delusions, hallucinations, or disorganized speech maintains the resem­blance of the modern- day diagnosis to that first described by the clinician Emil Kraepelin over a century ago. Kraepelin’s discovery that schizophrenia is marked by a chronic and gradually worsening course is seen in modern- day criteria as well. A DSM-5 diagnosis of schizophrenia requires continuous signs of illness for at least 6 months, during which the individual must show at least 1 month of active symptoms (less if well treated). The diagnosis also requires social or work deterioration over a signifi­cant amount of time. Lastly, the diagnosis requires that the observed symptoms are not due to some other medical condition, including other psychiatric disorders such as bipolar disorder or major depressive disorder.

With the type of ailments increasing and with the methods of diagnosis improving day by day, wearable devices are increasing in number. Many times, it is found to be beneficial to have continuous diagnosis for certain type of ailments and for certain type of individuals. One will feel uncomfortable if a number of needles are protruding out of one's body for having continuous diagnosis. From this point of view, wearable diagnosis systems are preferable. With Internet of Things (IoT), it is possible to have a number of diagnostic sensors as wearable devices. In addition, for a continuous monitoring, the information from these wearable devices must be transferring information to some central location. IoT makes this possible. IoT brings full range of pervasive connectivity to wearable devices. IoT of wearable devices can include additional intelligence of location of the person wearing the device and also some biometric information identifying the wearer.

Abstract I was not diagnosed with epilepsy until I was a senior in high school. I am now 21 years old, so I have dealt with this for only 3 years now. At first, it was a little scary to hear the neurologist say ‘‘You have epilepsy,’’ but it was even more frustrating before the diagnosis was made because my family and I had no idea what was wrong with me. At least having a diagnosis brought a bit of relief. At times I consider myself very lucky. There are so many people who have epilepsy that is more severe than mine. I have experienced a grand mal seizure; however, I have no memory of it. My mother is the one that has the not-so-pleasant honor of being able to recall the scene. I consider myself lucky because on a regular day-to-day basis, I just pop pills.

Cancer has emerged as a prevalent ailment in contemporary times. A range of clinical and pathological diagnostic methods are available for the detection of cancer. However, to this day, a comprehensive understanding of the precise diagnostic methods and stages of cancer has not been entirely achieved. In this chapter, we explored various advanced techniques for the detection and diagnosis of cancer. One of the ways includes the utilization of artificial intelligence, specifically deep learning, in combination with microfluidics chip technology. Deep learning models offer a dependable, expeditious, and efficient approach to addressing the complexities of these diseases in the given circumstances. Microfluidic devices generally detect various cancer-diagnostic variables present in sample biological fluids, as well as facilitate the production of nanoparticles suitable for drug delivery. Therefore, the utilization of microfluidics, deep learning in the domain of cancer diagnosis and research has significant promise owing to its exceptional sensitivity, capacity for high-throughput analysis, and cost-effectiveness

Use of antiretroviral therapy (ART) to treat HIV leads to extensive benefits at both the individual and the public health levels. By gaining a more complete appreciation of the many benefits of ART, clinicians can make informed decisions regarding when to initiate ART for patients recently diagnosed with HIV. This chapter reviews both the immunologic and longevity gains attributable to ART, as well as ART’s effectiveness for preventing onward HIV transmission. Considering its effectiveness and due to improvements in ART’s potency, along with concomitant declines in ART-related adverse effects and pill burden, the pendulum of when to initiate ART has swung toward early imitation. Same day-of-diagnosis ART initiation, or rapid start within several days of diagnosis, has moved from the realm of research to clinical care. In the United States, the Centers for Disease Control and Prevention estimates that only 53% of people living with HIV have achieved virologic suppression. In recognition of the need to improve HIV-related outcomes, the US government has launched its Ending the HIV Epidemic (EtHE) initiative, which seeks a 90% reduction in the number of annual, new HIV diagnoses by 2030. HIV treatment, inclusive of the rapid start of ART, represents one of the EtHE initiative’s fundamental pillars. This chapter reviews the benefits of ART, highlights data supporting same-day/rapid ART imitation, and discusses its real-world application.

Abstract A little over four decades ago when I was a supervisor at a treatment institution for emotionally disturbed youngsters, I was summoned one day to the director’s office. Without warning I was told that as part of the process of being groomed to be his assistant director, I would be required to fire one of my supervisees. Very anxious, extremely selfconscious, and most uncertain about how I would conduct myself, after much hesitation I arranged an appointment with my supervisee. With enormous trepidation, I initiated the discussion by asking, “How is it going, Melvin?” To my deep consternation, Melvin confidently and enthusiastically responded, “I think you are doing a good job!” Although Melvin’s reply to my query might be considered somewhat unconventional even in the year 2000, it was “out of this world” in 1959.

In this era of technology, for effective treatment of patients, clinical experts are getting great support from automated e-healthcare systems. Nowadays, one of the leading reasons of death is cancer. Some common cancers are breast cancer, prostate cancer, lung cancer, skin cancer, brain cancer, and so on. To save human lives from cancer, an effective and timely treatment is required. Many different types of image modalities like CT scan, ultrasound, x-ray, MRI can be used to determine the disease, but traditionally, this was purely dependent on the knowledge and experience of doctors. So, the death rate was quite high and increasing day by day. Machine learning and deep learning are providing robust solutions in this field. There are many deep learning techniques like RNN, CNN, DBN, autoencoders, generative adversarial networks which are providing robust solutions in cancer diagnosis and prognosis so that many human lives can be saved. The objective of this chapter is to give an insight into deep learning techniques in the field of a cancer diagnosis.

Membranous nephropathy (MN) is one of the various glomerular diseases causing nephrotic syndrome, also referred to as membranous glomerulopathy. It can be diagnosed at any age in general, and males are more often affected than females (with the sex ratio being 2–3:1). Membranous nephropathy is a relatively rare disease in adults (approximately half of all cases are common in older White adults). Statistical analysis shows that 80% of patients with MN have high creatinine level, dyslipidemia, hypoalbuminemia, proteinuria more than (3.5 g/day), and fluid retention (edema), while 20% with asymptomatic with non-nephrotic levels of proteinuria (< 3.5 gram/day) involves the reaction of an inflammatory process in the basement membrane. It can be distinguished from nephritic syndromes by the absence of active sediments, hematuria, and red cell casts in urine microscopy. The two main causes of nephrotic range proteinuria are the loss of the anionic charge barrier in the membrane and podocyte destruction, which results in albuminuria. The field has advanced greatly and quickly over the past 10 years thanks to the development of cutting-edge instruments for disease diagnosis, classification, monitoring, and treatment. This core curriculum aims to serve as both a broad guide for the clinical management of disease and an overview of recent developments in the field. In the review, we critically summarized different diagnosis biomarker therapies used for the treatment of MN patients in Iraq. These groundbreaking discoveries were swiftly applied to clinical diagnosis and management. The diagnosis and treatment monitoring processes benefited significantly from significant advancements in detection techniques.

Abstract Aneurysms are usually diagnosed only after they rupture. Subsequent to this catastrophe, patients generally evidence severe headache of sudden onset, signs of meningeal irritation, and depression of consciousness. Difficulties in diagnosis arise when the ictus is mild and the headache is not typical. Aneurysmal rupture classically causes a violent and sudden headache, worse than any previously experienced, which is followed by depression of consciousness and the development of neck stiffness. This constellation of signs and symptoms is readily diagnosed by most physicians as aneurysmal rupture. Unfortunately, the nature of the headache is highly variable. Although it has a severe character at onset, is continuous, and becomes generalized, the deviations from this pattern are considerable (Table 7-1). In one series of 192 cases of subarachnoid hemorrhage (SAH), 10% of patients reported no headache, and another 8% reported mild headache, which gradually increased. In another large series, the percentage of patients with headache increased from 66% of those admitted on day O to 77% of those on day 3. The headache of aneurysmal rupture is set apart from other headaches in severity and suddenness of onset, which can cause patients to scream with pain and alarm.3 The elicitation of associated symptoms, the past medical history, and confirmatory physical, laboratory, and radiologic findings are helpful in making the diagnosis.

Abstract While many researchers in this field would reasonably believe that the automation of tests of mental capabilities would have started with the advent of the microcomputer in the late 1970s, this is by no means the case. Some may think the pioneering attempts of Gedye (1967) in the 1960s were the earliest attempts, or those with longer memories the introduction of the Continuous Performance Test in the 1950s (Rosvold et al., 1956). However, to the knowledge of the authors, Clark Hull was one of the true pioneers in this field. Hull, better known for his later work on Classical Conditioning, actually conducted his PhD thesis on the effects of tobacco smoking on mental efficiency. In a publication of his thesis, Hull (1924) described a remarkable apparatus which included a reaction time measurement system, accurate to 1/300 second, and a voice key to facilitate the measurement of reading reaction times! The purpose of this chapter is to shed some light upon the intriguing question of why, for decades, some researchers have worked diligently to harness the latest technological advancements of the day in order to automate tests of mental capabilities, while their colleagues have been perfectly happy to make such assessments simply using pencil, paper, and sometimes, a stopwatch.

Context: Benign Acute Childhood Myositis (BACM) is a self-limited syndrome of acute myalgia prevalent in calf with impaired walking after Upper Respiratory Tract Infection. This report analyze the clinical condition and investigation of BACM case, by medical record. Case report: C.L.F.A., male, 12 years, in use of clobazam, sodium divalproate, topiramate and lamotrigine, started low back pain. One day after, presented headache, fever and nasal congestion. Reported convulsive febrile episodes. At following morning received Upper Respiratory Tract Infection diagnoses. Next day, maintained symptoms and developed thrombocytopenia. Discharged due to suspicion of dengue. After 24 hours, returned with improved thrombocytopenia, also with leukopenia. At 5th day, started pain in lower limbs and impaired walking. Due to muscle symptoms worsening and increased creatinophosphokinase, hospital admission were indicated. Laboratory tests found increased in creatinekinase (10,180 U/L), CKMB (129,6 U/L), leukopenia (2800/mm3 ) and thrombocytopenia (174,000 / mm3 ). Anti-HIV, anti- leptospirosis, dengue, Chikungunya and anti-HCV tests resulted negative. At the 6th hospitalization day, he was discharged virtue of muscle symptoms, leukocytosis and creatinekinase levels favorable progression. Conclusions: BACM has excellent prognosis and self-limited course, so outpatient care is feasible. The diagnosis is clinical. If neurological deficits, modified urine tests and rash, or symptoms duration longer than one week, differential diagnoses must be researched. Measure creatinekinase is important if pain or walking disability after viral episode. Early intervention avoids complications.

Background: GBS is an acute inflammatory polyneuropathy resulting from an immune response after infection. Characterized as an ascetic, progressive, selflimiting flaccid tetraparesis. It has several phenotypic presentations, which one is AMAN. The treatment’s based on use of intravenous immunoglobulin (IGIV) and plasmapheresis (PLEX). Methods: A literature review of the PubMed and UpToDate databases using descriptors “GBS” and “AMAN” between 2014-2020. Objectives: Report a case of GBS, addressing AMAN variant; a literature review with therapeutic and diagnostic possibilities. Case report: DTS, 32y, male, admitted with a picture of flaccid, limp asymmetrical tetraparesis, with an asymmetrical pattern, predominant in lower limbs, without sensory symptoms. Progressive evolution, onset of motor symptoms on the 8th day after self-limited diarrhea. CSF on 3rd day of onset of motor symptoms without dissociation cytological protein - CN: 62 / Ptn: 80.1mg / dl. Repeated CSF on the 10th day with CN: 27 / Ptn: 215 mg / dl. electroneuromyography 16/04: electrophysiological examination shows motor neuropathy of axonal pattern with signs of denervation in activity, findings compatible with axonal neuropathy. IGIV was performed for 5 days, without complications. Results: The diagnosis of GBS is based on CSF clinical criteria and findings on electroneuromyography. AMAN is a phenotypic variant characterized by purely motor and axonal impairment. The therapeutic options proven effectiveness are PLEX, and IGIV. Conclusion: Studies demonstrates that there’s no difference in effectiveness between PLEX and IGIV, the choice of treatment being dependent on socioeconomic and patient-related factors.

"Diagnosing infections with SARS-CoV-2 is still of great interest due to the health and economic impact of COVID pandemic. The 4th wave of the COVID-19 pandemic is expected and is considered to be stronger and faster due to the dominance of Delta variant which is highly contagious [1]. SARS-CoV-2 also known as 2019-nCoV is one of the three coronaviruses (together with SARS-CoV or SARS-CoV1/Severe acute respiratory syndrome coronavirus), MERS-CoV /Middle East Respiratory Syndrome coronavirus) which can cause severe respiratory tract infections in humans [2]. Early diagnosis in COVID 19 infection is the key for preventing infection transmission in collectivity and proper medical care for the ill patients. Gold standard for diagnosing SARS-Co-V-2 infection according to WHO recommendation is using nucleic acid amplification tests (NAAT)/ reverse transcription polymerase chain reaction (RT-PCR). The search is on to develop reliable but less expensive and faster diagnostic tests that detect antigens specific for SARS-CoV-2 infection. Antigen-detection diagnostic tests are designed to directly detect SARSCoV-2 proteins produced by replicating virus in respiratory secretions so-called rapid diagnostic tests, or RDTs. The diagnostic development landscape is dynamic, with nearly a hundred companies developing or manufacturing rapid tests for SARS-CoV-2 antigen detection [3]. In the last 3 months our hospital introduced the antigen test or Rapid diagnostic tests (RDT) which detects the presence of viral proteins (antigens) expressed by the COVID-19 virus in a sample from the respiratory tract of a person. All RDT were confirmed next day with a RT-PCR. The number of positive cases detected during 3 months in our laboratory was 425. There were 326 positive tests in April, 106 positive tests in May and 7 positive tests in June. Compared with the number of positive tests in the 1st semester of 2021, the positive tests have significantly declined."

Although maternal and perinatal mortality and morbidity in pregnant patients with ITP are lower than previously assumed, they are not negligable. Significant postpartum hemorrhage occurs in 7% of the mothers with ITP. Thrombocytopenia is found in 51% of the newborns born from mothers with ITP and 6% of these have serious bleeding problems. Tests which predict which fetuses are at risk, are not yet available. Thrombocyte counts in a fetal blood sample are falsely low in 40% of cases.A prospective controlled randomized study done in the Netherlands failed to show an effect of antenatal corticosteroid treatment on neonatal platelet counts. Elective caesarean section has not been shown to protect against intracranial bleeding in thrombocytopenic newborns. The choice between vaginal delivery and caesarean section in ITP patients should be made on obstetric grounds with one exception: no other assisted vaginal delivery than the easy outlet forceps should be done. All cases of slow progress of the second stage of labour with insufficient descent should be terminated by caesarean section as well as breech delivery with suboptimal progress. Newborn thrombocyte counts should be done daily during the first week of life, since lowest platelet counts are often found between the 3rd and 5th postpartum day. Newborn thrombocytopenia is transient and does not warrant splenectomy, but can necessitate treatment with corticosteroids and/or high doses of immunoglobulin 6. Current data do not justify to dissuade breastfeeding.The recurrence of neonatal thrombocytopenia in subsequent patients is unknown.

Introduction: Anti-MOG Antibody Associated Disease (MOGAD) is an autoimmune neurological condition with antibodies directed against the myelin glycoprotein of oligodendrocytes, with a monophasic or relapsing course. Symptoms include optic neuritis (ON), transverse myelitis, cerebral, brainstem, and cerebellar dysfunction. The diagnosis is based on the clinical picture and complementary exams, mainly the anti-MOG antibody. Treatment involves, in the acute phase, pulse with corticosteroids, plasmapheresis and, especially in children, immunoglobulin, and in the chronic phase (recurrent course), immunosuppressants, immunobiologicals and, especially in children, monthly immunoglobulin. Objectives: To report a case of MOGAD. Methods: Review of medical records and brief literature review. Results: A 16-year-old male patient started with headache and fever, and the next day, low visual acuity (LVA) in the right eye (RE) with gradual worsening, and after two weeks, amaurosis in the RE and LVA in the left eye (LE). He received methylprednisolone pulse for five days, with improvement. After three weeks, he presented a new bilateral LVA, with amaurosis in the LE. Opted for new pulse therapy. Relevant findings included cerebrospinal fluid (CSF) with 15 cells, absence of oligoclonal bands in blood and CSF, neuraxial magnetic resonance Imaging with extensive bilateral ON affecting up to the optic chiasm, with gadolinium enhancement, and perineuritis. After results of non-reactive antiaquaporin 4 and reactive serum antiMOG, the diagnosis of MOGAD was confirmed, prednisone was maintained and azathioprine was prescribed. There was complete visual recovery afterwards. Conclusion: This case sheds light on the diagnosis of an uncommon demyelinating disease that is MOGAD, however, a condition that should be remembered as one of the differential diagnoses of ON, especially in patients with atypical ON and in children.

Objective: The aim of this study was to evaluate compliance with the law of 60 days to start breast cancer (BC) treatment in Brazil. Methodology: This is an ecological observational study, based on retrospective data from a National Oncology Database (DATASUS – SISCAN/Cancer Information System) that is publicly available for download. Oncological treatment data from 2017 to 2021 were selected, referring to the time from the diagnosis of BC to the beginning of the first oncological treatment. Only data with all available variables were considered, and an analysis was performed by federative unit and by region of Brazil. Results: In the 5-year study period, 202,371 patients with BC treatment in Brazil were included in the SUS, being in the north region 11,198 (5.5%), northeast region 46,775 (23.1%), southeast region 90,151 (44.6%), south region 41,288 (20.4%), and midwest region 12,959 (6.4%). BC treatment in Brazil begins in 50% of patients within 60 days of diagnosis; however, 16.3% take up to 90 days, 11.3% take up to 120 days, 19.8% take up to 300 days, and 2.6% take longer than 301 days. With regard to the regions that comply with the 60-day law, it is the north region with 65% of treatments initiated within 60 days and the one that least complies is the southeast with 45.7%, with a significant difference between the regions (p=0.0363). Likewise, the state that best complies is Rondônia with 84.5% and the one that least complies is Rio de Janeiro with 39.1%, with a significant difference in all states in relation to their region (p>0.0001). Conclusion: It is observed that compliance with the 60-day law is much lower than expected, where only 50% of patients in Brazil start their treatment within 60 days, and in many states, more than 1/4 of patients take more than 120 days to start, with an impact on prognosis.

Case presentation: A 10-year-old male presented with a sudden onset of excessive daytime sleepiness (EDS) in the last 36 hours. Currently, the patient sleeps around 18 hours per day associated with headache and irritability. Patient received his second dose of Pfizer-BioNTech COVID-19 (coronavirus disease) vaccine. He has a past medical history of subtotal resection craniopharyngioma around one year ago. Neurology exam showed new deficits of motor aphasia and drowsy but aroused easily to voice. Axial FLAIR (FluidAttenuated Inversion Recovery) and T2-weighted magnetic resonance imaging (MRI) show symmetrical hyperintense lesions on the thalamus. Magnetic resonance venography shows a lack of flow in the vein of galen, straight, superior sagittal and bilateral transverse extending to the right sigmoid sinus. The findings above confirmed the diagnosis of cerebral venous thrombosis (CVT). Patient received enoxaparin for three months. Patients complete resolution of symptoms and a new MRI shows complete recanalization. Discussion: EDS is a common complaint in neurologic practice and has a wide spectrum of differential diagnoses. We describe an unusual cause of EDS caused by an extensive CVT in the bilateral thalamus. Bilateral lesions of the medial thalamus can cause hypersomnia and decrease consciousness. Infection, trauma, neurosurgery, malignancy and thyroid problems are risk factors of children CVT. Another risk factor to be considered is the COVID vaccination. In literature, there are more reports of thrombocytopenia and CVT is very rare. Although these factors are associated, they are not necessarily causality. Conclusion: Clinicians must be aware of CVT as a differential diagnosis of EDS, especially in the presence of sudden EDS onset or neuropsychological signs.

In a prospective, randomized study patients undergoing hysterectomy were treated either by the low molecular weight heparin Fragmin or by the combination of unfractionated sodium heparin + dihydroergotamin (HDHE). The dosage in the Fragmin group was 2× 2500 anti Xa-U on day 1 = day of surgery, from day 2-8: 1× 5000 anti Xa-U, in the HDHE-group from day 1-8: 2× 5000 IU heparin + 0.5 mg DHE. 99 patients were randomly allocated to prophylaxis with Fragmin, 101 to HDHE prophylaxis. 95 and 96 respectively were evaluated, the others excluded for different reasons. The 2 groups were comparable for general data and risk factors. Duration of surgery, intraoperative blood loss, transfusion rates and postoperative hemoglobin levels were identical. Blood volumes in subcutaneous and subfascial drainages were slightly but not significantly higher in the Fragmin group. In patients with an additional Marshall-Marchetti-operation, blood volumes in the drainages of the spatium retzii were significantly higher in patients on Fragmin. No differences were observed in the incidence of minor and major wound hematoma. Painful injections and sugillations at the injection sites were more frequently observed in the HDHE-group. The thermographic DeVeTherm test, which was carried out daily for diagnosis of DVT, gave positiv results (= temperature difference 1°C) on one day only in 14 patients of each group. The test was positive on 2 or more consecutive days in 4 patients on Fragmin and 2 patients on HDHE. Phlebography, which was carried out in the latter patients, gave a positive result in 1 patient of each group. Localization of DVT was mainly the lower limb. Plasma anti-Xa activity (S-2222) 4 hrs. after injection of 5000 anti-Xa IU Fragmin was 0.45 IU/ml being 10 fold higher than after HDHE. aPTT was slightly prolonged in both groups, thrombin time and thrombelastogramm gave even more pronounced changes in the Fragmin group. The present data indicate that Fragmin dosage should be further decreased to avoid bleeding complications.

Introduction: Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare condition of secondary headache to reversible multifocal narrowing of cerebral arteries, coursing with recurrent thunderclap-like pain, associated or not with focal neurological deficits and seizures. The mechanism is unknown, but an abnormality in control of cerebrovascular tonus triggered by a vasoconstrictor trigger is suggested. Diagnostic criteria is based on RCVS2, with high diagnostic accuracy. The aim is to report an unusual trigger cause for SVCR in a woman admitted in ER at Hospital Geral de Cuiabá. Case: CMP, 43-year-old, admitted at the cardiology ER, with an implantable cardioverter-defibrillator (ICD) due to asymmetric septal hypertrophic cardiomyopathy, referring after 2 sequential shocks of ICD, started a sudden, intense holocranial headache, worst in her life, associated to nausea and vomiting, without focal neurological deficits. Brain computed tomography and angiotomography of cranial vessels was performed, showing a thin layer of cortical subarachnoid hemorrhage (SAH) in right postcentral gyrus region, without aneurysmal dilations or others. Opioid analgesia was performed and Nimodipine was started as prophylaxis for cerebral vasospasm. On next day, presented a new episode of pain with the same characteristics, a new neuroimaging was acquired, maintaining the characteristics described. A skull arterial magnetic resonance angiography was requested for a better evaluation, however, because of ICD, it was unable to perform. RCVS2 was calculated, totaling 10 points, with high accuracy, diagnosing the pathology. Event prophylaxis initiated with Verapamil and Amitriptyline to pain and mood control and, during hospitalization, presented just one new episode of pain after measurements until telemetry is performed. Conclusion: SVCR is a rare entity and must be readily differentiated from malignant causes, such as aneurysmal SAH or others. Due to the recurrence of pain associated with the potential trigger and exclusion of other causes, diagnosis was established. RVCS2 scale was essential for the outcome in question. It´s being followed up at the headache and arrhythmology ambulatory, with a new imaging exam in three months, described in literature to verifying the reversal of initial findings.

A 46-year-old male patient started a condition of lower back pain radiating to the lower limbs in 2016. He underwent lumbar arthrodesis surgery between L5-S1 due to a herniated disc and reports that after the surgery, his clinical condition improved, remaining asymptomatic over four years. In 2020, he started to experience hypoesthesia in the calf and dorsal region of his right foot, with progressive worsening throughout the year, with a tripping sensation associated with a numbness and decreased distal strength of the right lower limb, with subsequent difficulty in climbing stairs over the next year. He continued to follow up with orthopedics and began following up with neurosurgery, which did not identify a clear etiology for his clinical condition. In 2021, the patient was already complaining of worsening weakness in the right foot with foot drop and a decrease in trophism of the entire right lower limb. The patient denies sphincter alterations or sexual dysfunction throughout the course of the disease. In March 2022, the patient began using unilateral support due to falls and returned to the neurosurgery outpatient clinic with a referral to clinical neurology. He denies recent worsening of strength. In October 2022, during a consultation with neurology, treatment with prednisone 20 mg/day was started without improvement in the clinical condition, and during a followup visit in January 2023, the need for diagnostic elucidation led to the patient being hospitalized at the Hospital do Servidor Publico Estadual for etiological investigation. On neurological examination, the patient presented alterations in the right lower limb, with grade IV proximal strength and II distal strength of this limb, including plantar and dorsiflexion flexion, associated with global hypotrophy of the limb up to the gluteal region, with normoactive deep tendon reflexes and plantar reflex in flexion. With regard to sensitivity, the patient presented hypoesthesia in the lateral region of the right leg and the sole of the right foot, worse distally in the topography of L4 L5-S1, with preserved artresthesia and palesthesia. No other alterations were present on the somatic examination, except for a right-hand scraping gait with a component of proximal weakness. In complementary investigation, no signs of spinal cord compression lesions were found on magnetic resonance imaging, no inflammatory signs were found in cerebrospinal fluid results, and no systemic involvement was found in chest and abdominal computed tomography exams, except for asymptomatic hepatosplenomegaly. Electroneuromyography (ENMG) revealed motor impairment with preserved sensory parameters, leading to a preganglionic pattern of impairment, in addition to recent denervation findings with fibrillations and positive sharp waves, which were also visualized in the contralateral lower limb in a lesser degree of involvement. Despite the hypoesthesia on the physical exam, no sensory alterations were demonstrated on ENMG, which may be justified by the previous spinal surgery. Due to findings on the neurological and complementary exams, with impairment only in the right lower limb, substantial atrophy, and weakness with ENMG findings, the hypothesis of flail leg syndrome, a variant of amyotrophic lateral sclerosis (ALS) with lower limbs onset, was raised. Flail leg syndrome is a rare variant (6%) of atypical forms of amyotrophic lateral sclerosis, predominantly affecting males between 55–65 years of age. Its manifestation includes asymmetric and progressive distal onset weakness and wasting with restricted involvement of the lower limbs for at least 12 to 24 months. ENMG shows fibrillations and positive sharp waves, with little evidence of fasciculations. It has a significantly better prognosis in terms of median and 5-year survival rates compared to bulbar and limb onset ALS, due to its slower progression to other locations. FLS ir rare, but it should be considered as an alternative diagnosis when there is limited impairment of lower limbs after at least one year of clinical observation.

Intro: Undifferentiated dyspnea can be a complicated presentation muddled by patient comorbidities and similar symptomology shared among etiologies. Some studies have shown increased mortality and length of stay in the hospital when incorrectly initially diagnosed in the ED. US has been shown more effective at differentiating these causes and improves diagnostic accuracy. This study will implement US exam upon initial exam of patient and chart time to diagnosis/treatment, length of stay in ED, length of stay in hospital admissions versus discharge rates, and 30 day mortality. ADHF and COPD/asthma patient differentiation will be the focus. Methods: Prospective cohort study of more than 18 years that present with the primary complaint of dyspnea with more than one complicating comorbid condition. Initial exam by physician will be accompanied by cardiothoracic US previously verified. Results: Study powered by previous year average of time to diagnosis of institution. Patient characteristics, distribution by diagnostic category, and characteristics found on US in correlation with diagnosis will be included for multivariate analysis. Conclusions: We expect to see a singificant difference in our time to diagnosis/treatment and mortality rate.

Introduction and Importance: A double cystic duct with a single gallbladder is one of the extremely uncommon variations of the cystic duct and only a few cases were reported in literature. Case Presentation: A 33-year-old female, with an unremarkable medical history, presented to the emergency department with a 2-day history of right upper quadrant abdominal (RUQ) pain. The abdominal pain was gradually increasing in intensity radiating to the back and was associated with anorexia and multiple episodes of vomiting. Abdominal examination revealed RUQ pain and tenderness. Abdominal ultrasonography was performed, showing a markedly distended gallbladder with evidence of a few calculi one of which was impacted at the neck. laparoscopic cholecystectomy was done within 2 days of admission during which another luminal structure was identified that suggested a double cystic duct. Clinical Discussion: Anomalies of the biliary tree are common with the classical anatomical picture presenting in only 33% of cholecystectomy cases. However, the presence of a double cystic duct is a rare variation, especially in the case of a single gallbladder. The identification of such anomaly can be achieved preoperatively using imaging modalities or it can be identified during the surgical procedure itself. such identification reduces the chances of postoperative comorbidities. Conclusion: Pre-operative identification of biliary tract anomalies by different imaging modalities is limited. Hence the importance of cautiousness and achieving a proper critical view of safety intra-operatively to prevent possible complications intra- and post-operatively. Our case report emphasizes the diagnostic and surgical challenges of the double cystic duct.

Objectives 1. Establish diagnostic procedures to identify tolerant carrier birds based on a) Isolation of ALV-J from blood, b) Detection of group-specific antigen in cloacal swabs and egg albumen. Application of these procedures to broiler breeder flocks with the purpose of removing virus positive birds from the breeding program. 2. Survey the AL V-J infection status of foundation lines to estimate the feasibility of the eradication program 3. Investigate virus transmission through the embryonated egg (vertical) and between chicks in the early post-hatch period (horizontal). Establish a model for limiting horizontal spread by analyzing parameters operative in the hatchery and brooder house. 4. Compare the pathogenicity of AL V-J isolates for broiler chickens. 5. Determine whether AL V-J poses a human health hazard by examining its replication in mammalian and human cells. Revisions. The: eradication objective had to be terminated in the second year following the closing down of the Poultry Breeders Union (PBU) in Israel. This meant that their foundation flocks ceased to be available for selection. Instead, the following topics were investigated: a) Comparison of commercial breeding flocks with and without myeloid leukosis (matched controls) for viremia and serum antibody levels. b) Pathogenicity of Israeli isolates for turkey poults. c) Improvement of a diagnostic ELISA kit for measuring ALV-J antibodies Background. ALV-J, a novel subgroup of the avian leukosis virus family, was first isolated in 1988 from broiler breeders presenting myeloid leukosis (ML). The extent of its spread among commercial breeding flocks was not appreciated until the disease appeared in the USA in 1994 when it affected several major breeding companies almost simultaneously. In Israel, ML was diagnosed in 1996 and was traced to grandparent flocks imported in 1994-5, and by 1997-8, ML was present in one third of the commercial breeding flocks It was then realized that ALV-J transmission was following a similar pattern to that of other exogenous ALVs but because of its unusual genetic composition, the virus was able to establish an extended tolerant state in infected birds. Although losses from ML in affected flocks were somewhat higher than normal, both immunosuppression and depressed growth rates were encountered in affected broiler flocks and affected their profitability. Conclusions. As a result of the contraction in the number of international primary broiler breeders and exchange of male and female lines among them, ALV-J contamination of broiler breeder flocks affected the broiler industry worldwide within a short time span. The Israeli national breeding company (PBU) played out this scenario and presented us with an opportunity to apply existing information to contain the virus. This BARD project, based on the Israeli experience and with the aid of the ADOL collaborative effort, has managed to offer solutions for identifying and eliminating infected birds based on exhaustive virological and serological tests. The analysis of factors that determine the efficiency of horizontal transmission of virus in the hatchery resulted in the workable solution of raising young chicks in small groups through the brooder period. These results were made available to primary breeders as a strategy for reducing viral transmission. Based on phylogenetic analysis of selected Israeli ALV-J isolates, these could be divided into two groups that reflected the countries of origin of the grandparent stock. Implications. The availability of a simple and reliable means of screening day old chicks for vertical transmission is highly desirable in countries that rely on imported breeding stock for their broiler industry. The possibility that AL V-J may be transmitted to human consumers of broiler meat was discounted experimentally.

The overall goal was to identify survival factors that can improve pregnancy success following insemination or embryo transfer in lactating dairy cows exposed to heat stress. First, we demonstrated that oocytes are actually damaged by elevated temperature in the summer. Then we tested two thermoprotective molecules for their effect on oocyte damage caused by heat shock. One molecule, ceramide was not thermoprptective. Another, insulin-like growth factor-1 (IGF) reduced the effects of heat shock on oocyte apoptosis and oocyte cleavage when added during maturation. We also used lactating cows exposed to heat stress to determine whether bovine somatotropin (bST), which increases IGF1 levels in vivo, would improve fertility in summer. Cows treated with bST received a single injection at 3 days before insemination. Controls received no additional treatment. Treatment with bST did not significantly increase the proportion of inseminated cows diagnosed pregnant although it was numerically greater for the bST group (24.2% vs 17.8%, 124–132 cows per group). There was a tendency (p =0.10) for a smaller percent of control cows to have high plasma progesterone concentrations (≥ 1 ng/ml) at Day 7 after insemination than for bST-treated cows (72.6 vs 81.1%). When only cows that were successfully synchronized were considered, the magnitude of the absolute difference in the percentage of inseminated cows that were diagnosed pregnant between bST and control cows was reduced (24.8 vs 22.4% pregnant for bST and control). Results failed to indicate a beneficial effect of bST treatment on fertility of lactating dairy cows. In another experiment, we found a tendency for addition of IGF1 to embryo culture medium to improve embryonic survival after embryo transfer when the experiment was done during heat stress but not when the experiment was done in the absence of heat stress. Another molecule tested, granulocyte-macrophage colony-stimulating factor (GM-CSF; also called colony-stimulating factor-2), improved embryonic survival in the absence of heat stress. We also examined whether heat shock affects the sperm cell. There was no effect of heat shock on sperm apoptosis (programmed cell death) or on sperm fertilizing ability. Therefore, effects of heat shock on sperm function after ejaculation if minimal. However, there were seasonal changes in sperm characteristics that indicates that some of the decrease in dairy cow fertility during the summer in Israel is due to using semen of inferior quality. Semen was collected from five representative bulls throughout the summer (August and September) and winter (December and January). There were seasonal differences in ion concentration in seminal plasma and in the mRNA for various ion channels known to be involved in acrosome reactions. Furthermore, the proportion of sperm cells with damaged acrosomes was higher in post-thaw semen collected in the summer than in its counterpart collected in winter (54.2 ± 3.5% vs. 51.4 ± 1.9%, respectively; P < 0.08Further examination is required to determine whether such alterations are involved in the low summer fertility of dairy cows.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

March 8th, 2024 is International Women’s Day and this year’s theme is “Inspire Inclusion.” Unfortunately, women who hold multiple intersecting identities that are systemically oppressed world-wide are often excluded from discussions. One example includes women who are neurodiverse, and more specifically for this post, women with attention-deficit/hyperactivity disorder (ADHD). Women and non-binary folks are often excluded from appropriate diagnosis of ADHD due to bias in providers, boy/men-dominated symptoms in the DSM-5 (Barkley, 2023; Hinshaw et al., 2021), socialization to mask and internalize symptoms, and sexism and other forms of discrimination. As with most discrimination, this is even worse for women with ADHD who also hold other systemically oppressed identities. This blog will focus on how to increase equity for women with ADHD with concrete solutions for multiples systems that affect them.

The Food Standards Agency (FSA) is a non-ministerial government department within the United Kingdom responsible for protecting public health and protecting consumer interests in relation to food in England, Wales, and Northern Ireland. Food Hypersensitivities (FHS) is a key priority within the FSA as it is an important food-related health issue with a severe and enduring impact for people living with it. FHS includes individuals living with a food allergy, coeliac disease and food intolerance. It is the responsibility of the FSA to seek ways to understand and reduce avoidable deaths, the negative impact of FHS on both consumers and businesses, and make sure that FHS consumers have access to safe food that is what it says it is on the label, which they can trust. For people with chronic and / or potentially life-threatening FHS, that trust becomes even more important. FHS places both a public health and financial burden on society. According to the FSA’s Food and You 2 Wave 3 Survey(footnote 1), an estimated 800,000 people are living with a clinically diagnosed food allergy, 300,000 with coeliac disease and 1.2 million living with food intolerance and other FHS conditions in the UK. The FSA has invested in a programme of research to understand the economic and societal burden of FHS and to explore how people living with FHS are impacted in their daily lives. The FSA commissioned RSM UK Consulting (RSM), Dr Audrey DunnGalvin from University College Cork and Alizon Draper from the University of Westminster to quantify and monetise the financial burden imposed on people living with FHS through their day-to-day management of the physical risks associated with food allergies, food intolerance and coeliac disease. This is the first study of its kind to consider whether residents in England, Northern Ireland, and Wales who live with any type of FHS condition (food intolerance, coeliac disease or food allergy) results in additional financial burden for their household. About this study The aim of the study was to quantify and monetise the financial burden imposed on households with FHS through the day-to-day management of the physical risks associated with food allergies, food intolerance and coeliac disease, by: comparing the price paid for food between households with at least one adult above 18 years old living with FHS, to households without FHS valuing the direct costs incurred through efforts to manage FHS and remain symptom free (for example, medical and kitchen supplies) monetising indirect costs incurred when having to deal with an FHS condition (for example, lost working days) This study is unique in terms of estimating price differentials for food consumption across different types of FHS and then comparing to a non-FHS comparison group. Previous studies have focused on coeliac disease, specifically the comparison between gluten-free and gluten-containing products, so this study is adding new knowledge to the evidence base.