Best Combination Of Sensitivity Research Articles

A-231 Can Embedded Performance Validity Measures Predict Performance on a Stand-Alone Test?

Abstract Objective: Determine the extent to which a group of embedded performance validity tests (PVT) predict performance on a stand-alone test; and examine the classification accuracy of embedded PVTs. Method: Participants were 102 adult patients who underwent neuropsychological evaluation (M age = 31.85, SD = 11.79; M education = 13.82, SD = 2.50; M FSIQ = 104.72). Patients were administered the Medical Symptom Validity Test (MSVT), and 10 embedded PVT scores were extracted from their neuropsychological profiles. Logistic regression determined the extent to which scores on embedded PVTs predicted MSVT designation as credible or noncredible. Classification accuracy also was calculated for the embedded PVTs, both individually and based on number of “failures.” Results: A final regression model (Chi-square (6) = 20.06, p = .003, Nagelkerke R Square = .42) was 38% sensitive, 97% specific, and correctly predicted credible patients (negative predictive accuracy = 95%) more often than noncredible patients (positive predictive accuracy = 50%). Several embedded PVTs had comparable classification accuracy. Conservatively defining noncredible performance as failure on at least three embedded PVTs produced the best combination of sensitivity (50%) and specificity (86%), and was associated with a false positive rate of 14%. Conclusions: Embedded PVTs correctly predict credible and noncredible performance on the MSVT at a high level. Although a multivariate predictive approach may have slightly more utility than examining embedded PVT scores separately, several individual PVTs have comparable accuracy. It remains unclear which approach is superior, and more research is needed.

Performance of Malnutrition Universal Screening Tool and Patient-Generated Global Subjective Assessment in screening for cancer-related malnutrition in Nairobi, Kenya

Background: Malnutrition is a common feature among oncology patients. It is responsible for poor response and tolerance to anticancer therapy, increased morbidity, and mortality. More than half of malnourished cancer patients remain undetected owing to lack of effective screening. Body mass index is the main indicator for assessing malnutrition in Kenyan public hospitals. However, it underestimates weight loss in patients with chronic illnesses. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment have been widely used in research and clinical practice and have both reported good validity and reliability. However, their diagnostic evaluation has not been performed in Kenya. Methods: A cross-sectional study was conducted among 138 and 76 cancer outpatients from Kenyatta National Hospital and Texas cancer treatment centres, respectively. Participants had a confirmed disease, stage 1-4 cancer, and aged 18 years and above. They were screened for malnutrition using both Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. A separate study questionnaire was utilized to gather participant’s socio-demographic and clinical characteristics. A Bayesian latent class modelling framework was employed to infer the tests’ estimates based on participants ‘cumulative scores from the two tests. Results: The cut-off value of ≥ 1 and ≥ 4 gave the best combination of sensitivity and specificity of Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. Both tests yielded statistically similar sensitivities and specificities. Predictive values were comparable between the tests and across the two populations. The posterior median true prevalences of malnutrition were high (˃ 54%) and numerically similar between the studied populations. Conclusions: The performance of both tests among patients with cancer is similar. Healthcare workers are therefore at liberty to use either of them to inform treatment. Given the high true prevalence of cancer-related malnutrition, routine screening is critical and should be included as part of cancer care.

Validation of the 33-Item Hypomania Checklist-External Assessment in Screening Adolescents for Bipolar Disorder.

BackgroundBipolar disorder (BD) is often misdiagnosed, leading to poor treatment outcomes. Thus, accurate assessment of BD is of great importance, including in BD adolescents. The aim of the study was to explore the psychometric properties of the 33-item Hypomania Checklist-External Assessment (HCL-33-EA) in depressed adolescents.MethodsThe study was conducted between March and November 2020 in Beijing, China. Depressed adolescents aged between 13 and 17 years (N = 260) with BD (N = 147) or major depressive disorder (MDD) (N = 113) diagnosed according to the International Classification of Diseases, Tenth Revision (ICD-10) were recruited. Patients’ hypomanic symptoms were assessed by their carers using the HCL-33-EA.ResultsThe HCL-33-EA showed high internal consistency (Cronbach’s alpha = 0.82) with two factorial dimensions. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.61 (95% confidence interval (CI): 0.54–0.67). The optimal cut-off score of 7 generated the best combination of sensitivity (0.81) and specificity (0.37) for discriminating between adolescents with BD and MDD.ConclusionThe HCL-33-EA, with a two-factor structure, seems to be a useful tool for screening for BD in depressed adolescents. However, the high sensitivity and low specificity of the HCL-33-EA at the optimal cut-off value of 7 indicate that the HCL-33-EA needs to be further refined for young patients.

Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study

BackgroundThere is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect.MethodsA cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed.ResultsUterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery.ConclusionA lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.

Correlation of Pyuria and Bacteriuria in Acute Care

BackgroundPyuria is often used as an import marker in the diagnosis of urinary tract infection. The interpretation of pyuria may be especially important in patients with nonspecific complaints. There is a paucity of data to demonstrate the utility of pyuria alone in the diagnosis of bacteriuria or urinary tract infection. This study aims to further define the relationship of pyuria and positive bacterial growth in urine culture, as well as the diagnostic utility of different urine white blood cell cutoff points. MethodA total of 46,127 patients older than the age of 18 were selected from the inpatient population of HCA Healthcare System Capital Division. Urine microscopy results were stratified by white blood cell count and correlated with positivity of urine culture bacterial growth. The optimal urine white blood cell cutoff was derived based on the receiver operating characteristic curve plot. ResultsUrine microscopy finding of white blood cell 0-5 cell/hpf, 5-10 cell/hpf, 10-25 cell/hpf, and higher than 25 cell/hpf was associated with 25.4%, 28.2%, 33%, and 53.8% rates of bacteriuria, respectively. The receiver operating characteristic curve plot demonstrated that pyuria alone did not provide adequate diagnostic accuracy to predict bacteriuria. The optimal cutoff point for the best combination of sensitivity and specificity was found to be 25 cell/hpf. ConclusionPyuria alone provides inadequate diagnostic accuracy for predicting bacteriuria. Urine white blood cell count greater than 25 cell/hpf was found to be the optimal cutoff to detect bacteriuria. The result of this study supports the current guideline recommendation against antibiotic treatment based on urine analysis alone. It also informs future design of randomized controlled trial that investigates interventional strategies for patients with pyuria and nonspecific complaints.

Efficacy of SPECT Myocardial Perfusion Imaging (MPI) in Combination with Coronary Artery Calcium (CAC) Score for the Diagnosis of Coronary Artery Disease (CAD)

Background: Cardiovascular disease (CVD) is an important cause of morbidity and mortality in Bangladesh. The coronary artery calcium (CAC) score is a readily and widely available tool for noninvasive diagnosis of atherosclerotic coronary artery disease (CAD). Aims: To evaluate the diagnostic efficacy of combined CAC score with Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging (MPI) for the diagnosis of CAD. Methods: This cross sectional study was carried out in the National Institute of Nuclear Medicine & Allied Sciences (NINMAS) during July 2017 to June 2018. A total of 33 participants with known or suspected cases of CAD were included in this study who underwent SPECT MPI and CAC imaging. Statistical analyses of the results were obtained by using Statistical Packages for Social Sciences (SPSS-22). Results: Nearly half (48.5 %) of the participants belonged to age 51-60 years. Was male predominant in this study, 93.9% and 6.1% ware female. Regarding MPI 69.7% participants had severely abnormal perfusion and 21.2% had normal perfusion. According to CAC score 33.3% participants had moderate calcification in coronary artery. Significant CAD was found in 81.82% participants in Coronary Angiogram (CAG) study. Combined SPECT MPI and CAC score diagnosed significant CAD in 90.9% patents. The performance test of CAC score showed 96.3% sensitivity, 33.3% specificity, 84.8%accuracy, 86.7% positive predictive value (PPV) and 66.7% negative predictive value (NPV) for diagnosis of significant CAD. The performance test of SPECT MPI has sensitivity of 85.2%, specificity 50%, accuracy 78.8% and PPV 88.5% and NPV 42.8%. The performance test of combined SPECT MPI and CAC score, has 96.3% sensitivity, 50% specificity, 87.8% accuracy, 89.6% PPV and NPV 75%. CAC score with a cut off value of 12.5 had best combination of sensitivity 93.9% and specificity 50% for identifying the CAD missed by SPECT MPI. Conclusion: The CAC score may offer incremental diagnostic information over SPECT MPI for identifying patients with significant CAD and negative MPI results. Bangladesh J. Nuclear Med. 23(1&2): 21-28, 2020

Bridging the Gap Between Symptom Onset and Diagnosis in Axial Spondyloarthritis.

To evaluate a stratified screening process for the early identification of axial spondyloarthritis (SpA) with consideration of the following: 1) wait times from primary care to rheumatology screen, 2) incremental precision and accuracy from primary care to rheumatology screening, and 3) diagnostic delay. Adults with low back pain attending primary care at low back pain clinics prospectively underwent a primary standardized clinical screening. Patients with low back pain of >3 months who experienced symptom onset at age <50 years were referred for a comprehensive secondary screening by a physical therapist with advanced rheumatology training. At secondary screening, patients with features of inflammation were classified as being at a low, medium, or high risk for axial SpA versus no risk for axial SpA. Precision and accuracy of this screening strata were measured against a rheumatologist with expertise in axial SpA. Overall, 405 patients underwent primary and secondary screening in the present study. The study cohort had a mean ± SD age of 36.9 ± 9.9 years, and 55% were women. HLA-B27 was present in 14.4% of patients. Median wait time from primary screening to secondary screening was 15 days. Axial SpA risk assignment by rheumatologist was 64.9% for no risk or low risk for axial SpA and 35.1% for medium risk or high risk for axial SpA. The best combination of sensitivity (68%), specificity (90%), positive predictive values (80%), and negative predictive values (84%) was evident in the secondary screening. In this cohort, 15.6% of patients received a final diagnosis of axial SpA. Median low back pain duration from symptom onset to diagnosis was 2 years for nonradiographic axial SpA and 7 years for ankylosing spondylitis. A stratified interprofessional screening process can facilitate rapid diagnosis of persistent low back pain with high precision and accuracy in patients who have axial SpA.

The compensatory reserve index predicts recurrent shock in patients with severe dengue

BackgroundDengue shock syndrome (DSS) is one of the major clinical phenotypes of severe dengue. It is defined by significant plasma leak, leading to intravascular volume depletion and eventually cardiovascular collapse. The compensatory reserve Index (CRI) is a new physiological parameter, derived from feature analysis of the pulse arterial waveform that tracks real-time changes in central volume. We investigated the utility of CRI to predict recurrent shock in severe dengue patients admitted to the ICU.MethodsWe performed a prospective observational study in the pediatric and adult intensive care units at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Patients were monitored with hourly clinical parameters and vital signs, in addition to continuous recording of the arterial waveform using pulse oximetry. The waveform data was wirelessly transmitted to a laptop where it was synchronized with the patient’s clinical data.ResultsOne hundred three patients with suspected severe dengue were recruited to this study. Sixty-three patients had the minimum required dataset for analysis. Median age was 11 years (IQR 8–14 years). CRI had a negative correlation with heart rate and moderate negative association with blood pressure. CRI was found to predict recurrent shock within 12 h of being measured (OR 2.24, 95% CI 1.54–3.26), P < 0.001). The median duration from CRI measurement to the first recurrent shock was 5.4 h (IQR 2.9–6.8). A CRI cutoff of 0.4 provided the best combination of sensitivity and specificity for predicting recurrent shock (0.66 [95% CI 0.47–0.85] and 0.86 [95% CI 0.80–0.92] respectively).ConclusionCRI is a useful non-invasive method for monitoring intravascular volume status in patients with severe dengue.

Comparison Of Centralized And Traditional Methods Of Heart Failure Hospitalization Endpoint Capture

Introduction Pragmatic clinical trials (PCTs) employ innovative approaches to improve clinical trial efficiency and reduce trial-related costs. Leveraging electronic medical records (EMR) has the potential to lower trial burden and cost related to patient follow-up and data acquisition. Hypothesis Centralized (EMR-based) and traditional (trial-based) methods of heart failure (HF) hospitalization endpoint capture are comparable. Methods In the Veteran Affairs (VA) national integrated EMR, we used four distinct algorithms: 1) any (primary or secondary) discharge diagnosis code of HF; 2) any discharge diagnosis code of HF and IV diuretic use during associated hospitalization; 3) principal discharge diagnosis code of HF; 4) principal discharge diagnosis code of HF and IV diuretic use during associated hospitalization, to identify HF hospitalizations for 405 Veteran participants of the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated heart failure (INVESTED) PCT. HF hospitalizations identified by EMR were compared to INVESTED study events adjudicated according to FDA definitions by a blinded clinical events committee. Sensitivity and specificity of the EMR algorithms were estimated with the adjudication by the clinical events committee as the gold standard. Results Sensitivity and specificity for each algorithm are shown in Table 1. The algorithm comprising any discharge diagnosis code of HF had the highest sensitivity, while the principal discharge diagnosis code of HF and IV diuretic use during associated hospitalization algorithm had the highest specificity. The algorithm containing any discharge diagnosis code for HF with IV diuretic use during associated hospitalization had the optimal balance between correctly capturing and classifying HF hospitalizations and distinguishing non-HF hospitalizations. Conclusions Centralized endpoint capture of HF hospitalizations is sensitive and highly specific when compared to traditional methods for all algorithms examined. Any discharge diagnosis code of HF combined with IV diuretic use during associated hospitalization had the best combination of sensitivity and specificity. Pragmatic clinical trials (PCTs) employ innovative approaches to improve clinical trial efficiency and reduce trial-related costs. Leveraging electronic medical records (EMR) has the potential to lower trial burden and cost related to patient follow-up and data acquisition. Centralized (EMR-based) and traditional (trial-based) methods of heart failure (HF) hospitalization endpoint capture are comparable. In the Veteran Affairs (VA) national integrated EMR, we used four distinct algorithms: 1) any (primary or secondary) discharge diagnosis code of HF; 2) any discharge diagnosis code of HF and IV diuretic use during associated hospitalization; 3) principal discharge diagnosis code of HF; 4) principal discharge diagnosis code of HF and IV diuretic use during associated hospitalization, to identify HF hospitalizations for 405 Veteran participants of the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated heart failure (INVESTED) PCT. HF hospitalizations identified by EMR were compared to INVESTED study events adjudicated according to FDA definitions by a blinded clinical events committee. Sensitivity and specificity of the EMR algorithms were estimated with the adjudication by the clinical events committee as the gold standard. Sensitivity and specificity for each algorithm are shown in Table 1. The algorithm comprising any discharge diagnosis code of HF had the highest sensitivity, while the principal discharge diagnosis code of HF and IV diuretic use during associated hospitalization algorithm had the highest specificity. The algorithm containing any discharge diagnosis code for HF with IV diuretic use during associated hospitalization had the optimal balance between correctly capturing and classifying HF hospitalizations and distinguishing non-HF hospitalizations. Centralized endpoint capture of HF hospitalizations is sensitive and highly specific when compared to traditional methods for all algorithms examined. Any discharge diagnosis code of HF combined with IV diuretic use during associated hospitalization had the best combination of sensitivity and specificity.

Accuracy of the Edinburgh Postnatal Depression Scale in screening for major depressive disorder and other psychiatric disorders in women towards the end of their puerperium.

To assess the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) in screening for severe depression and other mental disorders in women at the end of puerperium. We administered the Czech version of the EPDS to assess depressive symptoms and the Mini International Neuropsychiatric Interview to determine psychiatric dia-gnoses in 243 women at the end of their puerperium. Then, we determined the frequencies of severe depressive disorder and other psychiatric disorders in our cohort. Furthermore, we assessed the sensitivity, specificity, positive predictive value, negative predictive value, and other dia-gnostic variables for the presence of severe depression and other psychiatric disorders for different threshold scores on EPDS. We evaluated the detection potential of EPDS for detecting monitored mental disorders by using the receiver operating characteristic curve analysis and determining the area under the curve. Severe depressive disorder was present in 2.5% (95% CI: 1.1-5.3%) of women. Any monitored mental disorder was present in 13.6% (95% CI: 9.8-18.5%). The best sensitivity/specificity ratio for detecting major depressive disorder was found for the EPDS threshold score 11; sensitivity was 83% (95% CI: 35-99%) and specificity was 79% (95% CI: 74-84%). The EPDS 11 then achieved a sensitivity of 76% (95% CI: 58-89%) and specificity of 82% (95% CI: 76-87%) for the detection of any mental disorder of interest. Our results showed that the Czech version of EPDS has good internal consistency, and the EPDS score 11 achieves the best combination of sensitivity and specificity values for detecting major depressive disorder. Screening with EPDS in women at the end of puerperium can detect psychiatric disorders other than severe major depression.

C-Reactive Protein as a Triage Test in Guiding Who Should Get a Confirmatory Test for Pulmonary Tuberculosis Diagnosis among Adults: A Case-Control Proof-of-Concept Study from Urban Tanzania

Background: The current screening tools for tuberculosis (TB) are inadequate resulting in insufficient TB case detection and continued community transmission of TB. As the world is geared into finding missing TB cases, new strategies are called for to aid in rapid identification of TB cases. This study aimed to evaluate the role C-reactive protein (CRP) in triaging patients to get a definitive test for active pulmonary TB diagnosis in urban Tanzania. Methods: A case-control study was conducted among pulmonary TB (PTB) patients and contacts without active PTB. The diagnosis of PTB was performed using GeneXpert MTB/RIF assay and culture. Blood was collected from cases and controls for measuring CRP levels during recruitment. We compared socio-demographic characteristics, clinical and laboratory parameters obtained during recruitment and performed diagnostic accuracy analyses for CRP. Results: Out of all 193 study participants who were involved in final analysis, 147 (76.2%) were males. Pulmonary TB cases had significantly lower median BMI than controls (median 17.4 kg/m2 [IQR: 15.8 - 19.2 kg/m2] vs., 24.9 kg/m2 [IQR: 22.1 - 28.5 kg/m2), p i.e., 13.33% vs., 11.7%, p = 0.48. CRP was significantly higher in PTB cases vs., controls (median 67.8 mg/L, [IQR: 36.5 - 116.9 mg/L] vs., 1.55 mg/L, [IQR: 0.59 - 6.0 mg/L], p = 0.003). Furthermore, CRP at cut-off ≥10 mg/L was associated with best combination of sensitivity, specificity and area under the curve of 89.9%, 95% CI: 82.2 - 95.0, 80.9%, CI: 71.4 - 88.2 and 0.85, 95% CI: 0.80 - 0.90 respectively. A multivariate logistic regression model adjusted for fever, night sweats and body mass index showed that CRP above 10 mg/L was significantly associated with PTB, aOR 5.2, 95% CI 1.2 - 22.8. Conclusions: CRP at cut-off ≥10 mg/L can be used to screen pulmonary TB. These findings can be used to improve TB screening algorithm by incorporating CRP in combination with TB symptoms to identify patients who need further confirmatory TB tests. However, additional prospective studies are required to support our findings and contribute into policy recommendations on use of CRP in a screening algorithm for pulmonary TB.

Métodos diagnósticos para lesões de cárie com sulcos pigmentados em superfície oclusal

ABSTRACT Objective: The aim of this study was to compare methods for in vitro diagnosis of pigmented pits and fissures on the occlusal surface. Methods: Forty-one human molars and premolars extracted with pigmentation in pits and fissures were used. The teeth were evaluated with artificial illumination for classification according to ICDAS, followed by fluorescent laser evaluation. For the radiographic evaluation, the teeth were positioned to obtain interproximal images, adopting the criterion of Rodrigues et al. 2008 for diagnosis of lesions. For histological evaluation, the teeth were sectioned in the mesiodistal direction in the occlusal sulcus region and evaluated in a 20-fold stereoscopic magnifying glass, using the criterion of Ekstrand et al. (1997) for evaluation. The methods were compared with the histological evaluation, obtaining values of accuracy, sensitivity and specificity regarding the response variables “presence / absence” of enamel caries. Results: When comparing visual inspection with histological analysis, 65.85% accuracy, 40% sensitivity and 90.48% specificity were observed with false positive and negative probability of 20% and 38.71%. When comparing the fluorescent laser with the histological analysis, the accuracy was 58.54%, sensitivity 70% and specificity 47.62%. Comparing the radiographic analysis with the histological analysis, it was obtained 53.66% accuracy, sensitivity of 42.11% and specificity of 73.68%. Conclusion: The ROC curve and the Yuden index showed that visual inspection presented the best combination of sensitivity and specificity than fluorescent laser and radiographic analysis for diagnosis, which represented the best method for detecting inactive carious lesions in enamel.

Assessment of Rapid Diagnostic Tests for Typhoid Diagnosis and Assessment of Febrile Illness Outbreaks in Fiji.

ABSTRACT.Typhoid is an endemic in Fiji with increases observed since the early 2000s and frequent outbreaks reported. We assessed the diagnostic accuracy of currently available typhoid rapid diagnostic tests (RDTs) (TUBEX, Typhidot Rapid, and Test-It assay) to establish their performance against blood culture in Fiji and to examine their suitability for rapid typhoid outbreak identification. The performance of RDTs was assessed in the public health reference laboratory in Suva, Fiji, according to the manufacturers’ instructions. A simulation was used to examine the potential use of RDTs for attribution of a febrile illness outbreak to typhoid. For the diagnostic evaluation, 179 patients were included; 49 had blood culture–confirmed typhoid, 76 had fever as a result of non-typhoid etiologies, and 54 were age-matched community controls. The median (interquartile range) age was 29 (20–46) years. Of the participants, 92 (51.4%) were male and 131 (73.2%) were indigenous Fijians. The sensitivities of the tests were 77.6% for TUBEX, 75.5% for Typhidot Rapid, and 57.1% for Test-It assay. The Test-It assay had the highest specificity of 93.4%, followed by Typhidot Rapid 85.5% and TUBEX 60.5%. Typhidot Rapid had the best performance in the simulation for attribution of a febrile illness outbreak to typhoid. Typhoid RDTs performed suboptimally for individual patient diagnosis due to low sensitivity and variable specificity. We demonstrate that RDTs could be useful in the field for rapid attribution of febrile illness outbreaks to typhoid. Typhidot Rapid had the best combination of sensitivity, specificity, positive and negative predictive values, cost, and ease of use for this purpose.

Novel Adiposity and Biochemical-Anthropometric Indices to Identify Cardiometabolic Risk and Metabolic Syndrome in Mexican Adults.

Although several indices used in clinical practice identify cardiometabolic risk (CR) and metabolic syndrome (MetS), it is imperative to develop indices for specific populations. Therefore, we proposed and validated sex-specific indices to identify CR associated with visceral adipose tissue (VAT) accumulation or MetS in Mexican adults. Additionally, a cut-off value for the visceral fat area (VFA) to identify CR was proposed. Clinical, anthropometric, biochemical, and body composition variables were evaluated in 904 subjects (25–45 years old) (84.4% men). Multiple and logistic regressions were used to model the indices and ROC curve analysis to determine predictive performance. An additional cohort (n = 186) was used for indices validation, and Cohen’s kappa coefficient was employed for agreement analysis. The proposed sex-specific indices, called Mexican adiposity indices (MAIs) and biochemical–anthropometric indices (BAIs), were good predictors for CR and MetS. The kappa coefficients showed a moderate agreement level. The VFA cut-off value chosen to identify CR was 100.3 cm2 because it had the best combination of sensitivity (66.8%) and specificity (64.4%). MAIs and BAIs could be clinical tools to identify either CR associated to VAT accumulation or MetS, respectively. A VFA cut-off value of 100.3 cm2 could identify CR in Mexican men.

Canonical babbling ratio – Concurrent and predictive evaluation of the 0.15 criterion

IntroductionCanonical babbling ratio (CBR) is a commonly used measure to quantify canonical babbling (CB), and 0.15 is the commonly accepted criterion for the canonical babbling stage. However, this has not been thoroughly investigated. The aim of this study was to evaluate the validity of this criterion using concurrent and predictive comparisons. MethodsLongitudinal data from 50 children recruited in different clinical projects were used. At 10 months of age, CBR was calculated based on counted utterances from audio-video recorded parent-child interactions. The videos were also assessed by CB observation, where an observer made an overall judgement on whether the child was in the canonical babbling stage or not. For the concurrent evaluation, CBR was compared to CB observation as a reference test, using area under the curve (AUC). The criterion resulting in the best combination of sensitivity and specificity was identified using positive likelihood ratios. In the predictive comparisons CBR was analyzed as a predictor of speech/language difficulties at 30–36 months. Participants presenting with difficulties in consonant production and/or parent-reported vocabulary were considered to have speech/language difficulties. Sensitivity and specificity were compared for CBR using the 0.15 criterion and the new criterion identified in this study. ResultsAn AUC of 0.87 indicated that CBR is a valid measure of canonical babbling in 10-month-old children. The best combination of sensitivity and specificity was found at a criterion of 0.14 (sensitivity 0.96, specificity 0.70). In the predictive comparison, CBR with a 0.14 or 0.15 criterion revealed the same sensitivity (0.71) but 0.14 showed a slightly better specificity (0.52 versus 0.42). ConclusionsCBR is a valid measure of CB (at 10 months). However, when using CBR to classify children's babbling as canonical or non-canonical, researchers need to carefully consider the implications of the chosen criterion.

Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture

BackgroundThe evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry. ObjectivesTo examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors. MethodsEighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC). ResultsHigher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88). ConclusionThe novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors.

Comparison of the sensitivity of commercial aPTT tests in measurement of the pharmacodynamic response of milvexian, a novel FXIa inhibitor

Abstract Introduction The activated partial thromboplastin time (aPTT) assay is a test routinely used to evaluate abnormalities or deficiencies in coagulation factors of the intrinsic and common pathways. The composition of the surface activator and phospholipids in the aPTT reagent is known to influence the response of heparin and direct FXa or thrombin inhibitors. Milvexian (formerly referred to as BMS-986177/JNJ-70033093) is an investigational small-molecule Factor XIa (FXIa) inhibitor being studied for the prevention and treatment of major thrombotic conditions. Clinical pharmacology evaluation of milvexian includes aPTT as the primary pharmacodynamic assay, thus underscoring the need for a sensitive reagent to evaluate its anticoagulant activity. Purpose This study evaluated the sensitivity of six commercially available aPTT reagents in plasma from individual donors spiked with milvexian, at concentrations spanning the anticipated clinically relevant exposures. Methods Platelet-poor plasma (PPP) prepared from citrated whole blood collected from consenting, healthy adult volunteers (n=12) was spiked with vehicle (DMSO, 0.5% v/v) or 0.1–10 μM milvexian. The aPTT was measured using six commercially available aPTT reagent kits which included silica; kaolin, or ellagic acid as the contact activator, in combination with natural or synthetic phospholipids. The coagulation automated analysers used for testing were matched to the kit's manufacturer recommendations. All reagents and respective normal or abnormal controls were prepared as instructed by the manufacturer. Results Milvexian exhibited dose-dependent prolongation of aPTT with all reagents tested. Assays performed with aPTT reagents containing kaolin or ellagic acid demonstrated the highest sensitivity, as measured by the concentration that achieved a 2-fold aPTT prolongation (EC2x), and showed the widest dynamic range of response. Coefficient of variability of aPTT measurements in plasma from 12 individual donors was between 5.6–7.9% for Dade® Actin® FS, and 7.1–8% for STA®-C.K. Prest® 5. Conclusions Prolongation of aPTT in PPP spiked with milvexian exhibited a dose-dependent relationship, with statistically significant differences observed among reagents at milvexian concentrations above 0.3 μM. The highest sensitivity measured by changes in the ratio to baseline was obtained with aPTT reagents containing an activator/procoagulant phospholipid combination of ellagic acid + purified soy phosphatides or kaolin + cephalin, which performed similarly. Identification of the reagents with the best combination of sensitivity, precision, and dynamic range may help guide the selection of reagent for assessing milvexian activity. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Janssen Research &amp; Development, LLC

Retrospective Evaluation of the Pre- and Postoperative Neutrophil-Lymphocyte Ratio as a Predictor of Mortality in Patients Who Underwent Coronary Artery Bypass Grafting.

We aimed to investigate the neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients, who had undergone on-pump and off-pump coronary artery bypass grafting (CABG). This retrospective study comprised of 457 patients, who underwent CABG (323 on-pump and 134 off-pump) between January 2014 and October 2019. Preoperative, postoperative (PO) 1st hour, PO 1st day, and PO 5th day neutrophil-lymphocyte ratios were calculated. The patients were compared, according to demographic, laboratory, and clinical data. A receiver operating characteristics curve was applied to estimate a cut-off value of NLR for mortality. The on-pump group was older (P = 0.001), had a lower Euroscore II (P = 0.036), had a higher graft number (P < 0.001), intensive care unit stay (P = 0.001), and all PO NLRs, except preoperative NLR. There were 14 (3.06%) patients with mortality. Overall (N = 457), PO 1st hour (P = 0.001), PO 1st day (P < 0.001), and PO 5th day (P = 0.016) NLRs were considerably higher in patients with mortality. While none of the NLRs revealed a significant difference in the off-pump group, PO 1st hour (P = 0.004) PO 1st day (P < 0.001), and PO 5th day (P = 0.007) NLRs were higher in patients with mortality in the on-pump group. The increase in odds ratio of PO NLR was higher in patients with mortality in the overall group of PO 1st day and in the on-pump group of PO 1st hour and PO 1st day. The best combination of sensitivity and specificity was reached at a cut-off value of 6.4 for PO 1st hour NLR and 31.8 for PO 1st day NLR. As in indicator of inflammatory state, NLR readily can be used as a predictor of mortality. Regardless of the CABG technique used, postoperative 1st hour and postoperative 1st day NLR >6.4 and 31.8, respectively, are highly related to mortality.

Role of the urinary N-acetyl-beta-D-glucosaminidase/creatinine (NAG/Cr) ratio in discriminating between true and false pyuria in sterile urine bag specimens

Urethral catheterization (CATH) and suprapubic aspiration (SA) are reliable methods of collecting urine for the diagnosis of urinary tract infections (UTIs), but both are invasive and difficult. Therefore, urine collection through a sterile urine bag (SUB) is commonly used for UTI screening. However, when pyuria is found in SUB specimens, it is difficult to interpret whether this result is true or false. We aimed to determine the diagnostic performance of the urinary NAG/Cr ratio in detecting true pyuria in SUB specimens for children with suspected UTIs. This retrospective study included children 2-24 months of age presenting to the pediatric emergency department (PED) and in whom urinary NAG and creatinine levels were measured and a urine culture was performed between January 1, 2018, and December 31, 2019. Children with the presence of pyuria in SUB specimens were categorized into true or false pyuria groups depending on whether pyuria was present in CATH specimens. The diagnostic performance of the urinary NAG/Cr ratio in detecting true pyuria was identified using receiver operating characteristic (ROC) curve analysis. The optimal cutoff was calculated based on ROC curve analysis. Sensitivity, specificity, and positive and negative likelihood ratios were assessed for optimal cutoff values. Among 606 children with measured urinary NAG levels, 144 children with pyuria in SUB specimens were included in the analyses. Pyuria was consistently present in the CATH specimens of 67 (46.5%) children and absent in those of 77 (44.5%) children. The urinary NAG/Cr ratio was significantly higher in the true pyuria group than in the false pyuria group (21.5 IU/g; 95% confidence interval [CI]: 12.3-35.6; vs 9.6 IU/g; 95% CI: 6.7-16.1, P<0.001). The area under the ROC curve (AUC) for the urinary NAG/Cr ratio was 0.776 (95% CI: 0.700-0.851). The optimal cutoff of 18.85 IU/g corresponded to the best combination of sensitivity (58.2, 95% CI: 46.4-70.0) and specificity (83.3, 95% CI: 74.7-91.6), with positive and negative likelihood ratios of 3.49 (95% CI: 2.04-5.97) and 0.50 (95% CI: 0.37-0.68), respectively. The urinary NAG/Cr ratio may be a potential indicator discriminating true pyuria from false pyuria in SUB specimens in the PED. However, large prospective studies are required to implement the NAG/Cr ratio in clinical practice.

Clinical Utility of 30-Min Postload Plasma Glucose in Paediatric Obesity

Introduction: Intermediary glucose measurements at other time points in a standard 2-hour oral glucose tolerance test (OGTT) is increasingly being investigated, and a number of studies have demonstated strong predictive value of 1-hour plasma glucose (PG) in identifying subjects with high risk of future diabetes and vascular complications. The association between 30-minute PG and incidence of diabetes is less extensively studied and all the suggested 30-minute PG cutoff values in current literature are derived from adult population. Our study aimed to evaluate the optimal cutoff value of 30-minute PG in predicting abnormal OGTT (prediabetes/diabetes) in a cohort of paediatric subjects with overweight or obesity. Since 30-minute PG could be easily performed even in a busy clinic setting, such cutoff allows clinicians identify high risk subjects who should proceed to a 2-hour OGTT. Methods: Record of 332 paediatric subjects with overweight/obesity who had OGTT done in a tertiary unit from January 2012 to December 2018 was reviewed. Standard OGTT was performed and blood samples for PG and insulin were obtained at 0 minute, 30 minutes and 120 minutes. Subjects with prediabetic and diabetic response were considered together as a group (abnormal OGTT group) for statistical analysis. 30-min PG and insulinogenic index (IGI) were compared, and 30-min PG cutoff which predicts abnormal OGTT response was derived. Results: Our cohort consists of 97.3% Chinese with mean age of 15.4 ± 2.3 years and mean BMI z-score of 2.7 ± 0.6. Sixty subjects (18.1%) had abnormal OGTT – out of which 47 (14.2%) and 13 (3.9%) had prediabetes and diabetes range of glycaemic response respectively. 30-minute PG was statistically higher in the abnormal OGTT group compared to the normal OGTT group (9.6 vs 7.9 mmol/L, p=0.001). IGI was statistically lower in the abnormal OGTT group compared to the normal group (262.1 vs 377.2, p=0003). 30-min PG ≥ 9.2 mmol/L predicts abnormal OGTT with best combination of sensitivity and specficity (AUC 0.77, sensitivty 62.1%, specificity 83.7%). Conclusion: Children with abnormal OGTT reseponse showed impaired first phase insulin secretion suggestive of beta-cell loss. Instead of performing a 2-hour OGTT in every child referred for obesity, 30-min PG, with a cutoff value of 9.2mmol/L, could be used as a stratification tool in identifying high risk subjects who should return for a 2-hour OGTT in another visit.