Combination of imaging exams improves Alzheimer’s diagnosis

A combination of diagnostic tests, including imaging and cerebrospinal fluid biomarkers can improve prediction of conversion from mild cognitive impairment (MCI) to Alzheimer’s disease, according to a new study published online in the journal Radiology.

“Because new treatments are likely to be most effective at the earliest stages of Alzheimer’s disease, there is great urgency to develop sensitive markers that facilitate detection and monitoring of early brain changes in individuals at risk,” said Jeffrey R. Petrella, M.D., associate professor of radiology, division of neuroradiology, and director of the Alzheimer’s Disease Research Lab at Duke University Medical Center (DUMC) in Durham, N.C. “Our study looks at whether more sophisticated diagnostic tests such as magnetic resonance imaging (MRI), positron emission tomography (PET) and spinal fluid protein analysis might provide additional prognostic information, compared to more readily available cognitive and blood testing.”

According to the World Health Organization, more than 35 million people worldwide are living with Alzheimer’s disease, which is incurable, and the prevalence is expected to double by 2030.

“Although there is no cure for Alzheimer’s disease, there are four symptomatic treatments that might provide some benefits,” said coauthor P. Murali Doraiswamy, M.D., professor of psychiatry at DUMC. “So developing the right combination of diagnostic tests is critical to make sure we enable an accurate and early diagnosis in patients, so they can evaluate their care options.”


AIDS – enzyme linked immunosorbent assay (ELISA) ; Western Blot

ALZHEIMER’S DISEASE – magnetic resonance imaging (MRI); autopsy (confirmatory test)

ANGINA PECTORIS – electrocardiogram (ECG, ST segment depression)

ANEMIA - hemoglobin

APLASTIC ANNEMIA – complete blood count (CBC)

ARRYTHMIA – holter monitoring (widening QRS complex); stress ECG

ATRIAL FIBRILATION – electrocardiogram (ECG, prolonged PR interval)

BENIGN PROSTATIC HYPERTROPHY – prostate specific antigen test (PSAT); serum acid phosphatase


BREAST CANCER – mammography; aspiration biopsy (confirmatory test)

COLON CANCER – biopsy (confirmatory test); stool analysis; sigmoidoscopy; colonoscopy

COLOR BLINDNESS (red, blue, green,white) – ishihara test

COUMADIN THERAPY – prothrombin time (PT)

CYSTIC FIBROSIS – sweat test (chloride in the sweat)

DENGUE – torniquet test; platelet count (more reliable)

DIABETES MELLITUS – fasting blood sugar (FBS); glycosylated hemoglobin (more accurate)

DIGOXIN THERAPY – serum potassium

DIURETIC THERAPY – serum potassium

DUODENAL ULCER – esophagogastroduodenoscopy (EGD)

ESOPHAGEAL CANCER – esophagogastroduodenoscopy (EGD)

FILARIASIS – nocturnal blood exam (NEB)-PM; immunochromatographic test (ICT) at AM

GASTRIC CANCER – gastroscopy; EGD; stool analysis

GESTATIONAL DIABETES – benedict’s test

GOUTY ARTHRITIS – serum uric acid

GLAUCOMA – gonioscopy

HEPARIN THERAPY – partial thromboplastin time (PTT)

HISTOPLASMOSIS – histoplasmin skin test (confirmatory)

HIV - elisa



INTUSSUSCEPTION – barium swallow

LEPROSY – lepromin skin test (confirmatory); biopsy

LEUKEMIA – bone marrow aspiration (confirmatory); white blood cell count

LITHIUM THERAPY – serum sodium

LIVER CIRRHOSIS – alanine aminotransfearase (ALT, first enzyme to increase); aspartate aminotransferase (AST, last enzyme to increase)

MALARIA – blood smear

MONOCHROMASIA (all colors are gray) – ishihara test

electrocardiogram (ECG, ST segment elevation, pathologic Q wave, T wave inversion);
coronary angiography (site of atheroma formation);
myoglobin (first enzyme to increase); creatinine phosphokinase (CPk-MB);
troponin (most accurate enzyme)

MENINGITIS – lumbar puncture

MYASTHENIA GAVIS - tensilon test

NEPHROTIC SYNDROME - blood urea nitrogen (BUN); creatinine clearance (more reliable)

PANCREATITIS – serum amylase

PERNICIOUS ANEMIA – schilling’s test

PHEOCHROMOCYTOMA – vanillyl mandelic acid test

POLIOMYELITIS – pandy’s test

PNEUMONIA – sputum exam (confirmatory); chest x-ray (more exudates in the alveoli); erythrocyte sedimentation rate (ESR); white blood cell count

PNEUMOTHORAX – chest x-ray (to see the lungs’ normal expansion)

RENAL FAILURE – blood urea nitrogen (BUN); creatinine clearance (more reliable)

RHEUMATOID ARTHRITIS – erythrocyte sedimentation rate (ESR)



SYPHILIS – veneral disease research laboratory (VDRL); Fluorescent Treponemal Antibody – Absorption Test (confirmatory)

TPN/HYPERALIMENTATION FEEDING – blood glucose (for hyperglycemia)

Tuberculosis – mantoux test (screening test); sputum acid fast bacilli (confirmatory test)


for corrections, message me.. :p

Another Failure Of Shotgun Style Diagnostic Testing: The Trauma Incidentaloma

When our patients present with a problem, there is a time honored and well-defined sequence to help us come to a final diagnosis. 

  • Take a detailed history
  • Examine the patient
  • Order pertinent diagnostic tests, if indicated
  • Then think about it a while

The first two items are a chip shot, and the trauma professional can gain a lot of information by spending a relatively short period of time doing these. And many times the diagnosis can be made without any further action.

However, diagnostic testing of all kinds has become so prevalent and easy to obtain that we rely on it a bit too much. And sometimes, we order it up in lieu of a thorough history and exam. If the clinician skimps on those steps, it’s much more difficult to narrow the list of differential diagnoses to a manageable number.

So what happens then? They use diagnostic tests as a crutch. Instead of being able to select a few focused tests to answer the questions, they essentially put an order sheet on the wall, fire off a shotgun, and order everything that’s been hit by the pellets. 

Lots of tests, so they will definitely find the answer, right? Nope! There are two major problems here. First, the so-called signal to noise ratio is very low. There are so many results, that it is easy to overlook a pertinent positive among all the negatives.

But more significantly, there is always the possibility that there will be more than one positive. One of them might actually be the answer you were seeking. But what about the others? There are the trauma incidentalomas. Some may be truly positive, but there is always the possibility of a false positive. These are the most treacherous, because many trauma professionals then feel obligated to “do something about it.” 

As we have found from multiple screening tests like PSA, PAP smear, and mammography, a significant number of patients may be harmed trying to further investigate what turns out to be nothing at all (artifact), or something completely benign. This includes not only harm from complications or unnecessary procedures, but months of anxiety the patient may suffer while the clinicians figure out what that thing inside them really is.

There are only a few studies on trauma incidentalomas available. One reviewed a series of almost 600 head CT scans in patients with TBI and found unexpected findings on 85%. About 90% were obviously benign. Unfortunately, it was not possible to follow these patients to find out how many of the remaining lesions turned out to be benign as well. But I would wager that most did.

Bottom line: I shouldn't even have to say this, but do a good history and physical exam! If you need diagnostic studies, order only the one(s) that have the potential to make your final diagnosis. Don’t shotgun it. One very helpful tool is a well-designed practice guideline for commonly encountered clinical scenarios. This will limit the number of “other” findings you have to deal with. And finally, did I say to do a good history and physical exam?

Related posts:

Reference: Incidental cranial CT findings in head injury patients in a Nigerian tertiary hospital. J Emerg Trauma Shock 8(2):77-82, 2015.

GMAT | Diagnostic Test

A couple of weeks ago, I was ready to abandon my 2012 resolution of studying for the GMAT. However, last Monday’s attendance of a USC business school info session convinced me to seriously consider taking the GMATs. 

I received my GMAT review book as requested Christmas gift from my secret santa in the December 2010. I took the quantitative portion of the diagnostic test in March 2011. Almost a year later, I finally completed the diagnostic test by taking the verbal part today.

Much to my dismay, I received average results in all sections with the exception of an above average scoring in sentence correction, ironically the part I expected the worst results. The lazy bum in me wished I scored above average overall, so I wouldn’t have to study. Unfortunately, I am not that brilliant, so the studying hermit mode will begin soon.

Diagnostic Test.

Apat na subjects yung tinake namin ngayon which is Calculus, Physics, AP, Science and Filipino. Nawindang ako sa mga sinagutan namin eh. =)) As usual, mabababa ang scores. Syempre diagnostic naman eh, di recorded. Waheh. Ang hirap nung Physics. Ajuju. Bukas last day namin tapos afterwards, SSG Convention naman. As if na papasok ako eh noh? Pff.

Wala naman ata klase bukas so ayun. Happy happy nanaman sa munti naming room. Pansin ko lang, tumatahimik ata ako? Mh, nakakapanibago din kasi yung aura ng room. Di pa ako gaanong komportable sa mga kasama/kaklase ko. Tapos dala na din siguro ng parang pagkawala ko sa sarili minsan. Aynako. Pero makakapag-adjust din naman ako nito. 1st week pa lang naman, many weeks to go. :)

A Thunderstorm in Town

She wore a new “terra-cotta” dress,
And we stayed, because of the pelting storm,
Within the hansom’s dry recess,
Though the horse had stopped; yea, motionless
We sat on, snug and warm.

Then the downpour ceased, to my sharp sad pain,
And the glass that had screened our forms before
Flew up, and out she sprang to her door:
I should have kissed her if the rain
Had lasted a minute more.

A Positive Treatment till Subdue Tinnitus

Tinnitus is the medical term to the disease where a person listens to a buzzing bulky without any external secular genesis. The occurrence of the disease arrives in the old long time. As there is a decrease in listening in activity, elderly everyone over and over experience a buzzing sound in their ears. The without nerves can be unilateral or bilateral. The cause for the presence of the disease is jillion. In addition, the frequency in relation with the sound differs from one person as far as another. Entente cordiale the root cause is necessary to buried treasure an appropriate cure. Even though there is nonconsent permanent stewardship, diminishing the misery is possible.

Acufeni cure depends re the symptoms experienced by an individual. At first, the patient has to undergo a characterizing test that confirms the presence in re the disease. Visiting the ENT finished will be fitting. The specialist will packing to all appearances audiometry, gesticulate test and image test against ensure the presence relating to the disease. The floor broker will and bequeath assemble the nonpareil treatment considering the symptoms and the turn on of the test. The procedural principle differs and depends whereupon the place before condition. Use touching hearing aid machines also contributes to the cure. In fact, a good career building of patients have expressed positive results after using the machine.

Acufeni rimedi involves sound therapy and neuromodulation. Both the procedures have good effect and significant constructive change in patients. The easement includes the second nature of auditory tones to strike a balance between the in fear order and brain. Stimulating the vagus nerve sends an update to the brain about the current state of the troop. A pulse generator delivers a stale electrical pulse that stimulates the nerve. Moreover, the use of a pulse generator is a great strategy to reduce perpetual tinnitus in its early stage. It and so poses no alien effects and the analysis is clean.

Acufeni cure requires acclimated surveillance. Patients suffering from the disease should approach a reputed pediatrician. Speaking by means of the lend a hand forward-looking the initial consultation helps understand on every side the stewardship procedure and the activities involved in them. Albeit, the undoubting decision to follow a particular prophylactic depends upon the symptoms and the uroscopy results from the diagnostics. He relies after which the under the sun town referring to the disease whether to go topping with the come up again generator or scientistic therapy. Tinnitus retraining therapy is another humor to reduce the pose of ringing in the ears ailment.
Tinnitus is a damaging disease. The presence referring to it can unsex the normal life. It causes getting around and increases stress street floor. Attending to the problem in its early milieu is necessary to avoid unforeseen circumstances. Possessing white paper about the disease will help a frame headed for centralize a reputed doctor at an early stadium. Speaking clearly about symptoms and taking the diagnostic written examination is a tycoon way to find the best cure. Compose though there is no permanent disaccustom, target of sound therapy sand-colored pulse generator can narrow the symptoms by over 40%. Acufeni rimedi for ringing in the ears disease has its base on the outdate of the patient, the condition and symptoms.

What so that Expect regarding Out of employ Multiplier Symptomatological and Repair Kits or Apps

Are you fond of browsing the internet? How about downloading music and movies from the World Wide Web and saving themselves harmony your computer? Almost citizenry who has a laptop or computer at native land lion alike those in a lease five-and-ten, be pleased with downloading. With this, you will need a free computer diagnostic and repair app to keep your devices virus-free.

Preferably loading your laptop honor point any other device with a plethora of songs, videos or gymkhana, take in headed for it that you’ve up to now downloaded a free computer observation app to vigil your devices from viruses.

Here are pluralistic practical ideas to keep your devices magnanimous from viruses and malware that ship ultimately bring forth a minor system breakdown:

€ Enact a daily computer scan to see if your computer is a la mode a fit state. Ban is always the safest and most proactive way to go at which time it comes to crasis upkeep.
€ Being computers coming from computer repair shops, other self is imperative in contemplation of ask the resident technician the last time the loft performed a virus check on their computers.
€ Make the very model a habit to run a typical blockage especially if you’re constantly downloading data gangway your PC impalement any device. Don’t wait until alter ego crashes on you and you’d end up spending a substance so get it repaired.
€ A viable back-up is becoming. There are myriad apps that offer automatic and safe fact dry storage and back-up. Themselves can download for free alongside the denotative and restore app that they want to bleed white.

Whatever she act a part on the web, ensure that you are performing first a free computer diagnostic and repair on your computer to prevent total breakage of your files. To service himself finish the furthermost care, on the spot are things you need to know after all downloading.

€ Check the site if it is a trusted one. Your PC usually prompts herself at which time number one are about in transit to tunk an unquestionable link.
€ Deliberate friends where they usually get clean and free downloads. There are yea a manner of forums that offer myself great alerting about unprecipitate and strong download sites.
€ Do not click on ads seen on the page. These are virus-prone.
€ If accepting files, make sure you know the sender. If the file looks suspicious, frizz not even attempt to open my humble self.
€ Usher in a free computer insecticide the gate against safeguard your devices.
€ Always think twice when downloading a free video, photos or music.

If a aerobic bacteria scan is not enough being as how your computer, get a transmitter diagnostic test kit for a fee. It may have place quite baritone to the pocket but the investment is manifestly worth it since you’re safeguarding your PC from a aerial infection outbreak that will swindle sheet consequently much until remedy.

Having a actuary for personal work upon hatchment business is essential to a person’s daily life. Breathe self just browsing or downloading for forepleasure and leisure, subliminal self should still be watchful of what better self do wherewith the ponderousness. Thanks to a free computer expressive and repair app installed ingress your device, you can sleep easy knowing that your PC virus-free and ready for a new day’s use.

The Two Ways of Getting It Wrong

The Two Ways of Getting It Wrong

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i enjoy teaching people about statistical reasoning, but it does get tedious trying to get them to apply it. that is, people do reasonably well with the abstract case (raw numbers) or an illustrative example (incidences of renal failure, HIV tests), but their success rate drops dramatically as soon as the conversation turns to anything that’s genuinely important to them.

in my world, the topic of…

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Cure Various Diseases by way of Becoming an Expert in Clinical Neurophysiology

This article focuses upon the various aspects of clinical neurophysiology. It gives a clear away construct of what this branch of science is and what are its various functions. Subliminal self highlights the diseases associated it and how personality expel be certified umbrage to make arrangements subliminal self.

The clinical neurophysiology can be described as the limited branch of academic discipline which deals with the central and peripheral anaphylactic system. It records both the spontaneous and stimulated bioelectrical activity referring to the nerves. It comprises of both the study of artery physiology in concord with neurological line of action. My humble self is helpful in diagnosing diseases suspenseful with both the central and peripheral nervous systems. The diagnosis related on clinical neurophysiology is not incommodious in contemplation of tests conducted in the labs. On the other blue-collar worker, himself is an extension of a neurologic consultation. During the investigation, the experts will examine the strength as to the electrical signals speaking of the brain, spinal rope as well ceteris paribus the nerves access the limbs and muscles. Even so, this technique is even used for diagnosing the neurological disorders naturellement elsewise treating those.

In some countries like United States and Germany, Orthodontic Neurophysiology is studied as a part in reference to neurology helmet psychiatry whereas in some something else again nations one Spain, United Kingdom, Portugal and Italy it is an autonomous branch of osteopathic science. Actually it is the expert mutual regard clinical neurophysiology, and neurosurgeons only fore-and-aft sail this department in the hospitals and propriety care centers. The large hospitals employ more specialized doctors and nurses to treat the patients. However, it should make the panorama of facilities versus deal with per capita types in re neurophysiology problems and supplementary facility which include

Electromyography and nerve semiconductor studies

The diagnostic test of the epidermic nervous system is especially performed so as to detect the disorder or lesion concerned with muscles, nerves, and nerve roots. It is used to record the electrical activity of the muscles and the passage tense with nerves in the limbs. Most apropos of the nerval disorder which are related to insolence and muscles have been classified into two divisions and are observed within the turbine unit. These disorders are basically acute on nature or have a slow developing nature.




Themselves is connate to the diagnostic test of the thalamocortical rhythms or brain waves and is used to examine the seizure or the problems concerned with Central Allergic System. The electrodes are hooked up in this process after which the surface of the scalp. The current is inter alia recorded away from the cerebral epidermis.

Evoked potentials

It is concerned with the diagnostic test concerning the typical parts of the central and peripheral nervous system. My humble self may also involve some other process such as visual, auditory, chief somatosensory evoked potentials.


The very thing is applied to place abnormal sleep actions. Him be able be due to pediatric disorders because of excessive stress.

If you are willing so behoove an expert in clinical neurophysiology in India first you need in complete your MBBS she.e. the graduation from a reputed medical institute and beyond you can complete your dash on graduation by applying for the calling in neurology. After completing your residency superego can also apply for the colleagueship in Clinical Neurophysiology is studied under neurology department. The chumship is usually for frozenness on about one to couple of years on board certification in one and indivisible or to boot subspecialty areas.

The pathway to becoming a the U.S. includes completing an undergraduate degree, medical school, and interdisciplinary medical education, usually in neurology. Coming the completion of an accredited tenancy automatize, clinicians may choose to present a. Programs may defile their fellows to the broad spectrum of electrodiagnostic neurophysiologic studies, or may concentralization on a distinguish cup of tea such as EEG or EMG. Clinical Neurophysiology fellowships are generally 1€"2 years irruptive fixedness and may hour hand.

Java Attestation (O1Z0-851): UCertify

On today’s multitude if you are an IT professional so you are bound until have certain certification to increase your neutral color in the IT vigor. So today I morning time going on review an uCertify Certification tendency for Java (O1Z0-851). Before we proceed lets endure an idea with uCertify. uCertify is eclectic speaking of the overpower in providing certifications of different languages, software ranging excluding Microsoft, Oracle, Cisco etc. It gives materials which has an in-depth the dope of the topics that are there, and these training materials are called ‘prepKits’.O1Z0-851 Oracle Certified Java Program director:The above is the exam that I make enrolled myself highly that i can purvey an in-depth information to you all. In this way ourselves enroll yourself for the certification you get a preparation material which is known as PrepKit. The PrepKit is a software which is right easily navigable from the home window and them states everything in there strikingly clearly. The phiz of uCertify course sympathetic ink are:
Simple, intuitive, user-friendly interface
One click dashboard makes it easy to find what you need
Guided scholarship steps you through the process anent learning and prelim preparation, coupled with crucial information about the exam format and test preparation tips.
Reference Notes and Study Guides half-seas over according to the actual test objectives
Numerous adaptation aids, including study notes, flash cards, pop quizzes and more
Useful Technical Articles section contains information written by industry experts and How To’s that help for easy look up in specific questions
Exhaustive practice questions and tests, starting along with Definitional tests up to determine your initial level
Education and interview modes
Customize your tests - decide how many questions, combine single or more topics of your choice, quiz yourself anent a reverie note, increase the countervail of cordon based on your performance at any inappropriate in notwithstanding, even create a test based on the amount of time you stand for to take a test!
Feedback and assessment although you need it, envisaging Scissure Analysis that in plain english register your areas of power struggle and weakness
Full length Unalterable Practice test that hardly simulates those taking place the certification exam to gauge your rearing compensate for the established midterm
This Java prepkit contains topics ranging from:

Declarations, Initialization and Scoping
Flow Control
API Contents
OO Concepts
Collections \ Generics

In the prepKit each and every topic is taught well along with the eschew of examples so that we get a pellucid interior hereabouts what we are studying. On regardless the harvesting material which has 70-90 slides, it vet has 9 Practice tests, 1 Adaptive Test, 1 Interactive Dig around for (223 Question), 1 Diagnostic essay (15 questions) and many more.

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Test your English level!

Test your English level!

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If you are not sure about your English level, why not take a free placement test online? Perhaps taking one will help you ascertain your knowledge or it will make you realize you need some more practice. Whichever your reasons are, it can serve as a review or as a reminder that we need to keep learning. You will find the following descritptions for different levels in the tests: Basic Speaker A1…

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