Search Results (7)

Introduction: While low back pain (LBP) is most often associated with musculoskeletal issues, in a minority of cases, it can be caused by serious underlying conditions such as cancer. Recognizing malignancy early remains a major clinical challenge, as the warning signs, known as red flags (RFs), are often vague and inconsistent. Methods: A comprehensive search of six databases (PubMed, Scopus, Google Scholar, Web of Science, Cochrane Library, and SciELO) and grey literature was conducted for studies published from January 1999 to March 2025. Eligible sources included studies describing adult patients with cancer presenting with LBP. Study selection and data extraction were independently performed by two reviewers. Results: We included 70 studies, most of which were case-based, along with reviews and observational research. In these studies, cancer prevalence among patients with LBP ranged from 0.1% to 1.6%, with metastatic disease being the most common finding. A prior history of cancer emerged as the most reliable red flag (specificity up to 0.99), while other signs and symptoms were less consistent. Notably, combining multiple RFs, such as a history of cancer and unexplained weight loss, significantly improved the diagnostic accuracy (LR+ = 10.25 in one study). Conclusions: While current evidence is limited and largely based on case-based studies, some RFs, particularly a history of cancer, show greater diagnostic value. In patients with LBP associated with underlying malignancy, RFs seem to be more useful for ruling in rather than ruling out (i.e., screening) serious pathologies. Most RFs have poor standalone accuracy; however, considering combinations of RFs within the broader clinical context may improve early detection of spinal malignancy in patients with LBP. Full article

Immune dysregulation is being increasingly recognized as a leading sign of a wide spectrum of inborn errors of immunity (IEIs). Therefore, patients with IEIs are frequently managed in non-immunological settings, including hematology and oncology units, during the diagnostic process or follow-up. The most relevant hematological signs associated with IEIs comprise autoimmune cytopenia (AIC), lymphoproliferative diseases (LPD), malignancies, hemophagocytic lymphohystiocitosis (HLH), bone marrow failure (BMF), myelodysplastic syndromes (MDS), and peripheral or tissue eosinophilia. The prognosis of patients with IEIs can significantly improve when a molecular diagnosis is established, as it can allow the use of targeted treatments, guide appropriate follow-up strategies and, in some cases, support the rationale for hematopoietic stem cell transplantation or gene therapy. Therefore, there is an urgent need to recognize the warning signs suggestive for an underlying IEI among patients presenting with common hematological features and to ensure an appropriate diagnostic approach. As a general rule, clinicians should always provide a clinical alert in the presence of two or more IEI-associated hematological signs, as well as a positive familial history for IEI or hematologic immune dysregulation, a personal history of severe infections, and other signs of immune dysregulation. Concerning AIC, an increased likelihood of IEI is characteristic of patients with treatment refractoriness, autoimmune hemolytic anemia, or multilineage cytopenia. In the case of LPD, the main elements of suspicion are represented by the chronic or recurrent disease course, the persistence of Epstein–Barr Virus (EBV) infection, and the development of lymphoproliferation in atypical localizations. Among patients with malignancy, clinicians should investigate for IEI those with rare neoplasia, virus-associated tumors, and an association with syndromic features, while patients with HLH should always receive an immunological assessment when a clear rheumatologic trigger, underlying malignancy, or well-recognized cause is not evident. The case of MDS and BMF is complex, as new monogenic entities are continuously being described. However, it is pivotal to consider the presence of monocytopenia, warts, vasculitis, and neurological disease, as well as specific cytogenetic abnormalities, such as chromosome 7 monosomy, as warning sings for IEIs. Finally, the main red flags for IEIs in patients with eosinophilia are skeletal/facial abnormalities, recurrent abscesses, refractory eczema, organomegaly, or thrombocytopenia. Full article

The National Weather Service is responsible for alerting wildland fire management of meteorological conditions that create an environment conducive for extreme fire behavior. This is communicated via Red Flag Warnings (RFWs), which presently lack a national standardized methodology and rarely are explicitly linked to fuel conditions such those as provided by National Fire-Danger Rating System (NFDRS) indicators. The need for a revamped RFW has been expressed recently by both fire management and fire weather meteorologists. A decision matrix approach was developed to determine criteria that consistently and explicitly associates meteorological and fuels information to extreme fire behavior. Extreme fire behavior is defined here as maximum rates of spread (area per day) observed on documented large fires from 1999–2014 utilizing the ICS209 all-hazard dataset. Meteorological conditions occurring with these rates of spread were compared to historical percentiles of relative humidity, wind speed, and the NFDRS Energy Release Component. These percentiles were assigned a numerical score from one through five based on percentile rank. The additive result of all three scores was plotted against rates of spread yielding a two-step decision matrix of RFW categories where, for example, the highest score is the most extreme RFW case. Actual RFW issuances were compared to this matrix method. Full article

Dyeing vegetables with harmful compounds has become an alarming public health issue over the past few years. Excessive consumption of these dyed vegetables can cause severe health hazards, including cancer. Copper sulfate, malachite green, and Sudan red are some of the non-food-grade dyes widely used on vegetables by untrusted entities in the food supply chain to make them look fresh and vibrant. In this study, the presence and quantity of dye-based adulteration in vegetables are determined by applying ¹H-nuclear magnetic resonance (NMR) relaxometry. The proposed technique was validated by treating some vegetables in-house with different dyes and then soaking them in various solvents. The resulting solutions were collected and analyzed using NMR relaxometry. Specifically, the effective transverse relaxation time constant, T_2,eff, of each solution was estimated using a Carr–Purcell–Meiboom–Gill (CPMG) pulse sequence. Finally, the estimated time constants (i.e., measured signatures) were compared with a library of existing T_2,eff data to detect and quantify the presence of unwanted dyes. The latter consists of data-driven models of transverse decay times for various concentrations of each water-soluble dye. The time required to analyze each sample using the proposed approach is dye-dependent but typically no longer than a few minutes. The analysis results can be used to generate warning flags if the detected dye concentrations violate widely accepted standards for food dyes. The proposed low-cost detection approach can be used in various stages of a produce supply chain, including consumer household. Full article

Red Flags in fiscal projects are warning signs that may indicate underlying problems with their implementation. In this paper, we present how National Strategic Reference Framework Open Data can be used to take full advantage of semantic web technologies and data mining techniques to build a knowledge-based system that identifies Red Flags. We collected the data from the Open Data API provided by the Greek Ministry of Economy and Finance. Data modeling consist of two ontologies; the Vocabulary of Fiscal Projects, describing the fiscal projects and the National Strategic Reference Framework Greece Vocabulary, illustrating the Greek National Strategic Reference Framework data. We transformed the data into RDF triples and uploaded them onto an OpenLink Virtuoso Server, so that we could retrieve them via SPARQL queries. Performance indicators were defined to assess the state of the project and Density-Based Spatial Clustering of Applications with Noise, (DBSCAN) was used to identify Red Flags. User’s demands is that rejected projects should raise Red Flags, to avoid project failure and assist the auditor to organize the monitoring process efficiently, by avoiding to examine most of the non-problematic projects. We performed a use case scenario in which an auditor has to examine NSRF projects, approximately 12 months before the end of the programming period. The system retrieved the fiscal information, calculated the performance indicators and identified the Red Flags. The last update of the projects status after the end of the programming period was retrieved and extracted the number of rejected projects, to test whether the user requirements are satisfied. Rejected projects consist of 3.8% of the total projects. The results of the use case scenario show that RedFlags platform is more likely to identify project failures and not raise Red Flags on not rejected projects. Therefore, the RedFlags platform using open data, assists the auditor to organize the monitoring process better. Full article

Red Flag Warnings (RFWs) issued by the National Weather Service in the United States (U.S.) are an important early warning system for fire potential based on forecasts of critical fire weather that promote increased fire activity, including the occurrence of large fires. However, verification of RFWs as they relate to fire activity is lacking, thereby limiting means to improve forecasts as well as increase value for end users. We evaluated the efficacy of RFWs as forecasts of large fire occurrence for the Northwestern U.S.—RFWs were shown to have widespread significant skill and yielded an overall 124% relative improvement in forecasting large fire occurrences than a reference forecast. We further demonstrate that the skill of RFWs is significantly higher for lightning-ignited large fires than for human-ignited fires and for forecasts issued during periods of high fuel dryness than those issued in the absence of high fuel dryness. The results of this first verification study of RFWs related to actualized fire activity lay the groundwork for future efforts towards improving the relevance and usefulness of RFWs and other fire early warning systems to better serve the fire community and public. Full article

Functional gastrointestinal disorders (FGIDs) account for at least 40% of all referrals to gastroenterologists. Of the 33 recognized adult FGIDs, irritable bowel syndrome (IBS) is the most prevalent, with a worldwide prevalence estimated at 12%. IBS is an important health care concern as it greatly affects patients’ quality of life and imposes a significant economic burden to the health care system. Cardinal symptoms of IBS include abdominal pain and altered bowel habits. The absence of abdominal pain makes the diagnosis of IBS untenable. The diagnosis of IBS can be made by performing a careful review of the patient’s symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history), evaluating the patient for the presence of warning signs (e.g., “red flags” of anemia, hematochezia, unintentional weight loss, or a family history of colorectal cancer or inflammatory bowel disease), performing a guided physical examination, and using the Rome IV criteria. The Rome criteria were developed by a panel of international experts in the field of functional gastrointestinal disorders. Although initially developed to guide researchers, these criteria have undergone several revisions with the intent of making them clinically useful and relevant. This monograph provides a brief overview on the development of the Rome criteria, discusses the utility of the Rome IV criteria, and reviews how the criteria can be applied clinically to diagnose IBS. In addition, a diagnostic strategy for the cost-effective diagnosis of IBS will be reviewed. Full article