Systemic objective test in medical biochemistry: Part 1-metabolism of carbohydrates

A very important element of the teaching plan is students’ assessment. Assessment should be very objective and backed up with feedback. A necessary condition for this type of evaluation is the formation of questions. The questions should lead the thinking process of the students with skills and clarity of thought. In this way, these questions will serve as clear ideas and help to develop the imagination and the research. Such innovation provides systematic evaluation, which is based on systematic diagram. Testing plays an important role in this system. The objective test is created in a way that a different estimator that assesses independently will achieve the same results for the introduced level of knowledge and abilities based on true answers. In comparison with the traditional objective test, the systemic objective test includes many demands that are completely structured; it covers a huge part of the educational schedule, and measures high levels of education (synthesis, analysis and estimation). In this article, we will introduce STFQs, SMCQs, SSQs, SSQs, ASQs, and SCQs as examples of the systemic objective test in medical biochemistry

Systemic approaches to teaching and learning a module of Biochemistry [SATL-BC]

In this article, we introduce the application of SATL in the subject of medical biochemistry. The strategy of this method is based on the collection, organization, and presentation of the map of concepts through the interactive system in the module of which the relations between the concepts and issues will be clarified. The main structural element of the SATL is the systemic diagram which bears all the attributes of a closed concept map. The systemic diagrams are created on the basis of the combination of the concepts that students already have and what they acquire through the study of the modules. The construction of systemic diagram helps students to understand the conceptual framework of the subject. Through the application of systemic methodology, students will study not only concepts, principles, and various metabolic procedures that occur in the organism they will also understand the vital role of biochemistry in medicine and how biochemistry principles are applied in everyday professional practices.[AJCE, 3(1), January 2013

What’s new on quantitative CT analysis as a tool to predict growth in persistent pulmonary subsolid nodules? A literature review

Pulmonary subsolid nodules (SSNs) are observed not infrequently on thin-section chest computed tomography (CT) images. SSNs persisting after a follow-up period of three to six months have a high likelihood of being pre-malignant or malignant lesions. Malignant SSNs usually represent the histologic spectrum of pulmonary adenocarcinomas, and pulmonary adenocarcinomas presenting as SSNs exhibit quite heterogeneous behavior. In fact, while most lesions show an indolent course and may grow very slowly or remain stable for many years, others may exhibit significant growth in a relatively short time. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored. In order to solve these two open issues, the use of quantitative analysis has been proposed to define the “tailored” management of persistent SSNs. The main purpose of this review was to summarize recent results about quantitative CT analysis as a diagnostic tool for predicting the behavior of persistent SSNs. Thus, a literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases to find original articles published from January 2014 to October 2019. The results of the selected studies are presented and compared in a narrative way

The Role of Morphologic and Functional Imaging in Pretreatment Assessment

Anterior skull base (ASB) tumors can be classified into three groups according to their site of origin: (1) sinonasal neoplasms involving or extending through the anterior cranial base; (2) neoplasms which arise from the bony framework of the base itself; (3) neoplasms originating from adjacent intracranial structures. With few exceptions, most of these tumors have a non-specific appearance on CT and MRI, which limits the role of imaging in terms of characterization. However, treatment planning (transnasal endoscopic surgery in particular) mostly depends upon the tumor map, exploiting the potential of modern cross-sectional imaging. As a result, the radiologist who has to evaluate a neoplasm involving the ASB needs to be fully aware of all the technical solutions available and the specific strengths/weaknesses of the different imaging techniques. Knowledge of radiological anatomy (and its variants) is also essential, which includes the ability to translate the CT appearance of structures into the equivalent MR signal (and vice versa). These main prerequisites have to be combined with up-to-date knowledge of treatment options and surgical procedures in order to be able to create a reporting checklist covering all the aspects that are essential for clinical decision making

Lombardy, Northern Italy: COVID-19 second wave less severe and deadly than the first? A preliminary investigation

Background: The much-heralded second wave of coronavirus disease (COVID-19) has arrived in Italy. Right now, one of the main questions about COVID-19 is whether the second wave is less severe and deadly than the first wave. In order to answer this challenging question, we decided to evaluate the chest X-ray (CXR) severity of COVID-19 pneumonia, the mechanical ventilation (MV) use, the patient outcome, and certain clinical/laboratory data during the second wave and compare them with those of the first wave. Methods: During the two COVID-19 waves two independent groups of hospitalised patients were selected. The first group consisted of the first 100 COVID-19 patients admitted to our hospital during the first wave. The second group consisted of another 100 consecutive COVID-19 patients admitted to our hospital during the second wave. We enlisted only Caucasian male patients over the age of fifty for whom the final outcome was available. For each patient, the CXR severity of COVID-19 pneumonia, the MV use, the patient outcome, comorbidities, corticosteroid use, and C-reactive protein (CRP) levels were considered. Nonparametric statistical tests were used to compare the data obtained from the two waves. Results: The CXR severity of COVID-19 pneumonia, the in-hospital mortality, and CRP levels were significantly higher in the first wave than in the second wave (p ≤.041). Although not statistically significant, the frequency of MV use was higher in the first wave. Conclusions: This preliminary investigation seems to confirm that the COVID-19 second wave is less severe and deadly than the first wave

Radiographic severity index in COVID-19 pneumonia: relationship to age and sex in 783 Italian patients

Purpose: To improve the risk stratification of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an experimental chest X-ray (CXR) scoring system for quantifying lung abnormalities was introduced in our Diagnostic Imaging Department. The purpose of this study was to retrospectively evaluate correlations between the CXR score and the age or sex of Italian patients infected with SARS-CoV-2. Materials and methods: Between March 4, 2020, and March 18, 2020, all CXR reports containing the new scoring system were retrieved. Only hospitalized patients with SARS-CoV-2 infection were enrolled. For each patient, age, sex, and the CXR report containing the highest score were considered for the analysis. Patients were also divided into seven groups according to age. Nonparametric statistical tests were used to examine the relationship between the severity of lung disease and the age or sex. Results: 783 Italian patients (532 males and 251 females) with SARS-CoV-2 infection were enrolled. The CXR score was significantly higher in males than in females only in groups aged 50 to 79 years. A significant correlation was observed between the CXR score and age in both males and females. Males aged 50 years or older and females aged 80 years or older with coronavirus disease 2019 showed the highest CXR score (median ≥ 8). Conclusions: Males aged 50 years or older and females aged 80 years or older showed the highest risk of developing severe lung disease. Our results may help to identify the highest-risk patients and those who require specific treatment strategies

Sensibility and specificity of FDG PET/CT for preoperative staging of esophageal cancer

Objective: Limited information is available on the sensibility and specificity of 18Ffluorodeoxyglucose positron emission computed tomography (FDG-PET/CT) for esophageal cancer clinical staging. Aim of the current study was to evaluate the diagnostic performance of FDG-PET/CT. Methods: Thirty one patients (28 men, median age 63 years r. 41\u201381) who underwent FDG-PET/CT and thoraco-abdominal CT-scan, were retrospectively evaluated. Lymph node (N) and presence/absence of distant (M1b) and nodal (N) metastases as determined by FDG-PET/CT and CT were assessed in relation to clinical patterns (for M) and pathology (for N). Esophagectomy and extended lymphadenectomy without prior neoadjuvant treatment was performed in 22 patients. Sensitivity, specificity, diagnostic accuracy and k statistics of the two imaging techniques were calculated. Results: Four tumors (13%) were located at the cervical esophagus (2 squamous cell carcinomas, 1 anaplastic cell carcinoma and 1 adenocarcinoma) 15 (48%) at the gastroesophageal junction (11 adenocarcinomas, of whom 6 with Barrett's metaplasia and 4 squamous cell carcinomas) and 12 (39%) at the thoracic esophagus (11 squamous cell carcinoma, 1 adenocarcinoma). At pathology, 18 patients (81%) had metastatic N, no distant metastatic disease was reported. Data on performance of the two imaging techniques are summarized in Table 1. Conclusions: FDG-PET/CT with respect to CT improves specificity in N and sensibility and specificity in M disease. FDG-PET/CT provides additional value for clinical staging of esophageal cancer versus CT and, in relation to the data of the literature, versus FDG-PET

Chest X-ray severity index as a predictor of in-hospital mortality in coronavirus disease 2019: A study of 302 patients from Italy

Objectives: This study aimed to assess the usefulness of a new chest X-ray scoring system — the Brixia score — to predict the risk of in-hospital mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: Between March 4, 2020 and March 24, 2020, all CXR reports including the Brixia score were retrieved. We enrolled only hospitalized Caucasian patients with COVID-19 for whom the final outcome was available. For each patient, age, sex, underlying comorbidities, immunosuppressive therapies, and the CXR report containing the highest score were considered for analysis. These independent variables were analyzed using a multivariable logistic regression model to extract the predictive factors for in-hospital mortality. Results: 302 Caucasian patients who were hospitalized for COVID-19 were enrolled. In the multivariable logistic regression model, only Brixia score, patient age, and conditions that induced immunosuppression were the significant predictive factors for in-hospital mortality. According to receiver operating characteristic curve analyses, the optimal cutoff values for Brixia score and patient age were 8 points and 71 years, respectively. Three different models that included the Brixia score showed excellent predictive power. Conclusions: Patients with a high Brixia score and at least one other predictive factor had the highest risk of in-hospital death