3 research outputs found
ΠΠ²Π°Π»ΡΠ°ΡΠΈΡΠ° Π½Π° (1,3)--d-Π³Π»ΠΈΠΊΠ°Π½ Π΅ΡΠ΅Ρ Π²ΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠΎ Πspergillus
Invasive fungal infections caused by Aspergillus are a significant problem in immunocompromised and critically ill patients and associated with increased morbidity and mortality. Early diagnosis of invasive aspergillosis is still a big clinical and diagnostic challenge. Conventional methods are not sensitive enough, and therefore, there is a need for rapid, more sensitive methods for early diagnosis of invasive fungal infections with Aspergillus. The aim of this study was to evaluate the diagnostic performance, sensitivity and specificity of serological panfungal (1,3)-b-D-glucan marker compared to conventional method for diagnosis of invasive fungal infections with Aspergillus. Material and methods: Specimens of 125 patients divided into 4 groups (group I - immune deficiency, group II - prolonged ICU stay, group III - chronic aspergillosis, group IV - cystic fibrosis), classified according to clinical diagnosis and EORTC/MSG criteria, were analyzed at the Institute of Microbiology and Parasitology, with conventional and serological methods, during a period of two years. Results: A total of 71 isolates of Aspergillus were confirmed in this study. Four isolates were recovered from bloodculture of patients with primary immune deficiency. With BAL culture, Aspergillus was detected in the group of chronic aspergillosis (63.33%), followed by the groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of BAL culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in I, II, III and IV group, respectively. In 79.1% (53/67) from positive BAL cultures in all groups, A. fumigatus was confirmed, of which, 32.1% (17/53) in group III, followed by group I β 26.42% (14/53) and group IV β 26.42% (14/53), and 15.1% (8/53) in group II. Other species confirmed in BAL were A. flavus 16.42% (11/67) and A.terreus 4.48% (3/67). Sensitivity and specificity of the serological panfungal (1,3)-b-D-glucan (BDG) marker were: 64.71% and 85.71%, 50% and 87.5%, 36.36% and 50%, in groups I, II and III, respectively. No positive findings of the panfungal (1,3)-b-D-glucan (BDG) marker were found in the group with cystic fibrosis. Conclusion: The results obtained in this study have demonstrated that a positive (1,3)-b-D-glucan assay highlights the value of this test as a diagnostic adjunct in the serodiagnosis of invasive fungal infections with Aspergillus, and along with the results from conventional mycological investigation, helped in reaching a timely antifungal treatment with a favorable clinical outcome.
Β ΠΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡΠ΅ ΡΡΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠΎ Aspergillus ΠΏΡΠ΅ΡΡΡΠ°Π²ΡΠ²Π°Π°Ρ ΡΠ΅ΡΠΈΠΎΠ·Π΅Π½ ΠΏΡΠΎΠ±Π»Π΅ΠΌ ΠΊΠ°Ρ ΠΈΠΌΡΠ½ΠΎΠΊΠΎΠΌΠΏΡΠΎΠΌΠΈΡΠΈΡΠ°Π½ΠΈΡΠ΅ Π»ΠΈΡΠ° ΠΈ ΠΊΡΠΈΡΠΈΡΠ½ΠΎ Π±ΠΎΠ»Π½ΠΈΡΠ΅ Π»ΠΈΡΠ°, ΠΈ ΡΠ΅ Π°ΡΠΎΡΠΈΡΠ°Π½ΠΈ ΡΠΎ Π·Π³ΠΎΠ»Π΅ΠΌΠ΅Π½ ΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅Ρ ΠΈ ΠΌΠΎΡΡΠ°Π»ΠΈΡΠ΅Ρ. Π Π°Π½Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½Π°ΡΠ° Π°ΡΠΏΠ΅ΡΠ³ΠΈΠ»ΠΎΠ·Π° Π΅ ΡΡ ΡΡΡΠ΅ Π³ΠΎΠ»Π΅ΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ ΠΈ Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΏΡΠ΅Π΄ΠΈΠ·Π²ΠΈΠΊ. ΠΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΈΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π½Π΅ ΡΠ΅ Π΄ΠΎΠ²ΠΎΠ»Π½ΠΎ ΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΈ, ΠΈ Π·Π°ΡΠ°Π΄ΠΈ ΡΠΎΠ°, ΡΠ΅ Π½Π°ΠΌΠ΅ΡΠ½ΡΠ²Π° ΠΏΠΎΡΡΠ΅Π±Π° Π·Π° Π±ΡΠ·ΠΈ ΠΈ ΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π° ΡΠ°Π½Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈ ΡΡΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠΎ Aspergillus. Π¦Π΅Π»ΡΠ° Π½Π° ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ° Π±Π΅ΡΠ΅ Π΄Π° ΡΠ΅ Π΅Π²Π°Π»ΡΠΈΡΠ° Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΈΠΎΡ ΠΏΠ΅ΡΡΠΎΡΠΌΠ°Π½Ρ, ΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡΠ° ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΠ° Π½Π° ΡΠ΅ΡΠΎΠ»ΠΎΡΠΊΠΈΠΎΡ ΠΏΠ°Π½ΡΡΠ½Π³Π°Π»Π΅Π½ ΠΌΠ°ΡΠΊΠ΅Ρ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ ΡΠΏΠΎΡΠ΅Π΄Π΅Π½ΠΎ ΡΠΎ ΠΊΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΈΠΎΡ ΠΌΠ΅ΡΠΎΠ΄ Π·Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡΠ΅ ΡΡΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠΎ Aspergillus. ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΡΠΈΠΌΠ΅ΡΠΎΡΠΈ ΠΎΠ΄ 125 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ, ΠΏΠΎΠ΄Π΅Π»Π΅Π½ΠΈ Π²ΠΎ 4 Π³ΡΡΠΏΠΈ (Π³ΡΡΠΏΠ° I - ΠΈΠΌΡΠ½ Π΄Π΅ΡΠΈΡΠΈΡ, Π³ΡΡΠΏΠ° II - ΠΏΡΠΎΠ»ΠΎΠ½Π³ΠΈΡΠ°Π½ ΠΏΡΠ΅ΡΡΠΎΡ Π²ΠΎ ΠΠΠ, Π³ΡΡΠΏΠ° III - Ρ
ΡΠΎΠ½ΠΈΡΠ½Π° Π°ΡΠΏΠ΅ΡΠ³ΠΈΠ»ΠΎΠ·Π°, Π³ΡΡΠΏΠ° IV - ΡΠΈΡΡΠΈΡΠ½Π° ΡΠΈΠ±ΡΠΎΠ·Π°), ΠΈ ΠΊΠ»Π°ΡΠΈΡΠΈΡΠΈΡΠ°Π½ΠΈ ΡΠΏΠΎΡΠ΅Π΄ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠ°ΡΠ° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° ΠΈ EORTC/MSG ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌΠΈΡΠ΅, Π±Π΅Π° Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ Π½Π° ΠΠ½ΡΡΠΈΡΡΡΠΎΡ Π·Π° ΠΌΠΈΠΊΡΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ° ΠΈ ΠΏΠ°ΡΠ°Π·ΠΈΡΠΎΠ»ΠΎΠ³ΠΈΡΠ°, ΡΠΎ ΠΊΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΈ ΠΈ ΡΠ΅ΡΠΎΠ»ΠΎΡΠΊΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ, Π²ΠΎ ΡΠ΅ΠΊ Π½Π° Π΄Π²Π΅-Π³ΠΎΠ΄ΠΈΡΠ΅Π½ ΠΏΠ΅ΡΠΈΠΎΠ΄. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: ΠΠΊΡΠΏΠ½ΠΎ 71 ΠΈΠ·ΠΎΠ»Π°Ρ Π½Π° Aspergillus Π±Π΅Π° ΠΏΠΎΡΠ²ΡΠ΄Π΅Π½ΠΈ Π²ΠΎ ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ°. Π§Π΅ΡΠΈΡΠΈ ΠΈΠ·ΠΎΠ»Π°ΡΠΈ Π±Π΅Π° Π΄ΠΎΠΊΠ°ΠΆΠ°Π½ΠΈ Π²ΠΎ Ρ
Π΅ΠΌΠΎΠΊΡΠ»ΡΡΡΠ°, ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΠΏΡΠΈΠΌΠ°ΡΠ΅Π½ ΠΈΠΌΡΠ½ Π΄Π΅ΡΠΈΡΠΈΡ. Π‘ΠΎ ΠΊΡΠ»ΡΡΡΠ° Π½Π° ΠΠΠ, Aspergillus Π½Π°ΡΡΠ΅ΡΡΠΎ Π±Π΅ΡΠ΅ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΠ°Π½ Π²ΠΎ Π³ΡΡΠΏΠ°ΡΠ° Π½Π° Ρ
ΡΠΎΠ½ΠΈΡΠ½Π° Π°ΡΠΏΠ΅ΡΠ³ΠΈΠ»ΠΎΠ·Π° (63,33%), ΠΏΠΎ ΡΡΠΎ ΡΠ»Π΅Π΄ΡΠ²Π°Π° Π³ΡΡΠΏΠΈΡΠ΅ ΡΠΎ ΡΠΈΡΡΠΈΡΠ½Π° ΡΠΈΠ±ΡΠΎΠ·Π° (56,67%), ΠΏΡΠΈΠΌΠ°ΡΠ΅Π½ ΠΈΠΌΡΠ½ Π΄Π΅ΡΠΈΡΠΈΡ (51,43%), ΠΈ Π³ΡΡΠΏΠ°ΡΠ° Π»ΠΈΡΠ° ΡΠΎ ΠΏΡΠΎΠ»ΠΎΠ½Π³ΠΈΡΠ°Π½ ΠΏΡΠ΅ΡΡΠΎΡ Π²ΠΎ Π΅Π΄ΠΈΠ½ΠΈΡΠΈΡΠ΅ Π·Π° ΠΈΠ½ΡΠ΅Π½Π·ΠΈΠ²Π½ΠΎ Π»Π΅ΠΊΡΠ²Π°ΡΠ΅ (43,33%). Π‘Π΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡΠ° ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΠ° Π½Π° ΠΊΡΠ»ΡΡΡΠΈΡΠ΅ Π½Π° ΠΠΠ Π±Π΅Π°: 64,29% ΠΈ 100%, 59,09% ΠΈ 100%, 54,55% ΠΈ 12,5%, 100% ΠΈ 54,17%, Π²ΠΎ I, II, III ΠΈ IV Π³ΡΡΠΏΠ°, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ. ΠΠΎ 79,1% (53/67) ΠΎΠ΄ ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΈΡΠ΅ ΠΊΡΠ»ΡΡΡΠΈ Π½Π° ΠΠΠ Π²ΠΎ ΡΠΈΡΠ΅ Π³ΡΡΠΏΠΈ, Π±Π΅ΡΠ΅ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½ A.fumigatus, ΠΎΠ΄ ΠΊΠΎΠΈ, 32,1% (17/53) ΠΎΠ΄ Π³ΡΡΠΏΠ° III, ΠΏΠΎΡΠΎΠ° 26,42 % (14/53) ΠΎΠ΄ Π³ΡΡΠΏΠ° I ΠΈ 26,42% (14/53) ΠΎΠ΄ Π³ΡΡΠΏΠ° IV, ΠΊΠ°ΠΊΠΎ ΠΈ 15,1% (8/53) ΠΎΠ΄ Π³ΡΡΠΏΠ° II. ΠΡΡΠ³ΠΈ ΡΠΏΠ΅ΡΠΈΠ΅ΡΠΈ ΠΏΠΎΡΠ²ΡΠ΄Π΅Π½ΠΈ Π²ΠΎ ΠΠΠ Π±Π΅Π° A.flavus 16,42% (11/67) ΠΈ A.terreus 4,48% (3/67). Π‘Π΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡΠ° ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΠ° Π½Π° ΡΠ΅ΡΠΎΠ»ΠΎΡΠΊΠΈΠΎΡ ΠΏΠ°Π½ΡΡΠ½Π³Π°Π»Π΅Π½ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ (BDG) ΠΌΠ°ΡΠΊΠ΅Ρ Π±Π΅Π°: 64,71% ΠΈ 85,71%, 50% ΠΈ 87,5%, 36,36% ΠΈ 50%, Π²ΠΎ Π³ΡΡΠΏΠΈΡΠ΅ I, II ΠΈ III, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ. ΠΠ΅ Π±Π΅Π° Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΠ°Π½ΠΈ ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΈ Π½Π°ΠΎΠ΄ΠΈ ΠΎΠ΄ ΠΏΠ°Π½ΡΡΠ½Π³Π°Π»Π½ΠΈΠΎΡ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ (BDG) ΠΌΠ°ΡΠΊΠ΅Ρ Π²ΠΎ Π³ΡΡΠΏΠ°ΡΠ° ΡΠΎ ΡΠΈΡΡΠΈΡΠ½Π° ΡΠΈΠ±ΡΠΎΠ·Π°. ΠΠ°ΠΊΠ»ΡΡΠΎΠΊ: Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΎΠ΄ ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ° ΠΏΠΎΠΊΠ°ΠΆΠ°Π° Π΄Π΅ΠΊΠ° ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π΅Π½ Π½Π°ΠΎΠ΄ Π½Π° (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ ΡΠ° ΠΈΡΡΠ°ΠΊΠ½ΡΠ²Π° Π²ΡΠ΅Π΄Π½ΠΎΡΡΠ° Π½Π° ΠΎΠ²ΠΎΡ ΡΠ΅ΡΡ ΠΊΠ°ΠΊΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΎ Π½Π°Π΄ΠΎΠΏΠΎΠ»Π½ΡΠ²Π°ΡΠ΅ Π²ΠΎ ΡΠ΅ΡΠΎΠ΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π°ΡΠ° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡΠ΅ ΡΡΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠΎ Aspergillus, ΠΈ Π·Π°Π΅Π΄Π½ΠΎ ΡΠΎ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΎΠ΄ ΠΊΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΈΡΠ΅ ΠΌΠΈΠΊΠΎΠ»ΠΎΡΠΊΠΈ ΠΈΡΠΏΠΈΡΡΠ²Π°ΡΠ°, ΠΏΠΎΠΌΠ°Π³Π°Π°Ρ Π²ΠΎ Π½Π°Π²ΡΠ΅ΠΌΠ΅Π½Π° ΠΏΡΠΈΠΌΠ΅Π½Π° Π½Π° Π°Π½ΡΠΈΡΡΠ½Π³Π°Π»Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ°, ΠΈ ΠΏΠΎΡΡΠΈΠ³Π½ΡΠ²Π°ΡΠ΅ ΠΏΠΎΠ²ΠΎΠ»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ ΠΈΡΡ
ΠΎΠ΄.
Inequalities in the patterns of dermoscopy use and training across Europe : conclusions of the Eurodermoscopy pan-European survey
BACKGROUND: Dermoscopy is a widely used technique, recommended in clinical practice guidelines worldwide for the early diagnosis of skin cancers. Intra-European disparities are reported for early detection and prognosis of skin cancers, however, no information exists about regional variation in patterns of dermoscopy use across Europe.OBJECTIVE: To evaluate the regional differences in patterns of dermoscopy use and training among European dermatologists.MATERIALS & METHODS: An online survey of European-registered dermatologists regarding dermoscopy training, practice and attitudes was established. Answers from Eastern (EE) versus Western European (WE) countries were compared and their correlation with their respective countries' gross domestic product/capita (GDPc) and total and government health expenditure/capita (THEc and GHEc) was analysed.RESULTS: We received 4,049 responses from 14 WE countries and 3,431 from 18 EE countries. A higher proportion of WE respondents reported dermoscopy use (98% vs. 77%, p<0.001) and training during residency (43% vs. 32%) or anytime (96.5% vs. 87.6%) (p<0.001) compared to EE respondents. The main obstacles in dermoscopy use were poor access to dermoscopy equipment in EE and a lack of confidence in one's skills in WE. GDPc, THEc and GHEc correlated with rate of dermoscopy use and dermoscopy training during residency (Spearman rho: 0.5-0.7, p<0.05), and inversely with availability of dermoscopy equipment.CONCLUSION: The rates and patterns of dermoscopy use vary significantly between Western and Eastern Europe, on a background of economic inequality. Regionally adapted interventions to increase access to dermoscopy equipment and training might enhance the use of this technique towards improving the early detection of skin cancers
Dermatologist-like explainable AI enhances trust and confidence in diagnosing melanoma
Abstract Artificial intelligence (AI) systems have been shown to help dermatologists diagnose melanoma more accurately, however they lack transparency, hindering user acceptance. Explainable AI (XAI) methods can help to increase transparency, yet often lack precise, domain-specific explanations. Moreover, the impact of XAI methods on dermatologistsβ decisions has not yet been evaluated. Building upon previous research, we introduce an XAI system that provides precise and domain-specific explanations alongside its differential diagnoses of melanomas and nevi. Through a three-phase study, we assess its impact on dermatologistsβ diagnostic accuracy, diagnostic confidence, and trust in the XAI-support. Our results show strong alignment between XAI and dermatologist explanations. We also show that dermatologistsβ confidence in their diagnoses, and their trust in the support system significantly increase with XAI compared to conventional AI. This study highlights dermatologistsβ willingness to adopt such XAI systems, promoting future use in the clinic