Search Results (131)

Microbiological contamination of food remains a critical global public health concern, contributing to millions of foodborne illness cases each year. Traditional diagnostic methods, particularly culture-based techniques, have been widely employed but are often limited by low sensitivity, insufficient specificity, and lengthy turnaround times. Recent advances in molecular biology, biosensor technology, and analytical chemistry have enabled the development of more rapid and precise diagnostic tools. Among these, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has emerged as a transformative method for microbial identification. This review provides a comprehensive overview of the current applications of MALDI-TOF MS in the diagnosis of microbiological contamination in food. The method offers rapid, accurate, and cost-effective identification of microorganisms and is increasingly used in food safety laboratories for the detection of foodborne pathogens, ensuring the safety and quality of food products. We highlight the fundamental principles of MALDI-TOF MS, discuss its methodologies, and examine its advantages, limitations, and future prospects in food microbiology and quality assurance. Full article

Candida auris (C. auris) is an emerging multidrug-resistant fungal pathogen recognized by the World Health Organization (WHO) as a critical global health threat. Its rapid transmission, high mortality rate, and frequent misidentification in clinical laboratories present significant challenges for diagnosis and infection control. This review provides a comprehensive overview of current and emerging diagnostic methods for C. auris detection, including culture-based techniques, biochemical assays, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and molecular diagnostics such as PCR and loop-mediated isothermal amplification (LAMP). We evaluate each method’s sensitivity, specificity, turnaround time, and feasibility in clinical and surveillance settings. While culture remains the diagnostic gold standard, it is limited by slow turnaround and phenotypic overlap with related species. Updated biochemical platforms and MALDI-TOF MS with expanded databases have improved identification accuracy. Molecular assays offer rapid, culture-independent detection. Antifungal susceptibility testing (AFST), primarily using broth microdilution, is essential for guiding treatment, although standardized breakpoints remain lacking. This review proposes an integrated diagnostic workflow and discusses key innovations and gaps in current practice. Our findings aim to support clinicians, microbiologists, and public health professionals in improving early detection, containment, and management of C. auris infections. Full article

Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett’s esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are revolutionizing in vivo diagnostics, enabling the real-time visualization of tissue microarchitecture and physiological mechanisms. Fluorescence molecular endoscopy (FME) enhances the detection of precancerous and cancerous lesions, even those undetectable by conventional methods, by highlighting subtle molecular changes. Clinical applications include early tumor detection, therapy response monitoring, and improved lesion characterization. Despite these advancements, challenges persist, including high costs, a lack of standardization, and the need for specialized training. Recent innovations, such as a multi-parametric rigid standard, aim to ensure the reliable performance assessment and quality control of FME systems, addressing subjective variability and improving reproducibility. In addition, the integration of artificial intelligence (AI) with molecular endoscopy offers the potential to further reduce detection errors and significantly enhance diagnostic accuracy. This advancement underscores the potential of molecular endoscopy for personalized GI disease management, while highlighting the need for ongoing research to refine the technology, validate its clinical utility, and overcome the barriers to routine clinical application. Full article

Brevibacterium species are Gram-positive, non-sporulating, coryneform, aerobic rods that are catalase positive and exhibit a distinctive transition from diptheroid to coccoid morphology during culture. Infections by these species are seldom identified. Objective: This narrative review aims to present all the reported cases of Brevibacterium spp. infections in humans, focusing on data about epidemiology, antimicrobial resistance, antimicrobial treatment, and mortality. A narrative review based on a literature search of PubMed/MedLine and Scopus databases was performed. In total, 41 studies providing data on 42 patients with Brevibacterium spp. infections were included in the present analysis. The median age was 48 years, while 57.5% were male. The presence of a central venous catheter and malignancy, and end-stage renal disease on peritoneal dialysis were the main predisposing factors. Bacteremia was the most common type of infection, with peritoneal dialysis-associated infections being the second most common. B. casei was the most commonly identified species. Microbial identification required the use of advanced molecular techniques, such as 16s rRNA sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry in most cases. Brevibacterium spp. was highly resistant to the combination of trimethoprim with sulfamethoxazole, clindamycin, and common beta-lactams. The most commonly used antimicrobials were vancomycin and aminoglycosides. The mortality was about 10%. Clinicians and laboratory personnel should consider this pathogen in the differential diagnosis in patients with malignancy or peritoneal dialysis-associated peritonitis. Vancomycin should be used for empirical treatment and while antimicrobial susceptibility testing results are pending. Full article

The diagnosis of cholangiocarcinoma (CCA) remains challenging. Although new technologies have been developed and validated, their routine use in clinical practice is needed. Conventional cytology obtained during endoscopic retrograde cholangiopancreatography-guided brushings is the first-line technique for the diagnosis of CCA, but it has shown limited sensitivity when combined with endoscopic ultrasound-guided biopsy. Other diagnostic tools have been proposed for the diagnosis of CCA, with their respective advantages and limitations. Cholangioscopy with biopsy or cytology combined with FISH analysis, intraductal biliary ultrasound and confocal laser microscopy have made significant advances in the last decade. More recently, developments in the analytical “omics” sciences have allowed the mapping of the microbiota of patients with CCA, and liquid biopsy with proteomic and extracellular vesicle analysis has allowed the identification of new biomarkers that can be incorporated into the predictive diagnostics. Furthermore, in the preoperative setting, radiomics, radiogenomics and the integrated use of artificial intelligence may provide new useful foundations for integrated diagnosis and personalized therapy for hepatobiliary diseases. This review aims to evaluate the current diagnostic approaches and innovative translational research that can be integrated for the diagnosis of CCA. Full article

Background: Skull base tumors can extend into the temporal bone and occasionally even be visible through the tympanic membrane (TM) if they grow into the middle ear cavity. The differential diagnosis of a skull base mass is extensive and ranges from non-tumorous lesions like cholesteatoma to benign tumors like schwannoma and to malignant lesions like metastatic cancer. Optical coherence tomography (OCT) is a noninvasive imaging technique that can image tissue with high resolution in three dimensions, including through structures such as the TM and bone. OCT angiography is also able to assess tissue vascularity. We hypothesized that OCT could help shrink the differential diagnosis in clinic on the day of initial presentation. Specifically, we thought that OCT angiography could help distinguish between highly vascular skull base tumors such as glomus jugulare and other less vascular tumors and middle ear pathologies such as cholesteatoma and schwannoma. Objectives: We sought to determine whether OCT can image through the TM in clinic to distinguish a normal ear from an ear with a mass behind the tympanic membrane. Furthermore, we sought to assess whether OCT angiography can detect vascularity in these masses to help inform the diagnosis. Methods: We designed and built a custom handheld OCT system that can be used like an otoscope in clinic. It is based off a 200 kHz swept-source laser with a center wavelength of 1310 nm and a bandwidth of 39 nm. It provides a 33.4 μm axial and 38 μm lateral resolution. Cross-sectional images of the middle ear space, including OCT angiography, were captured in an academic neurotology clinic. Patients with normal ear exams, glomus tumors, cholesteatomas, and facial nerve schwannoma were imaged. Results: OCT images revealed key structures within the middle ear space, including the TM, ossicles (malleus and incudostapedial joint), chorda tympani, and cochlear promontory. OCT also identified middle ear pathology (using pixel intensity ratio in the middle ear normalized to the TM) when compared with patients with normal ear exams (mean 0.082, n = 6), in all patients with a glomus tumor (mean 0.620, n = 6, p < 0.001), cholesteatoma (mean 0.153, n = 4, p < 0.01), and facial nerve schwannoma (0.573, n = 1). OCT angiography revealed significant vascularity within glomus tumors (mean 1.881, n = 3), but minimal vascularity was found in normal ears (mean 0.615, n = 3, p < 0.05) and ears with cholesteatoma (mean 0.709, n = 3, p < 0.01), as expected. Conclusions: OCT is able to image through the TM and detect middle ear masses. OCT angiography correctly assesses the vascularity within these masses. Thus, OCT permits the clinician to have additional point-of-care data that can help make the correct diagnosis. Full article

Background: Vascular complications, following the application of non-permanent, hyaluronic acid-based tissue fillers are a rare but very serious and rapidly progressive disorder that can, in extreme cases, lead to skin necrosis, blindness, or a stroke. Interest in aesthetic procedures is constantly growing, so awareness and knowledge of the correct and comprehensive treatment of complications are important. The human face is an area characterised by complex innervation and vascularisation. There are high-risk areas in which the application of fillers should be carried out with particular care using appropriate techniques and instruments, as well as preparations with specific rheology. The aetiopathogenesis of vascular complications is complex—involving partial or complete vessel occlusion, the presence of local inflammation in the affected tissues, and potential arteriospasm of the vessels supplying the area, resulting in tissue dysperfusion and ischaemia. Methods: In this article, the case of a patient who developed signs of a vascular compromise on the forehead area after improperly administering filler in the glabellar and nasal areas is presented. Result: The diagnostic and therapeutic management applied, including above all high doses of hyaluronidase, Doppler ultrasound diagnostics, and general medications, as well as a complementary treatment of the distant effects of the complication, i.e., erythema and tissue loss in the forehead area, by autologous injection procedures and laser therapy, resulted in a full recovery and a very good aesthetic result. Conclusions: This case proves that complications after aesthetic medicine procedures, including vascular complications are possible. Education of patients and doctors, proper diagnosis, and initiation of appropriate treatment at an early stage of the problem can bring very good therapeutic results for the patient. Full article

Background: Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20–30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, and, in certain cases, surgery. Proprioceptive neuromuscular facilitation (PNF) techniques and electrical stimulation have been shown to be significant for recovery. Although PFP has a high recovery rate, up to 40% of patients may experience permanent sequelae. Objective: to assess the efficacy of treatment based on electrical stimulation and/or PNF in patients affected by PFP. Methods: A systematic search was conducted across six databases (PubMed, Medline, SportDiscus, CINAHL, Scopus, and Web of Science) in November 2024. Randomized controlled trials were included. Results: Fourteen articles were analyzed, applying PNF and/or electrical stimulation methods, pharmacological treatment, low-level laser treatment, subcutaneous collagen injections, and physiotherapy protocols involving facial expression exercises, yielding evidence for the variables assessed. Conclusions: PNF and/or electrical stimulation treatment in patients with PFP can be effective when employed early with appropriate parameters, showing promising results in improving quality of life, facial movement quality, and CMAP and reducing both the incidence and degree of synkinesis. Full article

The diagnosis of kidney diseases presents significant challenges, including the reliance on variable and unstable biomarkers and the necessity for complex and expensive laboratory tests. Raman spectroscopy emerges as a promising technique for analyzing complex fluids, like urine, and detecting important disease biomarkers. However, its complexity, high cost and limited accessibility outside clinical contexts complicate its application. Moreover, the analysis of Raman spectra is a challenging and intensive task. In response to these challenges, in this study, we developed a portable, simplified and low-cost Raman system designed to acquire high-quality spectra of liquid complex samples. Using the “Starter Edition” methodology from the OpenRAMAN project, the system was optimized through laser temperature adjustments, by evaluating the laser emission spectrum under different temperatures with a spectrometer, and through adjustment of the acquisition parameters of the software used, by acquiring the ethanol spectra. The system validation was performed through the acquisition of Raman spectra from five urine samples, demonstrating its consistency and sensitivity to composition variations in urine samples. Additionally, a neural network was designed and trained using methanol and ethanol solutions. The model’s hyperparameters were optimized to maximize its precision and accuracy, achieving 99.19% accuracy and 99.21% precision, with a training time of approximately 3 min, underlining the model’s potential for classifying simple Raman spectra. While further system validation with more samples, a more in-depth analysis of the biomarkers present in urine and the integration with more sophisticated elements are necessary, this approach demonstrates the system characteristics of affordability and portability, making it a suitable solution for point-of-care applications and offering simplified accessibility for assessing the diseases risk outside clinical contexts. Full article

The development of laser technology has revolutionized dentistry, offering complementary and alternative approaches to traditional techniques. Lasers have been successfully integrated into various dental procedures, enhancing treatment outcomes and patient care. Several types of lasers can increase the acid resistance of enamel, thus preventing caries. Laser fluorescence has been utilized for the pre-operative diagnosis of dental caries, enabling early detection and effective treatment planning. The therapeutic application of lasers in caries treatment aligns with the contemporary philosophy of minimally invasive procedures. Clinicians can use laser Doppler flowmetry as a supplementary tool for pulp vitality testing by detecting pulpal blood flow. Lasers are also employed in various pulp-related interventions, such as managing dentine hypersensitivity and performing root canal therapy. These procedures benefit from the precision and reduced invasiveness provided by laser technology. Furthermore, laser fluorescence serves as an additional tool for subgingival calculus detection. High-power and low-power lasers are used in both nonsurgical and surgical therapies to treat periodontal and peri-implant diseases, oral mucosa conditions, and even cancer based on their specific properties. Lasers are also utilized to accelerate bone regeneration, promote adhesive strength, and remove ceramic brackets. In summary, laser technology has significantly impacted contemporary dentistry by facilitating early diagnosis, minimally invasive treatments, and precise operative procedures, ultimately improving patient outcomes and expanding the scope of dental practice. Full article

Objective: Ex vivo confocal laser scanning microscopy (EVCM) is an emerging imaging technique, which offers rapid tissue examination. While the current literature shows promising results in the evaluation of non-melanoma skin cancer, only limited research exists on the application of EVCM in melanocytic lesions. This study aimed to assess the utility of EVCM in the characterization of melanocytic lesions and compare its findings with gold-standard histopathology. Methods: A total of 130 skin lesions, including 76 benign and 54 malignant melanocytic lesions, were prospectively collected and imaged using EVCM. Three blinded investigators were asked to identify characteristic morphologic features observed in the lesions and classify them into benign vs. malignant. The results were then compared with the corresponding histopathology. Sensitivity and specificity were calculated using contingency tables to assess the diagnostic performance. Results: The application of EVCM allowed for the visualization of cellular and tissue-level details, including cellular pleomorphism and atypical melanocytes. A comprehensive list of benign and malignant features identified by EVCM was compiled. Using these diagnostic criteria, the imaging of the inexperienced and dermatohistopathology-experienced investigator reached 67.7% concordance, and the imaging trained dermatologist obtained 69.2% agreement with dermatohistopathology in differentiating benign vs. malignant lesions. The imaging-trained dermatohistopathologist performed best with concordance up to 79.2%. Conclusions: In conclusion, EVCM is a promising technique for the rapid assessment of melanocytic lesions. Our study provides a comprehensive overview of morphologic EVCM features, which will contribute to the development of diagnostic algorithms for accurate diagnosis and appropriate treatment planning. Further studies are needed to evaluate its clinical utility and validate our diagnostic criteria. Full article

Background: Ex vivo fluorescence laser scanning microscopes (FCMs) allow digital tissue imaging directly from fresh, unfixed specimens without the need for conventional histological slide preparation. To date, no data have been reported on the use of FCMs in the endoscopy suite for immediate evaluation of endoscopic ultrasound (EUS)/endobronchial ultrasound (EBUS) fine needle aspiration/biopsy (FNA-B) specimens of lung lesions and/or mediastinal lymph nodes. Objectives: The aim of this study was to evaluate the performance of the FCM Vivascope 2500 (Vivascope, Munich, Germany) in providing real-time adequacy assessment and diagnostic information on the digital images of fresh unprocessed EUS/EBUS FNA-B specimens and to compare it with the corresponding final histological sections of formalin-fixed and paraffin-embedded cell blocks. Methods and Results: Thirty-two patients (50% male; 71 ± 8 years old) were enrolled between May 2023 and June 2024. In 28/32 (87.5%) patients, samples were defined as adequate at Vivascope evaluation, and in 20/28 (71.4%) patients, samples were classified as malignant. At final cytohistological evaluation, 87.5% of specimens were defined as adequate and 20/28 (71.4%) were diagnosed as malignant. There was perfect agreement between the Vivascope assessment of adequacy and the final cytohistological assessment on the same specimen (k Cohen 1). From a diagnostic point of view, perfect agreement was found between the two techniques in the identification of malignant neoplasms (k Cohen 1). Conclusions: The use of FCM could provide rapid information on both the adequacy and malignancy of the sample obtained during EBUS tissue acquisition (EBUS-TA), with minimal or no preparation and without destroying or losing the tissue. This technique allows for obtaining representative material in EBUS/EUS for lung cancer staging and is expected to change the turnaround time from biopsy sampling to diagnostic characterization of the tumor, ultimately improving patient management both at diagnosis and at restaging in follow up. Full article

Background and Objectives: This study aimed to evaluate the recurrence rates at three years for upper tract urothelial carcinoma (UTUC) cases managed conservatively, using Narrow Band Imaging (NBI)-assisted flexible ureteroscopy and Holmium laser vaporization. Materials and Methods: The study group included 61 patients who were diagnosed with NBI-assisted visualization with superficial pyelo-calyceal urothelial tumor lesions, treated conservatively by the flexible ureteroscopic approach and Holmium laser vaporization, also assisted by NBI. This was compared with a control group with the same number of cases, which underwent the same procedure, but without NBI technology. Recurrence rates, the rate of patients who underwent nephroureterectomy, and cancer-specific survival were compared. Results: The relapse rate at 1 year was 3.3% in the study group, and respectively 8.2% in the control group (p < 0.05). Depending on the histological characteristics, at 1 year the relapse rates in the study group were 1.8% in patients with low-grade tumors and 20% in those with high-grade tumors. At 3 years, the relapse rate was 11.5% in the study group versus 18% in the control group, (p < 0.05): 7.1% in patients with low-grade lesions and 40% in patients with high-grade lesions versus 21.4% in patients with low-grade lesions and 100% in patients with high-grade lesions (both arms with statistically significant differences, p < 0.05). Cancer-specific survival was 93.4% in the study group versus 86.9% in the control group (p < 0.05). Conclusions: The recurrence rates at three years for the UTUC cases managed conservatively, using NBI-assisted flexible ureteroscopy and Holmium laser vaporization, were lower than in patients treated by the same technique without NBI assistance, both in low- and high-grade tumors. Cancer-specific survival was also significantly improved by the association of NBI visualization during diagnosis and laser vaporization. Full article

The increasing incidence of and resulting deaths associated with malignant skin tumors are a public health problem that can be minimized if detection strategies are improved. Currently, diagnosis is heavily based on physicians’ judgment and experience, which can occasionally lead to the worsening of the lesion or needless biopsies. Several non-invasive imaging modalities, e.g., confocal scanning laser microscopy or multiphoton laser scanning microscopy, have been explored for skin cancer assessment, which have been aligned with different artificial intelligence (AI) strategies to assist in the diagnostic task, based on several image features, thus making the process more reliable and faster. This systematic review concerns the implementation of AI methods for skin tumor classification with different imaging modalities, following the PRISMA guidelines. In total, 206 records were retrieved and qualitatively analyzed. Diagnostic potential was found for several techniques, particularly for dermoscopy images, with strategies yielding classification results close to perfection. Learning approaches based on support vector machines and artificial neural networks seem to be preferred, with a recent focus on convolutional neural networks. Still, detailed descriptions of training/testing conditions are lacking in some reports, hampering reproduction. The use of AI methods in skin cancer diagnosis is an expanding field, with future work aiming to construct optimal learning approaches and strategies. Ultimately, early detection could be optimized, improving patient outcomes, even in areas where healthcare is scarce. Full article

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP’s pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP’s pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP’s likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens. Full article