Diagnostic performance of 128-slice computed tomography angiography in patients with suspected coronary artery disease

الملخص: أهداف البحث: لتحديد الأداء التشخيصي والعوامل المؤثرة في التصوير الوعائي المقطعي المحوسب للشريان التاجي المكون من 128 شريحة مقارنة بتصوير الأوعية التاجية المجتاحة في مرضى الشريان التاجي. طريقة البحث: سجلت دراسة تحليلية مقطعية 139 مريضا يشتبه في إصابتهم بمرض الشريان التاجي والذين خضعوا لـ 128 شريحة للتصوير المقطعي المحوسب للأوعية وكذلك تصوير الأوعية التاجية المجتاحة. النتائج: أظهر النموذج المعتمد على المريض حساسية عالية بنسبة 93.2٪ وقيمة تنبؤية إيجابية بنسبة 95.3٪ للتضيق ≥ 50٪. ومع ذلك ، كانت هذه القيم أقل عند تحليلها من خلال النماذج المستندة إلى الشرايين (حساسية عالية بنسبة 85.6٪ وقيمة تنبؤية إيجابية بنسبة 81.1٪) والقطاعات (حساسية عالية بنسبة 73.9٪ وقيمة تنبؤية إيجابية بنسبة 66.6٪). كانت الخصوصية والقيمة التنبؤية السلبية هي الأعلى في النموذج المعتمد على القطعة ، وانخفضت في النماذج المستندة إلى الأوعية والمرضى بنسبة 96.4٪ و 95.4٪ ؛ 90.5٪ و 90.0٪ ؛ و 36.4٪ و 42.1٪ على التوالي (للتضيق ≥ 70٪). انخفضت جميع القيم التشخيصية عندما كانت درجة الكالسيوم 400 وحدة أغاتستون. الاستنتاجات: يظهر التصوير الوعائي المقطعي المحوسب للشريان التاجي المكون من 128 شريحة الطريقة المثلى وذات الحد الأدنى من الاجتياح وعالي الأداء لتشخيص تضيق وتشكل آفات الشريان التاجي. كان الأداء التشخيصي لتصوير الأوعية المقطعي المحوسب للشريان التاجي المكون من 128 شريحة مرتفعا جدا. لم يؤثر معدل ضربات القلب ومؤشر كتلة الجسم على دقة التشخيص، بينما تم العثور على درجة الكالسيوم البالغة 400 وحدة أغاتستون كعامل يتسبب في انخفاض الأداء التشخيصي. Abstract: Objectives: To determine the diagnostic performance and influencing factors of 128-slice coronary computed tomography angiography (CCTA) compared with invasive coronary angiography (ICA) in patients with suspected coronary artery disease (CAD). Methods: A cross-sectional analysis study enrolled 139 patients suspected of having CAD, who underwent and received a 128-slice CCTA and ICA. Results: The patient-based model showed high sensitivity and a positive predictive value of 93.2% and 95.3%, respectively (for stenosis ≥50%). However, these values were lower when analyzed using vessel-based (85.6% and 81.1%) and segment-based (73.9% and 66.6%) models. Specificity and negative predictive value were highest in the segment-based model, decreasing in vessel- and patient-based models at 96.4% and 95.4%, 90.5% and 90.0%, and 36.4% and 42.1%, respectively (for stenosis ≥70%). All diagnostic values were reduced when the calcium score was ≥400 Agatston units. Conclusion: 128-slice CCTA is an optimal, minimally invasive, and high-performance method to diagnose the stenosis and morphology of coronary artery lesions. The diagnostic performance of 128-slice CCTA is very high. Heart rate and body mass index do not affect diagnostic accuracy, whereas a calcium score ≥400 Agatston units is a factor that causes a decrease in diagnostic performance

Giant breast cavernous hemangioma

Although breast vascular tumors are exceedingly rare, the benign group's most common tumor, the hemangioma, is frequently found in lumpectomy or mastectomy tissues during histological analyses. The 3 types of hemangiomas are capillary, cavernous, and venous. The most typical kind of hemangioma is cavernous. Cavernous hemangiomas are benign blood vessel tumors that arise from established blood vessels. The best imaging technique for examining the makeup of breast vessels is magnetic resonance imaging. In this article, we purposed to describe an exceptionally uncommon case of giant breast cavernous hemangioma

Physicians, primary caregivers and topical repellent: all under-utilised resources in stopping Dengue virus transmission in affected households

Primary health care facilities frequently manage dengue cases on an ambulatory basis for the duration of the patient's illness. There is a great opportunity for specific messaging, aimed to reduce dengue virus (DENV) transmission in and around the home, to be directly targeted toward this high-risk ambulatory patient group, as part of an integrated approach to dengue management. The extent however, to which physicians understand, and can themselves effectively communicate strategies to stop focal DENV transmission around an ambulatory dengue case is unknown; the matter of patient comprehension and recollection then ensues. In addition, the effectiveness of N,N-diethyl-3-methylbenzamide (DEET)-based insect repellent in protecting dengue patients from Aedes aegypti mosquitoes' bites has not been investigated.A knowledge, attitude and practice (KAP) survey, focusing on the mechanisms of DENV transmission and prevention, was performed using semi-structured questionnaires. This survey was targeted towards the patients and family members providing supportive care, and physicians routinely involved in dengue patient management in Southern Vietnam. An additional clinical observational study was conducted to measure the efficacy of a widely-used 13% DEET-based insect repellent to repel Ae. aegypti mosquitoes from the forearms of dengue cases and matched healthy controls.Among both the physician (n = 50) and patient (n = 49) groups there were several respondents lacking a coherent understanding of DENV transmission, leading to some inappropriate attitudes and inadequate acute preventive practices in the household. The application of insect repellent to protect patients and their relatives from mosquito bites was frequently recommended by majority of physicians (78%) participating in the survey. Nevertheless, our tested topical application of 13% DEET conferred only ~1hr median protection time from Ae. aegypti landing. This is notably shorter than that advertised on the manufacturer's label. No differences in landing time between febrile dengue cases or matched healthy controls (n = 19 experiments) were observed.Our study identifies missed opportunities for primary care physicians to improve public health through communication of strategies that could prevent focal dengue transmission in and around a case household. We advocate better access to more efficient communication methods for physicians and auxilliary health workers, supporting to educate those at high risk of DENV transmission. Our empirical testing of a widely-available 13% DEET-based repellent was limited in its protective efficacy against Ae. aegypti mosquito bites, and therefore DENV transmission, suggesting more frequent application is necessary to be beneficial